Diseases of the Hip, Knee and Ankle Joint

Last week the National Health Service celebrated its 75^th anniversary. It is interesting to note that a rare first edition of the book ‘Diseases of the Hip, Knee and Ankle Joint and their treatment by a new and efficient method’ authored by the surgeon Hugh Owen Thomas and published in 1875, was bought by the Library last year. The book was published by T. Dobb of Liverpool and bears the author’s signature on the title page.

Hugh Owen Thomas was born in Anglesey in 1834. He first trained as a surgeon with his uncle, Dr Owen Roberts at St. Asaph in North Wales for four years, then studied medicine at Edinburgh and University College, London. He developed into a successful orthopaedic surgeon and brace-maker in Liverpool and wrote widely on the treatment of fractures using the pioneering methods that he developed. This is one of Thomas’s earliest publications, most of which were printed in very small numbers for the purpose of presentation to his friends. He made no effort to promote or publicise the book and it is believed that he destroyed all undistributed copies.

At least three of the basic scientific precepts of fracture therapy are due to Thomas. First is the importance of enforced and uninterrupted rest for the patient. Secondly is the adverse effect of forcing a contracted joint and thirdly is the importance of stimulating the circulation within the immobilized limb during the healing period.

The surgical methods described in the book are still used today and this has enabled many more patients to be treated successfully, avoiding defective healing of limbs after fractures, and succeeding in significantly reducing the number of amputations.

This book was published seventy-three years before the founding of the NHS. It offers a glimpse to the availability of medical care to the general population before state provision. There are regular references to the cost of treatments and that their availability depends on the wealth of the patient.

It is interesting to note that Thomas reports treatment methods used by surgeons throughout the world. He evaluates these different approaches critically and seeks to improve on them when devising his own techniques. He also includes a number of case studies which shows that he carefully considers the successes and failures of his techniques when educating other surgeons.

Hugh Owen Thomas certainly made a significant contribution to the advancement of surgical methods over many decades.

Hywel Lloyd,

Assistant Librarian.

This post is also available in: Welsh