The Founding of the ASSH: A politician, a general, and a duck hunter

Season 3, Episode 38.  Chuck and Chris welcome Pete Carter back for his story of the founding of the American Society for Surgery of the Hand.  Pete shared this story years ago at the annual meeting of the ASSH and retells it here for us.  A politician, a general, and a duck hunter.

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Transcript

Charles Goldfarb: 0:03

Welcome to the upper hand podcast where Chuck and Chris talk Hand Surgery.

Chris Dy: 0:07

We are two hand surgeons at Washington University in St. Louis here to talk about all things hand surgery related from technical to personal.

Charles Goldfarb: 0:15

Please subscribe wherever you get your podcasts.

Chris Dy: 0:18

And thank you in advance for leaving a review and leaving a rating wherever you get your podcasts.

Pete Carter: 0:24

Well, Chuck, thanks a lot for asking me to give this talk. As you can see, almost 20 years ago this month, it's actually in October, I gave this talk at the hands Society meeting at the fellows and residents conference, I gave the Richard Smith Memorial Lecture. And I thought it'd be fun to talk a little bit about him. I did not know him well, but I knew of him everybody in hand surgery, knew about Dick Smith. See if I can get this thing to work. Here we go. And he was a very handsome guy was born in 1930, in Bronx, New York, he went to Bronx High School, which for those of you who are not from the New York area, might not realize what a famous high school this is. Eight of their students have won Nobel Prizes. And these guys are some of the brightest people in America. You went from there to Brown University and then on to New York Medical College, which now is NYU. He did an orthopedic residency at the hospital for joint diseases. We used to tease when I was at Roosevelt Hospital, talked about it as the joint for hospital diseases. But it was a very famous orthopedic residency. And his chief then was a very distinguished hand anatomist named Emanuel Kaplan. And he went from there and join the Public Health Service, like most of us had to spend some time in the military. He did a handful of chips with Joe boys, and with another in England with a Guy Pulvertaft and then he came back to the hospital for joint diseases and succeeded Dr. Kaplan and then he got the job, for which he became famous as the chief hand surgeon at the Mass General. And he was the most articulate man, very fine mind, quick witted, the friendly, a lot of fun to hear him speak. And he became the president of the American Society for Hand Surgery in 1982, when he was just barely 50 years old. And by 1987, at age 56, he was dead from a glioma. So it was one of the great tragedies of and surgery certainly lost to the famous guy. He was a unique individual, who many of us fear cannot be replaced in our time as capacities, talents and commitments made him in the eyes of many, our finest flower. And the 30 years he gave the hand surgery, one of its finest periods. That was Henry Mankin, the famous chief at Harvard. Dick as a teacher reflected deck as a man, the person, the persona, I were inseparable. He was at his core entirely cerebral, an optimist, an explorer and an inquirer. And that's Clay Peimer, one of his residents. He gave a very important hand society address on the education of a surgical specialist when he was president. And this is the talk that I gave at that meeting. The title of this talk is the embryogenesis of the speciality of hand surgery, you can tell I'm kind of a pediatric hand surgeon and someone who's spent a lot of time dealing with congenital differences. The word embryogenesis means the development before birth. And this talk is not about what's happened since the hand society formed. It's about how Hansestadt It became a specialty of surgery. And it's an American story. It's the story of a politician and a general and a duck hunter. The politician was Franklin Roosevelt. The general was a man named Norman Kirk, which unless you're in the army probably haven't heard of him. And the duck hunter was the father of hand surgery. Sterling Bunnell. These guys were 20th century Americans. They were part of what Tom Brokaw ad called the greatest generation. And really, they weren't they they were fathers of the greatest generation. Because they were older than the guys that typically fought in World War Two. The first one, The New Yorker, was born in aristocrat, he became a politician, and he grew into a statesman. And here's a picture of Roosevelt when he was a young man. Born in January of 1882, he married his cousin Eleanor, who was the niece of Teddy Roosevelt. Her brother or her father Eliot was Teddy's brother. And that together, they had five children. All of them were boys, except for the first one. And he was about as East Coast of blueblood, as you could possibly imagine. You talk about a guy having been born with a silver spoon in his mouth. This is the guy. He graduated from Harvard College in 1903. He went to Columbia Law School, he was in the New York State Legislature from 1911 to 1913. And then in 1913, he was appointed the Assistant Secretary of the Navy and that was the job he had during World War One. He did not fight he was home in the Washington being the Assistant Secretary of the Navy, and this is a picture of a woman in that role, and he's bowler hat there. He was a sportsman he loved all kinds of sports, sailing, swimming, rowing, football, horseback riding, tennis, golf, he was good at all of them, not graded any of them. But he was a participant, and an enthusiastic one. That all came to an end in the summer of 1921, when he's like, literally changed forever. One afternoon, after swimming at the family compound called Camp Abello. In Nova Scotia, he was 39 years old, the father of five. And one day after swimmin he was stricken with a childhood disease took a long time for them to decide that that's what he had. And an orthopedic surgeon was the one that finally made the diagnosis. But he was stricken with polio, and he became a paraplegic. And he never walked without aids again, it happened suddenly one afternoon. And as Goodwin said, or his White House physician, Ross McIntyre said, all the horror of a lifetime of helplessness wept over for polio at that time was a mysterious disease, for which there seemed to be no cure. We did not of course have any vaccine then the actual identity of the polio virus had not been worked out. And it was a terrifying thing that happened to this guy that had really been a tot lived a charmed life up until that time. And indoors could go and Kearns Goodwin's famous book no ordinary time, she said yet the paralysis which gripped his body, expanded his mind. Because far more intensely than before he reached out to people to pick up their emotions to put himself in their shoes. He had been kind of a pompous, East Coast blueblood until he had the rug pulled out from under him. And he became a completely different person and became empathetic, and for three years was convinced that if he did enough rehab, he could, he could solve this he could beat it and became intensely interested in hydrotherapy and went to a resort in Georgia. called Warm Springs, in which he invested invested two thirds of his personal net worth in this hospital or in this rehab hospital and actually tried to present his feelings to the American orthopedic Association before he was President. And they turned him down who wouldn't let him speak. But that rehabilitation period for three years, when he emphasized water therapy and in Warm Springs to Georgia, he was one of the first Americans to use aluminum drop lock knee brace. And, as I mentioned, Robert Levin in Boston was the one that made the diagnosis. He in 1938, with one of his associated at the White House started the March of Dimes, which eventually led to the development of the polio vaccine. And he accomplished so much it's hard to imagine. I mean, he was a paraplegic. And this was a long time before the American Disabilities Act. But as a paraplegic, he was elected the governor of New York twice. And President of the United States, four types, it's hard to believe that somebody would run and be elected on four times. So that's the story of our first personality, The New Yorker. Now let's talk about another east coaster. This guy was flown further down from the state of Maryland. His name was Norman Kirk. Kirk was born. Certainly not with a with a silver spoon in his mouth. He was a very average American born and rising sun America. That's up at the top of the Chesapeake Bay. He loves hunting and fishing. And he went down to Washington to train and get his MD degree. And then when it after he'd done some general surgery training, joined the army because he didn't have any money. And in 1912, his first post was actually in Texas at Texas City, where he went to be part of the Mexican War. And then in 1915, he was assigned to the Panama Canal during its first year of operation, and was instrumental in helping eradicate malaria and yellow fever, but he spent the whole war in Panama. This is not a good place for a military man during the war. And after the war was over, they shifting back to Washington to Walter Reed. And he's kind of low on the totem pole. So he got the absolute worst assignment. They assigned him to the amputee clinic as a general surgeon, assigned to the amputation clinic, and he was said to have examined 1/3 Of all the people that had an amputation and world war one at Walter Reed. And this experience made him an expert, obviously in rehabilitation, and it changed his life. He changed from being a general surgeon to being an orthopedic surgeon, and he became the Army's first fully trained orthopedist. He furthered his education at the Mass General and at Hopkins, and he was the Army's first board certified orthopod. And from his World War, one amputee experience. He wrote a book

called Amputations: 14:04

Operative Technique, which was the standard at that time in a potations. And from that he developed the respect of his civilian medical peers. A lot of times, military doctors are not held in high esteem by the civilian medical community. But because of his work with amputations, he was actually made a member of the American orthopedic association. So this is a big deal as an army surgeon, but it wasn't for his medical skills that Kurt was really famous. He was an administrator, like anyone in the Army Medical Corps if you want to advance pretty soon you have to quit seeing patients and start pushing papers around and his first job was back in Texas, where he was assigned to Fort Sam Houston in San Antonio, where he was the chief of the orthopedic service and then subsequently, Chief at the surgical service. He went from there to Manila. Or he was the chief of orthopedics. He came back to Walter Reed in 1930, and was the chief of orthopedic surgery at the top Army Hospital. And then he must have made somebody mad because they shipped him back to the Philippines, where he was the chief of surgery. But then he got the assignment of assignments, and it changed his life. And it changed hands surgery forever, because he was made the commanding officer of the hospital in the Presidio in San Francisco. And for those of you that know, San Francisco, this is one of the most beautiful pieces of real estate in America is an enormous area right on the edge of the Golden Gate Bridge on the San Francisco Bay. And he was the Chief of Surgery at Letterman. And that's where he met the third character in this story. He was in California, this guy was from the Left Coast, and he was a true California. He was born, the son of Gold Rush pioneer. He was born in June of 19, or 1882. That was a year before the first electric streetlight in San Francisco. And his family was a very famous California family. He had a cousin named Lafayette Bunnell, who was a doctor who was in the Army battalion that wrote in to the Yosemite Valley. And he was among the first white people to ever see Yosemite and was involved with making sure that it was named after the Indians, and not the guy that was the head of the army battalion that wrote into it. He went to the University of California. And this is what he looked like when he was in medical school there. He graduated in 1908. But important to me, he also went to Berkeley, which is where I went to college. And he graduated exactly 60 years before I did from Berkeley. This is what he looked like when he was a college student. And he looked out over that same glorious view from the East Bay at the mouth of the San Francisco Bay. Now, it was a little bit different because the Kappa Neely that you see there wasn't there when he was a student that was built in 1914. And the Golden Gate Bridge Why hadn't even been dreamed up yet then because the Golden Gate Bridge wasn't built until 1937. So it was an unobstructed view of the Pacific Ocean that he had. And he was a duck hunter, he loved hunting and fishing of all kinds. And more than that, he was a naturalist. He was a tremendous comparative anatomist. And was fascinated by the flight of birds and airplanes actually wrote an article about that. And prior to World War One, he was a general surgeon in practice in San Francisco. And a young lady got interested in tendon surgery, and wrote a fascinating little paper that was published in test, you know, entitled The repair of tender tendons in the fingers and the descriptions of two new instruments. He submitted that paper and just so you won't get discouraged, Chuck. He's submitted that paper 18 times. His wife said she was going to have to divorce him if they didn't get that damn paper published. But in World War One, like so many Americans, he joined the army to serve in the medical corps. As a as a surgeon, and he got a plum assignment. He was the chief of the surgery, surgical service in bone in France. This is the absolute heart of the wine country. And he became a terrific gormond there and loved great food, great wines and became Known for that after he came back home, but one of the things that fascinated him was the incredible way that amputation was used as a battlefield expedient. And he felt that many of those arms could have been salvaged. And he was completely put off by that. And when he came back home, he vowed to do something about it. Now, another thing he did while he was in France, is he got interested in aviation is, like I mentioned, he was interested in it before the war, but he met a bunch of these pilots during World War One. And when he came home, he bought himself an airplane. This is the plane he bought. This is not the exact one but it is the one. The Jedi was the one he owned. And here's a picture of him with his flight instructor. And he used to fly that airplane, from San Francisco up to Petaluma, to his clinic, gave them an excuse to fly the plane. And he would fly up to Petaluma. And here's a little map to show you. He lived out in San Francisco down below. And he flew the plane up north to Petaluma. And then after the clinic, if you've ever lived in the Bay Area, you know, particularly in the summertime, the fog rolls in in the afternoon. Well, he could fly out to the coast, and fly down the coast until he heard the waves stop crashing. And then he knew that was the mouth of the bay, and he would fly into the bay and land at what was then the San Francisco airport that is now called the marina. It's one of the most posh areas in San Francisco, the homes there cost millions of dollars. But at that time, it was just a green field. And he would land the airplane in that green field after he flew through the mouth of the bay. And then he'd walk up the hill to his house, because he lived at 2000 Broadway. And here's a picture of even in front of the house. The house is not there anymore. It's been torn down to become a a high rise apartment. But he was like I said a naturalist. And he had a garden in which he kept live alligators. And he loved to invite people to cocktail parties, and not tell him that there were alligators roaming around in the garden. So he had a great sense of humor. But in 1926, his flying days came to a tragic end. He was flying a friend of his who was a photographer, up to his favorite family hot the Yosemite Valley, and the plane crashed. His friend was killed. And the nail had a femoral neck fracture. And so about that time, Smith Peterson was writing about a nail that he was using to nail femoral neck fractures. So but they all got on the train and San Francisco, rode it all the way to Boston, and had Smith Peterson put a pin in his hip. And it never healed.

Unknown: 23:29

He came back home, he said, I think the guys back home could have done the same job that they did in Boston, I should have stayed in San Francisco. But it's interesting because for 30 years, this man had a non-united fracture of his femoral neck. He used to say that he always walked with a limp. And he used to say that a little bit of pain every day makes men pay more attention to the circumstance. So he was pretty tough, a little bird. He practiced general surgery in the interval between the war and a building that is still there at the corner of Sutter and Powell. And he was a prolific writer in hand surgery. He wrote articles about just about every topic, you can imagine. That republished both in STL know, the journal bone and joint surgery, many, many things that we now appreciate, he was just discovery. And that was where he met Colonel Kirk. Because Kirk was then a bird Colonel. He was the head of the the hospital there and the Presidio, and it was obvious that these two guys would get together. And here's one of the very few photographs I've ever seen of these two men together. This is Bunnell on the left 60 year old man, the prime of his career in general surgery and writing and collecting his information about hand surgery and writing his book about hand surgery and in Manila's obituary. Kirk wrote an obituary about their time together. He said during my tour of duty at the Letterman hospital, I was fortunate to get to know the Chanel's Sterling as his personnel and Sterling Jr. Sterling Jr. was born when Bunnell was over 50. And when someone asked him if he was going to have another, Getty said, I think it's an act of God that I had this one, I would never have another one. At any rate, the son grew up to become a psychiatrist in the Bay Area and understand he died recently. This is the second wife is former art office nurse. And together these two guys used to hunt and fish on the coast there in the Presidio, which was off limits to anybody except the military. And of course, the general the, the colonel could get Bunnell pass and he, his son remembered fishing out there with Kirk. They had dinners in the Bunnell home because by this time, Bunnell was very much a gore man and love to have dinners in the home. His son said he remembered all of these military guys in the house at these dinners, and they were served by Japanese caterers. This is right before World War Two. And one of those caterers apparently turned out to be and they were getting information from these military guys. But Kirk and Bunnell got to be great friends, and Kirk. By that time it moved on to writing about non unions and bone grafts and the nails work and reconstructive surgery, and really impress her. He was fascinated with work Brunel was doing. And of course, at this time, Bunnell was collecting his experience for the textbook of hand surgery that he would publish in 1943, the first edition. Now that textbook really made him famous immediately. And as Leo lair, the great tendon surgeon in New York said it was literally the hand surgeons Bible, it went through five editions. And it was in that book that Brunel developed a new concept for the treatment of hand injuries. Prior to Bunnell hand surgery was what I call a parade of specialist, the orthopedic surgeon came in and did the bone work. The plastic surgeon followed, repairing tendons, moving skin around, and then the neurosurgeon came in and did the nerve grafts. And Bunnell always said, This is ludicrous, we need to have one surgeon that can do all three of these things. And it was his concept that it should be a regional specialist. This was a breakthrough moment in surgery. And his concept of what constituted a hand surgeon came at about the time that he's putting that book together. Now, in January of 1941, Kurt made general and he was transferred back to Washington, to the absolute pinnacle of Army Medicine. He was the Chief of Surgery at Walter Reed. And then at the end of that year, on December 7, everything changed forever when Pearl Harbor was bombed. It was truly a day that lived in infamy. And it was also a day that changed and surgery forever. Because in 1942, Kirk was left Walter Reed, and was assigned to the Percy Jones hospital of all places. Here's a guy in the absolute ivory tower of Army Medicine. And he was stuck in Grand Rapids, Michigan, or Battle Creek, Michigan, at the Percy Jones hospital. This is what that hospital looked like. And when he got there, there were 1700 beds. By the one year later, there were 12,000 patients in this hospital and he is responsible for training the staff, most of whom, who are civilians. In World War Two, in 1942, things weren't looking too good. United States had the 16th largest army when we were attacked and declared war on Germany. But we started getting the great engine of the American economy started. And the production in war goods is staggering to those of us this day, it's hard to imagine this was when these huge assembly lines to develop and build bombers took place. This was an assembly line at the River Rouge plant in Detroit. It was one mile long, and they produced a beat 24 Bomber, every hour 24/7 around the clock. Now, these guys in 1942, were flying these bombers. They were thin as paper, you could cut the aluminum with a pocket knife. And basically, they were just a giant gas tank with the biggest engines they could possibly put on them, and filled with the maximum bomb mode possible. And they were flown by a bunch of young kids. These, here's a picture of a crew of a B24 crew flying out of London, or one of the bases around London. Most of the men in this photograph have not reached 20 years of age yet. And the captain of the crew was a guy named Bill Smith. He was 21. And the boss of this group, they would be flying through flax, which was exploding cells would go through these, these ships. Like they were made of paper, and enormous mortality rates occurred. There were more Americans lost in the Eighth Air Force. During these bombing raids than all of the Marines in the Pacific. They were extremely lethal. But here's the guy fly in that plane. Here's old Smith, on leave, they were cocky. I was a flight surgeon, these guys had the fighter pilots mentality. It's always going to happen to somebody else. But they and I heard these stories and got these photographs from Bill Smith, because Bill Smith was volunteer at the Scottish Rite Hospital, making popcorn. And this is him. And Bill told me these great stories of what happened during those bombing rights bill actually bombed Berlin and his be 24. Now, in 1943, things were looking better. The tide of the war was beginning to change. And the US public opinion was strongly swing switching to doing more for the returning GIs because after World War One that hadn't worked out very well. And this wonderful photograph here was on the cover of Life magazine, an amputee, looking gazing out at the Golden Gate Bridge. Now, as you know, Eleanor and FDR were somewhat estranged. They didn't have the same bedroom. But she was a tremendous advocate for her husband. And while he stayed home in the White House and his wheelchair, she flew to the Pacific and traveled visiting these soldiers. There were tremendous numbers of orthopedic injuries. In fact, that was the most common injury, the head injuries all died. And a lot of the the abdominal injuries didn't make it either, because the evacuation and treatment of shock wasn't what it should be. So lots of what it would become later. But lots of these men who had extremity injuries were in the hospitals. And when she came home, to tell FDR of this, she convinced him of the importance of better treatment. And from that union, a very important piece of legislation, perhaps the most important piece of legislation ever passed by the US Congress. The GI Bill was passed, which allowed for these soldiers to attend college, and it grew the academic institutions in this country enormously as a result of that, and interestingly, it was still going when I was in Vietnam, I got the GI Bill when I was a resident I think I got a couple 100 bucks monitors But the battle better medical care, obviously involved rehabilitation and orthopedic surgery. Now, FDR knew something about orthopedic surgery. He'd had the lecture and the lab on orthopedic surgery. And here's a wonderful story by his White House, Dr. McIntyre. On all of his trips, the president never failed to visit hospitals. And on one occasion, visiting the moraine, whose leg had been smashed by mortar fire, who had actually completed his own amputation. This guy cut his own leg. Roosevelt heard this story, he sat down beside him, and he says to this marine is private, he says, Well, good morning, doctor, I understand you require a surgeon. He said, I have to be a pretty good orthopedic surgeon myself. So how about a consultation. So the guy had a great sense of humor. Also, in 1943, it was time for a new Surgeon General the army. And of course, FDR, was involved with this. He knew a lot about orthopedic surgery. This photograph you see here is one of the few photographs ever made of him in a wheelchair. This little girl here was not one of his children. I think he was the child of a gardener or something. But it's a famous picture of him with his dog. He knew something about orthopedic surgery because he had an orthopedic problem from polio, paraplegia, years of orthopedic rehab, and his own personal experience plus what Eleanor told him, told him what the army needed in the way of a Surgeon General. You needed somebody that knew something about rehabilitation. And he needed someone who knew something about orthopedic surgery, and that someone needed to have the respect of his civilian peers. And Norman Kirk was the guy he appointed. He was an orthopedist. And he got his second star. With that. He was not the Army's choice, Eisenhower and Marshall. Neither one wanted him to be Surgeon General. They wanted Eisenhower's personal physician, even Henry Stimpson, the Secretary of War, whom Kirk had actually operated on in the Philippines, when he was out there did not want him for Surgeon General. But he was the choice of the guy who mattered. He was the choice of the Roosevelts and because of his civilian respect, his rehabilitation, the fact that he was an orthopedist, and I'm convinced because of Roosevelt's own personal disability. Now, the Surgeon General, the army during World War Two, was not like Dr. Koop did. He wasn't just a figurehead, like today's Surgeon General. Yes. He was in charge of 47,000 doctors, 4500 of them, almost 4600 were civilians who were wearing the uniform. But on the inside weren't really fighters. And only 1200 of the doctors were regular army. There were 57,000 nurses, a half a million medics, and even 2000 veterinarians who were inspecting what courses they still had. And of course, were responsible for inspecting the meat. So as Surgeon General during World War Two, he was responsible for 600, almost 700 hospitals overseas 78 hospitals in the United States, and these hospitals had 15 million admissions. And there were 592,000 of those who were wounded. Well, in 1944, I call it the golden year of hand surgery, because the nail or Kirk was in inspecting a hospital called Valley Forge General Hospital. It was a plastic surgery center in the fall of 1944. And he was shocked to see how many crippled and cases there were. And he didn't think that there was enough being done for them. So he immediately thought of his old friend in California, Sterling, but now and he wrote a letter to him, asking him to start a hand surgery service in the army. I had looked for this letter for 20 years yours, and I've never found it. It's not in Roosevelt's archives. It wasn't in the archives of Bunnell. I never could find it. But his response was immediate. This guy was at the pinnacle of his surgery career. He was 62 years old. He was the busiest general surgeon in the entire city. And he closed the doors of his office, immediately walked out the door, and didn't come back for two years. And he spent those two years as the civilian consultant to the US Army. He was the most famous hand surgeon in America then because of this book. He closed his private practice. He packed his lantern slides, they didn't have PowerPoint programs, then they had these great big glass slides, carry them in a big wooden box. He packed these under his arm, and he traveled the country, teaching hand surgery, lecturing, showing them how to do it in the operating room. And here's a wonderful picture of Bunnell, examining a man that has an older American policy look close his first and roseus muscle there is atrophy. And all the surgeons you can imagine, are a bunch of guys that were stuck in an army base. And in walks this guy is the most famous hand surgeon in the world at that time. And he's teaching them himself these tricks gave him an opportunity to promote this concept of the regional specialist. And it allowed him to set up 10 centers for the care just of injured hands. He had complete control and all of the hand Reconstruction were sent to these 10 centers. They treated over the period of a couple of years 10,000 Hand patients most of the hospitals you've never heard of. In fact, the only one that still exists today is number eight William Beaumont General Hospital. It's still at Fort Bliss, Texas, and these hospitals were run by very junior doctors that Bunnell personally picked to run them. Many of these names you know what some of the most famous names in hand surgery Dr. Littler who trained me, Walter Graham, Gilbert Hiroo, Benjamin Fowler, former president of the American Academy of Orthopedic Surgeons from Nashville, Lot Howard, Bunnell's old partner, Arthur Barsky wrote the first book children's children's hand surgery, George Phelan of the Phalens test, William Frankleton, the Frankleton pickups, Don Pratt, these guys became very famous and surgeons, and by 1945, Bunnell had this thing really rolling, he would go from center to center, he would arrive and see patients with the doctors. And here's a picture on the left here of Dr. Litter presenting a case to Dr. Bunnell afterwards, the next day, they would operate for a couple of days he would give lectures on one of the days and they managed to find a little time for fun too. You can see the amber colored beverage containers on the on the table there and there's been a lot of these had you always had had some of the docks with him that night. And after World War Two, he got these guys to write up their experience and published it. In an army publication. Entitled Hand Surgery is edited by Bunnell. The entire multivolume set was edited by Mike Debakey. But he got Bunnell to do the Hand Surgery section and those of you that like to collect old books, this is a very interesting book. And as Mennella said, in this volume, we have attempted to record what has been learned at hand surgery, so that such knowledge may be and we hope will be utilized in any future conflict. Now these guys developed just about every technique you can imagine. And believe me, they were much younger, Chuck than you were in fact, William Littler had had only an internship and six months in the dog lab, and he was running the hand service at the cushy Hospital. and wrote one of these chapters. They came up with new techniques in bone grafting with tendon grafting with tendon transfer, with nerve repairs and transfers, skin grafting for the many burns of the hand, full thickness crafting, even hand therapy at its origins there, you can see the splints look very similar to what they didn't have arthroplasty and so they just put a well fitted plaster cast on and rubber bands in the stirrups that we use now and and they're we owe a lot to these centers. These guys are the nucleus that started hand surgery and to these men that ran them. And they got together in 1946 in Chicago and Bunnell tuck them into forming a club. They call it the American Society for Surgery of the Hand. And all those stars there are pictures that were of the guys that were subsequently president. One of those guys you see down at the end of the table here, he looks like a baby, a high school kid, he's got a buzz haircut looks like you know the deer in the headlights look there. He would become the 18th president of the Hands Society. And 30 years later, was still handing on the tradition of teaching hand surgery, teaching me about these techniques. And here we are 25 years later with DIck Eaton at his famous favorite restaurant there in New York called Genome. So he taught me about hate lips, kind of go forward here. The technique that Littler became very interested in and Bunnell encouraged him to read as much as he could and write about it was pollicization. And at that time, it was primitive. The thumbs looked awful. They were just stiff, insensitive posts, and Littler worked in a hospital called Pushing Hospital was very close to Boston. And he used the Boston Medical Library to read the literature from Europe, but other could read French and German so he was able to get hidden Hilgenfelts work and the work of the French surgeons. And he took that technique of pollicization and converted it to the technique we use today. There are some improvements that have been made to his method, but basically, he was the one that turned it into a really precise, meticulous operation. And he documented that in the very first journal of Hand Surgery, the first volume, like 100 years of surgical effort, and you can see Bunnell here, and he felt was very important. And here's a drawing of Bunnell by Littler. That technique made it possible for us to operate on kids in Scottish Rite Hospital and this little boy called Patrick he was a little boy was born with how to tell them on either hand and through that technique, as Relton McCarroll said, pollicization is probably the crowning achievement of 20th century hand surgery give him a hand that has a thumb on and it's not just a statue either because this little boy Patrick actually got the nickname of Mr Snappy because and I'm hoping I can make this movie work no of course not. Let me see if I can get that to work just a second-should work obviously you stopped me by like it'd be three would have been better at any rate. Snappy is happy and so is his mama and all of us know that If mama ain't happy, ain't nobody happy? How do we learn to do these amazing things? These operations didn't just fall out of the sky, you know? They came, and they're a part of another debt we owe to that greatest generation, that group of American surgeons and wounded American soldiers in World War Two, whom they operated on those 10,000 soldiers in 10 places around the country. And it's a debt we owe really, to these three Americans, the politician, the general, and the duck hunter. The duck hunter, of course, was Sterling Bunnell, and he was a lot more than a duck hunter. He was, first of all a Californian through and through. He was a naturalist. He was a pilot. He was an innovative surgeon. He was a friend of Norman Kirk, a consultant to the US Army, an inspirational teacher and the father of hand surgery. So that's what I've got to tell you about. I want to acknowledge Doris Goodwin's help in this she helped a lot. Ray Tighten, the curator of FDR library. She got me into FDR's library, and it was a tremendous opportunity. I actually happen to have the good fortune to know a couple of FDR's grandchildren who live here in Dallas. This is Chandler Lindsley and her husband, Tony Roosevelt. Chandler is dead now that she was alive when I did this, and she told me some great stories about the White House. The Army about General Norman Cook, believe it or not the army at that time, at a full time historian at the Pentagon, he had a PhD in history. His name was John Greenwood, he was very helpful, and especially helpful was an orthopedic surgeon, Paul Daughtery, who was the chief of orthopedics at William Beaumont when I met him, or I first got introduced to him, I believe he's in Detroit now as the chief of an orthopedic residency Sterling Bunnell Jr. was also instrumental in helping me learn about his father. And Paul Brown, the great hand surgeon who wrote 'Less than 10' also had some advice for me, I want to thank you. And I want to thank the surgeons and soldiers of World War Two, and the Texas Scottish Rite Hospital, who made it possible for me to work and see all of these kids and take care of them. So that's what I have to tell you about the beginnings of hand surgery.

Charles Goldfarb: 53:01

Now was awesome, and I know that everyone is gonna love revisiting this story or visiting it for the first time. So thank you. Fantastic.

Pete Carter: 53:10

I'm glad to do it. It's an honor for me and I appreciate you being interested to let an old dinosaur talk about a paper he gave 20 years ago.

Charles Goldfarb: 53:25

This is good stuff.

Pete Carter: 53:27

Pretty rare that you get an opportunity like that, and I thank you.

Charles Goldfarb: 53:31

Hey, Chris, that was fun. Let's do it again real

Chris Dy: 53:33

Sounds good. Well, be sure to check us out on Twitter at hand podcast. Hey, Chuck, what's your Twitter handle?

Charles Goldfarb: 53:39

Mine is@congenitalhand. What about you?

Chris Dy: 53:42

Mine is @ChrisDyMD spelled d-y. And if you'd like to email us, you can reach us at handpodcast@gmail.com.

Charles Goldfarb: 53:50

And remember, please subscribe wherever you get your podcast and be

Chris Dy: 53:53

sure to leave a review that helps us get the word out.

Charles Goldfarb: 53:56

Special thanks to Peter Martin for the amazing music. And remember, keep the upper hand. Come back next time