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rmarcel17
04-15-1995, 02:03 AM
THE DEVELOPMENT OF ORTHOPAEDICS IN INDIA AND WHAT THIS AND OTHER
SPECIALITIES ARE GOING TO FACE IN THE 21st CENTURY


On the occasion of his 75th birthday, K.T. Dholakia (Past
President and Honoured Member of SICOT) made this opening address
at the SICOT Asia-Australia 1994 meeting.

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For reasons of history, orthopaedics in India has been largely
influenced by the Liverpool school of orthopaedics. The First
World War stimulated some of our surgeons to take an interest in
orthopaedics and eventually helped them launch the speciality in
our country.

M.G.K. of Madras, R.J.K. of Bombay and S.R. Chandra of Calcutta
who had their training in Liverpool laid the foundation and can
be considered the "pioneers" as they qualified as orthopaedic
surgeons in the 30's and started their own specialised practices.

Academic and professional advances in orthopaedic surgery in
India owe a great deal to the efforts of a group of second
generation orthopaedic surgeons led by Dr. B.N. Sinha, Narsinh
Ayer, Mukhopadhaya and others. These founder leaders developed
orthopaedics based on the Liverpool school.

It took nearly three decades following independence for European
and American orthopaedic techniques and methodology to influence
Indian thought and practice in orthopaedic surgery. In time,
special orthopaedic departments were set up in medical schools
and possibly the first was at the K.E.M. Hospital, Bombay headed
by the late Dr. R.J.K. , under the kind patronage of the far-
sighted dean of that school, the late Dr. Jivraj Mehta. The idea
was not easily accepted in the forties and it was an uphill task
due to the attitude taken by general surgeons. However, they
persisted and eventually succeeded. I had the privilege of
observing this as a young orthopod.

In 1954 on 15th December, 15 pioneers of Indian orthopaedics got
together in Hyderabad and laid the foundation for the formation
of the orthopaedic section of A.S.I. as an independent body.
After this there was a rapid growth in varieties of technique,
methodology, education, research and later the inevitable
development of super specialities within orthopaedic surgery. We
now already have several super specialised societies
independently pursuing their own scientific activities,
organising teaching courses and workshops. We have hand, foot,
spine, knee and arthroscopy, paediatric orthopaedics, joint
replacement and asami besides a trauma group. Orthopaedic
oncology is on its way too as young people are becoming
interested in this topic.

The first major development was the launching of the
Rehabilitation Centre by the S.R.C.C. which later established the
children's orthopaedic hospital in 1950 dealing mainly with
polios and c.ps. and I had the privilege along with a number of
others to be one of the pioneers and first resident
superintendent and surgeon. The second step was the setting up
in various locations by the Indian Government of an all India
Institute of Physical Medicine and Rehabilitation for the
orthopaedically handicapped. Its first director was the late Dr.
M.V. Sant at its main centre in Bombay.

With the explosion of knowledge in the last 20 years or so, the
orthopaedic elders seem taken aback with spiralling super
specialities as they seem to threaten the very existence of
orthopaedics. Calling yourself an orthopaedic surgeon may sound
a little out-dated, at least in more developed countries.

We faced the same problems in SICOT in the early seventies as the
super specialities were maturing and people were reluctant to
come to a general orthopaedic meeting when their interests were
mainly in hip or spine or paediatric orthopaedics. SICOT had to
attract them to the triennial meeting and keep them under the
umbrella of the Society by giving them their rightful place. Dr.
Robichon (Canada) did pioneering work as Vice President of SICOT
from 1975-78 when I was second Vice President. He was able to
sell this idea very convincingly to these specialised groups and
perhaps for the first time in Kyoto and Rio we had the
participation of at least some specialised societies with their
own programme at the same time as the main SICOT Congress. I was
fortunate to be president of SICOT at that time.

Today the orthopaedic surgeon and orthopaedic associations are
facing the same threat as general surgeons some fifty or sixty
years ago. Robert Jones, the founder of orthopaedic surgery in
the U.K., was the first surgeon of stature to challenge the
dominance of general surgery. In this context it is worth reading
Sir Rodney Sweetnam's address when he delivered the Sir Robert
Jones lecture at Torquay in September 1993 "Whither Orthopaedic
Surgery". Many of you must have heard it or read it.

He questions whether an orthopaedic association will survive.
Obviously, it will have difficulty doing so unless it learns from
the mistakes of the general surgeons, who in their colleges
suppressed the emerging specialities for so many years. The scene
is now different, general surgery is largely defunct and emerging
specialities dominate with orthopaedics being the largest.

The onus is now on us and these broad specialities. How do we
want our speciality and association to develop? Is there really
any need for an umbrella organisation like the A.O.A., B.O.A. or
even the I.O.A.? If so, should they encompass all our super
specialities or should they go the way of general surgery,
leaving the term 'orthopaedics', almost defunct?

Those who practise in the sub-specialities of general surgery now
resent being called general surgeons. Will the day come when
those of us with super speciality interests resent the title of
orthopaedic surgeon?

We must start by recognising that the day has gone when we can
cope with the ever widening spectrum of orthopaedic skills. The
demand of the day is now for super specialities. At the same
time, I doubt whether we as specialists can practice in
isolation. Our techniques are now too sophisticated to be
separated from other facets of high technology procedures in
medicine or surgery. I feel we should retain our allegiance to
the umbrella organisation. Our super specialities share so much
common ground and must gain from the collective strength of a
large association.

Trauma and accident services is one such speciality which needs
special attention. Trauma forms a major speciality as the rate
of industrial and highway accidents continues to grow all over
the world. If we look at the statistics of accident cases
occuring every hour and the time is takes to offer assistance
(the time it takes for a victim to reach a care centre) we will
be appalled to realise how sadly we fail them. Specialised trauma
centres and surgeons practising trauma exclusively is an urgent
need today and the medical profession, politicians and the public
must apply their minds to rectifying the situation before it is
too late.

It is time for us to apply ourselves to these problems which we
are going to be facing for the foreseeable future.

K.T. DHOLAKIA
India


Published in SICOT Newsletter 32 (1995)