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fevereiro 2012

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HISTÓRIA

Quinta-Feira, 23 Fevereiro de 2012

HAND SURGERY AND THE WAR

The relation between wars and the advances of medicine is paradoxical. The horrors of combat, suffering, and human casualties ultimately promote the development of medical techniques and know-how.

It was precisely in a war scenario – specifically WWII – that our specialty came into being, thanks to the meeting of three prominent American citizens: a politician, a general and a duck hunter.

The politician was called Franklin Delano Roosevelt. Son of aristocrats, an athlete and brilliant student, he suffered a life-changing setback in the summer of 1921, at the age of 39. He fell victim to polio that left him paraplegic.

Thereafter, he spent two years trying to walk again. He learned a great deal about orthopedics and rehabilitation, and eventually met many people from this specialty, like Norman Kirk, the general, who was a general surgeon that became an orthopedist. Kirk was appointed by Roosevelt, then President of the United States, as U.S. Army Surgeon General.

In the early 40’s, there was an enormous concentration of military personnel in San Francisco, CA, and that’s where Norman met Sterling Bunnell, Father of our specialty, the duck hunter (Fig. 1).

Fig 1 Sterling Bunnell

Sterling Bunnell
Born in California, he graduated in Medicine from UCLA – San Francisco. He served in France during WWII, on the Neurology team.

He loved birds and animals. He learned how to fly during the war, and upon returning to the United States, bought his own plane that he would use for work and for leisure.

On one of these jaunts, he tried to land at Yosemite Park and had an accident.

He fractured his femur neck, which condemned him to a life of pain and limping.

He was a brilliant man. In the period between wars, he wrote many articles about hand surgery.

He upheld the concept of a “REGIONAL SURGEON,” a professional who could take care of bones, joints and nerves, and also reconstruct skin and soft tissues.

In 1944, he was invited by Normal Kirk to help treat upper limb lesions of American soldiers who were coming back from battle fronts in Europe, Africa and Asia. There were so many of them that they were dubbed the “Legion of the Crippled.”

At age 62, Bunnell abandoned his private practice and started traveling throughout the country, establishing hand treatments centers – nine HAND CENTERS in all (Fig. 2). By 1945, about 10 thousand patients had been treated at these centers, and many young surgeons were trained there, like Barski, Littler, Fowler, and others. The centers were such a success that, in 1946, the American Society of Hand Surgery was founded.

...................Fig 2 HAND SURGERY AND THE WAR

THE PIONEERS IN BRAZIL

Meanwhile, in Brazil, some general and plastic surgeons were strongly influenced by the English and the French to perform hand surgeries. Some of them eventually erected the groundwork for the development of this specialty in our country. They were our pioneers!

Alípio Pernet
Born in Manaus in 1913, he graduated from the Bahia Medical School. He served 18 years in the Air Force as a doctor. He was both a general and plastic surgeon.

He interned at Brook Army Medical Center in Texas and under Pulvertaft, Gillies and Watson Jones. He published 60 scientific papers. He was President of the Brazilian Society of Plastic Surgery, President of the Brazilian Society of Hand Surgery (SBCM) from 1965 to 1967 and 1971 to 1973, and Chairman of the First Brazilian Hand Surgery Conference, and also the Head of the São Paulo Municipal Hospital Hand Surgery Clinic. He died in São Paulo in April 1992.

Danilo Gançalves
Hailing from Recife, where he graduated as a doctor in 1939, he traveled to Rio de Janeiro, where he did his specialization in General Surgery.

In 1951, he received a scholarship from the British Council, which allowed him to intern under Tureta, Allen, Pulvertaft and Agnes Hunt, among others. Danilo was the first President of the Brazilian Society of Hand Surgery. He presided the Second Brazilian Hand Surgery Conference. He was Head of Orthopedics at the Souza Aguiar Hospital and Head of the Lagoa Hospital Hand Service. He died in November 1983.

Henrique Bulcão de Moraes
Born in June 1925, Henrique graduated from the School of Medicine and Surgery in 1949. In the same year, he earned a degree in Nutrition.

He specialized in General Surgery. In 1951, he interned under Allen in Boston. In 1952, he began his residency at Baltimore City Hospital. He began his apprenticeship in hand surgery with Raymond Curtis. Back in Brazil, he set up the Santa Casa Hand Surgery Service in Rio de Janeiro. He was President of the Brazilian Society of Hand Surgery (1963-65) and Chairman of the First International Conference of the SBCM.

Lauro Barros de Abreu
Born in June 1925, Henrique graduated from the School of Medicine and Surgery in 1949. In the same year, he earned a degree in Nutrition.

In 1944, he won a scholarship from the British Council of Medicine, but Lauro was torn; he had just gotten married and had been invited by Prof. Godoy Moreira to work at the Hospital das Clínicas. Despite the offer, he decided to accept the challenge of traveling to England. He was advised not to embark in Brazil, since its coastline was infested by German and Italian submarines. He went to Argentina by train. There were many Nazi spies in South America and Argentina. When he arrived in Buenos Aires, he wasn’t sure when or where he would be embarking. After three days incommunicado, he was woken up in the middle of the night and taken to a port where an English destroyer that had come to load up on canned mean in Uruguay was waiting for him.

In the first couple of days, we had to navigate in zigzags to throw off enemy submarines. During the trip, Lauro took part in shooting practice, which cost him a temporary hearing loss. He disembarked in Liverpool 28 days later. He interned with Gilles, Watson Jones, and Seddon, among others (Fig. 3).

....................................Fig 3 Lauro e Gillies - 1944

He published 117 articles. He was President of the Brazilian Society of Hand Surgery from 1961-1963, and Head of the Hand Surgery Group of the Hospital das Clíncias-São Paulo University School of Medicine (HC-FMUSP).

Orlando Graner
A native of the capital city of São Paulo, he was born in August 1914. He graduated from the São Paulo University School of Medicine (FMUSP) in 1941 and soon thereafter began his internship (last two years of undergraduate school) at the Fernandinho Simonsen Pavilion. This is where he created and headed the first Brazilian Hand Surgery Group, from 1945 to 1968, with the support of Prof. Domingos Define.

He was the President of the Brazilian Society of Hand Surgery from 1969 to 1971, and also organized the services of the Hospital do Servidor Estadual and the Escola Paulista de Medicina.

BRAZILIAN SOCIETY OF HAND SURGERY

In the period right after World War II, Brazil was visited by renowned specialists like Guy Pulvertaft, Watson Jones, Trueta and Sterling Bunnell. This served as a catalyst to encourage the creation our Society.

In 1959, Brazil was being conducted by President Juscelino Kubitschek. Car dealerships were full of DKWs and the recently launched Rural Willys jeep station wagon. Fidel seized power in Cuba, overthrowing the corrupt government of Batista. Bahia was the Brazilian soccer champion, with Pelé as its top scorer. Radios had just started playing “Chega de Saudade” by the genius composer-songwriter duo of Tom Jobim and Vinícius de Moraes. Starring in the movies were Charlton Heston in “Ben-Hur,” and Marilyn Monroe, Tony Curtis and Jack Lemon in “Some Like It Hot.” It was at this time, on June 17, 1959, at the Biological Research Center, RJ, on Rua Camerino, at 8:30 pm, that 57 doctors invited by Danilo Gonçalves, with Henrique Bulcão de Moraes as secretary of the meeting, signed the minutes of the Brazilian Society of Hand Surgery Foundation.

After some seminars and courses, the first major event of the SBCM was the First International Conference, held in Rio de Janeiro from July 19-21, 1965. Bulcão was the Chairman of the Conference, attended by some 400 registered participants, with simultaneous interpretation into several languages, and prominent names in Hand Surgery at the time, like Erik Moberg, Joseph Boyes, Starck, O'Brien, Kauko Vainio, the Argentines, Firpo and Loda, in addition to our pioneers (Fig. 4 & 5).

Fig 4 Audiência do Congresso

Fig 5 Convidados Estrangeiros

Another active participant in the event was Ivo Pitanguy, one the founders of SBCM, Head of the first Hand Surgery Sector of Rio de Janeiro and Vice President of SBCM from 1959 to 1963.

In 1965, Ronaldo Azze and Marcus Castro Ferreira began performing the first limb reimplantations at the Hospital das Clínicas – FMUSP, and created the first Microsurgical Service of South America in 1974.

Another momentous event in our history occurred during the American Hand Surgery Conference in Chicago, in which the SBCM – represented by Alípio Pernet – took part in the International Federation of Hand Societies Foundation (Fig. 6).

............... Fig 6 Fundação da Federação Internacional

In addition to the First International Conference, there have been 23 Brazilian conferences and innumerous courses and seminars since 1967.

THE HEIRS

Almir Joaquim Pereira wrote in his book on the history of the Brazilian Society of Hand Surgery that, “the SBCM is a tree of good lineage, planted and cared for by men of culture, of exemplary character and of tireless enterprise. When superseded by their successors, they proudly watched it flourish, protected by a pleiad of professionals who treated it with devotion.”

Pois bem,

Rightfully so. This tree of good lineage produced plentiful fruit. Some of this fruit became the Presidents of the SBCM: