Who’s Who in Orthopedics Such are the bare facts, but there was much more than that.
The years 1929 to 1939 were the great days of the orthopedic department of St. Thomas’. The force and power of Rowley Bristow, loyally assisted by George Perkins, could not be resisted and a powerful department grew up. Perkins was the “eminence grise,” the assistant surgeon in the best sense of the words, whose assistance was based on loyalty and respect. This superb combi- nation was broken by the Second World War.
In 1948, Perkins created a professorial depart- ment of surgery out of the tattered remains of the old surgical unit. This was an extremely success- ful innovation since he was essentially a clinical surgeon who was happiest when teaching the fun- damentals of his subject in the clinic or at the bedside. His conception of the treatment of frac- tures is well known and continues to be practiced, but when he was first teaching his method, which did not require immobilization of the fracture, it was revolutionary.
Perkins had a realistic appreciation of his abil- ities and intellectual gifts, and it was just as well if his associates shared this evaluation. Although he was a persuasive teacher, he could not tolerate unquestioning adherence to tradition for its own sake and the Sister who looped a Samways tourni- quet to the foot of the bed of one of his amputee patients “just in case” was left in no doubt that it was a silly thing to do.
I like to imagine George Perkins today walking (perhaps striding would be the more appropriate word) through the Elysian Fields. He might be reflecting how different they were from those at Lincoln’s Inn but, since he always contrived to disregard his environment, I fancy his thoughts would be directed toward people and ideas. There might be perfunctory though friendly nods for the eminent shades of erstwhile colleagues such as Sir Robert Jones, Rowley Bristow and Sir Max Page, but his focus would be intent upon the men he had left behind: what had become of them and, more important, what of the ideas he had bequeathed to them?
Certainly he would not have cast a single back- ward glance at his own meteoric career. No more shall I. Those who wish to read of his brilliance at Oxford, of his military valor in two world wars, his headlong rise to fame, first as an orthopedic surgeon, then as professor of general surgery, of his masterly textbooks and piquant essays, or of
265George PERKINS
1892–1979
George Perkins was born on September 22, 1892, an only child. He was educated at Herstmonceux School, Hertford College, Oxford, and St.
Thomas’ Hospital. He qualified in 1916 and joined the Royal Army Medical Corps. Within 2 years, in the East African Campaign, he had been awarded the MC and been captured by the Germans.
When he returned to the UK, he became house surgeon to Max Page and Percy Sargent—both surgical giants at St. Thomas’ Hospital. He pro- ceeded FRCS in 1921. After a time spent at the Military Orthopedic Hospital, Shepherds Bush, where he was in contact with Sir Robert Jones and Naughton Dunn, he became chief assistant to Rowley Bristow in the newly formed orthopedic department of St. Thomas’ Hospital. He became assistant orthopedic surgeon in 1929, but in the meantime he had joined and resigned from the staff of the Royal National Orthopedic Hospital.
In September 1939, Perkins was recalled to the
army and after a short and uncomfortable time in
a Casualty Clearing Station in Dieppe he was
invalided home in 1940. It took him most of the
war time to regain his health, but in 1944 he
joined the staff of Queen Mary’s Hospital,
Roehampton. He succeeded Rowley Bristow in
1946 as head of the department in St. Thomas’ and
in 1948 was appointed first professor of surgery at
St. Thomas’ and also remained as head of the
orthopedic department until 1955, when he retired
from the professorial unit, though continuing as
orthopedic surgeon until he retired in 1957.
his prowess as a penetrating thinker and dynamic teacher, can do so elsewhere (J Bone Joint Surg [Br] 1973; 55-B:4–6). Immortality resides neither in paper panegyrics nor in stone statues; it is ideas that carry the seeds of survival, and it is as a matt of ideas that we will remember George Perkins.
He certainly had ideas on the subject of frac- tures, and these so far outstripped orthodox think- ing as to be unacceptable to his contemporaries, or even to the juniors who trod in his progressive and iconoclastic footsteps. His single-minded insistence on function, leading to an apparent dis- regard for immobility and sometimes even for position, was too much for people to take in at a time when “plaster” and “immobilization” were the twin gods of fracture treatment.
Lorenz Böhler in Vienna and Sir Reginald Watson-Jones in England preached and practiced splintage, which had to be extensive, encasing both the joint above and the joint below the fracture; and which had to be prolonged, until the fracture was completely consolidated.
Only today, with the increasing popularity of cast-bracing techniques, are fracture surgeons beginning to do what Perkins advocated and to appreciate fully the enormous value of allow- ing (no, the word is too passive for Perkins), of demanding active movement as early as possible and at every relevant joint. To him, movement at the fracture site did not represent an important problem; it would, he felt, be adequately con- trolled by muscles, and difficulties arose only at anatomical sites such as the femoral neck and carpal scaphoid, where one or both fragments were devoid of muscle attachments.
Much to the surprise of his colleagues, Perkins proclaimed Hugh Owen Thomas a genius. It seemed paradoxical therefore that he should discard the famous splint, together with its numerous modifications. But, he insisted, it was the traction and not the splint that was the quintessential feature of Thomas’ treatment; and traction should be untrammelled. Only those who worked with Perkins could accept that so simple a method embodied so penetrating a truth. Most surgeons smiled pityingly and persisted with splints; naturally they had not given his technique a trial. Yet now, years after his retirement, his methods are being more and more widely used, and those who seek an uncluttered exposition of the fundamentals of contemporary fracture man- agement can hardly do better than to read Chapter 3 of his Fractures and Dislocations, published in 1958.
As for the current school of rigid internal fixa- tion, many assumed that Perkins, the apostle of traction, would oppose it. On the contrary, he embraced it—with enthusiasm. Indeed it was wholly appropriate that the very first Perkins Lecture at St. Thomas’ Hospital should be given by Professor Maurice Muller on this very subject.
Perkins saw its dangers clearly enough, but he welcomed eagerly the prospect of liberating joints; fixation that needed the additional support of an external splint he viewed with scorn (as I learned when he fractured his own ankle and I had to treat it).
His views on fractures exemplify only one facet of a mind, which, though wide-ranging, always cut straight through to the heart of a problem and scattered startling ideas in profusion.
His aims were to clarify, to simplify, to provoke and to stimulate. To these ends he was prepared to devastate his opponents, to disturb his peers, and to exasperate even his protagonists. At clini- cal conferences his swiftness of thought and rapier-like verbal sallies kept those of us who worked with him always on tiptoe. We were sometimes apprehensive and occasionally dis- mayed by the staccato succession of ideas that seemed to threaten intellectual inebriation. Tire- less himself, he demanded constant effort from those who would keep pace with him. Those who lagged behind were quickly lost to view; they thought him impatient, austere, almost forbid- ding. Those who stayed the course saw his true self: helpful, abundantly stimulating and with a warm friendliness hidden from the world at large.
After his devoted wife Jill had died, Elizabeth, his only child, and herself a doctor, provided him with a charming and comfortable home. But he has also left behind another family, of surgeons, who worked with him at St. Thomas’ and at Pyrford. They are the custodians of his ideas.
George Perkins’ greatest service to the Journal of Bone and Joint Surgery was as true begetter of the British volume. He came to the presidency of the British Orthopedic Association in 1946 fully resolved that there must be created a proper British voice. He first raised the matter at a dinner of the Association and received wide support;
informal discussion went so far as naming Watson-Jones as the obvious prospective editor.
Perkins gained further support at a general meeting of the British Orthopedic Association in October 1946. These were the beginnings.
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Who’s Who in Orthopedics
Who’s Who in Orthopedics The American-owned Journal of Bone and
Joint Surgery was the official organ of the British Orthopedic Association, but the British circulation was small and British articles rarely appeared, one long-standing source of dissatis- faction. Authors preferred indigenous journals;
consequently the few communications submitted to the journal from the UK were usually deplorable and rightly rejected. The American sponsors also were unhappy about the journal, largely because its circulation had long been too small to sustain it and so its survival depended upon the great generosity of its sponsors besides the outstanding dedication of its successive editors, Elliot Brackett and William Rogers.
The familiar tale of friendly discussion between representatives of the bodies concerned does not need recapitulation. When there was a chairman he seems always to have been Perkins, and it was he who successfully brought proposals for joint publication to the British Orthopedic Association.
He also chaired the meeting that set up an independent British editorial board to include the editor and other officers besides representatives of Australia, Canada, New Zealand and South Africa, as well as the United Kingdom. Sir Harry Platt accepted its chairmanship in the initial stages, but then handed over to Perkins, who served till retiring in 1952.
In a number of the journal dedicated to George Perkins at that time, Sir Reginald Watson-Jones wrote: “He inspired the British Volume of The Journal of Bone and Joint Surgery. Without him there would probably never have been a British Volume of this Journal. He thought of it long before it started. In pursuing his thought he over- came every obstacle.”
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