Politics and Professionalization

Abstract

Modern orthopaedics was not fated to exist, and Robert Jones was not preordained to play a major part in its development. Had it not been for the First World War, the specialism in its modern form might never have come into being. In Britain, at least, the treatment of fractures and other traumatic injuries involving bones and joints might have remained in the hands of general surgeons, and the aspects of child health that preoccupied orthopaedists after the First World War might have been subsumed in paediatrics. Specialization might have taken place only around the treatment of chronic skeletal deformities and muscular contractures, in which case the work of William Little, rather than that of Hugh Owen Thomas and Robert Jones, might now be regarded as more relevant to the study of its origins. In fact, shortly before the war, it was largely in terms of such a practice (applicable mainly to children) that a niche for orthopaedics came to be established in hospital medicine. In 1906, at the Charing Cross Hospital, H. A.T. Fairbank became the first orthopaedic consultant appointed to a British hospital with no responsibility for surgery outside the specialty. Thereafter several other major teaching hospitals established orthopaedic departments to which they appointed general surgeons with specialist interests in orthopaedics.¹