that you may be receptive of the tribute paid to doctors by Jeshua, the son of Sirach, early in the second century before Christ. He writes: “. . . The skill of the physician exalts him, And he is admired among the great.”
The active and productive life of Fremont A.
Chandler came to an end suddenly and without warning on Christmas Eve 1954. Truly, Fremont A. Chandler is a worthy example of Jeshua’s saying. He was “admired among the great” of his day, and long will he be remembered in the days to come for the sound and lasting contributions he made to his beloved orthopedic surgery; and with the passage of time, his name will grow.
Perhaps his greatest contribution was the recognition that “locomotor ataxia,” a frequent cause of disability, was caused by tabes dorsalis, a form of neurosyphilis. Charcot was a great teacher, whose clinics became world famous. His relationship with Duchenne was very productive and his students, Jules Dejerine, Pierre Marie, and Babinski, carried on his great tradition.
60 Who’s Who in Orthopedics
Jean-Martin CHARCOT
1825–1893
Jean-Martin Charcot was born in Paris where his father was a carriage builder. He was educated in Paris and, after deciding to become a doctor, entered medical school at the age of 19. At that time, Paris was the world center of medical thought and activity: Charcot was exposed to some of the best teachers available.
As he progressed through his training, he con- tinued to develop his skills at drawing. His doc- toral thesis, illustrated by his own drawings, dealt with the differential diagnosis of gout and other forms of acute rheumatism.
Moving up the academic ladder, Charcot, in 1862, was appointed chief physician of l’Hospice de la Salpêtrière, an ancient hospital that con- tained 5,000 chronically ill patients of all types.
It was from this voluminous material that he described various conditions that established his reputation as a founder of the specialty of neurology.
John CHARNLEY
1911–1982
John Charnley was born in Bury on August 29, 1911. He was educated at Bury Grammar School and Manchester University, where he was awarded several prizes and scholarships. He made his ambition for a surgical career plain by passing the primary examination of the Royal College of Surgeons while he was an undergraduate—a feat that was possible for the gifted students of those days—and he became a Fellow of the college in 1936, 1 year after graduating in medicine.
Before the outbreak of the Second World War he held surgical appointments at Manchester Royal Infirmary and Salford Royal Hospital. It was evident then to his mentors and contempo- raries that he was destined for a brilliant career.
During his period of army service, spent in the Middle East, he used every opportunity to work in the REME workshops where he produced an adjustable Thomas’ splint, which was widely used in the treatment of casualties from the North African campaigns. This engineering experience
was later put to good use in his biomechanical laboratory.
After the war, Charnley returned to Manches- ter; he was appointed lecturer in orthopedic surgery and started a long and fruitful association with Sir Harry Platt. They had much in common, a directness of vision and purpose and a dislike of humbug. Sir Harry was one of John’s staunchest supporters and was instrumental in persuading the Regional Hospital Board to back his revolutionary concept of a Centre for Hip Surgery. John maintained that significant advances in surgery could only be achieved by concentrating effort and research on a specific problem, a philosophy amply vindicated when the center at Wrightington became the Mecca for orthopedic surgeons from all over the world.
In 1947 he was appointed Consultant Orthope- dic Surgeon to Manchester Royal Infirmary and in 1950 his book on the Closed Treatment of Common Fractures was published. It was an orig- inal and stimulating approach to the manipulative treatment of fractures “which far from being a crude and uncertain art can be resolved into some- thing of a science.” It was an instant success and persuaded many orthopedic surgeons to revise some of their cherished suppositions.
In the late 1940s arthrodesis was regarded as an acceptable treatment for a stiff and painful joint, but no entirely reliable procedures were available. His technique of compression arthrode- sis of the knee, published in 1948, was simple and highly effective. The principle of this operation was extended to the hip and other joints. Com- pression arthrodesis of the hip was an ingenious procedure but it required considerable technical expertise and even in Charnley’s hands it was not always successful. He realized that fusion of the hip could only have a limited application and he turned his fertile mind to solving the problems of replacing the joint. Cup arthroplasty was an anathema to him; it offended his engineering prin- ciples and required a prolonged period of reha- bilitation. Total joint replacement was the only solution.
Charnley was appointed Professor of Orthope- dic Surgery at Manchester Royal Infirmary in 1972. He was appointed as a Doctor of Science of Manchester University in 1964 for his work on bone union and lubrication of joints. His remark- able achievements in the development of total joint replacement had received worldwide acclaim and the award of many honors and dec- orations. He was made a Commander of the
British Empire in 1970 and Knight Bachelor in 1977. In 1975 he was elected a Fellow of the Royal Society, an honor unique in the history of British orthopedics. The citation for the Lister Medal awarded the same year was an admirable summary of his achievements. “In a period of some 15 years totally concentrated on this diffi- cult problem by a combination of engineering, biological science, and superb surgical technique he has resolved these problems to the immense benefit of tens of thousands of patients. His inves- tigation of the mechanical, material, and surgical problems of total replacement of the hip have helped to advance joint replacement in the knee, elbow and elsewhere.” He received honorary doc- torates of the Universities of Liverpool, Leeds, Belfast and Uppsala and was an honorary member of numerous orthopedic associations in Europe and North and South America. In 1978 he was awarded the Gold Medal of the British Medical Association and later he became an Honorary Fellow of the British Orthopedic Association.
One of the honors that gave him special pleasure was conferred on him by the citizens of Bury in 1974, who made him a freeman of the borough.
Charnley’s approach to surgery was always that of a perfectionist. This is reflected in his report, Low Friction Arthroplasty of the Hip: Theory and Practice, published in 1979, in which he described the operation in minute detail. For some years he insisted that surgeons who wished to perform the operation must first master the tech- nique by working with him at Wrightington.
There were those who thought that this was an attempt to maintain the unique position of the Centre for Hip Surgery, but this was not so, he was determined that surgeons should not under- take the operation with only general knowledge of the principle in the hope that they could improvize the details. A constant stream of sur- geons came to Wrightington from all over the world, where they were treated to a surgical tour de force and at the same time warned of the mishaps that could and did occur from shoddy surgery.
He had no time for medical politics or com- mittees and it was the “establishment” more than anything else that provoked his occasional explo- sions of anger. He worked with unabated energy after his retirement from the Health Service in 1976 and lost none of his interest and enthusiasm for research.
John had a lighter side, he loved a party and had a great sense of fun. He enjoyed messing 61
Who’s Who in Orthopedics
about in boats and in his younger days he was a keen skier. It was on one these holidays in 1957 that he met his wife Jill; they were married 3 months later and had two children, Tristram and Henrietta. Jill was a gifted and charming hostess;
she created a beautiful home and a delightful garden at Mere in Cheshire, where she and John entertained their many friends and visitors from home and abroad with great generosity.
John Charnley, one of the most remarkable surgical innovators of this generation, died on August 5, 1982. He will be remembered by pos- terity for his low-friction arthroplasty of the hip, the inspiration of a surgical revolution that brought relief to countless patients crippled by arthritis.
Charnley is assured of a permanent niche in the annals of British orthopedic surgery. He will be remembered for his incisive thinking, his disdain of shibboleth, and his dedication to the solution of a surgical problem.
In the development of low-friction arthroplasty, Sir John was always ready to admit serendipity and good luck as well as help from his colleagues, experts in other disciplines and the Manchester Regional Hospital Board. What he never dis- cussed is the superhuman effort and single- mindedness needed to achieve the aim he so firmly believed in.
Starting with a single clinical observation of a squeaking femoral head replacement, he repeated experiments on lubrication of joints and dis- proved the results of others.
A biological approach to the problem using Teflon shells to replace articular surfaces of the hip failed. Not discouraged, he continued with Moore and Thompson femoral head replacements articulating on a Teflon shell; the shell moved against the bone causing wear and bone damage.
It was at this stage that the concept of “low fric- tional torque arthroplasty” was conceived and he developed a small diameter femoral head replacement, which articulated with a thick shell of Teflon; the Teflon failed. A lesser man would have surely given up. Yet the short-term clinical results had been so spectacular that he was con- vinced of the soundness of this concept. From then onwards, with the fortuitous introduction of high-density polyethylene, all his efforts were directed toward a perfect mechanical solution to a biological problem. In this he had the unfailing support of Chas F. Thackray of Leeds. He was the
first to use acrylic cement as it should be used—
as a grout. Parallel with this was the development of a clean-air operating enclosure, the total body exhaust system, special instruments and the tray system, which has made the operating room an extension of the autoclave and significantly reduced the rate of infection.
At the same time Charnley carried on with a very busy clinical practice and teaching both res- idents and visiting surgeons. He traveled exten- sively, lecturing, demonstrating and operating. He invariably provided the photographs and draw- ings for his numerous publications, including Low Friction Arthroplasty of the Hip: Theory and Practice.
He was proud of the Centre for Hip Surgery he created and the Low Friction Society formed by his past residents.
Every new problem was a challenge to be mas- tered. When histology of the bone–cement junc- tion was to be studied, he took up the challenge with enthusiasm. Even in his last months of life, when surely he must have been aware that his health was failing, he did not cease to work and plan for the future and was ready to travel to Japan when invited by one of his disciples.
In all this he never lost sight of the human aspect and would easily recall patients’ details from years before in a chance meeting in the long corridors of the hospital.
He will be missed by so many, including those he has worked with and those he has treated and whose lives he has shaped. He was a man of many talents, yet single-minded in his effort. If a man’s claim to immortality is judged by the quality of life he leaves behind and the alleviation of human suffering, then surely the long-term results of the low-friction arthroplasty must be the living monument to a truly great man and benefactor of humanity.
62 Who’s Who in Orthopedics
