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The life and times of Hugh Owen Thomas Sarah Wren and Neil Ashwood Trauma 2010 12: 197 originally published online 7 September 2010 DOI: 10.1177/1460408610381548 The online version of this article can be found at: http://tra.sagepub.com/content/12/4/197

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Trauma 2010; 12: 197–201

The life and times of Hugh Owen Thomas Sarah Wren and Neil Ashwood

A brief summary of the ancestry and life of Hugh Owen Thomas.

Key words: Hugh Owen Thomas; orthopaedics

Introduction It is impossible to attend medical school without acquiring at least some knowledge of Hugh Owen Thomas, and rightly so. Even those lacking an interest in orthopaedics cannot fail to appreciate the magnitude of his contribution to the specialty and indeed society as a whole. And yet, for someone who should have been so highly regarded, he sadly received little recognition while he was alive. More importantly however, he did receive sincere gratitude and adoration from the many hundreds of patients who would surely have lost their limbs without his care (Hagy, 2004). So why did the general public, especially the poor, love him and yet his peers disdain him?

Antecedent First of all, one cannot discuss the life of Hugh Owen Thomas without first reviewing the remarkable ancestry from which he came. To begin with, his great-grandfather was washed ashore on the Anglesey coast in a ship-wreck. Some people believed this occurred in 1740 but others say it was some time between 1730–1745 (Carter, 1991; Jones, 2003). There is controversy over his country of origin. It is generally thought that he was Spanish Queens Hospital, Burton upon Trent, UK. Address for correspondence: Neil Ashwood, Queens Hospital, Belvedere Road, Burton upon Trent, DE13 0RB, UK. E-mail: [email protected]

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although others have said that he was a Scot who was escaping to France following the Jacobite rebellion of 1745. Which of these possibilities is true will never fully be known, but what followed is more easily verified. This poor ship-wrecked boy was adopted by a local childless couple (Mr & Mrs Thomas) and was given the name Evan. The Thomas’ farmed maze between the church and the sea and even from an early age it was clear that Evan had a natural talent for healing, often helping injured birds and animals on the farm. Later he married a local Anglesey girl and fathered four sons, the most famous of whom was Richard Evans. Richard Evans earned his living as a farmer but also had an unusual talent for healing and the family began to be well known for being ‘bone-setters’. Many people, including the gentry, would turn to them for help, despite their not having a medical education. Richard was known for being austere, religious and having a very commanding personality. This is evident in one story, which relates how he was at a local fair when a couple of young lads mocked him and pretended to have a dislocated shoulder. Apparently, Richard Evans grabbed him and physically dislocated his shoulder, so that the boy had to beg Evans to reduce it for him. Richard Evans had seven children – three sons and four daughters, all of whom continued the family tradition of working as a bone-setter to some extent. Two of his daughters emigrated to America and practised successfully in Wisconsin. One of their brothers, Evan Thomas, was fully intending to join them; however, on reaching Liverpool he realised he did not have the fare for his passage to America. To earn money to pay for his fare, he worked in a foundry where he found many industrial injuries 10.1177/1460408610381548

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which he treated. Evan soon realised that he had such a good practice in Liverpool that he did not need to travel to America and so he settled in the city and his reputation continued to grow. Initially, he had a good relationship with the local medical doctors, who would refer him patients and at one point even talked of appointing him to the staff of the David Lewis Hospital but this never actually happened. Eventually, the relationship soured as the medical profession became increasingly frustrated at the significant earnings he acquired from his work and all ties were cut. However, the early relationship must have had some impact on Evan Thomas, as he insisted on sending all five of his children to medical school, determined that they would have the medical education that he was denied (Jones, 1953, 2003; Carter, 1991).

Early life One of those five children was Hugh Owen Thomas. Despite his father living and working in Liverpool (in Cross hall street), Hugh was born in Anglesey on the 23 rd of August, 1834 because his mother was on holiday visiting relatives when she went into labour. Hugh was a sickly and frail child. His parents were concerned about his poor health and felt that the countryside air would be more beneficial to him than the industrial Liverpool air so he was sent to live with his grandparents in Anglesey until he was 13. While he was there, he was the victim of an attack by another school boy who threw a stone at Thomas hitting him in the eye. An ectropion formed, and the young Thomas began to wear an eye patch to keep the cold air out and to stop others staring at it (Carter, 1991; Jones, 2003). This was later replaced by the peaked cap pulled low over the eye, which he became famous for in his later years. When he left school, Hugh was apprenticed to his uncle, Owen Thomas, and he went to Edinburgh University when he was 21. While he was there, he was horrified at the number of amputations he observed being carried out for tuberculosis, while he had watched his father treat patients afflicted with this disease conservatively with good results. He also studied the works of the seventeenth century physician Thomas Sydenham, who believed that illnesses were best treated by working with nature rather than against her. He was also greatly Trauma 2010; 12: 197–201

influenced by the professor of Medicine at Edinburgh University at the time, John Hughes Bennett, who was an early believer in the beneficial effects of fresh air. It was around this time that Hugh began to fully realise the potential of bringing the techniques that had been passed down to him from his forefathers into conventional medicine (Jones, 2003). He left Edinburgh after 3 years and went to London where he attended the University College Hospital, which meant that all five brothers were together in London, which was a rarity. He was going to sit for his final exams in 1857 when sadly his father became ill; so he was forced to return to Liverpool to take over his father’s practice (while presumably his father was cared for by his mother) until his father recovered. As he had missed his final exams, Hugh had to take a conjoint diploma instead and graduated with an LRCP MRCS. After graduating, Hugh travelled to Paris and spent some time there before returning to Liverpool to join his father’s practice (Carter, 1991).

Later career Inevitably, the working relationship between father and son soon disintegrated as the son with the medical education constantly crossed swords with the father who had no formal qualifications. As a result, Evan Thomas retired back to Anglesey 2 years later, leaving Hugh in Liverpool to start his own practice. He took up residence in Hardy street and had a practice in Nelson street. Gradually, both of these buildings were converted to suit his growing practice and ideas, with the Nelson street surgery including a workshop where he had a blacksmith, a saddler and a bandage-maker working full time for him, and the Hardy Residence became an eight-bed private hospital (Jones, 1953; Carter, 1991). Despite medicine being infamous for its long hours, I doubt if anyone before or since has worked as long hours as Hugh Owen Thomas. He worked 7 days a week, only taking three days off a year to visit his mother’s grave in Anglesey. His days started at 5 or 6 am, when he would start his home visits. Thomas believed that all fractures should be treated conservatively and at home (irrespective of the type of fracture – open, closed, comminuted or simple!) and he visited them all. After this, he went to Nelson Street where he would see an average of 40 patients

The life and times of Hugh Owen Thomas single-handedly, and if they required a splint, it was made there and then in the premises by his skilled staff. Following this (and a quick lunch!), he would return to Hardy street where he would begin operating and stay until 8 pm. It was at this time of the day that he would begin writing, as he was well known for being a prolific writer and would write well into the night. Surprisingly, he did not restrict his writing to orthopaedics and indeed covered other such topics as intestinal obstruction and cancer of the breast, ovary and mouth. Hugh’s long days meant that he saw on average approximately 80 patients a day in one capacity or another, though it was reported that on some days he would see as many as 162 patients in 1 day. He was also the surgeon for 28 labour organisations along the Liverpool docks (Watson, 1934; Jones, 2003). Despite these gruelling hours, he was described by many as being ‘full of energy’ and the great man himself once remarked ‘There isn’t a happier man in England than I am. I find my enjoyment in my work and my home and am never happier than here with all of you about and plenty of work. I would much prefer a short useful life to a long lazy one. I hope to die in harness’ (Jones, 2003). During these intensive working hours, Thomas contemplated and refined many of his orthopaedic theories, which varied from the benefits of rest and fresh air, to specific examination techniques and splint designs. He is perhaps now best known for two significant contributions to orthopaedics: the Thomas splint and the Thomas test. His splint consists of two rigid rods attached to a circular ring that fits around the thigh which can be combined with other apparatus to provide traction, which sadly did not become widely used until after Thomas’s death. The Thomas test is performed to assess whether or not a patient has a flexion contracture of their hip. This is performed by having the patient lie supine, with their pelvis level, while the examiner places his hand under their lumbar spine (to obliterate lumbar lordosis). The patient is then asked to bring their thighs up to their trunk and hold one (the ‘good’ or not painful) leg in that position while straightening out their other leg. If the thigh raises off the table, the Thomas test is positive for a flexion contracture. Thomas’s test does not differentiate between a contracture caused by a tight ilipsoas or a tight rectus femoris, though it can be modified accordingly to do so.

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Personality Hugh’s personality appeared to be full of contradictions. At times he had been described as being short-tempered and strict, an example of this being on his house calls in the morning, if he felt someone had loosened a dressing without his permission, he would re-dress it tighter and seal it with a big blob of candle wax and put his initials (H.O.T!) on it (Carter, 1991). At other times though, he appeared friendly and caring, and thought of others above himself, which was most evident when he was engaged to Elizabeth, soon to be wed, and there was a huge outbreak of cholera, he threw himself into the slums where the disease raged and treated all that he could, oblivious of the risk to himself (Jones, 1953). He was often described by other medical professionals as a loner (Carter, 1991), mainly because he constantly refused invitations to various meetings. Though this is more likely to be due to his busy schedule and the fact that he was married and had trusted, skilled staff in his workshop suggests that he was not quite the loner as often considered to be. His wife described him as ‘an original, entrancing, heroic husband’ (Watson, 1934).

Legacy Despite his clear dedication to his patients and the advanced knowledge of the medical profession, sadly Hugh was not held in high regard by the majority of his peers. Many could not believe that his splints and his theories of complete rest actually worked, and continued to favour surgical amputation to treat the main ailments of the day: skeletal tuberculosis, rickets and poliomyelitis. They were also outraged that someone that they considered to be an unknown, provincial ‘upstart’ with no medical family background, was daring to contradict and criticise the most distinguished figures of medicine and surgery at that time. As a result they regularly mocked his ideas of rest and fresh air and constantly criticised him in print. As well as criticising his ideas, they often regularly made fun of his writings, pointing out his spelling mistakes or grammatical errors, though given the time of night at which he wrote and how busy his days were, these slight errors are hardly surprising. This criticism appeared to incense Hugh who would often lash out at them Trauma 2010; 12: 197–201

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in return; so angry was he at the number of children who needlessly lost their limbs at the hands of his peers. Hugh often pointed out how quick his peers (whom he referred to as ‘opponents’) were to decide that a child from a poor background required early excision of the joint or even amputation yet often chose to treat patients from the upper classes with much more conservative methods (Jones, 2003). This bitter feud continued until Hugh’s early death at the age of 57 of pneumonia. Indeed it was often remarked how miraculous it was that Hugh did not catch cholera, which he himself attributed to his constant cigarette smoking, which is another infamous association. The gratitude felt towards Hugh by the people was never more obvious than it was at his funeral, where hundreds lined the streets and surrounded his graveside to pay their respects to the man who had dedicated his life to helping others (Mostofi, 2005; The National Library of Wales, 2009). Sadly almost 50 years passed before Hugh’s nephew, who was apprenticed to him, finally managed to succeed in having Hugh’s ideas and work accepted by the medical profession. It was during the First World War when many young men returned from the front line with gunshots to the thigh that he managed to do this. Previously this kind of injury had a mortality of 80% but after the introduction of the Thomas splint this was reduced to 20% (Hagy, 2004). It was this breakthrough that brought Hugh’s work the widespread recognition and gratitude that it deserved. Given the amount of time that had passed, one cannot imagine the number of limbs, if not lives, that were needlessly lost in that interim, because of the stubbornness of the medical profession and their decision to reject not only the man but his principles (Jones, 2003, 2007; Mostofi, 2005).

Conclusion It may be ironic that the man who is now widely considered to be the ‘father of Orthopaedics’ (Mostofi, 2005), was trying to persuade his peers to put down their scalpels and to allow rest to be ‘enforced, uninterrupted and prolonged’ (Jones, 2003), but his theories have indeed passed the test of time, and are now commonly taught and used in virtually every hospital and medical school of the Trauma 2010; 12: 197–201

Western world. He was a pioneering orthopaedic surgeon who invented life-saving techniques, who received much admiration, respect and gratitude from his countless patients while simultaneously being rejected by his peers. It is no wonder that it

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has been said ‘if you only ever read about one person in Orthopaedics, that one person should be Hugh Owen Thomas’ (Jones, 2007).

References Carter AJ. 1991. Hugh Owen Thomas: the cripple’s champion. BMJ 303: 1578–81. Hagy M. 2004. Keeping up with the Joneses – The story of Sir Robert Reginald Watson-Jones. Iowa Orthop J 24: 133–37. Jones AR. 1953. The influence of Hugh Owen Thomas on the evolution of the treatment of skeletal tuberculosis. J Bone Joint Surg Br 35-B: 309–19. Jones M. 2003. The origins of modern orthopaedics and the Anglesey bonesetter (Welsh Orthopaedic Society). Available at: http://www.wos.ac/asp/ general.asp?PageName¼13 (accessed 27 December 2009). Jones M. 2007. Foundations of modern orthopaedics Hugh Owen Thomas. Available at: http:// www.worldortho.com/dev/index.php?option¼ com_content &view¼article&id¼149&Itemid¼13 (accessed 26 December 2009). Mostofi SB. 2005. Who’s who in orthopaedics. New York: Springer Verlag, 389. The National Library of Wales. 2009. Dictionary of Welsh Biography online. Available at: http://yba.llgc.org.uk/en/s-THOM-OWE-1834.html (accessed 27 December 2009). Watson F. 1934. Hugh Owen Thomas: a personal study. New York & London: Oxford University Press.

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