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Hugh Owen Thomas

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Hugh Owen Thomas
Hugh Owen Thomas

Hugh Owen Thomas (23 August 1834 – 6 January 1891) was a Welsh orthopaedic surgeon. He and his nephew Robert Jones have been called "the Fathers of orthopaedic surgery".

Thomas was descended from a line of Welsh bone setters and placed great importance on rest in treatment of fractures. He is responsible for a number of contributions to orthopaedic treatment and surgery, producing a number of books and methods that revolutionised orthopaedic practice. He is particularly known for the Thomas splint, which was widely used during World War I, reducing mortality from 80% to just 8% by the end of the war. His principles of practice were also spread to the USA by John Ridlon, amongst others.[1][2][3]

Family background

Hugh Owen Thomas was the great-grandson of a young boy who had been shipwrecked on Ynys Môn/Anglesey between 1743 and 1745 with his brother. One of the young brothers died a few days later bur the survivor was given the name Evan Thomas by the family that adopted and raised him, he established a family tradition of bone-setting. Later DNA investigations found Evan Thomas to have come from the Caucasus mountains, on the Georgia-Russia border.[4][5]

Early life and education

Hugh Owen Thomas was born on Ynys Môn/Anglesey on the 23rd of August, 1834 whilst his mother was visiting relative on the island. Hugh was described as frail child and his parents sent him to live with his grandparents on Ynys Môn/Anglesey until he was 13, hoping this environment would benefit his health more than industrial Liverpool. Whilst at school, another school-boy threw a stone at Thomas, hitting him causing an ectropion eye. Thomas started wearing an eye patch to keep the cold air out and later kept his peak hat down over it to stop others from staring.[6][7][8]

The eldest son of Evan Thomas (the grandson of the prior Evan Thomas of the same name), Hugh Owen Thomas was educated at the college at New Brighton, until the age of 17. He was and apprentice to Dr. Owen Roberts before studying at Edinburgh University in 1855. Following two sessions in Edinburgh, he moved to University College London for his third session. In 1857 he qualified with an MRCS England and travelled to Paris to study surgery.[9]

A plaque dedicated to Hugh Owen Thomas at Llys Meddyg, Bodedern, Ynys Môn/Anglesey."Hugh Owen Thomas, 1834 - 1891, Meddyg Esgyrn" (Bone Doctor).

Professional career

Following his stint in France, Hugh Owen Thomas joined his father Evan Thomas' practice for a year.[9] His working relationship deteriorated with his father, as the academically uneducated father and medically educated son continued to disagree.[8] Thomas started his own practice at 24 Hardy Street, Liverpool and in 1866 he acquired 11 Nelson Street, Liverpool, enlarging the surgery house to contain two waiting rooms, four consulting rooms, a surgery, and a workshop.He employed a full-time smith and leather worker to make splints and other medical devices that he himself designed and treated many patients from the Merseyside area. He is known for his principles of rest and bone alignment before the discovery and use of x-ray and was also known for encouraging immobility and rest of the injured or diseased bone or joint. In 1875, Thomas published his first book, titled "Diseases of the Hip, Knee, and Ankle Joints" where he first described his designs of the hip and knee splints.[10]

Medical legacy

Application of the Thomas splint.

His contribution to orthopaedics was manifold. In the treatment of fractures and tuberculosis he advocated rest, which should be 'enforced, uninterrupted and prolonged'. He designed the Thomas Splint to treat fracture of the femur and hip joint, the Thomas test to assess for hip contracture and extensibility, the Thomas collar to treat tuberculosis of the cervical vertebrae, and the Thomas manoeuvre to assess for hip joint fracture, the Thomas wrench to reduce fractures (bring bones back into place) and the Thomas heel to prevent depression of the talus bone (in the ankle).[11][12]

Thomas Splint

Main article: Thomas splint

In order to achieve a combination of prolonged rest, Thomas created the 'Thomas Splint', which would stabilise a fractured femur and prevent infection.[11] The Thomas splint was introduced in 1916 to treat injured soldiers and reduced the rate of mortality from fractures (particularly femoral fractures) from 80% to 20%, in 1918.[2]

Thomas test illustration. From Hugh Thomas Owen's "Diseases of the hip, knee, and ankle joints: with their deformities, treated by a new and efficient method", 1875.

Thomas Test

Main article: Thomas test

The Thomas test, is a method of detecting hip flexion contracture (fixed partial flexion of the hip) and to measure hip extensibility by having a patient lie flat on a firm bed/table whilst holding one knee to their chest. The opposite thigh is then observed for hip contracture and extensibility.[13]

Thomas manoeuvre

Thomas's manoeuvre' is an orthopaedic investigation for fracture of the hip joint.[14]

Thomas Collar

See also: Cervical collar

The Thomas's collar' was designed and applied to treat tuberculosis of the cervical vertebrae of the spine.[11]

Thomas Wrench

The 'Thomas's wrench' was designed for reducing fractures.[11] and correct clubfeet. The club foot would be rolled between the two shorter cylinders to forcibly correct it.[15]

Thomas Heel

The 'Thomas heel' is part of a shoe for children consisting of a heel one-half inch (12 mm) longer, and an eighth to a sixth of an inch (4 to 6 mm) higher on the inside. This is used to bring the heel of the foot into varus deformity, and to prevent depression in the region of the head of the ankle bone.[12]

Memorial in Toxteth Park Cemetery

Works

  • Diseases of the hip, knee and ankle joints (1876)
  • A review of the past and present treatment of disease in the hip, knee, and ankle joints: With their deformities (1878)
  • The past and present treatment of intestinal obstructions (1879)
  • The treatment of fractures of the lower jaw (1881)
  • Intestinal disease and obstruction (1883)
  • Nerve inhibition and its relation to the practice of medicine (1883)
  • Principles of the treatment of diseased joints (1883)
  • The collegian of 1666 and the collegians of 1885: Or, what is recognised treatment? (1885)
  • The principles of the treatment of fractures and dislocations (1886)
  • Fractures, dislocations, diseases and deformities of the bones of the trunk and upper extremities (1887)
  • A new lithotomy operation (1888)
  • An argument with the censor at St. Luke's Hospital, New York (1889)
  • Fractures, dislocations, deformities and diseases of the lower extremities (1890)
  • Lithotomy (1890)

References

  1. ^ Cope, R. (1995). "Hugh Owen Thomas: bone-setter and pioneer orthopaedist". Bulletin (Hospital for Joint Diseases (New York, N.Y.)). 54 (1): 54–60. ISSN 0018-5647. PMID 8541785.
  2. ^ a b Archives, The National (1 December 2016). "The National Archives - A revolution in treatment: the Thomas splint". The National Archives blog. Retrieved 25 April 2022.
  3. ^ "DNA unravels clues to shipwrecked Anglesey bone setter". BBC News. 5 August 2012. Retrieved 25 April 2022.
  4. ^ "DNA unravels clues to shipwrecked Anglesey bone setter". BBC News. 5 August 2012. Retrieved 25 April 2022.
  5. ^ Groom, Polly (22 October 2015). "Welsh History Month: Hugh Owen Thomas, inventor of the Thomas splint". WalesOnline. Retrieved 25 April 2022.
  6. ^ Carter, A. J. (21 December 1991). "Hugh Owen Thomas: the cripple's champion". British Medical Journal. 303 (6817): 1578–1581. doi:10.1136/bmj.303.6817.1578. ISSN 0959-8138. PMC 1676236. PMID 1773176.
  7. ^ "Historical Article (Mel Jones)". Welsh Orthopaedic Society. Retrieved 25 April 2022.
  8. ^ a b Wren, Sarah; Ashwood, Neil (October 2010). "The life and times of Hugh Owen Thomas". Trauma. 12 (4): 197–201. doi:10.1177/1460408610381548. ISSN 1460-4086. S2CID 57767973.
  9. ^ a b "THOMAS, HUGH OWEN". biography.wales. Retrieved 25 April 2022.
  10. ^ "THOMAS, HUGH OWEN". biography.wales. Retrieved 25 April 2022.
  11. ^ a b c d "Thomas wrench for club foot". Royal College of Physicians and Surgeons of Glasgow. Archived from the original on 19 November 2014. Retrieved 6 September 2015.
  12. ^ a b "Thomas heel".
  13. ^ Vigotsky, Andrew D.; Lehman, Gregory J.; Beardsley, Chris; Contreras, Bret; Chung, Bryan; Feser, Erin H. (11 August 2016). "The modified Thomas test is not a valid measure of hip extension unless pelvic tilt is controlled". PeerJ. 4: e2325. doi:10.7717/peerj.2325. ISSN 2167-8359. PMC 4991856. PMID 27602291.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  14. ^ "Thomas's manoeuvre (Hugh Owen Thomas)". www.whonamedit.com. Retrieved 25 April 2022.
  15. ^ "Thomas Wrench". Worcester Medical Museums. Retrieved 25 April 2022.

Further reading

  • Aitken, D. McCrae, Hugh Owen Thomas: His Principles and Practice (London, Oxford university press, 1935)
  • Watson, Frederick, Hugh Owen Thomas: A Personal Study (London, Oxford university press, 1934)
  • Le Vay, Abraham David, The life of Hugh Owen Thomas (Edinburgh, 1956)
  • McMurray, Thomas Porter, The life of Hugh Owen Thomas: Centenary Lecture Delivered at the Liverpool Medical Institution (1935)
  • Galasko, Charles S. B. (1988). "Sir Harry Platt and the evolution of orthopaedic surgery in North-West England". In Galasko, Charles Samuel Bernard; Noble, Jonathan (eds.). Current Trends in Orthopaedic Surgery. Manchester University Press. ISBN 9780719025358.
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