Politics and Professionalization

  • Roger Cooter
Part of the Science, Technology and Medicine in Modern History book series (STMMH)


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


General Surgeon Joint Surgery Royal Infirmary Orthopaedic Hospital Voluntary Hospital 
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  1. 1.
    In 1908, the London Hospital appointed T.H. Openshaw; in 1912, St Bartholomew’s appointed R.C. Elmslie; and in 1913, Guy’s appointed W. H. Trethowan; while at the century-old Birmingham Royal Orthopaedic and Spinal Hospital, one of Jones’s former assistants in Liverpool, Naughton Dunn, was appointed. See H. Osmond-Clarke, ‘Half a Century of Orthopaedic Progress in Great Britain’, JBJS, 32B (1950), p. 630; andGoogle Scholar
  2. St. J. D. Buxton, ‘Sir Thomas Fairbank’, JBJS, 38B (1956), pp. 4–21.Google Scholar
  3. 2.
    See Harry Platt, ‘Orthopaedics in Continental Europe, 1900–1950’, JBJS, 32B (1950), pp. 570–86;Google Scholar
  4. Leo Mayer, ‘Orthopaedic Surgery in the United States of America’, JBJS, 32B (1950), pp. 461–569.Google Scholar
  5. 3.
    E. Muirhead Little (quoting Sir James Paget, the president of the 1881 Congress), ‘Specialism and General Surgery’, JOS, 1 (1919), pp. 63–6 at p. 64.Google Scholar
  6. 10.
    Charles Macalister, The Origin and History of the Liverpool Royal Southern Hospital with Personal Reminiscences (Liverpool, 1936), pp. 61–2.Google Scholar
  7. 11.
    See Anson Rabinbach, The Human Motor: energy, fatigue, and the origins of modernity (Berkeley, 1992).Google Scholar
  8. 17.
    Thornton Brown, The American Orthopaedic Association: a centennial history (n.p., [1986]), p. 4.Google Scholar
  9. 19.
    Royal Whitman, ‘The Emancipation of Orthopaedic Surgery’, Proc. Roy. Soc. Med., 36 (1943), pp. 327–9.PubMedCentralGoogle Scholar
  10. 32.
    Stephen Trombley, Sir Frederick Treves: the extra-ordinary Edwardian (1989), p. 19.Google Scholar
  11. 34.
    Cited in Mayer, ‘Orthopaedic Surgery in America’, p. 487. In one of his reports as Surgeon-in-Chief to the New York Orthopaedic Dispensary and Hospital, Shaffer maintained that ‘in true orthopaedic surgery, operative work, per se, has no real status’. Quoted in George M. Goodwin, Russell A. Hibbs: pioneer in orthopaedic surgery, 1869–1932 (New York, 1935), p. 40.Google Scholar
  12. 41.
    George Rosen, The Structure of American Medical Practice, 1875–1941 (Philadelphia, 1983), esp. ch. 1: ‘Competition in the Medical Market’.Google Scholar
  13. 49.
    Summary contained in Annual Report for 1900, p. 221. For Edinburgh see Douglas Guthrie (ed.), The Royal Edinburgh Hospital for Sick Children, 1860–1960 (Edinburgh, 1960), p. 72.Google Scholar
  14. 51.
    Morris Vogel, The Invention of the Modern Hospital: Boston, 1870–1930 (Chicago, 1985), pp. 64ff.; and seeGoogle Scholar
  15. Clement A. Smith, The Children’s Hospital of Boston (Boston, 1983), ch. 12. Bone and joint surgery similarly became the focus of attention at the Children’s Hospital of Philadelphia: see F. A. Packard’s article on the hospital (written c. 1897) in Henry (ed.), Founders’ Week Memorial Volume, pp. 770–6.Google Scholar
  16. 53.
    Harry Platt, ‘Orthopaedic Surgery in Boston’ Med. Chron., 58 (1914), pp. 473–9.Google Scholar
  17. 57.
    See Helen Clapesattle, The Doctors Mayo (Garden City, New York, 1943), pp. 508–9; the obituary on Stiles byGoogle Scholar
  18. John Fraser in Year Book of the Royal Society of Edinburgh (Edinburgh, 1946), pp. 30–3, and that by W.J. Stuart, in Guthrie (ed.), Royal Edinburgh Hospital, pp. 45–9. Stiles was also responsible for the fundamental research on bone and joint tuberculosis carried out by John Fraser. SeeGoogle Scholar
  19. John Fraser, Tuberculosis of the Bones and Joints in Children (1914). On Henderson (who became president of the AOA in 1934), see Sketch of the History of the Mayo Clinic and the Mayo Foundation (Philadelphia, 1926), pp. 42–3 (which also gives an account of the rise of bone and joint operations from 1890 to 1924); and his obituary in JBJS, 36A (1954), pp. 1087–8.Google Scholar
  20. 58.
    On the history of the Edinburgh Chair of Orthopaedics, see Walter Mercer, ‘Inaugural Lecture’, Edin. Med. J., 56 (1949), pp. 173–86. Stiles’s wartime involvement in orthopaedics is mentioned in his ‘Practice and Training of Orthopaedic Surgery’, Lancet, 19 Apr. 1919, pp. 671–2.Google Scholar
  21. 63.
    Cited in Mayer, ‘Orthopaedic Surgery in America’, p. 480. For the context of specialization in American medical education in this period, see William Rothstein, American Medical Schools and the Practice of Medicine: a history (New York/Oxford, 1987), pp. 101–9.Google Scholar
  22. 65.
    See John R. Paul, A History of Poliomyelitis (New Haven, 1971), esp. p. 61 on the pioneer orthopaedist and physiotherapist, Charles F. Taylor of New York.Google Scholar
  23. 67.
    A. McGehee Harvey, Science at the Bedside: clinical research in American medicine, 1905–1945 (Baltimore, 1981), p. 159. See also,Google Scholar
  24. Sydney A. Halpern, American Pediatrics: the social dynamics of professionalism, 1880–1980 (Berkeley, 1988), p. 51ff.Google Scholar
  25. 70.
    See George Carpenter, ‘Introductory’, Br. J. Childr. Dis., 1 (1904), pp. 1–3, and Carpenter, ‘The History of the Society for the Study of Diseases in Children’, Reports of the SSDC, 8 (1907–8), pp. xxix-lxi. On professionalization in American paediatrics, see A. Jacobi’s introduction toGoogle Scholar
  26. George Payne, The Child in Human History (1916);Google Scholar
  27. Harold Faber and R. Mcintosh, History of the American Pediatric Society, 1887–1965 (New York, 1966); and Halpern, American Pediatrics. Google Scholar
  28. 77.
    See Maurice Davidson, The Royal Society of Medicine: the realization of an ideal (1955). There exists as yet no adequate study of the politics of the Royal Society of Medicine in these years, but there are some hints in Lindsay Granshaw, St. Mark’s Hospital London (1985), p. 180.Google Scholar
  29. 80.
    On Moynihan, who shared a summer cottage in Norway with William Mayo, see Donald Bateman, Berkeley Moynihan, surgeon (1940); on Horsley, seeGoogle Scholar
  30. J. B. Lyons, The Citizen Surgeon, a biography of Sir Victor Horsley (1966).Google Scholar
  31. 87.
    See Peter English, Shock, Physiological Surgery, and George Washington Crile: medical innovation in the progressive era (Westport, Conn., 1980).Google Scholar
  32. 96.
    Loyal Davis, Fellowship of Surgeons, a history of the American College of Surgeons (Springfield, Illinois, 1960).Google Scholar
  33. 99.
    E. Hey Groves, ‘A Surgical Adventure: an autobiographical sketch’, reprinted from Bristol Medico-Chirurg. J., 50 (1933), p. 21; and Platt, ‘British Orthopaedic Association’, pp. 116–25.Google Scholar
  34. 104.
    Moynihan’s Association of Surgeons of Great Britain and Ireland was not founded until 1920. See H. Platt, ‘The Foundation of the Association of Surgeons of Great Britain and Ireland’, Br. J. Surg., 69 (1982), pp. 561–3. Moynihan was also behind the postwar Surgical Union which first met in Leeds in 1921. SeeCrossRefPubMedGoogle Scholar
  35. Peter Boreham, Surgical Journeys: a history of the Surgical Union which became the 1921 Surgical Travelling Club of Great Britain (Braunton, Devon, 1990).Google Scholar

Copyright information

© Roger Cooter 1993

Authors and Affiliations

  • Roger Cooter
    • 1
  1. 1.Wellcome Unit for the History of MedicineUniversity of ManchesterUK

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