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Trueta's teachings saved limbs and lives
Although he gained fame in the United Kingdom for his scientific research, he remained a Catalonian in spirit.
Josep Trueta, MD, was an innovative thinker whose advances in wound care saved the lives of thousands of patients. He was also one of the first orthopaedic pioneers to recognize the relationship between blood and bone.
Trueta was first and foremost a Catalan. He was born in Barcelona in 1897 into a family with a long tradition of medical and military service. His great-grandfather Anthony Trueta was the army surgeon for General Lancaster in the 1795 Franco-Spanish war. His father was a surgeon and a stern disciplinarian who changed young Josep’s early focus from the arts to the medical field.
One of the most influential people in young Josep’s life was his grandfather, a prominent member of the military who opened the boy’s mind to the possibility and importance of improving society through thought rather than might.
Early research
Trueta graduated from the University of Barcelona in 1921 with a degree in medicine. His first surgical experience involved assisting his father repair a hernia at a time when most surgeries were performed in the patient’s home. After graduation, he toured Europe and met Lorenz Böhler and was inspired by his Accident Hospital. Returning to Barcelona, he worked as an assistant surgeon at the hospital de la Santa Crus i Sant Pau, the largest teaching hospital in Catalonia.
In 1929, he was appointed chief surgeon to the Caja de Provision y Socorro, which treated more than 40,000 accident cases a year. His earliest research began at this time in the areas of osteomyelitis and wound care based on tissue physiology and blood supply, the latter culminating in the “Trueta Method,” a five-step technique for the management of wounds. This method, which would eventually gain him worldwide recognition and remained a standard of military medical care for four decades, consisted of prompt surgical treatment, cleaning, excision, drainage and immobilization with plaster.
The mystery of fate
In what could be considered an act of fate, Trueta’s appointment as chief surgeon and professor of surgery at the University of Barcelona coincided with the outbreak of the Spanish Civil War. He had the distinction of witnessing and treating the aftermath of history’s first mass aerial attacks on a civilian population.
This also gave him the opportunity to put his wound care method through a rigorous test. Word soon spread through the Catalonian region in the northeast corner of Spain of the surgeon who was saving the limbs and lives of bombing victims.
As the Nacionales descended on Barcelona in 1939, Trueta escaped to France where the hand of fate would again guide his life.
In France, Trueta was asked to give a presentation on his experiences in the war and its wounded. He later recounted how he spoke in French, but an Englishman stood up in the audience and demanded he continue in English. Trueta complied, albeit poorly in his own estimation.
After his talk, the Englishman introduced himself and pressed him to come to Oxford. The English gentleman was Gathorne Robert Girdlestone, the Nuffield professor of orthopaedic surgery at Oxford. That event was the beginning of a 10-year friendship and the opening of the doors of the university to the Catalan exile.
The Oxford expatriate
Trueta’s reputation preceded him to Oxford University in 1940. By the time he arrived in England, he had already published his classic paper, “The treatment of war fractures by the closed method,” and many physician volunteers from the Spanish conflict had returned home to Europe and North America with stories of the “Spanish method” or the “Catalan method” for wound healing.
One well-known first recounting of Trueta and his method came from Rodolfo Matas, MD, of New Orleans, who described Trueta’s explanation of the smell that emanated from a wound following cast removal as, “Not all cheese that smells bad is bad.”
Trueta’s experience with casualties was welcomed by British surgeons, whose country was on the brink of war. In an obituary for Trueta published in the Journal of Bone and Joint Surgery, British Edition, Herbert John Seddon called Trueta’s arrival in England “a godsend; after a short-lived display of characteristic British skepticism, we converted to the ‘closed-plaster’ regimen.”
During World War II, Trueta’s wound care method spread throughout the allies’ medical corps. It is credited, in part, with lowering the rate of battlefield gangrene from 18% during World War I to 0.16% in the Vietnam War, where it was still in use.
The English years
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Concurrent with his research in wound care, Trueta also investigated osteomyelitis and the function of blood supply. His investigations into osteomyelitis led him to focus on the vascularization of bone, bringing a scientific angle to a clinical arena.
In 1947, his publication of Studies of the Renal Circulation and investigations with induced ischemic myopathy on renal perfusion in rabbits shed light on the mysteries of crush syndrome. His work with posttraumatic vasomotor nephropathy was 20 years ahead of a confirming study performed in the United States.
He was fascinated by the role of blood flow and supply in different areas of the body, as well as osteogenesis of bone, cartilage growth, osteomyelitis, epiphyseal function and osteoarthritis.
In a memorial to Trueta published in an honorary volume of Clinical Orthopaedics and Related Research, John W. Goodfellow, MD, said that Trueta made “classic” contributions to osteoarthritis research by showing that the “diseased head of the femur contained more and not fewer blood vessels than normal.”
Goodfellow credited Trueta for noting the radiologic appearance of subchondral sclerosis, which should not be confused with avascular necrosis. Trueta also reportedly introduced the concept that articular cartilage can deteriorate from repetition as well as overuse. He was also one of the first surgeons in the United Kingdom to respond to the thalidomide catastrophe, Goodfellow wrote.
An excellent educator
In 1949, Trueta was appointed to the Nuffield chair of orthopaedic surgery after the death of his good friend Girdlestone; Trueta remained there until his retirement in 1966. Young orthopaedists from all over the world came to the Nuffield Orthopaedic Center to study under the esteemed orthopaedic trauma surgeon.
J. Ted Hartman, MD, emeritus professor of orthopaedic surgery at Texas Tech University Health Sciences Center, served a fellowship under Trueta at Nuffield in the 1950s. He said Trueta was an excellent educator. “He had a tremendous fund of information that went in almost every direction.”
Hartman said he traveled to Oxford for the fellowship expressly because of Trueta’s reputation. This experience gave him a much broader understanding of orthopaedic healing.
“My understanding of the blood supply in bone really changed [after my experience in Oxford],” he said. “It altered what I would do in order to be certain that I retained an adequate blood supply into any area that I was treating.”
Hartman noted that while Trueta was not necessarily the most skilled surgeon, “He brought a lot into the operating room. He wasn’t just mechanical; he had a reason for everything that he did. It was interesting to see it play out.”
Dedication to his homeland
Sadly, during Trueta’s exile, the Franco dictatorship banned Trueta’s name from being used by the media, leaving a generation of his countrymen to go unaware of his accomplishments.
However, in an effort to educate and share his love of his homeland with his adopted home in England, Trueta published The Sprit of Catalonia in 1946. He referred to the book as something he did during the war, using the half-day he worked on Fridays to do research. In addition to his many varied published topics in orthopaedics, Trueta also wrote a biography of his friend, Girdlestone, in the 1970s.
Trueta was nominated for the Nobel Prize in Medicine twice and held many honorary memberships in the world’s top surgical societies. He was an Officier de la Légion d’Honneur, a Comendador da Orden do Cruzeiro do Sul, Brazil, and a Grand Order of the Order of Carlos II.
One of his last honors was perhaps his sweetest. In 1976, while suffering from the effects of a stroke, he was celebrated by his former home, the hospital de la Santa Crus i Sant Pau. In his final public speech, Trueta said, “After leaving Catalonia, when democracy was dying here, it is with great satisfaction for me to receive this award when democracy is flourishing again. … Freedom has always been an inherent part of my life. This ceremony symbolizes my true return to my homeland, which I left because I did not want to witness the death of freedom in my country.”
He died a short time later in January 1977. He was posthumously granted Spanish citizenship.