The early weeks of July are significant for a number of anniversaries and commemorations. This July marks the 75th anniversary of the founding of the National Health Service by Aneurin Bevan, as well as the 107th anniversary of the beginning of the Battle of the Somme.
At a glance these events seem to have little in common. One is the commemoration of mass slaughter, the likes of which the world had never seen before, and the other a foundational pillar of social justice and health improvement. On closer inspection, however, events happening on and behind the lines during the Somme would revolutionise medical practice and form an essential blueprint for much of the work carried out today in the NHS.
The Battle of the Somme began on 1 July 1916 and ended in blood, mud, and an effective stalemate that November. It saw an estimated 420,000 British casualties, including almost 96,000 deaths, of which 19,240 occurred within the first 24 hours.
The battle was an attempt by the British Empire and France to break through the German lines, but also to relieve some of the pressure exerted on French lines further to the south, such as the German assault on Verdun. Though it somewhat succeeded, the efforts of the British and French at the Somme failed to decisively break through the German lines and win the war.
The First World War saw a refinement of human’s ability to wound and kill other humans. Bullets, shrapnel, explosives, and even poison gas each wrought their terrible impact on combatants. The memorials to be found in villages and towns across Wales testify to the effectiveness of such weapons. But what of efforts to save lives and minimise fatalities?
Should a soldier immediately survive a gunshot or explosion, one of the historically fatal complications he might then experience was a compound fracture. This is when a bone not only breaks but also pierces through the skin, exposing the bone to the outside world.
Certain types of these fractures – for example, in the femur, the leg bone which joins with the hip – had a fatality rate of 80%. In the muddy conditions of the battlefield, pierced skin enabled bacteria to infect soft tissue and bone. Blood supply would be significantly compromised, and shock would set in. In the 21st century, these fractures are eminently survivable, and for this we have one particular Welsh family to thank.
At some point between 1730 and 1745, a shipwreck off the northern coast of Ynys Môn saw two young boys washed up on a beach. Nobody could understand anything they said; they did not appear to speak either English or Welsh. For many years, they were believed to have been Spanish. This myth persisted until 2012, when DNA analysis revealed they were originally from the region of the Caucasus mountains.
The bonesetters of Ynys Môn
One boy was adopted by a local doctor and named Evan Thomas. He was to be the first of the fabled Anglesey bonesetters. In a time before X-rays and plaster casts, Evan showed a remarkable aptitude for identifying broken bones and setting them, therefore allowing them to heal. It is claimed that he honed the skill by healing injured birds and animals.
A plaque to commemorate Evan’s skills could be found in the church of Llanfairynghornwy, raised by a grateful Lord Bulkeley after Evan successfully treated his wife. Each subsequent generation of the family had prominent and expert bonesetters.
In 1834, Hugh Owen Thomas was born in Bodedern, Ynys Môn. He is widely credited as being the “the father of modern orthopaedics”. He had an exceptional career, which took him from Bodedern to Edinburgh, Liverpool, London, and Paris. The revolutionary work for which he is best remembered took place in Liverpool, where he ran a practice at 11 Nelson Street: the Thomas splint.
Hugh would use a splint to treat a patient who had tuberculosis (TB), which can often infect bone. This allowed the affected bone to be immobilised, forcing the patient to rest and allow the bone to heal naturally. This invention allowed Hugh to spare the patient an otherwise life-altering amputation, which at the time was the only accepted course of action for advanced skeletal TB.
Hugh Owen Thomas’s other significant contribution to orthopaedics – and to saving lives at the Somme – was taking on the care of his nephew, Robert Jones. Robert left his life of relative poverty in London to live with his uncle at the age of 16.
In keeping with being a member of the family of bonesetters, Robert demonstrated himself to be an excellent orthopaedic surgeon and was responsible for organising the formation of the British Orthopaedic Society. Robert was also a keen innovator, and quickly saw the utility of X-rays in his work. He took his first diagnostic image within weeks of the 1895 announcement by Wilhelm Rontgen of the discovery of the mysterious rays.
As the First World War began, Robert was recruited into the Royal Army Medical Corps, and found himself in charge of military orthopaedic hospitals. He quickly set about reforming the care and treatment of patients. One of his major innovations was the introduction of the Thomas splint, previously used by his bonesetter uncle to treat TB, into the management of complex fractures.
Rather than beginning this therapy when a soldier had reached hospitals in the UK, which could take days, by 1916 Robert had rolled this treatment out to casualty clearing stations located just behind the front lines. This meant patients received almost immediate treatment and, as we now know, prompt treatment makes all the difference.
The legacy of the bonesetters
Together with the use of X-rays, and the development of new antiseptics (such as the Dakin solution in 1916), mortality rates for femoral fractures fell from 80% to 20%, not only saving lives but preventing the amputation of limbs from countless other survivors. The remaining 20% mortality remained for a few decades, requiring innovations unleashed by a second world war to come down further: most particularly the mass production of antibiotics such as penicillin.
The direct impact of the introduction of the splint on victims of the Battle of the Somme can be seen in a document held by the National Archives. This is the pension book of a Private George Prentice, who was severely wounded during the third phase of the Somme with a left femur fracture. He was placed in a splint for 14 weeks. He was eventually able to walk unaided and did not require an amputation.
The legacy of the Thomas bonesetters can still be felt in the NHS today. Treatment of fractures involves many of the technologies pioneered by Robert and his uncle. These often involve the work of what is called the multidisciplinary team: radiographers who take X-rays, physiotherapists who help with rehabilitation, and surgeons who can intervene if additional specialist treatment is required.
Evidence of the respect in which the bonesetters of Ynys Môn are held can be seen above the door of one of the most pre-eminent orthopaedic hospitals in the UK. The Robert Jones and Agnes Hunt Orthopaedic Hospital in Gobowen – Dame Hunt is herself a remarkable individual, but perhaps the topic of another tale – has been part of the NHS since its founding in 1948. Happy anniversary, from Wales to the world.
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