BRIEF DISCUSSION ON

HUGH OWEN THOMAS

On 28-07-2009
Moderators: -Professor Seetharam Rao
Dr K Ramachandra Kamath
Presenter: - Dr Praveen Babu K H

EARLY LIFE
Hugh Owen Thomas was born at Bodedern, Anglesey in North Wales, on August 23, 1834. He
has been called "the Father of British Orthopaedics". Hugh descended from a family that had
originally been settled in Anglesey, where a family tradition of bone-setting had been
established. By a shipwreck in 1745, Evan Thomas the grandson of the original survivor, and
Hughs father had moved to Liverpool at the age of 19, where he set up a successful practice
as bone-setter. Evan, however, was not a trained physician, and three times he was taken to court
to defend his practice. There was much jealousy on the part of the orthodox practitioners in the
city and, although he never lost a case, he resolved that his sons should train and qualify as
doctors, which is what all five of them did.

PROFESSIONAL CAREER
Hugh trained first with his uncle, Dr. Owen Roberts at St. Asaph in North Wales for four years,
then he studied medicine at Edinburgh and University College, London. Thomas enrolled as a
student at the University of Edinburgh at a time when Syme, Simpson, and Goodsir were at the
height of their fame. Lister and Turner, newly arrived from London, were beginning their great
careers in Scotland. He qualified as MRCS in 1857. Returning to Liverpool, he first worked with
his father, but incompatible temperaments did not allow this for long, so in 1859 he set up his
own practice in the poorer part of town.
Hugh was known as an eccentric and rather temperamental man. He was short, just over five feet
tall, always wore a black coat buttoned all the way up, a patch over one eye, and constantly had a
cigarette in his mouth. Among the poor people of Liverpool though, he stood in great esteem. He
practiced from his home in No. 11, Nelson Street, where he worked all day from five or six in the
morning, and every Sunday he would treat patients for free.

CONTRIBUTION
His contribution to Orthopaedics was manifold.
In the treatment of fractures and tuberculosis he advocated rest, which should be
'enforced, uninterrupted and prolonged'. In order to achieve this he created the socalled 'Thomas Splint'. The splint was prepared in his home only by a blacksmith, has
two rings on which the patient could walk. It was popularized by his nephew Sir Robert
Jones during world war I when its use for open fracture femur shaft reduced the
mortality from 80% in 1916 to 8% in 1918

He is also responsible for numerous other medical innovations that all carry his name:
'Thomas's collar' made of sheet metal covered with felt & sheep skin to treat tuberculosis
of the cervical spine.
'Thomas's manoeuvre', an orthopaedic investigation for fracture of the hip joint
Thomas's test', a method of detecting fixed flexion deformity of hip. The patient lying flat
in bed, Have the patient hold one leg to his chest and let his other leg down until it is flat
on the table. If the thigh rises off the table, the test is positive for a hip flexion
contracture.
This test does not differentiate between tightness of the iliopsoas versus the rectus
femoris.
'Thomas's wrench', to osteoclysis malunited distal radius fractures and reset bones.
Thomas heel support to medial longitudinal arch of foot
Thomas Spinal Brace for ambulant treatment of spinal tuberculosis
One man reduction technique of reduction of hip
Thomas Sign of tuberculosis of the hip. Consists of the formation of a compensatory
curve of the spine being formed on extension of the diseased leg.

 Reduction of old elbow dislocation

His work was never fully appreciated in his own lifetime, but when his nephew, Sir Robert
Jones, applied his splint during the First World War, this reduced mortality of compound
fractures of the femur from 80% to less than 8% in the period from 1916 to 1918.

WORKS

Diseases of the hip, knee and ankle joints (1876)

A review of the past and present treatment of disease in the hip, knee, and ankle joints: With
their deformities (1878)

The past and present treatment of intestinal obstructions (1879)

The treatment of fractures of the lower jaw (1881)

Intestinal disease and obstruction (1883)

Nerve inhibition and its relation to the practice of medicine (1883)

Principles of the treatment of diseased joints (1883)

The collegian of 1666 and the collegians of 1885: Or, what is recognized treatment? (1885)

The principles of the treatment of fractures and dislocations (1886)

Fractures, dislocations, diseases and deformities of the bones of the trunk and upper
extremities (1887)

A new lithotomy operation (1888)

Fractures, dislocations, deformities and diseases of the lower extremities (1890)

Lithotomy (1890)

It has been said that the medical profession might not have practiced the black art of bone
setting, if Hugh Owen Thomas had not graduated from a Medical school. The teaching of Owen
Thomas was slow in spreading but there were some surgeons who immediately grasped the
significance of what he taught and adopted his splints. Among them were Rushton Parker in
Liverpool, Edmund Owen and Thomas Bryant in London, Professor Thiersch in Germany and
John Ridlon in America. Ultimately the hip splint began to appear in the teaching hospitals. The
good effect of prolonged immobilization was so convincible that radical operations diminished
and conservative control of skeletal tuberculosis came into favor.

REFERENCES
1. Anthopology of orthopaedics Mercer & Rang 1968
2. The influence of Hugh Owen Thomas on the Evolution of the treatment of skeletal
tuberculosis N Jones Jbjs 1953
3. Traction and Orthopaedic appliances Jhon D M Stewart
4. The Orthopaedic centers of great Britain and their American medical officers Robert B
Osgood JBJS Am1918 2-16 132-140
5. The orthopaedic aspect of Chronic Arthritis: the Huge Owen Thomas Lecture delivered
before the Medical Institution of Liverpool - Robert B Osgood JBJS Am1926:8 1-41