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THE CLASSIC:Fifty Years of the American Board of Orthopaedic Surgery

Wickstrom, Jack, K

Clinical Orthopaedics and Related Research: August 2006 - Volume 449 - Issue - p 11-15
doi: 10.1097/01.blo.0000224043.61968.d8
SECTION I: SYMPOSIUM I: C. T. Brighton/ABJS Workshop on Orthopaedic Education
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†Deceased 1985.

(This reprinted Classic Article is reprinted with courtesy from Wickstrom JK. Fifty years of the American Board of Orthopaedic Surgery. Clin Orthop Relat Res. 1990;257:3-10.)

The American Board of Orthopaedic Surgery originally consisted of nine men, three from each of these organizations: the American Orthopaedic Association, the American Academy of Orthopaedic Surgeons, and the Orthopaedic Section of the American Medical Association. Each member was elected by the Board from two or more candidates nominated by each parent organization. The original members elected to the Board in 1934 were elected for staggered terms of one to three years to insure continuity of the Board policy and yet make possible the incorporation of “new blood” on a regularly scheduled basis. It was planned that members would be eligible for re-election for two additional terms of three years each.

During the first two years of its existence, the Board certified without examination. All 134 active members of the American Orthopaedic Association as of June 5, 1934 were certified as well as professors and associate professors of orthopaedics in “recognized teaching institutions,” provided they had practiced orthopaedics for more than ten years. A selected group of men who were not members of the American Orthopaedic Association but who had limited their practices to orthopaedic surgery for ten years, were also included in the original certification process.

When examinations were introduced at the Board meeting in Philadelphia on June 10, 1935, the fee for taking the Board examinations was fixed at $25.00. Candidates who failed were allowed to repeat their examinations up to three times without paying additional fees.

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PERSONALITIES ON THE BOARD: THE FOUNDING FATHERS

Few organizations, except possibly some government bureaucracies or legal organizations, consist solely of rules and regulations. The single most important factor that determines whether any organization functions well or poorly is the human factor, the personnel who function within the rules and regulations and make the organization “go.” In gathering material for this chapter, we encountered several difficulties: first, in selecting a title and, second, in determining who would be included in the section. The junior member (JKW) of the original two who started compiling this history voted for the title of “Characters of the Board” (or “on the Board”); the senior member (GAC) preferred “Personnel of the Board;” we compromised on “Personalities on the Board.” I still believe there were many characters among the Board personnel; we will attempt to show how these “characters” worked together to make the Board a success. I believe everyone who served on the Board should be included.

The original group consisted of nine men, three nominated by each of the three sponsoring societies as their representatives to this new board. This Board was somewhat hesitatingly accepted by many but not by all members of the parent organizations, and the new group was somewhat uncertain of how to proceed or of what they were actually expected to do. These nine founding fathers gathered together at 5:00 p.m. in a private dining room on the third floor of the Palmer House Hotel in Chicago on January 7, 1934. They selected Dr. Melvin Henderson as temporary chairman. Philip D. Wilson served as temporary secretary, although Dr. Wilson had not yet been elected to the Board. Dr. Henderson read the Articles of Incorporation and was authorized to proceed with the incorporation process. The first order of business was the appointment of a committee of four to attend the meeting of the “Advisory Council on Medical Education and Licensure” (actually the Council on Medical Education and Hospitals of the AMA) scheduled for February and the drawing up of a constitution and by-laws. A second committee of two was appointed and charged with developing a “Methods of Examination.”

Representatives of the Board next met in the office of The Corporation Trust Company in Wilmington, Delaware for purposes of incorporation. This was accomplished without incidence, but some confusion was manifested as to who was serving as representative of which sponsoring organization and for how many years.

The third meeting of the Board was held at the Kahler Hotel in Rochester, Minnesota, the home of the temporary chairman, on June 5, 1934. At this meeting Dr. Henderson was elected President of the Board; Edwin W. Ryerson, Vice-President; Fremont Chandler, Secretary; and Henry Meyerding, Treasurer. The first order of business was to accept the ad hoc committee's report of its meeting with the Advisory Council. The Board next voted to seek membership in the Advisory Council and established an application fee of $25.00 for those who wished to be considered for certification. They also established the qualifications for those to be certified without examination and selected candidates for such certification from two lists, one compiled by Dr. Henderson and another by Dr. Kleinburg. This was all accomplished in one evening's time and was followed by a lengthy discussion of the types of examinations to be given to those seeking certification the following year. These remarkable feats, completed so promptly, gives some indication of the talent these orthopaedic leaders possessed. A thumbnail description of these nine should serve to at least record their qualifications and accomplishments.

The first president of the Board, Melvin Starkey Henderson (Fig. 1), prominent Head of Orthopaedics at the Mayo Clinic, was a natural leader with great talent for organization and management. He also had a wonderful sense of humor and great personal charm and he gained wide acclaim for his clinical work in bone grafting; he introduced the use of a guide pin to aid in inserting hip nails in “blind” hip nailing and advocated knee joint re-section for acid-fast infections as an alternative to knee fusion. His accomplishments included gaining acclaim in managing patients with internal derangements of the knee. He was a close friend and advisor of Willis Campbell. The two seemed bound by an affinity which reputedly had its origin in the difficulty both had experienced in gaining recognition as they attempted to gain a foothold in orthopaedic politics. In fact, a persistent rumor, repeatedly denied, held that Henderson and Campbell were the primary movers behind the establishment of both the American Academy of Orthopaedic Surgeons and the American Board in Orthopaedic Surgery; their actions were said to be a retaliatory response to their rejection by the orthopaedic establishment “in the East.”

Fig. 1

Fig. 1

After all, in the opinion of the East coast establishment, Dr. Henderson (who was born in St. Paul, was educated in Canada, and had his beginning with the Mayo brothers as a clinical assistant riding a bicycle around Rochester, making house calls on the Mayo brothers' patients) was a mere upstart. He became first surgical assistant to William Mayo, and later the Mayo brothers sent him first to Liverpool to work with Sir Robert Jones and then on to Edinburgh, but he still was considered an outsider by the orthopaedic establishment. When he returned to Rochester, he was invited to establish a section of orthopaedic surgery and played an important role in establishing the graduate education program at the Mayo Clinic.

By the time he was elected President of the Board, he had already served as president of the Clinical Orthopaedic Society, chairman of the Section of Orthopaedics of the American Medical Association, and president of the American Orthopaedic Association. While serving his first term as president of the Board, he was elected president of the American Academy of Orthopaedic Surgery.

The minutes of the first Board meeting indicate Henderson's unusual ability to lead a group whose personnel repeatedly changed and sometimes seemed uncertain of the group's objectives. Henderson compared the experience to that of “guiding a new ship with a new crew sailing on uncharted seas for unknown shores.” Dr. Caldwell and several other early members of the Board expressed their opinions that Melvin Henderson's personality and his abilities as a leader assured the early success of the Board more than any other factor. He was succeeded as president of the Board by his close friend, Dr. Willis Campbell, as soon as Campbell was elected to the Board in January, 1937. Dr. Henderson remained a member of the Board and continued to represent the Board on the Advisory Committee for Medical Specialties. He was particularly active in selection of examiners for the first certification examination. He remained most active in Board affairs until the end of his third term in 1943.

The second member of the fledgling Board, originally elected for a three year tour and representing the American Academy of Orthopaedic Surgeons, was Edwin W. Ryerson (Fig. 2), a powerful giant of orthopaedics in the middle west.

Fig. 2

Fig. 2

Dr. Ryerson was senior among the founders of the Board. He was born in 1872, graduated from Harvard Medical School in 1897, and trained at Boston Children's Hospital as well as in Berlin and Vienna. He migrated to Chicago in 1899 and was one of the organizers of the Clinical Orthopaedic Society in 1912, serving as its president in 1914. He was president of the American Orthopaedic Association in 1925, and was one of the instigators of the movement in the Clinical Orthopaedic Society that helped in the organization of the American Academy of Orthopaedic Surgery in 1933. He was elected the Academy's first president. He served as vice-president of the newly formed Board and furnished dignity, authority, and stature to the Board. He was the power in orthopaedics on the plains and continued to serve until 1940, when he was succeeded by Dr. Frank Dixon, as a representative of the Academy.

One of the strongest, if not the strongest and most influential of the founders was Dr. Fremont Chandler (Fig. 3). He was originally elected to serve three years as a representative of the American Medical Association and was elected secretary at the first meeting of the Board. He served at this post for eight years. More concerning Dr. Chandler's activities, accomplishments, and influence on the Board will follow at the end of this discussion of the founders.

Fig. 3

Fig. 3

The group of founding members of the Board elected for two years consisted of equally prominent surgeons. The first of these, Henry W. Myerding (Fig. 4) of the Mayo Clinic, had an excellent reputation as a master surgeon and had remarkable abilities as a speaker. Dr. Myerding was born on September 5, 1884, received his Doctorate in Medicine from the University of Minnesota in 1909, and began working at the Mayo Clinic as an assistant in orthopaedic surgery in 1911. He was a consultant in the section of Orthopaedic Surgery at the Mayo Clinic at the time he was elected to the Board and became a senior consultant in 1938 and an emeritus member of the staff in 1949.

Fig. 4

Fig. 4

I've discussed Dr. Myerding and his contributions in orthopaedics with a number of people who trained under him and who worked with him, the majority of whom agreed that Dr. Myerding was a superb technician, technically the best on the staff at the clinic for a number of years, who had a caustic tongue and was somewhat difficult to live with. One of his former residents attributes this to a disappointing family life; another attributes it to disappointment all the time he was on the staff at the Mayo Clinic probably because he was not chief of the section of Orthopaedics. One of his associates credits Dr. Melvin Henderson with not allowing the development of personal animosities to disrupt the orthopaedic service at the clinic. This source of information believes that Dr. Myerding was originally choosen [sic] for the Board and elected its treasurer at Dr. Henderson's insistence in order that Dr. Henderson's selection as President of the Board would be less irritating to his colleague Dr. Myerding. After being with Dr. Myerding in Mexico years after his service on the Board, I had difficulty in reconciling the tales I had heard about him and the charming gentleman I enjoyed so much while we were both guests in Mexico.

John Cree Wilson (Fig. 5), a most distinguished orthopaedic scholar from California, trained at Massachusetts General Hospital after a short period in general practice. He was one of the few orthopaedists who served in World War I but who did not work under Sir Robert Jones or Joel Goldthwait. He established a reputation on his own by organizing an orthopaedic training program for general surgeons at Fort McPherson in Atlanta.

Fig. 5

Fig. 5

When he came on the Board, he had given up the position of Professor of Orthopaedics at the University of Southern California to serve as a trustee of that university, and he furnished the Board with a stability and dignity possessed by few. He continued to serve until 1942 and was succeeded by Dr. Robert D. Schrock who was elected as a representative of the American Medical Association.

The last of the founding group originally elected for two years was Samuel Kleinberg of New York City (Fig. 6). He had trained as an associate with Royal Whitman and was a most industrious and prolific writer. He had made significant contributions to a wide variety of orthopaedic subjects: congenital dislocation of the hip and scoliosis (contained in a masterful two volume treatise), muscle transplantations, arthrography of the knee, as spinal manipulation for sciatica, and the correction of bunions. His contributions to this new Board of Orthopaedic Surgery were in the areas of examinations and the qualifications of candidates, work that later evolved as functions of the Committee on Eligibility. At all Board meetings he was invariably the one who made the motion to pay the expenses of members of the Board and Associate Examiners. He was twice re-elected to the Board as a representative of the Academy and served until 1942.

Fig. 6

Fig. 6

Three of the founding members were elected for a term of one year. The first of these was Hulett Wyckoff (Fig. 7), elected as representative of the American Orthopaedic Association. Although not as well known as some of the other founders, Wyckoff was a true pioneer in orthopaedics in the Pacific Northwest. Dr. Wyckoff was born in Arkansas City, Kansas, and was taken to Washington state at the age of one. He started his education at the University of Washington, where he studied engineering, and then entered Northwestern University School of Medicine, receiving his doctorate in 1916. He received part of his postgraduate education under Dr. John J. Porter of Chicago after an internship at Cook County Hospital in Chicago and then served in England and France in the Army during World War I. He was a trustee of the Easter Seal Society (the National Society for Crippled Children and Adults) and the National Foundation for Infantile Paralysis. He was such a quiet, unassuming individual that one of his closest associates, who worked with him after his Board experience and who continued their joint medical office after his death, never knew that he had been one of the founders of the Board until we wrote him about Wyckoff's background. Wyckoff's special interest was in children's orthopaedics. He was a true pioneer in the management of cerebral palsy (in which he was particularly interested). He interested many orthopaedics, including Dr. William Duncan, in the care of patients with cerebral palsy, and Dr. Duncan continued the clinics after Dr. Wyckoff's death. He was succeeded on the Board in 1935 by Philip D. Wilson, who was nominated as a representative of the American Orthopaedic Association.

Fig. 7

Fig. 7

Dr. W. Barnett Owen (Fig. 8) of Louisville, Kentucky was also elected to the original Board as a representative of the American Medical Association and served a one-year term. Dr. Owen had trained in general surgery at Mount Sinai in New York and later trained in orthopaedics at the Hospital for the Ruptured and Crippled. He was the first orthopaedist in Kentucky and an outstanding one. He was succeeded on the Board by Willis Campbell in 1935.

Fig. 8

Fig. 8

The third founding member originally elected for a one-year term as a representative of the new Academy was Philip Lewin (Fig. 9), a prominent orthopaedist from Chicago. He was a prolific writer, an enthusiastic teacher, and a tireless worker. There was a breakdown in communications at the original meeting of the Board and some question arose as to whether Dr. Lewin was to serve beginning in 1934 or at a later date. Dr. Lewin rendered his resignation, but the Board apparently ignored this gesture, and he continued to serve for two full three-year terms after his initial year.

Fig. 9

Fig. 9

Philip Lewin was born on Chicago's South Side in 1888 and worked his way through the University of Chicago by delivering papers in the Loop before dawn. He received his M.D. from Rush Medical School and served in France in the A.E.F., attached to the Fourth French Army; he also became close friends with the French orthopaedist Henri Clegagnier, who was attached to the Fourth Army. Dr. Lewin returned to Paris after the war to study with Clegagnier and served as abstract editor for the orthopaedic section of the International Abstracts in Surgery, Gynocology [sic], and Obstetrics. He worked principally on the examination committee of the Board. One of his peers on the Board claims that his brain was absolutely packed with ideas and that he could produce limitless numbers of questions on a moment's notice. This reputedly irritated the secretary of the Board. He was re-elected to the Board and served two additional three-year terms. Guy A. Caldwell followed him in 1941 as the Academy's representative on the Board.

These nine founders of the American Board of Orthopaedic Surgery were certainly representative of American orthopaedics in the mid-nineteen-thirties. The geographic distribution seems somewhat out of balance, with five members coming from within a little more than a three hundred miles radius, two from the west coast and only one representative from the east.

© 2006 Lippincott Williams & Wilkins, Inc.