OTI

Merle d'Aubigné unified his country's orthopaedic community

French pioneer separated discipline from general surgery while introducing new concepts and practices.

Robert Merle d’Aubigné, MD, was born at the dawn of the modern era of orthopaedics. In his lifetime, he saw the specialty grow from the simple treatment of fractures to the success of contemporary joint arthroplasty and experimental use of biologics.

Merle d’Aubigné’s dedication to orthopaedics led him to usher the specialty into France and to develop procedures, philosophies and institutions that remain in place today.

“Without a doubt, Robert Merle d’Aubigné was a pioneer in orthopaedics not only in his country, but throughout the world,” said Jacques Duparc, MD, of Paris, who serves on the Orthopaedics Today Editorial Advisory Board. “He was my master as well as good friend.”

Poets and clergy

The Merle d’Aubignés came from Huguenot lineage and many poets, writers and clergymen fill his family tree. His grandfather was Jean Henri Merle d’Aubigné, a famed Swiss ecclesiastical historian. His great-grandfather, Aime Robert Merle d’Aubigné, whom Robert was named after, founded an international postal service based in Geneva and died during the Napoleonic Wars while couriering mail from Eastern to Western Europe. Merle d’Aubigné’s father and six of his uncles were all members of the clergy.

He was born in 1900 in a small village north of Paris called Neuilly, which has since been incorporated into the city. His father’s position in the clergy naturally resulted in a strict religious education for the young Merle d’Aubigné, emphasizing a strong sense of morals and duty, attributes he would carry throughout his life. His father’s many travels combined with relatives in England, Switzerland and the United States enriched the young Merle d’Aubigné’s life by adding a worldly component as well as firm commands of the English and German languages.

Blossoming medical interest

Robert Merle d’Aubigné, MD [photo]Robert Merle d’Aubigné's dedication to orthopaedics led him to usher the specialty into France and to develop procedures, philosophies and institutions that remain in place today.

Merle d’Aubigné attended the Lycée Pasteur, which was turned into an American military hospital while he was there during World War I. The interactions he had with medical students, nurses and ambulance drivers exposed the young student to the study and practice of medicine and set his life course. He nearly missed involvement in World War I, serving just two months at the end of the war. He began his medical education at the Hôpitaux de Paris, receiving his medical degree in 1928.

In “Surfing the Wave,” published in Clinical Orthopaedics and Related Research in 1982, Merle d’Aubigné wrote about his life and the development of the orthopaedic specialty in France. He claimed his early years as an intern were disappointing because of the overcrowded hospitals, overworked nurses and the condescending attitudes of his fellow students. “Many of our young students hardened their hearts and gained professional indifference before gaining any knowledge,” he wrote.

During his surgical training, he studied under a caring physician who would change his opinion and show him the work he was meant to pursue. In his fourth year of his intern training, he came under the tutelage of Paul Lecéne, who, like Merle d’Aubigné, had a special interest in fractures and skeletal disorders, areas that were given little attention by the general surgeons. Lecéne noted the interest of his student and proposed they co-author a text on the subject; however, Lecéne died before the book was written.

A learning voyage

After receiving his doctorate, Merle d’Aubigné set off on a voyage that would shape the rest of his career and the future of French orthopaedics. He traveled to Vienna to meet Lorenz Böhler at his pioneering trauma center. Observing Böhler and his results with fracture treatment, Merle d’Aubigné realized that specialized treatment of fractures showed “overwhelming superiority” over what was seen in general surgical departments. However, Böhler’s belief in the separation of trauma and orthopaedics “did not seem to be the right answer,” according to Merle d’Aubigné.

He also traveled to Bologna, Italy, to meet the Italian pioneer, Vittorio Putti. There, the concept of a stand-alone orthopaedic hospital was bolstered by a visit to the Instituto Rizzoli. “It was a dream and I hardly dared to think that something similar could be realized in France,” Merle d’Aubigné wrote following the visit.

In 1936, he was made “chirugien des hôpitaux” in the surgical department of Hôpital de Vaugirad under Pierre Duval, and became fascinated with reading the Journal of Bone and Joint Surgery.

Serving in the French Resistance

With the outbreak of World War II, Merle d’Aubigné became chief of a surgical ambulance corps of 100 men and eight nurses serving near the front lines of battle. Many times he was fired at with machine guns or cared for patients with bombs dropping nearby from diving German planes. During this time, he became part of the French Resistance. “He joined the Resistance early on,” Duparc said. “He organized a clandestine health service for the French forces.” In March 1944, he narrowly escaped being arrested by the Nazi Gestapo.

Following the French liberation, Merle d’Aubigné had the opportunity to visit England, a desire whose flames were fanned by his JBJS fascination. He was in London while the V-2 bombs were still falling. There, he observed Reginald Watson-Jones perform a Bankart procedure, discussed with Jim Seddon his work on peripheral nerve injuries, and discovered Frank Stinchfield’s advances with rehabilitation.

In his autobiography, Une Trace, published in 1987, Merle d’Aubigné wrote: “It was fantastic to discover modern orthopaedic and traumatic surgery. I learned more every day of those two weeks than in any of the past 10 years.”

Forming an orthopaedic center

Near the end of the war, Merle d’Aubigné, along with friend Jean Cauchoix, had the opportunity through the French Army Medical Service to open a center for specialized orthopaedic care. At the Centre de Chirurgie Réparatrice, Merle d’Aubigné and Cauchoix gathered aspiring orthopaedic talent and concepts and treatments gleaned from the pioneers he visited in Italy, Britain and Austria.

Soon, the center moved to larger quarters in the newer Hôpital Foch in Suresnes, France, and patients came from all over the country. At the orthopaedic center, he fostered innovation and treatments such as intramedullary nailing and tendon transfers.

Interest grew in the center and young surgeons came from France and other countries to learn the new surgical techniques. In his memoirs, Merle d’Aubigné said this work was very hard, but the collective enthusiasm of the group kept them going. “It was like surfing. We had only to let the wave of orthopaedic progress carry us, trying to go in the right direction and not be left behind.”

Hôpital Cochin

Merle d’Aubigné became the director of the new orthopaedic university department at the Hôpital Cochin in 1950 and was given the opportunity to create a surgical center there. “He made many visits to hospitals in the United States and United Kingdom,” Duparc said. “He was very interested in the development of orthopaedics in these two countries. This gave an Anglo-Saxon touch to the organization of his service.”

He brought in collaborators such as Cauchoix, Raoul Tubiana, Michel Postel, Robert Meary and Jacques Ramadier to develop different fields of study, including trauma, hand surgery, neural surgery, spine, hips, and tumors, Duparc said.

“The orthopaedic service at Hôpital Cochin quickly became successful, attracting many visitors from various countries,” Duparc said. “This intense activity resulted in the many valuable publications.”

Merle d’Aubigné used the experiences and doubts he had in medical school to construct a nurturing and influential learning environment. “The interns were impressed by Merle d’Aubigné’s strong personality,” Duparc said. “They were very proud to belong to such a prestigious school. To be a fellow at Hôpital Cochin gave one an excellent prospect for the future.”

During this time, Merle d’Aubigné led a successful effort to keep the practice of orthopaedics and trauma united, as opposed to the German system that he had disapproved of many years before.

Society membership

Merle d’Aubigné became involved with the French orthopaedic society — Société Francaise de Chirurgie Orthopédique et Traumatologique (SOFCOT) — and was appointed editor of its journal, Revue Française d’Orthopédie in 1954. Under his direction, it evolved from an archaic publication to a respected peer-reviewed journal. In 1956, he was elected president of the society.

Somewhat of a French orthopaedic ambassador, Merle d’Aubigné traveled the world to speak, teach and learn. He was named honorary member of most European and North American orthopaedic societies.

In 1966, he organized the Paris meeting of the Societé International d’Orthopédie et de Traumatolgie (SICOT) at his clinic’s new world-class facility. It was a very proud moment for him. He served as the SICOT president from 1967-69.

“Despite all the honor he obtained, Merle d’Aubigné remained very attentive to his residents,” Duparc said. “They were frequently invited to his home in Paris or his country house.”

Alpinist, skier, writer

Merle d’Aubigné was a great sportsman for most of his life. As a young man, he was an accomplished alpinist, or mountain climber; later, he turned to skiing and sailing. In fact, some said his keen interest in intramedullary nailing came from being treated with traction for a tibial fracture as a young man.

Duparc said that after retirement, Merle d’Aubigné spent much of his time in Spain, where he took up sailing. “As with everything he did, it was with a passion. In 1966, he sailed with his wife from Spain to Israel to attend the SICOT meeting in Tel Aviv.”

He published eight textbooks, two autobiographies and founded International Orthopaedics, the SICOT journal. He devised low-exposure procedures for fracture fixation using early nailing and wires, which were passed through the bones of the extremities and held in place with external pins.

He investigated sacrolumbar arthrodesis with posterior grafting for spondylolisthesis and Bankart repairs with special instrumentation for recurrent dislocation of the shoulder. He also was interested in the hip and devised an improvement to the stem of the Judet prosthesis. His scale for functional grading of the hip was, until just recently, a standard measurement tool.

Merle d’Aubigné died in 1987, shortly after finishing Une Trace, which Duparc said he wrote questioning whether or not he left a track behind him.

“We can affirm that, despite time erasing all things, Robert Merle d’Aubigné’s deeds remain [alive] and strong in our memories,” he said.

Robert Merle d’Aubigné, MD, was born at the dawn of the modern era of orthopaedics. In his lifetime, he saw the specialty grow from the simple treatment of fractures to the success of contemporary joint arthroplasty and experimental use of biologics.

Merle d’Aubigné’s dedication to orthopaedics led him to usher the specialty into France and to develop procedures, philosophies and institutions that remain in place today.

“Without a doubt, Robert Merle d’Aubigné was a pioneer in orthopaedics not only in his country, but throughout the world,” said Jacques Duparc, MD, of Paris, who serves on the Orthopaedics Today Editorial Advisory Board. “He was my master as well as good friend.”

Poets and clergy

The Merle d’Aubignés came from Huguenot lineage and many poets, writers and clergymen fill his family tree. His grandfather was Jean Henri Merle d’Aubigné, a famed Swiss ecclesiastical historian. His great-grandfather, Aime Robert Merle d’Aubigné, whom Robert was named after, founded an international postal service based in Geneva and died during the Napoleonic Wars while couriering mail from Eastern to Western Europe. Merle d’Aubigné’s father and six of his uncles were all members of the clergy.

He was born in 1900 in a small village north of Paris called Neuilly, which has since been incorporated into the city. His father’s position in the clergy naturally resulted in a strict religious education for the young Merle d’Aubigné, emphasizing a strong sense of morals and duty, attributes he would carry throughout his life. His father’s many travels combined with relatives in England, Switzerland and the United States enriched the young Merle d’Aubigné’s life by adding a worldly component as well as firm commands of the English and German languages.

Blossoming medical interest

Robert Merle d’Aubigné, MD [photo]Robert Merle d’Aubigné's dedication to orthopaedics led him to usher the specialty into France and to develop procedures, philosophies and institutions that remain in place today.

Merle d’Aubigné attended the Lycée Pasteur, which was turned into an American military hospital while he was there during World War I. The interactions he had with medical students, nurses and ambulance drivers exposed the young student to the study and practice of medicine and set his life course. He nearly missed involvement in World War I, serving just two months at the end of the war. He began his medical education at the Hôpitaux de Paris, receiving his medical degree in 1928.

In “Surfing the Wave,” published in Clinical Orthopaedics and Related Research in 1982, Merle d’Aubigné wrote about his life and the development of the orthopaedic specialty in France. He claimed his early years as an intern were disappointing because of the overcrowded hospitals, overworked nurses and the condescending attitudes of his fellow students. “Many of our young students hardened their hearts and gained professional indifference before gaining any knowledge,” he wrote.

During his surgical training, he studied under a caring physician who would change his opinion and show him the work he was meant to pursue. In his fourth year of his intern training, he came under the tutelage of Paul Lecéne, who, like Merle d’Aubigné, had a special interest in fractures and skeletal disorders, areas that were given little attention by the general surgeons. Lecéne noted the interest of his student and proposed they co-author a text on the subject; however, Lecéne died before the book was written.

A learning voyage

After receiving his doctorate, Merle d’Aubigné set off on a voyage that would shape the rest of his career and the future of French orthopaedics. He traveled to Vienna to meet Lorenz Böhler at his pioneering trauma center. Observing Böhler and his results with fracture treatment, Merle d’Aubigné realized that specialized treatment of fractures showed “overwhelming superiority” over what was seen in general surgical departments. However, Böhler’s belief in the separation of trauma and orthopaedics “did not seem to be the right answer,” according to Merle d’Aubigné.

He also traveled to Bologna, Italy, to meet the Italian pioneer, Vittorio Putti. There, the concept of a stand-alone orthopaedic hospital was bolstered by a visit to the Instituto Rizzoli. “It was a dream and I hardly dared to think that something similar could be realized in France,” Merle d’Aubigné wrote following the visit.

In 1936, he was made “chirugien des hôpitaux” in the surgical department of Hôpital de Vaugirad under Pierre Duval, and became fascinated with reading the Journal of Bone and Joint Surgery.

Serving in the French Resistance

With the outbreak of World War II, Merle d’Aubigné became chief of a surgical ambulance corps of 100 men and eight nurses serving near the front lines of battle. Many times he was fired at with machine guns or cared for patients with bombs dropping nearby from diving German planes. During this time, he became part of the French Resistance. “He joined the Resistance early on,” Duparc said. “He organized a clandestine health service for the French forces.” In March 1944, he narrowly escaped being arrested by the Nazi Gestapo.

Following the French liberation, Merle d’Aubigné had the opportunity to visit England, a desire whose flames were fanned by his JBJS fascination. He was in London while the V-2 bombs were still falling. There, he observed Reginald Watson-Jones perform a Bankart procedure, discussed with Jim Seddon his work on peripheral nerve injuries, and discovered Frank Stinchfield’s advances with rehabilitation.

In his autobiography, Une Trace, published in 1987, Merle d’Aubigné wrote: “It was fantastic to discover modern orthopaedic and traumatic surgery. I learned more every day of those two weeks than in any of the past 10 years.”

Forming an orthopaedic center

Near the end of the war, Merle d’Aubigné, along with friend Jean Cauchoix, had the opportunity through the French Army Medical Service to open a center for specialized orthopaedic care. At the Centre de Chirurgie Réparatrice, Merle d’Aubigné and Cauchoix gathered aspiring orthopaedic talent and concepts and treatments gleaned from the pioneers he visited in Italy, Britain and Austria.

Soon, the center moved to larger quarters in the newer Hôpital Foch in Suresnes, France, and patients came from all over the country. At the orthopaedic center, he fostered innovation and treatments such as intramedullary nailing and tendon transfers.

Interest grew in the center and young surgeons came from France and other countries to learn the new surgical techniques. In his memoirs, Merle d’Aubigné said this work was very hard, but the collective enthusiasm of the group kept them going. “It was like surfing. We had only to let the wave of orthopaedic progress carry us, trying to go in the right direction and not be left behind.”

Hôpital Cochin

Merle d’Aubigné became the director of the new orthopaedic university department at the Hôpital Cochin in 1950 and was given the opportunity to create a surgical center there. “He made many visits to hospitals in the United States and United Kingdom,” Duparc said. “He was very interested in the development of orthopaedics in these two countries. This gave an Anglo-Saxon touch to the organization of his service.”

He brought in collaborators such as Cauchoix, Raoul Tubiana, Michel Postel, Robert Meary and Jacques Ramadier to develop different fields of study, including trauma, hand surgery, neural surgery, spine, hips, and tumors, Duparc said.

“The orthopaedic service at Hôpital Cochin quickly became successful, attracting many visitors from various countries,” Duparc said. “This intense activity resulted in the many valuable publications.”

Merle d’Aubigné used the experiences and doubts he had in medical school to construct a nurturing and influential learning environment. “The interns were impressed by Merle d’Aubigné’s strong personality,” Duparc said. “They were very proud to belong to such a prestigious school. To be a fellow at Hôpital Cochin gave one an excellent prospect for the future.”

During this time, Merle d’Aubigné led a successful effort to keep the practice of orthopaedics and trauma united, as opposed to the German system that he had disapproved of many years before.

Society membership

Merle d’Aubigné became involved with the French orthopaedic society — Société Francaise de Chirurgie Orthopédique et Traumatologique (SOFCOT) — and was appointed editor of its journal, Revue Française d’Orthopédie in 1954. Under his direction, it evolved from an archaic publication to a respected peer-reviewed journal. In 1956, he was elected president of the society.

Somewhat of a French orthopaedic ambassador, Merle d’Aubigné traveled the world to speak, teach and learn. He was named honorary member of most European and North American orthopaedic societies.

In 1966, he organized the Paris meeting of the Societé International d’Orthopédie et de Traumatolgie (SICOT) at his clinic’s new world-class facility. It was a very proud moment for him. He served as the SICOT president from 1967-69.

“Despite all the honor he obtained, Merle d’Aubigné remained very attentive to his residents,” Duparc said. “They were frequently invited to his home in Paris or his country house.”

Alpinist, skier, writer

Merle d’Aubigné was a great sportsman for most of his life. As a young man, he was an accomplished alpinist, or mountain climber; later, he turned to skiing and sailing. In fact, some said his keen interest in intramedullary nailing came from being treated with traction for a tibial fracture as a young man.

Duparc said that after retirement, Merle d’Aubigné spent much of his time in Spain, where he took up sailing. “As with everything he did, it was with a passion. In 1966, he sailed with his wife from Spain to Israel to attend the SICOT meeting in Tel Aviv.”

He published eight textbooks, two autobiographies and founded International Orthopaedics, the SICOT journal. He devised low-exposure procedures for fracture fixation using early nailing and wires, which were passed through the bones of the extremities and held in place with external pins.

He investigated sacrolumbar arthrodesis with posterior grafting for spondylolisthesis and Bankart repairs with special instrumentation for recurrent dislocation of the shoulder. He also was interested in the hip and devised an improvement to the stem of the Judet prosthesis. His scale for functional grading of the hip was, until just recently, a standard measurement tool.

Merle d’Aubigné died in 1987, shortly after finishing Une Trace, which Duparc said he wrote questioning whether or not he left a track behind him.

“We can affirm that, despite time erasing all things, Robert Merle d’Aubigné’s deeds remain [alive] and strong in our memories,” he said.