PREFACE

One hundred fifty years ago orthopaedics as a surgical discipline hardly existed. A few individuals in New York and Boston and fewer still elsewhere called themselves orthopaedic surgeons, but their impact was minimal. They had little to offer patients suffering with musculoskeletal disease and deformities. They could only prescribe rest and immobilization with braces. In the early 21st century, however, thousands of men and women call themselves orthopaedic surgeons. Industries have evolved to support them and their patients with specialized instruments, implants, and medications. The public has instant name recognition for the term “orthopaedic surgeon,” and insurers and the government set aside billions of dollars annually to cover the expenses of orthopaedic care.

This book seeks to tell the story of the rise of orthopaedics in America. The specialty originated in Europe and Great Britain in the late 18th and early 19th centuries; American physicians crossed the ocean to study and emulate techniques developing there. They eventually created their own version of musculoskeletal surgery in the United States.

Initially, in the 1850s and 1860s when orthopaedics began to be practiced as such in America, it dealt mostly with the musculoskeletal manifestations of tuberculosis. That disease afflicted large numbers of children during the middle of the 19th century, prompting a demand for physicians to treat them. Later, as the prevalence of tuberculosis declined, the waves of polio epidemics began. This occurred paradoxically because of cleaner water and better sanitation. The enteric poliovirus was present in the drinking water of most Americans until the late 19th century, a fact which conferred a herd immunity to polio. The loss of this immunity allowed polio to infect thousands of children and adults, many of whom required orthopaedic care. After the advent of the polio vaccines, orthopaedics took off in new directions. Total joint replacements and arthroscopic surgery led to a revolution in the specialty in the late 1970s and 1980s. The stage was set for this revolution, however, by a decision of the Surgeon General of the Army in World War II. He was an orthopaedic surgeon, and ordered that all fractures in the army would be treated or supervised by members of his specialty. Many physicians on active duty during the war years acquired an interest in orthopaedics as a result. They became the men who developed the discipline when the war was over.

This history is a celebration of the 75th Anniversary of the founding of the American Academy of Orthopaedic Surgeons. It has been written by an orthopaedic surgeon for other orthopaedic surgeons to provide insight into the origins of the specialty and how it developed. It is incomplete, of course, because orthopaedics continues to grow and change. The project was made possible with the support of an educational grant from the Stryker Corporation; I am grateful for their interest and help.

Henry Sherk, MD