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John J. Gartland, M.D. (1918-)
Fifth Chairman
Fourth
James Edwards Professor (1970-1985) |
Dr. John J. Gartland joined the
Department as an Instructor after completing his
orthopaedic residency at the Columbia-Presbyterian
Medical Center in 1952. DePalma invited him back
to Jefferson to become his first associate in
practice. This association lasted only one and a
half years because of philosophical differences that
developed between them. DePalma was primarily a
clinician with a huge practice. Gartland, although
he also considered himself a clinician, believed a
large overwhelming practice stifled academic
achievements and took time away from
educational pursuits. Their parting was cordial and
Gartland retained his faculty appointment,
progressively rising through the ranks to be made
Associate Professor in 1968. Like other young
orthopaedists who followed him on the faculty,
Gartland found it difficult to develop much of a
clinical practice of his own at Jefferson during
those years and did most of his clinical work at
other hospitals. He was an attending orthopaedic
surgeon at Fitzgerald Mercy Hospital (1954-1960),
Chief of Orthopaedics at Methodist Hospital
(1960-1968) and Chief of Orthopaedics at
Lankenau Hospital (1968-1970).
Gartland had a deep interest in orthopaedic
education. He wrote Fundamentals of Orthopaedics
a textbook for medical students, in 1965, that
received national acceptance and by 1986 was in its
fourth edition. He was a faculty member in many
of the continuing education courses sponsored by
the American Academy of Orthopaedic Surgeons
and was a frequent contributor to the orthopaedic
literature. In 1966 he was invited to become an
associate editor of the Journal of Bone and ]oint
Surgery the official publication of the
English-speaking orthopaedic world. He was the
first Jeffersonian to be so honored, and he
remained active on the editorial board until 1978.
Gartland's reputation as an educator grew, and he
was elected to membership in the American
Orthopaedics Association in 1968.
When Dr. Gartland accepted the Chairmanship
in 1970 he became the first full-time Professor
of Orthopaedic Surgery and the fourth James
Edwards Professor. He saw as his immediate task
the need to strengthen the full-time orthopaedic
faculty component to complement the volunteer
faculty already present and to restructure the
residency program to correct the educational
imbalance previously noted by the Residency
Review Committee for Orthopaedic Surgery.
Rather than build an educational structure around
the clinical practice of one physician, Gartland
believed in a broader based educational program
in which the students and residents could be
exposed to many teachers, but still one in which
the Chairman retained a directing and supervising
role.
By 1970 Thomas Jefferson University Hospital
had become a sophisticated medical center with a
significant level of tertiary care demands. The
medical college student body had been enlarged,
leading to an increase in the number of affiliated
hospitals required for the undergraduate teaching
programs. In orthopaedics, specialized care was
required for children's orthopaedic problems and
for surgery of the hand. The University Hospital
was well suited to provide this specialized care. As
noted previously, James Hunters group of hand
surgeons was formally incorporated into the
department structure as the Division of Hand
Surgery. By 1985 this division was supporting four
fellowships in hand surgery and was totally
incorporated into the teaching programs of the
Department.
Dr. Roshen N. Irani was brought from
Children's Hospital in 1972 as the full-time Chief
of a Division of Pediatric Orthopaedics within
the Department. An affiliation agreement was
negotiated with the A.I. dupont Institute in
Wilmington, Delaware, to provide an additional
rotation in pediatric orthopaedics for Jefferson
residents. In 1982 an additional rotation for
Jefferson residents in pediatric orthopaedics was
negotiated with Shriners Hospital of Philadelphia
when it became apparent that the Children's
Hospital at Elizabethtown might be incorporated
into the structure of the new medical school at
Hershey, Pennsylvania.
Three men who had trained in orthopaedic
surgery at Jefferson under DePalma now headed
the orthopaedic services in three of Jefferson's
major affiliated hospitals. Phillip J. Marone was
Chief at Methodist Hospital, Dr. Hal E. Snedden
took over at Bryn Mawr Hospital, and Dr. John J.
Dowling replaced Gartland at Lankenau Hospital
in 1970.
These affiliated hospitals were incorporated
into the newly designed program to provide an
experience for the residents in community
orthopaedics and trauma. Jefferson's additional
agreement with the Wilmington Veterans Hospital
allowed orthopaedic resident rotations to that
facility for further broadening of the resident
educational experience. Cooperative programs were
arranged with the Department of Rehabilitation
Medicine and the Division of Rheumatology
of the Department of Medicine at Jefferson. By
1974 the restructuring of the resident education
program was complete and was renamed the
Thomas Jefferson University Affiliated Hospitals
Program, with a total complement of 24 residents.
The new program received full approval from the
Residency Review Committee for Orthopaedic
Surgery. The restructuring proved successful and
gradually developed a national reputation for its
excellent clinical and academic background. By
1980 the program was regularly receiving in excess
of 350 applications yearly for the six first-year
positions from students of the best medical
schools in the country.
Gartland viewed himself as orchestrating the
best out of all the component parts of the
Department. He believed that all the available
strengths should be used adequately and fully
to provide a well-balanced education for students
and residents. He encouraged and supported the
development of special clinical interests among his
faculty members.
Dr. Jerome M. Cotler became the third full-time
member of the orthopaedic faculty in 1973. Cotler had finished his residency under
DePalma in 1957 and opened a private practice in
Bridgeton, New Jersey. Because of an interest in
academic orthopaedics, he gave up private practice
to join Gartland as a full-time general orthopaedic
surgeon. He proved to be a hardworking and
effective member of the faculty, rising eventually
to Professor of Orthopaedic Surgery and
Vice-Chairman of the Department. He added
many clinical strengths, particularly his
involvement with the Spinal Cord Injury Center;
Thomas Jefferson University Hospital had been
designated the regional Spinal Cord Injury Center
of the Delaware Valley in 1979. This was a
multidisciplinary team effort involving the
Departments of Rehabilitation Medicine,
Neurosurgery, and Orthopaedic Surgery. Cotler
was appointed a CoDirector of this Center and
supervised the orthopaedic aspects of the patient
care programs.
Cotler was well regarded nationally and served
in many important posts, including Chairman of
the Board of Councilors of the American Academy
of Orthopaedic Surgeons in 1975 and President of
the American Board of Orthopaedic Surgery in
1982. He was a frequent contributor to the medical
literature and received the Christian R. and Mary
F. Lindback Award for Distinguished Teaching
in 1979. He remained active in the continuing
education activities of the Academy for many years
and was elected to membership in the American
Orthopaedic Association in 1979.
Gartland turned his attention to reorganizing
the orthopaedic research laboratory that had been
acquired a decade before, but which had not been
effectively utilized in the period 1970-1974.
He recruited Peter Frasca, Ph.D., who was a
postdoctoral research fellow at Albany Medical
College. Frasca's doctorate was in biophysics but
his research interest was in bone as a tissue. He
joined the Department in 1975 as Research
Assistant Professor of Orthopaedic Surgery and
Director of the Orthopaedic Research Laboratory.
He later obtained a secondary appointment in the
Department of Anatomy that enabled him to
involve graduate students in his research projects.
He was able to obtain National Institutes of
Health funding for many of his research efforts
and subsequently obtained the first scanning
electron microscope on the Jefferson campus.
Podiatry
The care of the feet for such things as the clipping
of nails and the trimming of calluses was an area
that most physicians were willing to relegate to
podiatrists. There had been a question about
which of those procedures constituted foot surgery
and whether such procedures could be safely and
legally performed at Jefferson by podiatrists. Dr.
Arthur E. Helfand, Professor and
Chairman, Department of Community Medicine,
Pennsylvania College of Podiatric Medicine, had
been providing podiatric services in the hospital
and clinics for several years but there was no
clearly defined program for him, and therefore his
teaching activities were casual. In March of 1977
negotiations were started to integrate him and
his work into the Jefferson Medical College and
Thomas Jefferson University Hospital Staff.
Considerable opposition was met, but because his
services and teaching were valuable, particularly
to the Division of Endocrinology and Metabolic
Diseases, Dr. Gray, Chairman of Medicine,
persisted. An arrangement was completed whereby
Dr. Helfand received a hospital appointment in
the Department of Orthopaedic Surgery in the
category of Specified Professional Personnel, to
provide consultative services on inpatients and
perform minor procedures under local anesthesia
at the bedside or in his clinic. His academic
appointment was Adjunct Professor of Medicine
(Podiatry). His Ambulatory Clinic was established
in the area of the Division of General Medicine.
Residents in Medicine and students, during their
medical clinic clerkship or while on their elective
program had the opportunity of working with Dr.
Helfand. He authored Clinical Podogeriatrics (1981),
Rehabilitation of the Foot (1984), and Public Health
and Podiatric Medicine (1987). In March 1985, his
appointment was changed to Adjunct Professor of
Orthopaedic Surgery (Podiatry).
Further Departmental Expansion
The full-time component of the orthopaedic
faculty was raised to four when William C.
Hamilton (Jefferson, 1971) became Assistant
Professor of Orthopaedic Surgery in 1978.
Hamilton had received his orthopaedic education
at Jefferson, completing the program in 1976. In
the spring of that year he was selected by the
American Orthopaedic Association as one of its
four North American Traveling Fellows. These
fellowships, sponsored by the American
Orthopaedic Association and awarded yearly to
senior orthopaedic residents selected by a
committee as the best in the country, included a
four-week tour of selected orthopaedic centers in
North America and Canada. A group of these
Traveling Fellows visited Jefferson twice during
Gartland's term as Chairman. Hamilton left the
full-time faculty in 1982 to go into private practice
at Lankenau Hospital but remained active in the
Department's teaching activities. |
The position of Assistant Professor of
Orthopaedics on the full-time faculty was again
filled in 1983 with the recruitment of Eric L.
Hume. Hume had graduated in medicine from
Syracuse but had come to Jefferson to obtain his
graduate education in orthopaedic surgery,
completing the program in 1983. He proved a happy
choice because of his interest in academic
orthopaedics. He reorganized the resident teaching
program, assisted in teaching biomechanics and
psychomotor skills and, in 1985, organized and
directed Jefferson's tirst metabolic bone disease clinic.
Gartland inherited a volunteer group of the
orthopaedic faculty who had been working at
Jefferson since Dr. DePalma's time. Among them
were Drs. John M. Fenlin (Jefferson, 1963),
J. David Hotfman (Jefferson, 1956), and Renato
J. Nardini. These men joined enthusiastically in
the Department restructuring and contributed a
great deal of time to the teaching programs.
Fenlin developed a special interest in the shoulder
joint, including clinical and basic research.
Dr. Scott Jaeger (Jefferson, 1972) joined the
Division of Hand Surgery in 1979 after completing
his orthopaedic residency at Jefferson and a hand
fellowship at the University of Louisville. Dr.
Sanford H. Davne, who finished the orthopaedic
program at Jefferson, joined the volunteer faculty
in 1981 and confined his clinical work to Thomas
Jefferson University Hospital. Dr. Mario J. Arena,
who finished the Jefferson Residency in 1984,
joined Drs. Fenlin and Nardini in practice in 1985,
thus further swelling the ranks of the volunteer
faculty and contributing to the teaching program
and clinical volume.
Physicians involved with teaching orthopaedics
to Jefferson students or residents at the affiliated
hospitals were offered faculty rank within the
Department. A strong and loyal affiliated faculty
resulted. By 1985 there were eight affiliated faculty
members at Bryn Mawr Hospital, seven at
Lankenau Hospital, three each at Methodist
Hospital and the A.I. DuPont Institute, and two
at the Wilmington Veterans Hospital. Seven of
these affiliated faculty members were orthopaedic
surgeons who received their orthopaedic education
at Jefferson during Gartland's Chairmanship.
In 1971 the senior orthopaedic resident, Dr.
S. Terry Canale, now a prominent orthopaedic
surgeon in Memphis, Tennessee, persuaded
Gartland to undertake the publication of a
Department orthopaedic journal as part of the
resident's learning process. It was planned that
residents would serve as editor and editorial
board, negotiate with the printer, plan the layout,
and solicit some advertising, with the assistance of
a small faculty committee. The idea took hold, and
the first issue of the Jeffirson Orthopaedic Journal
appeared in 1972. It has been published yearly
since then under the same guidelines. In 1973 the
Jefferson Orthopaedic Society adopted the Journal
as its official publication. Since 1973 the cost of
publishing the Journal has been divided equally
between the Jefferson Orthopaedic Society and the
Department. The Journal is distributed free to
members of the Jefferson Orthopaedic Society and
a large group of persons known simply as "Friends
of Jefferson." Since the Jefferson Orthopaedic
Journal has appeared, the Orthopaedic
Departments at the University of Iowa and the
University of Pennsylvania have begun similar
Department journals modeled on the Jefferson
publication.
The Jefferson Orthopaedic Society, founded in
1960 by DePalma, had lost most of its forward
momentum by 1970. It had deteriorated into a
parochial format depending upon orthpaedic
residents, Jefferson orthopaedic faculty, and local
speakers to put on the yearly program. As a
consequence the meetings became less interesting
and attendance dropped off alarmingly. Between
1970 and 1974 Gartland and Cotler, because of
their national contacts, were able to reverse this
trend by the use of all. outside invited faculty. The
Society membership was persuaded to build its
program around a specific orthopaedic theme
selected by the Society officers in collaboration
with the Chairman. National authorities in the
selected area were then invited to come to
Jefferson to present their material. Between 1974 and
1985 some of the most prominent orthopaedic
surgeons in North America and Canada spoke at
the annual Jefferson Orthopaedic Society meetings.
Interest in the Society quickened and registrations
of 175 to 200 people for the meeting became
common. As an additional aid to the resident
education program, a Visiting Professor Program
started in 1972 was scheduled for the spring of
each year. The senior residents chose the Visiting
Professor who canle for a two-day visit.
In September, 1976, Dr. Everett J. Gordon
(Jefferson, 1937), an orthopaedic surgeon then
practicing in Washington, D.C., gave the
Chairman a significant contribution to establish
the Everett J. Gordon Fund for orthopaedic
resident education. Proceeds from this fund
allowed the orthopaedic faculty ro select the "best
resident" each year and recognize the selected
resident at the annual Jefferson Orthopaedic Society banquet. In addition to this recognition,
the selected resident received an appropriate plaque
and an expenses-paid trip to the Annual Meeting
of tlle American Academy of Ordlopaedic Surgeons.
During 1981 Dr. and Mrs. Thurman Gillespy
generously initiated the Gillespy Fund in the
Department to be used for special resident
educational needs for which no other funds were
readily available. Dr. Thurman Gillespy (Jefferson,
1953) completed the orthpaedic residency at
Jefferson in 1958 and subsequently practiced in
Daytona Beach, Florida.
In 1984 Dr. Richard D. Lackman was recruited
to start an adult musculoskeletal tumor service,
the first such service in Philadelphia. Lackman
had received his orthopaedic education at the
University of Pennsylvania followed by a
Fellowship in musculoskeletal oncology at the
Mayo Clinic. The service flourished, and Jefferson
gained additional stature as a center for adult
musculoskeletal tumors. Lackman proved a hard
worker and entlmsiastic teacher.
Gartland was elected President of the
Pennsylvania Orthopaedic Society in 1961 and
the Philadelphia Orthopaedic Society in 1970.
He served as President of the Jefferson Alumni
Association in 1974. In 1977 he was elected
Second Vice President of the American Academy
of Orthopaedic Surgeons, the largest orthopaedic
organization in the world. He became First Vice
President in 1978 and assumed tlle Presidency in
1979, considered the key leadership position in
American orthopaedics. He was the second
Philadelphian and the first Jeffersonian elected to a
leadership position in this organization since its
founding in 1933.
Gartland represented orthopaedic surgery in the
Council of Medical Specialty Societies from 1980
until elected to the Board of Directors of that
organization in 1984. From 1980 to 1985 he was a
member of the Board of Trustees of the Journal of
Bone and Joint Surgery, serving as Treasurer (1982-1983) and Chairman of the Board (1984-1985).
With these elections and appointments he
represented Jefferson in the highest orthopaedic
organizational circles. During 1981 his friends and
associates at Jefferson presented his portrait to the
University. The excess funds were donated to the
Philadelphia Orthopaedic Society to support a
yearly Gartland Lecture.
The period 1980 to 1985 was an exciting time for
orthopaedic surgery at Jefferson and provided
visible evidence of the tremendous growth that
had occurred in the Department since its founding
in 1904. During one four-year period, 1979 to
1982, members of the Jefferson orthopaedic faculty
held the three most highly regarded positions in
organizational orthopaedics. Gartland was
President of the American Academy of
Orthopaedic Surgeons in 1979, G. Dean MacEwen
(affiliate faculty) was President of the American
Orthopaedic Association in 1981, and Jerome
Cotler was President of the American Board of
Orthopaedic Surgery in 1982.
Dr. Gartland retired on December 31, 1985, to
become the James Edwards Professor Emeritus of
Orthopaedic Surgery. He then continued his
academic career at Jefferson as Director in the
Office of Departmental Review.
Richard H. Rothman, M.D., Ph.D.
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