Henry Earle

Henry Earle (1789 – 1838)

Henry Earle (1789 – 1838) was an English surgeon.

Most commonly remembered (or rather forgotten…) for his description of fracture-dislocation of the ankle with avulsion of the posterior edge of the tibia. Initially described as Earle triangle (Lauge, 1948) but now referred to as Volkmann triangle

Earle designed a fracture bed for the conservative management of neck of femur fractures first published in Practical observations in surgery in 1823 then re-designed and reviewed in the Lancet 1824. The device provided comfort for the patient; allowed treatment of the femoral neck fracture in semiflexion; and caused a war of words with Sir Astley Cooper


Biography

  • Born 28 June 1789 in London, England. Son of Sir James Earle (FRS 1794); grandson of Percivall Pott (1714-1788)
  • 1805 – Apprenticed to his father (aged 16)
  • 1808 – Member of the Royal College of Surgeons
  • 1813 – Jacksonian prize at the College of Surgeons
  • 1815–1827 assistant surgeon to St Bartholomew’s Hospital
  • 1822 – Fellow of the Royal Society (FRS)
  • 1828–1838 lecturer in surgery, St Bartholomew’s Hospital
  • 1833 – professor of anatomy and surgery at the Royal College of Surgeons
  • 1835-1837 president of the Royal Medical and Chirurgical Society
  • Surgeon extraordinary to her majesty Queen Victoria
  • Died 18 January 1838

Medical Eponyms

Earle-Volkmann triangle (1829)

[Earle triangle; Volkmann triangle] the avulsed posterior edge of the distal tibia (posterolateral tibial lip), in cases of traumatic fracture-dislocation of the ankle.

Richard von Volkmann (1830-1889) described the anterior fragment in 1875. However, it was Henry Earle (1789 – 1838) in 1829 who first described the avulsed posterior edge of the distal tibia in a publication relating to a 53-year-old man who sustained a severe injury of his right ankle:

There was found to be dislocation of the tibia forwards, and a comminuted fracture of the fibula. The muscles of the limb were acting spasmodically with great violence. The dislocation of the tibia was reduced, and the leg put up in splints. Twelve leeches to be applied to the part, and cold cloths…The tibia dislocated forwards, with a small portion of its posterior edge fractured and retained in situ – considered perfectly novel.

Earle 1829
Earle Fracture bed (1823)

[*Earle’s bed for Invalids] for the conservative management of proximal femur fractures. First published in Practical observations in surgery in 1823 then re-designed and reviewed in the Lancet 1824. The device provided comfort for the patient and allowed treatment of the femoral neck fracture in semiflexion

Mr. Earle is of opinion that these cases may be cured by long continued attention in keeping the parts at perfect rest. I think a trial should be made of the bed recommended by Mr. Earle, and heartily wish him success in his laudable attempt to prevent the lameness and shortening of the limb in cases of fracture within the capsule

Sir Astley Copper 1837
Earle Shoulder apparatus (1823)

Apparatus/bandage to secure the ‘whole extremity in cases of clavicle and scapula injuries


Controversies

Embroiled in controversy with Sir Astley Cooper as to whether fractures of the neck of the thigh-bone ever unite. The war of words arose after Earle’s publication proposed that neck of femur fractures could unite with conservative management only.

Upon reading this work, Sir Astley Cooper was hear to exclaim ‘Good God! Is this written by an English surgeon ‘ and charged Earle with misleading the rising generation of surgeons. Further acrimonious discourse at a meeting of the London Medical Society was recorded in the Lancet 1823.

I have been baffled at every attempt to cure, and have not yet witnessed one single example of union in this fracture….no argument can ever settle the question of the possibility of union, which can only be decided by observation…[Cooper 1823]

…the question never can be decided in the affirmative by following the doctrines which he [Cooper] has inculcated, as the practice Sir Astley recommends and follows, renders union by bone a moral impossibility…though there is no actual law in the animal economy prohibiting such union. By reasoning, I have endeavored to explain the causes which have hitherto contributed to interrupt bony union, and by reasoning, I hope to induce my professional brethren not to abandon these cases as hopeless. [Earle 1824]

The Lancet and the Chirruping Cock-Sparrow

The ‘Lancet,’ didn’t much care for Earle. They made many indecent attacks on him referring to his teachings the ‘chirrupings of a cock-sparrow, ’ (for his diminutive stature). Quite a series of tirades from the editorial staff of the illustrious journal… [Lancet 1828: 597-600; Lancet 1829: 255-258]

This surgical cock sparrow [Mr Earle] has been hopping and fluttering about lately at a great rate, and chirping away at the height of its lungs to its own complete satisfaction…it can only make an empty chattering, without sense or melody….it is necessary to clip its wings a little, lest the poor little thing should do itself an injury in its violent and ill-judged efforts…we have never estimated very highly the professional or the literary attainments of this bustling little body…

Some people are so stupid, that they ought not to be trusted at large without a keeper; they will run their heads against walls or posts, if any are to be met with.

Lancet 1828: 597-600

Major Publications


References


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

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