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ORTHOPAEDIC SURGERY IN THE LIGHT OF ITS EVOLUTION.

FREIBERG, ALBERT H.
The Journal of Bone & Joint Surgery: April 1937
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I am convinced that Orthopaedic Surgery represents today a development which is desirable and needful, for the good of humanity. It calls for a high degree of specialized training, both of a scientific and of a practical nature. It demands talent and personal devotion both in kind and amount such as will justify men who possess them to dedicate their lives to this work with the assurance that in so doing there may accrue to them the most ample satisfactions. Orthopaedic Surgery is in its essence a combination of the mechanical and the operative in surgery, but in its quintessence it is and must continue to be surgery. A proper blending of these two factors is required if we would avoid unfulfilment on the one hand or the infliction of harm on the other. If Orthopaedic Surgery was originally too much concerned with the external use of mechanical appliances, this was largely so because operative surgery had come to be noxious and even destructive in its definitive effects and in this particular sphere. It is not surprising that a movement to the opposite extreme ensued. Today, we find it necessary to be armed with all resources, both operative and non-operative, as well as to know how to mingle them skilfully as regards time and manner. The emphasis of Orthopaedic Surgery today is upon the mechanism of the body's motor apparatus, and what may be done with it and for it. It must be possible to employ such means as will be to the greatest advantage of the patient, be they operative, or non-operative. Orthopaedic Surgery has made valuable contributions to knowledge in its field, both in regard to the normal and pathological physiology of the motor apparatus and in respect to the employment of non-operative and operative methods of help. It has a mission to accomplish much more. For this, ample encouragement and opportunity must be afforded. It is necessary that Orthopaedic Surgery be taught to undergraduate students as a discipline in Surgery, just as Gynecology and Urology are taught. Its teachers should have appropriate academic recognition, as befits their accomplishments and proper functions. While this should imply dignified rank, this cannot be specified. Academic position must depend largely upon a personal and individual factor. However, it should be held that the place of Orthopaedic Surgery in the curriculum may not depend upon the opinion or the whim of any man. Happily, it seems unlikely that the demand will be made that it do so. The place which Orthopaedic Surgery has been able to assume, both in its professional and general social relationships, is dependent upon an idealistic attitude on the part of a great number of practitioners and upon their effective service. It must be assumed possible for the general surgeon who is a skilful operator to learn to do the most difficult orthopaedic operations in an acceptable manner; just as it is possible for a well-trained orthopaedic surgeon to accomplish the same thing in the case of abdominal or other operative measures which are granted to belong within the realm of general surgery. Certainly, the financial consideration should never be the factor to decide what shall be done. However, he who enters the orthopaedic field upon occasion only is likely to misconceive the place of operations in the scheme of things which the orthopaedic patient requires, just as he is unlikely to be provided with the training, the routine, the organized personnel, and the armamentarium which will enable him to do full justice to those who require this kind of service. While many persons still live under such conditions as make it imperative for them to forego highly specialized service in many departments of Medicine and Surgery, the standards of our time call for a large number of able and well-trained men who are thoroughly equipped in the fundamentals of General Medicine and Surgery, but who devote their lives to the practice of Orthopaedic Surgery. Nothing less will fulfil the needs of our present-day society; nothing less will answer its demands acceptably.

Doubtless, many of you have had pleasure and profit from the reading of Stephen Paget's 'Confessio Medici' and it is likely that you have been touched, as I have been, by his concluding words. I beg permission to repeat them: 'He has not fulfilled his ambition to be at the top of the tree; but he can still congratulate himself that he is on a branch. The natural dignity of our work, its unembarrassed kindness, its insight into life, its hold on science-for these privileges, and for all that they bring with them, up and up, high over the top of the tree, the very heavens open, preaching thankfulness. Circle above circle, the reasons for it are established, out of the reach of words.' This was an expression of the author, having in mind the practice of the medical profession generally. I became acquainted with these words quite long ago and they have remained fixed in my mind with an appeal of indefinable strength. More remarkable sentences than these are to be found in this charming book, but these closing words impress me with their appositeness, not simply in respect of our common profession, but particularly to that part of it to which my own career has been dedicated. I commend these words to the thought of every orthopaedic surgeon. They might well conclude his testament.

(C) 1937 All Rights Reserved.The Journal of Bone and Joint Surgery, Inc.

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