Ollier - The Father of Bone and Joint
and of Reconstructive Surgery (1830-1900)

L.P. Fischer *, M.H. Fessy *, J. Bejui *, H. Chavane *,
P. Papin *, J.C. Chatelet ** , G. Eyraud ***
* Lyon - ** Ambérieu - *** Roussillon

Léopold Ollier devoted his life to the surgery of the locomotor apparatus. His early research into the properties of the periosteum enabled him to devise novel strategies for the management of the joints and the extremities. In reconstructive surgery, he dealt with the soft tissues of the face, and invented a special type of skin graft. This pioneer of bone and joint surgery has rightly been called the Father of orthopaedic surgery. He was the first to suggest that bone surgery should be recognized as a discipline in its own right, and demanded this status in a speech given at the 1867 Congress of French Surgeons. In the world of experimental medicine, Ollier is seen as the Father of experimental surgery.

Léopold Ollier was born in Les Vans (Ardèche). His ancestors - who originally spelt their name Olier had come from Malzieu in the neighbouring Département of Lozère. Both his father and his grandfather had been doctors. His early interest, as an undergraduate at Montpellier, was in botany. He was made a demonstrator (1849), and involved in the teaching of the subject at the famous botanical garden of the medical school. Perhaps it was a detailed study of the bark of certain trees that led him later to look more closely at the periosteum.

In Lyon, he came top of his year in the competitive examination required for specialty training (1851), and went back to Montpellier to present his thesis on the detailed structure of cancerous tumours at different stages of development. During his training at the Hôtel-Dieu hospital in Lyon, he was influenced by Amédée Bonnet, who was Chief Surgeon, a residential post in those days. Bonnet had already managed to "specialize" in bone surgery, which accounted for 95% of his work.

Ollier himself came to be appointed Chief Surgeon at the Hôtel-Dieu hospital in Lyon, in 1860. Scientifically speaking, he followed in the footsteps of Bonnet, who, on 1 December, 1858, had died rather suddenly, at the age of 56. Bonnet had been keenly interested in joint disorders, in surgical trauma and accidental injuries, with all the dreaded consequences such as septicaemia, erysipelas, or gas gangrene that were frequently seen in those days.

Bonnet used cautery (red hot irons, caustic potash), and straightening and immobilization; he greatly improved amputation surgery which, in his days, carried a high mortality. He felt that joint-sparing treatments should ideally give the patient a functional rather than a fused joint; and in order to achieve this ideal, he conceived the very advanced idea of joint excision.

Attempts to revolutionize surgery by exploiting the osteogenetic properties of the periosteum were made well before Ollier's time. Thus, Duhamel (1739-1743) had suggested the idea, which was subsequently taken up Flourens, in 1847. Ollier recalled the dictum of Claude Bernard that "there could be no scientific medicine without experimental medicine." Experimental research became the ruling passion of his life. His first experiments were conducted on his father's farm in the Ardèche mountains. There, he would take a piece of periosteum from the long bone of a rabbit or a cockerel, and wrap the flap around the adjacent muscles. Similarly, he would take a flap of periosteum from a rabbit tibia, and transplant it to the skin of the forehead. These two initial experiments later came to be repeated many times, when Ollier was working in Chauveau's laboratory at the Lyon Veterinary College. What he found was bone formation.

As early as 1858, Ollier decided to devote his life to research into this process of ossification induced by different components of bone and by whole bone. In due course, he was able to show that joint repair was predicated upon the preservation of the joint capsule and periosteal sheath, and on keeping the tendons, ligaments and muscles in situ. He also studied bone growth in general, establishing the laws of long-bone growth. He looked into the effects of irritation of the various components of bone; and studied bone grafts using periosteum, periosteum plus the osteogenetic layer immediately beneath the periosteum, bone marrow, and whole bone.

Although Ollier was immediately vilified by some (especially his competitors such as Sédillot, Desgranges, and others), he was supported by Velpeau and, above all, by Verneuil, who remained a lifelong friend and who, at Beaujon in 1860, was the first to perform a subcapsular-subperiosteal excision of the elbow based upon the results of Ollier's experimental studies.

For his textbook called Traité expérimental et clinique de la régénération des os et de la production artificielle du tissu osseux (2 volumes, octavo, with 9 copper engraving plates and 45 illustrations in the text, V. Masson, 1867), Ollier was awarded the Great Prize for Surgery instituted by Napoleon III (sharing the prize with his opponent Sédillot, who had written a Traité de l'évidement des os).

Ollier went on to become a celebrity, not only in Lyon, but also in Paris, and Europe-wide. He was particularly famous in Berlin and in Edinburgh, where his Traité des résections (published between 1867 and 1891) was highly appreciated.

BIOGRAPHY IN BRIEF
Louis Xavier Edouard Léopold Ollier - Born in Les Vans (Ardèche), on 2 December, 1830; died in Lyon, on 25 November, 1900.

Father and grandfather were both doctors.
Medical studies in Montpellier.

Top of his year in exams qualifying for specialty training at Lyon, 1851;
trained with Amédée Bonnet (who died in 1858).

Thesis accepted by Montpellier Medical Faculty, 1856.

Chief Surgeon at the Hôtel-Dieu hospital, following a competitive exam for the post, 1860.

At the time, Chief Surgeons were appointed for a probationary period, before being confirmed in their posts. They were expected to leave the hospital position after 18 years, to work in the independent sector.

Ollier was lucky enough to be appointed at a time when the Lyon Medical School had been transformed into a Faculty of Medicine. He was made Professor of Clinical Surgery, and was thus able to go on doing bone surgery at the Hôtel-Dieu until his death in 1900, since professors, in those days, were allowed to stay on at least until the age of 70.

Eugène Vincent, one of Ollier's students, devised the following break-down of Ollier's career into three distinct phases:

- Phase 1, from the acceptance of his thesis to the publication of his studies on the regeneration of bone (the 2-volume textbook covering his animal studies prompted by, and using the methodology of, Claude Bernard) - 1856-1867;

- Phase 2 - from the Regeneration of Bone to the Textbook of Bone Resection - 1867- 1891;

- Phase 3 - from the Textbook of Bone Resection to his death on 25 November, 1900.

Ollier may be considered both as the father of experimental surgery and as the creator of bone and joint surgery, the discipline now known in France as Orthopaedics and Traumatology. Ollier himself frequently used the term reconstructive and conservative surgery of the locomotor apparatus. Far from being exclusively interested in this branch of surgery, however, he also involved himself with soft tissue procedures, and even devised a skin graft which bears his name.

Ollier's only son was tragically killed in southern Alsace, at the start of WWI. The family line was carried on by his daughters. He is buried at Lyon-Loyasse cemetery.

OLLIER'S RESEARCH
INTO THE ROLE OF THE PERIOSTEUM AND THE SUBPERIOSTEAL LAYER

Ollier's great contribution to the history of joint excision (generally employed as a treatment of joint suppuration and, in the upper limb, of some cases of ankylosis) was the finding that osteotomies should be performed subcapsularly-subperiosteally, using an elevator to detach a continuous sheet of periosteum in continuity with the subperiosteal layer and the capsule.

- Between 1850 and 1868, Ollier showed that the periosteum and the subperiosteal osteogenetic layer allowed joint excision to be performed underneath the periosteum or underneath the capsule and periosteum, in cases of severe inflammation of the joints, which, in those days, would either be fatal or require amputation to save the patient's life. Ollier was modest enough to point out that the true "inventors" of such procedures, which left "useful" joints in the upper limb but were less likely to produce benefit in the lower extremity, were the Moreaus (father and son, at Bar-le-duc) and Flourens.

What Ollier failed to point out was that his own work went further than that of his predecessors: Through his meticulous experimental work in the period from 1850-1868, this disciple of Claude Bernard shed a significant light on the function of the periosteum.

The animal work done in chickens, pigeons, rats, rabbits, cats, and dogs allowed Ollier to extend his osteotomies from the upper ends to the shafts of bones, the ribs, etc. He kept a detailed record of the age, weight, and species of every animal used in the studies.

In the shaft of an animal bone, the bone formed after the periosteum had been incised and "somehow stripped off with an elevator" was found to be quite unlike normal bone. These experiments and findings were reflected in his Traité de régénération osseuse chez l'animal.

For the harvesting of bone chips adherent to the periosteum, Ollier invented a special elevator, as well as a range of other instruments such as retractors, bone holding forceps, etc.

In the period between 1864 and 1868, Ollier was severely criticized: Most of the surgeons and scientists of his day did not believe in the osteogenetic role of the periosteum. When Ollier tried to counter these criticisms by taking to scientific congresses, not only his papers, but beautiful boards on which his bone specimens were mounted with little copper discs: He was told by many that these specimens were not evidence, since they came from animals rather than from human beings.

Figure 1 : One of Ollier's early experiments, some of which were conducted in the poultry-yard on his father's farm at Les Vans (Ardèche). Above: Heterotopic bone formation obtained after transplanting a piece of periosteum from the tibia (chicken). Below: Bone granules obtained by transplanting discrete pieces of the osteogenetic layer of the periosteum (implanted under the skin of a rabbit)

Figure 2 : Title page of Vol 2 (1872) of the Traité expérimental et clinique de la régénération des os et de la production artificielle du tissu osseux by L. Ollier, Chief Surgeon at the Hôtel-Dieu in Lyon. This 2-volume textbook was published before the famous 3-volume Traité des résections.

- The second phase of Ollier's career, from 1864 to 1875, was dedicated to work in human subjects, using the specially designed elevator to perform subperiosteal bone resections and subcapsulo-subperiosteal joint excisions.

Ollier's rival, in the field of subperiosteal excision, was the famous German surgeon Langenbeck, who had performed a vast number of excisions, but whose results were inferior to Ollier's. After subperiosteal excision, Langenbeck's patients were left with flail joints in the upper limb. Langenbeck was not, however, using Ollier's technique; he confined himself to detaching the periosteum as such, without the thin bony layer just beneath, whose vital role Ollier had discovered.

This second phase in Ollier's life resulted in the publication of the 3-volume textbook of bone resection.

- The third phase of Ollier's career, especially the period between 1890 and 1900, was that of establishing the indications for this type of surgery. By 1875, Lister's antiseptic technique (derived from the teachings of Louis Pasteur) had become firmly established. Also, new ideas of aseptic surgery had come to be applied in many centres, including Ollier's department in Lyon. While, in Paris, Terrillon and Felix Terrier were putting into practice the ideas of Pasteur's pupil Emile Roux, Poncet and Ollier, at the Hôtel-Dieu in Lyon, were using aseptic techniques, following the advice of Mérieux, who had also been trained by Pasteur.

Ollier came to the conclusion that joint excision should be done in a more restricted number of cases; in particular, he felt that it should be a procedure of last resort, where the patient's life was at risk; and that it should be employed much more sparingly in the lower limb, especially in the knee. Whenever possible, the joint should merely be aspirated, especially in young subjects. If excision of the knee joint was vital, the growth plate should be left intact as much as possible, by yet more sparing osteotomies. (Ollier's law: Growth plates are close to the knee, far from the elbow.)

Ollier had followed up hundreds of cases, and was well aware that properly done excisions would give excellent results in the elbow, with a functional elbow joint; in the shoulder, the results of a well-done excision would be acceptable. However, in the knee it was better to go for a stiff knee rather than a joint that would be prone to dislocation after excision. In the hip, Ollier felt that, while the capsule and the adjoining periosteum should be preserved, there was a need, initially, for maintaining the femur in forced abduction.

Figure 3 : Some of the instruments invented by Ollier. The illustration shows the most commonly used convex tendon stripper; the concave tendon stripper; and the smooth-backed convex stripper. Ollier also emphasized the usefulness of a range of instruments for stripping the periosteum with bone chips attached. After Ollier's time, all these instruments were refined by Robert Judet.

Figures 4 & 4 bis : M.B., photograph and radiograph, March 1896: Wrist excision performed ten years previously. Radiograph taken with a Destot tube; exposure time 3 minutes.

OLLIER AND ASEPSIS

From 1875 onwards, Ollier insisted on applying Lister's method as well as other antiseptic techniques, and sought himself to improve what was available by inventing, for instance, an "occlusive dressing under glass" for the care of upper limb wounds. It should be noted that even before the advent of Lister's carbolic acid spray, Ollier had stressed the need for clean and well ventilated rooms - and even suggested that patients should be put into single rooms. These revolutionary demands were made as early as 1865, and repeated in official addresses at conferences as well as in his dealings with the administration of his hospital.

In Lyon, asepsis was first introduced at the Hôtel-Dieu hospital by Antonin Poncet and Ollier.

Considering the degree of sophistication achieved at that hospital, it is strange to note what happened when the French President, Sadi Carnot, was stabbed by an assassin in a Lyon street, in June 1894. The victim, who had a wound near the liver, was driven in his state coach to the Prefecture, where he was put on a couch in one of the reception rooms. The mayor of Lyon, Dr. Gailleton, then summoned Prof. Ollier and Prof. Poncet, who tried, from 9 p.m. until gone midnight, to staunch the bleeding from the portal vein. They had to work under makeshift conditions, whereas, at the Hôtel-Dieu, Poncet could - and normally would - have used his operating theatre incorporating the latest principles of asepsis.

OLLIER AND GRAFTS
TRAUMATOLOGY

During the final twenty years of his life, Ollier devised the long-strip skin grafts that have been named after him. These grafts were further improved by Thieze. Ollier also studied compact bone grafts - autografts, homografts, and allografts. He felt that allografts (from an animal of a different species) were not viable in the long term.

The list of Ollier's publications in the field of traumatology is much shorter than that of his work on bone. The subject of fractures was covered by his students, during his lifetime. Ollier himself used awls screwed into the bone to keep the fragments of certain oblique fractures together; the awls were then included in the plaster cast. He also did a certain amount of fixation using screws or pins. Above all, he was concerned with the treatment of upper limb ankylosis; his particular interest was in the management of elbow stiffness following fractures. Another major subject was the treatment of the callus of malunion with osteotomy or osteoclasis.

OLLIER
AND THE ORGANIZATION OF HIS DEPARTMENT
AT THE HTEL-DIEU AT LYON - BONE SURGERY

It is important to remember that, at the outset, Ollier's department was that of the traditional Chief Surgeon of the Hôtel-Dieu hospital. (The post itself was a very prestigious one, and the competitive exam for the appointment was the highlight of the surgical year in Lyon.) Very soon, the department became one of bone surgery, with 90% of the case load accounted for by that discipline. The patients treated there were adults, since there was a women's and children's hospital, the Charité, next door. However, there were many children among Ollier's patients.

In the early days after taking over the department, Ollier had done some abdominal procedures; however, he very soon came to confine his activities to surgery of the locomotor apparatus (80% of it joint surgery), as well as reconstructive surgery (skin grafting; plastic surgery for rhinophyma, hypospadias, etc.). It is interesting to note that the unit itself was never referred to as a department of orthopaedics. In 19th century French, orthopédique was an adjective applied to the makers of braces and surgical boots, or to physicians who practised straightening of the spine.

Ollier had many students, who worked extremely hard for their beloved teacher, and who should perhaps be better known themselves. There was old faithful Viennois, who worked throughout as his secretary; there were Mondan, Eugène Vincent, and many others. Anything published on the subject of bone surgery had to be translated for the boss, who would read English-language papers in the original and have anything German, Spanish, Italian, or Russian translated for his perusal.

The patient files established by Ollier are marvellous examples of medical record-keeping in the pre-computer age: They are richly illustrated with drawings, water colours, photographs of most of the patients seen after 1860; and contain questionnaires that had to be filled in at intervals (handwritten, since photocopiers had not yet been invented either), as well as specimens obtained from the surgical patients after their death some 5, 10, or 20 years later. The specimens were retrieved by Ollier's assistants who, if need be, would go on horseback or by coach to some remote village in the mountainous hinterland to bring back bits of knee or elbow joints to place in the patients' files. These specimens and the associated visual material made up the Ollier Museum, while the great surgeon was still alive. The 19th century was very fond of museums: Edinburgh had its Monro Collection; London, its Hunterian Museum; and Paris, the Péan Museum, preceded, in the first half of the century, by the Dupuytren Museum.

Ollier described himself as a surgeon, a bone and joint surgeon, or a reconstructive surgeon.

In this, he was following the example of Amédée Bonnet (d. 1858), who had done almost exclusively bone surgery, with devices for the correction of deformities. In those days, the term orthopédie was associated with Jules Guérin and his tenotomies, and many felt it to be derogatory.

In pre-1860 France, orthopédie was something practised by non-surgeons, be they truss makers, manufacturers of braces or boots for club foot sufferers, etc. Equally, the term was applied to the 'straightening' done by certain centres, who - in keeping with the fashion of the day - would undertake to straighten the backs of young girls (regardless of whether the patients were suffering from TB of the spine, scoliosis, or poor posture).

Orthopaedics, however, was a very popular term in the English-speaking countries. Its actual inventor had been a Frenchman, Nicolas Andry from Lyon, who was Professor of Medicine at the Collège Royal and Dean of the Faculty in Paris. He was a famous helminthologist, nicknamed Doctor Verminosus. His book (1741) was entitled L'orthopédie ou l'art de prévenir et de corriger les difformités du corps dans les enfants. Le tout par des moyens à la portée des pères et mères et toutes les personnes qui ont des enfants à élever (Orthopaedics or the art of preventing and correcting deformities of the body within [sic] children. A system that can be afforded by parents and other persons bringing up children).

Figure 5 : Ollier's flywheel saw. A picture of this mechanical saw was reproduced in the brochure of the SOFCOT conference by Mr Postel in the year of his presidency of SOFCOT.

Figure 6 : Line drawing by G. Mondan, one of Ollier's most brilliant students. Mondan used to work self-effacingly in the shadow of his great master; only rarely did his name appear in the publications. Curvilinear incision with or without resection of the greater trochanter (1880)

In 19th century Lyon, the Orthopaedic and Pneumatic Institute (on what is now the Quai Jean-Jacques Rousseau) was run by the famous Dr. Pravaz, who had studied at the prestigious Ecole Polytechnique and who, with his system of trolleys and traction, was able to reduce dislocations of the hip. In the same city, the father of the famous art nouveau architect Hector Guimard (who designed the entrances to the Paris Métro stations) was practising orthopaedics in the Avenue de Saxe.

In 1860, de Saint-Germain, a surgeon at the Enfants Malades children's hospital, wrote a Chirurgie Orthopédique, in which the term orthopédique was applied exclusively to paediatric bone and joint surgery. The author expressed his regrets that the term should have been abused so much in the past. He wanted to use it, in accordance with its etymological derivation from Greek pais = child, for the treatment of children; whilst also considering the underlying sense of education (as in encyclopaedia - where the Greek paideia refers to instruction in the arts and sciences).

It was not until after Ollier's death, in 1914, that Calot, a surgeon at Berck (amongst other duties) coined the term chirurgie orthopédique de guerre, in his famous book that showed how conservative surgical principles of joint drainage could be transferred from paediatric surgery to the treatment of battlefield casualties. Subsequently, the Société de Chirurgie Orthopédique was established, by paediatric surgeons such as Kirmisson. However, a terminological distinction was still made between adult and paediatric orthopaedic surgery.

OLLIER AND BONE GRAFTING

Prior to Ollier's studies, bone grafting in the strict sense of the term - transferring a bone or piece of bone from one site to another, distant one - had failed to produce the same results in humans that had been achieved in animal experiments.

Ollier was able to show that autografts (where the bone came from the same subject) and homografts (between two human subjects) would take; whereas xenografts were short-lived at a time when antisepsis had not yet been introduced, and would ultimately be rejected.

Around 1885, Ollier decided to go back to work on xenografting, in order to see whether the aseptic techniques introduced meanwhile at the Hôtel-Dieu hospital had changed the dire outlook of these grafts. He found that grafts between mammals and birds (rabbit or cat bone grafted into a chicken host) did not work. However, in some cases, chicken bone was successfully grafted into rabbits. Grafts were found to work better where the recipient (rabbit or cat) belonged to a higher species than the donor (chicken). Grafting from the higher to the lower species was found to be less successful. When grafting between mammals, Ollier found that rabbit bone would take well in the cat host. However, often the graft would provide only temporary support, and eventually disappear.

He concluded that there was no certainty of a graft taking in humans even if the material had come from "an animal very closely related to man, such as monkeys." Ollier used dowels of dead or living bone in the treatment of non-union in human patients, in particular in six cases of non-union of the tibia. The donors of the fresh bone were rabbits, calves, sheep, and humans. At the same time, Ollier used metal nails and ivory pins. The bone grafts invariably resorbed. The only advantage seen by Ollier was the stimulation of the host bone's osteogenetic potential.

In conclusion, Ollier wrote that "it is mainly interhuman transplants (autografts or homografts) that provide a means of repairing certain bone defects. Xenografts between different animal species will give only incomplete and transient results."

OLLIER AND SKIN GRAFTING

Ollier took an interest in a number of problems in plastic surgery. The list below shows some of the subjects dealt with in various theses:

- On the superiority of wire sutures over ordinary suture materials (1862), thesis by Muguet, Montpellier 1862, and published in the Weekly Gazette.

- Rhinoplasty - different procedures for the reconstruction of the nose (1862) Bulletin de la Société de Chirurgie

-
Elephantiasis of the nose, and treatment of the condition by decortication Academy of Medicine, 16 August, 1876

- Repair of the lower lip by means of a novel grafting technique and special precautions to prevent the flap from gradually disappearing under the chin Thesis by Lavis, Lyon 1883.

Figure 9 : Compression of radial nerve in callus; release by surgery Below: Periosteal rhinoplasty. On right - nose destroyed by lupus vulgaris; on left - result of surgery. (Photographs of plaster casts)

Ollier's greatest contribution was his creation of autografts involving the transfer of full-thickness skin to cover large raw or granulating surfaces. "I presented these grafts in two papers given at the Academy of Science and the Academy of Medicine, in 1872. The grafts are totally different from the ones described by Reverdin, whose technique is designed only to speed up healing by creating centres of epithelialization. My technique is designed to cover the wound with proper skin that remains flexible and stable; this produces a fundamentally different healing process. To this end, I take skin from an unaffected part of the same patient, or even from healthy limbs that have been amputated following trauma. The skin is harvested in the form of large squares 8, 12, or 15 cm2 in size, which are placed on fresh or on granulating wounds. Prior to the advent of antisepsis, grafting onto fresh wounds had been successful in some exceptional cases only; and I would recommend that only granulating wounds should be thus treated. Now, however, skin autografts will readily take on recent wounds. Some surgeons working after me (e.g. Thiersch in Leipzig) have even suggested that the granulating tissue should be scratched to make it bleed, since they feel that blood, being an aseptic fluid, will form a more effective bond between the transplant and the host tissue. However, I cannot see the benefit such a modification would provide."

"After 15 or 16 years, I have found the grafted skin to have preserved its original colour, volume, and thickness. Even the hairs were still there. At the same time (1873), I started using the Italian (tagliacotian) method of autografting, which provides thicker and stronger grafts that are better able to resist pressure and friction. However, these distant flaps force the patient into prolonged immobility, and make him adopt positions that can be unbearably awkward. Which method is ultimately used will depend on the site of the lesion."

OLLIER AND SURGERY

Ollier loved surgery, which was his true vocation.

Eugène Vincent wrote that "he was fascinating and magnificent in theatre. Like all first-rate surgeons, he was at his very best when faced with danger."

"Ollier was calm and fully in control. Any decisions that needed taking would be taken promptly, energetically, and with foresight." "Those working now (1900) only knew him when he was the dignified Professor, who would work slowly and methodically, at surgical workshops or lectures. However, when - twenty years earlier - he was Chief Surgeon, he would work with a speed, dexterity, and sure-handedness that few of us could match. It is staggering to note how active he was in those days. After operating all morning at the Hôtel-Dieu, he would rush off to do some more operations at a nursing home or at a patient's private residence. He seemed to be able to be in several places at once, having a number of operations on the go in different theatres. He had a huge practice. After operating or seeing patients all day, and grabbing a snack meal at odd times, he would often spend part of the night reading, or writing in his beautifully clear style that did not betray the slightest hint of fatigue." (E. Vincent)

OLLIER AND FOOT SURGERY

Between 1890 and 1900, when he was between 60 and 70 years old, Ollier produced a large number of papers on the surgery of the foot:

- On amputation vs various conservative operations in the treatment of tuberculosis of the tarsal bones;

- Management after removal of the talus;

- Long-term results of the removal of the talus in children;

- A textbook of amputations of the foot, with a preface by Dr. Roux (Brignoles), Professor at the Medical School of Marseilles; etc.

Figure 7 : A.B. Removal of talus and the greater part of the distal aspect of the tibia, in 1889. Radiograph (May 1897): The foot is supported on its outer edge. Destot tube; exposure time 15 minutes

Figure 8 : Ollier: Fixation of fracture of the distal end of the femur with 2 pins, in 1896. Radiograph: May 1896

"'The foot can easily do without the talus,' according to Mr. Ollier's remarks in his little textbook on limb resections. 'Given good surgical technique, the foot will recover its shape and function. Therefore, surgeons should not hesitate to remove the bone in case of rapidly progressive tuberculous lesions with sinus tract or abscess formation'."

Whilst making these recommendations, Prof. Ollier did not, however, advocate the wholesale removal of the talus, and was opposed to the routine talectomy in congenital club foot surgery that was widely practised in Lyon at that time.

Robert Judet, who came to Lyon to work under my teacher Georges de Morgues, often told me how he used to bury himself in Homer's Odyssey - and how he would spend even more time reading Ollier's works on how to obtain movement from an infected joint.

OLLIER,
THE FATHER OF EXPERIMENTAL SURGERY

Dean René Mornex (Lyon) wrote that "experimental surgery follows the rules laid down by Claude Bernard for scientific medicine, or experimental medicine, as it is called: The researcher starts from a clinical observation; designs and performs experiments, i.e. he creates new, and sometimes more limited situations which he can control and vary; and he observes the consequences of his actions and of any changes made to the original pattern."

"The ultimate goal towards which this research is directed should be the identification of the laws governing the processes involved, to solve the underlying biological questions, and - as far as possible - to derive clinical applications such as a better understanding of a particular disease, the design of a means of investigation, or, as the supreme goal, new management principles."

"If the problem to be researched is a surgical one, if surgical animal models are to be used, and if the end result is surgical techniques, then this work may rightly be termed experimental surgery, i.e. research in surgery."

R. Mornex also noted that "Ollier worked in the second half of the 19th century, shortly after the publication of Claude Bernard's pioneering principles, which must have impressed him profoundly. We are told that he started his surgical work on animals on his father's farm. His experimental work really took off when he joined Chaveau's laboratory at the Veterinary College in Lyon. He was to continue these activities for the rest of his life, with a remarkably consistent pursuit of his chosen subjects, and with meticulous attention to detail. By the time he started his research, Duhamel and Flourens had already shown that the periosteum is involved in bone tissue formation; however, apart from a few forerunners such as Velpeau, nobody had as yet systematically applied these findings to human subjects."

Figure 10 : Prof. L. Ollier in 1895.

"Ollier carried out extensive research, meticulously recording which animal species the work had been done in, what age each animal was, and the details of survival following each experiment. He designed a large number of experiments, and had the idea of using the bone of the opposite limb as a control. He analyzed what he saw in great detail, and showed that the subperiosteal layer was osteogenetic, and that by preserving this layer , reconstruction could be obtained, not only of a piece of bone but of a joint." (R. Mornex)

"When I became a surgeon at the Hôtel-Dieu hospital in Lyon, I was able to check in humans what I had previously observed in animals." (Ollier) Thus, Ollier was the first fully to apply the ideas of experimental medicine, i.e. to transfer the results of fundamental research into the clinical setting - something that Claude Bernard himself had been unable to do, since he did not have any patients.

"In 40 years, Ollier performed 827 joint excisions, and assembled over 1000 beautifully detailed patient files that can still be seen at the Museum of Medical History in Lyon. He was interested, not only in the actual surgical procedure, but in the follow-up of his patients, which, in some cases, went on for a very long time. To this end, he used the most advanced techniques then available: photography, and, after 1896, radiography, for which he worked together with Destot. His students would go out into the surrounding country, to retrieve anatomical specimens that were then added to Ollier's impressive collection still on view at Lyon." (Mornex)

In his history of experimental surgery (1986), Mornex singles out three surgeons who, to his way of thinking, embody the spirit of experimental surgery:-

- Ollier, whom he calls the Father of Experimental Surgery;

- Cushing at Baltimore, who worked with Halsted and was contemporaneous with Kocher at Berne; and

- Alexis Carrel, who breathed new life into cardiovascular surgery.

(Sci Techn Anim Lab 1987 12(2) 103-108)

Mornex, an eminently cultured man, has often said how much he admires Ollier, and how he would like to get the Post Office to issue a stamp of series of stamps to commemorate the surgeon and his work. 1994 was the centenary of the assassination of Sadi Carnot in Lyon, when Ollier and Poncet were among the doctors summoned to attend to the fatally wounded President. That opportunity was missed - perhaps there will be a commemorative stamp in the year 2000, to mark the centenary of Ollier's death.

OLLIER AT INTERNATIONAL CONFERENCES
THE TRAITÉ DES RÉSECTIONS

In the Revue Médicale de la Suisse Romande, Auguste Reverdin, in 1885, wrote about the International Congress of Surgeons at Copenhagen, under the title Voyage chirurgical à Copenhague et en Allemagne. He was very disappointed to have missed Lister's presentation on his latest antiseptic dressing, and Paul Bert's paper on the use of hydrogen peroxide; however, he had listened with interest to Mikulicz (Cracow), who was advocating the use of iodoform and trying to defend himself against the frequently made accusations of poisoning his patients. According to Reverdin, the highlight of the day was Schede's paper on the use of sublimate at his old and crowded hospital in Hamburg, with statistics to show that out of 74 compound fractures operated on, 69 had healed and only 5 patients had died.

Reverdin saw Prof. Sayre (New York) at a workshop where patients were to be suspended from a frame to have his famous plaster jackets fitted: "Sayre is a tall, heavily built man, with a low forehead, an aquiline nose, and thin lips - in other words, the very image of a strong and energetic man. He came in and set up his large sheer-legs of three poles joined at the top, from which the patients were to be suspended."

He next discusses some gynaecologists such as Hegar and Koeberle, and then refers to Ollier (Lyon): "Prof. Ollier, from Lyon, spoke about arthrotomy and excision in cases of tuberculous osteoarthritis. He gave the results of his experience, and argued in favour of arthrotomy; he thought that excisions had been overdone in children, leaving the young patients with virtually useless limbs, since excisions involving the growth plates had caused the bone to stop growing. Without wishing to castigate those who have been carried away by their enthusiasms for what can be achieved with antiseptic techniques, he thought that surgeons had to realize that joint excisions in the lower limb, especially at the knee joint, should not be done in young children. In such cases, arthrotomy was the procedure of choice, provided it was performed sufficiently early on and that it involved not only the diseased synovial membrane but also any affected cartilaginous and bony structures."

"This way, the joint may be thoroughly debrided, without, however, doing lasting harm to the growth plates. Otherwise, the patient might have been better off with an amputation. After excision for tuberculous osteoarthritis, Mr. Ollier does not seek healing by first intention, but wants to be able to shape the bone surfaces and the soft tissues during the healing process. He controls recurrent granulation with cautery or with iodoform. Simply, he manages to control the repair process, to prevent excessive granulation, and to obtain healing that lasts."

The surgeon from Lyon "concluded that arthrotomy and joint debridement were superior in children, while typical joint excisions should be performed in adults, especially in joints that are intended to regain mobility."

In 1885, Ollier had, in fact, become a victim of his own success: he found that his method of subcapsulo-subperiosteal excision was being used too widely. At the Hôtel-Dieu in Lyon, he had, in 1860, been put in charge of a major department of adult bone surgery. However, he closely followed the work of his former student Eugène Vincent, Chief Surgeon at the children's hospital next door, which provided him with the paediatric input that enabled him to devise specific management principles for children.

By the time of the 1885 Copenhagen congress, bone and joint surgeons dealt, not only with trauma cases, but also with the correction of major malalignment (using either osteoclasis or osteotomy), and ankylosis (where Ollier, in certain cases of ankylosis in the upper limb, would consider excision in order to restore some mobility). One of the chief indications was tuberculous arthritis, where surgery could, at times, be life-saving.

In tuberculous arthritis, some surgeons were not much bolder than Amédée Bonnet had been at the beginning of the 19th century: All that would done was some joint aspiration and injection of iodoform, followed by the application of a splint to prevent malalignment. On the other hand, cases where it was felt that the patient's life was at risk would be managed with amputation. Ollier was thus the first to promote conservative surgery, by introducing a technique that made it possible sparingly to excise the affected joints.

The Traité des résections et des opérations conservatrices qu'on peut pratiquer sur le système osseux, Ollier's main textbook, reflects the author's work over a period of more than 20 years (1867-1891). Ollier spent more than six years (1885-1891) writing the book or having it published, and presenting it at international meetings such as the Copenhagen congress. It was tremendously well received: After the Franco-Prussian war, Ollier's was one of four portraits of famous surgeons displayed in the Berlin Academy of Surgery. Ollier was in good company - one of the other portraits showed that other great innovator in surgery, Lister. We know of at least three statues of Ollier: one of Ollier with a mother and child, which was commissioned by his radiologist friend Emile Destot; plus a bronze statue in the Place Ollier in Lyon (which was taken away in WWII) and another one in Les Vans (Ardèche), which is well worth seeing. There are many marble busts; a famous ward at Cochin Hospital named after Ollier; several private hospitals (especially the one at Roanne) that bear his name; the Ollier Department of Biomechanics at Lyon-Grange Blanche; etc.

Ollier was a researcher and a scientist of the first order. His life and work made him the Father of bone and joint (or orthopaedic) surgery as well as the Father of experimental surgery.

Figures 12 and 12a : Menu of the Léopold Ollier commemorative dinner, listing 5 wines, including a carafe Beaujolais Fleurie. In 1930, Lyon went to great lengths to celebrate the centenary of Ollier's birth, with a large number of theses on the different procedures devised by Ollier, and case presentations of such of his former patients as were still alive. The forthcoming centenary of Ollier's death will, it is hoped, produce some major papers and events.

Figure 11 : Ollier's statue in the Place Ollier, on the banks of the Rhone. This statue was taken away by the Germans to be melted down for ordnance. The statue in Les Vans stands among the plane trees of a typical little town square in the south of France.