“American orthopaedic surgeons chose a bad year to launch a national professional organization.”

That’s how Henry H. Sherk, MD, begins his account of the founding of the American Academy of Orthopaedic Surgeons in the AAOS book, Getting It Straight: A History of American Orthopaedics.

January 1933 was, in fact, a precarious time to establish a new national medical society. In the wake of the 1929 stock market crash, public confidence in the future was at an all-time low, and birth rates had fallen to the lowest ever recorded.

The United States was in the darkest days of the Great Depression. Starving World War I veterans rioted in Washington, D.C., nearly 1,500 bank failures had stripped countless citizens of their life savings, and people began moving into shantytowns known as “Hoovervilles.”

Yet despite these dismal conditions, a determined group of orthopaedic surgeons recognized the need for a national organization and boldly moved ahead.

A “Midwestern flavor”
The members of the newly-established Academy convened their inaugural meeting in the auditorium of Northwestern Medical School in Chicago. The gathering was held in conjunction with the 21-year-old Clinical Orthopaedic Society (COS), which Dr. Sherk describes as “an amalgam of Midwestern and Western orthopaedic clubs.”

The Academy’s first president—Chicago resident Edwin W. Ryerson, MD—called the meeting to order on Thursday, Jan. 12, 1933.

The nascent organization had a distinctly “Midwestern” flavor. Eighteen of the speakers practiced in Chicago; the rest had traveled from Detroit, St. Louis, Memphis, Milwaukee, Minneapolis, Rochester, Minn., and Lincoln, Neb.

Not a single speaker listed in the program hailed from the East Coast.

Unlike the format of American Orthopaedic Association (AOA) meetings, where speakers presented short papers on specific subjects, the AAOS meeting featured five symposia presented by multiple speakers addressing a single topic.

“This may have conveyed the impression that at the AOA, physicians came to report on their research, whereas at the AAOS they came to learn,” writes Dr. Sherk.

The national historic context surrounding the AAOS meeting was also significant, he adds. It would be another 8 weeks before President-elect Franklin D. Roosevelt would take office and assert that “the only thing we have to fear is fear itself.” During the Academy’s first decades, the United States would enter a second World War, emerge from the Great Depression, and orthopaedists would shift from being bone setters to life savers.

First AAOS president: Edwin W. Ryerson, MD
Dr. Ryerson’s 1933 presidency did not come out of the blue. The Academy’s first president was a visionary individual—well equipped to establish the themes of education and outreach that continue to mark the Academy today.

Before taking office, Dr. Ryerson had long advocated for the creation of a large, inclusive national organization of orthopaedic surgeons—beginning as early as 1912, when he had helped launch COS. In 1914, he served as president of the COA and was elected AOA president in 1925.

In the wake of the 1887 establishment of AOA, and the formation of the Orthopaedic Section of the American Medical Association in the early 1900s, orthopaedic clubs and societies had emerged all over the country.

During the Oct. 29, 1931, meeting of COS, members discussed the prospect of forming a nationwide organization that would link these various distinct groups into one society. Dr. Ryerson was appointed chair of a committee to consider the idea. Other committee members included Willis C. Campbell, MD; Fredrick J. Gaenslen, MD; Melvin S. Henderson, MD; Philip Lewin, MD; E. Bishop Mumford, MD; and H. Winnett Orr, MD.

The very next day, the committee returned with a complete report, which included an outline for the society’s organization, and the recommendation that COS invite all U.S. practitioners who considered themselves orthopaedic surgeons to attend its1932 meeting for the purpose of founding a national society.

The completeness of this report—ready in just 24 hours—suggests that Dr. Ryerson and his committee members had already spent considerable time discussing the matter.

In fact, Dr. Campbell had initiated discussion of a national organization at the Oct 11, 1931, meeting of AOA—just 18 days prior to the COS meeting. Every member of the organizing committee—now considered the “Founders of the AAOS”—had also been present.

Thus, when the COS met again in October 1932, Dr. Campbell was prepared to recommend that a much larger organization—a national academy—should convene its own meeting in January 1933. At this time, Dr. Ryerson was elected as the first president of the AAOS and Dr. Campbell as secretary.

Willis C. Campbell, MD
In January 1933, Dr. Campbell became the first AAOS president to be elected in an open meeting. He served through the Academy’s second Annual Meeting, held Jan. 7-10, 1934, in Chicago.

“Dr. Campbell deserves special mention as a founder of the AAOS,” Dr. Sherk writes. “Energetic and intelligent, he was instrumental in the creation of a national academy of musculoskeletal surgeons that helped the members realize their best potential in healing the injured and straightening the crippled and lame.”

Born in Jackson, Miss., in 1880, Dr. Campbell graduated from the Medical School of the University of Virginia. He briefly practiced medicine in Memphis, Tenn., but early on was determined to pursue orthopaedics. Surmounting many hardships, he traveled to Europe to undertake the study of the specialty. Over a 5-year period, he studied with the celebrated orthopaedic surgeons of that time in London, Vienna, New York, and Boston. In 1909, he returned to Memphis and resumed his practice, specializing in orthopaedic surgery.

Virtually every modern orthopaedist has used Campbell’s Operative Orthopaedics, which has been revised numerous times since Dr. Campbell first published it in 1939. Hundreds of orthopaedic surgeons have received their training at the Willis C. Campbell Clinic since he built and opened the institution in 1920. Even more began their training a decade earlier, when he organized a Department of Orthopaedic Surgery at the University of Tennessee Medical School. He became the institution’s first professor of orthopaedic surgery, an office he held with distinction until his death in 1941.

Philip D. Wilson, MD
All of the officers elected at the second AAOS Annual Meeting were Midwesterners, with the notable exception of Philip D. Wilson, MD, of Boston and New York, who was elected to serve as AAOS president through the January 1935 meeting.

Dr. Wilson came from a medical tradition that differed considerably from the one that produced Dr. Campbell. Born in Columbus, Ohio, Dr. Wilson graduated from Harvard Medical School in 1909—cum laude and class president. Following a surgical internship at Massachusetts General Hospital, he accepted a wartime post with the renowned “Harvard Unit” in France. Dr. Wilson returned to Harvard after the war.

In 1934, Dr. Wilson became Surgeon-in-Chief of the Hospital for the Ruptured and Crippled in New York. His legendary achievements there included changing its name to “The Hospital for Special Surgery” and moving it to its present location on East 70th Street.

“National character” emerges
The selection of Dr. Wilson as the Academy’s third president, and his willingness to accept the position, gave the organization “a heavy coating of East Coast patina,” says Dr. Sherk. The Academy even met at the prestigious Waldorf Astoria Hotel during Dr. Wilson’s presidential year.

“By 1935, the national character of the Academy was emerging,” Dr. Sherk writes. “Presenters from Iowa City; Pueblo, Colo.; Nashville; and Seattle joined those from Chicago, New York, Pittsburgh, and elsewhere.”

By this time, the Academy had grown to become a respected specialty organization, with 506 members—exceeding the AOA membership at that time.

The Journal of Bone and Joint Surgery (JBJS) responded to these developments by devoting three full pages to the AAOS meeting. The remarks of AOA President DeForrest Willard, MD, were published in JBJS that year, rather than Dr. Wilson’s AAOS presidential address.

“Buckle-and-strap men”
Dr. Willard made respectful reference to the AAOS, and spoke of the “struggle” of the early years during which the “medical profession and the public were loathe to recognize orthopaedics as a surgical entity.”

Dr. Willard noted that at the beginning of the 20th century, orthopaedists were merely “fitters of apparatus” and “buckle-and-strap men,” not skilled enough to perform operations. As a result of treating the wounded during World War I, however, a great number of youthful, energetic surgeons—such as Dr. Wilson—emerged with experience, interest, and skill in treating musculoskeletal injuries and diseases.

Orthopaedics attracted these veterans, and Dr. Willard observed that, “The number of men who practice [orthopaedics] has grown from a few score to many hundreds.”

Acknowledging that the AOA could not cope with these numbers, Dr. Willard hoped that the “new American Academy of Orthopaedic Surgeons” would provide “an outlet for the clinical and scientific experience of the large number of people coming into the specialty.”

Frank D. Dickson, MD
By 1936, the AAOS Annual Meeting—held in St. Louis—featured 32 scientific exhibits, 38 technical exhibits, and six “radio talks.” When Frank D. Dickson, MD, gave his presidential address that year, JBJS published it in its entirety.

“His 1936 remarks today seem prescient,” Dr. Sherk writes. “He showed no self-consciousness in quoting English essayist and poet Joseph Addison: ‘Knowledge is, indeed, that which, next to virtue, truly and essentially raises one man above the other.’”

Dr. Dickson heralded the goals of the Academy, which included “nationwide representation... and influence in establishing orthopaedic surgery; the elevation of the standards of education in orthopaedic surgery, a systematic study of important orthopaedic problems, a freer exchange of information and ideas, and a source of advice and guidance” on public questions.

He went on to describe orthopaedics as a “wide field and one that demands the broadest of medical training and deep, if not profound, knowledge.”

Dr. Dickson believed that orthopaedists should have the knowledge to treat patients medically as well as surgically for musculoskeletal diseases and conditions.

“His influence on education and certification is still evident today,” Dr. Sherk states.

Without the AAOS and visionary leaders such as Drs. Ryerson, Campbell, Wilson, Dickson, and others, “orthopaedics surely would have remained a small subset of general surgery and the revolution in musculoskeletal surgery in the last half of the 20th century” would have played out much differently, Dr. Sherk concludes.

For more information on the Academy’s 75th Anniversary Celebration, see the December 2007 AAOS Now article, “AAOS Turns 75,” at www.aaos.org/now

Carolyn Rogers is a staff writer for AAOS Now. She can be reached at rogers@aaos.org

“Getting It Straight”
In honor of the Academy’s 75th Anniversary, the AAOS is publishing the historical reference book, Getting It Straight: A History of American Orthopaedics, written by Henry H. Sherk, MD.

This new hardcover text documents the development of orthopaedics, historical markers, and medical advances in areas such as fracture care, manipulation, and surgery—as well as the history of the AAOS and other orthopaedic societies.

The idea for the book was conceived by Stuart Hirsch, MD, and Robert W. Bucholz, MD, in 2004. Dr Sherk—a member of the 75th Anniversary project team—was selected to write the text, which was reviewed and edited in its entirety by Dr. Bucholz and James J. Hamilton, MD. A grant to fund publication of the book was provided by Stryker Inc.

The information in “AAOS: The early years” is based primarily on Getting It Straight, which will be published in time for the March 2008 Annual Meeting in San Francisco.