Georg Clemens Perthes

Georg Clemens Perthes (1869 – 1927)

Georg Clemens Perthes (1869 – 1927) was a German surgeon.

As a surgeon, Perths wrote on vascular and chest diseases; maxillofacial injuries; and the surgery of war. He developed a procedure to drain empyema with continuous aspiration of the pleuritic exudate; a pneumatic cuff to maintain haemostasis during limb surgery (Kirschner-Perthes cuff); and a test to evaluate the competence of deep femoral veins (Perthes test).

Early exponent of the clinical use of x-rays in Germany researching the concepts of radiation treatment and therapy. Pioneer in pioneered the use of radiation in the treatment of warts, skin cancer and breast carcinoma.

His interest in tuberculosis and tuberculous hip disease, led to in depth study of atypical hip cases he termed arthritis deformans juvenilis Legg-Calvé-Perthes disease (1910). Perthes took the first X-rays of a patient with LCPD in 1898


Biography
  • Born January 17, 1869 in Mörs, Rheinland
  • 1891 – MD, University of Bonn
  • 1900 – Military surgeon at Tsingtao (Qingdao), China
  • Surgical Polyclinic Institute in Leipzig
  • 1910 – Professor of Surgery in Tübingen
  • Died January 3, 1927 in Arosa, Switzerland

Medical Eponyms

Perthes test (1895) clinical test for assessing the patency of the deep femoral vein

Perthes method: Limb is elevated and firm elastic bandage applied from the toes to the upper thigh. This obliterates the superficial veins. The patient ambulates with the bandage in situ for 5 minutes. If the deep venous system is competent the patient will be asymptomatic; if incompetent, the patient will complain of severe pain in the leg.

Modified method: Apply a tourniquet at the level of the sapheno-femoral junction and the patient is asked to move the limb. With the superficial veins iatrogenically occluded, If the deep veins are pathologically occluded, the dilated veins increase in prominence.


Legg-Calvé-Perthes disease (LCPD); (1910)

LCPD develops as a result of proximal femoral epiphysis ischaemia of unknown aetiology; aka avascular necrosis (AVN) of the proximal femoral head.

The disease is usually insidious in onset and may occur after an injury to the hip. It is most common in male children aged 4-10 years, unilateral in 90% of cases. In cases which are bilateral, the joints are involved successively, not simultaneously.

In 1910LeggCalvé and Perthes independently reported a hip disease in children with a symptomatic picture resembling that described by Henning Waldenström in 1909. These authors believed the process to be unrelated to tuberculosis:

Georg Clemens Perthes: 6 cases, one of which was bilateral. Perthes refuted the importance of trauma but opined the disease he termed ‘Arthritis deformans juvenilis‘ was the result of an inflammatory process in the joint that had occurred during the years of infancy. Furthermore, he commented on the likely importance of poor vasculature being a contributing aetiological factor.

Im Februar 1909 wurde ein 11jähriger Knabe zur Poliklinik gebracht, weil seinen Eltern ein wenig hinkender Gang aufgefallen war. Der Trochanter stand 1 cm über der Roser-Nélatonschen Linie. Schmerzen bestanden weder bei den Beugebewegungen, noch bei Druck auf das Gelenk. Das Röntgenbild zeigte, daß unser erster Gedanke an eine Coxa vara nicht richtig war. Der Schenkelhalswinkel war völlig normal; dagegen zeigte der Schenkelkopf an Stelle der Kugelform die Form eines Kegels…

Perthes 1909 11 year old boy Fig 3

Wenn wir zum Schluß auf die Ätiologie der juvenilen Arthritis deformans des Hüftgelenks und auf die Auffassung eingehen, welche das Leiden erfahren hat, so stoßen wir nun auf Hypothesen und können nichts anderes tun, als unbewiesene Anschauungen auf ihren Wert prüfen.

Jedenfalls werden wir an der interessanten Möglichkeit nicht zweifeln können, daß die Arthritis deformans juvenilis auf eine anscheinend zunächst ohne Folgen ausgeheilte Hüftgelenksentzündung im Säuglingsalter zurückgeht…

Als ätiologisch bedeutungsvollsten pathologischen Befund betrachtet Wollenberg die von ihm nachgewiesenen Veränderungen kleiner Knochengefäße (Endarteritis obliterans) und Stauungen in den Venen. Diese Veränderungen, die selbst durch verschiedenartige Ursachen hervorgerufen werden, können doch…das Bild der Arthritis deformans hervorrufen, indem der Arterienverschluß zu Ernährungsstörungen im Knochen, die Stauung zu Wucherungsvorgängen führt.

Perthes G. 1910

In February 1909 an 11 year old lad was brought to the clinic, as his parents had noticed a somewhat limping gait. The trochanter lay 1cm above the Roser-Nélaton line. Pain was not elicited on active movement, nor with pressure on the joint. The X-ray showed that our initial thought of Coxa vara was not correct. The femoral neck was completely normal; in contrast the femoral head appeared to have a conical, rather than a rounded shape.

Perthes 1909 11 year old boy Fig 3

To end, if we consider the aetiology of the juvenile Arthritis deformans, and the conception of this illness, we encounter hypotheses and can do nothing other than test unproven opinions for their merit.

In any case we cannot doubt of the interesting possibility, that the juvenile arthritis deformans can be traced back to a seemingly initially inconsequential inflammation of the hip in infancy.

The most aetiologically significant pathological discovery, according to Wollenberg, it the changes he has demonstrated in the small bony vasculature (Endarteritis obliterans), and the venous congestion. These changes, which can be the sequel of different causes themselves, can indeed…create the picture of arthritis deformans, whereby the arterial closure can lead to nutritional deficiencies in the bone, and the congestion to proliferative processes.

Perthes G. 1910


Key medical contributions

Bankart repair: (1906) – Perthes recognised that the inferior glenoid fracture with detachment of the labrum caused instability of the shoulder and emphasized reattachment of the labrum to stabilize the joint. However, Bankart popularised the operation for recurrent shoulder dislocation in 1938 and his eponym has remained as Bankart repair.

Die operative Behandlung der rezidivierenden Schultergelenksluxation ist noch kein abgeschlossenes Kapitel der Chirurgie…Bedeutungsvoller scheint mir vielmehr in einer gewissen Gruppe von Fällen der Abriß der am Tuberculum majus inserierenden Muskeln, und in einer anderen der Abriß des Labrum glenoidale am inneren Pfannenrande. Die Rücksicht auf diese pathologischen Veränderungen führte mich dazu, in zwei Fällen die verloren gegangene Insertion der Muskeln am Tuberculum majus wiederherzustellen, in einem weiteren Fall die am inneren Pfannenrand abgesprengte Gelenklippe wieder zu befestigen, während in einem vierten Falle nur die Verkleinerung und Verstärkung der erweiterten und erschlafften Kapsel ausgeführt wurde.

Perthes, 1906;85: 199-227

The operative treatment of recurrent shoulder subluxations is still no concluded chapter in surgery…Of greater significance it would seem to me, is in a certain group of cases the tearing of the muscles inserting on the major tubercle, and in another group, the tearing of the glenoid labrum on the inner glenoid fossa. The consideration of these pathological changes led me to reconstruct the lost insertion point of the muscles on the major tubercle in two cases, in a further case to reattach the labrum to the glenoid, whilst in a fourth only the reduction and reinforcement of the enlarged and loosened capsule was performed

Perthes, 1906; 85: 199-227


Major Publications

References

Biography

Eponymous terms


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Resident medical officer in emergency medicine MB ChB (Uni. Dundee)  MRCS Ed. Avid traveller, yoga teacher, polylinguist with a passion for discovering cultures.

Emergency physician MA (Oxon) MBChB (Edin) FACEM FFSEM with a passion for rugby; medical history; medical education; and asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane | Eponyms | Books |

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