HISTORY OF ORTHOPAEDICS Great Names in the History of ...

Figure 1 Portrait of Sir William Arbuthnot Lane (reproduced
courtesy of the Wellcome Library, London).
lived in 8 countries on 4 continents. Eventually, he went
to a public school in remote Scotland, where he became
interested in the anatomy of small mammals, which he
loved to dissect. A family tradition of manual dexterity
was evident at this early phase of his life. One day, the
schoolmaster found him dissecting a bird most splendidly.
The school encouraged Willie and obtained small
animals for him, which was thought to have prompted
him to take up medical studies. Later, he matriculated
at the University of Edinburgh.
STUDENT AT GUY’S HOSPITAL
In May 1873, Lane entered Guy’s Hospital Medical
School (founded in 1742), then at the zenith of its
fame. Sir Astley Cooper (1768-1841), Thomas Addison
(1795-1860), Richard Bright (1789-1858), and Thomas
Hodgkin (1798-1866) had been associated with the
hospital. In his unpublished autobiography, Lane
explained that the reason for his choice of Guy’s was
because his father was stationed at nearby Woolwich.
Hence, he was able to live at home because of the
proximity to London Bridge Station. As a 16-year-old
at Guy’s, he looked very young among the class of 100
students. He gave a fascinating account of his life as a
medical student at that time:
I was regarded as somewhat of a child by the students
generally, who seemed to be quite old. At that
time many had beards or moustaches and wore top
hats. However I managed to survive.
I found the lectures very trying since they ended
very quickly in regular orgy. There was too often
a struggle to get into the lecture theatre, and the
duration of the lecture depended entirely upon the
personality of the teacher. The Botany lectures which
Great Names in the History of Orthopaedics
were then obligatory were hopeless. The lecturer, a
very mild gentleman, was only allowed a limited
period during which he attempted to impart some
knowledge to his audience.
Dr Davy, a physician of great distinction, had but
little control over his class. He showed experiments
on animals and these were perpetually interrupted by
cat calls and by barking, which tended to upset him.
He sometimes omitted his H’s, and when he spoke of
‘Guy’s Orspital’, the place resounded with cheers.
One of the lecturers in chemistry, Dr Stevenson a distinguished
expert on poisons, and who usually gave
evidence in medico-legal cases, was treated with scant
respect, but the other lecturer on the same subject,
Dr Debus, stood no nonsense from the students, and
from his lectures I learned much and was stimulated
to study chemistry, which I found very interesting.
At that time Guy’s had a wonderful medical staff,
including Addison and Gull, who had just left,
and Samuel Wilks… were names to conjure with.
They impressed me very much with the supreme
importance of medicine, and of the vast problems
it offered. I was very interested in anatomy as the
functions of the skeleton appealed very much to me.
While a student I was appointed assistant demonstrator
in anatomy, and I thoroughly enjoyed the
work of learning and teaching this subject.
Medical education at that time was divided into a
summer session lasting from May to July, and a winter
session from October to March. The most prominent
subject in the medical curriculum at that time was
anatomy. Lane attended 56 lectures in his first year
and 66 in his second. In summer, when dissection was
not done, he was devoted to physiology.
THE MATURE SURGEON
After qualification in 1877, Lane was appointed house
surgeon to the Victoria Hospital for Children in Chelsea.
There, he published his first paper on rib resection
in 5 children with chronic empyema with 4 successes.
At the time, the standard operation for empyema was
repeated aspirations followed by intercostal incision
and drainage. Lane began to resect the ribs instead for
thorough drainage and more rapid recovery.
Eventually his method became the standard treatment.
However, he decided that surgery was not for
him and his ambition was to get on the staff of Guy’s
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Hong Kong J Orthop Surg
as a physician. The surgical ‘dressers’ had despised
him:
During the first three months of its duration the
dressers never condescended to speak to me. At that
time class distinction between men of different
years was very marked, and the dressers regarded
themselves as people of great importance, while the
ward clerk, a green apprentice, being regarded as
unimportant. If I recollect correctly the dressers
wore top hats and frock coats.
What made Lane change his mind was the advice
from Dr Moxon, a staff physician at Guy’s, who told
Lane that his chances of getting on to the medical side
were remote because all physicians were strong and
healthy, whereas all surgeons suffered from one condition
or the other and were likely to be influenced
prejudicially during the duration of his life!
From the Victoria Hospital, Lane returned to Guy’s in
1882 as demonstrator in anatomy at a salary of £200
a year, while also serving on the staff of the Hospital
for Sick Children at Great Ormond Street, London. He
married during this time. In 1888, he was elected to
the surgical staff at Guy’s where he was to remain until
his retirement in 1920. His work as a demonstrator
afforded him ample opportunity to examine a large
number of dead bodies. At Guy’s, Lane worked alone
in the dissecting room night after night, scraping soft
tissues from the bones of bodies left after medical students
had done their work. In this way, he examined
the skeleton and ligaments of 35 bodies of working
class Londoners. He discovered spinal curvatures,
changes in the dominant shoulder joint, and abnormal
mobility of the spinal column. On checking the clinical
records of these cases, he was able to confirm a
link between these findings and the deceased’s former
occupation.
As a result of these investigations, Lane observed
that the general structure of a bone corresponds with
the directions through which forces applied to it are
transmitted in life:
This investigation very soon convinced me that
the result of the treatment of fractures was most
unsatisfactory, and that the statements which were
made and generally accepted as to its efficacy were
absolutely false and misleading. While the works on
surgery described the means by which the broken
bones could be brought into accurate apposition,
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the results, as shown in the dissecting room, proved
that, except in very favourable cases, the restoration
of the broken bone to its normal form was
hardly ever affected by whatever treatment had
been adopted. This was not altogether unexpected,
since the treatment of fractures in the general way
was most perfunctory and some surgeons were not
possessed of much technical skill or mechanical
knowledge. The displacement of fragments upon one
another not only resulted in local inconvenience and
deformity, but the resulting alteration in the mode
of transmission of pressure through other bones and
joints affected indirectly by the displacement was
progressive.
It became obvious to me that the skeleton represented
the crystallization of lines of force and that any
alteration in the form of the bone resulted in recrystallization
of that bone, and in pressure changes
in such bones and joints which were affected. Such
remarkable change when observed had been called
rheumatoid or osteo-arthritic, and these so-called
diseases were very common. When very definite
coarse changes came about in the structure of the
skeleton, such as the formation of a new joint, they
were usually regarded as congenital abnormalities,
on the presumption that they existed at birth.
The study of the skeleton and the ideas developed
from it was central to Lane’s later work in revolutionising
the treatment of fractures:
The detailed examination of the several bodies in the
dissecting room threw an entirely new light upon
anatomy. The vast number of changes which the pathologists
and the anatomists regarded as evidence
of disease or abnormality were very conspicuous in
the structure of the bodies which were mostly those
of working men and women. These changes were so
definite that I was enabled, by observing them, to
determine the occupation of the individual during
lifetime.
I formulated these four laws:
1. The skeleton represents the crystallization of
lines of force.
2. Pressure exerted habitually over a long period
of time results in alteration in the form and
texture of the bones, cartilages and joints, old
joints being modified or destroyed, and new ones
developed.
3. Strain in the same way alters the form and

structure of bones, cartilage and joints, alters existing
joints and causes new ones to develop.
4. Apart from the exercise of pressure or strain,
when it is to the advantage of the individual in
his special relationship to surroundings, an old
mechanism may be modified or an entirely new
one developed.
By the application of these principles it is easy to
determine the labour history of the individual by the
examination of his skeleton. The body of labourer
represents first the fixation and later the exaggeration
of the tendencies to change which exists when
attitude of activity is assumed habitually in the
particular form of work. These several changes
which result render the individual more capable of
nerve and muscular energy. This is best illustrated
by a law which I formulated, namely:
We bear a simple mechanical relationship to our
surroundings; any change in that mechanical relationship
produces a corresponding alteration in our
anatomy. Everything that nature does to meet such
an alteration in our mechanical relationship to our
surroundings tends to shorten our life.
At this time, Lane’s lifelong dogmatic views began to
dominate his thinking and work. This was his belief in
the control of the body by mechanical forces. He was
determined to attribute all abnormality and deformities
to mechanical causes.
OPEN REDUCTION AND INTERNAL
FIXATION OF FRACTURES
Lane’s work on fractures stood above all others. He
was not the first surgeon to reduce and fix fractures
with metal plates and screws. Before his time, criteria
for a good result in fracture healing were aesthetic
rather than functional. Given a firm union, the rest
was an aesthetic problem affecting the surgeon’s
reputation rather than the patient’s function. The
Figure 2 Lane’s original steel plates for fracture fixation manufactured
by Down Brothers of England.
Great Names in the History of Orthopaedics
traditional view among surgeons was: “Pay great attention
to your cases, with them alone the grave does
not cover your mistakes.”
Open reduction of fractures was not new. Joseph
Lister (1827-1912) had carried out open reduction and
wiring for a fractured patella. In Lane’s daily practice,
he encountered patients who could not return to their
occupation despite apparent good healing. During visits
to the work places of these patients, Lane realised
that to enable a man to go back to his job, the surgeon
must restore the surface of those joints exactly to the
relationship they had previously borne to one another,
and to the line of force, of stress, and strain that
were passing across them. Lane concluded that he
could only achieve this by open reduction of simple
fractures that became displaced. He himself used the
term ‘internal splint’ instead of ‘wires’ or ‘plates’.
At first wires were used, then followed by screws, and
finally plates. Lane pioneered the use of steel screws
for internal fixation as early as 1893, much before
Wilhelm Conrad Roentgen’s (1845-1923) discovery of
the X-rays in November 1895 revolutionised clinical
diagnosis and treatment of fractures.
In 1905, Lane introduced perforated steel plates
(Figure 2) for plating fractures of the long bones.
His secret of success lay in the use of the ‘no-touch’
technique for his operations. No fingers of the surgeon
or assistants should enter within 4 inches of the
wound and every instrument, swab, or suture should
come closer than 4 inches of the hands — the ‘4-inch
from finger-to-wound’ principle. For this, he devised
long dissecting and haemostatic forceps so that
fingers never touched the tissues or wound edges.
Forceps gradually lengthened from 4 to 8 inches long,
ensuring that fingers would not touch the depths of a
wound.
Even the sutures were never touched but were
threaded using forceps. All instruments were handed
to the surgeon by the nurse in a forceps dish and
never touched by the gloved hands. This strict aseptic
technique was combined with meticulous haemostasis
and gentle handling of tissues. Every spicule of
bone was replaced and reduced with meticulous care.
When rubber gloves came into use, Lane insisted
on continuation of this ‘no-touch’ practice, as he
believed that the gloved hand might be contaminated
unknowingly at some stage of the operation. The
patient’s skin was liberally cleansed with antiseptics.
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Hong Kong J Orthop Surg
In addition, sterile towels were clipped to the wound
edge for protection. Perfect haemostasis was another
prerequisite of Lane’s methods. He designed toothed
artery forceps with ‘bull-dog’ ends so that there was
less crushing of the arteries. Although Lane’s fingers
flashed like lightning during an operation, he said.
“I do not believe in quick operating. It is wrong to
do in twenty-five minutes an operation that ought
to take three-quarters of an hour. Except, of course,
when the patient’s condition needs it.”
LANE, THE PERFECTIONIST
To many of those who objected, antisepsis was comparatively
new. Operating theatres were unhygienic,
the staff inadequately trained, and there were no
antibiotics. The antiseptic method of Lister, by introducing
carbolic acid spray into the wound and the use
of instruments, plates and screws wet with irritating
solution, necessitated the removal of implants. Hence,
Lane’s ideas were regarded as surgical sacrilege. The
Professor of Surgery at Cambridge was sure that Lane
was unfit to be a surgeon. The then President of the
Royal College of Surgeons said openly that a man who
converted a simple fracture into a compound fracture
was guilty of malpractice, and should be brought before
the General Medical Council. This announcement
only caused several young surgeons to come to Guy’s
the next day to see what Lane was doing. Students
who approved of Lane’s methods were advised to
avoid such procedures in future if they desired to
pass the examination held by the Royal College of
Surgeons.
During his early years as a qualified surgeon, Lane
published 74 papers, including original works on the
surgery of the middle ear and the mastoid antrum.
Lane was also on the staff of the Hospital for Sick
Children, where he became interested in cleft palate
surgery. He wrote 13 papers and a book on this subject
in 1897 titled Cleft Palate and Adenoids; Treatment of
Simple Fractures by Operations; Diseases of Joints;
Operative Treatment of Cancer; Acquired Deformities;
Antrectomy, Hernia etc. which went into several
editions. He insisted on immediate operation at birth
instead of waiting until the child wanted it done, as
was the custom. He designed special cleft palate forceps,
knives, scissors, and needles (Figure 3).
Lane also did much work on the treatment of shock.
He advocated continuous saline infusion drips
throughout the operation, sometimes into the axilla
subcutaneously or into the veins. He was the first
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Figure 3 Lane’s plate-holding forceps, plate benders, screwguiding
forceps, and screwdriver.
surgeon to ligate the internal jugular vein in septic
thrombosis of the lateral sinus. He introduced exploration
and drainage of the mastoid antrum in chronic
suppurative otitis media. He was also the first to
perform successful internal cardiac massage in 1902
in a 65-year-old man undergoing appendectomy, as
described in the following account:
During the trimming of the stump both the pulse
and the respiration stopped. Artificial respiration
and traction on the tongue were performed without
result. Then the surgeon introduced his hand
through the abdominal incision and felt the motionless
heart through the diaphragm. He gave the heart
a squeeze or two and felt it restart beating.
In 1896, Lane successfully removed a brain tumour
and in 1909 he developed an operation for resection
of the cervical oesophagus with reconstruction of the
defect by skin flaps. Lane did not doubt his own abilities.
He used to tell the following story:
A distinguished provincial surgeon was sued for
malpractice. It was contended that he should have
plated a fracture. Lane was called in for the defense.

Figure 4 Lane’s bone-holding forceps, bone lever, and periosteal
elevator.
He was asked: “Should you have plated the fracture?”
“Certainly,” replied Lane.
Then Counsel said to Lane: “Then the defendant was
wrong not to plate it?”
“No” replied Lane, “he was quite right.”
The Judge said: “I don’t understand you, Mr. Lane.
You said you would have plated it and that the defendant
was quite right not to.”
Lane replied: “All I said, my lord, is that I should have
plated it.”
Lane was a perfectionist. More than anything else,
he liked to invent new operations, procedures, and
surgical instruments. He was not keen on routine
surgery and disliked teaching. All the instruments
that he designed — 42 in total — were made by
Down Brothers of St. Thomas’s Street, London, which
was close to Guy’s Hospital. They included artery forceps,
awls, plate benders, bone chisels and gouges,
screw drivers and screw-guiding forceps, tissue
forceps, stomach clamps, and twin intestinal clamps
(Figures 3, 4, and 5). Unfortunately, all original notes
and sketches kept by Down Brothers were destroyed
Great Names in the History of Orthopaedics
Figure 5 Lane’s tissue retractor, dissecting forceps, and tissue
forceps.
during the German bombing in the Second World
War.
While most British surgeons continued to oppose Lane,
German surgeons on the other hand carefully investigated
the matter and soon proceeded to operate on
simple fractures. Lane was invited to a congress in Berlin
to describe his principles and methods of treatment.
Next, he visited America to demonstrate his methods
at a congress in Atlantic City. There, he made friends
with many American surgeons, including the President
of the American College of Surgeons, Rudolph Matas.
They, like the Germans, investigated the matter thoroughly
and, being more aware of the failures of the
conventional treatment methods than British surgeons,
determined to give Lane’s methods a trial. He revisited
the United States in 1906, 1911, 1918, and 1925.
In New York in 1911, Lane was invited to demonstrate
his operating skill. There were 2 theatres, each with
400 spectators. Lane would operate in one and, leaving
the skin wound to be sutured by his assistant,
go into the next where the patient would be already
prepared! This visit witnessed a tragic incident. Lane
was expected to plate a femur. However, as there
were no patients available, an ambulance was sent
to secure one from another hospital. On the way, the
vehicle ran over a man, with the victim also suffering
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Hong Kong J Orthop Surg
from a broken femur. The poor victim was placed on
the operating table, and Lane, who saw only the limb
with the fractured femur, plated the fracture. Unfortunately,
that night, the patient died of other severe
injuries of which Lane had been quite unaware.
A former house surgeon told the following story:
One day Willie asked his assistant, “What’s the nearest
animal to us?”
The reply was, “I suppose it is the gorilla.”
Willie mused, “We can’t get that.”
The fact was that he had a patient with ankylosed
elbow joint and Lane was considering excision of
the joint and replacing it with one from an animal.
A gorilla being impossible, he decided on a sheep
and instructed his assistant to slaughter it and cut
out the joint. When the Medical Superintendent of
Guy’s heard of this, he would not allow it on any
account. So the assistant had to do it in a house
nearby. Having killed the sheep and cut out the joint,
he hurried to the operating theatre where Lane was
waiting. As expected this grafting ended in failure.
Lane never attempted one again!
It was not until 20 years later that the British Medical
Association appointed a committee to investigate the
experience and results of fracture treatment at home
and abroad. As a consequence of this investigation,
the British Medical Association published a report
proving the accuracy of Lane’s methods.
Lane was knighted for his contributions to medicine
in 1913. During the First World War, Lane was made
Consultant to the British Army and organised the
Queen’s Hospital for treatment of facial disfigurements
of soldiers. A young surgeon from New Zealand
named Harold Gillies trained under him and the 2
laid the foundations of plastic and reconstructive
surgery.
THE HONG KONG CONNECTION
Surgery in Hong Kong may be said to have begun
in 1912 with the appointment of the newly married
Kenelm Hutchinson Digby, MB, FRCS (Figure 6),
formerly Registrar to Sir William Arbuthnot Lane,
to the Chair of Anatomy at the infant University of
Hong Kong. He also taught surgery and in 1915 Digby
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Figure 6 Portrait of Professor KH Digby (courtesy of the Department
of Surgery, University of Hong Kong, Hong Kong).
was appointed to the Ho-Tung Professor of Clinical
Surgery, and also Chair of Surgery in 1922. He was
to remain Professor of Surgery in Hong Kong for 30
years until 1945! Digby propagated his former chief’s
‘no-touch’ technique in surgery to Hong Kong. He also
designed new plates and screws for internal fixation
of fractures (Figure 7). At the surgical section conference
of the China Medical Association meeting in
1926, Digby addressed the gathering:
It is somewhat of a reproach to modern surgery that
when a bone is broken the average surgeon hesitates
to accurately unite the fragments. Yet a nerve, a
muscle, a tendon, a ligament or an aponeurosis
will be sutured as a matter of routine. It is true that
Lane and others have long adopted the fixation of the
fragments in position with metal plates and screws
in almost all fracture cases…
But the routine treatment of fractures by open operation
has never become popular, and during the
Great War [1914-1918] open operation played only
a small part in the treatment of simple fractures.

Figure 7 Special plates and screws designed by Digby, with
tracings of radiographs of operated fractures.
1. The proneness to septic infections in such operations
and the appalling results of such septic
infection.
2. A tendency to delay in firm bony union.
3. Technical difficulty in accurately replacing the
fragments; manipulating the plates, drilling
holes and inserting screws; and controlling
haemorrhage.
It has been pointed out by Hey-Groves that the stoutest
union of fragments could be obtained by two steel
plates on opposite sides united by bolts and nuts
through the whole thickness of the bone…
Great Names in the History of Orthopaedics
It then occurred to one that a plate outside the compact
tissue and another inside the medullary cavity
could be held to one another by a single bolt and nut,
and that such would not require a very long incision
or excessive stripping of periosteum…
Two short plates are employed, one within the medullary
cavity, the other outside on the surface of the
bone. These are tightly clamped together by means of
a single screw attached to the inner plate and outer
plate and traversing a hole in the bone near the
fracture. A nut outside the outer plate screws up to
compress the plates.
In this preliminary report, Digby gave details of 4
patients with not-too-recently fractured long bones
that failed to respond to conservative treatment.
The first patient was a Chinese rickshaw coolie who
sustained a fractured tibia and fibula after being
knocked down by a motorcar 42 days before admission
to the Government Civic Hospital. The second
was a Chinese scavenger who fell off his bicycle 30
days before operation and had fractured radius and
ulna. The third patient was a European who, whilst
riding a motorcycle, collided with a lorry and was
thrown down some 4 weeks prior to surgery and had
fractured his tibia and fibula. The fourth patient was
a European sailor who fell 60 ft from the top of the
mast onto the deck of his ship, sustaining a fractured
femur that was treated for 8 weeks without union.
The mode of injuries of these patients gave an interesting
glimpse into the social life of Hong Kong in the
early 20th century, i.e., the different modes of transport
preferred by the Chinese and Westerners. Digby
claimed the following advantages for his method of
fixation:
1. Ease and speed of application. It is not necessary
to drill numerous holes for screws.
2. The inner plate acts as a guide for reduction of the
fracture.
3. Periosteal stripping is reduced. Risk of infection is
reduced.
4. The plates can easily be applied near the ends of
bones when compact tissue is too thin to afford a
secure hold for screws.
5. Removal of the plates is easy if it is necessary.
CONCLUSION
Sir William Arbuthnot Lane was a brilliant technical
surgeon whose manual dexterity was equalled only
by his contemporary Lord Moynihan (1865-1936) of
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Hong Kong J Orthop Surg
Leeds. During his days as demonstrator in anatomy,
students at Guy’s used to say, “Don’t let Lane touch
your part or you will have nothing of it left!”
Stories abound about Lane’s skill in operative surgery
and the speed with which he could assess a situation.
On one occasion, he had given his registrar a hernia
to do while he watched. After a while he said to the
young man, “I wonder what you have got there.” The
registrar replied, “Omentum, sir. I was just going to
ligature it and cut it off.” Lane said, “I was wondering
if it could possibly be the bladder. Would you
mind if I washed up and assisted you?” After dissection,
Lane said, “Yes, Simpson, you’re quite right, it
is the bladder.”
One of his former staff surgeons at Great Ormond
Street wrote of him, “Lane had two very definite
sides, the technician and the theorist. As a technician
he was superb. Lane the theorist had the faults
that so often accompany originality. With the birth
of a new idea he became possessed of it and thought
and talked of nothing else. Lane as a man combined
great force of personality, irregularity of genius,
complete control of all professional technique, and
great selflessness. In nothing Lane did was there
any ulterior motive.”
At a private dinner party in which nearly all the guests
were surgeons, they all agreed that Lane was the man
they would choose to operate on them!
Lane became famous in 4 subspecialties: fracture
fixation, middle ear surgery, cleft palate repair, and
abdominal surgery. Undoubtedly, his greatest contribution
was his pioneering work on the open reduction
and fixation of fractures. In the 19th and early 20th
centuries, it was still possible for a person to make
many innovations and to build a world reputation
in 4 different branches of surgery. Sir Harold Arthur
Thomas Fairbank, consultant surgeon to the Hospital
for Sick Children at Great Ormond Street, concluded,
“It can be said without conviction that none of his
pioneer work had a greater influence on the practice
of surgery than his no-touch technique.”
Lane’s first wife, Charlotte, died in 1935, but he remarried
in the same year. Although he was then aged
79 years, he continued giving lectures around the
country. During the Second World War, Lane practised
walking around the streets of London regularly
despite the frequent air raid alarms. Sadly, he was
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knocked down by a car in Pall Mall during a blackout.
He died on 16 January 1943, aged 86.
The obituary in The Times newspaper said he was “one
of the most brilliant British surgeons during that
period when surgery took such big strides forwards.”
An obituary in the 30 January 1943 issue of the Lancet
said of him:
Lane was interested in his craft rather than his
profession. He was for instance a teacher but not an
examiner, and he attended societies only to address
them. He inspired his students with enthusiasm
and devotion, but he gave them dogmatic statements
rather than reasoned expositions. He gave his patients
meticulous care and exacted punctuality and
attention to details from his assistants. His loyalty
was unswerving and he remained true to his friends
and his own ideas.
At a memorial service at Guy’s Chapel on 21 January
1943, one of his associates said, “Lane would follow
the line he had laid down for himself, utterly by opposition
or criticism. Indeed he thrived on opposition,
and I have often heard him say what a blessing
it was to have enemies, because their opposition was
so stimulating. He himself was a hard hitting and
vigorous opponent on any matter of professional
controversy, but personally he was the most kindhearted
and gentle of men, loyal to a degree to those
who had gained his affection.”
Another obituary in the 23 January 1943 issue of the
British Medical Journal summarised:
Bygone controversies will be recalled — but not
revived — by the announcement of the death of Sir
Arbuthnot Lane, which took place on January 16.
An Irish ancestry and a Scottish upbringing combined
to produce a combative and tenacious personality,
partly concealed, but made more dangerous
to opponents by a mild and persuasive exterior. A
man of undoubted gifts and insight, he seemed to
take pleasure in the expression of extreme views, in
season or — preferably — out of season, believing
probably that by the clash of extremes a true balance
can be maintained.
ACKNOWLEDGEMENTS
The author is indebted to Ms Marianne Smith, College
Librarian of the Royal College of Surgeons of

Edinburgh, Scotland, for locating and supplying many
of the archival materials relating to Mr Lane. The
portrait of Sir William Arbuthnot Lane was supplied
by the Wellcome Library, London. The photograph of
Professor Kenelm Hutchinson Digby was supplied by
the Department of Surgery, University of Hong Kong,
Hong Kong.
SELECTED BIBLIOGRAPHY
1. Anonymous. Sir William Arbuthnot Lane at Guy’s Hospital.
Br J Surg 1920;3.
2. Dally A. Fantasy surgery 1880-1930. Amsterdam: Editions
Rodopi BV; 1996.
3. Digby KH. A preliminary note on a new method of plating
fractures (read before the surgical section of the conference
of the China Medical Association at Peking in September
1926). China Med J 1926;316-24.
4. Ellis H, editor. Bailey and Bishop’s notable names in medicine
and surgery. London: HK Lewis; 1983. p. 130-4.
5. Lane WA. Remarks on the results of the operative treatment
of chronic constipation. Br Med J 1908;1:126-30.
6. Lane WA. A method of treating simple oblique fractures of
the tibia and fibula more efficient than those in common use.
Trans Clin Soc Lond 1894;27:167-75.
7. Lane WA. On the advantage of the steel screw in the treatment
of ununited fractures. Lancet 1893;2:1500.
8. Lane WA. On the operative procedure for simple fractures
which have been unscientifically treated. Edin Med J 1901;
9:45.
9. Lane WA. A few cases illustrating the results of operative
interference for fractures about the elbow joint. Edin Med J
1902;11:388.
10. Lane WA. A lecture on the operative treatment of simple
fractures. Lancet 1900;1:1489.
Great Names in the History of Orthopaedics
11. Lane WA. On the treatment of fractures around the vicinity
of joints. Lancet 1907;1:1283.
12. Lane WA. Discussion on the operative treatment of simple
fractures. Br Med J 1910;2:1059.
13. Lane WA. Method of procedure in operations in simple
fractures. Br Med J 1912;2:1532.
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The Author
FU Louis Kuo-Tai, FRCSEd, FHKCOS, Faculty of History
and Philosophy of Medicine and Pharmacy, The Worshipful
Society of Apothecaries of London.
61

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APPENDICES
Appendix 1 Lane’s early report on plate fixation of fractures of
long bones, published in the Transactions of the Clinical Society of
London, 1894.
Appendix 2 Lane’s report on operative reduction and fixation of
articular fractures in the Edinburgh Medical Journal, 1902.
62
Fu LKT
Appendix 3 Digby’s report on plating of fractures in the China
Medical Journal, 1926.