Who’s Who in Orthopedics and affection. Indeed, this applied to everyone ugly uncivilised North,” he would say, “or they’ll who worked with him, including the many all come up from the South and spoil it.” foreign surgeons who came for a period of train- He was very happy in his home and family life. ing in his department. He left behind his wife Marjorie, herself a York- He was essentially a modest man and although shire woman endowed with many of his own ster- he had so strong a personality and such gifts of ling qualities, his son John and his daughter Mary. leadership, he had that sense of humility about his own achievements that is so characteristic of many great men. Indeed, he was always faintly surprised at finding himself famous and sought after, and although he knew for years that the writing was on the wall, he refused to make any concessions. To the despair of friends and medical advisers alike, he continued to drive himself as hard as ever in the many high offices to which he was called—President of the British Orthopedic Association, Senior Vice President of the Royal College of Surgeons of England, Examiner to the College and to many universities apart from his own, and a much sought after lecturer in many parts of the world. Even in his last year he visited the United States twice and on the last occasion was made an Honorary Fellow of the American College of Surgeons—an honor very rarely awarded to surgeons outside that country. His knighthood in 1967, followed by a professorship in 1969 in his own university, made a fitting climax to a brilliant career. Few people go so far Dame Agnes HUNT without leaving in their wake some enemies and detractors but Frank Holdsworth left none. 1867–1948 Perhaps the secret lay in the fact that he was com- pletely devoid of guile or malice, that he never Believing that a fortune might be made in contrived a situation in his life, and that at the end Queensland by breeding Angora goats, Mrs. of it all, as Professor Sir Frank Holdsworth, Rowland Hunt, widow of the Shropshire squire he was essentially the same warm, unaffected, whose estate lay in fertile plains between the approachable and very human person as the villages of Baschurch and Ruyton-Eleven-Towns, young man from Bradford who started the ortho- gathered those of her 11 children who still pedic department at Sheffield Royal Infirmary accepted an imperious domination and arrived in more than 30 years earlier. Brisbane, intent on the purchase of a desert island. Of his other interests, he liked traveling, No desert island was for sale. No Angora goats fishing, history, Westerns, good cooking, good were in Brisbane—indeed there were none conversation and good companionship. As a throughout the length and breadth of Australia; founder member of The Journal of Bone and Joint but Mrs. Hunt refused to believe it and said Surgery (he was on the original editorial board), that if there were no goats there ought to be. She he was also a founder member of the traveling did, however, weaken in her resolve and compro- club derived from it, and those of us who traveled mized by purchasing a 50-acre paddock in which with him will remember what a good companion to rear chickens. The stock was not good, and he was. He could be equally stimulating and many chickens were born with crippling defor- provocative whether defending the Plantagenets, mities, but Mrs. Hunt was undaunted and when whom he greatly admired, or extolling the beau- she decided to amputate limbs with a carving ties of his native Yorkshire and the inestimable knife and replace them with peg-legs made of advantages of living and working there, which he Bryant and May matches, it was the duty of always insisted should remain a carefully guarded her youngest daughter Agnes to administer the secret. “Don’t ever explode this myth about the anesthetic. 147 Who’s Who in Orthopedics Agnes was then aged 16. She had been bred in North Wales, and the West London Hospital, a school of hard and rigid discipline. Her mother Hammersmith. Her one and only term of night disliked children—“disliked them when they duty was devoted to a midnight game of catch-as- were coming, during their arrival, and most catch-can round the wardroom table, chased by an intensely after they had arrived.” Her father epileptic madman who threw inkpots at her while “laughed immoderately at any accident.” Her she threw jugs of water at him. At that time nurses brothers induced a robust spirit of fearlessness; lived in primitive conditions and engaged in and the only governess who served the family astonishingly long hours of duty; the evening with efficiency gave notice because the children meal consisted of bread, cheese, and beer. “were allowed to kill themselves in too many dif- The life was hard and arduous, and was indeed ferent ways.” When Agnes was aged 10 she a sacrifice. So impressed was this young girl with developed septicemia and infective arthritis of the the adverse conditions under which nurses served hip joint with high fever, sinus formation, and that she made a vow: “If ever I rise to be Matron, rapid destruction and dislocation of the joint; but no girl shall ever be the worse in health because within 9 months her bath chair was harnessed to of her work among the sick. This vow I kept.” a pony, which was raced until the chair was over- This vow, Dame Agnes Hunt, you did indeed turned, and within 12 months she was playing ice- keep. Today, in the Robert Jones and Agnes Hunt hockey—on a home-made sledge, keeping goal. Orthopaedic Hospital the prowess of a nurse in In later years she wrote of her mother: “Her psy- the hockey field is almost as important as her skill chology of childhood amounted almost to a crime in the operating theater. Never was a staff of girls but her treatment of me as a cripple was beyond more able, more happy, and more ready to give praise. I was never allowed to pity myself or con- of their best. sider myself different. My brothers and sisters It was in Rhyl, on the sea-coast of North Wales, were never made to fetch and carry for me, and I that two fundamental principles of the nursing joined in their play.” It is true that at this age of chronic illness were learned—open air and Agnes Hunt began her “apprenticeship to crip- happiness. The Royal Alexandra Hospital was pledom and the great education of pain”; she was perhaps the first hospital for cripples ever to advo- destined to limp her way through life with stick cate fresh air as an integral part of treatment; and or crutch; but already she had learned a first prin- it was the teaching of Miss Graham, one of the ciple—the joy of life despite disability—and this founders, that “no nurse is worth her salt if she was to be her great contribution to medicine. has not the joy of life within her and the power When Mrs. Hunt decided that the Australian of sharing it with her patients.” In due course continent had failed to live up to expectation, Agnes Hunt qualified. She was awarded the Agnes knew that “you might as well try to stop queen’s badge and brassard, and spent a year in Niagara as stop my mother when once she had Northamptonshire nursing a typhoid epidemic. made up her mind.” But a proud spirit of deter- After resting in bed for 6 months on the instruc- mination in the mother had been inherited by the tion of a heart specialist, she engaged once more daughter and, when Mrs. Hunt decided to return as a district nurse in treating 500 victims of a to England, Agnes Hunt decided to stay in smallpox epidemic. Tasmania to look after her brother Tom. She was In 1900, “mother broke it to me that she was influenced in this decision by an accident sus- becoming old and deaf and intended to live with tained by a young man who was felling trees. “In me. This was rather a blow.” It was a blow splitting a big tree, one of the wedges slipped and because at first it appeared that the daughter’s the great trunk closed over his hand, holding him career of nursing might be ended; there could be fast. The poor lad’s axe was just out of reach. He no more travel and there could be no more respon- was found dead 2 months later and from the sibility as a district nurse. But, on reflection, this marks on his wrist he had tried to gnaw his hand indomitable girl realized that it might still be pos- off. I decided to stop.” sible to live at home and yet to nurse—and thus In 1887, at the age of 20, having received three began the story of Baschurch, the pioneer conva- proposals of marriage in 1 day—“not very eligi- lescent home from which developed and spread ble ones” she wrote “but still rather a record,” she throughout Great Britain and the world the ideals left the Tasmanian ranch and returned home with of country orthopedic hospitals, after-care clinics, her brother. Training as a nurse began as lady- preventive treatment, and resettlement of the dis- pupil at the Royal Alexandra Hospital in Rhyl, abled. Now, in 1948, the vast resources of the 148 Who’s Who in Orthopedics Ministry of Health and the Ministry of Labour are cars had recently been introduced; the roads of engaged in the treatment and resettlement of Shropshire were narrow; and the Baschurch nearly one million disabled persons. Orthopedic Home was out for a picnic as usual. Bobby met hospitals and after-care clinics have been estab- Jonathan Hustler’s new car with its rush and hoot lished throughout the country. Hundreds of ortho- and roar. pedic surgeons and thousands of orthopedic nurses, physiotherapists, almoners, and resettle- Bobby thought this is something new, something very ment officers are solving the problems of the unpleasant too! It may be right but I don’t quite know, crippled and the disabled. But what was the so back to home I am going to go. Round he turned beginning? The beginning was: “mother intended with his precious load, and off he set in the middle of to live with me.” A small and broken-down the road. The road was narrow, the road was long; country house with an estate of no more than Jonathan’s language grew very strong. He hooted, he three-quarters of an acre was adapted. The tooted, he shouted, he swore; Bobby went steadily on drainage was primitive; the garden was so run-riot before. The neighbours laughed to see the sight; Bobby looked neither to left nor to right; till the dray and the that it was a jungle and became known as the whole of its cripple crew, safely back to the home he lion’s den; there were a few cowsheds with drew. When Jonathan started out that day, he swore that broken walls and leaking roofs—this was the nothing should bar his way, though police traps in every Baschurch Convalescent Home. Very soon the hedge were hid, no bobby should stop him. But Bobby accommodation was unequal to the demand and did. stables and cowsheds were used for sleeping quarters. The sheds were more damp and Three years later, recurrence of infection in the draughty within than without, so that open-air hip joint made it necessary for Sister Hunt to treatment was quickly enforced. The lesson had consult Robert Jones in Liverpool. For some been learned in Rhyl—open air and happiness. months thereafter she was immobilized on a Open air was inevitable. Happiness may be Jones’ abduction frame. “Immobilized” is perhaps judged from the pages of Ye Olde Baschurch hardly the term to use in relation to Agnes Hunt, Cripples’ Journal, produced in 1905 by two crip- even when she was secured on a spinal frame with ples and illustrated in color by Mrs. Rowland its bars, bandages, and traction tapes. She wrote: Hunt. The total circulation was two handwritten copies. An editorial, signed by Brother Aaron, One day, soon after I had returned from the Royal reads: Southern Hospital and was still on a frame, I drove the black cob in the dray to Shrewsbury to do my What causes the most excitement is the picnics. We put Christmas shopping. I had several cripples with me, the cripples on drays with springs and the others on one of whom was disabled only in the arm and could wagonettes. When we have reached the spot planned, climb on and off the vehicle to ask the shopkeepers to the horses are taken out and fastened to the trees and come out. As luck would have it the cob was restive all the cripples who can’t get about are put on rugs. and a new bobby came up and asked who is in charge Then we get sticks and put the kettle to boil and tea is of this horse? With all the dignity I could muster I ready in no time. We have a good game of something replied haughtily that I was. A frame is not an instru- such as rounders. Those on crutches play as well but ment that adds to one’s dignity and the bobby’s only they are far more artful for when they are about a yard answer was that he considered it unsafe and must take off the base they suddenly drop; of course the crutches my name and address. I told him, and thinking to reach it if they don’t and they are let stand up as if they impress him added that I used to live at Boreatton Park. got there by fair means. All sing until they have hardly Unfortunately he knew this place only as a private any breath left to sing the National Anthem. The people lunatic asylum; my brother had let the house for that in the cottages all come out and by the look on their purpose some time after my father’s death. The police- faces we could almost believe they wished to be ill just man remarked acidly that it was just the sort of place for the sake of the picnics. he would have expected me to come from.

There were picnics to the country and picnics This association with Robert Jones was a mile- to the seaside. The famous pony, Bobby, “the stone by which the Baschurch Convalescent dearest and wickedest of ponies,” made history Home became an orthopedic hospital. McCrae for himself when he was so often left in sole Aitken was at that time house surgeon at the charge of a cargo of cripples. Sir Frederick Royal Southern Hospital, Liverpool, and he Kenyon recorded an incident in verse. Motor wrote: 149 Who’s Who in Orthopedics There arrived from time to time in the out-patient theaters, which are essential features of a modern clinic, a woman, an outside porter from the railway hospital, became available. Consultants visit from station, and a homemade handcart like a baker’s tray Liverpool, Manchester, Birmingham, Cardiff, on perambulator wheels. The cart contained crippled and London. The resident staff includes sur- children, perhaps as many as eight, in various forms of geons from England, Scotland, Ireland, Wales, splints. The woman was Miss Hunt of Baschurch. A Australia, Canada, South Africa, and the United return train had to be caught so the party was soon inspected. Those requiring operative treatment were States of America. admitted; cases left at a previous visit were put on the A short visit to this hospital may convey the handcart; it was as simple as changing books at the same impression as a visit to any other important library. country orthopedic hospital. Was this the contri- bution of Agnes Hunt? It was one of them; but it The outside porter was employed on arrival at was perhaps the least. As early as 1907 it had Merseyside because this was so much cheaper become obvious that extensive accommodation than bringing an assistant from Baschurch. Even and excellent facilities in the central hospital the perambulator wheels were of significance. did not solve the problems of preventive treat- The railway ticket for a child’s perambulator cost ment and follow-up supervision. Many families only one shilling; the ticket for a handcart was had spent their lives in the wilds of Blaenau much more expensive; and it needed only the Ffestiniog, or some remote hamlet, with a geo- good-humored domination of Miss Hunt to per- graphical horizon limited to a 20-miles radius. suade railway officials that this unusual form of Were they to be expected to travel with a crippled transport was indeed a perambulator. child to Shropshire, a journey that seemed as ven- As work increased, Robert Jones himself went turesome as one of the explorations of Columbus? to Baschurch and operating lists were performed And if initial fear was overcome, and the child every month on the kitchen table. Doctor Urwick was admitted to hospital, could the week-by-week of Shrewsbury accepted the responsibilities of supervision of after-treatment be continued over medical superintendent. More and more beds many months and years when every hospital visit became available and the facilities were steadily called for one day’s travel in each direction? It improved. After the 1914–1918 war, a hutted was not enough for the patient to go to the hos- army hospital was taken over. Many original huts pital; the hospital must go to the patient. And so still remain and the private wing, known face- a system of after-care clinics was established—a tiously as Harley Street, consists still of the horse- plan that may now appear obvious but which at boxes, which were unwanted after the first war. that time called for vision, enterprise, and a com- Staff was gathered and the talent of Alwyn Smith, plicated organization. The first after-care center Girdlestone, Naughton Dunn, McCrae Aitken, was established in Shrewsbury, and as the influ- and many other distinguished contemporary sur- ence of the hospital widened, so were its outposts geons, made it certain that the Baschurch Conva- created. Today, in an area that includes many lescent Home should serve the county and counties, and covers hundreds of miles of rural become the Shropshire Orthopedic Hospital, and and sometimes densely populated country, there in due course should serve the whole country and are 36 after-care centers visited daily or weekly become the Robert Jones and Agnes Hunt Ortho- by orthopedic nurses, physiotherapists, and social pedic Hospital. Gradually, the hospital was rebuilt service workers, and at less frequent intervals by in accordance with Agnes Hunt’s ideals. “I can orthopedic surgeons from the parent hospital. see in my mind’s eye a hospital with its long, low, In this activity Agnes Hunt was responsible for one-storied wards and big French windows the development of a vast scheme of voluntary opening out on to lovely lawns, flowers, and big service, which might well be recalled in this spreading trees. Is this dream impossible?” It was day of state direction and centrally planned not impossible; John Menzies saw to that. He was health service. Every clinic is served by a County the man who was “found” by Sister Hunt, was Voluntary Orthopedic Association. Hundreds inspired by her, and for so many years had served of women, previously untrained as nurses but faithfully as secretary–superintendent. Under his quickly acquiring sufficient knowledge to recog- direction new open-air wards were built; the nize early cases, using their influence to ensure gardens, lawns, and trees, which were imagined that such cases were brought within the ambit of by Miss Hunt, became a reality; and the labora- the center and thus applying themselves to the tory facilities, x-ray equipment, and operating important tasks of preventive treatment, learning 150 Who’s Who in Orthopedics to carry out the instructions of orthopedic nurses within a year, Mr. Rhaiadr Jones and his wife and orthopedic surgeons, giving encouragement were appointed manager and matron, and thereby and moral support to cripples and their parents the Cripples’ Training School gained the services during long months and years of treatment, have of a first-class financier and a devoted woman, devoted their lives and given whole-time service, who have applied themselves to this task. A 5 days a week, throughout the last 30 years. They college was established for the training of crip- were inspired by Agnes Hunt because she worked pled children, of whom no less than 90% have with them; she herself attended the clinics and made their own livings. was one of them. Let us hope and believe that this Twenty years later, the Disabled Persons’ spirit of devotion, which has been maintained for Employment Act was passed by the government a full generation, will not be dispelled, or even of this country, and the Disabled Persons’ dimmed, by the reforms of hasty planning. Corporation was established. Of the one million It was in 1927 that Sister Hunt succumbed to disabled who are now registered in Great Britain, the stimulation of Robert Jones and agreed that a high proportion have been trained to take their the problem was not yet solved. It was not enough place in the open labor market and have proved to search out cripples and arrange hospital and themselves to be no less efficient than their able- after-care treatment. Crippled adolescents must bodied colleagues. Those few whose disabilities be taught not only the joys of normal recreation were so grave that they could not have been but also the responsibilities of normal work. A expected to compete in the open market have retraining scheme was necessary. She wrote: “I been engaged in the sheltered factories of the collected four boys, already training in the boot Disabled Persons’ Corporation, the trade name of and blacksmith’s shops, and two girls from which is “Remploy.” At the same time voluntary the splint-making department, and solemnly effort has continued at the St. Loyes’ College for informed them that they were ‘The Shropshire Training and Rehabilitation of the Disabled, Orthopedic Training School for Cripples.’ They Exeter; the Queen Elizabeth’s Training College were suitably impressed but were anxious to for the Disabled, Leatherhead; the Heritage know what happened next. As this was more than Crafts’ School, Chailey; the Lord Roberts’ I could tell them the meeting adjourned.” Miss Memorial Workshops; the John Groome’s Hunt decided to write to the County Councils and Cripplage; the Robert Jones’ Workshops; the Poor Law Guardians and “offer this splendid Papworth and Enham Village Settlements; the St. opportunity of making their cripples self- Dunstan’s Institutes for the Blind; the National supporting.” The replies flabbergasted her. Institute for the Deaf; and the Duchess of Port- “Before you could say ‘knife’we had one hundred land’s Training College for the Disabled, Not- and fifty names on the waiting list: and not even tingham. Little did those four boys and two girls a hut to put them in. Where were they to be realize, when they were appointed solemnly as a housed and fed? What trades would be suitable? training school for cripples, that they were to be What about instruction? How would the hospital forerunners of a great reform in resettlement of committee take this new venture? And where on the disabled, of which Great Britain is now proud. earth would the money come from?” As usual, Agnes Hunt, the “Florence Nightingale of enthusiasm came first; but accomplishment came orthopedic nursing,” who received the Royal Red next. With Miss Sankey, who is well remembered Cross in 1918, and was created a Dame of the as a superb after-care superintendent, Miss Hunt British Empire in 1926—the highest honor that moved into the Derwen, which was to become the can be awarded to any woman in this country— Cripples’ Training College. There was an early was responsible for important advances in pre- stage when, after being granted £50 by the com- ventive treatment, the creation of an orthopedic mittee, “we also annexed some unconsidered hospital, the organization of an after-care system, trifles from the hospital.” In the next stage Miss and the development of a Cripples’ Training Hunt tried to work out the cost of surgical boots College. Shortly before she died, she asked and wrote: “Ten shillings for leather and two days herself to name the essential qualities of a nurse of man’s time at three pounds ten shillings a week and replied: “Common sense, gentleness, kindli- plus 5 per cent profit equals—? Eventually I put ness, and the power of giving hope and joy to x which I had been told meant an unknown quan- those who are suffering.” In these words she tity, and went dismally to bed.” Mathematics and linked herself with those who are ageless, for was financial acumen were not her strong points but, it not Galen who wrote: “Confidence and hope do 151 Who’s Who in Orthopedics more good than physic. He cures most in whom William was diligent as a boy, and at the age most are confident”? Most were confident in of 14 went with a bursary to Glasgow University, Agnes Hunt. At the early age of 11 she learned to where he studied for 5 years. Afterwards he spent enjoy life despite disability; at the age of 81 she a short time in Edinburgh, and finished his died as she had always been—cheerful, brave, medical training at St. George’s Hospital, courageous, indomitable. She proved by example London. Later he started a school of anatomy in rather than by precept, and the decision of history Covent Garden, which soon acquired consider- may well be that the greatest of all her contribu- able reputation by reason of the facilities he tions was her own life. offered for dissection, and his own capacity as a lecturer. In 1770 he transferred the school to Great Windmill Street, where a building had been Reference erected with lecture theater, dissecting rooms, and museum. He had already been elected physi- The quotations in this appreciation are from This is my cian–accoucheur at the Middlesex Hospital and Life by Agnes Hunt (Blackie & Sons, Ltd., London, later was appointed Physician Extraordinary to 1933) and The Story of Baschurch (Caxton Press, Queen Charlotte; but his main interest was Oswestry). I am also grateful to Mr. Rhaiadr Jones anatomy, and he lectured upon it to the end of his for access to many unpublished documents. life. He was elected a Fellow of the Royal Society, to whose transactions he contributed a paper “On the Structure and Diseases of Articulating Cartilages.” In this communication he was the first to give a clear account of the structure and arrangement of synovial membranes. John Hunter was 10 years younger than William Hunter. In early life he had none of the studious habits of his elder brothers, both of whom went to a university, one studying medi- cine and the other law. Being the youngest, and favored by his mother, John was somewhat undis- ciplined. He was averse to schooling of any kind but gave early evidence of the thread of his pecu- liar genius when he rambled in the woods, watched ants, bees, birds, and tadpoles, and pestered country folk with simple questions on natural history. Until the age of 20 his mind remained fallow and untroubled, but on the verge of manhood he woke from slumber and for the next 45 years worked so prodigiously in the pro- duction and study of scientific material in medi- cine and biology that the like of him has not been John HUNTER seen again. He began by joining his brother in the school of anatomy. He soon acquired such 1728–1793 patience and skill as a dissector, and such knowl- edge of anatomy, that within 12 months he was John Hunter was born on February 13, 1728, at appointed demonstrator. He studied surgery under Long Calderwood, a small estate in Lanarkshire Cheselden, and afterwards under Pott, the two about 7 miles from Glasgow. His father, whose master surgeons of the day. Later he enrolled as a name was also John, was one of the Hunters of pupil at St. George’s Hospital, and in due time Hunterston in Ayrshire—an old Scottish family. became house surgeon. In 1759, through over- He and his wife Agnes had ten children, of whom work in the dissecting rooms, he developed pneu- William was the seventh, and John the youngest. monia; symptoms appeared that were suggestive Both brothers achieved fame as anatomists but of tuberculosis. He therefore sought a change of they were very dissimilar in temperament and work and secured appointment as a staff surgeon character. in the army. He sailed with the expedition to 152