John Barton

John Rhea Barton (1794 - 1871) 150

John Rhea Barton (1794 – 1871) was an American Orthopedic Surgeon.

Talented ambidextrous surgeon. Performed first hip arthroplasty in 1826 – Pennsylania Hospital, Philadelphia. His widow endowed the first surgical chair in the United States, the John Rhea Barton Professor of Surgery at the Perelman School of Medicine, University of Pennsylvania.

Eponymously associated with Barton fracture. Considered a pioneer of modern osteotomies. Recorded to have performed an intertrochanteric osteotomy, without anaesthesia, in only seven minutes.


Biography
  • Born April 1794, in Lancaster, Pennsylvania. Son to Judge William Barton of Lancaster, designer of the United States Seal
  • 1813 – Appointed as an apprentice to Philip Syng Physick (1768-1837), known as ‘The Father of American Surgery’
  • 1818 – Graduated from medical training aged 22 from the Pennsylvania Hospital, University of Pennsylvania. Thesis: Certain Injuries of the Bones of Children
  • 1820 – Surgeon at Philadelphia Almshouse
  • 1823 – Surgeon at Pennsylvania Hospital
  • 1824 – First account published in America of an operation for imperforate anus
  • 1826 – Performed first subtrochanteric osteotomy on an ankylosed hip
  • 1827 – Performed a femoral osteotomy between the greater and lesser trochanters to secure motion in an ankylosed hip. This was hailed the first successful arthroplasty.
  • 1834 – Wired a fractured patella in the same year as Lister
  • 1838 – First described the Barton fracture
  • 1839 – First account published in America regarding the use of a seton to ‘cure’ a recto-vaginal fistula.
  • 1840 – Retired
  • Died January 1, 1871 in Philadelphia

As an operator, Dr. Barton was cool, decided, elegant, and full of resource. Using either hand with equal facility, he seldom changed his position when engaged in any surgical procedure. His dressings were applied with the utmost precision and neatness of detail. The roller with him was like plastic clay in the hand of the potter; obedient to the master’s wish, every turn fell into place like a well-fitting garment; indeed, there was an unstudied grace in every move­ment of the man

D. Hayes Agnew 1878

Medical Eponyms
Barton fracture (1838)

Intra-articular fracture of the distal radius with subluxation or dislocation of the radiocarpal joint in the direction of the fracture fragment.

Barton described a ‘subluxation of the wrist consequent to a fracture through the articular surface of the carpal extremity of the radius.’ in his publication Views and treatment of an important injury of the wrist. Barton’s original description delineates the posterior marginal injury (dorsal type Barton fracture):

A fragment is thus broken off from the margin of the articular surface of this bone, and is carried up, before the carpal bones, and rested upon the dorsal side of the radius; they having been forced from their position, either by the violence, or by the contraction of the muscles alone. We have then an imperfect luxation of the wrist, depending on a fracture through the extremity of the radius. The deformity will be found to correspond with this state of the case. There is a tumour on the dorsal side of the arm formed by the bulging of the carpal bones and fragments; whilst below it, on the palmar side, the extremity of the radius projects.

The fragment may be, and usually is, quite small, and is broken from the end of the radius on the dorsal side, and through the cartilagenous face of it, and necessarily into the joint…

Barton 1838: 366
Barton fracture - Dorsal Barton fracture
Barton fracture; Dorsal Barton fracture

Contrary to most literature stating that Barton only defined the posterior marginal injury, Barton also defined the anterior marginal injury. This injury was later termed a ‘volar Barton fracture’ or ‘reverse Barton fracture’.

It sometimes happens also, though rarely, that fracture of a similar character to the one just described, occurs on the palmar side of the radius, from the appli­cation of force against the. back of the hand whilst it is bent forward to its ulti­mate degree. Whenever the fracture takes place in front, the end of the radius projects over the wrist on the dorsal side, and the carpal bones and fragment rise out of their proper situations, and form the tumor on the palmar side thus revers­ing the deformity of the arm…

Barton 1838
Reverse Barton fracture or Volar Barton fracture
Reverse Barton fracture; or Volar Barton fracture

Barton bandage for fractured jaw
Barton bandage

Barton Bandage

Bandage configuration for fractured jaw; a figure-eight bandage to support an injured jaw. Barton’s bandage employs, a compress, and a roller five yards long; the application of which is thus described by Sargent:

Place the initial extremity of the roller upon the occiput, just below its protuberance, and conduct the cylinder obliquely over the centre of the left parietal bone to the top of the head; thence descend across the right temple and the zygomatic arch, and pass beneath the chin to the left side of the face; mount over the left zygoma and temple to the summit of the cranium, and regain the starting-point at the occiput by traversing obliquely the right parietal bone; next wind around the base of the lower jaw on the left side to the chin, and thence return to the occiput along the right side of the maxilla; repeat the same course, step by step, until the roller is spent, and then confine its terminal end.

Hamilton, 1860: 68

Barton bran dressing: applied to compound fractures to reduce serous extravasation

Many years since Dr. J. Rhea Barton introduced into the Pennsylvania Hospital what has since been called the ” bran dressing” for the treatment of compound fractures of the leg; the limb being made to repose in a box filled with this material

Hamilton, 1860: 68
John Rhea Barton Professorship of Surgery

The first full and permanent endowment of a medical professorship in America

Mrs. John Rhea Barton gave $50,000, the income thereof to be annually for­ever appropriated to the payment of the salary of a Professor of Surgery who shall be the occupant of a chair to be designated as the John Rhea Barton Chair of Surgery.

Pepper W, 1916

Arthroplasty (1826)

On the Treatment of Anchylosis, by the Formation of Artificial Joints. A new operation, devised and executed by J. Rhea Barton MD, of the Pennsylvania Hospital”

Barton performed a femoral osteotomy between the greater and lesser trochanters to secure motion in an ankylosed hip.

This has been called the first successful arthroplasty. Important to the history of orthopedic surgery not merely for performing the operation but for introducing the concept of restoring motion to an ankylosed joint. His work was quoted in contemporary American and European Journals. It became the foundation for later development of arthroplasty

I beg leave to call the attention of my professional brethren to the following paper, believing that it contains some new views, in relation to a deformity and lameness hitherto, I think, excluded from the surgeon’s list of curable complaints, and one of the opprobria of our art; I allude to a firm, bony anchylosis of the human joints.

Barton JR, 1827

Controversies

Barton was criticized by Joseph François Malgaigne (1806-1865) in 1859, and later Lewis Atterbury Stimson (1844-1917) in 1883, for not using autopsy specimens. They hypothesised that Barton had most likely observed Colles-type fractures and paid tribute to Lenoir, a member of Dupuytren’s study group, who demonstrated this fracture type during autopsy. However in Barton’s original paper he specifically states:

This accident must not be confounded with those which are of frequent occurrence, namely, fracture of the radius, or of the radius and ulna just above, and not involving the joint.

Barton 1838

Major Publications

References

Biography

Eponymous terms


eponymictionary CTA

eponym

the person behind the name

Dr Ronan McKenna, MB BCh BAO at National University of Ireland Galway. Living in Australia with  plans for a future in Emergency Medicine. A keen interest in Medical History, Wilderness Medicine and Sport.

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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