Who’s Who in Orthopedics that you may be receptive of the tribute paid to doctors Perhaps his greatest contribution was the by Jeshua, the son of Sirach, early in the second century recognition that “locomotor ataxia,” a frequent before Christ. He writes: “. . . The skill of the physician cause of disability, was caused by tabes dorsalis, exalts him, And he is admired among the great.” a form of neurosyphilis. Charcot was a great teacher, whose clinics became world famous. His The active and productive life of Fremont A. relationship with Duchenne was very productive Chandler came to an end suddenly and without and his students, Jules Dejerine, Pierre Marie, and warning on Christmas Eve 1954. Truly, Fremont Babinski, carried on his great tradition. A. Chandler is a worthy example of Jeshua’s saying. He was “admired among the great” of his day, and long will he be remembered in the days to come for the sound and lasting contributions he made to his beloved orthopedic surgery; and with the passage of time, his name will grow.

John CHARNLEY Jean-Martin CHARCOT 1911–1982 1825–1893 John Charnley was born in Bury on August 29, Jean-Martin Charcot was born in Paris where his 1911. He was educated at Bury Grammar School father was a carriage builder. He was educated in and Manchester University, where he was Paris and, after deciding to become a doctor, awarded several prizes and scholarships. He made entered medical school at the age of 19. At that his ambition for a surgical career plain by passing time, Paris was the world center of medical the primary examination of the Royal College of thought and activity: Charcot was exposed to Surgeons while he was an undergraduate—a feat some of the best teachers available. that was possible for the gifted students of those As he progressed through his training, he con- days—and he became a Fellow of the college in tinued to develop his skills at drawing. His doc- 1936, 1 year after graduating in medicine. toral thesis, illustrated by his own drawings, dealt Before the outbreak of the Second World War with the differential diagnosis of gout and other he held surgical appointments at Manchester forms of acute rheumatism. Royal Infirmary and Salford Royal Hospital. It Moving up the academic ladder, Charcot, in was evident then to his mentors and contempo- 1862, was appointed chief physician of l’Hospice raries that he was destined for a brilliant career. de la Salpêtrière, an ancient hospital that con- During his period of army service, spent in the tained 5,000 chronically ill patients of all types. Middle East, he used every opportunity to work It was from this voluminous material that he in the REME workshops where he produced an described various conditions that established adjustable Thomas’ splint, which was widely used his reputation as a founder of the specialty of in the treatment of casualties from the North neurology. African campaigns. This engineering experience 60 Who’s Who in Orthopedics was later put to good use in his biomechanical British Empire in 1970 and Knight Bachelor in laboratory. 1977. In 1975 he was elected a Fellow of the After the war, Charnley returned to Manches- Royal Society, an honor unique in the history of ter; he was appointed lecturer in orthopedic British orthopedics. The citation for the Lister surgery and started a long and fruitful association Medal awarded the same year was an admirable with Sir Harry Platt. They had much in common, summary of his achievements. “In a period of a directness of vision and purpose and a dislike some 15 years totally concentrated on this diffi- of humbug. Sir Harry was one of John’s cult problem by a combination of engineering, staunchest supporters and was instrumental in biological science, and superb surgical technique persuading the Regional Hospital Board to back he has resolved these problems to the immense his revolutionary concept of a Centre for Hip benefit of tens of thousands of patients. His inves- Surgery. John maintained that significant tigation of the mechanical, material, and surgical advances in surgery could only be achieved by problems of total replacement of the hip have concentrating effort and research on a specific helped to advance joint replacement in the knee, problem, a philosophy amply vindicated when the elbow and elsewhere.” He received honorary doc- center at Wrightington became the Mecca for torates of the Universities of Liverpool, Leeds, orthopedic surgeons from all over the world. Belfast and Uppsala and was an honorary member In 1947 he was appointed Consultant Orthope- of numerous orthopedic associations in Europe dic Surgeon to Manchester Royal Infirmary and and North and South America. In 1978 he was in 1950 his book on the Closed Treatment of awarded the Gold Medal of the British Medical Common Fractures was published. It was an orig- Association and later he became an Honorary inal and stimulating approach to the manipulative Fellow of the British Orthopedic Association. treatment of fractures “which far from being a One of the honors that gave him special pleasure crude and uncertain art can be resolved into some- was conferred on him by the citizens of Bury in thing of a science.” It was an instant success and 1974, who made him a freeman of the borough. persuaded many orthopedic surgeons to revise Charnley’s approach to surgery was always that some of their cherished suppositions. of a perfectionist. This is reflected in his report, In the late 1940s arthrodesis was regarded as Low Friction Arthroplasty of the Hip: Theory an acceptable treatment for a stiff and painful and Practice, published in 1979, in which he joint, but no entirely reliable procedures were described the operation in minute detail. For some available. His technique of compression arthrode- years he insisted that surgeons who wished to sis of the knee, published in 1948, was simple and perform the operation must first master the tech- highly effective. The principle of this operation nique by working with him at Wrightington. was extended to the hip and other joints. Com- There were those who thought that this was an pression arthrodesis of the hip was an ingenious attempt to maintain the unique position of the procedure but it required considerable technical Centre for Hip Surgery, but this was not so, he expertise and even in Charnley’s hands it was not was determined that surgeons should not under- always successful. He realized that fusion of the take the operation with only general knowledge hip could only have a limited application and he of the principle in the hope that they could turned his fertile mind to solving the problems improvize the details. A constant stream of sur- of replacing the joint. Cup arthroplasty was an geons came to Wrightington from all over the anathema to him; it offended his engineering prin- world, where they were treated to a surgical tour ciples and required a prolonged period of reha- de force and at the same time warned of the bilitation. Total joint replacement was the only mishaps that could and did occur from shoddy solution. surgery. Charnley was appointed Professor of Orthope- He had no time for medical politics or com- dic Surgery at Manchester Royal Infirmary in mittees and it was the “establishment” more than 1972. He was appointed as a Doctor of Science anything else that provoked his occasional explo- of Manchester University in 1964 for his work on sions of anger. He worked with unabated energy bone union and lubrication of joints. His remark- after his retirement from the Health Service in able achievements in the development of total 1976 and lost none of his interest and enthusiasm joint replacement had received worldwide for research. acclaim and the award of many honors and dec- John had a lighter side, he loved a party and orations. He was made a Commander of the had a great sense of fun. He enjoyed messing 61 Who’s Who in Orthopedics about in boats and in his younger days he was a first to use acrylic cement as it should be used— keen skier. It was on one these holidays in 1957 as a grout. Parallel with this was the development that he met his wife Jill; they were married 3 of a clean-air operating enclosure, the total body months later and had two children, Tristram and exhaust system, special instruments and the tray Henrietta. Jill was a gifted and charming hostess; system, which has made the operating room she created a beautiful home and a delightful an extension of the autoclave and significantly garden at Mere in Cheshire, where she and John reduced the rate of infection. entertained their many friends and visitors from At the same time Charnley carried on with a home and abroad with great generosity. very busy clinical practice and teaching both res- John Charnley, one of the most remarkable idents and visiting surgeons. He traveled exten- surgical innovators of this generation, died on sively, lecturing, demonstrating and operating. He August 5, 1982. He will be remembered by pos- invariably provided the photographs and draw- terity for his low-friction arthroplasty of the ings for his numerous publications, including Low hip, the inspiration of a surgical revolution that Friction Arthroplasty of the Hip: Theory and brought relief to countless patients crippled by Practice. arthritis. He was proud of the Centre for Hip Surgery he Charnley is assured of a permanent niche in the created and the Low Friction Society formed by annals of British orthopedic surgery. He will be his past residents. remembered for his incisive thinking, his disdain Every new problem was a challenge to be mas- of shibboleth, and his dedication to the solution tered. When histology of the bone–cement junc- of a surgical problem. tion was to be studied, he took up the challenge with enthusiasm. Even in his last months of life, when surely he must have been aware that his In the development of low-friction arthroplasty, health was failing, he did not cease to work and Sir John was always ready to admit serendipity plan for the future and was ready to travel to and good luck as well as help from his colleagues, Japan when invited by one of his disciples. experts in other disciplines and the Manchester In all this he never lost sight of the human Regional Hospital Board. What he never dis- aspect and would easily recall patients’ details cussed is the superhuman effort and single- from years before in a chance meeting in the long mindedness needed to achieve the aim he so corridors of the hospital. firmly believed in. He will be missed by so many, including those Starting with a single clinical observation of a he has worked with and those he has treated and squeaking femoral head replacement, he repeated whose lives he has shaped. He was a man of many experiments on lubrication of joints and dis- talents, yet single-minded in his effort. If a man’s proved the results of others. claim to immortality is judged by the quality of A biological approach to the problem using life he leaves behind and the alleviation of human Teflon shells to replace articular surfaces of the suffering, then surely the long-term results of hip failed. Not discouraged, he continued with the low-friction arthroplasty must be the living Moore and Thompson femoral head replacements monument to a truly great man and benefactor articulating on a Teflon shell; the shell moved of humanity. against the bone causing wear and bone damage. It was at this stage that the concept of “low fric- tional torque arthroplasty” was conceived and he developed a small diameter femoral head replacement, which articulated with a thick shell of Teflon; the Teflon failed. A lesser man would have surely given up. Yet the short-term clinical results had been so spectacular that he was con- vinced of the soundness of this concept. From then onwards, with the fortuitous introduction of high-density polyethylene, all his efforts were directed toward a perfect mechanical solution to a biological problem. In this he had the unfailing support of Chas F. Thackray of Leeds. He was the 62