picture of James Herndon, MD, MBA

James H. Herndon, MD, MBA, is the William H. & Johanna A. Harris Distinguished Professor of Orthopaedic Surgery at Harvard Medical School and Chairman Emeritus of Mass General Brigham’s Department of Orthopaedic Surgery. Dr. Herndon has long been interested in patient care, working with more than 1,000 patients who underwent amputation at Valley Forge General Hospital during the Vietnam War. He played a key role in the early development of orthopedic surgery across Mass General Brigham (formerly known as Partners Healthcare), and has chaired orthopedics departments and directed surgical fellowships across the country.

Dr. Herndon has held leadership positions in many national medical organizations, including the American Academy of Orthopaedic Surgeons (AAOS), the American Orthopaedic Association, the Journal of Bone and Joint Surgery and the Academic Orthopaedic Society. His interest in the history and evolution of the field to which he has dedicated his career led to the recent publication of a five-volume history, Birth of A Specialty: A History of Orthopaedics at Harvard and Its Teaching Hospitals. Below, Dr. Herndon shares more about this project and the history of orthopedic surgery in the U.S.

picture of the four volume set of Birth of a Specialty

What led you to Boston and Mass General?
I was a resident in the Harvard Combined Orthopedic Residency Program (1966-1970). After, I spent two years in the amputee service at Valley Forge General Hospital before going into private practice for four years in Michigan. I then served as chairman of orthopedics at Brown University for 10 years before going to the University of Pittsburgh where I was vice chancellor for health sciences and vice president for medical affairs. In 1998, I was recruited back to Mass General to develop an orthopedic department across all Mass General Brigham hospitals. Over five years, we made some progress, but realized it was going to be a much longer and more complex project. I stepped aside when I was 65, but continued running the residency program for another five years.

In 2008, I retired and began working on my book. I had to have something to fill my time and focus my energies on, and the book was wonderful for that.

How did orthopedics first emerge as a field in the U.S.?
18th century surgeons did a little of everything and typically dealt with the extremities. Surgery was largely done to amputate damaged or diseased body parts. Orthopedists at this time were known as “belts and buckles” doctors, because they rarely performed surgery, and instead were focused on using traction, straps, wooden splints, and other devices to manipulate and shape the bones and muscles as they grew. For this reason, orthopedists typically focused on treating pediatric spinal deformities, like scoliosis, as well as congenital deformities of the foot, like clubfoot. Orthopedists also commonly treated fractures non-surgically with casts or splints. Because of the need for this sort of treatment, especially during war times, more doctors were drawn to the field.

In the 1830s, Dr. John Ball Brown was one of the first surgeons to limit his practice by opening an orthopedic institute in Boston—just a few blocks from where Mass General now stands. Dr. Brown and his orthopedic-trained son, Buckminster, were the first to bring the specialization to the U.S., starting right here in Boston. In the early 20th century, American medical schools began to offer specialized training programs for doctors to focus on orthopedics.

How do competition and collaboration intersect in the pursuit of innovation?
There's a lot more cooperation now due to the complexity of research projects and the ease and speed with which researchers can collaborate and share information globally. I’ve found that collaborative efforts that cross barriers lead to much more innovation, rapid improvement of patient outcomes, and the proliferation of new knowledge. For complex research projects, researchers need to work with scientists and physicians in different fields to test their hypotheses from every angle.

How did sports medicine begin as a specialty, and why do you think it emerged from orthopedics?
Sports medicine started at Harvard Medical School (HMS) when many surgeons started to care for athletes on a voluntary basis. One such surgeon was Dr. Edward Nichols, HMS pathology researcher and former chief of surgery at Boston City Hospital. He became the first team physician in the U.S. and was essential to the founding of sports medicine, publishing some of the first reports on athletic injuries.

In 1905, there was a series of deaths from football injuries at U.S. universities, and President Theodore Roosevelt called a meeting of the coaches at Harvard, Yale and Princeton. Dr. Nichols was the only doctor in attendance and helped form the NCAA. He also went on to develop a concussion protocol that stipulated that if a player sustained a head injury, the doctor overseeing the game would ask them a series of questions. If they couldn’t answer, they would come right out of the game. He also developed helmets and pads for the shoulders, thighs and knees, which significantly reduced the number of concussions and injuries. Dr. Augustus Thorndike, a surgeon at Mass General and Chief of Surgery at Harvard University Health Service (1931-1962), later built on Dr. Nichols’ work, improving the design of protective pads and helmets, and recommending that physicians be present at all contact sports. During that period, physicians would treat sports injuries with massage and heat. Dr. Thorndike discovered that heat actually aggravated bleeding, and instead instituted using ice for an acute injury and compression to stop bleeding—a practice still used today.

How have Boston and Harvard orthopedic doctors played a role in innovating the care of war injuries?
In World War I, orthopedic doctors were still utilizing non-surgical mechanical treatments and apparatuses, and doctors were typically either orthopedists or surgeons, and both groups were somewhat skeptical of the other. That changed when Dr. Robert Osgood, former chief of orthopaedic surgery at Mass General, emphasized that orthopedic surgery should be recognized as a significant surgical field that requires clinicians in the field to become excellent surgeons.

There were no physical medicine and rehabilitation experts in those days, rather orthopedics did both sides of that equation. After Dr. Osgood, orthopedic surgeons began to offer conservative, non-operative care, like traction, while also operating. Physical medicine and rehabilitation developed alongside the development of orthopedic surgery to handle long-term, non-operative treatments for musculoskeletal problems.

How does Mass General continue to build on this long tradition of orthopedic innovation?
Mass General doctors are still the best of the best; their natural intellectual curiosity, drive to excel and passion for patient care leads them to one of the top research hospitals in the nation, where they work with and learn from Harvard Medical School faculty. Orthopedic surgery has been refined to an exact science that minimizes invasiveness and speeds recovery time – many procedures that would have involved being in traction for weeks in the past are now performed as day surgery! Similarly, non-surgical orthopedic care has benefitted from decades of research and refinement, with new physical medicine and rehabilitation protocols and devices being developed every day. Mass General’s Department of Orthopaedic Surgery offers patients unique, innovative treatments they can’t find elsewhere—for example, the vertebral tethering system John Braun, MD, and the pediatric orthopedic team offers, or the shoulder tendon transfer surgeries Bassem Elhassan, MD, performs, or the orthobiologic treatments the podiatry team administers. In addition, Mass General benefits from the spirit of collaboration that the Mass General Brigham system instills; orthopaedic researchers and clinicians share knowledge freely, both within the MGB system and globally, working towards the common goal of improving patient care. As someone who has worked towards this collaborative model his entire career, it’s exciting to see.

The latest research and innovation from Mass General’s Department of Orthopaedic Surgery is summarized and shared on Advances in Motion.