By: Rudy Dewantara MD
It has been known that Nicholas Andry was the first to introduce the word ORTHOPAEDIA in 1741, in his book Orthopaedia, or the Art of Preventing and Correcting Deformities in Children.
Nicholas Andry used the terminology which derived from orthos (free from deformity) and pais (child). He stated that most deformities in adults have their origin in childhood. The book also contained a symbol of a crooked young tree (refered to a deformed young child) which is able to grow straight by applying appropriate forces. The symbol, also known as “Tree of Andry” then become the international symbol of orthopaedic surgery.
However, his contribution on the word ORTHOPAEDIA and the international symbol of orthopaedic surgeon wouldn’t sufficient to make him The Father of World’s Orthopaedy. There were a lot of controversies rised on who is the real Father of World’s Orthopaedy. In my humble opinion, based on world’s orthopaedy history, i would regard JEAN-ANDRE VENEL (1740-1791) as the one who deserves the title for he was the first to build an orthopaedic institution in Orbe, Canton Waadt. The institution was the first orthopaedic hospital in the world which dealt in particular with therapy of deformities in children. All methods were recorded by Venel, and the hospital became the role model for others in Europe.
Back to the controversy of Nicholas Andry. Below is the article from European Orthopaedics Bulletin MAY 1995 ISSUE No 2 which explains clearly why Nicholas Andry was a controversial figure..
Lyon 1658 – Paris 1742
The grandfather of orthopaedics
Nicolas Andry has an important place in the history of our specialty since he used, for the first time, the word “orthopaedics” in the title of a book which he published in 1741. In addition, this book contained an illustration of “the crooked tree’ (Fig. I) which has become the symbol of many orthopaedic societies throughout the world. In this article I describe the life and work of our illustrious predecessor which, curiously enough, are not particularly well known.
Nicolas Andry was born in Lyon in 1658 into a family of relatively poor merchants. He started theological studies, but in 1690 he adopted the surname of BoisRegard and went to study medicine at the Faculty of Reirns, which at that time was part of the Faculty of Paris. This link was, however, dissolved in 1694 by Louis XIV and he had to retake all his examinations in Paris.
In 1697 he defended his unusual thesis An in morborum cura, hilaritas in medico, obedientia in aegro, of which an approximate translation is “The relationship in the managemet of diseases between the happiness of the doctor and the obedience of the patient’!”
Although he was ambitious and very active, the success of his career was somewhat limited by controversy. As Professor at the Gollege de France, and then Dean of the Faculty, he never ceased to hound his peers, particularly ‘the barber surgeons’, and reduced thern to the level of “sous medecins’.
He suppressed the recently created posts in “operative medicine”, forbade the barbers to operate other than in the presence of a doctor, and prevented them from granting exemption from the restrictive custom s of Lent, a series of humiliating measures. This spite, well illustrated in his pamphlet of 1738 Cleon a Eudoxe, touchant lu preeminence de la medecine sur la chirurgie (on the pre-eminence of medine over surgery), is paradoxical because Andry has been recognised later by orthopaedic surgeons as their “father’.
He also turned his controversial habits on to his Faculty colleagues who described him as “‘superb, spiteful, confused, scornful, irascible and jealous”. After a long and unpleasant battle, he was forced to resign both from the Journal des Savanrs and as Dean.
He married three times and had a daughter by his last wife. He died in Paris at the age of 84 years on March 13 1742, a year after having written his famous book L’Orthopedie.
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 having been persecuted.
Among his many writings there are several philosophical texts of little interest and others which are no more than Iampoons. but some of’ his publications were originally constructive, and bear witness to careful observation, making recommendations which even today continue to be of interest.
In 1700 he published his first hook – De la generation des vers dans le corps del’homme. De la nature et des especes de cette maladie, les moyens de s’en preserver et de la guerir.-.
This work earned him the title of “the father of parasitology’, even if his explanations of infestations are, often both fanciful and eccentric. In any case it gave rise to notoriety and mockery, and he bore the nickname of “the man of worms’ or “wormy”. Even Voltaire mentions this in his – L’homme aux guarant e ecus.-
It was towards the end of his life that he wrote his -famous work L’orthopedie, ou l’art de prevenir et de corriger dans les enfants, les difformites du corps, le tout par des moyens a la porte des peres et des meres, et de toutes les personnes qui ont des enfants a elever, which was first published in Paris in 1741 in two volumes (fig. 2).It had immediate success and was soon translated and published in Brussels In 1742, in London in 1743 and Berlin in 1744. It is easy to read, with simple suggestions and points worth learning, although, perhaps a little too paternal – Art d’etre grandpere. It is important to remember that Andry wrote this book when he was 80 years old,two years ,befor his death.
It is divided into four main sections.
The First reminds us of the surface ‘artistie’ anatomy of- the entire body, with a curious and interesting chapter on its external proportions The style is pleasing and full of poetic, literary and historical quotations.
The second section describes useflul methods for preventing and correcting posrural deformities of the trunk and spine. The therapeutic suggestions, which often relate to physiorherapy, are sensible: a healthy posture,the importance of active mobilisation as opposed to passive movement, and the importance of sport and physical activities.
The third section covers limb deformities. For genu varus he suggested an orthopaedic treatment with correction produced slowly by bandaging the bent leg to an iron plate (the method one would use to straighten the crooked trunk of a young tree). Hencet our orthopaedic crooked tree. (Fig. 1). Club foot was also treated early and without operation. His description of the actual treatment is certainly not grotesque.
The fourth section covered deformities of the head and the face and he described these in detail. Throughout the book Andry emphasiscs 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 Encyclopedia in 1763, Diderot makes considerable mention of Andry and his work in establishing the specialty of orthopaedics.
Andry describes carefully in his preface of his, book the birth of this new word “orlhopaedics’ (Gk: orthos = straight; paidion =child) which was preceded by the terms “pedotrophie’, “callipedie” and “orthomorphie’. Although the term originally covered a wider range, its field has been progressively reduced and it is now restricted to the treatment of problems of the locomutor system. Initially, the subject was part of general surgery and then became an important surgical discipline in its own right. Curi ously, it is now divided into orthopaedics of the adult (a semantic mistranslation) and of the child (a pleonasm).
As for the famous picture of the crooked tree, this was adopted by many fledgling orthopaedic societies throughout the world during the early part of the 20th century (fig. 3).It is interesting and worthwhile to learn a little about the «best known portrait» of Nicolas Andry.Unlike the custom prevalent in the 18th century, this painting was not reproduced as a frontispiece in his books.
There was an authentic portrait of Andry in the collection of the Faculty of Paris until the end of the 19rh century. It had been recorded by Chereau but then it mysteriously disappeared. It was found some 50 years later in the Dean’s apartment, but its identity was not confirmed.
The portrait, thought to have been painted by Francois de Troy in 1738, shows Andry with a wig, a cape of ermine and a red coat.
Bonnola, a pupil of Putti, did not think that this painting represented Andry, as he appeared much younger than his real age of 80. Doubt must remain because this portrait has again disappeared! Unfortunately, in spite of research among various Parisian collectors, no further clues have come to light as to its whereabouts
Ironically, the only remaining picture of Andry is an engraving in the French Bibliothegue Nationale .This wicked caricature entitled – homini verminoso – (worm man) was the frontispiece of a pamphlet written by a surgeon as an answer to Cleon a Eudoxe (see above).
One of the motst virulent critics of Andry, OIivier de la Mettrie who caused even greater trouble among colleagues described this caricature as “a doctor who is kicking down the door of a barber-surgeon, carrying on his back a pot o f – eau de fougere (a purgative) and crying “Fresh water, who wishes to drink ?'”.”
This is an allusion to the worms which according to Andry were the cause of all illness. De la Mettrie goes on to say that “This man is the dishonoured father of orthopaedics””,
Today these controversies make us smile.
Nicolas Andry neither deserves to be scorned nor to be given too much respect.
Orthopaedic surgeons have pardoned the nran who created the name of their specialty. Andry is certainly not “the father ” of orthopaedics, a title which should perhaps be given to Venel (1740-179I), He produced nothing fundamenral, only some simple ideas on methods of prevention, the «plasticity» of the child, and the importance of gymnastics, ideas which should perhaps make him the “grandfather” of our art, and a wise and aesthetic gentleman.