was the only means of survival in those days when all hospital work was unpaid.
R.W.-J, gained the MChOrth degree in Liver- pool in 1926 and was awarded the gold medal.
He became FRCS (England) in 1927 at the age of 25. In 1928, he was appointed to the Country Orthopedic Hospital at Gobowen, later to become the Robert Jones and Agnes Hunt Orthopedic Hospital, and also held an honorary appointment at the North Wales Sanatorium, where there were at that time many cases of ortho- pedic tuberculosis. In 1936, R.W.-J. hit upon the idea of an instructional course on fractures. This was held at Liverpool Royal Infirmary. It was oversubscribed and many of those who attended were his equals or elders, which was a great tribute to a young man in his early thirties.
However, it must be remembered that he had by then become well known nationally and interna- tionally for his contributions to the literature. The success of the fracture course prompted his admirers to urge him to write a textbook on the treatment of fractures, and this led him to the first of his three great achievements.
My first encounter with Watson-Jones was as a medical student. My father was medical officer of health for the County of Denbigh. Orthopedic clinics were held within the ambit of Gobowen at different centers, including Wrexham, my father’s headquarters. I can remember vividly now, 45 years later, the compelling personality of R.W.-J.
and his eagerness to enlist a new disciple to ortho- pedics. It now seems to have been inevitable that I should later have become his registrar, and then his assistant and successor at the Royal Infirmary.
What great times they were in those happy days of the 1930s in Liverpool! The great man had a Packard limousine, a chauffeur, a butler, a per- sonal secretary and assistant; two radiographers and two physiotherapists. A working day started at 6.30 a.m. with three or four private operations at the nursing home at Number 1, Gambler Terrace; then a morning of patients at 88 Rodney Street; in the afternoon a hospital clinic or oper- ating session; back to Rodney Street for the paper work, and letters to doctors; and then home for a dinner party and bridge.
And so to the book, now irreverently and affec- tionately known as the “Bible.” At 88 Rodney Street there was, and still is, a top flat. There, R.W.-J. surrounded himself with the books of ref- erence and all the things he needed for the task of writing what has become, and may long continue to be, the classic fracture textbook. Passing late at
Sir Reginald WATSON-JONES
1902–1972
Reginald Watson-Jones was born on March 4, 1902. He died in London after a short illness on August 9, 1972. With his passing, the surgical world has lost one of its great leaders.
The First World War was a tragic illustration of the fact that injuries can eclipse other causes of deformity. Before the war, Robert Jones himself, in his work as surgeon to the Manchester Ship Canal, had taken the practice of orthopedic surgery beyond the confines of the crippling dis- eases of childhood into the realm of trauma in adults. After the war, he realized that industrial, domestic and road accidents would increasingly call upon the services of orthopedic surgeons, and the idea of fracture clinics was born. Robert Jones was quick to realize the talent of the young Watson-Jones, and persuaded the Liverpool Royal Infirmary to appoint him as an honorary assistant surgeon in charge of a new orthopedic department and fracture clinic in 1926. Robert Jones made an excuse of asking his protégé to make some researches into the literature in order to “repay” him by arranging a tour of continental orthopedic centers as a grooming and preparation for the young man’s new responsibilities.
The department at the Royal Infirmary was soon, like all R.W.-J.’s enterprises, a great success. The official beds were six, but the number of “unofficial” beds in many different wards was always a little uncertain. R.W.-J.’s devotion to the treatment of his hospital patients soon led to a successful private practice, which
night or in the small hours, one could see the light in the flat. R.W.-J. was at work. This was the beginning of a lifelong habit of working by night as well as by day. The day was not long enough.
Fractures and Joint Injuries was first published in January 1940, reprinted 15 times, translated into many languages and famous the world over.
R.W.-J.’s approach to surgery was always that of an idealist, and this is reflected in the style of his book. In his philosophy, the ideal treatment of a fracture or injury would lead to the best possi- ble result, and any other form of treatment that did not fall into line with the so-called principles of fracture management was bound to result in some degree of failure, and perhaps in disaster. It was not a humble approach, but it worked, and in any event he was a realist in his actual treat- ment of patients; no one could have been more commonsensical and ready to throw so-called principles overboard as soon as they became inconvenient. Woe betide anyone who did not
“immobilize the joint above and below” in frac- tures of the tibia and the forearm, but when it became inconvenient to immobilize the hip in fractures of the femur, or the shoulder in fractures of the humerus, the principle was easily set aside.
It was a joy to work with him. His enthusiasm was highly infectious. He had enormous vitality, not only in his working hours but also for any light-hearted activities that might follow the day’s work. He was completely devoid of “side.” He would listen with the same earnest attention to an idea propounded by a student as he would to a fellow consultant’s suggestion. Because of this, and because of his gentleness and kindness, he inspired tremendous loyalty in his juniors. If he had to reprove or criticize a junior colleague on a matter of treatment, the victim would be led to one side and dealt with gently. The rebuke was never public. I have never known him speak ill of anyone.
In the early part of the Second World War, Watson-Jones was appointed civilian consultant in orthopedic surgery to the Royal Air Force.
Thus, close on the heels of the success of the book, came his devoted service to the treatment of the injured airman, which continued through- out the war, and after. His position in relation to the RAF was similar to Robert Jones’ position in the army in the First World War. Like Sir Robert, Reg inspired and trained the young surgeons who were later to become leading orthopedic consult- ants in civilian practice, so that apart from the influence of his book, and of his many contribu-
tions to the literature, he played a big part in the personal training of young consultants.
In 1943, he became a member of the Council of the Royal College of Surgeons of England and he served in this capacity until 1959. He was vice president of the College from 1952 to 1954. He was member of the Court of Examiners from 1958 to 1962.
In the latter part of the war, Watson-Jones was appointed director of the orthopedic and accident department of the London Hospital, and was joined in this new venture by Osmond-Clarke.
The British Journal of Bone and Joint Surgery was first published in 1948. Although others on both sides of the Atlantic took a prominent share in the launching of the new enterprise, there can be little doubt that it was Watson-Jones’ enthusi- asm and drive that made certain that the idea everyone had approved for many years should be put into practice. Watson-Jones was the editor from the time of the first number until his death and, especially in the early years of the journal, a great deal of its success was due to the countless hours of hard work he put into his job as editor.
He was no figurehead; he was the working editor and, in collaboration with Charles Macmillan of the Edinburgh publishers E. & S. Livingstone, he set a high standard of content and presentation, which has been maintained over the years.
In 1952, the British Orthopedic Association, under the presidency of Watson-Jones, met in London for a combined meeting with America and the Commonwealth. Again, his remarkable flair for organization made a grand success of the whole crowded week. It was inaugurated at the Senate House of the University of London by the Queen Mother, who was fulfilling her first public engagement after the death of King George VI.
Watson-Jones was knighted in 1945 in recog- nition of his services to orthopedic surgery and in particular for his work in the Royal Air Force. He was the Sir Arthur Sims Commonwealth Travel- ing Professor, visiting Africa, Australia and New Zealand in 1950. Many honors, too numerous to mention, came his way. His appointments to the Royal Family included those of extra orthopedic surgeon to the Queen, and from 1946 to 1952 orthopedic surgeon to King George VI.
In 1930, Watson-Jones married Miss Muriel Cook, who died in 1970. They had a son and a daughter. In 1971, he married Miss Wallace Robertson.
Sir Reginald and the Journal
Reginald Watson-Jones created the British section of The Journal of Bone and Joint Surgery. At a time when the fragmentation of the Second World War was being painfully but energetically over- come, there seemed to be a real need for a new journal devoted to orthopedics and accident surgery. The task of editor would clearly be for- midable; equally clearly the man to undertake it, if he would, was R.W.-J. His literary talent had been established by his splendid book: his admin- istrative skill had been amply displayed in both peace and war. Fortunately he agreed and we reap the harvest of his labors—given freely for a quarter of a century.
To this task, as to all else, he brought a seem- ingly tireless energy and a superb intellect. His methods were always his own, and they revealed his rich personality. Like his patron saint Robert Jones, he had a warm regard for his fellow men and the art of discovering latent merit. Thus he found collaborators whom he imbued with his own enthusiasm and loyalty.
Perhaps the most original and inspired part of the achievement was the close link forged with the Americans’ long-established Journal of Bone and Joint Surgery, already the official organ of both the American and the British associations.
That unique and happy symbiosis was the fruit of collaboration with such men as William Rogers and R.I. Harris; it was characteristic of R.W.-J.s imaginative mind and broad vision. From these beginnings there has emerged an international journal belonging in spirit to every country where English is spoken. This is how R.W.-J. liked to think of it.
He had an outstanding affection for the English language, of which he himself was so fine a master. His own writings had not only the essen- tial virtues of clarity, simplicity, precision and brevity, but displayed also a splendid style of his own, always recognizable, exciting, stimulating and persuasive. His speaking was much akin to his writing, but he recognized the necessary dis- tinction between literature and oratory.
A leader and not an autocrat, he was always approachable and he respected opinion from the humblest source. His complex but warm char- acter was completely devoid of pomposity. It was always a joy to attend laborious editorial meetings enlivened by his sparkling personality and penetrating assessments. In his judgment of papers, as of men, he was prompt to perceive
any merit and equally prompt to detect the pretentious.
Sir Reginald and the Royal Air Force Watson-Jones was appointed civilian consultant in orthopedic surgery to the Royal Air Force early in the 1939–1945 war. He quite quickly and with his usual enthusiasm, energy and power of per- suasion had convinced the new and very progres- sive Director-General of Medical Services, Air Vice-Marshal (later Air Marshal Sir Harold) Whittingham what was required to produce a competent orthopedic-rehabilitation service for the RAF. Ten orthopedic units of 100–150 beds each were established in strategically placed Royal Air Force hospitals, each unit consisting of a team of three surgeons, nurses, secretaries, clin- ical photographers and rehabilitation orderlies.
These units were backed up by residential reha- bilitation centers working in the closest harmony with the hospitals and, like the hospitals, visited monthly by Watson-Jones or myself. Later, similar units were established overseas. Every single member of these teams, both in the hospi- tals and in the rehabilitation centers, had to make at least two contributions—the exercise of pro- fessional skill, and the exercise of a cheerful con- fident personality, which so inculcated the “will to get well” that a mood of apathy was never allowed to develop. These were of course the characteristics so typical of R.W.-J. himself, who found it came easily to him, a man of exceptional panache.
On a morning early in January 1941, Watson- Jones telephoned me, urging that I should join him and followed with a letter asking me to think and think quickly and ending with a sentence so typical of him: “I know that you will think this offer over carefully! I hope you will not turn it down lightly, not only because of the importance of the appointment, but also because of the oppor- tunity it will afford of doing something for ‘those few to whom so many owe so much” ’—Sir Winston Churchill’s wonderful description of what the free world owed to the RAF fighter pilots of the Battle of Britain. Thus I joined him in this remarkable wartime experience, which even now I look back on as the finest orthopedic–
rehabilitation accident service I have ever worked in. By mutual agreement we decided that I should go into uniform and conform to the pattern of
service life and make the bullets, which, as a civil- ian, he could fire without being held up by “the usual channels’. ” He enjoyed direct access to the Minister for Air, Sir Archibald Sinclair (later Lord Thurso), and this was certainly a great advantage in avoiding “red tape” and getting things done promptly.
Just before the war, it had been rumored that the Air Council had considered that any pilot or other member of air-crew injured in battle could not engage in combat again. What a tragedy this would have been, especially in the year after the fall of France when we were “going it alone.” As the result of R.W.-J.’s vision and organizational capacity, the orthopedic–rehabilitation service returned 77% of injured personnel to full duty—
flying and other trades; 18% were retrained or returned to modified duties in the service, and only 4.8% were invalided. For this magnificent achievement he was knighted in 1945. Before the war ended, he had persuaded friendly financiers to buy Headley Court for the Royal Air Force, and it remains to this day one of the finest rehabilita- tion units in the world.
During the war he organized with the Dean of the Postgraduate Hospital at Hammersmith two courses every year of lectures of 1 week each, covering the whole of fractures, for medical offi- cers of the Allied Armed Forces. These we gave together—lectures in the mornings and practical classes in the afternoons, in which everyone had to apply plaster-of-Paris casts, Tobruk splints and other conservative treatments, on enthusiastic local schoolboys or boy scouts. At the end of the week, R.W.-J. would summarize the week’s lec- tures in 5 minutes precisely—a superb tour- de-force, which always received a standing ovation.
In 1943, he was invited by the London Hospi- tal to organize an orthopedic and accident depart- ment and become its director. To this he brought the same qualities of drive, enthusiasm and com- petence. When I left the Royal Air Force in 1946, he insisted on my applying for a consultant post at the London Hospital, and so I joined him there in 1947. With our colleagues, Mr. O. Vaughan- Jackson and Mr. W. Alexander Law, a superb department was built up much along the RAF lines, in which the four of us worked in great hap- piness and rapport until he and I retired from the National Health Service within a year or two of each other.
He was a wonderful colleague, inspiring and dedicated to the task of the present; I always
envied him his ability to put affairs of the past behind him. For these he had done his best and, as always, they were highly successful and self- perpetuating. A new task demanded his dedicated attention.
Sir Reginald and Oswestry
My first contact with Reginald Watson-Jones, like that of many other Liverpool undergraduates, was in the unique plaster session he conducted in the basement of the old medical school, but it was as his house surgeon in the Royal Infirmary in 1940 that a working association began, which was to last 32 years. R.W.-J., at that time aged 38, was already nearing the height of his career. His dynamic enthusiasm infected his residents, and my recollections of this impressionable period were of putting on spinal jackets for fractured spines at three o’clock in the morning, of a theater sister gladly giving up her evening off to take a list that should have begun that morning, and of immaculate plasters put on by the master. In the winter of 1940, during the Liverpool “blitz,”
R.W.-J. persuaded the late H.C.W. Nutthall to exchange his week on night call. The hospital was struck three times one night, and I remember vividly a tall, striding figure in his element organ- izing, directing and operating in the emergency basement theater.
Of the following 5 years in the orthopedic service of the Royal Air Force, what still stands out clearly in my memory was the meticulous care with which he prepared a meeting of the Royal Society of Medicine at Ely in 1942. Each contributor received a personal letter with detailed instructions on presentation. Each paper had to be word perfect, we were to speak to the back row, adhere strictly to the time allocated, and have illustrations of the highest standard. Such attention to detail characterized so much of what he did.
In June 1928, R.W.-J. was elected the first con- sultant orthopedic surgeon to the Wrexham War Memorial Hospital, and it was typical that his acceptance was conditional on the allocation of one of the local practitioners exclusively to the management of fractures. In the same year he joined the consultant staff of the Shropshire Orthopedic Hospital at Oswestry, where he became the chief of the North Wales firm. I suc- ceeded him in both these commitments. After-
care clinics held in chapels, schools and cottage hospitals throughout North Wales took him far afield. He enjoyed recalling that on one of these visits to Blaenau Ffestiniog, he ran into and killed a horse: it was an insignificant cob that crossed the road that day without looking both ways, but by the end of the litigation that followed it had become a most valuable racehorse.
His close association with Oswestry continued right up to the end. His powerful teaching was often uncompromising and strongly held beliefs were always communicated with conviction; he believed passionately. Many a young Oswestrian suffered painful knuckles in the process of learn- ing the “no-touch” technique. The word “func- tional” rarely entered his vocabulary. Less widely accepted beliefs were his obsessions about anky- losing spondylitis, physiotherapy and the value of crooked and elongated heels in the treatment of genu valgum. He deplored shoddiness in work, incomplete immobilization, plasters in equinus or the use of abbreviations in case notes. His dark, penetrating, alert eyes and warm personality pro- claimed the message, whether it was his philoso- phy of fracture treatment to his colleagues or understanding and sympathy to his patients. He listened sympathetically to the views of young residents but towards the end of his career R.W.-J. became less tolerant.
He will be remembered by many an adminis- trator and some of his senior colleagues for his midnight telephone calls, by nurses and doctors of all ranks alike for his identification with the social life of the hospital. He introduced many of the established traditions of the Oswestry doctors’
mess, notably “Roll the Red,” a peculiar game later to become known as Oswestry billiards, and champagne breakfasts on Christmas morning.
The sound of music was often to be heard in the early hours of the Welsh weekend, and a grand piano and an electric organ in the doctors’
residency are a permanent reminder of his generosity.
It would be foolish to pretend that in later years some of his unpredictabilities were not embar- rassing, but there was something other than the reputation of a great surgeon, something indefin- able and personal that always commanded the utmost loyalty. When ultimately the time for retirement arrived in March 1967, he refused to admit it and nobody dared to refer to his retire- ment party other than as his birthday. He loved Oswestry dearly, and his last clinical activity was with his colleagues in the Welsh firm, when, in
failing health, he journeyed to the Eryri Hospital at Caernarvon. All of us who were there will remember how keen and sharp his mind was, and how clear the message. Later on this occasion he was struck down by his last illness, and it was a privilege to be able to repay a very small part of a long-standing debt. Reggie died young: we could not imagine him dying old.
Sir Reginald first came to Oswestry in 1928 as assistant surgeon to David Macrae Aitken, barely 4 years after qualification, having already estab- lished his reputation in Liverpool as a young surgeon of outstanding ability. From the outset, he fell in love with “The Orthopedic” and this was returned in no small measure over the years. He loved the Welsh border county. Indeed it was in a small cottage in Shropshire that he took refuge while preparing his epic book. His old friend, John Menzies, recalls those mammoth writing sessions interspersed with bridge, music and asparagus.
Wattie J., Reggie or R.W.-J., as he was vari- ously known, soon settled into the Oswestry scene. In the late 1920s he pioneered the periph- eral clinics in Wrexham and North Wales in the best traditions of Robert Jones, and attended Llangwyfan Hospital in the Vale of Clydd with the late Arthur Rocyn Jones, at a time when bone and joint tuberculosis was rife in the Welsh coun- tryside. He became a household name: his friend- liness to patients of all ranks, his love of children and his personal magnetism proved irresistable to his Celtic patients. They adored him, as did all grades of staff in the hospital community.
Those of us privileged to have worked with him will not forget his marathon ward rounds extending deep into the night—an indication of his prodigious vitality and his peculiar facility to command unstinting loyalty. Generations of young orthopedic surgeons trained at Oswestry will especially recall the traditional Friday con- ferences when he would listen to the views of the most humble but, if the occasion arose, would do battle with his colleagues almost to the point of intolerance.
Even when his international interests were legion, Oswestry remained his spiritual home. As senior surgeon, his advice and support were freely available, locally and in high places. He acted as senior adviser in postgraduate studies for some years and was instrumental, with others, in found- ing the Charles Salt Research Institute. In 1952
William WAUGH
1922–1998
William Waugh was born on February 17, 1922 in Dover, where his father was a general practi- tioner. Both of his parents came from Ulster, but he was brought up in England and educated at Eastbourne College and Pembroke College, Cambridge, although this was during the Second he was elected founder president of the Old Oswestrians Club and delivered the Gold Medal lecture in 1970. He faithfully supported the hospital League of Friends from its inception in 1961, and his radio appeal for funds in 1964 will be remembered as a masterpiece of oratory and cajolery. He retired from the active staff in 1967 but continued to visit us as an emeritus consult- ant until the end.
Sir Reginald was, above all, essentially
“human” and like all great men was an alchemy of strength and weakness—a perfectionist and a romantic. Throughout his career he never lost the art of joining with youth in fun and games. How greatly he treasured those relaxing musical evenings with his junior colleagues, and his brand of “Oswestry billiards” is now world famous.
So passes a gallant gentleman and friend. It is hard to imagine Oswestry without R.W.-J. In 1940 he wrote to Hugh Owen Thomas and Sir Robert Jones: “They whose work cannot die, whose influence lives after them, whose disciples perpetuate and multiply their gifts to humanity, are truly immortal.” This can truly be said of himself.
World War when students were few. He won an entrance scholarship to King’s College Hospital in London, where he did the clinical part of his medical studies, graduating in 1945 and being awarded the Legg prize in surgery. He sub- sequently worked as resident medical officer and senior house officer at the same hospital.
In 1947 he married Janet McDowell, whose father was professor of physiology at King’s College. They had two daughters.
His surgical career can be divided into three phases. The first was the period of training. He was a surgical registrar at King’s College Hospi- tal and then, for 2 years, a surgical specialist in the Royal Air Force, which included 9 months in Aden. After this he took up orthopedic surgery, returning to work at King’s and then in Toronto.
He obtained his MChir (Cantab) in 1952 and 3 years later moved to Oxford as first assistant to Professor Trueta, where he struck up a lifetime friendship with Jimmy Scott, who was later to become one of the senior orthopedic surgeons in Edinburgh. Connections established in these posts reappeared later. He arranged for orthopedic trainees in the Royal Air Force to spend 2 years at Harlow Wood Orthopaedic Hospital, and later at Nottingham. Mr. Buxton, his chief at Kings’
College Hospital, “was involved in the creation of an orthopaedic and rehabilitation service in war-shattered Greece. He arranged for Greek orthopedic surgeons to come to King’s and other centres for postgraduate training.” William main- tained this link and many Greek surgeons trained at Harlow Wood Orthopedic Hospital and in Nottingham and Derby. His work in the academic department of orthopedics at Oxford established his credentials to set up such a unit himself 20 years later.
In 1957 he was appointed consultant orthope- dic surgeon at Harlow Wood Orthopaedic Hospital in Nottinghamshire. It had been opened in 1929 through the initiative of Alan Malkin, who became president of the British Orthopedic Association in 1948–1949, by which time Harlow Wood had established a considerable reputation.
This was carried forward by William Waugh and his senior colleague Peter Jackson and they became close friends. He said that Jackson had the better clinical brain, but that he (William) was the better writer. They collaborated closely on numerous publications, especially on surgery of the knee and foot. Together they edited a book on Surgery of the Knee Joint, published by Chapman and Hall. William was an outstanding teacher; his
