In the last half of the 19th century, quickly following the advent of general anesthesia and the discovery of bacteria, some surgeons began specializing in treatments of the brain, eye, or other body parts. Fracture treatment, however, remained within the domain of the generalist in cities and at times left to the care of
This changed with the Industrial Revolution and specifically with the building of the Manchester Ship Canal in England, which remains the world’s longest river navigation canal at 36 miles.
Rather than war, which historically has been the usual catalyst for rapid advances in surgery, it was this massive peace-time project involving hundreds of cranes, locomotives, and excavators, thousands of trucks and wagons, and tens of thousands of construction workers. The mix produced a great number of skeletal injuries over the six-year construction period.
A few years earlier and because of hard times at home in London, Robert Jones, then a teenager, moved to Liverpool to live with his uncle, Hugh Owen Thomas. Thomas was an orthopedist. His father, grandfather, and great grandfather had been
Thomas made multiple contributions to the management of skeletal diseases that included published treatises on tuberculosis and on femur fractures. He encouraged his nephew, Robert, to attend medical school and then to join him in practice, which Robert did. Together Thomas and Jones developed a unique interest in fracture management whereas most orthopedists at the time dealt primarily with children’s skeletal deformities.
In 1888 there was a fortuitous turn of events. Jones became Surgeon-Superintendent of the Manchester Ship Canal construction project and took advantage of this opportunity to develop the world’s first comprehensive accident service. He spaced three hospitals at intervals along the canal with intervening first aid stations and a railroad connecting them all. Jones trained and staffed the hospitals with personnel skilled in fracture management, and he operated on many of the injured workers himself. This intense operative experience, along with great proficiency in the non-operative management of fractures, markedly improved fracture care techniques.
Soon after, these advances proved invaluable during the Great War when Jones became Inspector of Military Orthopaedics and oversaw a 30,000-bed organization. Knighthood followed.
In the course of their work, Thomas devised a splint for temporary immobilization of broken legs, and Jones devised a bulky bandage to be used after knee surgery. Both of these advances bear their innovator’s name and are still used today.
The most significant and lasting mark that these two orthopedists made on medicine, however, was that they defined a new specialty. Canal building and then a war ended a decades-long discussion about the nature of the specialty of orthopedics. Should it include surgical procedures or just focus on straightening crooked children with casts and splints? From 1920 on, the specialty has been appropriately called orthopedic surgery.
