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Key Points

  1. The successful development of the field of pediatric surgery has depended on the personal devotion of the founding fathers to a lifelong exclusive commitment to the surgical care of children.

  2. As diagnostic and treatment approaches have been refined for childhood disease, the principles have been disseminated by publications, presentations, and communication among like-minded colleagues, and through professional organizations and journals.

  3. Key to the perpetuation of the field of pediatric surgery has been the worldwide codification of content for a rational training program for future pediatric surgeons, assuring their competence and their future leadership of the field.

  4. Although surgical research may still be the least well-developed aspect of this field, there have been significant contributions by pediatric surgeons in the specific treatment of congenital and acquired pediatric disease, improvements in cancer care treatment and outcomes, our understanding of fetal development and the potential for in utero treatment, and disease-specific treatment outcomes.

  5. The continued success of pediatric surgery will require a commitment to clinical care excellence that assures institutional and individual surgeon competence, optimal education, research that is designed to improve child health outcomes, and a strong commitment to advocacy for children that ensures their access to optimal surgical care.

The history of pediatric surgery has developed sequentially and simultaneously along 4 complementary pathways. First, individual pioneering surgeons declared their interest by confining their practice to the surgical diseases of children. Second, the Boston school of Ladd and Gross provided the legacy and leadership by establishing principles for the surgical care of children and by training the majority of the subsequent training program leaders in pediatric surgery. The third critically important development was the evolution of organized pediatric surgery, the initiation of the Journal of Pediatric Surgery as a specialty journal, and the eventual evolution of a board certification process. Finally, the fourth pathway was the evolution of the field from a collection of anecdotal clinical observations to one of scientific achievement based on sound laboratory and clinical research. This chapter sequentially reviews these 4 topics as they collectively impact on the development of both international and American pediatric surgery.

The Pioneers of Pediatric Surgery

William E. Ladd (1880-1967)

William E. Ladd (Fig. 1-1) was born in Milton, Massachusetts, and was raised locally. At Harvard College he rowed crew. After graduation from Harvard Medical School (1906), he was a surgical intern at the Boston City Hospital. Thereafter, in addition to his general surgery and gynecologic surgery practice, he joined the staff of the Boston Children's Hospital in 1910 to do an occasional surgical procedure on a child.

Figure 1-1

William E. Ladd (1880-1967).

On December 6, 1917, the French munitions ship Mont Blanc collided with the Norwegian vessel Imo in the narrows of Halifax harbor. The result was ...

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