This is Oral History interview #16 on May 16, 1975 with Dr. Beckett Howorth, a member of the Washington University School of Medicine Class of 1925. Dr. Howorth, tell us of your family and of your early childhood.
I was born in West Point, Mississippi – that’s in the northeastern part of the state. My father was a businessman in town, after having been a banker for a few years. My mother had been a school teacher before she was married. My father’s father was a businessman and my great-grandfather was a physician, but I never knew him. My mother’s father and her brothers became lawyers. My mother had been interested in my becoming a lawyer and my father wanted me to be a businessman, so they were a little bit disappointed when I went into medicine, particularly since we had no real family background for that. Of course, as one goes back, ancestors multiply rapidly if the women are included, which sometimes are left out. The Becketts in my family, which was my mother’s family name, came from the north of Ireland. The Beckett who came over married a Kyle (spells K-y-l-e). My father’s family had migrated from South Carolina. One branch of them actually were in the French Huguenot group who came to Carolina in the early days. On my father’s side was a Marion who came from France, and General Francis Marion was of this family, one of Washington’s generals during the Revolutionary War. Of course that was many generations before.
[My] early childhood was [spent] in our own home. I remember very little of the time before I went to school. My aunt was in charge of the primary school and although that was on the other side of town, my family wished me to be in her grade the first year. So I walked two miles across town in order to go to school and to be in her class and then returning. Later I went to the school nearer home and [after] the first seven years it was decided that I should move up a grade, so they skipped me one grade in order to get me into a more advanced class, since we didn’t have any division in our classes at that time. It saved a year and was an advantage later.
In high school I remember being the most frightened student when it became necessary to recite. I would almost shake when I had to stand up and recite. I realized that this was a handicap later, and tried to overcome it. During high school, my interests were toward mechanical things. I can recall building a lathe from an old sewing machine; although it was foot-pedaled rather than motor-pedaled it was effective. I played tennis, but didn’t engage in any formal sports during that period, partly because in the afternoons after school and on Saturdays I worked in my father’s store. At other times, I worked in our garden, raked leaves, things of that sort, so I was rather busy with various activities around the home and at the store and didn’t really have much time to play.
Where did you [receive] your college education?
I went to the University of Mississippi at Oxford and had my academic work there. I liked school; I liked my subjects and they didn’t seem too difficult for me so I persuaded them to let me take extra courses. As a result of this, in three years I was able to obtain my Bachelor of Science degree, cum laude. During that time, as electives, I had taken engineering [courses] because I had been somewhat interested in engineering and wasn’t then particularly interested in medicine. This was good because civil engineering not only served as an opportunity to earn money in the summer to help pay my college expenses, but also it made a good background for the mechanics of orthopedics later. I did some photography in school and this, too, helped pay my expenses. This was mainly in connection with the college activities, such as football.
Dr. Howorth, what were your extracurricular activities in college?
In addition to those mentioned, I belonged to the literary society, which actually was largely run by the lawyers. This, to them, was a training place for learning to debate and for learning Robert’s Rules of Order. I did learn Robert’s Rules of Order and this stood me in good stead, particularly when later I became secretary of a medical organization. I also became editor of the yearbook for my class and the following year was business manager for the yearbook, something which I think was probably unique. So, I wasn’t just a bookworm – I had various activities, including myself being on the football squad and on the track squad.
How did you decide to enter medicine?
During this academic period at the University of Mississippi, I wrestled with the idea of which direction to go, first leaning toward engineering but being a little discouraged by the situation in engineering at that time, I leaned gradually toward medicine. In order to prepare the way, I took the premedical physics and chemistry instead of the regular courses, so that I didn’t lose any time. When I did finally decide to go into medicine, the background was already completed and I could go directly into medicine. At that time in Mississippi, particularly in my home town, we had general practitioners, general surgeons and eye, ear, nose and throat specialists, and that was about it. I had never even heard of orthopedics and had no idea what it was.
What was your medical education?
I had the first two years at the University of Mississippi, during which – against advice – I continued on the football squad and was business manager of the college annual. We had a very good faculty and this was a very fine background, but the University at that time had only the first two years of medicine, so it was necessary to transfer somewhere else. I debated whether to go to one of the nearer schools, like Tennessee or Tulane or Vanderbilt, but learned that at that time the four top-ranked medical schools in the country included Washington University, which was closer than some of the eastern schools. So I applied for my last two years there, was accepted, and thus entered Washington University.
What were your summer activities when you were in medical school?
When I was at the University of Mississippi, during the academic period as well as the first year of medicine, I worked as an engineer on the Mississippi River. My job was to survey the river and to prepare the way for flood control so that in the next spring the flood wouldn’t devastate a lot of the land. This was a rather interesting job but we can’t take time [now] to go into further detail. In my last year I worked on malaria control work in Shelby County in Tennessee where Memphis is located. This was quite interesting, particularly because my chief was a man, Major [Joseph A.] Le Prince, who had worked with [Col. George W.] Goethals and [William C.] Gorgas on the Panama Canal, and he was very [knowledgeable]. I can well remember one remark he made to me after he told me that I had to make the talks to the people in the evening and explain to them how mosquitoes developed and how they got malaria. He said, “You make the talks, but I have one suggestion: get them leaning forward in their chairs and then quit.”
What did you do just after graduation from Washington University Medical School?
I was interested in the possibility of getting involved with the Boy Scouts, so that I could have the job of being physician for the St. Louis Council of the Boy Scouts. That camp was at Irondale, Missouri in the Ozarks, so that summer I did serve because I had an interval before my internship started. I did serve as camp physician. But I found that there were many interesting things going on and I thought, as I always have, that it would be interesting to learn as well as to teach. So, I was given the job of teaching first aid and public health and so forth for the merit badge courses. At the same time, I took the Senior Lifesaving training and subsequently obtained the certificate, and also began taking merit badges myself. So in the course of the summer I obtained the twenty-one merit badges necessary to become an Eagle Scout. This may be something of a record, I suppose for anyone getting twenty-one merit badges in two months, but I’m very proud of that and it was a good start in that direction.
Tell us of your internship.
Dr. [Evarts] Graham, who was Chief of Surgery, had hoped that I would apply for an internship with him, and in thinking of the possibilities at that time I was not ready to specialize or to lead toward a specialization. It seemed that a surgical preparation might be a better background for general practice or anything else that I might like to do. On the other hand, some of my advisers suggested that having been at Washington University for two years it might be well to go somewhere else and get other ideas in training.
I did apply in New York, at Presbyterian Hospital, and was asked to come there for an interview, which actually was [done] after Dr. Graham’s appointment, so I had to make a decision and give up the opportunity of continuing at Washington University. I was accepted at Presbyterian, although at that time, their eight surgical interns were usually chosen six from Columbia University and two from Harvard. But the ice had been broken a year or so previously by two or three other men, such as Scott Johnson, who went there as a medical intern, and Ed Saunders and Henry Cooper who became surgical interns. So Washington University was allowed into the group of internships and thus I started my two-year service with Dr. Hugh Auchincloss as my chief and Dr. Alan Whipple as the Chief of Surgery and Professor of Surgery.
What were your vacation activities?
I continued to have no money – in fact, I had to borrow money while I was an intern. So, although we had only two weeks of vacation at the beginning, I inquired about the Boy Scout summer camp in New York State and found out that it didn’t open in June when my vacation occurred, but [I] was referred to the New York State YMCA. They welcomed me to their camp at Westport, New York, on Lake Champlain. So I spent my first two vacations there, helping somewhat as a camp physician. Subsequently, when I had a longer vacation, I was camp doctor for a number of years. Instead of just doing the work of a physician, again I participated in the program at camp, which included hikes into the Adirondack Mountains. I asked to be excused now and then to go on one of the hikes as a camp leader, and at that time began walking in the mountains.
How did you decide to enter orthopedics?
Again, I was wrestling with what direction to go and considered various possibilities. The consultant in orthopedics at the Presbyterian Hospital was Dr. Russell Hibbs, who was a very impressive man. It happened at that time that two of my associate house surgeons did decide to go into orthopedics. So I thought at least that I would investigate. I had an interview with Dr. Hibbs, he encouraged me, and I did then decide that I would take a residency with Dr. Hibbs at the New York Orthopedic Hospital, which was the teaching orthopedic department of Columbia University although it was geographically separate.
What was your orthopedic training?
When I entered training at Orthopedic Hospital, it was a two-year residency service and that was it. Quite a number of men had been graduated [from] that program. During the two years, although originally I thought two years would be a long time in addition to my surgical internship, a fellowship system was started. I think [it was] the first orthopedic fellowship in the United States – perhaps in the world. Dr. Hibbs obtained the money for this because he thought we needed additional training and that a fellowship would provide it. At first I was hesitant about spending three extra years, which the fellowship required, but decided it should be worthwhile, and although I was not the first, I did start in on the fellowship program of three years of full-time work. This included work in the clinic, work on the wards, [and] in the operating room.
Dr. Hibbs also was very farsighted in starting a follow-up clinic. In those days, major problems – and our most common problems – were joint tuberculosis and polio. Our third problem was scoliosis and we did have a country branch where these children went after their surgery. This was part of our residency training program, and a very important part because we were able to follow the children through their convalescence as well as through their early post-operative period.
Was a doctorate of medical science offered at that time?
We didn’t have the specialty boards, and there was an effort to qualify men beyond such things as the American College of Surgeons and the licensing which everyone had. It was thought that for these specialties, if there were a sort of super-degree in medical schools comparable to the Ph.D., or the Doctor of Philosophy [degree], that this would serve the purpose. So, the Doctor of Medical Science was created: Med.Sc.D., and several of us at that time went through this program. It required an oral examination and a thesis, very much as was done for the Ph.D. I did take this and received the degree. A year or two later the Boards were instituted and the degree, I believe, was continued but hardly ever did anyone attempt to do it because the Boards really took the place of it. So I think the medical science degree is hardly known today.
What were your outside activities at that time?
There wasn’t very much time for outside activities because we had a very long in-service program. But my vacation activities were largely connected with mountaineering. I started going West to Wyoming after having been trained in the East in rock climbing by a group in Appalachian Mountain Club. I joined the club because of its interest in outdoor activities which was a good antidote for working inside a hospital in a big city like New York. The club had such activities as Saturday and Saturday afternoon hikes and various other things like camping and canoeing and snowshoeing, at that time – although later skiing took precedence – and mountain climbing. Having been thoroughly trained in New York in the techniques of rock climbing and having spent one vacation period in Maine at Mount Katahdin [ed. note: 5268 feet – the highest point in Maine.] One of [these] three summers I took to go to Wyoming in the early 1930s, to the Wind River Mountains and the Tetons with the Appalachian Mountain Club. Having been so well trained, it was possible to do some fairly difficult ascents and I met my principal teacher, Fritz Wiessner, who had been in Germany before the war but was [by then] a naturalized American and a very great mountaineer. He came down from a trip to Alaska and, with two others, the four of us made the second ascent of the north ridge of the Grand Teton, which in those days was considered a very tough rock climb. We did quite a number of other ascents, too, not only that summer but in various other summers. In the club, there were canoe trips on what we called whitewater, which was through the rapids. We would run the rapids on the Delaware River and the Housatonic River in Connecticut – ten miles of it.
My wife, when we first knew each other, was not very active in outdoor things and couldn’t swim and couldn’t ski and couldn’t climb. But she learned to do these things and we were able to do them together. After she learned to swim, I was ready to take her along on these whitewater canoe trips in the rapids. At about this time I got interested in skiing which also was one of the Appalachian Club activities. In those days there were no ski lifts; we had to walk up the mountains; therefore there weren’t very many of us and the trails weren’t crowded. Actually, the trails weren’t nearly as well-developed as they have been since. The technique of skiing compared with today’s standards was somewhat primitive, but effective, and it was possible to come down these mountain trails safely. None of us ever got hurt because we were in good condition. We knew what we were doing; we were very conscious of staying within our abilities, and so this was not a great problem.
These, then, were my principal outside activities during this early period of orthopedics in New York.
How did you begin your investigative work?
Dr. Hibbs came to me one day during my early fellowship period, and said, “I’d like you to study the congenital hips.” This is congenital displacement of the hip which occurs in so many infants at birth. This was all he said, but we did have typed records – we had saved all the x-rays, even old glass plates in the files of the hospital – so we had access to all the material which had gone before. My study consisted of analyzing these records – what had been done and what the results were – and of course the follow-up clinic gave us a continuing study of how these patients fared after they had surgery or after they had treatment. Furthermore, I was assigned to examine each patient on admission before surgery, to participating in some way in the surgery itself, and to following the patient afterwards. So I had a rather complete personal approach to the study of this problem.
After some months, Dr. Hibbs came to me and said he’d like me to study the slipping capital femoral epiphysis, so I was assigned that job. We did have a relatively large number of cases of both these conditions, so the studies were fascinating and very productive in that we not only learned what had gone before, but also we learned what to do in the future to improve the quality of care of these patients and improve the quality of surgery. So these two subjects have become two of my life-long interests in orthopedics.
Dr. Hibbs didn’t suggest it, but during this time I became interested in body mechanics and the way people use their bodies, although the primary emphasis at the Orthopedic Hospital, because of the great need, was on surgery. After working along these lines and using my background of engineering, of orthopedics, and sports, such as football and track and mountaineering and skiing, I put together a set of principles which I called “Dynamic Posture” or “Posture in Action.” My first paper on this subject was published in the Journal of the AMA [the Journal of the American Medical Association] in 1946. This brought out the difference between [dynamic posture and] static posture, which Dr. Goldthwait in Boston had been so active in promoting; this was in particular relation to sitting and standing erect. My concern was how people used their bodies in action, and that really was what “dynamic posture” meant. So I began teaching people, patients particularly but others, too, the best and most efficient use and the safest use of the human body in action.
This concept has continued so that now I’ve had thirty years experience with it, with many thousands of patients. Also, I’ve taught various people skiing and taught many people mountaineering in connection with the Appalachian Club, particularly. Dynamic posture has been something that has been very close to me and actually has not been very widely used by others, principally because it takes a great deal of time and effort and training to understand its principles and to apply them. It takes a great deal of time with patients, so that it isn’t really remunerative, but to me it’s satisfying and it’s the way I like to do it. When I’ve been asked to speak in other places and given them a choice of subject, very often dynamic posture has been the first choice so that the subject now is fairly well-known in other countries and even on other continents.
These three, then, were my principal interests, but I began to think in terms of writing a text book. One of the publishers, Saunders, came to me and, in fact, requested that I write a book for nurses, a handbook of orthopedics. I went to work on this but had the idea that maybe it would be good if I wrote a better book than they requested, one that could be used not only by nurses but by physicians. They subsequently informed me that this was not possible; the book had to be directed toward only one audience. They thought that the work was satisfactory and that I should rework it and develop it in terms of a medical student audience and write a book of that sort.
This, of course, took a lot of extra time and effort and in the meantime, having worked on these various hip subjects and others, I’d been accumulating not only knowledge but also illustrations. So that when it became time to select illustrations for the textbook, I had a background of a great many to choose from, both in the hospital and those which I’d developed myself. Actually, the book took seven years to produce and this meant every evening and every Sunday and every holiday so that my wife began to say, “When am I going to see something besides your back?” A lot of this was not anticipated, such as the change from a nursing book to the other book, and this is one reason why it took that long. There isn’t much temptation today for anyone to write such a book because it does take a great deal of time and is very demanding. Therefore, the tendency now is for someone to become an editor and have various men write individual chapters.
During this time I also wrote a number of papers not only on congenital displacement of the hip but also on slipping capital epiphysis and coxa plana and several other subjects. Altogether, while I was working in New York this amounted to about twenty-five papers. I was [also] asked to write for Consumers Research because this was a then-new organization, the first of its kind, and the director and I knew each other. They needed help in relation to their medical articles, so I wrote a number of articles for them during this early period. Occasionally I wrote articles for nursing journals and also for the mountaineering journals such as Appalachia and the Journal of the American Alpine Club. Some of these were related to the body mechanics of climbing and some of the mountaineering articles were simply descriptions of our adventures in these various trips to Wyoming and elsewhere.
Tell us of your early teaching.
One day Dr. Hibbs came in to me, as he had with the writing and the investigation, and he said, “You have the students tomorrow.” I said, “What do I do?” He said, “That’s for you to find out. You have them for two hours just after lunch.” I had them and after a bit they went to sleep, some of them. I decided this was my fault – that I should learn how to teach. That’s the last time a student has ever gone to sleep in my class. We had the group from Columbia Presbyterian, who came for their orthopedic teaching, and we did have a fairly adequate time teaching program. The beginning which I speak of was basically practical in that they came into the clinic and we taught them how to examine patients and evaluate them and discuss the various possibilities as to treatment.
There was also a lecture program which usually was done by Dr. Hibbs and those closest to him, but we had a third course and that was in practical orthopedic anatomy. This was elective and I was assigned part of it. It occurred to me that instead of merely repeating the first year dissection, I should really teach them living, human anatomy. So I would have the students remove their shoes and socks or roll up their trousers or even come dressed in shorts or bathing suits and examine each other first, before we went into the dissecting room. In this way we learned living, human anatomy. Actually, I’d gotten this idea because I’d been given the job of teaching postgraduate nurses at Teachers College, which is connected with Columbia University. We had no cadavers and hardly any models of any sort; just our textbooks and diagrams. I realized that the nurses weren’t going to learn very much anatomy like this. So, I advised them to come in bathing suits and to pair off and to learn anatomy on each other, which they did. They became very good at living anatomy. It seemed to me that this was a good way for the students [to learn] and it turned out to be so. In fact, our course became so popular as an elective that the other departments wanted to participate. And so they forced us to share the course with departments such as medicine and surgery and obstetrics, and so forth.
During this time, because of my work on congenital hips, I was interested in the anatomy of the fetal hip and was able through the Department of OB-Pathology to get some specimens of stillborns, both at about term and as early as the tenth fetal week. These I dissected and studied, and not only did they give me a knowledge of the anatomy of the infant hip, but also they were a great help in improving surgery on these very young and relatively delicate hips as compared with the adult hips and older children that we’d been operating upon for such things as tuberculosis of the hip. This was the first such study, I believe, in the world and it was reported and was [of] considerable help in those ways. This was my chief laboratory investigative work because most of it was clinical.
Did you do writing in those days?
The principle which Dr. Hibbs set out for the staff was that each fellow – in addition to the attendings with whom it was voluntary – each fellow would be expected to write at least one paper while he was at the Orthopedic Hospital. He was asked to present this at a staff meeting where it was constructively criticized, and if it seemed worthwhile it was offered to the New York Academy of Medicine for one of their programs. Most of these papers by all of us were accepted for such programs. If it seemed still better, it was offered for presentation at one of the national meetings. As a result of this, all of the papers that I wrote did get presented at national meetings and did get published in various journals such as that of the A.M.A. and the Journal of the American College of Surgeons and also the then-only journal of Orthopedics, the Journal of Bone and Joint Surgery.
Some years later the Journal of Clinical Orthopedics was founded and so some of my articles [were published in this journal]. Usually in connection with meetings which I attended there was the request to submit a written copy of the presentation, and so some of [my articles] found their way into such journals as the Journal of the Western Pacific Orthopedic Association and the journal called Acta Orthopaedica Scandinavica. But this was in a subsequent period and I’m merely noting a little bit ahead in answering the question about my writing. In these early days, I would work along several lines. First, do the investigation in order to learn what I could and apply it to the practice of orthopedics at the Orthopedic Hospital and in my private practice, which had begun to develop at that time. Second, to use this as teaching material for the students. And third, to use it as writing material for publication and for presentation at these various national and, subsequently, international meetings.
At the conclusion of your training, what were your connections and activities?
I remained on the staff at the New York Orthopedic Hospital as one of the attending physicians. I did have one year of special experience as an attending on the Fracture Service at Columbia Presbyterian because at that time a physical union between the two institutions was contemplated. I was also consultant in orthopedics at the Roosevelt Hospital in New York and attended the clinics in the hospital twice a week. I was consultant at the Vanderbilt Clinic of the Medical Center and attended that once a week, and also was consultant at the Babies’ Hospital, which was part of the Medical Center. Of course, with this there were the teaching appointments at Columbia University College of Physicians and Surgeons.
Did you continue writing?
Yes. I have always thought that, for me at least, the important parts of medicine and orthopedics were patient care and investigation, which might be clinical or laboratory or both; teaching, which included writing; and thought for the future. Of course, administration is another part, but I was much less interested in this and did not wish to get too involved in administrative work because committee meetings and things of that sort take so much time away from the other work which I preferred to do.
Did you write for others besides orthopedists?
I mentioned my writing for Consumers Research and for the nursing journals and for the mountaineering journals. These were my principal activities. I did have some programs at the YMCA, for example, in New York at that time and for other groups occasionally.
Did your wife participate in your activities?
My wife soon became my “right-hand man.” Although she was not medical-trained, she helped with typing, [and] she helped in other ways with the production of the book, and she was very much concerned with my life. Since we had no children, she would go with me to the meetings and soon became rather knowledgeable as far as the activities at least of the ladies at the meetings. [She] became very well-known among these groups, although in New York this was only the beginning.
Were there any significant changes in your professional and personal life?
Yes. There was a very big change. The move of the New York Orthopedic Hospital to the Columbia Presbyterian Medical Center was delayed for several years, but it was in the offing. Since I was working there, too, I realized what this meant. We had a 160-bed hospital downtown at the New York Orthopedic, with 60 private beds for the use of about 10 attendings. When the move to the Medical Center was contemplated, the number of ward beds was reduced from 100 to about 40, although the Fracture Service of 20 beds was added to the orthopedic department. We hadn’t had an active fracture service at the New York Orthopedic Hospital. We completely lost the 60 private beds. There were 200 private beds in the whole Medical Center, used by 300 doctors. Of those beds, 30 or 40 of them were immediately taken by the chiefs who were allowed any number of beds. The rest of us had to compete for the remaining beds. You can see what that meant; there was a waiting list of many weeks to get a patient into the hospital. Even emergencies frequently had to wait for some time unless it were a matter of life and death.
When the move was finally made uptown, the Orthopedic Hospital was given one floor in the Babies’ Hospital and one wing in the Presbyterian Hospital. This was quite inadequate and, of course, the private situation was worse. The loss of time was great; it might take five minutes on average just to get an elevator. If this happened twelve times a day, there was an hour wasted just waiting for elevators. Waiting for x-rays was equally time-wasteful.
I had gone as far as I could in my work in New York. Even though I had excellent connections and a very good private practice I was spending thirty hours a week working for the institution without pay and having to try to make a living after that. I was then invited to come to Connecticut. Many of my patients came from Connecticut and the doctors who sent them would say, “Why don’t you come out here? We need you.” Actually, there was no orthopedics being done of consequence in southwestern Connecticut at that time. So, after interviews in Stamford and in Greenwich, I had decided to see what might happen and established an office two afternoons a week. This meant considerable driving – it’s about fifty miles each way back and forth – and so it was rather difficult in that way. But, I was consultant at not only those two hospitals but [also at] Northern Westchester [County] and St. Joseph, so I had an opportunity to see as consultant quite a number of patients for the general practitioners and general surgeons.
Not only did it become evident that I would be unable to work in Connecticut and continue working thirty hours a week for the institution in New York, but also for the good of my patients I would have to make a choice. I was involved in writing my textbook and in teaching and other commitments so that it wasn’t possible to make a quick change, but I did as rapidly as possible leave New York and gradually discontinuing my private practice there, continuing as consultant at Roosevelt Hospital for some time.
The transition period was about five years and it was very difficult, not only because of the commuting but because of the divided interests. It soon became evident that Connecticut needed me, that there was plenty of work there for me to do, and that although it was in a sense “pioneer work” I should make this change. Also, it meant a change in [my] way of life because in New York we lived in an apartment in a crowded city, difficult to get about. Although we had many advantages such as the Philharmonics and the natural history program at the Museum and the Metropolitan Museum of Art, all of which we enjoyed, we thought these might still be accessible to us. To have a home in the country was then quite appealing.
So, we did finally complete the move in 1949 and I gave up my work in New York entirely at that time. Naturally, it was necessary to resign from the Columbia Presbyterian Medical Center because I couldn’t meet the scheduled thirty hours a week. After that, I was invited to become a member of the staff of the New York University Medical Center, with Walter Thompson as my chief. He had been one of our trainees at the New York Orthopedic Hospital. He said that I would not have to lead a strict schedule but that whatever teaching I did, wherever I did it, would be sufficient for him to have me on the staff as a clinical professor. So, I have continued in that position, and although I now and then go in and give lectures to his residents, most of my teaching is done outside the city.
When I did move to Connecticut, my friends in New York thought it was a very bad move to give up such good connections in the city and go, as they called it, “into the wilderness.” Many people said, “Well, I guess you’re retiring, or semi-retired.” Actually, although it was a strange thing to many of the fellows with whom I worked in Stamford and Greenwich to teach and to write and to attend meetings, I did continue all of these things and continued my sixty-hour a week, six days a week schedule of patient care.
So, moving to Connecticut meant a very radical change in many ways. First, no one was familiar with orthopedic operations. So it was necessary not only for me to train the girls in the operating room and to work out new plans with the anesthetists and to demonstrate to the radiologists just what orthopedic roentgenograms were and what they meant, but to train orderlies and nurses on how to put on braces and use various appliances in connection with orthopedic work. We didn’t have specialist orthopedic nurses as we had in New York. So this was a pioneering type of period but a very exciting one, having been spoon-fed in New York, to start all over in a sort of pioneer atmosphere.
The work grew and developed and had other phases. Not only was this a form of teaching, but also the whole staff was unaware really of what orthopedics was and what it could do. At first there had been some resistance for fear that I would take away, as they expressed it, “the bread from their mouths,” but I soon assured them that I was interested in doing what they had not been doing and not taking away what they were doing, particularly if they were doing it well. The general surgeons, for example, were doing fracture work and doing it reasonably well, although hadn’t gotten involved with open fracture surgery. We had no interns and my assistants in the operating room were usually the general practitioners who referred the patients, which helped them to find out what orthopedics was all about. Sometimes this was difficult because in the midst of an operation they might suddenly remember that they had an appointment and have to leave, and this wasn’t always fortuitous.
We had no interns in those days and no teaching program but the staff itself was interested so with the slides which I had from New York and from the material from my book, I was able to develop a teaching program for orthopedics, first for the surgical staff and then for the medical staff. This became the nucleus of the teaching program, subsequently, when we began to get interns and residents, not in orthopedics but for medicine and for surgery. So actually, this was the initiation of the teaching program in the Greenwich Hospital. In the meantime, of course, groups like the Pediatrics Society were interested in orthopedics, which seemed to be coming to Connecticut. I was invited on their programs to teach them the diagnosis of displaced hips and slipped epiphysis, and so forth, which was very fine because this made it possible for early diagnosis and early treatment which I considered essential, and [which] I considered to be modern orthopedics at that time.
I was also invited to the state societies and continued in the national societies. With the new material in Greenwich as well as the basic material I had in New York, I was able to continue writing and to develop the new papers, including the material from all of these sources. In 1951, I was invited to attend the big international meeting called (spells) S-I-C-O-T, for Society International for Orthopedics and Traumatology. This was held in Stockholm, Sweden. This was the beginning of my international orthopedic activities, although I was not on that program.
While there I met a number of orthopedists, including Lieberg from Sweden and Robert Jaudet(?) from Paris who was then very much in the limelight because of his hip prosthesis operation. I did go and spend a week with him seeing his operation and subsequently came back and introduced it in the hospital in Greenwich. In the meantime, I had talked with those two men regarding the possibility of organizing an international small group of orthopedists so that we could really take up where the other meetings left off. Although this took some time to develop, and perhaps we’ll refer to it again later, this was its beginning, when I began my international career. So, the teaching in those days had many phases.
I found the teaching of medical students to be interesting but the medical students themselves were really not very concerned because most of them were not really going into orthopedics and in that sense undergraduate teaching was relatively unrewarding. I was given the teaching of the undergraduate nurses at the Greenwich Hospital and we also did have sessions for the graduate nurses because they, too, had not been trained in orthopedics. So we had a rather broad teaching program locally as well as generally. All of this led to writing, and it’s been my custom for many years to write two papers: one for oral presentation and one for publication because there are differences, not only in time and content, but also in the manner of presentation between oral and written. I found this a very good approach to these various articles.
How did Orthopedics develop in your part of Connecticut?
On coming to Connecticut, naturally with my exposure to joint tuberculosis and polio and so forth in New York I was thinking in these terms and suspected every swollen joint of being tuberculosis. Actually, none of them were; I never found a single fresh case of joint tuberculosis in twenty-five years in Connecticut. And polio rapidly disappeared because Greenwich was one of the first towns in which the vaccine was used, so we ceased getting early cases, but still had some residual cases. So instead of the greater volume of practice being related to these two problems – and also scoliosis, which was uncommon in our part of Connecticut – the nature of the practice was entirely different. The most common problem was low back ache and with it, often associated, sciatica. There were many sports injuries as the people in the Greenwich area were sports-minded. These were not the big injuries such as occur in professional football, but we did have torn knee cartilages and a great many skiing injuries. With the highways nearby and [driving] speeds much greater than in New York City, we had more serious automobile injuries and occasionally motorcycle injuries.
So, the nature of practice in Greenwich became quite different from the nature of practice in New York. Between the development program, the nature of the orthopedic practice itself, and a radical change in the teaching program – particularly in relation to the audiences to which it was directed – the whole situation in Connecticut for me was quite different and my wife and I called it our “second career.”
The international part of our activities developed considerably so that usually each year we made one or two trips to some foreign country, centered around some meeting. I became involved with a number of international associations, so that generally there were one or two meetings which involved me _____(?). These would be used as a focal point for other activities in orthopedics, such as being visiting professor or giving lectures and, occasionally, even operating in other countries. So the international aspect of my teaching developed considerably. Not only did I teach, but also I learned. I found always that it is possible to learn from everyone, from every situation, and in every country. Although sometimes other countries are called backward in some ways, I found that in orthopedics there were always men in each country who were very forward-looking and were very forward-acting in the practice of orthopedics. There was always something that I could learn, so it was a two-way street and a fair exchange, when I was able to help them and they were able to pass on some of their knowledge to me. This, I think, is essential in today’s world, so that we must first have communication; second, understanding; and third, an interchange of ideas and practices for all of us in medicine – which is one of the great joys of medicine – to remain way out in front.
Were you concerned with medical and orthopedic meetings?
Yes. Not only meetings but [the] various societies. In the course of these activities I was invited to become a member of the Canadian Orthopedic Association and after being the guest speaker for the president at one meeting, and subsequently, in a similar manner, a member of the Japanese Orthopedic Association. Because of my contributions in other countries, I was made an honorary member of the Societies of Orthopedics and Traumatology in Guatemala, Chile and Turkey and of the Latin American Association of Orthopedics and Traumatology and the South African Orthopedic Association, as well as the more local Louisiana Orthopedic Association and the New Haven Orthopedic Association. In addition, I am a member of the International Orthopedic Society, which I mentioned, the Pan-Pacific Surgical Association of which I was Orthopedic Vice President for one term, and a corresponding member of the New Zealand Orthopedic Association. I don’t like to be a member of anything unless I am active and participating and in all of these organizations I had, and continue to have, an active part.
What are your medical society connections?
I mentioned the foreign and honorary memberships. Of course, I’m a member of the American Medical Association, the American College of Surgeons, the American Academy of Orthopedic Surgeons and the American Orthopedic Association, of which I was vice-president in 1962 and I was President in 1963. I’m a member of the American Association of Bone and Joint Surgeons, and a founder and sponsor of the orthopedic journal, Clinical Orthopedics. I have been a member of the Interurban Orthopedic Club, which was the first orthopedic club, I believe, in the world, founded in 1907, since the early thirties. For the past thirty-five years [I] have been secretary of that club, which unintentionally apparently is some sort of record. I’ve long been a member of the Orthopedic Research Society.
We have several correspondence clubs and I’m a member of two of these. The first one was called the Orthopedic Correspondence Club, founded by Irvin and Clyde Bryant of Oklahoma City. The idea was that there would be fifty-two members and that each one would be assigned a week and during his week write a letter to the other fifty-one members. The early members were all, or nearly all, Americans. It operated in that fashion for a good many years and I became one of its relatively early members.
Another group, called The Spectators, founded on the same plan, has subsequently become more interested in having foreign members, although the Correspondence Club has quite a number now. I’ve been able to help in adding foreign membership because of my connections in other countries, so that The Spectators Club now is about equally divided between foreign and American members – about fifty of each. This means that first, we exchange ideas in orthopedics – often material which has not yet reached publication. Second, of course, we exchange friendships and this has been an important aspect of these clubs. Third, we can exchange information along any lines which we choose, such as our personal lives, our travels, thoughts, philosophy, and so forth. This has side benefits in that not only has this been very effective in these ways, but also we try to have at least once a year at some meeting a luncheon or a dinner so that particularly the foreign and American members can get together.
There are other benefits, too. For example, I was going to Egypt – only to Cairo – on one of my trips which involved a number of countries. I wrote to a member of the Correspondence Club and said that I was coming to Cairo and asked if there was anything that I might do for their orthopedic association. He lived in Alexandria, which is some distance from Cairo. He replied that he had arranged for me to give a lecture to the Cairo Orthopedic Association and that everything would be in order. When my wife and I checked into the hotel in Cairo, we had no idea of seeing anyone that we knew. But a half hour later the phone rang and we were told that this doctor was downstairs in the lobby waiting for us. He had driven 150 miles to come to Cairo from Alexandria to welcome us. I said, “Why did you do this? It’s taking your time and effort and it wasn’t really that important.” He said, “Well, I’ve known you for ten years; I have a copy of your book and I’ve studied it from cover to cover, as well as being a mutual member of the Correspondence Club.”
This has happened on a number of occasions in various ways, and it’s been one of the joys as well as a benefit of such international contacts. We have felt that all of these things were not only professionally worthwhile but helpful in developing orthopedics around the world, as well as developing a sense of international understanding and good will.
Tell me more about this international society that you founded.
We decided, as with our Interurban Orthopedic Club, to limit it to twenty-five members, so that we really could get close together in our exchange of ideas and in our friendships. This did not include those who might subsequently pass the age of sixty-five and thus become senior members so that they were not counted in the group. It took us a little while to get started, but we had our first meeting in 1960 in Greenwich, Connecticut, with ten charter members and proposals for additional members. At the next meeting in Oxford, England and at Ridington, with [John] Charnley, who has done so much in developing the total hip prosthesis operation, we just about filled our full complement of twenty-five members. Our qualifications for membership were first, that one must be a distinguished orthopedist in his own country; second, that he must be able to communicate in English because we weren’t able to set up a translation system; and third, that he be willing and able to regularly attend the meetings.
Our club has been very successful and we now are in our fifteenth year. We have had our last meetings in Geneva, Switzerland and in Munich, Germany. In our coming meeting in July of this year, we will meet in Paris and in Rotterdam. This will just about complete the circuit of all of the countries and cities represented in our group. We do have a member from Hong Kong who has long been internationally distinguished in orthopedics. Now we do have a member from South Africa and now two members, including a senior member, from South America. So aside from Australia, all continents are represented. Australia is considered too far to come to this meeting, which we can understand. We have limited the number of members from the United States to four; Canada and Britain to three, and the other countries to one, two or three, so that we would have a good distribution in this total membership. This has proven a very great success in that we’ve had excellent meetings, we have fine friendships, and we’ve had a wonderful exchange of ideas in our various meetings and our other contacts.
What is the official name of this society?
The International Orthopedic Society.
Can you summarize your work for us?
As mentioned, my work has consisted of the three important phases of medicine, those that I consider important: patient care, investigation, and teaching and writing. These I have pursued all of these forty-eight years since I’ve been in orthopedics, plus the two years [when] I started my training in surgery. It has been possible because I have been in control of my schedule since moving to Connecticut to be available for these various meetings and trips in other countries. I have thought that, for me at least, this was better than being too involved with one institution and with administrative work. During this time I have written three books: The Textbook of Orthopedics, a subsequent one called Examination of the Spinal Extremities, and a third one called Injuries of the Spine. For the latter I needed material on the neurosurgical aspects of orthopedics. I had trained and worked with Dr. William V. Cone, who subsequently went to the Montreal Neurological Institute. After his death, Dr. Gordon Petrie, who was the orthopedist who had worked with Cone, was able to obtain for me quite adequate material for that portion of the book on Injuries of the Spine.
Altogether, there have been some sixty-five papers on orthopedics, a dozen or so for Consumers Research, several for nursing journals, and several for the mountaineering journals. In addition, there have been many talks, some of which have not yet been published – some of which would not be published – and my activities with such groups as the Rotary Club. My special interests have been, as mentioned, congenital displacement of the hip, slipping of the capital femoral epiphysis, and dynamic posture, which has really been well-developed and is pretty much unique, and especially low back problems in more recent years. [Other interests are] skiing injuries, as well as some other aspects of trauma. [Through] these, I think, I’ve been able to make contributions which certainly have been worthwhile. My most recent activity was in Los Angeles where I was asked to initiate the new chair of Orthopedic Surgery at the University of Southern California in the Orthopedic Hospital. I’ve just come from that meeting two days ago.
This, then, is a summary of these various orthopedic activities.
What were your other interests and activities – for example, with the Rotary Club?
One is a member of his local Rotary Club, but, of course, Rotary is international. I participated in various programs and on the Program Committee of our club in Greenwich, until about six years ago [when] they asked me to become chairman of the World Community Service Committee. I asked what they would like me to do and they said, “We’d like you to do something because this committee has not been active.”
I thought about various possibilities and recalled that at the mission hospital in Katmandu, Nepal, there was a considerable problem with nurses, because all of their nurses had been brought in from other countries at considerable expense, and they didn’t speak the language and they weren’t familiar with the customs of the people. A nurses’ training school had just been started with considerable difficulty in recruiting nurses who were sufficiently well-educated to be able to take the course. Our club decided to subsidize the education of five nurses of a class of nine. My wife and I had one of these as our special nurse and the club subsidized the other four. This group graduated three years ago and we’re very proud of them. They’ve become very effective in the nursing care in their country. We started with the new group then, and are now beginning the third year with the second group. This was sufficiently unusual to have been, without our competing, awarded the district prize of the Rotary group. We’re very proud of this achievement in our club.
In addition, I’ve been asked to speak to many groups on many subjects, such as our local historical societies, our church groups, geriatrics or retired persons groups, and sometimes young groups such as the Boy Scouts. This has involved a variety of subjects. Altogether, in the Rotary Club I have been, for our local group, on twenty different programs as well as programs in many other places, such as Jackson, Wyoming and Aspen, Colorado, Bermuda, and even foreign countries.
Could you tell us of your whitewater canoeing?
This simply means being able to carry the canoe safely down through the rapids. There should be enough water in the stream to float the canoe between the rocks. Once, I remember, we went in relatively low water and the canoe got stuck on two rocks and broke into pieces. We use either an ordinary canoe or a fork boat. A fork boat is a folding boat which can be taken apart and easily carried inside a car, and stored under a bed. My wife and I were able to assemble our boat in about fifteen minutes. We used to make a fifteen- or twenty-mile trip down river in one day. Actually, we paddle backwards when we come to the critical places in the rapids, because if one is going slower than the stream the chance of disaster is much less, and the control of the canoe or fork boat is much better than if one is going faster than the stream. This is a very pleasant and exciting sport and quite different from mountaineering and skiing.
Have you continued to ski?
Yes, and I’ve been a member of the Rocky Mountain Society of Traumatology since the second year of its formation, at which time I was asked to come out and give a paper by one of the founders of the group. I was then put on the Program Committee and have given many papers for them at various times.
In connection with that, I, as well as other members of the group, have been skiing in Colorado. I had previously been skiing in New England for many years, as mentioned before, when I learned to ski. This was very nice in a way, because in Colorado we could depend much better on the weather and on the trail conditions. Instead of taking a quick weekend trip up to New England, it seemed much better to concentrate our skiing in two or three weeks. We have skied in other places in Colorado, such as Arapaho and in other places in this country, such as Sun Valley, Idaho and often near Salt Lake City. We’ve had two trips to the French Alps and three to the Swiss Alps, which were very exciting, not only because of the skiing but because if we wished, and I think we did, one can ski up on the glaciers. But of course, this is a different technique because it’s necessary to keep under complete control in order to avoid falling into crevasses.
At one time, the guide and I did climb the Grenz glacier between the Monta Rosa and the Lyskamm, two of the highest peaks in the Alps – an altitude above 14,000 feet. This was about five horizontal miles and about six or seven thousand vertical feet on skis, with no lifts. Then we skied down together, roped and under control the whole length of the glacier. Perhaps this might be called our most exciting excursion on skis.
Have you continued to climb mountains?
Yes. We haven’t always been able to do it as often as we would like because we’ve been too involved with meetings and can only afford so much time and expense. Last year, for example, we had eleven meetings and I was on twelve programs, so we didn’t do any climbing. In the previous year we had this third trip to South Africa and that, too, prevented our climbing. But the previous year we went to Switzerland and Austria and spent three weeks there on a pure vacation with no orthopedics. One day we took a bus trip to see the country, but the other twenty days I was climbing or conditioning in the mountains. This meant all together in 20 days about 150 miles of up-and-down walking at altitudes up to 10,000 feet, in addition to a vertical ascent and descent of three to four thousand feet each day. This is a sample of the kind of thing that we have done many, many summers, sometimes in Wyoming, and sometimes in the Alps. This includes not only the Swiss Alps but the French, Italian and the Austrian Alps – the four major Alpine countries.
At one time I was invited to participate in the meeting of the Winter Sports Association of the five Alpine countries – their languages being French, German and Italian – I being the only one who normally spoke English, although many of them, of course, speak and understand it. I gave my paper in French. That was the only time that I’ve given a paper in a foreign language but it was an interesting experience. So, we have and intend to continue skiing and mountaineering. The four questions I’m commonly asked are “Are you still in practice,” “Do you still ski,” “Do you still climb,” and “Do you still travel?” The answer to all four questions is “Yes.”
What are your community activities?
Well, I mentioned the Rotary Club activities, and in addition to that, which I think I’ve fairly well covered, the fact that I do talk to various groups. One of the last talks I gave was to a high school group on the selection of a career, with special reference to medicine. I know of no generation gap; I think gaps between people are produced by people. There are all kinds of gaps if people are looking for them and there are ways of bridging these gaps. Likewise, in traveling in foreign countries, I don’t consider that we have a language barrier. It is true that Americans and British people tend to expect everyone else to talk their language rather than to bother to learn the language of some other country. I find that if one learns even a few words of the language of a foreign country, this immediately makes people more friendly. I think of language not as a barrier but as a bridge. If we don’t cross the bridge it’s our fault; it’s not the fault of the language.
So, my community activities are related not only to the community in which we live, but we consider ourselves part of a world community and consider our relationships with our friends – contacts in other countries – as also community activities.
Could you tell us something more about your travels?
Since 1951 most of our travels have been centered around meetings. Before that, we often made skiing trips and mountaineering trips which had no connection with meetings. Usually, with any meeting as a focal point, there are several other connecting meetings. For example, when we had a meeting of the Western Pacific Orthopedic Association in Hong Kong, there were subsidiary meetings in Malaysia and Singapore. I had been asked to let certain friends know whenever I came their way, so we started that trip by having a meeting in Anchorage, Alaska. We continued with a meeting in Taipei, Taiwan, following a meeting in Sapporo, Japan with our Japanese friends. Then, the big meeting in Hong Kong and the subsidiary meetings in Malaysia and Singapore, which meant a total of six meetings in that one trip. This is representative and was done on quite a number of occasions.
Another time we started with a meeting in Montreal and continued with a series of meetings in Britain of the American Fracture Association, then went down to Uganda where I served as visiting professor for some days and from there to South Africa. So that, too, turned out to be a string of meetings. When we met in Australia or New Zealand, often that has been connected directly or indirectly with a meeting in Hawaii or some other place along the way.
We have many interests and we relate our travels to the situation in the various countries. For instance, we made a trip to Greece – this was made on a boat, stopping in various ports. There was a faculty from Oxford and Cambridge which lectured on the art, archaeology, sculpture [and] history of ancient Greece. We attended the lectures in the morning made field trips in the afternoon, and of course took pictures as we went along the way. So my slide collection includes many photographs of the great [antiquities] of Greece and our experience as related to things of interest there.
The same thing applied when we went to Egypt. But when we go to East Africa, of course our interests become those of that country. In New Zealand, for example, we were interested in the Maori people, the people who were there when Captain Cook arrived and have subsequently largely been integrated into the British population on the islands. If we go to Australia, we are interested in the aborigines; to the north islands of Japan, the _____(?) In many countries to the geography, the geology, the architecture, the archaeology, the way of life, even the dress and food and the art of people, like the Japanese, whose whole traditions and society are in many ways different from ours. Yet, basically they are people like ourselves and we find them to have many common characteristics and, incidentally, to be very fine people and very fine hosts.
Is there anything else you would like add to this oral history interview?
It’s been a privilege to record this and I hope that it’ll be of interest and use to others. We have had, my wife and I, a very interesting and fascinating and exciting life with a variety of facets to it. Our professional life, our international life, our community life – this has all been of great joy and interest. We feel that we have been especially fortunate in being able to do all of these things and to relate to them and to participate in them instead of just wandering through as a tourist, for example, and really not comprehending very much of what it’s all about.
This approach to travel can be a great help in learning what the rest of the world is doing, why it’s doing it, how it’s doing it. We never like to go to a country and say, “We know how to do it better than you do.” Often, in some ways, other people know how to do things better than we do. Our way of life is not necessarily their best way of life. Our intense industrialization and commercialism actually has destroyed many values in our country and I don’t think that all the other countries in the world should try to be like us.
I am distressed at times when I find that in some countries the things which they imitate are the things which I would consider bad characteristics, such as drug involvement, such as the girls dressing in high heels in the middle of the day instead of wearing their comfortable shoes, such as people changing their dress from their beautiful feminine wear to some of our horrible-looking feminine clothes. Certainly, in neatness and in posture we find much to be envied in the conduct of people in other countries as compared sometimes with our own.
I think, however, that in our country, now that we have deteriorated in many ways, there is a great opportunity for a renaissance and I trust that this will come. Certainly, those of us who feel that way can assist, each in our small way, in seeing that this does come. I encourage other people to retain their great traditions and their great art and other things which have come down to them rather than to try to change this and make it all American. On the other hand, there are things that we can contribute to other countries and which we have contributed. For a long time, we drew from Europe, but in the past decade or two it’s been our privilege and opportunity to pass on, particularly in orthopedics, some of the things that have been developed as well as originated in our country.
[To interviewer] Thank you very much for this opportunity.
Thank you for participating in this interview, Dr. Howorth. This concludes Oral History Interview #16.