Portal de Periódicos da CAPES

Adolf Lorenz – The Bloodless Surgeon of Vienna

2017; Elsevier BV; Volume: 92; Issue: 7 Linguagem: Inglês

10.1016/j.mayocp.2017.02.025

1942-5546

Ahmadreza Afshar, Robert A. Kyle, David P. Steensma,

Medical History and Innovations

Adolf Lorenz was born April 21, 1856, in Weidenau, a small town in Silesia (then part of Austria, now named Vidnava and part of the Czech Republic). His father Johann was an innkeeper and harness maker. In 1866, Adolf left for Graz, Austria, to become a grocer's apprentice in a shop owned by his maternal uncle, but he did not enjoy the work and soon left to attend a grammar school in the Lavant Valley in Southern Austria. In 1874, he graduated from a high school in Klagenfurt, also in southern Austria, and went to Vienna to study medicine. In order to support himself during his stay in Vienna, he worked as an assistant in the anatomy department, which gave him an encyclopedic knowledge of anatomy. After graduation from medical school in 1880, Lorenz became an assistant to an orthopedic surgeon, Professor Johann von Dumreicher (1815-1880), at the Rudolfinerhaus, a private hospital in Vienna newly founded by the legendary abdominal surgeon, Theodor Billroth (1829-1894). After the death of von Dumreicher, Bohemian-born Eduard Albert (1841-1900), another orthopedic pioneer, took over as orthopedics professor. Lorenz continued to work with Albert and soon became his favorite student. Albert routinely used carbolic acid during his antiseptic techniques, but Lorenz developed severe contact dermatitis from the carbolic acid. Albert advised Lorenz, “If you cannot get along with wet surgery, why not try dry surgery?” The term “dry surgery” (bloodless surgery) was used to describe procedures that did not require incision, such as manipulation and casting techniques for injured or diseased spine and limbs. Lorenz took Albert's advice and developed a number of non surgical treatments for children with musculoskeletal disorders such as clubfoot, congenital hip dislocation, scoliosis, and musculoskeletal deformities from tuberculosis. The main concept of nonsurgical treatment of pediatric orthopedic problems involved correction of deformities by patient promotion of re-modeling of growing bone and tissues by means of successive plaster casting. Lorenz's first book, published in 1884 (the same year he married Emma Leicher, who died in 1936), was about treatment of scoliosis. Lorenz's technique for treatment of scoliosis used pulleys and traction to improve the characteristic spinal curvature, then maintained the corrected alignment of the spine by plaster casting. Lorenz treated club foot by successive stretching and manipulation to alter tendons, ligaments, and physeal plates; he then casted the foot until it healed into the proper form. He wrote three treatises on congenital hip dislocation, which became his chief interest and for which he became known internationally. He developed a technique of reduction of the dislocated femoral head by traction, manipulation, and successive casting to bring the femoral head slowly into the acetabulum. He made so much use of plaster casting that other Viennese surgeons and students called him, “Gipsodozent” (plaster docent), a title that did not bother Lorenz. In 1889, Billroth proposed a special “extraordinary professorship” for Lorenz at the University of Vienna, and in 1896 the Austro-Hungarian Emperor Franz Josef appointed Lorenz as a councillor to the government. In 1901, Lorenz cofounded the German Orthopedic Society. In 1902-03 he traveled extensively in the United States and met President Theodore Roosevelt. Lorenz's successful exhibition in Dallas during this trip led to the establishment of the Texas Baptist Memorial Sanitarium, the forerunner of Baylor University Medical Center. Lorenz received many honors, including various visiting professorships and the Goethe Prize. The Nobel Foundation records that Lorenz was nominated for the Nobel Prize in Medicine 8 times between 1923 and 1936, but never was awarded the Prize. However, in 1973, his second son, Konrad, won a Nobel Prize in Physiology or Medicine for his achievements in ethology. Adolf Lorenz retired in 1924 and died February 12, 1946, in Altenburg, outside Vienna. On the occasion of an orthopedic congress in Vienna in 1997, Adolf Lorenz was honored philatelically on a commemorative stamp issued by Austria (Scott number 1734). In addition to a portrait of Adolf Lorenz, this stamp depicts a crooked growing tree splinted with a straight stake, a symbol of the type of “dry surgery” that Lorenz used to correct skeletal anomalies in children.