Karl Iversen NISSEN 1906–1995

Who’s Who in Orthopedics

served all these hospitals until his retirement in 1971.

This bare outline of his career does nothing to highlight his special talents or his stimulating per- sonality. In the early years he contributed erudite papers on the pathology of carpal tunnel syn- drome and of Morton’s metatarsalgia, but soon developed his special interest in osteoarthritis of the hip—or “primary coxarthrosis,” as he pre- ferred to call it. This motivated him throughout the rest of his life. Early on, he was quick to embrace the novel technique of replacement of the femoral head pioneered by the Judet brothers of Paris in 1950, and he wrote a book on the subject. The operation, however, failed to pass the test of time and was abandoned.

From then on, Nissen championed the cause of minimal displacement intertrochanteric osteotomy of the femur, a development of the original McMurray osteotomy. He saw in this a means of promoting natural healing through the medium of “tufts” of cartilage that sprouted from the articular surfaces. In many cases he was indeed able to show the reappearance of a sub- stantial cartilage space after the operation, which could persist for 20 years or more. He put the case for this “conservative” operation with character- istic force against the total joint replacement that was being advocated by Charnley to the exclusion of all other techniques. Nissen and Charnley each performed his chosen operation before the cameras for a notable television program some 30 years ago: Nissen was always keen to show later radiographs of his patient, who had gained lasting benefit from the osteotomy.

Nissen was always a stimulating teacher. At the Royal National Orthopedic Hospital he organized and convened annual postgraduate courses for young surgeons from European countries. The popularity and success of these courses were largely due to his infectious enthusiasm. They brought him many lasting friendships among European colleagues and led to his being elected as corresponding member of most of the ortho- pedic societies of Western Europe—honors that he greatly cherished.

He had a natural aptitude for the English lan- guage and a rare capacity for critical assessment of scientific papers, which led to his being drawn into the activities of the British volume of The Journal of Bone and Joint Surgery by Sir Reginald Watson-Jones, the journal’s first editor.

He served the journal with great loyalty for many years—mostly in an honorary capacity—and 244

Karl Iversen NISSEN

1906–1995

Karl Nissen began his career in England only 2 years after that great pioneer, Sir Robert Jones, had died. He was almost contemporary with such surgeons as Watson-Jones, Osmond-Clarke and Jackson Burrows. He added luster to the orthope- dic scene.

Karl Iversen Nissen was born in New Zealand of a Danish father and an English mother. Quali- fying in 1932 from the University of Otago, he first went into general practice before deciding to specialize. A research project followed, in which he studied in great detail several generations of a family affected with brachydactyly. A thesis based on this work gained him the MD (New Zealand) in 1934. In another project he studied that ancient reptile, the tuatara—almost unchanged in 130 million years and unique to New Zealand’s North Island.

Nissen came to England in 1935 to study for the FRCS examination and to train in surgery. He never returned to New Zealand. After a period in general surgery, he trained in orthopedics at the newly established Princess Elizabeth Orthopedic Hospital in Exeter, under the tutelage of Norman Capener, and later at the Royal National Ortho- pedic Hospital. During the Second World War he served in the Royal Naval Volunteer Reserve, mainly in South Africa and St. Helena.

After the war, Nissen was appointed to the staff

of the Royal National Orthopaedic Hospital and

was orthopedic surgeon to the Harrow Hospital

and the Peace Memorial Hospital in Watford. He

Who’s Who in Orthopedics even today there are many who are grateful to him

for honing their papers to his own high standards.

After his retirement he maintained a keen inter- est, especially in hip surgery. He continued to attend meetings and conferences. He studied French to enliven his contacts with friends in France and Belgium, and to give lectures in the native tongue. At the same time he devoted himself to the care of his ailing wife Honor, often taking her in her wheelchair for holidays abroad.

She died in 1981.

In later life Nissen himself was severely hand- icapped by peripheral neuropathy, but in spite of increasing difficulty in walking he remained active, through sheer determination. His enquir- ing mind and the wide scope of his interests led him to a deep study of the genetic basis of osteoarthritis and the early history of Man. He hypothesized on the manner in which early migra- tions of tribes carrying genes that marked specific skeletal disorders are reflected today in the world distribution of such disorders as congenital dislo- cation of the hip and osteoarthritis of the hip and knee.

Karl Nissen loved people. His hobby was conversing with colleagues, juniors, or even total strangers. He was always kind and notably gen- erous, with a happy twinkle in his eye. For many years after retirement he made a practice of enter- taining two or three sixth-formers from Sherborne School to tea on Sundays, and doubtless added significantly to their education from his enormous store of general knowledge and anecdotes. A few months before his death he gained particular pleasure from being able to travel to Aberdeen for the annual meeting of the British Orthopedic Association, at which he was given a standing ovation after accepting an honorary fellowship.

245

George C. NOULIS

1849–1919

George C. Noulis was born in the village of Paracalamos of Pogoru, Ioannina, Greece. He received his elementary and high school educa- tion at the famous Zosimea School in Ioannina, from which he graduated with honors in 1866. He was admitted to the University of Athens School of Medicine as an exceptional student, where he earned his medical degree with honors in 1871.

He was granted a scholarship to pursue postgrad- uate study at the University of Paris Faculty of Medicine. Noulis studied in Paris for 5 years, receiving further training in internal medicine and general surgery.

On May 3, 1875, Noulis defended his thesis,

“Sprains of the Knee,” before a committee at the University of Paris School of Medicine, which included many prominent professors. In his doc- toral thesis, Noulis described precisely the role of the cruciate ligaments of the knee and how to test their functional integrity. The method Noulis described in his thesis is identical to that used in the Lachman test. The article, “How New is the Lachman Test?”

cited the observations Noulis made 117 years before, and credited him with being the first to describe the physical finding.

Noulis returned to Greece in 1876, where he practiced medicine in Ioannina, which at that time was still a part of the Ottoman Empire. Because of his ability, Noulis was elected to be one of five physicians designated as physicians of the poor.

He also became the chief surgeon of the local

hospital. In this position he had a large practice,