04 Dec 2013 UK Disability History Month Blogs 2013: Hip Dysplasia and Congenital Hip Dislocation in the Eighteenth and Nineteenth Century - Gemma Almond
As a third year student at Swansea University the opportunity to study disability history, or in my eyes ‘finding a voice’, for my dissertation was one that was too good to miss. Whilst my ten thousand word final piece of work to be submitted next year does not offer much scope for self-discovery, delving into the past of people who perhaps experienced the same circumstances I and many others face today comes very close. At the same time I was exploring perceptions of nineteenth century females with a ‘physical disability’ or ‘impairment’ I came across a document titled Lectures on Orthopaedic Surgery by Bernard E. Brodhurst. To the majority of scholars or historians this would appear to be a very normal document but to me who has a condition called hip dysplasia, reading Lecture XVI on congenital hip dislocations was a surprising experience. The level of detail was unexpected and Brodhurst had clearly dealt with a number of patients to draw his findings and for this reason I found myself going off on a research tangent.
[Bernard Brodhurst. Image source: Wellcome Library, London]
I perhaps should not have been so sceptical of nineteenth-century research into hip dislocation but I was always under the impression that it was a condition which would not have had a specific diagnosis until the advent of x-ray. Bernard Brodhurst mentions three types of dislocation but for the purpose of this blog I will focus primarily on what he terms ‘upwards and outwards’ because this is my own type of hip dysplasia. The article alludes to the higher frequency in females to males, which has been confirmed by modern statistics, but is less conclusive on causes where similar debate also remains today. Brodhurst proposes three possible reasons: hereditary, inflammation of synovial fluid and sudden or violent traction at birth. However, away from this text there likewise existed a great body of medical literature cautioning social practices that were intended to improve the body’s ‘shape’ as a possible cause for disability or deformity.
The eighteenth century saw motherhood draw a new kind of cultural attention and a boom in medical texts which set out to advise the newly celebrated mother on dress, diet, and care for their children. One source of controversy, which has recently received renewed media attention, was swaddling (for example, this Guardian article of October 2013). Swaddling prior to this period was advocated and certainly practiced where children spent the first few months, even up to a year, constrained. The reason for this is given by John Peachy in a General treatise of the diseases of infants and children (1697) who states ‘the Infant must be swathed up, lest it should move its hands and feet too freely, and thereby distort the bones, which are yet very flexible’ or, in other words, to ensure that their child would grow ‘straight.’ Although there had always been critics of this practice, the eighteenth century marked a growing hostility.
A most fierce resistance was met by William Cadogon whose An essay upon nursing, and the management of children, from their birth to three years of age (1750) was produced to instruct the governors of the London Foundling Hospital – an institution founded in 1739 to take care of abandoned children - and went through at least eleven editions in both French and English throughout the latter half of the eighteenth century. Cadogan argues that ‘such tender Bodies cannot bear much Pressure… especially as the Fibres of Infants are so easily distended. To which doubtless are owing the many Distortions and Deformities we meet with everywhere.’ Similarly, William Buchan in Domestic Medicine or, a Treatise on the Prevention and Cure of Diseases by Regimen and Simple Medicines, Second edition with considerable additions (1770) propounds that ‘Deformities of the body may indeed proceed from weakness or diseases; but, in general, it is the effect of improper clothing. Nine tenths, at least, of this deformity against mankind, must be imputed to this cause’. Authors of these medical texts instead suggest loose clothing that ‘is light, thin and flimsy… laying aside all those Swathes, Bandages, Stays and Contrivances…[and] enjoying the free use of their Limbs and Faculties’. The suggestion that such practices can cause ‘bending’ of the body and for particular care around the hip draws uncanny parallels to the current attention on the revived practice of swaddling and the dangers of certain baby carriers in harming a healthy hip position.
[Portrait of William Buchan, 1821. Image source: Wellcome Library, London]
In returning to the lecture the one thing that struck me most was that although Bernard Brodhurst was aware that ‘upwards and forwards’ dislocation is present at birth but ‘goes undetected,’ as many cases still do today, he does not categorise it like the other two forms of dislocation as a ‘monstrous birth.’ Why? Beneath the skin the dislocation is, to use the nineteenth-century terminology, just as ‘monstrous’ but visible observation only detects the head of the bone as ‘slightly prominent’. Disability was not an existing concept and therefore the idea of ‘congenital disability’ did not exist and in its place was a polarised dichotomy between ‘monstrous’ and ‘natural.’ The categorisation of such births was very much founded on aesthetics whereby the nineteenth-century person judged visible appearance or ‘freakish spectacle’ rather than a medicalised condition or ‘disability.’ This factor alone makes the study of disability history particularly challenging because how do you study a concept that was not present in that time without enforcing your (then non-existent) cultural preconceptions? What was disability? Or, even, what is disability today -whilst impairment is a physical fact, disability is indefinitely a much more complex social construction.
While this study has been enlightening for me, it in some ways provides only the bones and not the flesh. The ability to access the lived experiences of people who grew up or existed with the same condition as me, alongside other ‘disabilities,’ is one that is much more challenging for an historian to access and is an issue that my dissertation is hoping to address. The opportunities that can be presented through disability history are vast, and are in my case, deeply personal.
Gemma Almond is a third year undergraduate history student at Swansea University and a current Paralympic swimmer who competed at London 2012.
- Lectures on Orthopaedic Surgery by Bernard E. Brodhurst, Lecture XVI, available online from the British Medical Journal: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2325540/
Guest post for Disability and Industiral Society's UK Disability History Month Blogs 2013.