Who’s Who in Orthopedics famous contributions are probably his studies on the pathogenesis of low-back pain, which led to a greater understanding of what many had pre- viously diagnosed as lumbago. He also had expertise in the areas of hallux rigidus, patellar dislocation, opponens transfer, whiplash injuries, pathological changes in the neurocentral joints of the cervical spine, lesions of the menisci, anterior tibial compartment syndrome, the effect on osteo- genesis of alternating currents in bone, blood supply of the vertebral bodies and the femoral head, the reaction of body tissues to ceramics, the microcirculation of the rotator cuff, and shoulder arthroplasty. He was awarded the Hunterian Lectureship of the Royal College of Surgeons of England for his studies on the rotator cuff.
As a teacher, Ian was unsurpassed. To North Americans, his knowledge and expertise, com- bined with his command of the English language and his Churchillian oratory, made him one of the most sought-after orthopedic lecturers and visit- ing professors. His ability to impart a message was exemplified in his classic Presidential Address, entitled “Seek and Ye Shall Find,” to the Canadian Orthopedic Association in 1977, in which he stated: “You do not have to be a trained investigator to discover. You must, however, pre- serve your sense of wonder, your ability to be astonished and you must be sure that your brain remains connected to your retina so that you will not only see, but you will also perceive. . . . Research is just not a laboratory activity. More importantly, it is an attitude of mind. Every surgeon must recognize his own potential in this regard and not be content to leave advances to others. Seek and ye shall find.”
As a testimonial and legacy to Ian’s outstand- ing influence as a teacher and his ability to shape the lives of others, a dynamic group of 40 of his orthopedic disciples founded the Macnab Club, which looked to Ian and his wife, Reta, as guiding patrons. These practitioners, who were postgrad- uate fellows with Ian, are now located in 22 ortho- pedic centers and seven countries.
Although Ian’s scientific contributions have made a lasting mark in orthopedics, for those who knew him personally his personal traits are what will be most cherished. His warm friendship, loyalty, tremendous sense of humor, ability to stimulate others, appreciation of nature, and enjoyment of his family and their good times together will remain a living memory. His wit and teachings, in both the spoken and written word, will be passed on by his friends, colleagues,
213Ian MACNAB
1921–1992
Ian Macnab was the son of a Scottish shipbuilder who was living in India. When Ian was 5 years old, his parents sent him home to Britain to receive an education in an English boarding school. He attended medical school at the Uni- versity of Birmingham, graduating with first-class honors. After a residency in general and orthope- dic surgery, he served in the Royal Army Medical Corps, from 1945 to 1947. He then completed his orthopedic training at the Royal National Orthopedic Hospital in London, England. He became interested in low-back disability and, at the recommendation of Sir Herbert Seddon, went to Toronto in 1950, to study the pathogenesis of low-back pain, as a research fellow at the Bunting Institute, in conjunction with Dr. R.I. Harris.
Ian’s outstanding contributions as researcher, teacher, and orthopedic surgeon led to his being asked, by the Chairman of the University, Dr.
Frederick P. Dewar, to establish a university orthopedic service at the Toronto General Hospi- tal. Ian acquired a passionate devotion and pride for his adopted country, for Toronto, and for its orthopedic service. A very close personal rela- tionship developed between Ian and Dr. Dewar and his other Toronto colleagues. He was appointed Professor of Orthopedic Surgery at the University of Toronto and Chief of the Orthope- dic Service at the Wellesley Hospital.
His range of academic interests truly made him a Renaissance surgeon—“a man for all seasons”
in orthopedic surgery. Although he was interna-
tionally renowned as a spine surgeon, his most
fellows, and residents to future orthopedic sur- geons as a viable continuation of his presence.
Ian Macnab died on November 25,1992, at the Toronto General Hospital, after a brief illness. He leaves behind his wife, who met Ian when she was a charge nurse in the orthopedic operating room at the Toronto General Hospital, and his three children.
and after a period under house arrest he retired to Gottingen.
Apart from his work on intestinal resections, intestinal typhoid, obstruction and so on, Madelung was one of the first advocates of early laparotomy for abdominal injuries. In 1909 he described arthrotomy of the shoulder from behind. His description of deformity at the wrist was not original, and only a little more complete than descriptions by Dupuytren and R.W. Smith, which had appeared many years previously.
It is difficult to give much impression of his personality—someone described him as a
“serious and conscientious man with powerful will” and this rather stern picture is supported by one of his sayings: “Every clinical lesson must be prepared and conducted in such a way that every student who contemplates missing the class must feel that he would miss something important.”
Madelung regarded the wrist deformity as a defect of growth of the wrist joint. It was not due to trauma or infection. Heavy work by young people produced more pressure on the anterior part of the distal radial epiphysis than the poste- rior part. In those with “primary weakness of bone” this degree of pressure may cause the ante- rior part of the epiphysis to stop growing. As a result, the lower end of the radius comes to be angulated forwards. The carpal bones are also compressed and show changes.
Treatment was not successful. Surgically replaced hands relapsed. However, Madelung noted that the pin disappeared after time, even when the subluxation was gross, and that the capacity for work was not impaired.
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