On Tracing the History of Hospital for Special Surgery: Q&A With Dr. David B. Levine of HSS

Written by Carrie Pallardy | August 01, 2013 | Print  |

Dr. LevineDavid B. Levine, MD, a practicing orthopedic surgeon from 1966 to 1995 and the former chief of scoliosis at Hospital for Special Surgery in New York, discusses his new book Anatomy of Hospital. He is currently the chair of the hospital's archives committee. In this history of Hospital for Special Surgery, Dr. Levine traces the hospital's roots from its founding as a small, private hospital for disabled children to its present as one the most well known names in orthopedics.


Q: What was the most interesting thing you discovered about HSS during your research?


Dr. David B. Levine: Many interesting facts emerged. Limiting my remarks to the orthopedic division, as in the early years before 1935, the hospital was equally divided in caring for orthopedic and hernia patients, I discovered major changes and "firsts" occurring during the surgeon-in-chief years of Virgil Gibney (1887 to 1924) and Philip D. Wilson (1935 to 1955).


Gibney established the first organized orthopedic training program in the United States. He coined the term "resident" to label those who were young doctors in training, a term that has emerged and remained over a century for all fields of medicine. He was a founder and the first president of the now prestigious orthopedic organization, the American Orthopaedic Association. In fact, he was the only person in the history of the AOA to be president twice. He was a progressive leader who introduced surgery into the hospital in 1889, surrounded himself with prominent physicians and surgeons such as Drs. Royal Whitman, William Bull, Edward Janeway, and L. Emmett Holt, and trained over 144 orthopedic residents. Among them, many became giants in orthopedic surgery.


It was Philip D. Wilson, MD, who had the vision that the hospital of the future needed to be closely affiliated with a major university and medical school. Not only did he enter into such negotiations with Cornell Medical College and University in 1949 and bring them to fruition when HSS moved up to the New York Hospital Cornell Medical Center in 1955, he realized the importance of maintaining a certain independence in a large medical community. Early on, HSS first negotiated with Columbia Presbyterian medical center, going down a pathway, which if allowed to transpire, would have submerged HSS into a large general hospital, losing its independence. The second most important vision of Dr. Wilson was his goal to establish a major research department, physically located next to the hospital and closely affiliated with professional clinical staff.


Q: What are some the main reasons HSS has grown to be one of the most recognized orthopedic specialty hospitals?


DL: There are three keys to the success of HSS.


1. Excellence in professional leadership.

The answer lies in the establishment of strong roots planted by James Knight who was able to assemble a nucleus of 20 prominent citizens of New York City in 1862 to fund and continue to support an independent hospital with its goals to rehabilitate the poor, needy and disabled.

This was followed by Virgil Gibney, who surrounded himself with the highest quality of surgeons, physicians and educators on his staff. He realized the importance of a solid, formal training program for young doctors. He was always at the forefront of medicine, introducing an operating room before the turn of the century and such innovations as an X-ray unit in 1899 – four years after Wilhelm Conrad Roentgen discovered the X-ray. Gibney was not only a surgeon, teacher and prolific writer, but a leader well-respected by his colleagues as well.

The third surgeon-in-chief, William Bradley Coley (1925 to 1933) was trained as a general surgeon and leaves a legacy in the field of cancer for his world renowned use of Coley's Toxins. Coley is known as the Father of Cancer Immunotherapy, a field today considered to be the future of cancer treatment.

Philip D. Wilson brought the hospital back on track as a major orthopedic institution. His visionary perception of the importance of a basic and clinical research program, maintaining independence, and yet having a close university affiliation and the expansion of medical teaching from resident training to the introduction of post graduate fellowship programs all laid the foundation of the hospital becoming a major leader in orthopedics and rheumatology.

The surgeons-in-chief to follow capitalized on the early years of the hospital, introducing new fields in sports medicine, joint implant design, development and surgical innovations and advanced spine care. Supporting fields of rheumatology, regional anesthesiology, radiology and imaging at HSS all became world leaders at the same time.


2. HSS Staff – Built on Strengths as a Team


Described in Chapter 20*, by Louis A. Shapiro, president and Chief Executive Officer at Hospital for Special Surgery are five interlocking elements that are the catalysts for such a successful hospital as HSS:

1.    Culture
2.    Specialization
3.    Best practices
4.    Volume
5.    Academics


3. Independence

HSS has the best of both worlds. It is an integral part of a medical center and university. It is governed by its own independent board of trustees functioning as a unified team and engaging major donors with explicit dedication, keeping HSS a leader in its field.


Q: How long did you practice as a spine surgeon at Hospital for Special Surgery?


DL: I was first appointed as an orthopedic resident at (the was dropped from "The Hospital for Special Surgery" in 1995) Hospital for Special Surgery in 1961 and upon completion of my training in 1964, was appointed as an orthopedic spine fellow at Rancho Los Amigos Hospital affiliated with the University of Southern California. Returning to New York in 1966, I joined the HSS staff as an assistant attending orthopedic surgeon.


In 1968, Dr. Robert Lee Patterson, surgeon-in-chief, appointed me as Chief of Scoliosis, a position I held until 1994, the year before retiring from patient care. During those years, we introduced and perfected the use of internal fixation/correction for spinal deformities with variations of the Harrington Rod system. The treatment of adolescent idiopathic scoliosis saw a major change of management from a year of in and out of hospital confinement in large body casts to finally reducing the length of stay to four or five days, and eventually, no cast.


The first male/female step-down children's unit at HSS was introduced in 1968. In collaboration with Felicia Axelrod, MD, I directed the first and only clinic in the world for children with scoliosis and Familial Dysautonomia.


In 1966, Wan Ngo Lim, MD, Chief of HSS Pediatrics, and I introduced the first New York School System screening carried out by HSS physicians. Together, we examined hundreds of school children at PS 65 in the lower Eastside (Chinatown area) monthly. Although our main objectives were to discover undetected scoliosis, many other orthopedic problems were diagnosed, and these children were referred to HSS.     


Non-operative treatment for scoliosis and associated deformities was researched and developed in the 1970s in collaboration with the hospital's brace shop – now known as the Orthotics and Prosthetics Department.


I believe that one of my biggest contributions in the field of scoliosis was as a senior HSS resident in 1964, when I proposed the formation of a national scoliosis society – a society now known as the Scoliosis Research Society (SRS). With its first meeting in 1966, the SRS has grown to an international society of over 1,000 members – the number one society of its kind. I served as secretary-treasurer from 1970 to 1972, secretary from 1972 to 1974 and president from 1978 to 1979, in addition to being a member of the board of directors for over 10 years.


Q: Why did you decide to explore the history of Hospital for Special Surgery?


DL: On November 8, 1988, as president of the HSS Alumni Association, I delivered my presidential address: "Steeped in Tradition-A Century of Training" at the annual HSS Alumni Meeting. I had researched the first and oldest orthopedic residency in our country founded by Virgil P. Gibney, MD, the second surgeon-in-chief at HSS. While researching the hospital's original documents, files, newspaper clippings and photos of the last century, I became very interested in continuing to pursue the rich history of HSS. I was amazed at the preservation of these archival memorabilia and began studying the original historical books, published papers and other documents.


Over the years, I continued to explore these archives that were well preserved but not catalogued, nor of course, digitized yet.  


In 2003, Thomas Sculco, MD was appointed surgeon-in-chief and asked me to become the first director of the HSS Alumni Association. That same year, I re-instituted an HSS library committee, which had been disbanded and of which I had previously been a member. I helped to re-organize the library, and many historical documents and photos became part of formal HSS archives. I established an archives committee and became its chairman, a position I continue to hold today. We now have a fulltime medical librarian, fulltime medical library coordinator, part time professional archivist, library volunteer and will soon have a library summer intern.


Q: How much time did you spend researching for your book and what were some of the sources you used?


DL: Phase I


Researching my book came in two phases over eight years. In September 2005, the HSS Journal was born with Richard Laskin, MD, as its editor-in-chief. Dr. Laskin and I agreed that I would write the lead article on the history of HSS from 1863 in each issue. It was my intent at the time to write a book on the history of HSS, and these articles would serve as the foundation. The articles were organized chronologically based on the years of the surgeons-in-chief. I would research each article and draft the chapter over a period of six months.


The major sources were taken from two books:

•    Fenwick Beekman's book on The Hospital for the Rupture and Crippled, published in 1939 on the event of the 75th anniversary of the hospital. Beekman at the time was a surgeon on the R&C staff and later president of the New York Historical Society in 1955.
•    The second book was Gibney of the Ruptured and Crippled, edited by Alfred R. Shands, Jr., MD, Medical Director Emeritus, Alfred I. DuPont Institute of the Nemours Foundation.


Other sources were the Annual Reports of the Board of Managers of the hospital (bound - beginning with the first report of 1864), original documents, letters, R&C/HSS newspaper clippings and original photographs all stored in shelves and a dozen cabinets in the HSS Archives. Supplementing these were a number of published papers in medical and orthopedic journals obtained through Pub Med, personal communications with descendants of Gibney, Coley, Philip D. Wilson and with Philip D. Wilson, Jr. Lastly, I researched the Rare Book Room at the NY Academy of Medicine, New York Society Library, New York Historical Society, Weill Cornell Medical College Library, Rockefeller University Archives and Memorial Sloan Kettering Cancer Center Archives located together in Sleepy Hollow, N.Y.


Phase II


The second phase began in 2010, after publishing my 11 papers in the HSS Journal. Additional sources came from interviewing surgeons-in-chief since 1989, senior hospital administrators and sections heads and various hospital staff. I enlisted five department heads, an educational anesthesiologist administrator, the president and CEO of HSS, and the sitting surgeon-in-chief to write seven specialty chapters. They independently wrote their own chapter. I edited each chapter for style, but did not change content.


Lastly, I needed to rewrite my 11 published articles to conform to my book style. In addition, I wrote three new chapters to cover the years 1990 to 2013. Included in my retrieval of historical events were photos and tables to include in the book. An appendix of over 200 names of deceased mentioned in the book was included.

Q: How did Hospital for Special Surgery first begin?


DL: In part from: Anatomy of a Hospital, Chapter 1:


"In the middle of the Civil War, with disease, poverty, and unemployment rampant in New York City, a relatively unknown physician — a general practitioner hailing from Maryland, James Knight, MD — was able to persuade a group of prominent local citizens to form a society to establish and support an orthopedic hospital. Neither a nation at war nor a city confronted with uncontrolled disease, overwhelming disabilities, poverty and suffering, medicine in its infancy, the growth of new large hospitals, civil unrest, and political corruption could discourage this physician, who held steadfast to his vision to establish a hospital for the treatment and rehabilitation of the crippled and disabled.


Little did he know that this hospital, eventually to be known as the Hospital for the Ruptured and Crippled, would one day become one of the world's leading institutions in musculoskeletal research, education and treatment. It would be renamed in 1940 as the Hospital for Special Surgery and now stands as the oldest existing orthopedic hospital in this country."*


* Anatomy of a Hospital


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