Orthopaedic History

Nicholas Andry

Nicholas Andry Lyon 1658 - Paris 1742

Nicholas Andry holds an important place in the history of orthopaedics and medicine as it was Andry who first used the word "orthopaedics" in a book published in 1741. Within the text he illustrated the "crooked tree" which has become the symbol for many orthopaedic organizations around the world. Although many related agencies have taken to modifying or customizing the tree, the essential design remains.

Andry was born in Lyon in 1658 and started his studies in theology but was drawn to the field of medicine. In 1697 he defended his thesis: The Relationship in the Management of Diseases Between the Happiness of the Doctor and the Obedience of the Patient. He became well known for his stand against the "bleeding barber surgeons" and worked tirelessly to limit their venues.

His fellow faculty members depicted him as "superb, spiteful, confused, scornful, irascible and jealous" as described by R. Kohler in the European Orthopaedics Bulletin. Andry was creative and prolific in his writings. In 1700 he wrote his first book in which his explanations earned him the title "Father of Parasitology". At the age of 80 he published his famous work L'Orthopedie, a two volume set, in Paris in 1741 and it was translated in Brussels in 1742, London in 1743 and Berlin in 1744.

The book had artistic chapters on external proportions, methods of preventing trunk and spine deformities and had suggestions for physical therapy. In a section addressing limb deformities, Andry recommended a bent leg be corrected by bandaging it to an iron plate as was commonly done to straighten the crooked trunk of a sapling. From there came the orthopaedic crooked tree symbol, which has stood the test of time, translation and modernization.

Andry died in Paris at the age of 84 not long after having written his famous volume L'Orthopedie. Kohler reminds us that Nicholas Andry neither deserves to be scorned nor to be revered. "He produced fundamental ideas on methods of prevention, the plasticity of the child and the importance of gymnastics" and was known for his astute observations and colorful personality. Few of Man's whims or drawings or scribblings have survived to become as internationally recognized as the "Tree of Andry".

More About Andry

Orthopaedia Andry published his introduction to orthopedics in 1741 under the title Orthopédie, then a neologism.

It was translated into English in 1743 as Orthopaedia.[10] Aimed more at parents than physicians, the book presents a theory of human anatomy, skeletal structure, and growth, along with instructions for correcting deformity.

Andry explains in the book that he formed its title "of two Greek Words, viz. Orthos, which signifies streight, free from deformity, and Pais, a Child.

Out of these two words I have compounded that of Orthopaedia, to express in one Term the Design I Propose, which is to teach the different Methods of preventing and correction of Deformities of Children."[11] Frontispiece of Orthopaedia

Though the book was read and cited extensively in the period, its main lasting influence in medicine has been its title, which became the name of the field devoted to skeletal and related injuries and ailments (later modified to "orthopaedics" or, in American spelling, "orthopedics").[12]

Outside of medicine, the principal impact of the book derives from the engraving on the frontispiece, which shows a straight stake tied to a crooked sapling, a metaphor for the correction of deformities in children.

The engraving captured the attention of contemporary readers; it is referred to, for example, in George Colmans 1787 comic opera Inkle and Yarico.[13] Andrys frontispiece has played a significant role in the cultural studies of eighteenth-century medicine. It is included, without comment, as the last in a series of ten eighteenth- and nineteenth-century illustrations in Michel Foucaults influential study of the history of correction, Discipline and Punish.[14] Scholar Paolo Palladino has explained Foucaults use of the image as showing that "practices as disparate as orthopedics and horticulture were increasingly predicated on operative principles that focused on the manipulation of these different life forms presumed common material substance.

Moreover, the image begs questions of agency, since it is unclear who exactly bound the tree: no human or divine form is visible anywhere in the background; the image therefore accorded with Foucaults understanding that the operation of these principles was invisible and pervasive."[15] A simplified version of Andrys illustration continues to serve as the international symbol for orthopedics, used by a number of different institutions in multiple countries.[12][16]