In 1881, British surgeon Arbuthnot Lane (1856-1943) advocated a surgical technique for the treatment of fractures: osteosynthesis. It consists of fixing plates on the bone with screws to immobilize it while waiting for the bone to recover.
French neurologist Guillaume-Benjamin Duchenne (1806-1875) is considered the father of electrotherapy.
He used this technique in the Paris 'l'Hôpital de la Salpêtrière' where local electrification was applied on muscles or nerves via galvanic current. The method also helped in the determination of the function of every muscle of the human body and in the diagnosis of certain diseases and the localization of their origin.
French Professor of Neurology Jean-Martin Charcot (1825-1893) installed a complete cabinet of electrodiagnostics and electrotherapy at the 'l'Hôpital de la Salpêtrière' in Paris, of which he entrusted the management to Doctor Romain Vigouroux (1831-1911).
The patients were treated with water baths, static electricity, galvanic and induction currents.
The 'Lehrbuch der Physikalischen Heilmethoden' (textbook of physical healing methods) by German Michael Joseph Rossbach (1842-1894), professor of Medicine at the Universität Würzburg, appeared in 1881. It was one of the very first textbooks in the field of 'physical therapy'. In his foreword he indicated that the so-called 'physikalische Heilmethoden und-mittel' (physical healing methods and remedies) for the prevention and cure of diseases had increasingly become prominent in Medicine during the last decades. Rossbach expressed his concern about the unbridled growth and the increasing specialization within these areas. The so-called electro-, hydro- and pneumotherapists and owners of facilities for gymnastics, orthopedics and massage created the danger of developing a one-sided view of Medicine. This would prevent a critical investigation into the operation of these methods and that research was of paramount importance to Rossbach.
French physician Fernand Lagrange (1845-1909) emphasized the great value of physical exercises and stated:
"The application of physical exercises is not sufficiently guided by physiological notions."
In this way he actually started with a primary form of 'Sports Medicine'. He was convinced that physical development begins with the development of the lungs and that a breathing test is the best way to determine the value of an exercise. As an expert of the ministry, he traveled to Sweden, Germany, Switzerland and Austria to study different methods.
Some of his most important works:
German chemist Wilbur Olin Atwater (1844-1907) was best known for his research on human nutrition and metabolism. He emigrated to the United States and studied respiration and metabolism in both animals and humans, and he developed the respiration calorimeter. Despite that the use of the device costed more than ten thousand USD per year, it was considered a dream project of the nineteenth century. The calorimeter was a big help in the study of nutritional analysis, food intake, dietary evolution and energy consumption during exercise. One could measure the human metabolic balance by analyzing the heat production, but also the metabolic range in people who exercised a certain physical activity. With this device the metabolism of the movement theory could be quantified and the balance between the energy output and the food intake could be measured. The results of the Atwater calorimeter influenced several domains of the American lifestyle. Most importantly, the calorimeter had an immense influence on the growing awareness of the nutrition calory as a unit of measurement for both consumption and metabolism. Atwater described the importance of calorie as a means to determine the efficiency of a diet. He stated that different types of food produce different amounts of energy. He stressed the importance of a cheap and efficient diet that contains more proteins and vegetables instead of carbohydrates. Atwater also studied the effect of alcohol on the body and found that people produce heat from alcohol, as they also generate heat from carbohydrates. After finishing his research, Atwater concluded that the Americans consumed far too much fat and sweets and practiced too little. In 1882 he returned to Germany, where he studied the metabolism of mammals in the lab of Carl von Voit (1834-1908).
His successor Francis Gano Benedict (1870-1957) continued the path that Atwater had outlined and he used the respiration calorimeter for further research on metabolism and other body processes. Benedict studied the varying metabolism rates of children, athletes, students, vegetarians, Maya Indians and normal adults. He even developed a calorimeter that was large enough to accommodate twelve girls for a long time. His greatest improvement was the invention of portable respiration calorimeters.
The cyclo-ergometer that Atwater and Benedict used during their metabolic studies.
The inside of the human calorimeter of Atwater and Benedict.
Medicine evolved at lightning speed and the devices became increasingly sophisticated, the image above is a spirometer that recorded not only the exhaled air, but also the chest movements and the elapsed time.
After a visit to Istanbul, French painter Edouard Debat-Ponsan (1847-1913) painted 'Scene de Hamam', a massage performed by a slave.
Professor Ernst von Bergmann (1836-1907), from the surgical Universitätsklinik Berlin, got the Russian army doctor Isidor Zabludowski (1850-1906) from St. Petersburg to his clinic to start a massage department. In 1896 the Russian was appointed Professor Massage and in 1900 he opened the first massageschool. Zabludowski approached the massage in a scientific way, he described, among other things, the so-called 'cramp points', which are now called 'trigger points', he took into account the reflective influence of distant organs, he involved the lymphatic system in the therapy and he treated the whole extremity instead of the affected area; Every year, 20,000 ambulatory treatments were carried out in the 230 beds of the clinic.
Carl Speck (1828-1916), a medical doctor from Dillenburg, developed the first ergometer in Germany. The device was used to measure the exact dosage and accurate reproducibility of body activity. It was a sling ergometer with standing exercise. By hanging weights on the handle he could determine a corresponding resistance. By adjusting the screw the labor could be adjusted. The exhaled air was collected in a spirometer and the composition was examined at the end of the load. Through this development and the resulting publications, Speck is considered one of the founders of modern sports physiology.
To study the oxygen consumption and heat production in smaller animals, German physiologist Max Rubner (1854-1932), a pupil of Carl von Voit (1834-1908), made further developments on the combined direct and indirect calorimetry system of Henri Regnault (1810 -1878) and Charles Richet (1850-1935). Later he made adjustments to the device of Carl von Voit (1801-1870) and became the first scientist to study the energy needs of small children and premature babies. Rubner determined the energy equivalence in foodstuffs: 100 g of fat was the equivalent of 211 g of proteins, 232 g of starch, 234 g of cane sugar and 256 g of glucose. This observation resulted in the formulation of the laws of energy consumption in food. The Rubner factors for proteins, fats and carbohydrates were 4.1, 9.3 and 4.1. In 1883 his work was first published. With his combined direct and indirect calorimeter he provided the definitive evidence on the equivalence of carbon oxidation and heat production, the two methods had an average variation of barely 0.2%.
The combined direct and indirect calorimeter from Rubner. Water circulated through the double wall of the calorimeter and spread through the device on the left that measured the temperature of melting ice. Simultaneous assessments of the gas volume within the system were obtained via the registration devices placed above the calorimeter. This experiment was used for long-term studies in small animals and provided the purest evidence of the heat equivalence of carbon in fats, proteins and carbohydrates.
The device developed by French physiologists Felix Jolyet (1841-1922) and Paul Regnard (1850-1927) for the study of respiratory products.
In 1883, French physician Leon Petit (1854-1910), a pupil of Georges Dujardin-Beaumetz (1833-1895), translated a pamphlet from Viennese army doctor Albert Reibmayr (1848-1914) from German to French.
In his 'Le Massage par le Médecin' (the massage by the physician) the curative aspect of massage in different branches of Medicine was strongly emphasized and the author expressed the wish to remain "a doctor while exercising massage". He was appointed head of the Children's Sanatorium of Ormessin near Paris. In 1885 he published the second edition of his book, which was decorated with many illustrations and in which French Professor of Physiology Paul Regnier (1851-1919) wrote the foreword.
In his book 'La Chirurgie Orthopédique', French surgeon Louis-Alexandre Saint Germain (1835-1897) described the impressions that had been experienced during a massage in a bathhouse in Paris.
The underwater massage as used in more and more French hospitals.
German physiologist Nathan Zuntz (1847-1920), a pupil of Eduard Friedrich Wilhelm Pflüger (1829-1910) and Professor at the Berlin 'Landwirtschaftliche Hochschule', did physiological research on metabolism, respiration and nutrition. But he is best known for his extensive studies on the physiological changes in animals and humans in extreme conditions and especially at high altitudes. Many experiments took place in Capanna Regina Margherita, a research center at the top of the Italian Monte Rosa. With his assistant Hermann von Schrötter (1870-1928) he also did balloon expeditions at great heights. In 1911 he opened the first German laboratory for sports medicine.
Together with his German colleague August Julius Geppert (1856-1937) he developed in 1885 the 'Zuntz-Geppert respiratory apparatus', a portable device for dry gas measurements during field studies.
In 1889 he constructed a first treadmill and in 1914 he added an X-ray device for observing cardiac changes during exercise.
In 1910, together with his colleagues physiologists Hermann von Schrötter (1870-1928), Arnold Durig (1872-1961) and Joseph Barcroft (1872-1947), Zuntz made a scientific balloon expedition to Mount Pico de Teide in the Canary Islands, and therefore he is also mentioned as the pioneer of aviation medicine.
Because breathing plays an important role in all metabolic tests, Nathan Zuntz (1847-1920) and August Julius Geppert(1856-1937) found it important to investigate the still dark mechanisms of a regulated respiration. There were two theories in this respect, the first one supposed to be a direct stimulation of the nerves of the respiratory center, the other assumed that the accumulation of metabolites in the blood was the stimulus for increased respiratory activity during physical exertion. In the course of their research, the two scientists developed their famous Zuntz-Geppert breathing apparatus and formalized the equation to determine the oxygen consumption during rest and movement only by expiratory or inspiratory volume measurements, so that the metabolism could be accurately determined. This established the relationship between ventilation and O2 intake as a basis for understanding pulmonary gas exchange and regulating blood-gas and acid-base status. After finishing their tests, Zuntz and Geppert came to the conclusion that during an exercise, breathing is not controlled by the nervous system, but is caused by unknown blood-absorbing substances of the contracting muscles, which in turn stimulated the respiratory center. The neurophysiological aspects of this research interested a certain Sigmund Freud (1856-1939) when he visited the laboratories of Nathan Zuntz (1847-1920) and Hermann Munk (1839-1912) in March 1886.
The physical education movement led to the formation of the 'American Association for the Advancement of Physical Education', a professional group founded, dominated and chaired by physicians who had faculty positions at major universities such as Johns Hopkins, Yale and Harvard. Eleven doctors were among the twelve first presidents. Afterwards in 1897, twelve of the sixteen members of the 'Society of College Gymnasium Directors' were physicians, in 1900 the editor of the 'American Physical Education Review' was a doctor and in 1903 the entire executive committee of the 'American Society for Research in Physical Education' consisted of physicians. The following year, fifteen of the twenty members of the 'National Council of the American Physical Education Association' were physicians, including the chairman and vice president. Most of the physicians who learned physical education did anthropometric measurements, wrote exercises, gave lectures about health and supervised the new gyms built on college campuses that the Chief Inspector of Public Education in Massachusetts called 'Palaces of Health'. In 1903, the 'American Association for the Advancement of Physical Education' was changed to the 'American Physical Education Association'. And in 1917 it created one of the most influential groups, the 'Committee on Women's Athletics'. The APEA joined forces with the 'Department of School Health and Physical Education of the National Education Association' in 1937 and in 1938 the 'Division of Recreation' was formed.