Adolf Lorenz was born in rural Austrian Silesia in 1854. His father was a harness maker and innkeeper. A smart boy, Lorenz was able to attend high school through the financial support of his uncle, a monk, and later self funded through his own tutoring. He graduated from the medical school at the University of Vienna aged 26, and soon became a surgeon. Unfortunatley within four years Lorenz developed a severe allergy to the carbolic acid that was routinely used in operating rooms for asepsis; causing skin lesions on his hands. On the advice of his mentor, Lorenz became a ‘dry surgeon’ in the relatively new field of orthopaedics.

With saved money he hired an office, put in some gymnastic apparatus, and hung out his shingle: “Specialist in Orthopaedic Surgery”. To justify the title, he sat down and wrote a book on the pathology and therapy of lateral deviation of the spine.

Bloodless surgery or orthopaedic treatment was disdained by physicians and surgeons of his time, but he managed to raise the practice of manipulation to a science and art. Numerous children came to Lorenz for treatment because of misshapen, stiff or unusable limbs. Long before the sunlight treatment for tuberculosis of the bones was introduced, Lorenz initiated a new form of treatment of great efficacy. On the subject he wrote,

Children with tuberculosis bone and joint diseases were my most frequent patients. Everyday experiences soon proved that a child with hip-disease could walk and even jump around all day long without any pain, but as soon as it fell asleep, the slightest movement of the body caused terrible pains, with the dreaded night crying. It was clear that pain was avoided during the day by the spastic contraction of the muscles, which prevented any movement of the joint. As soon as the muscles fell asleep with the child, motion became possible and the least suggestion of it was a source of acute pain. I resolved to imitate nature, adding to the muscular fixation of the diseased joint an artificial fixation by means of a well-fitting plaster-cast which had to be left undisturbed for many months, sometimes a whole year. In such a cast the children lost their pain and could even walk, and in mild cases nothing else was necessary. The children could even go to school with their casts on; instead of being bedridden”.

Lorenz also developed a strong reputation for his manipulative treatment of club feet, which he accomplished by essentially stretching or breaking the tendons, ligaments and epiphyseal plates until the foot was appropriately aligned. Serial plaster casting helped heal the foot in the new position. He treated scoliosis using pulleys and traction to achieve a correction and then applying a cast to maintain the position.

Lorenz however, was most famous for his treatment of congenital dislocation of the hip. He developed a technique for manipulating the hip in young children under light anaesthesia, and holding them in a plaster spica cast in abduction and external rotation as they matured. Although the revolutionary procedure was controversial, the timely discovery of X-rays in 1895 demonstrated that the operation worked. Lorenz was also the first to add a walking frame to his abduction hip spica casts, so that the children could be somewhat mobile. In 1896 Lorenz published his results and later, in 1900, published his book, On the Healing of Congenital Hip Dislocation. By that time he had already gained experience from over a thousand patients.

Lorenz was one of the founders of the German Society of Orthopaedic Surgery in 1901, and a year later, at the age of 48, was at the peak of his career, earning the moniker, ‘the bloodless surgeon of Vienna.’ He had patients from halfway around the world, and was a sought-after physician in European royal families. However, at the end of 1902 he became a veritable global superstar with the operation on a US millionaire’s daughter, Lolita Armour; whom he successfully treated in Chicago for a princely fee.

Philip Armour, a wealthy meatpacking magnate, was concerned for his 12-year-old daughter who had a congenital dislocation of the hip. Surgical relocation had failed so Armour invited Lorenz to come to Chicago to treat his daughter. Lorenz was reluctant because of the age of the girl and the fact that a prior surgical effort had been made, which minimised his opportunity to get a successful reduction. Lorenz’s wife, however, convinced him to go while negotiating a huge fee, somewhere between $30,000 – $75,000 (later rumoured to be $1 million). In 1902, Lorenz traveled to Chicago and treated the girl by manipulating her hip and putting her in a plaster cast.

In addition to Lolita, Lorenz treated many other patients while in the USA. It was estimated that he performed almost 150 operations and his assistant, Dr. Müller, more than 25. Lorenz demonstrated his operation on poor children free of charge, but he also had enough paying patients.

It was the first time a European doctor had been called to Chicago and the trip was associated with tremendous publicity; with more than a thousand newspaper articles appearing about his beneficial work. Lorenz was promoted as one of the most distinguished surgeons of the world and was subsequently invited to meet with President Theodore Roosevelt and other dignitaries of that time.

Lorenz returned to Chicago to remove the plaster cast from Lolita’s hip. He was reported in the media as having said,

I found the skin in healthy condition and the bone in correct position. She can walk with only a slight limp, although the parts affected are still weak from long disease. As she gains strength she will have better control of her leg”.

It was agreed with the family that Lolita should come to Vienna to train her muscles to improve her surgical results. Mrs Armour said, “He thought the trip might be necessary to teach her the art of walking and to give her limb perfect mobility.” Lolita, her mother, and entourage stayed in Vienna all summer to receive intensive exercise [physiotherapy], personally supervised by Lorenz. Lorenz said,

She has made capital progress since the operation. The case is thoroughly satisfactory. After a short course of massage and manipulation of the injured joint the girl would be able to walk perfectly”.

Lorenz generously shared his knowledge with physicians and non-physicians alike. We know of at least one Australian proto-physiotherapist who visited Vienna to learn from Lorenz around the time of Lolita’s attendance. In an interview with an Adelaide newspaper, medical gymnast and masseuse Josephine McCormick said,

Perhaps, the foremost surgeon of modern times is Dr. Lorenz. I was specially fortunate in having a good introduction to him, for he allowed me to be present at all the best clinics, and gave me entree to his medical gymnasium, where all kinds of deformity cases are treated. Dr. Lorenz is specially famous through his operations of bloodless surgery in cases of congenital hip disease, but his treatment of club foot, wry neck, and other deformities is no less remarkable. When I return to Melbourne I hope to benefit many sufferers by applying this most remarkable treatment, which, with Dr. Lorenz’s untiring help, I have studied thoroughly. So much of the work is in the after-treatment; that is to say, the operation of bloodless surgery is incomplete without the massage, movements, etc., that follow, and these are just as important factors in the success of the case as the surgical operation itself”.

The treatment of Lolita by Lorenz was completed in autumn 1904. There is no final statement from Lorenz himself. Lolita’s mother reported on the treatment success to the newspapers after returning from Europe. She said,

I am glad to say that Lolita has greatly improved. She can now walk and run about like other children. Dr. Lorenz’ s treatment has done wonders for her. She has been seven months under his constant care. She walks with a slight limp, but this will pass away in a few years. Lolita can walk miles at a time, and, in fact, part of her treatment in Vienna was to walk five miles a day.”

Lolita’s parents’ optimism about the outcome of the operation by Lorenz was not shared by the medical community in the US. They believed that Lolita benefited more from the systematic exercises [physiotherapy] for the muscles. Whilst the parents subjectively saw an almost perfect result the experts did not agree. Dr John Ridlon, who collaborated with Lorenz while he was in Chicago, concluded on the basis of 29 cases done by Lorenz and 65 of his own, that in only 10 – 20% of the patients was an anatomical reduction obtained. However, all agreed that as a result of Lorenz’s visits in 1902 and 1903 that much needed attention had been brought to orthopaedic problems among children in America.

Lorenz invested the large sums of money he earned during and after the trip, among other things, on his palatial villa in Altenberg. He was also one of the first motorcycle and car owners in Austria. Lorenz remained a benefactor for the poorest and after the First World War; he established a fund for needy children and students. Unfortunately he lost his entire fortune after 1918, making it necessary for him to continue working into his 70s, operating in New York with his son Albert who was also an orthopaedic surgeon.

Lorenz was nominated for the Nobel Prize eight times between 1904 and 1933, but was ultimately unsuccessful. His second son, Konrad, did win the Nobel Prize in 1973 for his work in ethology.

References

Bensusan, I. (1904). The future of the figure: A chat with Miss Josephine MacCormick, of Melbourne. The Critic, Adelaide, South Australia, 24 February. Accessed online at https://trove.nla.gov.au/newspaper/article/211402842?searchTerm=josephine%20mccormick

Holzer G & Holzer LA. (2020). Adolf Lorenz and the Lolita Armour case. International Orthopaedics, 44, 1869-1874.

Jackson RW & Pollo WJ. (2004). The legacy of Profession Adolf Lorenz, the “bloodless surgeon of Vienna”. Baylor University Medical Center Proceedings, 17, 1, 3-7.

Lorenz, A. (1936). A great surgeon speaks. Heal Thyself (The Homoeopathic World), LXXI (850). Accessed online at https://homeopathybooks.in/heal-thyself-the-homoeopathic-world-1936-oct-vol-lxxi-no-850/a-great-surgeon-speaks/2/

Matela, M. (2023). Dr. Adolf Lorenz a Vidnava. Dětství, vzpomínky a návraty. Časopis Slezského Zemského Muzea, Série B, 72, 130-149. Accessed online at https://cszmb.cz/wp-content/uploads/CSZMB_3_2023_3.pdf. Translated by Google Translate.

Peltier, LE. (1993). Orthopaedics: A history and iconography. Norman Publishing: San Francisco. Accessed online at https://storage.googleapis.com/global-help-publications/books/help_orthopedicshistoryiconography.pdf

Taschwer K. (2017). Adolf Lorenz: Der fast vergessene Pionier der “trockenen” Chirurgie. Der Standard. Accessed online at https://www.derstandard.at/story/2000055053908/adolf-lorenz-der-fast-vergessene-pionier-der-trockenen-chirurgie. Translated by Google Translate