University of the Pacific School of Dentistry - Chips Yearbook (San Francisco, CA)

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the skeleton. This would not mean that only lesions of bone shall be considered, for abnormal conditions of the soft parts produce many deformities of bone without any primary affection of the bone. From the excellent work of Tubby of London we get the suggestion that Orthopedic Surgery shall be referred to as the Surgery of deformities of the apparatus of locomotion in all three aspects, aetiological, prophylactic and therapeutic. The beginning of the consideration of deformities now known as Orthopedic Surgery is nearly as old as other parts of medical lore. The ancient Egyptians and East Indians as early as 800 B. C. had much knowledge of deformities and entered into much speculation as to the aetiology of the same. Owing to two customs extanti in ancient days the treatment of deformity lagged very far behind. Deformed children were exhibited for the purpose of begging, or else destroyed as the quickest and least troublesome way of curing them. However, many in- geneous appliances were invented, many of them of more or less merit. In fact many of them were superior to the faulty contri- vances of unskilled individuals of modern times. The most vexing part of the whole matter lies in attempting to fix a boundary within which a surgeon may work, without encroaching on other fields of surgery. The most logical way out of the difficulty would be to do away with the attempt to cir- cumscribe the work of any one portion of surgery by any fixed lines. lt would be better to encourage all surgeons to dispas- sionately study the work of each other and each consider his own ability in comparison and then elect to do that which each can do well and leave alone that which he might bungle. All ortho- pedic surgeons are not equally skillful in handling all classes of deformity, while each one perhaps does exccll in a portion of the work. lt is like the peculiar skill shown in athletics. Each athlete may be far superior to the untrained individual, while excelling in but a few events and being able to give mediocre account of himself in a few more events. Rather than attempt to pen a surgeon within a circumscribed limit, the boundary of which will ever be dispute, it will be greatly beneficial in future to try to show the surgeon which part of the work he does well in any field he may choose and encourage him to do that and relinquish the remainder to his fellows. Much discussion has been entered into as to whether any part of the work on fractures and dislocations should be included within the domain of Orthopedic Surgery. I-lere again we see the impossibility of fixing lines. The surgeon who cannot skfill- fully treat a fracture or a dislocation, could scarcely hope to suc- cessfully treat a deformity resulting from a fracture or disloca- tion which from some cause had resulted badly. q ' 28

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W'OLFF'S LAW Julius Wolff taught: l orm is the outcome of function and that a continuous or sufficiently frequent performance of function in a given position is followed by or associated with a corresponding structural change and adaptation. This law explains the rearrangement of bone structure seen after an injury, operation or change of form due to softening of bone. Many of the operations, much of modern nomenclature of Orthopedic Surgery have been handed down to us from and before the time of Galen. The individual who would claim to be the discoverer of something distinctly new would be greatly undeceived by a reference to the literature of the subject. lt would be impossible without injustice to many men of merit to attempt to give a list of many surgeons of Europe and America who have added to the efficiency of our work in deform- ities. However a just tribute to one of the greatest of them all cannot be harmful. To the late Lewis A. Sayre the writer wishes to record his gratitude and heartfelt thanks for his skill- ful teaching and hearty encouragement in the beginning of that which was to become a lifework. As a memento to the students of the little college, who have faithfully worked with the writer many days in the past few years, two illustrations will be included in this sketch. They represent the adaptation of a common and homely device to a useful purpose in our work, This device can be adapted to use in many ways and enables us to secure quick and safe results without pain to our patients. Many students have desired some- thing by which to remember the l'. X. S. orthopedic clinic, VVe have all worked hard in our clinic for the betterment of the poor and unfortunate. VVe have striven to learn and to help each other. The writer hopes to see the day when some of his former students may far outstrip our present work. The greatest ap- preciation possible for any student to express can be accompl- ished by adding something to the work on Orthopedic Surgery. VVishing all of the students of the College of Physicians and Surgeons Godspeed, the writer bids you adieu for the year. l2'rn.xN H. SMITII, M. D. 29