Senior Thesis Day
The Inn at Longwood Medical Center
Friday, June 19, 2009

Senior Resident Thesis Presentations

Osgood Lecture  •  First Session  •  Second Session  •  Third Session  •  Fourth Session
James H. Herndon, MD
Osgood Lecture
Birth of a Specialty

Harvard Medical School began in 1782. The first classes were held in Harvard Hall in 1783 and continued in 1783 in Holden Chapel. Between then and 1906, when Harvard Medical School moved to its current location on Longwood Avenue, there were 3 other locations for the medical school. Each lasted about 30-35 years. Two were close to Massachusetts General Hospital, one on Mason Street and the other on No. Grove Street, right in front of the hospital. The other was on Boylston Street where the main branch of the Boston Public Library is located today. It was on the Boylston Street site that many of the early famous orthopaedic surgeons -- Lovett, Goldthwaite, Osgood, Legg, Allison, Rogers – all graduated. It was also the location of the medical school where Codman graduated in 1895.

Early famous graduates of HMS Longwood Campus included Philip Wilson, Sr. in 1912 and Maurius Smith-Petersen in 1914. Dr. Smith-Petersen eventually became chief at Massachusetts General Hospital and Dr. Wilson left MGH to become the chief of the now-known Hospital for Special Surgery. Interestingly, education in these early years of the 19th century consisted of lectures series to which students purchased tickets. The professors pocketed the money. Orthopaedic surgery was nowhere to be found in the curriculum -- only surgery in general and human anatomy dissections. It wasn’t until 1869 when the president of Harvard, Charles W. Elliott, changed HMS from a “diploma mill”, as he called it, to an “academic enterprise” with established admission requirements, a curriculum, an optional 4th year and written exams.

From then on, Harvard Medical School grew and prospered.

The first appointment to teach orthopaedics was Edward H. Bradford in 1889, who was appointed “clinical instructor in surgery and orthopedics”. He became professor of orthopedics in 1903 and eventually became dean of the medical school. But orthopaedic surgery as a specialty began in Boston because of John Ball Brown. John Ball Brown was the first surgeon in New England to perform an Achilles tenotomy for club foot. He also founded the first orthopaedic hospital… called the Boston Orthopedic Institution, which was also near MGH. It was located at 65 Joy Street. For about 8 years before anesthesia was available, tenotomies of muscle tendon units about the spine were frequently performed for scoliosis and achilles tenotomy was performed for club feet at this orthopedic institution. The Boston Orthopedic Institution was active from about 1837 to 1851. After 14 years it closed; there is no known history for the reasons for its closing. This institution, John Ball Brown and his son, Buckminster, were responsible for the beginnings of orthopaedics in the United States.

Dr. Bradford, who became Dean, probably held the first chair in orthopaedic surgery at Harvard Medical School, the John D. and Buckminster Brown Chair, which is endowed in the will of Buckminster Brown. It was the only chair in orthopaedics at Harvard Medical School and the holder of that chair was known as the Professor of Orthopedic Surgery and Chief of Orthopedics at Children’s Hospital. Subsequent holders of the chair at Children’s Hospital were Robert Lovett, followed by Robert Osgood. When Dr. Osgood retired (he had insisted that the chair be available to any professor in the teaching hospitals), it moved to the MGH, where Dr. Barr, Sr. held the chair and then to and Women’s Dr. Sledge when he became the orthopaedic surgeon and chief at BWH.

Before Dr. Bradford became dean, he was the chief of orthopaedics at Children’s Hospital and the John B. and Buckminster Brown professor. During his tenure as chief, orthopedics flourished and many surgeons spent time in orthopedics at Children’s Hospital, including Drs. Osgood, Brackett, Lovett, Goldthwaite and others. Dr. Bradford has been credited for establishing orthopaedics as a discipline of its own, separate from general surgery.

Orthopaedic training before residency programs started consisted of an internship (in some cases) followed by a preceptorship with a surgeon who had an interest in musculoskeletal deformities…often in Europe, England or in the northeast of the US. Many of these surgeons and other general surgeons expanded their knowledge of orthopaedic surgery in WWI and returned to the United States at the conclusion of the war to limit their practice to orthopaedic surgery.

The real beginnings of the orthopaedic residency program in the Harvard hospital system began under the leadership of Robert Osgood. In 1919, Dr. Osgood was appointed chief of orthopaedics at the Mass. General and associate chief of the fracture service… the fracture service was led by general surgeons. In 1922 after Dr. Lovett retired, Dr. Osgood was named a Harvard Medical School professor… the John D. and Buckminster Brown Professor and chief of orthopaedics at Children’s Hospital. D. William, Sr. said “To him (Osgood) goes the credit for the beginnings of the residency as we know it today”. Dr. Osgood was always concerned for residents and their training. He was known as a spectacular teacher and surgeon and through his diplomacy, he incorporated the Massachusetts General Hospital into an orthopaedic residency program adding one year at the MGH to the existing one year program at Children’s. He also established a six-month basic science program at Harvard Medical School. This occurred in approximately 1922. The program at that time was 2 years in length, following an internship at another major institution. The Harvard orthopaedic program became “the model for other medical schools”. Dr. Ober during his reign as chief of orthopaedics at Children’s Hospital expanded the program by one additional year. This year was spent at Children’s Hospital. Occasional residents would rotate for 6 months at the Peter Bent Brigham Hospital and 6 months at Children’s…others spent the additional 12 months at the Children’s Hospital. The basic science component gradually diminished to include occasional lectures by Jonathan Cohen in pathology and radiology lectures by Dr. William Harris’ father. Additional rotations were added at the Beth Israel Hospital and the Robert Breck Brigham Hospital and the Veterans’ Administration Hospital. But it wasn’t until about 1974 under the leadership of Dr. Mankin and Dr. Sledge that the Harvard Combined Orthopaedic Residency Program was organized. It included 3 years of adult orthopaedics and 6 months of children’s orthopaedics. The adult orthopaedic rotations were at the Mass. General Hospital, the Brigham and Women’s Hospital, BIDMC and the VA. The 3 -year program followed a one-year internship in general surgery an adult hospital. Eventually the program became a five-year program, incorporating the internship into the orthopaedic residency curriculum, as defined by the American Board of Orthopaedic Surgery.

In summary the original program directors for training in orthopaedic surgery started at Children’s Hospital with Dr. Bradford, followed by Dr. Lovett and then Dr. Osgood. Dr. Osgood changed the program from the Children’s Hospital program to the Children’s Hospital/Massachusetts General Hospital program about 1922. He remained the head of the residency program and he was followed by Dr. Ober and then Dr. Green. It was until the late 1960’s that Dr. Glimcher, chief of orthopaedics at the Massachusetts General Hospital (around the time Dr. Green retired in 1968), became head of the residency program. Dr. Glimcher eventually moved to Children’s Hospital where he assumed the Peabody professorship. Dr. Mankin was recruited as chief at the Massachusetts General Hospital and the Edith Ashley professor. He was the residency director of the residency program from 1971 until 1998 when Dr. James Herndon was appointed as the Partners Chairman and the Harvard Combined Orthopaedic Residency Program Director. After his retirement in December, 2008, Dr. Dempsey Springfield was selected and is the current residency program director for HCORP.

The history of orthopaedic surgery training in the Harvard hospitals has a long and interesting history with the early training focused at Children’s Hospital. The training program began at Children’s Hospital…later expanded to include adults at the MGH. Experience in children’s orthopaedics always exceeded the time spent in adult orthopaedics until about the time the Harvard Combined Orthopaedic Residency program was formed. I know that I completed my residency program in December, 1970, having spent 1 years at Children’s orthopaedics...the residency time (2 years) in adult orthopaedics. By 1974 the residency program included only 6 months of children’s experience. This trend reflected the trends in practice in the United States. Today adult orthopaedics is a major component of any orthopaedic residency program, including HCORP. The residency program director has remained at Massachusetts General Hospital following Dr. Glimcher’s acceptance of that responsibility in the late 1960’s from Dr. Green. Children’s Hospital chiefs had led the previous orthopaedic training in the Harvard Hospitals for the previous 65 years.

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