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This article describes the history of pain therapy and anesthesiology with respect to the field of surgery. The history of this part of medicine is dependent upon the development of the appropriate medication groups, which were of great importance in the field of pain therapy and anesthesiology. Specifically the development of nitrous oxide, ether, morphine and the first local anesthesiologic substances will be described and discussed. The above mentioned developments combined with the knowledge of physiology of pain and new results from psychological studies led to the modern pain therapy in recent perioperative treatment concepts. Modern pain therapy is a multimodal therapy concept with a variety of specialties working as a team to optimize an individualized therapy plan which respects the needs of every single patient under different circumstances (acute, perioperative and chronic pain).

The 12-year dictatorship of National Socialism represents a decisive event in the history of orthopedics in Germany. Treatment and care was limited to those patients whose prognosis promised their reintegration into the work force. Those orthopedic patients with mental and psychological handicaps no longer came under the care of orthopedists and were potential candidates for annihilation. Despite concerted efforts to the contrary, as can be gleaned from the lists of topics at the annual meetings, the prevailing political circumstances encumbered scientific activities. The almost total isolation from international contacts had a negative effect. Orthopedists were hindered in their work by the law on sterilization, which provided for sterilization in cases of severe physical deformity. Some orthopedists even considered the presence of hip dysplasia to be an indication. The roles played by Georg Hohmann, Hellmut Eckhardt, Lothar Kreuz, and other leading orthopedists are described in detail. It can be regarded as certain that Hohmann and Eckhardt were able to prevent dire consequences for their orthopedic patients and the profession by cautious tactics. The ethnical problems of involvement with National Socialism are thoroughly discussed.

The German Orthopedic Society was founded in 1901. The period between 1918 and 1932 was characterized by the aftermath of World War I. Up to the middle of the 2nd decade, orthopedic surgeons mainly treated soldiers and civilians affected by the war. Almost every congress dealt with amputations and artificial limbs. At the same time, orthopedic surgery became a specialty at the German universities, legitimizing it as a subject of its own. Besides the large number of victims of the First World War who had to be treated by orthopedic surgeons, there was a second group of patients, the so-called cripples. These handicapped people had not previously been treated in general. A new law established in 1920 guaranteed the government's support for treatment and education of these patients. This law was called "Krüppel-Fürsorge-Gesetz," which entailed welfare but also resocialization of the handicapped, including their return to work. The German nation recognized the economic benefit of this law and accepted the financial burden. During this period, German orthopedic surgeons developed many important surgical techniques, diagnostic tests, and technical findings for the production of orthoses and artificial limbs. Some examples of techniques are described in the article: UVirradiation for the treatment of rickets according to K. Huldschinsky, Borggreve's rotationplasty of the leg (Umkehrplastik), hallux valgus arthroplasty according to Brandes, and Bragard's sign.

The census of cripples ("Reichskrüppelzählung") in the German Reich plays a central role in the development of orthopaedic surgery. Local censuses conducted by protestant ministers had already pointed out the great number of disabled children without appropriate care. It was the achievement of Konrad Biesalski, who was an orthopaedic surgeon, and of Eduard Dietrich, a Prussian government official, that a nation-wide census for disabled people was conducted. The concerns of the Reich-health-administration, which had complained about the way the survey was to be made, were neglected. These concerns were not all unjustified. Both the planning of the census itself and the technical interpretation of the obtained numbers were full of errors. The number of cripples in need of a place in an asylum were very exaggerated. Biesalski is to be held responsible for this systematic error. For him the census was only a way to influence the public opinion and had no scientific value. The public was worried by the great numbers of cripples in need of medical care and the foundation of asylums for cripples was added to the social political agenda. Along with these asylums came the promotion of orthopaedic surgery. The law, which laid the foundation for these institutions, the "law for the welfare of the cripples in Prussia" of 1920, would have never been passed, if it had not been for Biesalski's manipulated numbers. One can say that the artificially inflated numbers of the "Reichskrüppelzählung" were a lie for a good cause.

The German historical museum of orthopaedic surgery was founded 1959 in Würzburg. The main task of this institution is the furtherance of science in medical-history. Since the beginning, 41 years ago, the number of books and exhibits increased continuously. The library of the museum is the biggest public collection in Germany and contains more then 6000 books and publications in orthopaedics. Furthermore the museum includes a big amount of exoprostheses of the upper and lower limb, alloarthroplasties of hip- and knee-joints, traumatologic implants and instruments of orthopaedic surgery. A big number of bone-preparations with pathologic alterations and variations will also be presented. The exhibition and the library is open to the public and is available to those people in the history of orthopaedic surgery. Local requirements in Würzburg were one of the reasons to transfer the place of the museum to Frankfurt/Main. The museum was reopened at 6th of June 1998 at the university of Frankfurt/Main, department of orthopaedic surgery.

The term orthopaedics was first used by a French physician named Nicolas Andry in 1742. Since then the meaning of the term has changed dramatically. Starting as the planned title of a guidebook for parents it developed to become the name of a new medical discipline. During the 19th century orthopaedic surgery was dominated by private institutions, which were a privilege of the wealthy. Orthopaedic surgery as we know it in Germany today developed mostly from the so called "cripple asylums" (Krüppelheime). Their main objective was the treatment of infections of bones and joints, scoliosis and of hereditary diseases. Many of these orthopaedic diseases lost their importance due to prophylaxis and early diagnosis. The great improvements in the living conditions led to a change regarding the age of the patients and the diseases treated. Until world war II mostly children were treated by orthopaedic surgeons. After world war II orthopaedic surgeons have adjusted to the demographic change and have increasingly been treating elder patients. The development and the spread of prostheses display the increasing importance of age related illnesses.

The article affords insight into the one hundred years' history of the Journal of Orthopedics. The existing 130 volumes reflect the change in the orthopedic spectrum of illness, diagnostic investigation and treatment. Already in its first few years of existence, the journal was a forum for international exchange. Investigation of various epochs showed that the editors applied strict scientific standards in selecting the publication, despite basis changing historical conditions. They were able to prevent political interventions appreciably influencing the character of the journal. At the same time, the negative effects which the two world wars and National Socialism had on the further development of orthopedics become evident. The extent to which, as a result of these, the development of orthopedics fell behind international development could only be overcome in the last few decades.

The appearance of Albert Hoffa's "Textbook book of orthopaedics" in 1891 saw the young special discipline enter a new phase of professionalisation in the German-speaking countries. Hoffa defined in this work the scope and methodology of orthopaedics in a sense that is still valid today. By including operative and conservative forms of treatment, he created the foundation for a continued scientific development of the subject. Only with the appearance of Hoffa's work did orthopaedics gain acceptance as a special area by many physicians. The far-reaching influence and significance of the textbook for orthopaedics is portrayed with the aid of historic sources.

Rehabilitation of physically disabled persons and resettlement of employed orthopaedic patients into social and working life are integral components of orthopaedics. Unless the patient is reintegrated, orthopaedic care remains incomplete. It is absolutely necessary to develop, already during counselling and at the outset of in-patient therapy, a detailed treatment plan that takes into account the pertaining vocational and social integration considerations. Besides outlining some general ideas, the specific experience at the Orthopaedic Clinic of Frankfort university are described.