Professor Robert Salter's legacy will live forever. Most great men are remembered for a single seminal achievement; Dr. Salter will be remembered for many. His contributions to medical science have already helped millions, and they will continue to benefit millions for generations to come. Not only will the patients with the deformities and diseases he studied, and for whom he discovered solutions, benefit but also future scientists and health-care practitioners who will be inspired by his approach to complex scientific questions. We will remember Dr. Salter for his leadership, mentorship, research, teaching, and, most importantly, his humanity.
Robert Salter was driven as a young doctor to help his fellow man as evidenced by his initial work as a medical missionary for the Grenfell Mission in Newfoundland. He soon recognized that his passion for humanitarian endeavors could be best directed through medical science and therefore enrolled in the Gallie Course in Surgery in the University of Toronto. However, his compassion for those less fortunate than himself was a central theme throughout his career and profoundly influenced everything he pursued.
After completing his residency, Dr. Salter and his wife Robina moved to Britain, where he did his research training at the London Hospital working with world orthopaedic leaders such as Sir Reginald Watson-Jones, who was known for his dictum that immobilization for fractures should be complete, rigid, enforced, and prolonged. Dr. Salter's intuition told him that this dogma was false, much to the ire of his supervisor, and he began his career-long pursuit of the real truth, which culminated in his development of continuous passive motion. Today, largely because of Dr. Salter's research, immobilization of injured bones and joints is avoided whenever possible, and continuous passive motion is applied to many clinical situations for millions of patients. His spirit of inquiry characterized his entire fifty-five-year career at The Hospital for Sick Children (SickKids) in Toronto. His development of the Salter innominate osteotomy for hip dysplasia and his role in the Salter-Harris classification of growth plate injuries made him the best known orthopaedic surgeon in the world. His brilliantly innovative mind, tireless work effort, and knack for turning a phrase made him one of the most popular speakers and visiting professors of his generation, traveling the world many times over.
Despite his busy practice and demanding research program, he found time for leadership positions, serving as surgeon-in-chief at SickKids, chairman of the Division of Orthopaedics at the University of Toronto, president of the Canadian Orthopaedic Association, and president of the Royal College of Physicians and Surgeons of Canada. In recognition of the impact of his work, he was appointed as a Companion of the Order of Canada, was awarded the Order of Ontario, was named university professor at the University of Toronto, received the prestigious Canada Gairdner award for medical science, entered into the Canadian Medical Hall of Fame, was elected a Fellow of the Academy of Science of the Royal Society of Canada, was made an Honorary Fellow of the American Academy of Orthopaedic Surgeons, and received numerous honorary doctorates and fellowships from universities and surgical colleges worldwide.
His approach to clinical investigation was inspiring for young academic orthopaedic surgeons pursuing careers in research. He mentored many individuals across North America who were astonished when such a distinguished figure would respond to their requests and spend so much time giving them advice and encouragement for their research projects. He summarized his philosophy of research in his Alexander Gibson Memorial Lecture in 1967 (published in the Canadian Medical Association Journal in 1968;98:933-45), when he stated: “Facts, as opposed to opinions, are of the utmost importance to us; they are the building blocks with which we must build the structure of hypothesis, and the more facts we can gather, the more complete will be our hypothesis. Furthermore, we must make the hypothesis fit the known facts rather than try to make the facts fit a preconceived hypothesis.” For his contributions to musculoskeletal research, he received the Nicolas Andry Award from the Association of Bone and Joint Surgeons (1974), the Kappa Delta Orthopaedic Research and Education Foundation Award “for excellence in basic research” from the American Academy of Orthopaedic Surgeons (1987), and the American Orthopaedic Association-Bristol-Myers Squibb Research Award for Distinguished Achievement in Orthopaedic Research (2000). He certainly was one of the most decorated orthopaedic surgeons in history.
Robert Salter was as complex as a man as were the problems he tackled. It is this complexity that marveled those with whom he worked. While intensely focused on his work and relentless in pursuit of his goals, he always had time to address even the smallest concerns of others, no matter where they stood in the hospital hierarchy. He would spend hours writing letters, making telephone calls, and meeting with individuals to address their problems or advance their careers. His generosity became legendary among patients, trainees, and colleagues. He knew the service and maintenance workers in the hospital by name and frequently stopped to enquire about their welfare or that of their families, and, on discovering a need, would, to their amazement, set out to help them however he could.
Dr. Salter's last day in the hospital was March 30, 2010, when he was still able to contribute to a teaching seminar in a meaningful manner. Although it was a struggle for him to make visits to the hospital the preceding several months, he never complained about his decreasing mobility and clearly stated that his failing health would not prevent him from continuing to participate. He was deeply grateful to Robina, or Jane, one of his daughters, for accompanying him to the hospital when it was no longer safe for him to do so alone, and both worked diligently helping him to carefully archive his papers. His attitude in his physical decline perfectly reflected the characteristics that led him to such great achievements. His brief retirement was thus only six weeks long. I believe he would have no regrets that he did not live for long after completing his life's mission. His promise to the children he treated was “friends for life!” and he meant it. The loss of this great man to his family, to the entire orthopaedic community, and to the patients who benefited from his work is enormous. Let us keep him in our prayers and memories and celebrate his monumental accomplishments for many years to come.