While reviewing the case study, consider the following questions:
From Clinical Notes Vol. 2, pages 115-116.
The patient is an adult twenty-seven-year-old woman from LeRoy, New York. She is being treated by Sayre for the condition talipes equinovarus (also known as clubfoot). The patient case history indicates that H.B. had seen Sayre in the past for an operation (that record is in a ledger separate from these case notes). The casebook record outlines Sayre’s second surgical intervention on May 19, 1873, during which he performed a tenotomy and then put the foot into a plaster brace. During surgery, H.B. received chloroform and morphine. The entry ends with a follow-up appointment during which she showed continued improvement.
To page through Sayre's clinical notes and read the transcribed patient narrative for H.B., use the arrow icons to scroll through the gallery.
Sayre treated patients of all ages for different variations of talipes, also known as clubfoot. Although he identified it as a congenital condition, he also saw many patients for whom “long-continued walking” on clubfeet had worsened the condition by causing paralysis and inflammation. The treatments Sayre prescribed for clubfoot included massage of the feet and limbs, application of electrical currents, bracing or wearing of modified shoes, and surgical intervention such as tenotomies.
The first successful subcutaneous tenotomy of the Achilles tendon was performed by Dr. Louis Stromeyer of Hanover in 1831. It quickly became a popular surgery in America, following its introduction by orthopedic surgeon Dr. William Ludwig Detmold. In his lectures on the subject from the Bellevue Hospital Medical College session of 1874-1875, Sayre argued that tenotomy was becoming overused. He noticed that many of his adult patients needed the surgery more than once, as is seen in the case of H.B. above, and believed that dressing the foot and leg in a plaster brace following surgery could help patients maintain their foot position as they healed.
After dividing H.B.'s Achilles tendon, Sayre placed her foot on a flat board (as seen in the illustration to the right) and bandaged it with Plaster of Paris dressings to hold her foot and leg in position. Once the tenotomy incision healed, Sayre believed that the key to successful treatment lay not in immobilizing the foot but in regular manipulation. He encouraged his students to treat cases of clubfoot with daily massage "performed thoroughly, but gently, and never carried to over-fatigue."
Image: Sayre's plaster bracing for patients recovering from tenotomy. From Sayre's Lectures on Orthopedic Surgery and Disease of the Joints, 1885.
You may have noticed that Sayre's patient in this case study was given morphine for her pain and spoke with him about her previous issues with dependency. Eric Trickey's Smithsonian Magazine article "Inside the Story of America’s 19th-Century Opiate Addiction" provides helpful context about the use of painkillers during this era.