A review of orthopaedic surgery in Britain.

Abstract

introduced cutting for the correction of deformity. Tenotomy of the Achilles tendon was in itself a simple procedure but it was a new departure in the cure of crippling; its success was sufficient to warrant W. J. Little’s embarking upon a close study of the etiology, pathology and rational treatment of deformity. To achieve this purpose hospital accommodation was essential; he found, however, that general hospitals were too preoccupied with a multitude of other ailments to give time or space for the problem of crippling in the community. He therefore aroused the interest of the public to the deplorable state of the crippled poor, and the response was such that in 1840 the Orthopaedic Infirmary was opened in Bloomsbury. In casting about for a name descriptive of the particular function of the institution Little adopted the word orthopaedia (“ straight child “) coined by Andry in 1741 from two Greek words. In this way the word orthopaedic was added to our English vocabulary-a term expanded in its meaning by the process of time. It is worth recording that British usage in writing the word has remained faithful to Greek etymology and has refused to pay homage to a confusing phonetic expediency. The work of the Infirmary grew so rapidly that by 1845 it moved to Hanover Square, to a building with greater accommodation, and was granted a Royal Charter of Incorporation wherein its name was changed to the Royal Orthopaedic Hospital. Orthopaedic surgery in England literally began on the threshold of the Victorian Era. The first decades were occupied in an intense study of the etiology and pathology of deformity as a scientific basis for treatment. Little and his disciple William Adams were particularly active in their investigations, each having a distinctive approach of his own to the problem of crippling. Little, cured by Stromeyer of Hanover of a paralytic equinovarus foot due to poliomyelitis, felt compelled to seek facilities for the treatment of cripples in England. But he remained a physician, although keenly interested in the investigation of deformity and in such correction as was obtainable by splinting, manipulation and tenotomy. His book, entitled A Treatise on Club Foot and the Nature of Analogous Distortions, published in 1839, is a classic. His lectures on deformities of the human frame were collected and published exactly a century ago and his famous paper on infantile spastic paraplegia was an important contribution to neurology and orthopaedics. The study of deformities was commended to Adams by his great teacher J. H. Green, the philosopher surgeon of St Thomas’s Hospital, who encouraged him “ to take up the new study of orthopaedy because it opened a wide field for pathological investigation and usefulness.” And when elected surgeon to the Royal Orthopaedic Hospital in 1851 Adams was already a well disciplined pathologist of considerable experience. With great energy he explored the whole field of deformity and wrote extensively upon it. What he wrote bears the impress of first-hand knowledge and research. He published a monograph entitled On the Reparative Process in Human Tendons, based on research on rabbits and observations of tenotomy in human beings over a period of nine years. He spent several years investigating club foot, its causes, pathology and treatment-work which secured for him a Jacksonian Prize. He made an exhaustive study of spinal curvature and published a book upon it; he asserted that “horizontal rotation of the bodies of the vertebrae always precedes lateral curvature.” His comfortably fitting spinal support has never been surpassed. Adams made wide use of subcutaneous tenotomy, employing it with great success in the treatment of wryneck and Dupuytren’s contracture.