L’orthopédie ou l’art de prevenir et de corriger dans les enfans, les difformités du corps.

Paris: Chez la veuve Alix; Lambert & Durand, 1741.

First edition, rare, and a very fine copy, of the “first book on orthopaedics” (Garrison-Morton). A work “of supreme importance” (Bick). “Nicholas Andry coined the word ‘orthopaedics’ in French as orthopédie, derived from the Greek words orthos (‘correct’, ‘straight’) and paidion (‘child’), when he published Orthopedie (translated as Orthopaedia: or the Art of Correcting and Preventing Deformities in Children) in 1741. Though as the name implies it was initially developed with attention to children, the correction of spinal and bony deformities in all stages of life eventually became the cornerstone of orthopedic practice” (Wikipedia). Andry’s book was the first monograph on the subject, and the emblematic engraving it contains of a tree with a crooked trunk tied to a straight post has been adopted as a symbol of orthopedics. “Andry grasped the crucial principles that the muscles in balance are the molders of the body in childhood and that weakness in a muscle, resulting in a muscle imbalance, can result in the onset of a deformity during growth. He therefore recommended that the offending muscle be subjected to a course of exercise, by which deformities could be prevented or cured. His methods were simple but ingenious, based on observation and on the principle that deformities that are due to one form of movement or habit can be undone by a movement or habit of the opposite kind. For example, he observed that a corpulent man or a pregnant woman walks with a straight back; therefore, if a youth stoops, he should be made to carry a burden in front of his body. Andry devised balancing and gymnastic exercises and encouraged childhood games. He also used massage, cold applications, and what we now call orthopedic beds. For established deformities, he resorted to the use of mechanical aids. He also believed that deformities in children were caused by ill-fitting or restrictive clothing and by unnatural postures enforced by badly designed children's furniture. He thus paid great attention to the adoption of proper posture, which he regarded as being of the utmost importance. Later in the eighteenth century, Jean Pierre David was to show the value of rest in the body's own repair system, but Andry demonstrated that exercise as well as rest had an appropriate place in the treatment of physical problems” (Grolier/Medicine).

“At the end of his life (when he was 82!), he wrote the work which would give him his present notoriety: ‘L’orthopédie ou l’art de prévenir et corriger dans les enfants les difformités du corps’. This book was first published in Paris in 1741 in two volumes. It was an immediate success and was soon published abroad: in Brussels (1742), then London (1743) in English (‘Orthopaedia or the art of correcting and preventing deformities in children’) and, finally, in Berlin (1744) in German (‘Orthopaedie’).

It is pleasant to read, with simple suggestions full of practical, common sense in a similar style to the ‘Art d’être grand’père’ (How to be a grandfather). This is underlined in the subtitle to his book in these words: ‘by such means as may easily be put into practice by PARENTS themselves, and all such as are employed in educating children’. It was illustrated with 12 superb engravings designed by Humblot and sculpted in wood by Guelard.

“It is important to realise that this treatise is written neither for doctors nor for surgeons. It is a sort of homage to the grace and beauty of children; he wrote thus: ‘one must not neglect the body and let it become deformed, this would be against the intention of the Creator; this is the basic principle of orthopaedics’ and then ‘this book is aimed exclusively at fathers and mothers and all people bringing up children who must try to prevent and correct any deformed part of the child’s body’. If one looks only at the principle of prevention, then these words have real meaning today.

“The work is divided into four books, with the first three making up the first volume. A long ‘semantic’ preface explains the origin of the word orthopaedia: ‘as to the title in question it is formed from two Greek words, ‘orthos’ which means straight, devoid of deformity and ‘paidos’ which means child. From these two words I formed that of Orthopaedics to express in one word what I have set out to do, namely to teach several ways of preventing and correcting deformities in children’.

“This neologism, he explained, is similar to the method used previously by other authors like Scevolle de Sainte Marthe who, in 1584, wrote a work called ‘Pédo/trophie’ (how to breastfeed infants) or Claude Quillet in 1656, who wrote ‘la Calli/pédie’ (how to have beautiful children).

“The first book reminds us of the surface ‘artistic’ anatomy of the whole body, with a curious and interesting chapter on its external proportions. The style is pleasing and full of poetic, literary and historical quotations: the use of the word ‘gaster’ refers to a fable by La Fontaine called Les membres révoltés contre l’estomac (the limbs that revolted against the stomach).

“Books II and III deal with one of the most important parts of our specialty, more exactly that of ‘paediatric orthopaedics’ in its modern meaning. Book II describes useful methods for preventing and correcting postural deformities of the trunk and the spine. Apart from a few comments which give rise to a smile, the therapeutic suggestions are correct and sensible: a healthy posture (a straw-seated chair, a writing table, the right position for sewing), the importance of active movement (as opposed to passive manipulations), using curiosity to help with a stiff neck, carrying a ladder or a weight on the side opposite the deformity.

“And finally, to treat scoliosis, he suggests wearing a padded brace which should be changed every three months. Book III covers limb deformities: Andry distinguishes between inequalities that are congenital or acquired (by ‘emaciation’) and pseudo shortenings of the limbs due to dislocation (in this case, he recommends ‘a speedy intervention on the part of the surgeon’). We may notice that he also recommends loose swaddling in the fashion of the ‘negroes in Africa and the savages in Canada’, a principle still adhered to today. For curvature of the tibia, he suggests a ‘conservative’ treatment: a gradual straightening of the limb ‘by bandaging the bent limb to an iron plate as if one wanted to straighten the crooked trunk of a young tree’. This is the famous engraving of the ‘crooked tree’ often considered as representing a scoliosis correction, but this is wrong .

Club foot, according to Andry, should be treated early and without operation (which corresponds to present day practice in the method described by Ponseti!). He also recommended bandaging and shoes.

“Finally, certain chapters remain interesting, such as, for example, the treatment of extra fingers with no bone structure (dealt with by a strangulation thread), the one about left-handed children where one glimpses a modern day approach (namely, not to contrary the child in his everyday life except for gestures of ‘politeness’). Trauma are not dealt with in volume I.

“And lastly in the fourth book (the whole of Volume II), he covers the deformities of the head and face in considerable detail. Orthopaedia today does not deal with these sorts of deformities. However, many other specialists will enjoy this section, namely, maxillofacial surgeons, dental orthopaedics and aesthetic surgeons. He covers the harelip, sticking out ears, the principle of using strips of flesh (to repair a broken nose, taken from the arm) and even certain principles of speech therapy. The work ends curiously enough with some moral advice which is actually rather aggressive towards nannies who were ‘badly trained in looking after the physical and moral development of children’. He made three recommendations: everything should be done to avoid the child experiencing revenge, lies and fear.

“Throughout the book, Andry emphasises his love of the beauty of the human form and this gives him what is nowadays a very modern approach. In a chapter on surgery and orthopaedics, published in the Encyclopaedia by Diderot and D’Alembert, there is considerable mention made of Andry and this will help establish the term and concept of orthopaedics …

“Nicolas Andry was born in Lyon, in 1658, in the Catholic parish of Saint Nizier, on the banks of the river Saône of a relatively poor merchant family. He had two older brothers (Antoine and Claude), both of whom were priests. After studying theology for a time, he abandoned this ecclesiastical career in 1690, took on the surname of Bois-Regard and went to study medicine at the Faculty of Rheims (a faculty that vied in reputation with the Faculty of Paris). When it was dissolved in 1694 by King Louis XIV, he retook his exams in Paris …

“Although he was ambitious and very energetic, Andry had a rather turbulent life, being constantly in conflict with his peers. As a substitute, then full-blown Professor at the College of France and then Dean of the Faculty (1724), a critic for the Journal des Savants, he never ceased to hound his peers, particularly the ‘barber surgeons’ and reduced them to the level of ‘sous médecins’: he suppressed the five recently created posts in operative medicine, forbade them to operate other than in the presence of a doctor and prevented them from granting exemption from the restrictive customs of Lent which amounted to sheer harassment. This virulence, well illustrated in his pamphlet of 1738 ‘Cleon à Eudoxe touchant la prééminence de la médecine sur la chirurgie’ (on the pre-eminence of medicine over surgery), which raises a smile when one realises that its author is the man that, two centuries later, orthopaedists will recognise as their ‘father’: ‘barbers are these people who shave their customers every day in their shops where one can read: In this house we shave you clean’ … He then turned his controversial talents to his faculty colleagues who described him as a ‘superb, scornful, confused, contemptuous, irascible and jealous doctor journalist!’ Andry was eventually ‘beaten’ after a merciless battle: he was dismissed from his job at the Journal des Savants and forced to resign as a Dean.

“His private life saw him married three times with the arrival of a daughter from his third wife. He died in Paris on 13 March 1742, at the age of 84, a year after writing his famous book L’orthopédie. Such was the life of this man with his strong personality, who, even after two and a half centuries, appears to have been as much a persecutor as persecuted himself. In fact, we can read the following comments about him in the Dictionnaire des Sciences Médicales: ‘if he had spent as much time on useful work as he spent on base intrigues he could have had a place alongside the most famous doctors France has produced’ and also ‘he mercilessly criticised the writings of his fellow doctors and showed himself to be an unfair detractor rather than an impartial critic. The famous Jean-Louis Petit, who has been avenged by posterity, was all too often exposed to his envious, ill humour’” (Kohler).

Bick, Source book of Orthopedics, 67-68; Garrison-Morton 4301; Grolier, One Hundred Books Famous in Medicine 42; Keith, Menders of the Maimed, 191-92, 203-06; Lilly, Notable Medical Books 113; Norman 55; Heirs of Hippocrates 697; Still, The History of Pedicatrics, 352-59; Waller 418. Kohler, ‘Nicolas Andry de Bois-Regard (Lyon 1658–Paris 1742): the inventor of the word ‘orthopaedics’ and the father of parasitology,’ Journal of children's orthopaedics 4 (2010), 349-355.

Two vols, 12mo (167 x 97 mm), pp. [4], 47 [1] (French translation and Latin text of ‘Quaestio medica ... An praecipua valetudinis tutela exercitatio?’ for which Andry was praeses and L.J. Le Thieullier, respondent), i-cxviii [i.e., xcviij] 345 [3], engraved frontispiece by J. Guélard after A. Humblot, 14 engraved plates; [2] i-v [vi] 365, [5]. Contemporary French calf with richly gilt spines, marbled endpapers. A very fine and fresh copy.

Item #5120

Price: $18,500.00

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