Hugh Owen THOMAS1834–1891

Who’s Who in Orthopedics

he was fully alive to the advantages of medical training, and sent all his five sons to a medical school—surely a unique occurrence for one family. Each of them qualified to practice medi- cine. The eldest and the youngest, Hugh Owen and John Lewis, became widely known, one as a pioneer of orthopedic surgery and the other as a leader in gynecology.

H.O. Thomas was a small, thin, and nervous boy. Because of indifferent health he was sent to live with his grandparents at Rhos Colyn, where he went to school until the age of 13 years. His headmaster took a particular interest in him.

During this time he sustained an injury, the effects of which were life-long. A boy threw a stone, which struck him under the left eye. The result- ing scar caused a painful ectropion. In later years he always wore a seaman’s cap with the peak tilted down over the injured eye in order to protect it from cold winds and to screen the disfigure- ment. From Rhos Colyn he went on to the college at New Brighton, where he remained until the age of 17, when he became apprenticed for 4 years to his maternal uncle, Dr. Owen Roberts of St.

Asaph, who was surgeon to the Workhouse Infir- mary. In 1855, Thomas enrolled as a student at the University of Edinburgh at a time when Syme, Simpson, and Goodsir were at the height of their fame. Lister and Turner, newly arrived from London, were beginning their great careers in Scotland. After two winter sessions he transferred to University College, London, where he spent a third session. In 1857, when 23 years of age, he qualified as a member of the Royal College of Surgeons and then went to study the work of French surgeons in the hospitals of Paris. He admired the ingenuity and craftsmanship of the surgical instrument-makers and brought home ophthalmic knives on which he subsequently modeled his tenotomes. He joined his father in the practice at Great Crosshall Street, bringing to it a critical mind based on knowledge acquired at great medical schools. He could not help making suggestions about treatment, but he was not as tactful as he might have been. His father resented changes in the traditional procedure and at the end of a year the partnership ceased.

Hugh Owen Thomas started practice on his own at 24 Hardy Street in 1859 and became medical officer to several labor organizations and societies. His reputation grew rapidly and the number of his patients so increased that he had to seek greater accommodation. He found it at 11 Nelson Street, to which he moved in 1866. Soon, 330

Hugh Owen THOMAS

1834–1891

Hugh Owen Thomas was born at Bodedern, Anglesey, on August 23, 1834. He was descended from a well-known family of bonesetters, who for three generations had practiced their art in North Wales. They derived from Evan Thomas of Maes, of Spanish descent, who died in 1814 at the age of 79 years. A tablet to his memory was placed in Llanfairynghornwy Church, Anglesey, by Vis- count Bulkeley, in which tribute was paid to the esteem in which he was held as a great boneset- ter. Evan Thomas, the father of Hugh Owen Thomas, left Wales and settled in Liverpool at 72 Great Crosshall Street. He acquired an extensive practice in the treatment of fractures and bone and joint diseases. He held conservative views and differed from other bonesetters in that he never attempted to manipulate joints except to reduce dislocations by slow traction. In the setting of fractures he used a pulley, and insisted that a broken bone should have its proper length restored and the fragments brought into good alignment. Well-padded wooden splints were used for protection. Long continued rest was the principle he adopted in the treatment of chronic joint disease and in this way many a limb escaped amputation.

His success, however, was not altogether con-

genial to qualified practitioners and, notwith-

standing that the treatment of fractures was a

fertile field for failure, no matter who engaged in

it and no matter how painstaking he might be, he

had to suffer much criticism and opposition. But

even this house had to be enlarged by the build- ing of an extension of two waiting rooms, four consulting rooms, a surgery, and a workshop.

The house in Hardy Street was converted into a private hospital of eight beds with a trained nurse in charge. He staffed the workshop with a smith and a leather-worker, who were fully occupied in making splints and appliances of his design. Such was the establishment of Hugh Owen Thomas in 1868. What other physician or surgeon in Britain thought it essential to have a private hos- pital and an elaborately equipped workshop whereby to treat his patients and work out his ideas?

It mattered little that he never occupied a resi- dent hospital appointment, or that he was osten- sibly in general practice. Three factors accounted for his unique emergence as a surgeon of extraor- dinary type. First was his ancestral background:

he had inherited an unorthodox therapeutic of which he was to be the interpreter. Secondly, the field of his labors was eminently suitable for the application and wide extension of that therapeu- tic. Lastly, he was fortunate in the timely teach- ing of John Hunter’s “Rest and Pain,” which fitted his own conception of the way of cure for bone or joint afflicted with disease or injury.

Like Hunter, he had respect for the inherent power of repair possessed by living organisms. To foster this property of tissues he avoided, as he put it, “a hankering to interfere, which thwarts the inherent tendency to recovery.” In the treatment of tuberculous joints, he believed that the one essential was enforced, uninterrupted, and pro- longed rest.

He complained that surgeons did not know the meaning of rest, or if they did they were unable to secure it, with the result that many limbs were amputated.

Although for many years he had achieved remarkable results in the treatment of chronic joint diseases, his methods were not known until, at the instigation of Rushton Parker, he published in 1875 his first book entitled Diseases of the Hip, Knee, and Ankle Joints.

In this work the now famous hip and knee splints were described for the first time. He had tried his methods, and care- fully checked his results, on more than 1,000 patients before proclaiming the principles of his treatment. This publication revealed him as an original thinker in surgery. His appliances were the outcome of much probing of the problems of disease and deformity and of the laws that gov- erned restoration of function. After many trials, he simplified the construction of his splints to a

single design so that they would “enable any surgeon to treat his cases at home, with no more mechanical assistance than can be rendered by the village blacksmith and saddler.” But it is a great error to believe that Thomas was no more than an inventor of splints; indeed he protested against such an estimate of his work. He wrote on frac- tures and dislocations. By means of fixed traction and the bed caliper splint, he achieved in workmen’s dwellings such results in the treatment of fractures as were probably unequalled by any other practitioner. No surgeon in England handled so many fractures in one year or devoted such meticulous care to their management. In those days, the fracture was the Cinderella of surgical practice. Rest and alignment were his watch- words. Both were secured by his splints in a day when no x-rays were available.

In the treatment of infantile paralysis, he again insisted on rest, coupled with relaxation of the paralyzed muscles. An example of this principle was the cock-up splint he developed for drop- wrist. He introduced many other devices such as the wrench, the cuff and collar sling, the practice of damming and percussing for ununited frac- tures, and the clinical test for flexion deformity of the ankylosed hip. Once embarked as a writer, he issued a series of “Contributions to Medicine and Surgery,” which appeared at intervals throughout the rest of his life. All his teaching is embodied in these works, but unfortunately they were not well produced; he chose an unknown publisher;

they appeared in paper covers; they did not find a ready sale; and his teaching was much less dif- fused than it should have been.

Furthermore, he ploughed a lonely furrow and had few profes- sional contacts in Liverpool. There were discern- ing surgeons who valued his work—Edmund Owen, Ericksen, Thomas Bryant, and in America, Gibney, and Ridlon—the latter traveled to England to see his work and was amazed at what he saw.

Thomas was invited to scientific meetings to disclose his teaching, but he could not be induced to leave his practice. For 30 years he took no holiday. His teaching, however, was preserved. In 1864 he married Elizabeth, the daughter of Robert Jones of Rhy1, and was completely happy. They had no children and in 1873 they offered their young nephew Robert a home in Liverpool in order that he might study medicine. Uncle and nephew became deeply attached and the younger man imbibed all that Thomas could teach. In later years the disciple became the zealous apostle of 331

Who’s Who in Orthopedics

Thomas and at last the profession throughout the world became acquainted with his doctrine.

Thomas, overworked, died at the age of 57 on January 6, 1891. The manifestation of grief in Liverpool was astonishing. It was a testimony to

“his personal care in the service of his patients.”

No other pioneer contributed so much in estab- lishing the fundamental principles of orthopedic surgery.

References

1. Aitken D McC (1935) Hugh Owen Thomas. Oxford University Press, London, Humphrey Milford 2. Keith A (1919) Menders of the Maimed. Henry

Frowde, Oxford University Press, Hodder, Stoughton, Warwick Square, London, EC

3. McMurray TP (1935) Centenary Lecture on “The Life of Hugh Owen Thomas.” Liverpool Medical Chirurgical Journal vol XLIII, part 1:3–41 4. Thomas HO (1875) Diseases of the Hip, Knee, and

Ankle Joints. Liverpool, T. Dobb & Co

eight children, four boys and four girls. All of his brothers became surgeons and one sister married a surgeon. He received a Bachelor of Arts degree from the University of Texas in 1927 and a Doc- torate of Medicine from the University of Texas Medical School in 1931. He pursued postgradu- ate training in surgery at the Roosevelt Hospital in New York City and became a fellow at the New York Orthopedic Dispensary and Hospital in 1934, finishing his orthopedic training in 1939.

During that time he married Carolyn Laura Bryan, also from Texas.

Following a tour of the orthopedic clinics in Europe, Dr. Thompson joined the staff at St.

Luke’s Hospital in 1935, at the invitation of Dr.

Mather Cleveland. His interests in orthopedic surgery were widespread. He wrote 41 medical manuscripts and was the author of nine medical motion pictures. Although his primary interests involved hip and spine surgery, his publications included articles on trauma and adult and pedi- atric reconstructive surgery.

Dr. Thompson’s most outstanding contribution to orthopedic surgery was the development, in 1950, of the hip prosthesis that bears his name.

This design became a prototype for many later prostheses, including the femoral component for the total hip replacement in use today.

A member of many societies, including the American Orthopedic Association and the Cana- dian Orthopedic Association, Dr. Thompson was president of the Russell Hibbs Society in 1950, president of the Association of Bone and Joint Surgeons in 1961, a founding member of the Hip Society, and vice president of the American Academy of Orthopedic Surgeons from 1966 to 1968.

Dr. Thompson became director of orthopedic surgery at St. Luke’s Hospital in New York City in 1961, succeeding Dr. David M. Bosworth. An excellent technical surgeon, he personally tutored his residents in the art and skills of surgery. He demanded the highest level of proficiency and would never accept less. Under his direction, the size and scope of the orthopedic service grew, making it one of the most outstanding services and residencies of the hospital.

Although he committed most of his time to orthopedic surgery, Dr. Thompson was a devoted sportsman with great interest in hunting and fishing, which provided an important diversion from his medical activities. He approached these hobbies with the same enthusiasm as he did his professional life, and was particularly interested 332

Who’s Who in Orthopedics

Frederick Roeck THOMPSON

1907–1983

Frederick Roeck Thompson, former director of the Department of Orthopedic Surgery at St.

Luke’s Hospital Center in New York City, died on April 12, 1983. He was 75 years old.

Born in Galveston, Texas, in 1907, the son of

James Edwin Thompson, professor of surgery at

the University of Texas, Frederick was one of