William Henry Trethowan

Biographical Timeline

• Born on February 7, 1882 at Cawsand, Cornwall, second child and eldest son of William Henry Trethowan, grocer, and his wife née Hutchings. Educated at Devonport High School, followed by Plymouth Technical College
• 1901 – Entered Guy’s Hospital aged 19 with a junior entrance scholarship.
• 1902 – Awarded the Arthur Durham Prize; appointed Assistant Demonstrator in Histology.
• 1903 – Arthur Durham Prize Certificate and Hilton Prize for Dissection.
• 1906 – Qualified MRCS, LRCP and graduated MB BS London, receiving the Gold Medal with honours in medicine, surgery, midwifery and diseases of women.
• 1907 – House Physician to Newton Pitt.
• 1908–1910 – Resident Medical Officer to Bright Ward.
• 1912 – Obtained FRCS Eng and appointed surgeon in charge of the newly constituted orthopaedic department at Guy’s Hospital.
• 1913 – Helped establish the Guy’s Hospital School of Physiotherapy, together with hospital superintendent Sir Edwin Cooper Perry.
• 1916 – Married Joan Durham Hickson, granddaughter of Arthur Durham FRCS; they had two sons.
• 1918 – Commissioned Captain, RAMC(T) and selected by Sir Robert Jonesfor the Military Orthopaedic Hospital, Ducane Road, Shepherd’s Bush
• 1919 – Appointed surgeon to the Royal National Orthopaedic Hospital and, in October, consulting orthopaedic surgeon to Queen Mary’s Hospital for Children, Carshalton.
• 1920s–1930s – Became associated with fracture surgery, bone grafting, no-touch technique and foot surgery.
• Died on September 12, 1934 in Stockholm after acute tonsillitis complicated by septicaemia

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Medical Eponyms

Trethowan sign

Trethowan sign is a historical British radiographic sign associated with slipped capital femoral epiphysis (SCFE). It is commonly applied to the abnormal relationship in which a line along the superior femoral neck fails to intersect the capital femoral epiphysis.

The attribution to Trethowan is uncertain. No contemporary publication by him describing the sign has been located. The earliest printed attribution currently identified is W. A. Crabbe’s 1968 Guy’s textbook, which described loss of the normal angle between the superior femoral-neck border and lateral edge of the epiphysis. Later authors increasingly equated Trethowan sign with an abnormal Klein line.

See: Trethowan sign — historical attribution, evolving definition and relationship to Klein line.

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Trethowan bone lever

The instrument remains in contemporary orthopaedic use as the Trethowan bone lever, Trethowan retractor, or ring-handled spike. Modern surgical literature continues to use the eponym.

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Key Medical Contributions

Trethowan acquired a formidable reputation as both surgeon and teacher. His teaching stressed function and range of movement, and his clinics at Guy’s were remembered for rapid bedside analysis, blackboard diagrams and demonstrations of pathological gait.

One of his favourite mots when teaching was to point out that the whole of orthopedic diagnosis could be expressed in three words, “range of movement.”

H. A. H. H. 1934

Contemporary colleagues described his operative technique as rapid and technically accomplished, particularly in difficult fracture surgery and bone grafting.

Establishment of orthopaedics at Guy’s Hospital – Trethowan became the hospital’s first dedicated orthopaedic surgeon and helped develop the specialty independently from general surgery. Guy’s archival records also confirm his role in establishing its physiotherapy school.

Fracture fixation and bone grafting – He emphasised rigid fixation and meticulous no-touch technique and became an early British exponent of structural bone grafting for ununited fractures.

Foot surgery – Trethowan challenged prevailing dogma about flatfoot and other deformities, emphasising symptoms and function. His work encompassed hallux valgus, club foot and metatarsalgia.

Rehabilitation and mobilisation – He strongly supported physiotherapy, advocated early mobilisation for shoulder disorders and was credited with recognising a pre-ossific phase of myositis ossificans.

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Major Publications

• Trethowan WH. Manipulative methods of treatment in the surgery of bones and joints. Guy’s Hospital Gazette. 1914;28:490–496.
• Trethowan WH. The functional result of fractures. Guy’s Hospital Gazette. 1917;31:397–405.
• Trethowan WH. Some mechanical considerations in the surgery of the leg. Guy’s Hospital Gazette. 1920;34:247–268.
• Trethowan WH. Simple fractures of the upper and lower limbs. In: Jones R, ed. Orthopaedic Surgery of Injuries. 1921.
• Trethowan WH. Discussion on operative treatment of dislocated hips, congenital and pathological. Proc R Soc Med. 1923;16(Sect Orthop):24
• Trethowan WH. The treatment of hammer toe. Part I—General considerations; conservative measures. Lancet. 1925;1:1257.
• Trethowan WH. The treatment of hammer toe. Part II—Operative measures. Lancet. 1925;1:1312.
• Fairbank HAT, Cochrane WA, Trethowan WH, et al. A discussion on fractures in the neighbourhood of the ankle-joint. II. The operative treatment of ankle fractures. Lancet. 1926;1:90–96.
• Trethowan WH. Fracture-dislocation of the ankle-joint. In: The Robert Jones Birthday Volume. 1928:409–421.

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References

Biography

• WILLIAM HENRY TRETHOWAN, M.B.Lond.,F.R.C.S. Eng. Lancet 1934; 224(5795): 679-680
• W. H. TRETHOWAN, F.R.C.S. Br Med J 1934;2:614
• WILLIAM_HENRY TRETHOWAN, Eso., M.B., B.S(Lond.), FR.CS.Eng.). Guy’s Hospital gazette. 1934; 46: 378
• W H Trethowan. Guy’s Hospital Reports. 1935; 15 (4s)
• Wiliam Henry Trethowan (1882-1934). Guy’s Hospital Gazette Volume 1990; 104: 160-161
• Trethowan, William Henry (1882-1934), Plarr’s Lives of the Fellows