Beruflich Dokumente
Kultur Dokumente
SURGICAL HISTORY
INTRODUCTION
The book on which this is based is, in fact, two books. The first was
published in 1680 and the second a year later by the man who is
considered to be the father of modern biomechanicsGiovanni
Borelli. On browsing through these books one is immediately
fascinated by the diagrams, so painstakingly drawn and reproducedand the principles demonstrated by them. Borelli wasnt
the first to experience a surge in interest in the mechanics of
human movement because the mechanisms by which man and
other animals propel themselves have fascinated observers and
experimenters since the time of the ancient Egyptians. The earliest
studies by the ancient Greeks were directed to an understanding
of body structure, with a philosophical approach to the propulsive
mechanismsbased on theory and surmise, rather than on
experimental evidence (Fig. 1).
Philosophers, they were called, but the name of natural scientists
would perhaps give us a better idea of their activities . . . They were
not doctors in our sense of the word, that is to say specialised
physicians, for the separation of Medicine from Philosophy did
not come until the time of Hippocrates. For them at that time
the study of man, the working of the human body and the way in
which our sense organs operate were as much a part of their
activities as mathematics, physics and astronomy.1,2
THURSTON
277
Fig. 2. Galen (131201 AD). Most of his anatomy studies were based on
apes and pigs, and the errors into which this led him were perpetuated for
hundreds of years, until the time of the Italian anatomists.
278
GIOVANNI BORELLI
Fig. 4. Andreas Vesalius (15141564)probably the most wellknown anatomical dissector of the time.
Fig. 3. da Vinci anatomical drawingthese showed a sound
knowledge of mechanics which is also manifest in his art works.
THURSTON
279
Bichat (17711802) gained considerable anatomical knowledge in performing more than 600 postmortem examinations per
annum in his position as physician to the Htel Dieu. Through his
pioneering work in histology he contributed to the transformation
of anatomical knowledge from a collection of dogmatic statements, handed down through the ages, to a science.10
280
GIOVANNI BORELLI
THURSTON
281
282
GIOVANNI BORELLI
THURSTON
283
284
build was not allowed for, and that the material used in the
studies was cadaveric.26
Cinphotography gave experimenters rather greater scope,
and the invention of the electronic stroboscope by H. Eggerton provided the facility of instant photography with an increased sampling
rate. Charles Ducroquet carried out one of the earliest studies of gait
using cinphotography. The combination of his work and that
carried out subsequently by his family is a detailed record of
the various characteristics of gait in selected pathological states,
compared with normal gait.47 The studies are rather more qualitative than quantitative. Herbert Elftman used high-speed cinphotography and a forceplate, consisting of an embossed rubber
mat mounted on a glass sheet which was photographed from
below, for his work.48 Eberhart and Inman used two synchronized cincameras in their studies of the principal elements in
human locomotion.49,50
The goniometer, a protractor-like instrument for measuring
angular displacements at joints, was automated by Karpovich.51
His electrogoniometer was a device which incorporated an electrical transducer which, when attached to a limb above a joint,
gave a direct electrical readout of the angular displacements of
that joint. Many electrogoniometers have been developed since.
These range from simple devices to measure the movements at only
one joint to the complicated exoskeletal goniometer developed by
Lamoreaux (Fig. 13) which measured the movements of all of
the joints of the lower limbs.52
Modern studies of gait have become too numerous to be
covered by this survey. The major studies of recent years have been
carried out both in the laboratory by Murray et al.,5358 Gore et al.,59
GIOVANNI BORELLI
THURSTON
285
increases both the load that a specimen can support and the
amount of energy that it can absorb!90 Recently, more rigorous
control of the condition of the specimen has been exercised
when determining the mechanical properties, with specimens
being enclosed in environmental chambers during testing. With this
care and attention to hydration state, temperature and so on,
rather more credible results are being reported.
Attempts to measure spinal movement in vivo have been, at
best, approximate. Lhrs method involved the measurement of
spine movement from shadows thrown on to a screen. He measured
sagittal plane movement of the thoracic and lumbar spines in
47 subjects.33,91 Blumenthal also measured sagittal plane movement
but with a system of strings and small weights attached, with
adhesive tape, over the spines of his subjects.33,92 McKendrick, in
1916, measured the interspinous distances in flexion and extension.93 This marked the beginning of the appearance of many
ingenious devices to record the range of movement of the spine
in vivo. Cyriax produced a spinal torsionometer,94 Dunham produced a spondylometer95 and Asmussen used an inclinometer
to assess spinal movement in the sagittal plane in a group of
boys.96 Israel and Goff both introduced special instruments for
measuring spinal mobility.97,98 One recent introduction is the
vector stereograph which is capable of measuring spinal mobility
in three dimensions (Fig. 14).62,99 Schber devised a technique
Fig. 15. Steinman pins inserted into the spinous processes of volunteers to measure the axial rotation of the thoracic and lumbar vertebrae.
286
GIOVANNI BORELLI
REFERENCES
1. Gask G. Essays in the History of Medicine. London: Butterworth, 1950.
2. Beasley AW. The origins of orthopaedics. J. Royal Soc. Med.
1982; 75: 64855.
3. Cave AJE. Ancient Egypt and the origin of anatomical science.
In: Cope Sir Z. Sidelights on the History of Medicine. London:
Butterworth, 1957.
4. Elliott JS. Outlines of Greek and Roman Medicine. London:
John Bale, Sons & Danielsson, 1914.
5. Chadwick J, Mann WN, Lonie IM, Withington ET. Hippocratic
writings. In: Lloyd GER. Harmondsworth: GB. Pelican Books,
1978.
6. Schwartz RP, Heath AL. The pneumographic method of recording
gait. J. Bone Joint Surg. 1932; 14: 78394.
7. Thompson DAW. Science and the Classics London: Oxford
University Press, 1940.
8. Guthrie DA. History of Medicine. London: Nelson, 1945.
9. Steindler A. Mechanics of Normal and Pathological Locomotion in Man. London: Bailliere, Tindall and Cox, 1936.
10. Rasch PJ, Burke RK. Kinesiology and Applied Anatomy. Philadelphia: Lee and Febiger, 1971.
11. Bick EM. Source Book of Orthopaedics, 2nd edn. Baltimore:
Williams & Wilkins Co., 1948.
12. Weinstein R, Ehni G, Wilson CB. Lumbar Spondylosis. Diagnosis, Management and Surgical Treatment. Chicago: Year Book
Medical Publishers, 1977.
13. Singer C. Galen on Anatomical Procedures. London: Oxford
University Press, 1956 (in German).
14. Andersen N, Ekstrm T. Uber die Beweglichkeit der Wirbelsule. Gegenbaurs Morph Jabuch 1940; 85: 13585.
15. Beasley AW. The Hamilton Russell Memorial Lecture. Preserved through the medium: Art and the history of medicine.
Aust. N.Z. J. Surg. 1979; 49: 50418.
16. Campbell D. Arabian Medicine. London: Kegan Paul, Trench,
Truber and Co., 1926.
17. Dommasch HS, Brandell BR, Murray EB. Investigation into the
technique of gait analysis. J. Biol. Photogr. Assoc. 1972; 40:
10616.
18. Foster Sir M. Lectures on the History of Physiology. Cambridge: Cambridge University Press, 1901.
19. Par A. Dix Livres de la Chirgurgie. 1564.
20. Adelmann HB. The Embryological Treatises of Hieronymus
Fabricius of Aquapendente. New York: Cornwell University
Press, 1942.
21. Fabricius (ab Aquapendente) H. De Motu Animalium Secundum
Totum. Batavia: Johannes Baptista de Martinis, 1618.
22. Fabricii H. Opera Anatomica. Patauii: Antonii Meglietti, 1625.
23. Stirling W. Some Apostles of Physiology. London: Waterlow
and Sons (printed privately), 1902.
24. Adrian ED. Interpretation electromyogram. Lancet 1925; 2:
122933; 12836.
THURSTON
55.
56.
57.
58.
59.
60.
61.
62.
63.
64.
65.
66.
67.
68.
69.
70.
71.
72.
73.
74.
75.
76.
77.
78.
79.
80.
free and fast speed walking. Am. J. Phys. Med. Rehabil. 1966; 45:
824.
Murray MP. Gait as a total pattern of movement. Am. J. Phys.
Med. Rehabil. 1967; 46: 290333.
Murray MP, Kory RC, Clarkson BH. Walking patterns in healthy
old men. J. Gerontol. 1969; 24: 16978.
Murray MP, Kory RC, Sepic SB. Walking patterns of normal
women. Am. J. Phys. Med. Rehabil. 1970; 51: 63750.
Murray MP, Gore DR, Clarkson BH. Walking patterns of patients with unilateral hip pain due to osteoarthritis and avascular
necrosis. J. Bone Joint Surg. 1971; 53A: 25974.
Gore DR, Murray MP, Sepic SB, Gardiner GM. Walking patterns
of men with unilateral surgical hip fusion. J. Bone Joint Surg.
1975; 57A: 75965.
Thurston AJ. Pelvic and lumbar spinal movement during walking
in a group of normal males. Annu. Rep. Oxf. Orthop. Eng. Centre
1980; 7: 337.
Thurston AJ, Stokes IAF, Whittle MW. Lumbar spinal kinematics.
Annu. Rep. Oxf. Orthop. Eng. Centre 1980; 7: 2831.
Thurston AJ, Stokes IAF. Measurement of spinal movement
in 3-dimensions using the vector stereograph. Annu. Rep. Oxf.
Orthop. Eng. Centre 1980; 7: 278.
Thurston AJ. The effect of unilateral osteoarthrosis of the hip joint
on pelvic and spinal kinematics. Annu. Rep. Oxf. Orthop. Eng.
Centre 1981; 8: 3540.
Thurston AJ. Normal kinematics of the lumbar spine and pelvis.
Annu. Rep. Oxf. Orthop. Eng. Centre 1981; 8: 2834.
Thurston AJ, Whittle MW, Stokes IAF. Spinal and pelvic movement during walkinga new method of study. Eng. Med. 1981; 10:
21922.
Thurston AJ. Repeatability studies of a television/computer
system for measuring spinal and pelvic movements. J. Biomed.
Eng. 1982; 4: 12932.
Thurston AJ. Spinal and pelvic kinematics in osteoarthrosis of the
hip. Spine 1985; 10: 46771.
Drillis RJ. Objective recording and biomechanics of pathological
gait. Ann. N.Y. Acad. Sci. USA 1958; 74: 86109.
du Chatinier K, Molen NH, Rozendal RH. Step length, step
frequency and temporal factors of the stride in normal human
walking. Proc. Koninklikje Nederlandse Akademie Van Wetenschapen Series C (Biol. Med. Sci.) 1970; 73: 21427.
Molen NH. Problems on the evaluation of gait. Thesis. Vrije
Universiteit de Amsterdam, 1973.
Cavagna GA, Margaria R. Mechanics of walking. J. Appl.
Physiol. 1960; 21: 2718.
Jacobs NA, Skorecki J, Charnley J. Analysis of the vertical component of force in normal and pathological gait. J. Biomech.
1972; 5: 1134.
Whittle MW. Calibration and performance of a 3-dimensional
system for kinematic analysis. J. Biomech. 1982; 15: 18596.
Fisk GR. The influence of hip rotation upon the gait. Aust. N.Z.
J. Surg. 1979; 49: 712.
Thurston AJ. Kinematics of the lumbar spine and pelvis. MSc
Thesis. University of Oxford, 1981.
Bishop. Researches into the strength, flexibility and curvatures of
the vertebral column. Lancet 1852; 2: 470.
von Meyer GH. Die Stat und Mechanische d. Menschlichen.
Leipzig: Knochenger, 1873.
Gurin J. Mmoire sur les mouvments de flexion et linclinaison
e la colonne vertebrale. Bull. Acad. Md 1876; 5: 936.
Morris H. The Anatomy of the Joints of Man. London 1879.
Hughes AW. Die Drehbewegungen der menschlichen Wirbelsule und die segenaunten Musculi rotatores. Archiv fr Anatomie
und Entwicklungsgeschichte 1892; 26580 (in German).
287
81. Reiner M, Werndorf R. Zeitschrift fr Orthopdischen Chirurgurie. Sonderausgabe 1905 (in German).
82. Guibal MP, Mnard MV. Rev. dOrthop. 1900; 1: 123.
83. Lovett RW. Movements of the normal spine and their relation to
scoliosis. J. Boston Soc. Med. Sci. 1900; 142: 622.
84. Lovett RW. Zeitschrift fr Orthopdischen Chirurgurie. Sonderausgabe 1905; 14: 1.
85. Fick R. Spezielle Gelenkund Muskelmechanik. In: Handbuch der
Anatomie und Mechanik der Gelenke. Jena: G. Fischer, 1911.
86. Novogrodsky M. Die Bewegungsmglichkeit in d. menschlichen
Wirbelsule. Bern: 1911.
87. Strasser H. Lehrb. d. Muskel-u, Gelenmech. Berlin 1913.
88. Mller FW. Anat Anz Ergnzungsheft 1922; 55: 276.
89. Virchow H. Arch. Orthopdie 1928; 26: 1.
90. Evans FG, Lissner HR. Biomechanical studies of the lumbar
spine and pelvis. J. Bone Joint Surg. 1959; 41A: 27890.
91. Lhr C. Untersuchungen ber de Bewegungen der Wirbelsule
nach vorn und hinten. Mnchener Med. Wochenschrift. 1890; 37:
7397 (in German).
92. Blumenthal M. Eine einfachie Methode zur Darstellung und
Messung von Krperbewegungen insbesondere der Wirbelsule. Verhandlung d deutsch Gesellschaft f orthop Chirurgie,
Berlin 1912; 11: 10727.
93. Troup JDG, Hood CA, Chapman AE. Measurements of sagittal
mobility of lumbar spine and hips. Ann. Phys. Med. 1968; 9: 308.
94. Cyriax JH. An apparatus for estimating degree of rotation in
the spinal column. BMJ 1924; 2: 958.
95. Dunham WF. Ankylosing spondylitis: Measurement of hip and
spine movements. Br. J. Phys. Med. 1949; 12: 126.
96. Asmussen E. Heebll-Neilsen. Posture, mobility and strength
of the back in boys 716 years old. Acta Orthop. Scand. 1959; 28:
17489.
97. Israel M. A quantitative method of estimating flexion and
extension of the spine; a preliminary report. Mil. Med. 1959;
124: 1816.
98. Goff CF. Postural evolution related to back pain. Clin. Orthop.
1955; 5: 815.
99. Grew ND, Harris JD. A method of measuring human body
shape and movement. The Vector Stereograph. Eng. Med.
1979; 8: 11518.
100. Schber P. Ledenwirbelsule und Kreuzschmerzen. Mnchener med. Wochenschrift 1937; 84: 366.
101. Macrae IF, Wright V. Measurement of back movement. Ann.
Rheum. Dis. 1969; 28: 5849.
102. Moll JMH, Wright V. Normal range of spinal mobility: An
objective clinical study. Ann. Rheum. Dis. 1971; 30: 3816.
103. Moll JMH, Liyanage SP, Wright V. An objective clinical
method to measure spinal extension. Rheum. Phys. Med. 1972; 11:
293.
104. Moll JMH, Liyanage SP, Wright V. An objective clinical
method to measure lateral spinal flexion. Rheum. Phys. Med.
1972; 11: 255.
105. Moll JMH, Wright V. Measurement of spinal movements. In:
Jayson M. The Lumbar Spine and Back Pain. London: Sector
Publishing Ltd, 1976.
106. Flint MM. Lumbar posture: A study of roentgenographic measurement and the influence of flexibility and strength. Res. Q.
1963; 34: 1520.
107. Davis PR, Troup DG, Burnard JH. Movements of the thoracic and
lumbar spine when lifting. J. Anat. 1965; 99: 1826.
108. Loebel WY. Measurement of spinal posture and spinal range
of movement. Ann. Phys. Med. 1967; 9: 103.
109. Gregersen GG, Lucas DB. An in vivo study of the axial rotation
of the human thoraco-lumbar spine. J. Bone Joint Surg. 1967;
49A: 24762.
110. Lumsden RM, Morris JM. An in vivo study of axial rotation
and immobilization at the lumbosacral joint. J. Bone Joint
Surg. 1968; 50A: 1591602.
288
111. Collins JJ, Whittle MW. Impulsive forces during walking and
their clinical implications. Clin. Biomech. 1989; 4: 17987.
112. Hicks R, Durinick N, Gage JR. Differentiation of idiopathic toewalking and cerebral palsy. J. Pediat. Orthop. 1988; 8: 1603.
113. Jefferson RJ, Whittle MW. Biomechanical assessment of unicompartmental knee arthroplasty, total condylar arthroplasty
and tibial osteotomy. Clin. Biomech. 1989; 4: 23242.
GIOVANNI BORELLI
114. Todd FN, Lamoreaux LW, Skinner SR. Variations in the gait of
normal children. J. Bone Joint Surg. 1989; 71A: 196204.
115. Whittle MW. Gait AnalysisAn Introduction. Oxford: Butterworth-Heinemann Ltd, 1991.
116. Winters TF, Gage JR, Hicks R. Gait patterns in spastic hemiplegia
in children and young adults. J. Bone Joint Surg. 1987; 69A:
43741.
Copyright of Australian & New Zealand Journal of Surgery is the property of Wiley-Blackwell and its content
may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express
written permission. However, users may print, download, or email articles for individual use.