Where Is the Orthopedic Office at Sayre Hospital

Clin Orthop Relat Res. 2008 September; 466(9): 2263–2267.

Lewis A. Sayre: The Get-go Prof of Orthopaedic Surgery in America

Jay M. Zampini

Section of Orthopaedic Surgery, Drexel University College of Medical specialty, 245 N 15th Street, Mail Stop 420, Philadelphia, PA 19102 US

Henry H. Sherk

Department of Orthopaedic Surgery, Drexel University College of Music, 245 N 15th Street, Post Stop 420, City of Brotherly Love, PA 19102 USA

Received 2007 Oct 29; Accepted 2008 May 30.

This article has been cited by other articles in PMC.

Abstract

Lewis Albert Sayre (1820–1900) is considered to comprise among the institution fathers of orthopedic surgery in the United States. Atomic number 2 studied medicine at the College of Physicians and Surgeons (now of Columbia University). Sayre later helped establish the first academic department of orthopaedics at the Bellevue Checkup College where he served As their first Professor of Orthopaedics. Lewis Sayre treated a considerable diversity of musculoskeletal conditions and meticulously documented them with written notes, sketches, and photographs. Atomic number 3 a figure, his methods were arguable, attracting kudos aside some and tempting unfavorable judgment by other prominent members of the international community. Helium made great strides for physicians, helping to charter the Dry land Medical Association and to instal the weekly publishing of the Daybook of the American Medical Association.

Introduction

The art of practice in whatsoever theater of operations of medicine today relies heavily happening the efforts and advancements of our predecessors. John Llewelly Lewis Albert Sayre is one of our main forefathers in the field of orthopaedic surgery (Fig.1). Born on February 29, 1820 in Bottle Hill, NJ, now known as President Madison, Sayre was unrivalled of 12 children of Archibald Sayre, a prominent local farmer [4, 10, 11]. On the death of his get around Lewis's 10th natal day, Sayre touched with his family to Lexington, KY, to live with his uncle, Jacques Louis David Sayre, a prominent banker. There, helium began his advanced education in 1837 by attending Transylvania University. Despite the attempts of his uncle to persuade him to get over a banker as an alternative, Lewis returned east to New House of York City to receive a MD degree from the College of Physicians and Surgeons in 1842. (The College of Physicians and Surgeons, originally founded in 1807 A an introduction of the New York Board of Regents, established a relationship with Columbia River College only 7 years later in 1814, merely retained autonomy until a formal merger in 1860, well after the time Sayre was there.) While at the College of Physicians and Surgeons, Sayre studied disorders of the spinal cord and spinal nerves and successfully defended a thesis on, "Spinal anaesthesia irritation," which was published shortly thereafter [11]. Sayre's interest in the discussion of spinal disorders eventually led him to heavy renown.

Lewis Albert Sayre served as professor of the first department of Orthopedic Surgery in the United States (from the archives of the Bellevue Infirmary Medical College; used with permission from the Ehrman Medical Library of the NY University Medical school).

Lewis Albert Sayre remained in New York after commencement ceremony and served arsenic anatomy prosector at the College of Physicians and Surgeons for 10 years. In 1853, he transferred his practice to Bellevue Hospital where atomic number 2 concentrated happening diseases of the spine, bones, and joints. (Bellevue Hospital was also one of the oldest medical institutions in the country and credibly the first public infirmary in the America, having been founded in 1736.) He also served atomic number 3 consultant to the 1000-bed Charity Hospital, the New York Small Pox Hospital, the Insane Asylum, the Hospital for Epileptics and Paralytics, and the Nursery Infirmary. In 1861, the faculty and trustees of the hospital deemed Bellevue and its affiliates a prime location for learned profession education, a lucrative strive at the clock. Bellevue Medical College was opened [3]. Sayre was appointive to the faculty and called Professor of Orthopedical Surgery, the beginning of such a position in America.

The Case Log of Lewis Albert Sayre

A review of Dr. Sayre's case log reveals his position as a progressive and innovative thinker for his time. He wrote about and illustrated extensively tuberculous arthritis of the rose hip, or morbus coxarius as it was known at the time (Fig.2) [4, 9]. (While recognized arsenic a medical entity from clinical descriptions, the tuberculosis being was non identified until 1882 by Robert Koch.) Sayre described three stages of affair of the hip in tuberculosis. The first level was characterized by irritation or qualified motility. The rose hip was painful but the relation length of the leg was unchanged from formula. The second stage was one of evident prolongation of the involved extremity past joint effusion. The pelvic arch began to subluxate with the capsule remaining intact. The hallmarks of the third base and end were limb shortening, rupture of the joint capsule, and complete devastation of the proximal separate of the femur. Sayre was liberalist in the way He treated severe sick hip arthritis with surgery. He performed the second winning resection of the hip in 1854 following Henry Bigelow of Boston in 1852 [20]. In total, Sayre resected hips of much 70 patients throughout his career. He described the procedure in his case log, over 70 long time before a similar procedure was delineated and popularized by Girdlestone in the 1930s [3]:

"[I] placed the patient under chloroform and exsected the hip junction. Ready-made an incision concluded the trochanter major parallel with os femur. The periosteum was dissected from the osseous tissue and the last mentioned sawed off scarce above the trochanter minor. The wound was kept unconcealed that information technology might mature freely. After the operation, the patient was placed in wire britches so that rest could be had and extension kept. The combat injury suppurated freely but the discharge became healthy in 7 or 8 years. Rapid pulse (160), high fever for the first week... got slowly better. Removed the wire britches after 3 months. He is now quite healthy, able to walk, has but slight pain. Tail end walking about the street of NY with crutches and has but little shortness of the leg" [4].

Lewis Sayre treated a diversity of musculoskeletal conditions with nonoperative and operative techniques and became renowned universal for his writings on the discourse of spinal anesthesia disorders. Atomic number 2 wrote in 1895 in the New York Medical Journal of "The history of treatment of spondylitis and scoliosis by partial abatement and retention away means of plaster of Paris bandages" [18]. Patients were almost suspended from their arms and head so that compromising scoliotic deformities of the spine could atomic number 4 aplanatic and immobilized in a stamp (Fig.3). The plaster body cast he used intending to correct the disfiguration came to be called a Sayre jacket. Although the efficaciousness in for good altering the disease process is questionable, the contribution to the development of fashionable techniques of body casting and refreshing for scoliosis is trenchant.

This patient with tuberculous arthritis of the right-wing hip was treated with exsection (from the archives of the Bellevue Hospital Greco-Roman deity College; used with license from the Ehrman Medical Library of the New York University Schooltime of Medicinal drug).

Idiopathic scoliosis was treated with partial suspension American Samoa shown, and retained with a plaster of Paris bandage (from the archives of the Bellevue Medical College Hospital; used with permission from the Ehrman Medical Library of the Unweathered York University Medical school).

Sayre acted American Samoa a public wellness exponent while serving as Commissioner of Public Health of New York City City [4, 10]. Helium supported compulsory vaccination, quarantine for cholera, sanitary inspection of tenement houses, and developed facilities for sewage disposal during his tenure as Commissioner. However, his passion for improving public health did not end when he left-hand the Commissioner's office merely continuing throughout his practice. He represented incomparable of his cases of May 1869 in which a woman 21 years old presented to his clinic with progressive weakness and loss of power of all the extensors of both forearms and intrinsic musculature of the hands [4]. She had been seen by many physicians in New York City, no of whom could determine the etiology of the weakness. She then was sent to City of Brotherly Love and Boston for consultation away about of the most striking physicians of the time, also to no avail. When she finally presented her case to Sayre, the weakness had progressed and she had little Hope that the cause could be discovered operating theater whether there could atomic number 4 whatsoever chance of bring around. Dr. Sayre obtained an exhaustive history of the woman's life and social habits and discovered that she had been using cosmetics that contained considerable amounts of lead-based dyes. He instructed the patient to immediately stop using the lead-based cosmetics, and her disablement remained stable. He prescribed range of motion exercises and intentional useable braces for her to allow her to perform more meaningful activities in life. Moreover, the extent of Sayre's interest did not stop with the diagnosis and treatment. As a former Commissioner of Health, He was competent to convince the panel to investigate the use and amount of lead in women's cosmetics, pomades, and tonics. The Board of Health discovered well elevated levels of lead in many of the commonly used cosmetics and was able to discern brands with zero or negligible amounts of lead. Sayre and the Empire State Board of Wellness were subservient in banning further usage of lead in women's cosmetics [4, 7, 11].

During his career, Lewis Sayre became widely titled a physician and surgeon. His patients oft traveled from throughout the nation for treatment. They wrote to him a great deal, extolling his praises. He described, in 1884, a followup of General Harry Barnum, a patient He had bound 22 years earlier (Fig.4) [4]. Barnum had sustained a gunfire to the renal pelvis in the Subject War in 1862 and chronic osteomyelitis had developed. Atomic number 2 presented to Dr. Sayre who distant a large portion of his Ilion and inserted an Caoutchouc tube. Atomic number 2 instructed Barnum to perform wound care, including removing, cleanup, and replacement the enfeeble tube. Barnum complied and was able to return to active combat tariff. He utilised and cared for the waste pipe tubing for the remainder of his life.

General Harry Barnum was cut in the Civil War in 1862 and continued to use an Republic of India rubber drain metro for decades after surgical debridement (from the archives of the Bellevue Hospital Learned profession College; used with permission from the Ehrman Medical Library of the New House of York University School of Medicine).

Sayre extensively documented his do work with in-person notes and written publications and public addresses [12–19]. He is said to have authored closely 250 publications, still, many of the works are multiple concurrent printings of the same report in different journals [20]. His best known works report the treatment of spondylitis, scoliosis and club foot, and his lectures delivered at Bellevue Medical examination College [12, 16–18].

The Public Life of Lewis Prince Albert Sayre

Lewis Sayre was a highly public figure throughout his life. He good orthopaedics at a time when anesthesia and aseptic technique were in their infancies. Surgical intercession was not As thirstily embraced by all practitioners of orthopaedics. Charles Fayette Taylor also practised orthopaedics in New York City, just did non counsel operative intervention [5, 6]. He publicly accused Sayre of base conduct in the mode he performed brand-new and generally unproven surgical procedures. Taylor demanded reprimand of Sayre by the New York Honorary society of Medicate but finally was unsuccessful.

Although the medicolegal environment of Lewis Sayre's clock time was different than it is today, physicians were not immune to allegations of malpractice. In Walsh v Sayre, Dr. Sayre was accused of performing "...an operation happening the plaintiff so negligently and unskillfully as to deflate the joint of the plaintiff, causing the synovial fluid which lubricates the animal tissue surface of said spliff to escape, thereby seriously and permanently injuring the hip, rendering the whole peg useless and permanently game and perhaps rendering necessary an amputation of the leg, at the risk of the patient's animation" [21].

The account of the case describes how Sayre lanced an abscess of the left buttock near the greater trochanter of 6-twelvemonth-old Margaret Walsh. The five witnesses, all of whom were physicians studying under Sayre, recall Sayre fashioning a incomparable-one-half-inch incision through which atomic number 2, "Got pus, which gushed in a stream." The girl's mother became excited and seized her, functioning out of the office in front a proper dressing could glucinium applied. Although the girl's mother attested that she would rather have had her go bad than undergo an operation, Margaret Walsh did walking into the courtroom to testify in the case. With the evidence given by the witnesses, and the clumsy testimony of the alcohol abusing, poorly trained, and ethically questionable "expert," retained by the complainant, the case was decided in favor of Sayre.

Lewis Sayre was not without his supporters. He was a charter member of and activist in the Solid ground Greco-Roman deity Association (AMA), of which he served as president betwixt 1880 and 1881 [1]. As an executive of the AMA, He convinced the association that issue of medical information, then on an annual basis as the Transactions of the AMA, did non adequately address the dynamical medical exam times. Soon thereafter, the Daybook of the AMA was chartered. In addition, and after his initial objection to its creation, Sayre was made a member of the American Orthopedical Association (AOA) in 1889 [11, 20]. The starting time chairperson of the AOA, Virgil Gibney, was a protégé of Sayre and publicly defended Sayre's integrity. Furthermore, Sayre regularly received letters of praise from patients throughout the nation. His good repute, still, extended beyond the borders of New York and the United States. Piece in Europe, he formerly treated the boy of King Charles XV of Sweden. The noble family was so impressed with their boy's handling that they bestowed knighthood happening Lewis Sayre: "We have as our Royal Deck and Goodwill proclaimed him, Lewis A. Sayre, a Knight of the Order of Wasa, of which we ourselves are brain" [7, 8].

John Llewelly Lewis Sayre married Elizabeth Ann Anteroom in 1849 and produced one daughter and three sons [7]. Each of his sons followed him in the practice of orthopaedic surgery. His sons Lewis Hall Sayre and Reginald Hall Sayre were among the founders of the American Orthopaedic Association. Lewis served as the world-class secretary-treasurer of the association and Reginald A the eighteenth prexy. Sayre's daughter Mary Hall Sayre, did not take after her father into medicine, simply became a talented linguist. She occasionally would translate medical industrial plant from other languages into English for her father. Although three of his children did not have children of their own, Lewis Hall did bring on two sons and a daughter to continue the Sayre family lineage. At the least matchless descendent, James W. Sayre, a great great nephew, continues to practice medicine today [11].

Lewis Albert Francis Charles Augustus Emmanuel Sayre played an important role in the development of orthopaedic surgery in the United States. He believed in the importance of a nationalist meeting place in which orthopaedists could discuss and advance their practice and was implemental in the brass of the AOA. As a public wellness advocate, he initiated important measures to protect the wellness of the population he served. Finally, as an academic, he held high the principles of the physician-man of science to improve his practice and further his knowledge by declaratory that He "must exist permitted to question what is questionable and to doubt what is dubitable."

Acknowledgments

We thank B. J. Gooch, special collections bibliothec and university archivist at Transylvania University, for information regarding the education of Lewis Sayre; Colleen Bradley-Sanders, Archivist of the Ehrman Medical Depository library of the New York University School of Medicament, for her generous help with the photographs included in this article, the Extraordinary Collections staff of the Ehrman Medical Library, and the stave of the archives of the New York City Academy of Medicine for their assistance with our review of the Sayre collections.

Footnotes

Each author certifies that atomic number 2 or she has none commercial associations (eg, consultancies, stock possession, equity pursuit, patent/licensing arrangements, etc) that power pose a conflict of interest in connection with the submitted article.

References

1. American Medical Association. About the AMA: AMA History: Annual Encounter and Presidents of the AMA. Available at: www.ama-assn.org/ama/pub/category/3603.html. Accessed October 4, 2007.

2. Annual Ball-shaped and Catalog. New York, New York State: Bellevue Infirmary Medical College; 1871.

3. Brand RA. Acute pyogenic arthritis of the hip: an operation giving non-slave access and effective drainage: G.R. Girdlestone DM OXFD, FRCS. Clin Orthop Relat RES. 2008;466:258–263. [PMC free article] [PubMed]

4. Casebook of Lewis Albert Sayre. Bellevue Hospital Medical College Records. Archives, Frederick L. Ehrman Medical Program library, NYU School of Medication.

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7. Obituary : Lewis Albert Sayre, M.D., LL.D. In Shrady GF, male erecticle dysfunction. The Medical Record. New York, NY: William Natalie Wood and Co; 1900.

8. Proclamation to Sinclair Lewis Albert Sayre. Knight of the Wasa. Stockholm, 18 April, 1872.

9. Rutkow IM. The surgeon as illustrator. Arch Surg. 1998;133:914. [PubMed]

10. Rutkow IM. C. S. Lewis Albert Sayre and the break treatment of spinal disease. Condescending Surg. 2001;136:119. [PubMed]

11. Sayre JW. Historical linear perspective: Lewis Prince Albert Sayre. Spine. 1995;20:1091–1096. [PubMed]

12. Sayre LA. A Practical Blue-collar of the Treatment of Club-foot. New York, NY: D. Appleton and Co; 1869.

13. Sayre LA. Three Cases of Leash Palsy from the use of a Cosmetic Titled "Laird's Salad days." Trans Am MEd Assoc. 1869;20:563–572.

14. Sayre LA. Spinal Anemia: With Paralysis, Want of Co-ordinance from Discomfort of the Genital Organs. Philadelphia, PA: Collins, printer; 1875.

15. Sayre La. Removal of the head of the femur. Br Med J. 1877 (July 14):62.

16. Sayre LA. Spinal Disease and Spinal Curvature. London, England: Metalworker, Elder; 1877.

17. Sayre Lah. Lectures on Orthopedic Surgery and Diseases of the Joints. Delivered at Bellevue Hospital Medical College, during the winter academic term of 1874–1875. New York, NY: D. Appleton and Co; 1885.

18. Sayre LA. The account of discussion of spondylitis and scoliosis by partial hanging and keeping by means of plaster of Paris bandages. NY Med J. Mar 16, 1895.

19. Sayre LA. A new operation for faux hip in bony anchylosis. 1863. Clin Orthop Relat RES. 1994;298:4–7. [PubMed]

20. Shands AR. Lewis Albert Sayre, the first prof of orthopaedic operating theater in the United States. Curr Pract Orthop Surg. 1969;4:22–42. [PubMed]

21. The So-called Malpractice Rooms of Walsh vs Sayre. Empire State, NY: Geo. H. Arthur Jacob Arshawsky and Co; 1879.

Where Is the Orthopedic Office at Sayre Hospital

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2493005/

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