-John S. Thiemeyer, Jr., MD, Norfolk, Virginia
Article reprinted from Virginia Medical Quarterly, Spring 1994
Dr. Thiemeyer is a retired Norfolk Orthopaedic surgeon and a past president of the Virginia Orthopaedic Society. Address correspondence to him at 7706 North Shore Road, Norfolk VA 23505.
WHEN Dr. Alfred R. Shands, Jr., medical director of the Alfred 1. du Pont Institute de Nemours Foundation in Wilmington, Delaware, was a guest speaker at the Virginia Orthopedic Society meeting in 1951, he referred to the Society as the oldest in the United States. Dr. Shands was an authority on the history of Orthopaedic surgery in this country so I had no reason to dispute his statement.
This came as no great surprise because Virginia can claim many medical “firsts”:
Dr. Jessee Bennett, practicing in the Valley of Virginia, performed the first cesarean section in America on January 14, 1794, on his own wife.
Dr. Ephraim McDowell, 1771-1830, who was born in Rockbridge County, Virginia, and lived in Danville, Kentucky, became the “father of abdominal surgery.” He performed the first ovariectomy on Christmas Day, 1809.
Dr. John Peter Mettauer, of Prince Edward Courthouse and Norfolk, founded the Prince Edward Medical Institute in 1836 and performed many medical “firsts.” When he devised a method of repairing vesicovaginal fistulas, the great James Marion Sims took notice and did likewise. For his original work in congenital deformities he was called America’s first plastic surgeon and “a genius of his time,” in an article describing his innovations in cataract surgery.
Dr. George Ben Johnston, born in Abingdon in 1853, was a pioneer advocate of “Listerism” in America as early as 1879.
These are but a few of the significant surgical landmarks of Virginia. In this spirit the founding of the Virginia Orthopedic Society can be rightly added to the list of “firsts.” The American Academy of Orthopaedic Surgeons was also founded in 1933, so it, and the Virginia Orthopaedic Society, were “born” the same year.
IN OCTOBER 1933, 10 Orthopaedic surgeons practicing in Virginia met in Lynchburg for the founding meeting. They were Drs. W.T. Graham, B.H. Kyle, R.B. Funsten, J.B. Dalton, Donald Faulkner, H. Page Mauck, J.T. Tucker, Kim-brough (no further identification available), Foy Vann, and J. Blair Fitts. The meetings have continued uninterrupted since that time. The population of Virginia in 1933 was 2,441,000.
Orthopaedic surgery is an ancient art. Hippocrates described maneuvers for treating congenital club feet and stretching scoliotic spines but Orthopaedic as a specialty was founded by Nicholas Andry (1658-1742). Before the founding of the Virginia Orthopaedic Society most fractures were treated at first by “bone setters.” Later general practitioners and surgeons set fractures, occasionally did open reductions and sometimes closed reduction of hip fractures with traction and casts, often devoting their practice to this care. During the first 50 years of the Society, Orthopaedic surgery as a distinct specialty became established as more sophisticated procedures developed: nailing and plating of fractures, surgical correction of scoliosis, hip joint implants, joint reconstruction and surgical correction of musculoskeletal deformities and dysfunction all of which required great skill and training. What the future holds for the next 50 years will be most exciting.
In many ways the Virginia Orthopaedic Society reflects the many changes in the practice of medicine in the United States over these many years—from complete freedom and private entrepreneurship to tightening federal control. For many years what doctors need to know to survive has been changing constantly. From the 1930s to the ’50s having good clinical skills was enough. In the ’60s doctors had to learn how to deal with the government’s medical program. In the ’70s business skills became more important as group practices increased and doctors started advertising. All these things are reflected in the minutes and conversations of the members during the meetings of the Society.
This early Society was rather quaint compared to its present character. Meetings were held in various locations throughout the state wherever there was a practicing Orthopaedic surgeon (and, as noted, there were not many), and the academic programs were not overwhelming. I remember one presentation consisted of a travelogue of one member’s recent journey to a foreign country—entertaining, but not a great Orthopaedic experience. This is not the case today. Many members feel they often obtain a more rewarding clinical and academic experience from the Society meetings than from national ones. This may reflect the participation of Virginia’s three medical schools as well as the over 300 members in the Society currently.
DURING the founding years and for many years thereafter, the Virginia Orthopaedic Society had a close relationship with the Virginia State Crippled Children’s Program (SCCP, now called “Children’s Specialty Services”). Clinics were established throughout the state with the members of the Society providing free care. This was looked upon as a privilege by the members and the clinics were jealously controlled by those who attended them. Many of the early discussions and decisions of the Society were about who should head and attend these clinics which were run by members from the larger cities. Only when more Orthopaedic surgeons settled throughout the state were the clinics relinquished to those who practiced in the locale of the clinic. By agreement with the SCCP, only physicians who were members of the Society and hence diplomats of the American Board of Orthopedic Surgery could be responsible for the clinics.
Since the very beginning, the director of the SCCP has been an ex-officio member of the Society and annually reported to the Society at its meeting. The relationship has always been amiable and mutually supportive. The providing of free care was almost a sacred commitment by the members of that early era. State funding could go only to the two medical schools in existence at that time.
Wives did not accompany their husbands to the meetings until about 1955. There were no female Orthopaedic surgeons and, thus, no female members in the Virginia Orthopedic Society until April 1992 when Dr. Audrea H. Wynn of Winchester became a member. The business meetings were held at the Commonwealth Club in Richmond with only six to ten members attending each year as a rule.
The first decade was also marked by the beginning of World War II when a large number of Society members joined the Armed Forces. This left the state stripped to a few board certified orthopedic surgeons who tried valiantly to cover the state and man the clinics. It was a hard time for all, both at home and at war. During this period a self-acclaimed Orthopaedic surgeon rode about the state performing surgery at various small hospitals whose surgeons were serving in the Armed Forces. He would operate and leave quickly so the follow-up was left on the shoulders of a local practitioner. The results of this itinerant surgery were often quite tragic. The last of the “circuit rider” surgeons, he was ousted after the war.
The Society’s first president was Dr. William Tate Graham, one of the great pioneers in Orthopaedic surgery. He founded the Crippled Children’s Hospital in Richmond in 1919 in the basement of his office on Franklin Street following a serious poliomyelitis epidemic. Many a child with severe disability was able to walk and function again thanks to his compassionate and wise treatment. He joined the Medical College of Virginia faculty in 1913 and was professor of Orthopaedic surgery until he retired in 1948.
At the Society’s third meeting two new members were elected: Drs. R. D. Butterworth and C. E. Keefer. It was moved then that the presidency should be assumed according to the length of time served in practice in the state.
The first academic program, a round-table discussion on “Treatment of Intertrochanteric Fracture of the Femur by Means of Internal and External Fixation” led by Drs. Wescott and Tucker, was presented at the fifth meeting. At this meeting it was noted that no state funding was available for hospitalization of clinic patients. Also it was established that eligibility for membership entailed passing the examination of the “American Orthopaedic Board.” (sic)
At the sixth meeting in 1938, Dr. Claude C. Coleman, pioneer neurosurgeon, presented a paper on “Neurosurgical Causes of Low Back Pain and Sciatica.” Also the first by-laws were approved.
In 1939 a called meeting was held to restructure the state orthopedic clinics and to recommend that hospitalization for crippled children should be available in Roanoke, Lynchburg and Norfolk. State money totalling $132,626 was matched by federal funds. None of this money, with the exception of $36,250 for other areas of the state, was for use by the two medical schools and the Crippled Children’s Hospital in Richmond. Also, an additional $1,000 became available for Roanoke, Lynchburg and Norfolk. Fifteen dollars was allowed for surgeon’s travel. This was later raised to $20 if the surgeon was accompanied by a secretary. It was moved and approved that more funds be requested of the General Assembly for the care of crippled children.
The 1940 meeting at the Greenbrier Hotel was quite splendid. Dr. George E. Bennett of Baltimore was the first guest speaker, discussing shoulder and elbow injuries of professional baseball players.
In 1941 the Society met at the Cavalier Hotel in Virginia Beach. A round-table discussion of treatment of various fractures featured a presentation on fractures of the humerus, pinning of proximal ulna and olecranon fractures and grafting of non union of tibial fractures. General disappointment in the use of Vitallium cups for hip arthroplasty was expressed as the procedure was “too large” and ”too shocking.”
At the Hotel Roanoke in 1942. the Society decided to excuse from attendance all members serving in the armed forces of the United States. The scarcity of Orthopaedic surgeons and restrictions on transportation necessitated the curtailment of the number of clinics throughout the state.
In 1943 the population of Virginia was 2,886,068 and the membership of the Society was 14. The second decade was voted by the return of many members from service in the armed forces, the introduction of new procedures and practice modalities and the common usage of antibiotics.
My first experience with a parenteral antibiotic occurred in 1939 when, as a senior medical school student, I was making rounds with the professor of obstetrics. We were examining a patient with postpartum infection. The professor produced a small square box of rough cardboard which was divided into 24 compartments, each containing a glass vial filled with red liquid. “This is Prontosil,” he said, “and we will give her the contents of each vial twice a day intravenously.” The patient recovered miraculously as such a condition previously was almost always fatal. The drug was sulfanilamide which came from Germany and the dose was homeopathic compared to the megadoses later used.
My first experience with penicillin occurred in 1942 when, as a fellow at Lahey Clinic in Boston, we participated in a trial study of the use of the antibiotic, the first of its kind, in the treatment of Orthopaedic infections. The results were dramatic and the dosage was minute compared to later dosages recommended. I recall we had to save the patient’s urine so that the penicillin, a very scarce and precious commodity, could be recovered to be used again. The study was done in collaboration with Dr. Chester Keefer, Chief of Medicine (1940-1959) and later Dean (1955-72), at Boston University.
Techniques developed during the war were brought into private practice. Federal encroachment into private practice became more evident and third party payers became commonplace. The depression of the ’30s was a thing of the past as the post-war economy and population boomed.
By 1953 the population of Virginia was 3,529,367 and the membership in the Society was 34. Unfortunately, the Korean military involvement during this decade again called for members of the Society to serve, most by being drafted, thus depleting the coverage of the clinics and civilian population. During this period commercial airplanes were propeller-driven, the few television sets were black and white, the West had all the atomic bombs, mathematical calculations were done with slide rules and people paid with cash. Poliomyelitis was still a scourge and its effects taxed the ingenuity of Orthopaedic surgeons. Nationally, there were 10,000 to 30,000 cases each year—peaking in 1952 with nearly 58,000 new cases.
The third decade reflected the maturing of the Society. Membership increased along with the population increase of the state.
After the discovery of the virus causing poliomyelitis by Dr. John F. Enders of Harvard Medical School and the development of a vaccine against this scourge, massive immunization programs were supported by the membership, resulting in almost complete eradication of the disease over a period of a very few years. Much of the care and rehabilitation of the victims had been the responsibility of Orthopaedic surgeons. With the decline of the disease, efforts of Orthopaedic surgeons were directed to other fields, such as congenital defects, musculoskeletal disorders, arthritic conditions. back disorders, intramedullary fixation of fractures and joint replacement prosthetic devices. At the 1953 meeting, Dr. Paul Colonna presented a symposium on hip pathology in infants and children. The membership, concerned about the increasing control of care of poliomyelitis residual and cerebral palsy patients by physical therapists, voted against such practices.
A year later, in 1954, Dr. Leonard Goldner, head of the Department of Orthopedic Surgery at Duke University School of Medicine, presented a symposium on “Reconstruction of the Hand in Cerebral Palsy.” A summary of the meeting was sent to the Journal of Bone and Joint Surgery.
A memorial was authorized for Dr. W. Tate Graham who died in 1954. Standing committees of the Society included credentials and membership, infantile paralysis, redistricting crippled children’s clinics and cerebral palsy.
Problems had arisen with brace makers for crippled children, and the Crippled Children’s Bureau authorized only orthopedic surgeons to order braces.
In 1956 Dr. J.S. Speed, guest lecturer, spoke on “Hip Surgery.” Fusion was the treatment of choice for osteoarthritis of the hip joint; Fred Thompson prosthesis was preferred over the Judet prosthesis for subcapital fractures in the elderly; and the Gibson approach was the preferred surgical procedure for approach to the hip joint.
A state-wide fee schedule was proposed, obviously without thought of possible legal vulnerability as we snow it today.
The program was largely devoted to medical-legal problems, litigation, personal liability, compensation cases and “whip lash” injuries which were dominating the courts of this period.
It was requested that follow-up clinics, as proposed by the Poliomyelitis Foundation, be opposed; the disease had almost disappeared and programs for treatment of residual defects were lessening and could be incorporated into regular orthopaedic clinics. The poliomyelitis scourge was fast fading away.
In March of 1958 the meeting was held in Charlottesville. The guest speaker Dr. Otto AuFranc spoke on “Vitallium Cup Arthroplasty,” a popular procedure for degenerative joint disease of the hip developed by Dr. Smith-Petersen at Massachusetts General Hospital, Boston, Massachusetts.
The Society, now 48 members strong, passed a resolution supporting compulsory poliomyelitis inoculation. In other business it was noted that the Crippled Children’s Bureau would approve prostheses for amputees for malignancy only for those children who survived at least one year. Long-term survival of malignancy victims was a rarity as chemotherapy and other more successful modalities were not commonplace. A motion to raise the fee of $5 to $15 for treatment of vocational rehabilitation patients failed to pass.
In 1962 Dr. Louise Galvin, head of the Virginia Bureau of Crippled Children, reported to the Society that her annual budget to support seven major areas: orthopedics, rheumatic fever, congenital cardiac, plastic surgery, seizure control, pediatric surgery and pediatric urology was $804,499. Half of the budget went to orthopedic programs.
THE fourth decade, 1963-1972, marked the Society’s continued growth. The population of Virginia was 4,237,473 and the membership of the Society in 1963 was 54 active, 18 associate and 2 emeritus. Orthopaedic surgeons were practicing in every part of the Commonwealth, offering good care throughout the state. The crippled children’s program prospered. Involvement of the federal government and third party payers increased.
In 1970 the Society changed the meeting date to the spring of each year and the format to one several day session. The inclusion of both scientific and business sessions in a single meeting encouraged larger attendance. The meetings also focused around the medical schools which
enhanced academic participation. The meetings were rotated between the Homestead at Hot Springs and Colonial Williamsburg.
A code of ethics was established although no serious infractions had been recorded. Members of the Society agreed to abide by the Code of Ethics of the American Medical Association.
Clinics for the multiple handicapped were announced to the Society at both the University of Virginia and the Medical College of Virginia. The Society requested that UVa and MCV assign orthopedic residents to attend the crippled children’s clinics. There were 50 “clinics” in the state, 10 of which contributed to the crippled children’s program. In 1968, a total of 7,680 children were treated with 24,000 visits. Seven percent of these children were hospitalized and $565,000 was spent on Orthopaedic patients.
The Society authorized a certificate of membership incorporating the newly-designed Society seal which was presented to the members in 1970.
Also in 1970, the Society sent a resolution opposing driving under the influence of alcohol to the Director of the Virginia Highway Safety Division. The members continued to be deeply concerned about driving while under the influence of alcohol and advocated lower levels of blood alcohol in determination of drunkenness than were currently in effect.
Many members were active in sports medicine. The Society’s committee on “Medical Aspects of Sports” had long been established and a closer relationship to a similar committee of the Medical Society of Virginia with membership co-mingled was advocated.
Beginning in 1971, guest speakers were made honorary members of the Society. Dr. Fred Thompson was the first recipient of this membership; Dr. Charles Neer, the 1972 guest speaker, the second. Sir John Charnley was among the famous Orthopaedic surgeons who later became members.
The fifth decade continued the traditions and enhanced the character and status of the Society. Meetings became more sophisticated (and longer), the scientific presentations more diverse and of fine academic caliber, equal to any in the country. The Society had grown to 145 members while the population of the Commonwealth of Virginia registered more than 4,500,000.
A committee on peer review was established in 1973 to work in consortium with the Medical Society of Virginia.
AREPRESENTATIVE served on the Board of Counselors of the American Academy of Orthopaedic Surgeons, maintaining a close link with that organization. Yearly donations were made to the Orthopedic Research and Education Foundation and the Virginia Council on Health.
Dr. Mason Hohl, secretary of the American Academy of Orthopaedic Surgeons, addressed the Society in 1975 on the status of chymopapain in treating ruptured intravertebral discs and the release by the FDA of methylmethacrilate for use in treatment of pathologic fractures. Also discussed was a move to decrease orthopedic residencies, the establishment of an arthritis center by Congress, the problem of foreign medical graduates, rectification, PSRO and malpractice insurance.
It was noted that the American College of Emergency Physicians would hold its first examination in 1977. Because of the considerable involvement of the Society’s membership with emergency room cases, this was of considerable interest.
Screening of children for scoliosis was strongly endorsed. Dr. Joe Torg was guest speaker in 1977 and 101 members attended the meeting. At this time there were 28 general Orthopaedic, five amputee, three hand and six scoliosis clinics in Virginia. Subspecialization was becoming more prevalent in the orthopedic community.
Dr. J. Ted Hartman, a member of the American Board of Orthopedic Surgery, spoke on the vigorously discussed topic of rectification Compulsory versus voluntary participation was the primary issue; the Society strongly opposed the former.
Dr. Nicholas Cavarocchi was invited to be the guest speaker at the 1980 meeting. He spoke on the many problems facing orthopedic surgeons at the time. Continuing medical education credits for attendance at the meetings were now regularly obtained through the medical schools.
The question of hospital privileges for podiatrists was a much debated subject. Podiatrists had mounted an intense lobbying effort to obtain state legislative approval of such privileges. Most of the Society’s membership were strongly opposed to this.
In 1981 Sir John Charnley was guest speaker at the invitation of Dr. Joseph Romness, then president of the Society, and spent several days with the Society members at the meeting in Williamsburg. As the “father” of total hip joint replacement his talks were enthusiastically received. Attendance of orthopedic nurses and allied medical personnel at subsequent meetings was encouraged.
In 1982, a half century from its founding in 1933, the Society’s membership numbered 207 and the population of Virginia was 5,525,880. The vision of those 10 orthopedic surgeons who met in 1933 to form a Society for the benefit of orthopedic surgery in Virginia, for the exchange of ideas and the pursuit and dissemination of knowledge in their field, has been successful, very successful. The Commonwealth and its people have greatly benefited from the vision of these pioneers.
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