Who’s Who in Orthopedics the teacher and pupil a firm friendship, which tressing illness, has deprived British orthopedic endured until the former’s death. of one of its outstanding figures and the Following his training in orthopedic surgery, British Orthopedic Association of its President, a he transferred to Birmingham, where he became post that he held during 1938 and 1939. associated with the Birmingham Cripples’ Union, and through his instrumentality the organizations for the treatment of the cripple in the Birmingham district were gradually joined together, and, in place of a number of scattered societies, whose work necessarily overlapped, the present Royal Cripples’ Hospital was established. Wider recognition of the value and originality of his work came to him through his efforts during and after the Great War. He was one of that small band of British surgeons who were called on by Sir Robert Jones to carry out preventive and cor- rective surgery in the British Army, a task that they were able to accomplish only through the generous help of their American colleagues. Returning to Birmingham after the war, he con- tinued his work at the Royal Cripples’ Hospital and at the Robert Jones and Agnes Hunt Ortho- pedic Hospital in Oswestry, an institution in which he played a particularly vital part. Mr. Dunn received many honors, but of them all probably the one he treasured most was the honorary LLD, which was conferred upon him by his own University of Aberdeen in 1937. He was connected with many hospitals in the Midlands, 1777–1835 both in an active and in an advisory capacity, and he held the very important post of Lecturer Guillaume Dupuytren was born in Pierre-Buffière in Orthopedic Surgery at the University of near Limoges in 1777. There had previously been Birmingham. He was one of the original members several surgeons in the Dupuytren family. In of the British Orthopedic Association and for a 1719, a surgeon Michel Dupuytren lived at Pierre- number of years served on the executive com- Buffière, running the tobacco shop at the same mittee. He also held the office of President of the time. François Dupuytren, grandfather of Orthopedic Section of the Royal Society of Med- Guillaume, drowned while returning from visit- icine and was a corresponding member of the ing a sick patient. Two brothers of François, American, French, and Australian Orthopedic Leonard and Jacques, were also surgeons, so that Associations. it is not surprising that Guillaume selected Although Mr. Dunn’s contributions to the liter- surgery, although his own father was a lawyer. ature of orthopedic surgery were not as numerous Guillaume was sent to for his schooling in as one would have expected from a surgeon of his a Jesuit institution named after its founder, Jean standing, what they lacked in quantity was com- de la Marche. It was during this period, from the pensated by their extreme soundness and breadth dawn of the Revolution in 1789 through the of vision. They were typical of the man—inher- bloody Reign of Terror in 1793–1794, that young ently sound, sane, and thoughtful—and charac- Dupuytren was a student in Paris. The changes terized by an underlying care for the patient, that the Revolution wrought were to affect deeply which was always his first anxiety. His most the shape of his life. Now the road to success was notable contribution, which brought him an inter- open to the talented, without distinction of birth national reputation, was his work on the operative or fortune. treatment of paralytic deformities of the foot. Once at home again in 1794, Guillaume wanted The early death of Mr. Naughton Dunn, which to join the army. His father, however, insisted that, occurred on November 19, 1939, after a long, dis- in the family tradition, Guillaume become a 89 Who’s Who in Orthopedics surgeon. As a first step in his training, he was These two were passed over because of their close enrolled in the medical-surgical courses in relationship with Napoleon, and Guillaume Limoges, but after a few months, Dupuytren set Dupuytren became Chirurgien en chef at the out for Paris, where he remained for the rest of Hôtel Dieu at just under 38 years of age. For 20 his life. years he retained a place of pre-eminence in the Dupuytren’s medical studies coincided with the medical history of his time, sometimes called the period of Directoire, from 1795 to 1799. The Age of Dupuytren. This period corresponds with Terror was over, there was money to be made in the restoration of the monarchy in France after the manufacture and commerce, glory to be grasped Revolution, and the Empire, with the return of in the battlefields. This was also a period of dis- the brother of Louis XVI, King Louis XVIII. sipation and pleasure, but Dupuytren had given Dupuytren had been named surgeon of King his life over completely to his studies of , Louis XVIII in 1823 and the king conferred on experimental physiology and pathological him the hereditary title of baron. The king died in anatomy. He became Chef des Travaux 1824 and was succeeded by his younger brother, Anatomiques (Director of Anatomical Studies) in Charles X; thus Dupuytren immediately became the Medical School in 1801 and the Council of chief surgeon of the new king. the Ecole de Médecine formally requested that he Dupuytren was admired as a brilliant surgeon be exempt from the obligatory military duty. and a great teacher, but his ambition and his The reign of Napoleon (1801–1814) had been aggressiveness had aroused many envies and for Dupuytren a period of tough “open competi- enemies, hence the malicious tone of so many tion”; each post won gave rise to bitter rivalry. contemporary writings. For Lisfranc, Dupuytren The Revolution had released a flood of energy and was “the brigand of the Hôtel Dieu”; for Percy in this brilliant era of French , the rising “the greatest of surgeons and the least of men.” young men were Bichat, Broussais, Larrey, Roux, However, so high was Dupuytren’s status that his Laennec: all formidable rivals for Dupuytren. obituary in the London Lancet expressed the Dupuytren became, at just under 25 years of general view: “Regarding surgery in the true age, Chirurgzen de deuxième classe at the Hôtel sense, we hesitate not to place the late Baron Dieu in 1802. The Hôtel Dieu was the most Dupuytren at the head of European surgery” important hospital in Paris. The chief surgeon was (Lancet, February 21, 1835). Phillippe Joseph Pelletan, with whom Dupuytren Dupuytren’s powers of diagnosis were leg- had unceasing conflicts, which reduced his surgi- endary and the list of his innovations is too long cal activity. He continued his own researches and for enumeration. For example, in the field of animal experimentation at the school of veteri- orthopedics, he described in 1822 the congenital nary medicine at Maisons-Alfort (which still dislocation of the hip, which he distinguished exists). Here, Dupuytren worked closely with from accidental dislocations. He gave the original Alexis Dupuy for many years. Dupuytren proved description of fractures of the lower end of the that the spleen could safely be removed and he fibula, for which he devised a splint. He described published, with Dupuy, reports on the nervous, a distortion of the wrist, now called Madelung’s cardiac, circulatory, and cerebral systems and on deformity. He was also the first to perform a the role of the nerves in respiration. In 1812 he resection of the lower jaw, and the first to excise was Professor of Operative Medicine at the the neck of the uterus for cancer. He described Faculté de Médecine of Paris. post-traumatic shock. In his thesis on “lithotomy” In 1815, Pelletan was 68 years old and wanted (1812) he gave an anatomical description of the to “organize” his succession at the Hôtel Dieu. He perineal region, layer by layer, which is still a put forward his son Gabriel, who was a surgeon classic. He reported a considerable number of in the Imperial Guard, for the appointment as self-mutilations of the genitalia and took account clinical assistant, but with the passing of the of their determining factors: “self-punishment, Napoleonic era, Pelletan’s position was weak- guilt, jealousy, remorse, expiation, any of these ened. In September 1815, the Minister of the may be responsible.” Interior of Louis XVIII asked the Conseil des In 1832, he gave his classification of burns Hôpitaux to submit a list of five candidates for the arranged in six categories based upon the depth post of Chirurgien en chef at the Hôtel Dieu. of the burn. He even noticed the presence of Dupuytren’s name was third on the list, after ulceration of the gastrointestinal tract in severely Boyer and Dubois, his elders by some 20 years. burned patients 10 years before Curling, to whom 90 Who’s Who in Orthopedics that insight is now credited. For Garrison (in have of his operations, no error escaped the 1966), his most enduring title to modern fame is record. One failure, said Cruveilhier (1841), in the field of surgical pathology and perhaps afflicted Dupuytren more than 20 successes above all for his diagnosis and treatment of con- delighted him. It was only his failures to which tracture of the fingers. Hannah Barsky (1984) he was sensitive. wrote a comprehensive portrait of Dupuytren in After the operations came the outpatient clinic which she describes his daily activity when he for free consultations: “For the cold Dupuytren, was chief surgeon at the Hôtel Dieu, which is whom others saw on occasion, was not seen by summarized here: these indigent patients. All those who worked with him and all who visited his clinics agreed For twenty years, day in, day out, the Dupuytren that he showed toward these humble outpatients program was all but unvaried. When Marjolin became the same attentiveness and care he showed to the Dupuytren’s adjunct surgeon, Dupuytren told him he rich and famous who came to him for private was expected to act as substitute when the chief was consultations.” out of the town or ill, but added “I warn you that I am In all, 5–6 hours had been devoted to the Hôtel never away and never ill”. There was for Dupuytren no Dieu service. The rest of the day would be filled holiday, no vacation. Even Christmas found him at his with operations on private patients, medical post. His hospital arrival came no later than six o’clock in school duties, supervision of the laboratory, the morning. His arrival would be signaled by the clinical research, and private consultations. ringing of a bell. Ward round began promptly and Dupuytren’s professional day was not yet over might take as long as three hours. Dupuytren proceeded with the departure of the last private patient. from bed to bed (the four wards of his service held 264 There was always a return visit to the Hôtel Dieu beds). from 6–7 o’clock to see, once again, the patients The daily ward rounds were followed by the daily on whom he had operated that day and the new lectures. Seated in his high-backed green armchair admissions. And after that, there was a social life. behind a table, he would address as many as five On December 5, 1831, at the Hôtel Dieu, hundred auditors, not only hospital personnel, doctors Dupuytren described the permanent contracture and students, but professional colleagues and laymen from Paris, from France, from the world beyond. of the fingers. This lecture was reported verbatim Dupuytren began his clinical lectures in a low voice, in the Journal Universel et Hebdomadaire de which would force his auditors to pay close attention, Médecine et de Chirurgie Pratique by his assis- “His voice was soft and smooth, with not only a clarity tants, Paillard and Marx (Dupuytren, 1831). of thought but a clarity of diction, which made him, Dupuytren himself wrote very little apart from even for foreigners, so easy to follow”. a huge collection of observations. The lecture notes, religiously recorded by his assistants, Other well-documented biographies of Brière de Boismont, Paillard and Marx, were pub- Dupuytren have been written by Cruveilhier lished in the Leçons Orales de Clinique Chirurgz- (1841) and Mondor (1945). cale faites à l’Hôtel-Dieu de Paris par Monsieur The Leçons Orales (Dupuytren, 1832) recorded le Baron Dupuytren. They began in 1832 and by his associates and promptly translated abroad filled five volumes. Dupuytren died in November attest to the method, content, and style of these 1835. “La Rétraction Permanente des Doigts,” model clinical lectures. when it was published as the first article of the The hour’s lecture over, operations began. first edition of the Leçons Orales in 1832, was Dupuytren valued deliberation over brilliance, considered a completely unknown pathology. safety over sleight of hand. Surgery was an exten- Later, Dupuytren’s assistants and Dupuytren sion, a demonstration of clinical lectures. In 1818, himself discovered that this condition had already 2,363 patients were admitted to Dupuytren’s been mentioned by Astley Cooper, and the service and 764 major operations performed, “Leçon sur la Rétraction Permanente des Doigts” ranging from strangulated hernias, skull fractures, was relegated to article XI of volume 4 of the mastectomies, amputations of the upper and second edition, which appeared in 1839, after lower jaw, artificial anus and malignant tumors, Dupuytren’s death. as well as a series of orthopedic and ophthalmo- On June 12, 1831, Dupuytren operated on the logical procedures. right hand of M.L., the wine merchant who suf- His operative records were extraordinarily fered from a progressive contraction of the ring good. With so many eye-witness accounts as we and little fingers. 91 Who’s Who in Orthopedics At 58 years of age, Dupuytre of devel- great success and his high reputation. He devised oped pleurisy and died in a few days, while an apparatus for leg lengthening, an operation for Cruveilhier, Bouillaud and Broussais were debat- correction of internal rotation of the hip in spastic ing whether to drain his empyema. In paralysis, and a technique for transplantation of Dupuytren’s opinion it was “better to die of the the biceps femoris. disease than of the operation.” On the day of his He was a member of the American Academy funeral, colleagues and scholars came from all of Orthopedic Surgeons and of the American over the country. His mortal remains were carried Medical Association, a Fellow of the American to the Père Lachaise cemetery by his students, College of Surgeons, and a member of the Clini- who would not delegate this last duty to anyone cal Orthopedic Society and of the Eastern State else. Orthopedic Club. He was an out-of-doors man and got his recreation by shooting, riding, and golf. Dr. Herbert Alton Durham died at Shreveport, Louisiana, on March 13, 1946, at the age of 62. Herbert Alton DURHAM He was survived by his wife, Beatrice Anderson Durham, to whom he was married in England in 1884–1946 1918, and by two children.

Dr. Herbert Alton Durham was Surgeon-in-Chief of the Shriners’ Hospital in Shreveport, Louisiana, and an outstanding orthopedic Joseph Gichard DUVERNEY surgeon. He spent his boyhood on a farm in Vermont and received the degrees of AB in 1905 1648–1730 and MD in 1909 from the University of Vermont. After serving a general internship, he became a The son of doctor in a small town near Lyon, resident at the New York Orthopedic Hospital. Dr. Joseph Gichard Duverney was educated in Russell H. Hibbs was Chief Surgeon of the Hos- Avignon, and like so many ambitious young pital at that time, and had just announced his oper- Frenchmen, sought his fortune in Paris. Fortu- ation for spine fusion. He was impressed by nately for him, he carried a letter of introduction Durham’s ability and, at the completion of his res- by which he gained entrance into the scientific idency, sent him abroad on a traveling fellowship. community in Paris as an anatomist. In 1669, The greater part of the year was spent in England Duverney was appointed professor of anatomy under Sir Robert Jones, and in Austria and and surgery at the Jardin du Roi, a medical school Germany. developed with the support of Louis XIV. He With the onset of the First World War in 1914, became one of the first academic surgeons, in the he returned to New York and became a member modern sense of the term, because he occupied a of the staff of the New York Orthopedic Hospital. tenured chair that allowed him to teach, do When the United States entered the war, Durham research, and carry on a surgical practice. Among was at once commissioned in the army and went his students were members of the French court, to England with the first contingent of orthopedic including the Dauphin. His research included surgeons under the leadership of Dr. Joel E. investigations of the anatomy of the ear, of which Goldthwait. Durham served under Sir Robert in a he provided the first accurate description, and an British military hospital until the end of the war, important theory of hearing. Duverney was a when he again returned to the New York Ortho- member of the group of savants gathered around pedic Hospital, this time as an attending surgeon. Claude Perrault, who dissected and described a In 1923 he was appointed Surgeon-in-Chief of large number of species of animals, including the Shriners’ Hospital at Shreveport, in which many previously unknown until they were sent capacity he served until his death. He also was from North America by French explorers. His attending orthopedic surgeon at the Highland, clinical work resulted in his book, Maladies des North Louisiana State, and Tri-State Sanitaria. Os, which was published after his death. The He was an exceptionally skillful technician and first complete description of osteoporosis and the a capable mechanic. These qualities, combined description of what is called Duverney’s fracture with a sound surgical judgment, accounted for his of the pelvis are found in this work. 92