Orthopedic Center, 1823 – 1834
In France, both orthopedic surgery and post-surgery therapy originated in the first half of the 19th century. A pioneer in these fields was Dr. Jacques-Mathieu Delpech in Montpellier who demonstrated that orthopedics and gymnastics were interdependent. In Paris, the principal founders of these types of treatment centers were Jules Guérin, Sauveur-Henri-Victor Bouvier, Vincent Duval and Charles-Gabriel Pravaz, but numerous other doctors and practitioners established such centers in and outside of the capital between 1825 and 1840 (Quin and Monet 371).
In 1823, 4 rue de Chevreuse was transformed into an orthopedic and gymnastic establishment by Charles-Amédée Maisonabe, Professor at the Faculté de Médecine in Paris. Born in Rodez, France on September 17, 1779, the son and grandson of doctors, he completed his medical education at the Faculté de Montpellier in 1804 with a thesis on cataracts (Dumaitre 61). Maisonabe then practiced in the army, in hospitals, taught surgery and medicine, and published essays on the treatment of what were then referred to as "human deformities." His free course in Paris on "Les difformités du corps humain" was attended by hundreds of students and practitioners from France and other countries (Archives générale de médecine 629).
Maisonabe was particularly interested in elevating orthopedic procedures to the same level of respect as other forms of surgery. He was fascinated by the origins, causes, natures, and consequences of atypical physiologies so he decided to put his theories into practice by founding the Établissement Orthopédique et Gymnastique du Mont-Parnasse, a residential treatment center for a variety of impairments. The Archives générale de médecine praised his center (translated from the French):
[...] he created, in one of the healthiest and most agreeable neighborhoods of the capital, a vast and superb establishment where he treats individuals of both sexes whose bodies deviate more or less from their regular state, and several have already had the very best results from the treatment (629).
The property at 4 rue de Chevreuse, with its courtyard and back garden, was an ideal setting for such a residential treatment facility. Maisonabe's center differed from others in France because it mostly focused on "deviations of the spine," especially in women. Maisonabe specialized not only in scoliosis, but also in club feet, muscular contractures, defects of the sensory organs, and skin diseases. He treated both men and women as well as children.
In 1827, Maisonabe expanded his practice to include two other doctors, Amédée Dupau and N. Bellanger, who had enhanced their scientific expertise in England, Germany, and Russia (Revue Médicale 294). They also hired two other associates: a female residential manager and a male teacher who oversaw the patients' schooling. Additionally, each patient's physician was invited for regular site visits and for meetings with the directors. The center's brochure boasted about state-of-the-art equipment and a practice that not only conducted surgical operations but also helped patients regain strength and mobility in its user-friendly and healthy environment:
A vast and airy site, near the boulevard du Mont-Parnasse, with a tree-lined garden, serves for the promenades of its residents. The house is composed of three buildings destined for housing both sexes separately. Rooms are reserved for those who prefer to be alone, or for the parents who wish to follow the treatment of their child (2, translated from the French).
Orthopedic patients recovering from surgery or healing from an injury also benefited from rehabilitation and physical therapy. Different kinds of baths were installed on the property and an orthopedic gym allowed for several types of exercises. It included a trampoline, parallel bars, swings, and a trapeze. Patients could exercise on their own, with assistance and guidance available when needed.
In its brochure, Établissement orthopédique et gymnastique, the clinic also advertised up-to-date surgical equipment and other instruments, some of which had been invented by Maisonabe and vetted by independent medical authorities: "The results obtained by the machines recently invented by M. Maisonabe, for the treatment of clubfoot, were presented to the Institute, which was able to observe the promptness of the cure. Everyday experience confirms the superiority of these orthopedic procedures, which are carefully combined with the frictions and medicines necessary to combat various causes of disease" (3, translated from the French).
One instrument invented by Maisonabe was a bed that exerted forceful traction directly on the spine, based on the principle that the causes underlying spinal deviations needed to be reversed. His theory was that a patient had to remain in traction for extended periods to counteract a lifetime of spinal deviation. The Archives générale de médecine provided the best description of the bed's operation:
As for its mechanism, instead of elasticity, gravity is what drives it: a set of weights are situated under the strapped bottom of the bed, which pull the head and pelvis in the opposite direction; a crank positioned outside the bed can modulate this system of weights, and a dial allows one to calculate the desired degree of extension; patients can also suspend the play of the machine in order to make themselves temporarily comfortable, for blowing their nose, coughing, or satisfying other needs (285).
The Établissement orthopédique et gymnastique brochure claimed that this invention had been evaluated by "The Royal Academy of Medicine [which had] established in its report that Doctor Maisonabe's Extension Bed is as simple as it is efficient in its effects" (3, translated from the French).
Treatment at Maisonabe's orthopedic center was extremely expensive so it catered to a primarily wealthy clientele:
In Paris, the establishments are located in the beautiful districts of the French capital, where the average value of rentals per inhabitant are the highest […]. Several reasons [...] explain this geography: firstly, the proximity of a clientele likely to have recourse to the services of these specialized health centers – mainly middle-class clients; but also better air quality […] or even the availability of large spaces to establish gardens, gymnasiums [...], facilities and equipment essential to the smooth operation of these establishments (translated from the French, Quin & Monet 373-374).
In an 1831 bulletin describing the clinic's objectives, Maisonabe listed the costs that patients would incur depending on what they were suffering from, the kind of lodging requested, the number of teachers needed, and the length of their stay (determined ahead of time by the directors). If patients had to prolong their treatment, the price would be cut in half - proof, said Maisonabe, of the attention they gave to the healing process. For a full year, the center charged 2000 francs for treatment, room, and board, and 1500 francs for gymnastics, room, and board (36). The mechanical bed with all of its accessories cost 520 francs and was, naturally, available through his clinic. Given that the average annual income for French workers in 1831 was 300-400 francs, Maisonabe's bed as well as treatments at his clinic were only accessible to the rich.
One year after founding his orthopedic center, Maisonabe launched a quarterly journal which he edited and sold from 1825 –1829. In the ten illustrated issues that were produced, he wrote his observations and described the instruments used to correct various physiological anomalies. The journal was criticized by his contemporaries, one of whom published an anonymous pamphlet in 1827 accusing Maisonabe of "ignorance and bad faith disregarding the work of its predecessors" (cited in Izac 455). The pamphlet continues its attack:
We are surprised to see a doctor publish a collection intended only for a very small branch of surgery, when there are ten or twelve medical journals in Paris whose editors often lack interesting materials: also, this collection has had little success and it is so rare that you don't even find it in bookstores, which led a hoaxster to claim that Mr. Maisonabe was the only editor and the only subscriber to his journal (translated from the French, cited in Izac 455).
In 1828, Maisonabe and his partners established another treatment center in the neighborhood of Conflans at Charenton-le-Pont, a suburb of Paris (Dumaitre 61). This period marks a decline in Maisonabe's professional reputation. His extension bed was publicly criticized, especially by G. Jalade-Lafond and Claude La Chaise, who had invented their own orthopedic instruments. They claimed that Maisonabe's bed caused "Ulceration of the chin, the jaw and paralysis of the lower limbs" (cited in Weiner 432).
Controversies around Maisonabe's methods continued to grow and he was censured in 1829 by the "Conseil de l'université" after having been accused of malpractice by Baron Dupuytren, head surgeon at the Hôtel-Dieu hospital, professor of surgery at the Faculté de médecine de Paris, premier surgeon of the king, and member of the Institut et de l'Académie de médecine (Dumaitre 61). After this ordeal, Maisonabe is said to have uttered: "I will not survive this injustice" (translated from the French, cited in Dumaitre 66). In spite of the drama and scandal, he continued to publish and his center at 4 rue de Chevreuse remained active until c. 1833.
Maisonabe left France in 1837 and traveled to Moldova (formerly Moldavia), entruting his Charenton center to a notary (Izac 457). In Moldova, he became the headmaster of a boarding school, but found conflict with local doctors and was criticized for being too liberal (Izac 456). He returned to Paris in January 1838, only to discover that his center had lost its clientèle and had to be sold. In 1843, Maisonabe taught a course at l'Athénée de médecine de Paris on "Errors and Disappointments in Medicine and Surgery" (Izac 457).
Charles-Amédée Maisonabe died in Paris on August 31, 1851. According to Izac: "His last years were clouded by the accidental death of his son, the [...] lawyer, at the age of 44. Apart from a few short stays in his hometown, with his family, he remained in Paris where his life ended, terribly lonely [...]. He was just shy of 72 years old" (458, translated from the French).
What had begun as a ground-breaking medical venture became fraught with suspicion and accusations of charlatanry, bad judgment, and self-interested policies. And, indeed, many of Maisonabe's instruments and experiments seem to have caused more health issues than they resolved. In retrospect, however, one might surmise that the medical establishment, represented by certain reigning practitioners, harbored a kind of envy or fear of being upstaged by the ideas promoted by innovative doctors such as Maisonabe. Close to 150 years later, in her article on the quarrels between Dupuytren and Maisonabe, Dumaitre clearly indicates that evidence was manipulated to prevent Maisonabe from receiving a fair trial (68).
- Archives générales de médecine, volume 9, September 1825, pp. 628-631. Google Books.
- Bretonneau. “Exposé de six cas de deviation de la colonne vertébrale, traité à Tours d’après la méthode de M. Maisonabe.” Revue médicale française et étrangère et Journal de Clinique, vol. 4, 1827, pp. 155-158. Google Books.
- Delpech. “Considérations anatomico-médicales.” Revue médicale française et étrangère et Journal de Clinique, vol. 4, 1827, pp. 5-21. Google Books.
- Dumaitre, Paule. "Pugilat à la Faculté de médecine de Paris: Dupuytren contre Maisonabe (1829)." Histoire des Sciences Médicales, vol. 12, number 1, 1978, pp. 61–67. Speech presented at the 22 October 1977 meeting of the Société française d'histoire de la médecine.
- "Établissement orthopédique et gymnastique du Mont-Parnasse." Le Constitutionnel, May 25, 1829, notice 3338. Advertisement. RetroNews.
- Établissement orthopédique et gymnastique destiné au traitement de toutes les difformités dans les deux sexes, Dirigé par les Dr. Maisonabe, Dupau, Bellanger. Paris: Imprimerie de Gueffier, undated, pp. 1-4. Gallica.
- Gazette médicale de Paris: journal de médecine et des sciences accessoires, 2nd series, volume 3, 1835, pp. 529-839. Internet Archive.
- Izac R. "Du Rouergue en Moldavie: Note sur Charles Maisonabe (1779-1851)." Histoire des Sciences Médicales, vol. 12, no. 1, 1978, pp. 451-458. Speech presented at the 27 October 1979 meeting of the Société française d'histoire de la médecine.
- Jalade-Lafond, Guillaume. Recherches pratiques sur les principales difformités du corps humain et sur les moyens d’y remédier. Paris, 1827-1829. Gallica.
- Küss, Émile and Chrétien Heiser. Traité de gymnastique raisonnée, au point de vue orthopédique, hygiénique et médical ou Cours d'exercices appropriés à l'éducation physique des deux sexes... / par Ch. Heiser,.... [Supplément au traité de gymnastique orthopédique et médicale de Chr. Heiser], Paris, 1854, p. 235. Gallica.
- "Maison d'éducation et de traitement." Journal de la Ville de Saint Quentin, April 14, 1833, p. 18. RetroNews.
- Maisonabe, Charles Amédée. Établissement destiné au traitement des difformités et des paralysies, dirigé par le Dr Maisonabe, professeur de médecine et de chirurgie, agrégé à la faculté de médecine de Paris. Paris, Imprimerie Decourchant, 1831, pp. 1-4. Gallica.
- Maisonabe, Charles Amédée. Journal clinique : recueil d'observations sur les difformités dont le corps humain est susceptible à toutes les époques de la vie, et sur tout ce qui se rapporte en général à la mécanique et aux instrumens employés par la chirurgie, volume 1, July 1825. Wellcome Collection.
- Maisonabe, Charles Amédée. Orthopédie: clinique sur les difformités dans l'espèce humaine / accompagnée de mémoires et dissertations sur le même sujet, par plusiers médecins, français et étrangers. Paris: Rouvier et Le Bouvier, 1834. Wellcome Collection.
- "Nouvelle extension donnée à l'établissement orthopédique et gymnastique." Le Constitutionnel, October 26, 1828, notice 533(1). Advertisement. RetroNews.
- Quin, Grégory and Jacques Monet. "De Paris à Strasbourg: l'essor des établissements orthopédiques et gymnastiques (première moitié du XIXème siècle)." Histoire des Sciences médicales, vol. 45, no. 4, October-December 2011, pp. 369-379. Presented at the Journées de Strasbourg, 17-19 June 2011.
- Quin, Grégory. Le mouvement peut-il guérir? Les usages médicaux de
la gymnastique au 19e siècle. Edition BHMS, 2019.
- Shaw, John. "Distortions of the Spine: An Account of the Modes of Treating Distortions in Paris, with Remarks.” The London Medical and Physical Journal, volume 56, number 334, December 1826, pp. 488-503. Google Books.
- “Variétés.” Revue médicale française et étrangère et Journal de Clinique, vol. 4, 1827, pp. 293-295. Google Books.
- Weiner, M.F. and J.F. Silver. "Paralysis as a Result of Traction for the Treatment of Scoliosis: a Forgotten Lesson from History." Spinal Cord, vol. 47, 2009, pp. 429-434.