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KENTUCKY's ORTHOPAEDIC HERITAGE Alfred R. Shands, Jr

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KENTUCKY's ORTHOPAEDIC HERITAGE Alfred R. Shands, Jr KENTUCKY’S ORTHOPAEDIC HERITAGE Alfred R. Shands, Jr., M. D. Medical Director Emeritus Alfred I. Du Pont Institute Wilmington, Delaware 19899 Presented at a Meeting of the Innominate Medical Historical Society, Louisville, Kentucky, May 24th, 1974. Only two states in the Union, New York and Massachusetts, have a greater Heritage in orthopaedic surgery than Kentucky. Without the brains which Kentucky contributed to the specialty in its early days, its development would have been greatly retarded. The purpose of this paper is to tell you something about this heritage and these brains. One of Kentucky’s adopted sons, born in New Jersey, was the greatest orthopaedic surgeon of the 19th century; namely, Lewis Albert Sayre (1820-1900), of Lexington, a graduate of Transylvania of 1838. Another of her sons did more than any other one of his period to take the specialty out of what was called its “buckle and strap” era, and bring it into the modern day practices; namely, Virgil Pendleton Gibney (1847-1927), of Lexington, another graduate of Transylvania of 1869. A third son was more outstanding than any other of his time in developing the surgical aspects of the specialty; namely, Russell Aubra Hibbs (1869-1932) of Birdsville. These three were all national and international shining lights of their day. No lights shone brighter in the United States in orthopaedic surgery than these three from Kentucky. Gibney and Hibbs were the heads of the two great orthopaedic hospitals of New York City, Gibney at the Ruptured and Crippled from 1887 to 1924 (37 years); Hibbs at the New York Orthopaedic from 1898 to 1932 (34 years). Orthopaedics in New York City centered around their teaching and leadership. Before telling you about the lives and accomplishments of Kentucky’s orthopaedic surgeons, any historical talk on medicine in Kentucky, particularly surgery, should start with Transylvania and the University of Louisville Medical Schools and their two great surgeons, Benjamin Winslow Dudley (1785-1860) and Samuel David Gross (1805-1884) of which there were no greater in their times. Both made many worthwhile and outstanding contributions to orthopaedic surgery. First Transylvania, where Kentucky’s medical teaching began in 1799, and the first medical degrees were awarded in 1818. Before the school closed in 1859, 1,881 medical degrees had been given and 6,456 medical students had attended its classes – quite a record for that day. In 1821, incidentally, Transylvania had become one of the largest Universities in the country, being about the same size as Harvard, but larger than Princeton or Dartmouth. The Medical School was antedated on the United States by only four; namely, University of Pennsylvania, in Philadelphia, 1765, King’s College in New York, 1767, Harvard, in Boston, 1783 and Dartmouth, in Hanover, New Hampshire, 1798. It was the first medical school in the Ohio Valley, or what was the West of that day. The many outstanding doctors on the faculty were the drawing cards for the students. One of the best histories of the Transylvania Medical School was written by Doctor Gibney’s nephew, Dr. Charles A. Vance, of Lexington, and was given as his Presidential Address before the Southern Surgical Association in 1945. It was titled, “The Transylvania Medical Library.” This article is a storehouse of information on early medicine in Kentucky. First concerning Benjamin Dudley. He was born in 1785 in Spottsylvania County, Virginia. His family moved to Lexington when he was very young. He took his M.D. degree at the University of Pennsylvania in 1806 at the early age of 21, and then spent four years of study in England and Europe, mostly in Paris. He must have been a very outstanding young doctor, because it is reported that when he was in France, Napoleon Bonaparte offered him the position of Surgeon-in-Chief of his army, a position which was later filled by the famous Baron Larrey. When he came back to the United States, it is said that he had a foreign accent in his speech and French manners which he effected the remainder of his life. He returned to Lexington in 1814 and was appointed Professor of Anatomy and Surgery at Transylvania in 1815, which position in Surgery he held until 1850. He became world famous as a lithotomist and for his work on the removal of bladder stones. He made many significant contributions to orthopaedic surgery. Including the use of roller bandages in the treatment of fractures and other conditions. He was one of the first surgeons in the United States to trephine the skull for relief of epilepsy. He was considered a pioneer in this field of surgery. It is interesting that in his day, before antiseptic surgery, he stressed the use of boiling water in surgery, after a very careful preparation of the patient, a forerunner of Listerism. He was an excellent operator, and was said by some to be unsurpassed as a teacher. In 1850, at age 65, he retired to his home “Fairlawn,” outside of Lexington, and died in 1860 at the age of 75. Next, concerning Samuel Gross. He was considered by some to have been the pioneer orthopaedist in the Ohio Valley as well as the greatest surgeon of that period. He was a Pennsylvania Dutch extraction and graduated from Jefferson Medical College in Philadelphia in 1828 in its third class. He taught in Cincinnati in the 1830’s and came to the University of Louisville in 1840 as a Professor of Surgery. The University of Louisville Medical School was then only two years old. The school was rapidly increasing in stature with its eminent faculty, and soon surpassed in prominence the Transylvania Medical School. Some of Transylvania’s faculty went to Louisville to teach in the new school. Doctor Gross left Louisville in 1856 to become the Professor of Surgery at Jefferson Medical College in Philadelphia, his alma mater. He is more often in history associated with Philadelphia than Louisville, but the largest part of his great work was done in Louisville, and not in Philadelphia. He is certainly one of Kentucky’s foremost medical sons of all time. While he was here, he did the basic writing for his monumental “System of Surgery,” published in 1859, and the best surgical text in the 19th century; it had six editions. The writing of this book took 15 years and 12 of these years he spent in Kentucky. In Louisville he wrote his book in 1851 on the “Treatise of Diseases of the Urinary Organs” and in 1854 his book “Foreign Bodies in the Air Passages,” both of which were classics. It is interesting that after he left Kentucky he wrote an excellent “Manual of Military Surgery” which became very popular, being used by the surgeons in both the Northern and Southern Armies. Gross’s first contribution to orthopaedic surgery was his book published in Philadelphia in 1830 when he was two years out of medical school called “Diseases and Injuries of Bones and Joints.” This is the first orthopaedic book published in America. He was the first to use adhesive plaster for extension in fractures and the first to use chloroform in Kentucky. Gross received many, many honors. He was the President of the American Medical Association in 1867. He was one of the founders and first President of the American Surgical Association in 1880, remaining its President for four years. He was elected the President of the International Surgical Congress held on our 100th anniversary in Philadelphia in 1876. He was one of the founders of the Kentucky State Medical Society in 1851 and its President in 1854. He was very facile writer, a tremendous speaker and was in constant demand to talk at meetings. There was certainly no one more respected and more looked up to in surgery in the America of his day. As Sir William Osler (1849-1919) was the greatest physician of his period, so Gross was undoubtedly the greatest surgeon of his time. He and his family never lost their love for Kentucky and its people. In 1850 he was asked to be the Professor of Surgery at New York Medical School to succeed the eminent Valentine Mott. He accepted. However, he did not like the school, stayed only one year and returned home with his family to Louisville, much to their delight. Kentucky will probably never have again as outstanding a physician in its medical family as Doctor Samuel David Gross. Some say, and rightfully so, that he was the greatest surgeon of the 19th century. Orthopaedic surgery was not an established specialty in the United States until the middle and latter part of the 19th century. Our first orthopaedic surgeon was Louis Detmold (1808-1894) who came from Hanover, Germany in 1837 to practice in New York. At about the same time there was John Ball Brown (1784-1862) in Boston who founded in 1938 the first orthopaedic hospital, the Boston Orthopaedic Institution. However, Boston did not become a national center of orthopaedic surgery until the end of the 19th century and the beginning of the 20th. In 1839 there came to New York from Lexington, Kentucky, Lewis Albert Sayre (1820-1900) who became the most outstanding orthopaedic surgeon of the 19th century and was spoken of as the father of American orthopaedic surgery. He was comparable to Gross in general surgery. They were good friends. Doctor Sayre had been born in 1820 in Bottlehill, New Jersey, the son of a wealthy farmer who died when he was ten years old. He was taken to Lexington to be brought up by his uncle, David A.
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