the teacher and pupil a firm friendship, which endured until the former’s death.
Following his training in orthopedic surgery, he transferred to Birmingham, where he became associated with the Birmingham Cripples’ Union, and through his instrumentality the organizations for the treatment of the cripple in the Birmingham district were gradually joined together, and, in place of a number of scattered societies, whose work necessarily overlapped, the present Royal Cripples’ Hospital was established.
Wider recognition of the value and originality of his work came to him through his efforts during and after the Great War. He was one of that small band of British surgeons who were called on by Sir Robert Jones to carry out preventive and cor- rective surgery in the British Army, a task that they were able to accomplish only through the generous help of their American colleagues.
Returning to Birmingham after the war, he con- tinued his work at the Royal Cripples’ Hospital and at the Robert Jones and Agnes Hunt Ortho- pedic Hospital in Oswestry, an institution in which he played a particularly vital part.
Mr. Dunn received many honors, but of them all probably the one he treasured most was the honorary LLD, which was conferred upon him by his own University of Aberdeen in 1937. He was connected with many hospitals in the Midlands, both in an active and in an advisory capacity, and he held the very important post of Lecturer in Orthopedic Surgery at the University of Birmingham. He was one of the original members of the British Orthopedic Association and for a number of years served on the executive com- mittee. He also held the office of President of the Orthopedic Section of the Royal Society of Med- icine and was a corresponding member of the American, French, and Australian Orthopedic Associations.
Although Mr. Dunn’s contributions to the liter- ature of orthopedic surgery were not as numerous as one would have expected from a surgeon of his standing, what they lacked in quantity was com- pensated by their extreme soundness and breadth of vision. They were typical of the man—inher- ently sound, sane, and thoughtful—and charac- terized by an underlying care for the patient, which was always his first anxiety. His most notable contribution, which brought him an inter- national reputation, was his work on the operative treatment of paralytic deformities of the foot.
The early death of Mr. Naughton Dunn, which occurred on November 19, 1939, after a long, dis-
tressing illness, has deprived British orthopedic surgery of one of its outstanding figures and the British Orthopedic Association of its President, a post that he held during 1938 and 1939.
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Who’s Who in Orthopedics
Guillaume DUPUYTREN
1777–1835
Guillaume Dupuytren was born in Pierre-Buffière near Limoges in 1777. There had previously been several surgeons in the Dupuytren family. In 1719, a surgeon Michel Dupuytren lived at Pierre- Buffière, running the tobacco shop at the same time. François Dupuytren, grandfather of Guillaume, drowned while returning from visit- ing a sick patient. Two brothers of François, Leonard and Jacques, were also surgeons, so that it is not surprising that Guillaume selected surgery, although his own father was a lawyer.
Guillaume was sent to Paris for his schooling in a Jesuit institution named after its founder, Jean de la Marche. It was during this period, from the dawn of the Revolution in 1789 through the bloody Reign of Terror in 1793–1794, that young Dupuytren was a student in Paris. The changes that the Revolution wrought were to affect deeply the shape of his life. Now the road to success was open to the talented, without distinction of birth or fortune.
Once at home again in 1794, Guillaume wanted to join the army. His father, however, insisted that, in the family tradition, Guillaume become a
surgeon. As a first step in his training, he was enrolled in the medical-surgical courses in Limoges, but after a few months, Dupuytren set out for Paris, where he remained for the rest of his life.
Dupuytren’s medical studies coincided with the period of Directoire, from 1795 to 1799. The Terror was over, there was money to be made in manufacture and commerce, glory to be grasped in the battlefields. This was also a period of dis- sipation and pleasure, but Dupuytren had given his life over completely to his studies of anatomy, experimental physiology and pathological anatomy. He became Chef des Travaux Anatomiques (Director of Anatomical Studies) in the Medical School in 1801 and the Council of the Ecole de Médecine formally requested that he be exempt from the obligatory military duty.
The reign of Napoleon (1801–1814) had been for Dupuytren a period of tough “open competi- tion”; each post won gave rise to bitter rivalry.
The Revolution had released a flood of energy and in this brilliant era of French medicine, the rising young men were Bichat, Broussais, Larrey, Roux, Laennec: all formidable rivals for Dupuytren.
Dupuytren became, at just under 25 years of age, Chirurgzen de deuxième classe at the Hôtel Dieu in 1802. The Hôtel Dieu was the most important hospital in Paris. The chief surgeon was Phillippe Joseph Pelletan, with whom Dupuytren had unceasing conflicts, which reduced his surgi- cal activity. He continued his own researches and animal experimentation at the school of veteri- nary medicine at Maisons-Alfort (which still exists). Here, Dupuytren worked closely with Alexis Dupuy for many years. Dupuytren proved that the spleen could safely be removed and he published, with Dupuy, reports on the nervous, cardiac, circulatory, and cerebral systems and on the role of the nerves in respiration. In 1812 he was Professor of Operative Medicine at the Faculté de Médecine of Paris.
In 1815, Pelletan was 68 years old and wanted to “organize” his succession at the Hôtel Dieu. He put forward his son Gabriel, who was a surgeon in the Imperial Guard, for the appointment as clinical assistant, but with the passing of the Napoleonic era, Pelletan’s position was weak- ened. In September 1815, the Minister of the Interior of Louis XVIII asked the Conseil des Hôpitaux to submit a list of five candidates for the post of Chirurgien en chef at the Hôtel Dieu.
Dupuytren’s name was third on the list, after Boyer and Dubois, his elders by some 20 years.
These two were passed over because of their close relationship with Napoleon, and Guillaume Dupuytren became Chirurgien en chef at the Hôtel Dieu at just under 38 years of age. For 20 years he retained a place of pre-eminence in the medical history of his time, sometimes called the Age of Dupuytren. This period corresponds with the restoration of the monarchy in France after the Revolution, and the Empire, with the return of the brother of Louis XVI, King Louis XVIII.
Dupuytren had been named surgeon of King Louis XVIII in 1823 and the king conferred on him the hereditary title of baron. The king died in 1824 and was succeeded by his younger brother, Charles X; thus Dupuytren immediately became chief surgeon of the new king.
Dupuytren was admired as a brilliant surgeon and a great teacher, but his ambition and his aggressiveness had aroused many envies and enemies, hence the malicious tone of so many contemporary writings. For Lisfranc, Dupuytren was “the brigand of the Hôtel Dieu”; for Percy
“the greatest of surgeons and the least of men.”
However, so high was Dupuytren’s status that his obituary in the London Lancet expressed the general view: “Regarding surgery in the true sense, we hesitate not to place the late Baron Dupuytren at the head of European surgery”
(Lancet, February 21, 1835).
Dupuytren’s powers of diagnosis were leg- endary and the list of his innovations is too long for enumeration. For example, in the field of orthopedics, he described in 1822 the congenital dislocation of the hip, which he distinguished from accidental dislocations. He gave the original description of fractures of the lower end of the fibula, for which he devised a splint. He described a distortion of the wrist, now called Madelung’s deformity. He was also the first to perform a resection of the lower jaw, and the first to excise the neck of the uterus for cancer. He described post-traumatic shock. In his thesis on “lithotomy”
(1812) he gave an anatomical description of the perineal region, layer by layer, which is still a classic. He reported a considerable number of self-mutilations of the genitalia and took account of their determining factors: “self-punishment, guilt, jealousy, remorse, expiation, any of these may be responsible.”
In 1832, he gave his classification of burns arranged in six categories based upon the depth of the burn. He even noticed the presence of ulceration of the gastrointestinal tract in severely burned patients 10 years before Curling, to whom 90
Who’s Who in Orthopedics
that insight is now credited. For Garrison (in 1966), his most enduring title to modern fame is in the field of surgical pathology and perhaps above all for his diagnosis and treatment of con- tracture of the fingers. Hannah Barsky (1984) wrote a comprehensive portrait of Dupuytren in which she describes his daily activity when he was chief surgeon at the Hôtel Dieu, which is summarized here:
For twenty years, day in, day out, the Dupuytren program was all but unvaried. When Marjolin became Dupuytren’s adjunct surgeon, Dupuytren told him he was expected to act as substitute when the chief was out of the town or ill, but added “I warn you that I am never away and never ill”. There was for Dupuytren no holiday, no vacation. Even Christmas found him at his post.
His hospital arrival came no later than six o’clock in the morning. His arrival would be signaled by the ringing of a bell. Ward round began promptly and might take as long as three hours. Dupuytren proceeded from bed to bed (the four wards of his service held 264 beds).
The daily ward rounds were followed by the daily lectures. Seated in his high-backed green armchair behind a table, he would address as many as five hundred auditors, not only hospital personnel, doctors and students, but professional colleagues and laymen from Paris, from France, from the world beyond.
Dupuytren began his clinical lectures in a low voice, which would force his auditors to pay close attention,
“His voice was soft and smooth, with not only a clarity of thought but a clarity of diction, which made him, even for foreigners, so easy to follow”.
Other well-documented biographies of Dupuytren have been written by Cruveilhier (1841) and Mondor (1945).
The Leçons Orales (Dupuytren, 1832) recorded by his associates and promptly translated abroad attest to the method, content, and style of these model clinical lectures.
The hour’s lecture over, operations began.
Dupuytren valued deliberation over brilliance, safety over sleight of hand. Surgery was an exten- sion, a demonstration of clinical lectures. In 1818, 2,363 patients were admitted to Dupuytren’s service and 764 major operations performed, ranging from strangulated hernias, skull fractures, mastectomies, amputations of the upper and lower jaw, artificial anus and malignant tumors, as well as a series of orthopedic and ophthalmo- logical procedures.
His operative records were extraordinarily good. With so many eye-witness accounts as we
have of his operations, no error escaped the record. One failure, said Cruveilhier (1841), afflicted Dupuytren more than 20 successes delighted him. It was only his failures to which he was sensitive.
After the operations came the outpatient clinic for free consultations: “For the cold Dupuytren, whom others saw on occasion, was not seen by these indigent patients. All those who worked with him and all who visited his clinics agreed that he showed toward these humble outpatients the same attentiveness and care he showed to the rich and famous who came to him for private consultations.”
In all, 5–6 hours had been devoted to the Hôtel Dieu service. The rest of the day would be filled with operations on private patients, medical school duties, supervision of the laboratory, clinical research, and private consultations.
Dupuytren’s professional day was not yet over with the departure of the last private patient.
There was always a return visit to the Hôtel Dieu from 6–7 o’clock to see, once again, the patients on whom he had operated that day and the new admissions. And after that, there was a social life.
On December 5, 1831, at the Hôtel Dieu, Dupuytren described the permanent contracture of the fingers. This lecture was reported verbatim in the Journal Universel et Hebdomadaire de Médecine et de Chirurgie Pratique by his assis- tants, Paillard and Marx (Dupuytren, 1831).
Dupuytren himself wrote very little apart from a huge collection of observations. The lecture notes, religiously recorded by his assistants, Brière de Boismont, Paillard and Marx, were pub- lished in the Leçons Orales de Clinique Chirurgz- cale faites à l’Hôtel-Dieu de Paris par Monsieur le Baron Dupuytren. They began in 1832 and filled five volumes. Dupuytren died in November 1835. “La Rétraction Permanente des Doigts,”
when it was published as the first article of the first edition of the Leçons Orales in 1832, was considered a completely unknown pathology.
Later, Dupuytren’s assistants and Dupuytren himself discovered that this condition had already been mentioned by Astley Cooper, and the
“Leçon sur la Rétraction Permanente des Doigts”
was relegated to article XI of volume 4 of the second edition, which appeared in 1839, after Dupuytren’s death.
On June 12, 1831, Dupuytren operated on the right hand of M.L., the wine merchant who suf- fered from a progressive contraction of the ring and little fingers.
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Who’s Who in Orthopedics
At 58 years of age, Dupuytre of devel- oped pleurisy and died in a few days, while Cruveilhier, Bouillaud and Broussais were debat- ing whether to drain his empyema. In Dupuytren’s opinion it was “better to die of the disease than of the operation.” On the day of his funeral, colleagues and scholars came from all over the country. His mortal remains were carried to the Père Lachaise cemetery by his students, who would not delegate this last duty to anyone else.
Herbert Alton DURHAM
1884–1946
Dr. Herbert Alton Durham was Surgeon-in-Chief of the Shriners’ Hospital in Shreveport, Louisiana, and an outstanding orthopedic surgeon. He spent his boyhood on a farm in Vermont and received the degrees of AB in 1905 and MD in 1909 from the University of Vermont.
After serving a general internship, he became a resident at the New York Orthopedic Hospital. Dr.
Russell H. Hibbs was Chief Surgeon of the Hos- pital at that time, and had just announced his oper- ation for spine fusion. He was impressed by Durham’s ability and, at the completion of his res- idency, sent him abroad on a traveling fellowship.
The greater part of the year was spent in England under Sir Robert Jones, and in Austria and Germany.
With the onset of the First World War in 1914, he returned to New York and became a member of the staff of the New York Orthopedic Hospital.
When the United States entered the war, Durham was at once commissioned in the army and went to England with the first contingent of orthopedic surgeons under the leadership of Dr. Joel E.
Goldthwait. Durham served under Sir Robert in a British military hospital until the end of the war, when he again returned to the New York Ortho- pedic Hospital, this time as an attending surgeon.
In 1923 he was appointed Surgeon-in-Chief of the Shriners’ Hospital at Shreveport, in which capacity he served until his death. He also was attending orthopedic surgeon at the Highland, North Louisiana State, and Tri-State Sanitaria.
He was an exceptionally skillful technician and a capable mechanic. These qualities, combined with a sound surgical judgment, accounted for his
great success and his high reputation. He devised an apparatus for leg lengthening, an operation for correction of internal rotation of the hip in spastic paralysis, and a technique for transplantation of the biceps femoris.
He was a member of the American Academy of Orthopedic Surgeons and of the American Medical Association, a Fellow of the American College of Surgeons, and a member of the Clini- cal Orthopedic Society and of the Eastern State Orthopedic Club. He was an out-of-doors man and got his recreation by shooting, riding, and golf.
Dr. Herbert Alton Durham died at Shreveport, Louisiana, on March 13, 1946, at the age of 62.
He was survived by his wife, Beatrice Anderson Durham, to whom he was married in England in 1918, and by two children.
Joseph Gichard DUVERNEY
1648–1730
The son of doctor in a small town near Lyon, Joseph Gichard Duverney was educated in Avignon, and like so many ambitious young Frenchmen, sought his fortune in Paris. Fortu- nately for him, he carried a letter of introduction by which he gained entrance into the scientific community in Paris as an anatomist. In 1669, Duverney was appointed professor of anatomy and surgery at the Jardin du Roi, a medical school developed with the support of Louis XIV. He became one of the first academic surgeons, in the modern sense of the term, because he occupied a tenured chair that allowed him to teach, do research, and carry on a surgical practice. Among his students were members of the French court, including the Dauphin. His research included investigations of the anatomy of the ear, of which he provided the first accurate description, and an important theory of hearing. Duverney was a member of the group of savants gathered around Claude Perrault, who dissected and described a large number of species of animals, including many previously unknown until they were sent from North America by French explorers. His clinical work resulted in his book, Maladies des Os, which was published after his death. The first complete description of osteoporosis and the description of what is called Duverney’s fracture of the pelvis are found in this work.
92 Who’s Who in Orthopedics
