Joseph TRUETA 1897–1977

Joseph TRUETA

1897–1977

Joseph Trueta was professor emeritus of orthope- dic surgery in the University of Oxford. He qualified in Barcelona and became chief surgeon to the Caja de Provision y Socorro in 1929. As professor of surgery in Barcelona in 1935, he was faced, almost at once, with the problem of treating the casualties of the Spanish Civil War, which led him to develop the closed plaster tech- nique. Early in 1939, his liberal convictions drove him to move himself and his family to London, where his first-hand experience of air-raid surgery resulted in a great demand for his services as a lecturer and an invitation to Oxford as an adviser to the Ministry of Health. In 1949, he was elected to the Nuffield Chair of Orthopedic Surgery in Oxford and held this post until 1966. He was thus able to reorganize the Wingfield Morris Hospital as the Nuffield Orthopedic Centre and produce a steady stream of publications on almost every aspect of orthopedic surgery. His international reputation was recognized by an honorary DSc from the University of Oxford, and an honorary fellowship of the Royal Colleges of Surgeons of England and of Canada, and of the American College of Surgeons. He was an Officier de la Légion d’Honneur and honorary fellow of many other orthopedic associations round the world.

great figure, a most simulating chief, and a good friend.

The British Orthopedic Association presented him with the scroll of honorary fellowship during the sixth combined meeting in September 1976.

Joseph Trueta retired to his Catalonian mother- land in 1966 but continued his surgical and sci- entific work. He died on January 19, 1977, in his 80th year. His wife died in 1975, but he was sur- vived by his three daughters.

Many are so familiar with Trueta’s work on war (and other) wounds that there is no need to reca- pitulate his perfection of the method that Winnett Orr had previously and somewhat hesitantly devised. That Trueta arrived in this country in 1939 was a godsend; after a short-lived display of characteristic British scepticism, we were con- verted to the “closed-plaster” regimen. I had the immense privilege of seeing those wounds before and after he had dealt with them: but it fell to my lot to take a later look inside far more often than even J.T. himself. Because the Wingfield was an official nerve injuries center, hundreds of men with complex injuries came to us. Trueta—and Jim Scott—dealt with their soft-tissue and skele- tal injuries—apart from the damaged nerves, which we tackled as soon as they said it was safe to do so. Scores of photographs attest how benign was the scarring we encountered.

J.T.’s energy and scholarship were immense.

He made time for some refined experiments on the renal circulation, prompted by the anuria that is sometimes seen after a severe crushing injury of a leg. He and John Barnes found that the appli- cation of a tourniquet to a rabbit’s hind leg pro- duced arterial spasm extending up to the renal vessels. An imposing team headed by J.T. and Barclay produced an account of a comprehensive study in 1947. It was not accepted by the nephrol- ogists. Now I have it from one of the best of them that Trueta and his colleagues were very nearly right, but they overstressed the shutting down of the cortical, as opposed to the medullary, circula- tion. I quote: “the standing of Trueta, Barclay

But perhaps one remembers this great man best as the embodiment of the Spirit of Catalonia (the title of a work of filial piety that he published in 1946). It was always a pleasure to see his fine figure and handsome, vivacious face, and to listen to him, even though he never quite understood that going at top speed in a foreign tongue was not exactly the same as fluency. But there were

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occasions when he was almost wildly elated.

Someone had managed to escape from Franco’s Spain, or had certain news that deliverance would come to the country next month or, at the latest, the one after. Trueta had had it first-hand the night before. This was a fairly regular occurrence and we became bored with it, having a sizeable war of our own on our hands. But his faith was unquenchable, so it was inevitable that on retire- ment he returned to his native land: inevitable and well-nigh incredible that when in the UK for the treatment of his last illness, he dragged himself home to die in peace in the country he loved so passionately.

When Joseph Trueta took the chair in orthopedic surgery at Oxford, there already lay behind him two careers, each crowned by its own accom- plishment. By 1939, his first career in Barcelona had ended. He had responded brilliantly to what he called “the sad privilege” of his responsibility for the first urban population in history to be mas- sively attacked from the air. His second career, as an emigré in an Oxford laboratory unraveling some of the complexities of the renal circulation, was brief but characteristically fruitful and is now embalmed in the textbooks of physiology. It was in his third incarnation as Oxford’s professor that his remarkable experience was built upon, broad- ened and generously shared with anyone who cared to join him. For 20 years, J.T. rushed into everything at once, bombarding himself with questions, which sprang to his mind even from the most mundane of clinical problems. He was the very master of the art of digression, and yet capable of directing his energy to laboratory studies of the disease processes he strove to understand in his patients. The discipline he offered, that we should combine most intimately our therapeutic and research roles, was not a new one, but it has more theoretical adherents than it has practitioners. He taught it by precept and thereby caught the imagination of many of those who came from all over the world to work with him. He had little formal order in his life, was always tremendously busy but somehow had time for everyone.

Trueta’s long investigation, with generations of collaborators, into the vascular contribution to osteogenesis, the vascular anatomy of bone, the orderly and the disorderly function of the epiphysis, cartilage growth, repair and decay,

osteoarthritis and osteomyelitis can now be seen to constitute the firm basis of so much modern thought that to acclaim him the foremost among those who have contributed to fundamental orthopedic research in our era no longer seems unduly partisan. But he was involved in so much more. In Oxford he founded a Disabled Living Research Centre and was one of the first in this country to respond to the consequences of the thalidomide disaster. He pioneered a unit to deal with skeletal complications of hemophilia and, in collaboration with the department of hematology, established principles of management that are now widely practiced. He organized and person- ally inaugurated by several visits to that country an educational exchange with the Republic of the Sudan, a program that has continued uninter- ruptedly to this day.

In 1966, Joseph Trueta retired from Oxford to begin the last of his careers, once again in Barcelona. While still maintaining a busy clinical practice, he wrote a biography of G.R. Girdle- stone, whom he admired above all, prepared his own memoirs, read history and lectured his way around the world. Gradually, as the political climate in his country changed, the people of Cat- alonia saw him for the patriot he had always been, and before he died the reconciliation between the great surgeon and the country that he had fled nearly 40 years before was completed by his acceptance of the highest honor the King of Spain can bestow. And more significant yet of the extraordinary regard in which he was held, the citizens of Barcelona crowded the great church of Santa Maria del Mar to hear his funeral mass and to listen to the music of Pablo Casals, his old friend and fellow exile.

In the somewhat prosaic world of British ortho- pedics, the breadth of Joseph Trueta’s interests and influence, his sense of the drama of life and even perhaps his splendid misuse of the spoken English language all conspired to keep him a little apart from “The Establishment,” which, with another side of his personality, he so earnestly wished to join.

When Joseph and Amelia Trueta brought their young family to England and were befriended by G.R. Girdlestone, there was started a process that now links in a mutual experience some hundreds of men and women in many countries of the world. They remember the debonair, provocative and profoundly civilized man who enlarged our concept of the orthopedic surgeon to include the

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orthopedic scientist, and who by his example per- sonified both.

Joseph Trueta was more than a great clinical scientist; he was a man of immense intellectual distinction who could fascinate with his views on history, music, art, politics and people just as effectively as he would expound originally on the fundamentals of orthopedic disease. He generated a sense of authority, which was totally divorced from any pomposity or “chiefmanship.” Always realizing that one was in the presence of a master, one still felt completely at ease and could inter- rupt and contradict as though in discussion with an equal. This was one of his great strengths. As an orthopedic thinker, he will probably be judged by posterity as one of the most outstanding in his generation, yet he was completely open to ideas from a new house surgeon or from a worker in some quite unrelated field of medicine or science.

His scientific ethos was the primal position of the vasculature in health and disease. “It’s all a matter of blood supply,” was the basis of his philosophy of wound care. Likewise it was the essence of his novel concepts of the cause of many renal disorders, the pathology of osteoarthritis and the treatment of osteomyelitis.

He believed that the capillaries held the key to the understanding of the mysteries of development and decay of the human skeleton. His views, always unusual, were presented with passion in his own special brand of English, spoken with an arresting Catalan accent. While the listener was fascinated and stimulated, J.T. was always evolv- ing the concept as he went on explaining. Then it was back to the data and the experiment for further clarification.

In the early days in Oxford, this meant consid- erable efforts, because in 1947 he had to use the animal house at the Royal Veterinary College in London for his studies on long bone vasculariza- tion, making the journey from Oxford twice a week. Later he established his own facilities at the Nuffield Orthopedic Centre, surely the first in a British orthopedic hospital. For 20 years he was the acknowledged leader of one aspect of the emerging science of orthopedics—the investiga- tion of the disordered biology of bone.

He was a man of great loyalty, who inspired love and loyalty in his family, his friends, his patients and his pupils. Countless patients revered him; Lord Nuffield financed his concept of an

Orthopedic Centre at Headington, which was to house a School of Orthopedics, whose alumni now occupy professional chairs and other posi- tions of high responsibility in many countries of the world.

He loved to recount the story of his first meeting with Girdlestone at the surgical section of the Royal Society of Medicine, where he had been booked to speak on his experience in the Spanish Civil War, which was so relevant to what was about to break on Britain. He agreed to speak in French with an interpreter, but no sooner had he begun than up jumped G.R.G. to demand that he use English, no matter how poor. J.T. complied but he felt that the lecture was a disaster; at the conclusion the man with the piercing blue eyes who had interrupted came and grasped his hand with both his own and urged him to visit him in Oxford. This he did and stayed for 30 years.

That original meeting was crucial for all who worked and learned at his side. He loved G.R.G.

and gave everything he could to assist him, and after his death in 1950 J.T. perpetuated his tradi- tion in the minds of those men and women who came to Oxford under the influence of his own inspiration.

J.T. was a man of passion who always seemed to be in the throes of some excitement. When the violence of the Spanish Civil War was ultimately replaced by peacetime Oxford, there were always exciting plans, unexpected setbacks, overcrowded calendars and last-minute departures. Nothing ran smoothly for very long, but the ending was always happy.

The memory of this elegant, handsome man of natural refinement will remain bright in the minds of all who knew him. His delight was his family;

his wife and his three daughters and in turn their children, and also his family of pupils. He was a benign father to many of us. Some of us may have regrets that we did not repay more, but we will all be grateful for having known a man so great.

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