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THE FOUNDATIONS OF
MODERN ORTHOPAEDICS. It was not until the l2th century that Europe began to gradually awake from its Dark Ages. Universities and hospitals were beginning to be established, human dissection resumed and the great Greek texts were being translated from Arabic to Latin. However, until the l6th century, all developments remained within the shadow cast by Hippocrates. AMBROISE PARE (1510-1590)
NICHOLAS ANDRY (1658-1759)
Heberden was born in London were he also built up a busy practice. He is known for initiating the Medical Transactions in 1766, but even more so for his description of Heberden's nodes.
Much of Hunter's knowledge may be attributed to his military experience and his experiments on animals. He described how to assess muscle power in a weak muscle. With joint injury and disease, he states that voluntary movement should not be permitted until inflammation has settled, otherwise contracture is promoted. He believed that healing depended on the body's innate power, and that the surgeon's task was to aid this. Hunter believed that bone disease and and often required mechanical assistance. He studied loose bodies in joints, pseudoarthroses and fracture healing, where he described the transformation from fracture haematoma to fibrocartilagenous callus to the deposition of new bone, trabeculation, reestablishment of the medullary canal and the resorption of excess bony tissue. Hunter wrote "A Treatise on the Blood, Inflammation and Gunshot Wounds" in 1794, and also made attempts at tissue grafting. His collection of specimens (initially over 14,000 POT's; half destroyed in the bombing of London) is in the College of Surgeons, London. They describe the development of the various systems from the simplest (insects) to the most complex. It is a humbling and inspiring experience to visit the museum and see one mans monumental contribution to surgery. Jean-Andre Venel was a Genevese physician who studied dissection at Montpellier at the age of 39, and in 1780, established the first orthopaedic institute in the world at Orbe, in Canton Waadt. This was the first true hospital that dealt specifically with the treatment for crippled children's skeletal deformities. Venel recorded and published all his methods and for this was known as the first true orthopaedist. He is also regarded as the father of orthopaedics, as his institute acted as a model for hospitals throughout Europe. Venel stressed the importance of sunlight and made various braces and appliances at the workshops within the institute.
GIOVANNI BATTISTA MONTEGGIA (1762-1815) Monteggia was born at Lake Maggiore and was a Milanese pathologist who acquired syphilis by cutting himself at autopsy and became a surgeon and professor at Milan. He is particularly remembered for his description in 1814 of the fracture that bears his name, Monteggia's fracture.
BARON GUILLAUME DUPUYTREN (1777-1835)
SIR BENJAMIN BRODIE (1786-1862) Brodie was a national figure. He was a surgeon at St. George's Hospital and a friend of the Thomas family (that of Hugh Owen Thomas). He first published his book, "On the Diseases of Joints" in 1819, which proved to be a popular reference for many years. In 1832, he described the chronic bone abscess that has been named after him. The patient was a man of 24 who had recurring symptoms in the lower extremity of his right tibia. On examination, Brodie found a pus filled cavity, for which he believed that amputation could be avoided by trephination of that cavity. He recognised the association of arthritis with gonorrhoea and that all children's hip disorders were associated with infection. IN 1843, he introduced the Fellowship examination of the Royal College of Surgeons in order to improve the education and standing of surgeons.
ROBERT WILLIAM SMITH (1807-1873)
To this day, a POP cast is the mainstay of fracture immobilisation. WILLIAM JOHN LITTLE (1810-1894)
Lister studied at the University College Hospital in London, although he did his famous work in Scotland, first at Glasgow (where he first instituted antiseptic surgery), and then as Prof of Surgery at Edinburgh (where he was at the Royal Infirmary). In 1853, he became Syme's house surgeon at the Royal Infirmary. He there married Syme's daughter. In 1854 became assistant surgeon to the Royal Infirmary, and in later life came to London as Prof of Surgery at Kings College Hospital. Lister is known for the introduction of antisepsis. He first applied carbolic acid to a compound fracture in 1965. It was soon clear that the practices had had a dramatic effect in reducing in particular abscesses, pyaemia, hospital gangrene, erysipelas and amputation mortality. Lister was made a baronet in 1883, and later in his life was thought to have trialed the application of the Penicillium mould directly to wounds. JEAN-MARTIN CHARCOT (1825-1893) Charcot was from Salpetriere in Paris and is known worldwide as the first professor of Neurology. He wrote a thesis distinguishing gout, rheumatoid arthritis and osteoarthritis. Charcot also first described the arthropathy that bears his name. Charcot's joints. He was first to write about amyotrophic lateral sclerosis, intermittent claudication, disseminated sclerosis, intermittent hepatic fever and herpes zoster.
SIR WILLIAM MACEWEN (1848-1924) Macewen studied in Glasgow and had Syme and Lister as teachers. The new era of antisepsis enabled him to make many contributions to Surgery. In terms of his Orthopaedic contributions, he performed many osteotomies and developed a one-piece osteotome. Macewen's main research interest was in bone growth and in 1879 he performed the first of his pioneering bone grafts. Many of his grafts were performed on people who had had portions of their bones excised, but who had otherwise normal function. Macewen was also a pioneering neurosurgeon and cardiothoracic surgeon. He worked on cerebral tumours and abscesses and also performed the first pneumonectomy. RICHARD VON VOLKMANN (1830-1889)
Bennett studied at Trinity College, Dublin. He collected specimens of bone pathology and with these wrote a paper on fractures of the metacarpal bones in 1882. In this paper Bennett described his eponymous fracture dislocation of the base of the thumb metacarpal. Bennett is said to have introduced antisepsis to Dublin and to have performed many osteotomies for rickets. He became President of the Royal College of Surgeons of Ireland.
If you could only read about one person in the history of Orthopaedics, then you would have to read about Hugh Owen Thomas, "the father of British Orthopaedics". Hugh Owen Thomas was the eldest of five sons born to a well-known bonesetter at that time. All studied Medicine.Thomas was a thin and nervous child who was somewhat delicate. His peculiar temperament in adulthood led many to ignore him and his immense contributions to Orthopaedic Surgery during his lifetime. Hugh Owen Thomas could not even work with his father and never held a hospital appointment. He treated all his patients at his home. His practice was so busy that he started his rounds at five or six in the morning and never left his home for other than professional purposes. Thomas would designate Sunday as his "free day" and hundreds of patients from the country would surround his house in order to be treated.
It should be remembered that Hugh Owen Thomas had studied Medicine and was interested in litholopaxy and the management of acute abdomen as well as Orthopaedics. It has been said that the medical profession might not have practiced the "black art" of bone setting, if Hugh Owen Thomas had not graduated from a Medical school. SIR WILLIAM ARBUTHNOT LANE (1856-1938) Lane was a Scot from Inverness who trained and later worked at Guy's Hospital in London. Lane is known for his attempts at improving alignment of fractures by using internal fixation. He started off using silver wire, then he used steel screws and this was followed by the use of plates and screws. Lane was said to have been eccentric, regarding humans as machines and performed total colectomies as a cure for "auto-intoxication". He also initiated the programmes of health education that a e present today. Lane wrote columns in the newspapers, held public lectures and improved the distribution of fruit and vegetables. De Quervain was born at Sion in the Valais Canton of Switzerland. He studied at Berne and succeeded Kocher as Professor of Surgery there. In 1895, de Quervain described a form of chronic tenovaginitis, which is now known as de Quervain's stenosing tenovaginitis. Like Kocher, he studied thyroid disease and is responsible for the introduction of iodised table salt. FRIEDRICH TRENDELENBURG (1844-1924)
LOUIS XAVIER EDOUARD LEOPOLD OLLIER (1830-1900)
WILHELM CONRAD RONTGEN (1845-1923)
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Ambroise Pare is regarded as the most
famous surgical figure of the l6th century and "the
father of French Surgery". He was born in Bourg
Herent in France. In 1532 he became an apprentice to a
Parisian barber-surgeon, then worked for four years at
Hotel Dieu in Paris. In 1541, he became a master
barber-surgeon and did some work as an army surgeon. In
1564, he published a monumental work on Surgery, the
"Dix Livres de la Chirurgie". The first part
contained Anatomy and Physiology and the second, Surgery.
In this, many surgical techniques were described, one of
the most significant being the use of ligature for large
vessels in amputations. He also used a tourniquet in his
amputations, to hold the muscles retracted with the skin,
prohibit the flux of blood and to dull the senses. He
designed a wide variety of forceps, instruments and
braces of all kinds. With the help of armourers, he made
a variety of artificial limbs from iron. The majority
were cosmetic, although Pare did design a scoliosis
corset and a clubfoot boot.
Andry was the professor of Medicine at
the University of Paris and Dean of the faculty of
Physick. In 1741, at the age of 81, he published a famous
book called "Orthopaedia: or the Art of Correcting
and Preventing Deformities in Children. 
By
such means that may easily be put into Correcting and
Preventing Deformities in Children. By such means that
may easily be put into practice by parents themselves and
all such as are employed in Educating Children". In
this book, Andry presents the work Orthopaedic, which
derives from the Greek words "straight" and
"child". Andry was interested in postural
defects and this has been reflected by his famous
illustration, which is known "The tree of
Andry". Andry believed that skeletal deformities
were due to faults of posture and shortness of muscles.
Some regard Andry as the Father of Orthopaedics, by many
strongly disagree, believing that his work was
un-scientific and that his only contribution was the use
of the word Orthopaedics. 
Sydneham is likened to Hippocrates
because his writings cover a large field and are
characterised by good observation. Likewise, he is also
known as "the father of English medicine". He
was born at Winford Eagle, and studied at Oxford and
Montpellier. He himself suffered from gout and wrote an
excellent description of the disease, detailing the
attack, the changes in urine and the link with renal
stones. He described acute rheumatism, chorea, and the
articular manifestations of scurvy and dysentery.
Pott was from London and worked in St.
Bartholomew's Hospital, were he received the diploma of
the Barber-Surgeons' Company in 1763. He is best known
for the fracture that bears his name "Pott's
fracture", as he gave a good description of this
ankle fracture. In 1756, he received a fracture of his
own. It was an oblique compound fracture of the lower
third of the tibia, which was acquired after falling from
his horse. He refused to be moved until he had purchased
a door to be carried on, as he believed that the jolting
of a carriage would have exacerbated the injury.
Immediate amputation was usually conducted on such
injuries, but at the last moment amputation was stopped
and the limb was saved. Pott's most famous work is on the
paraplegia of spinal tuberculosis, where he stressed that
the condition was not related to spinal cord compression,
but associated with "strumous disorders" in the
lungs. This is known as Pott's paraplegia.
Hunter worked on a Lowland
farm until he was 20 years of age. Until he was 32, he
was a pupil and house surgeon at St. George's Hospital in
London and also worked in his brother's dissecting room
in Covent Garden. In the Seven Years' War, he served as a
military surgeon. He set up a research centre in London's
Golden Square and taught and lectured at Leicester Square
until angina eventually lead to his death. Hunter's
contribution was immense and even stemmed through the
pupils he taught (e.g. Abernethy, Chessher, Jenner and
Philip Syng Physick). Hunter himself was a pupil of
Percival Pott. Although he received little formal
education (unlike his brother William, an obstetrician in
London) Hunter put the practice of surgery on a
scientific foundation and laid the framework for the
twentieth century developments. His saying "Don't
Think, try the experiment" has inspired generations
of modern surgeons.
William Hey was born in Pudsey near
Leeds. At the age of 14 he was apprenticed to a surgeon
and apothecary and nearly died of an overdose of opium
whilst studying its effects. He was the founder of
Surgery at Leeds and trained at St. George's Hospital.
Hey wrote a book on Surgery which contained several
chapters on Orthopaedics. Subacute Osteomyelitis of the
tibia was described and he advocated deroofing of the
lesion. In 1773, Hey banged his knee getting out of the
bath, and many attribute his subsequent interest in the
knee to this. He coned the phrase "internal
derangement of the knee", and described meniscal
injuries. Hey described loose bodies and introduced
tarso-metatarsal amputation.
Colles was born in Kilkenny, Ireland,
of humble origins. Nevertheless, he became professor of
Surgery at the College of Surgeons in Dublin from the age
of 29. He was the first to tie the subclavian artery, but
is best known for his description of Colles' fracture, in
1814 (the same year as Monteggia).
Dupuytren was born in central France.
He was kidnapped as a boy by a rich woman from Toulouse
on account of his good looks. He was taken to Paris and
educated, but endured great poverty throughout his
studies. Dupuytren became Surgeon in chief at the Hotel
Dieu and worked tremendously hard and became very rich.
He was described as an unpleasant person to met, yet his
work was delightful to read. He was characterised as
"First among surgeons, Last among men". He was
an accurate clinical observer with a great interest in
pathology. Dupuytren's name is most associated with the
contracture of palmar fascia and a particular ankle
fracture that he described. He wrote on many subjects,
including congenital dislocation of the hip, the nature
of callus formation, subungal exostosis, the
Trendelenburg sign, tenotomy in torticollis and he
differentiated osteosarcoma from "spina
ventosa".
Syme was born in Edinburgh. As a
student at Edinburgh University he found a way of
dissolving rubber. Syme opened a school of Anatomy and
later opened a very successful private clinic. In 1833,
he became Professor of Surgery in Edinburg and held that
position until his death, (he had actually made an
agreement with his predecessor to pay him a pension if he
resigned). Syme is known for introducing conservative
alternatives to the major amputations that were carried
out at the time. In 1831, he released a booklet, which
detailed cases where joint excision could be used instead
of amputation for grossly diseased joint, as in
tuberculosis, and injured joints. In 1842, Syme described
an amputation at the ankle. This amputation bears his
name, as it replaced a portion of below knee amputations,
which were ordinary practice at that time.
Barton was born in Lancaster,
Pennsylvania, U.S.A. He studied at the Pennsylvania
Hospital and later worked for Physick (the father of
American Surgery) who in turn was a student of
Hunter's.It was said that Barton was ambidextrous and
that once he had positioned himself for an operation, he
did not move about. In 1826, he performed a
subtrochanteric osteotomy of the femur for a severe
flexion-adduction deformity of the hip. Barton is best
known for his innovative corrective osteotomies for
ankylosed joints. In 1834, Barton wired a fractured
patella and in 1835, he described "Barton's
fracture".
Smith was born in Dublin, he studied
and worked there. He became Professor of Surgery at
Trinity College in Dublin. Smith founded the Dublin
Pathological Society with Colles, Graves, Corrigan and
Stokes. In 1847, Smith wrote a classic book called
"A Treatise on Fractures in the Vicinity of Joints,
and on certain forms of Accidents and Congenital
Dislocations." Here he describes the eponymous
"Smith's fracture", and Madelung's deformity
before Madelung described it. In 1849, he published
"A Treatise on the Pathology, Diagnosis and
Treatment of Neuroma". This book was said to be so
large that it was larger than an ordinary sized
dinning-room table when opened up. Smith wrote on
neurofibromatosis in great detail, much before von
Recklinghausen did.
Mathysen was a Dutch military surgeon
who in 1851, invented the plaster of Paris (POP) bandage
which was to become so important to orthopaedic practice.
Little was educated at the Jesuit
seminary at St. Omer. He himself had a paralytic
clubfoot. The treatment in London was amputation,
however, he found a cure in Germany by tenotomy. Little
was a founder of the Royal Orthopaedic Hospital. He
published a detail report, in 1862, of the then
ill-understood group of deformed and partly retarded
children and young adults. This type of spastic paralysis
with paraplegia of the lower limbs was then called
Little's disease for many years.
Kocher was born in Berne and studied
in Berlin, London, Paris and Vienna. In 1872, he became
Professor of Surgery in Berne. Kocher had a great
interest in Anatomy and in 1870, he described his
eponymous method of reducing a dislocated shoulder.
Kocher wrote a remarkable book in which he detailed many
useful surgical incisions that he had developed, such as
his posterolateral exposure of the hip. He also developed
several surgical instruments, but his main interest was
in thyroid disease.
Paget was a graduate of St.
Bartholomew's Hospital in London, where he remained for
the rest of his career. It was in 1877 that Paget gave
the first description of what he called "osteitis
deformans", but what is now commonly called Paget's
disease. He noted the increased incidence of
osteosarcoma, the increasing head size and deformities.
(One of Paget's original drawings is shown.) Paget was
also a remarkable lecturer with a great interest in bone
pathology. His name is also associated with other
pathological processes.
Volkmann was from Halle, Saxony. He
was the first in Germany to institute Lister's antiseptic
methods. In 1881, Volkmann published his famous paper on
ischaemic muscular paralyses and contractures. Here he
attributed the cause of the contractures to direct
changes in the muscles produced by arterial occlusion and
emphasised the early warning of preliminary weakness.
These contractures are otherwise know as Volkmann's
ischaemic contractures. IT is interesting to note that
Volkmann wrote popular poems and fairy stories and also
founded a surgical journal.
Albert was born in Bohemia and studied
in Vienna. He is best known for producing
"artificial ankyloses" in paralysed limbs and
wrote a paper on this in 1881. Albert performed tarsal
and shoulder arthrodesis for paralysis and recurrent
dislocation, and was the first to use the term
"arthrodesis". Albert also described
synovectomy, the transplantation of nerves, sciatic
scoliosis and Achilles Bursitis.
The people of Liverpool knew Thomas as
a short and quick man. A man who always wore a black coat
buttoned up to the neck and a sailors cap pulled over a
damaged eye. A cigarette was also seen constantly in his
mouth. Despite Thomas's busy schedule, Thomas wrote
prolifically in the night and developed many new
techniques and surgical instruments. He believed in
enforced, prolonged and uninterrupted rest for the
treatment of tuberculous joints. Thomas developed a great
number of splints in order to achieve this. These
include, the cervical collar, metatarsal bar, heel wedge
and knee splint. Many of these are still in use, such as
the Thomas splint. Thomas was also able to recognise
early cases of hip disease. He was the first to
demonstrate concealed flexion of the hip joint and a way
of unmasking this by performing the "Thomas
Test".
Trendelenburg was born in Berlin. He
studied Medicine in Glasgow and in Berlin.
Trendelenburg's name is associated with the trendelenburg
sign and the Trendelenburg gait, which he described in
association with coxo-femoral incompetence in 1895.
Trendelenburg also devised pulmonary embolectomy, but it
was one of his pupils, Kirshner who first met success
with the procedure many years later in 1924.
Marie was born in Paris, he worked for
Charcot and eventually succeeded him as Professor of
Neurology at Salpetriere. Marie described peroneal
muscular trophy (Charot-Marie-Tooth disease). He was the
first to associate acromegaly with a pituitary tumour in
1886. IN 1980, he described hypertrophic pulmonary
osteoarthropathy. In 1898, he gave the first account of
cranio-cleidal dystosis and noted the partial aplasia of
the clavicles, the increased skull diameter, the
disordered dentition and the failure of ossification at
the fontanelles. Also in 1898, he published a classic
paper on ankylosing spondylitis, which he refereed to as
"spondylosis rhizomelique". Marie believed that
poliomyelitis was infectious.
Ollier was born in Vans in Ardeche and
studied at Lyons and ontpellier. Ollier, lie Macewen,
performed pioneering bone grafts. Although both were
successful, their methods and the theory behind them were
in fierce opposition. IN 1877, Ollier suggested that bone
growth may be inhibited in order to correct certain
deformities by resecting the epiphyeal plate. In 1899,
Ollier first described dyschondroplasia or "Ollier's
Disease". Ollier researched bone growth to an
enormous extent and believed that it might be possible
one day to treat patients by stimulating their cartilage
to ossify.
Although Rontgen was a professor of
Physics at Wurzburg, his discovery of X-rays (Rontgen
rays) and their use has provided an enormous contribution
to Orthopaedics and is still of great value to
Orthopaedic practice. The first radiography that Rontgen
took was of his wife's hand on the 22nd of December 1895.
This was allegedly her Christmas present. Rontgen
received the Nobel Prize for his discovery in 1901.