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Women have struggled for their place in the surgical discipline for thousands of years. Today, women in medicine, surgery, and Hand Surgery are increasing, but the history of this journey has not been recorded.
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Entrée to Hand Surgery includes effective mentorship, sponsorship, equitable training opportunities, research, funding, and engagement in national and international societies.
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Female Hand surgeons have made paradigm-changing contributions to the field of Hand Surgery.
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All hand surgeons should know the history of our specialty, its culture, and how to become active allies for contributing to our shared community.
No woman studying medicine today will ever know how much it has cost the individuals personally concerned in bringing about these changes; how eagerly they have watched new developments and mourned each defeat and rejoiced with each success. For with them it meant much more than success or failure for the individual, it meant the failure or success of a grand cause.—1899, Dr Marie Mergler, Dean of Woman’s Hospital Medical College
with hand fractures described as early as 300 bc, by Hippocrates. The history of women in surgery dates to 3500 bce, with historical roles in Egypt, Italy, and Greece.
SYM06: Women in Hand Surgery: Challenges We Face. Session Handout. Moderated by Melissa A. : Sonya P. Agnew D, Megan A. Conti M, Erika G. Gantt, MD, and Diane E S. Payne, MD, MPT. 75th Annual Meeting of ASSH, Virtual Meeting. October 1-3, 2020.
The Middle Ages saw women expressly banned from medicine and even burned as witches. Nevertheless, for hundreds of years, women persisted (Fig. 1), clandestinely, in monasteries; through midwifery and gynecology; and, in the 1700 to 1800s, presenting themselves as men to pursue medical education (Fig. 2).
Fig. 1The first female physicians from India, Japan, and Syria. (Left to right) Anandibal Joshi (India); Keiko Okami (Japan); Sabat Islambouli (Syria). They were students at the Women’s Medical College of Pennsylvania in 1885, and the first women from their respective countries to matriculate in Western medicine.
(Anandibai Joshee, Kei Okami, and Tabat M. Islambool, Author unknown via Wikimedia Commons / Public Domain.)
Fig. 2Dr Mary Edwards Walker (1832–1919) was the first American female surgeon and army surgeon, whose scope of practice included extremity amputations. She received the Congressional Medal of Honor in 1865, only to have it revoked in 1917. Refusing to return it, she wore it daily until her death.
Although not a hand surgeon, as the first American female board-certified orthopedic surgeon, Dr Ruth Jackson (Fig. 3) was a pioneer and founder of the eponymous orthopedic society for women. Graduating from Baylor in 1928, she was one of four women in a class of more than 100. Despite great deterrence, she pursued orthopedic surgery residency, only to begin her practice in Dallas, TX, during the Great Depression, earning $3/h from the Work Projects Administration as part of the New Deal.
Fig. 3(A) Dr Ruth Jackson. (B) On the right, age 84, outside of her clinic at Baylor University Medical Center in 1986.
([A]Courtesy of Ruth Jackson Orthopaedic Society, Schaumburg, IL; with permission.)
When the American Academy of Orthopaedic Surgery (AAOS) was founded, all male orthopedic surgeons were grandfathered into membership, but Dr Jackson, then Chief of Orthopedics at Parkland Hospital, was required to first pass the American Board of Orthopaedic Surgery (ABOS) examination, which she did in 1937. Some decades later, Dr Marybeth Ezaki would rotate through Parkland Hospital as a medical student, and, among other accomplishments, become the first female director of the ABOS.
In 1948, Dr Alma Dea Morani (Fig. 4) became the first female surgeon admitted to the American Society of Plastic and Reconstructive Surgeons (ASPS). Born in New York City in 1907, her father was an acclaimed sculptor and believed medicine was too difficult a career for women. And indeed, there were challenges—as the only female physician, her living quarters were relegated to nursing quarters. After earning board certification in general surgery, it took six applications to Plastic Surgery before Dr Barrett Brown accepted her as a trainee (St Louis, 1946). Yet, she was only permitted to observe during the week. Solely on Saturdays, when the male residents had their day off, was she permitted to scrub and assist with surgery.
Fig. 4Dr Alma Dea Morani repairs the damaged fingers of a patient in the hand clinic, undated.
Dr Morani is responsible for establishing Philadelphia's first Hand Surgery Clinic (1958) and cofounding the Robert H. Ivy Society of Plastic Surgery. She advocated for women throughout her life, through the American Medical Women’s Association and as president of the Medical Women’s International Association.
Organized Hand Surgery and Birth of Hand Societies
What we know now as organized, modern Hand Surgery as a specialty originated in the Second World War, with Dr Sterling Bunnell, who was tasked to lead the “crippled hand” service for the Medical Corps of the Army.
The embryogenesis of the specialty of Hand Surgery: a story of three great Americans – a politician, a general, and a duck hunter: The 2002 Richard J Smith memorial lecture.
Through his work developing Hand Centers and training surgeons, The American Society for Surgery of the Hand (ASSH) was founded in Chicago at the January 1946 annual meeting of the AAOS, at the Blackstone Hotel.
But the ASSH was exclusive. “For many years, the forward rows in the audience were cordoned off with a velvet rope, and nonmembers ventured into their area at their peril.”
Because of its stringent annual admission quota of ten new members, junior hand surgeons seeking to exchange knowledge began to organize in other ways. In 1970, the American Association for Hand Surgery (AAHS) was founded, “at an airport hotel near Chicago…to eliminate the elitist attitude for membership.”
The Beginnings of Female Surgeons in Hand Societies
Females are aware of our inherent difficulties; knowing the barriers and help[ing] to speak to that… Unless you have female representation… the institutional barriers will persist - Dr. Ann Van HeestIt has been a challenge to be president of these societies; there have been only one or no women in leadership of these societies…It’s not important that it be 50% women, but it is important they be present because it makes something different, you can address the whole community and it brings diversity…” We [women] have a tendency to think we aren’t good enough- we need to believe in ourselves and not wait for someone to call on us to promote us… no one at the table will give you a piece of the cake- you have to say it's for you” -Dr. Eva-Maria Baur∗—∗Dr Baur has served as President of the German Hand Surgery Society, President of International Wrist Arthroscopy Society, and will serve as President of the National Hand Society.
For the first 50 years of ASSH history very little was written about female hand surgeons.
Although few in number, their contributions to science and leadership have been profound.
In 1984, Dr Julia Terzis was the first female surgeon to win the Emanuel B. Kaplan Award for “anatomic excellence in surgery of the hand” for her work describing the organization of the median nerve. Dr Susan E. Mackinnon followed in 1985, for her work on the lateral antebrachial cutaneous nerve and superficial sensory branch of the radial nerve.
The first time a female surgeon won an ASSH research grant was in 1986, and there were multiple: Dr Mackinnon (“The Nerve Allograft Response- An Immunologic Study with Cyclosporin A″), Dr Sharon A. Clark (“The Reorganization of the Somatosensory Cortex Following Ulnar Island Pedicle Flap to the Face in an Animal Model”), and Dr Terzis (“Effects of Pulsed Electromagnetic Field on Nerve Regeneration”). Dr Amy Ladd was the first female surgeon to win the Sterling Bunnell Traveling Fellowship in Hand Surgery (2000).
The only female surgeon to serve in leadership in these first fifty years was Dr Elizabeth A. Ouellette, first on the Council in 1993, with the sponsorship of Dr Robert Hotchkiss, and then, as Co-Chair of the Business of Hand Surgery Committee, Vice President of the Kiros Society for Hand Research, Inc, and President of the Ruth Jackson Orthopaedic Society. She was also the Hand surgeon for Miami Heat, the Dolphins, the Panthers, and multiple universities, while continuing basic science research.
From 1995 to 2002, Dr Marybeth Ezaki (Fig. 5) and Dr Joan Wright were the only two women to serve on the council, and in 2002, as an American woman of Polish and Japanese descent, Dr Ezaki became the first female to serve as president of the ASSH in its 56-year history. She remains the only woman to have served in this role and recalls being “pushed through a door that was opened for her.”
The Upper Hand: Chuck & Chris Talk Hand Surgery Interview 3: Marybeth Ezaki. Past ASSH President, Current Mentor and Sage. Published May 10, 2020. Season 1. Episode 18.
Fig. 5(A) Dr Marybeth Ezaki. (B) Founder’s meeting of Congenital Hand Anomalies Study Group (CHASG).
([A] Courtesy of Marybeth Ezaki, MD; [B] From Foucher G. Ten years CHASG, a combination of science and friendship. Handchir Mikrochir Plast Chir. 2004;36(2-3):189-190. https://doi.org/10.1055/s-2004-817886; with permission.)
In the 2000s, more women began to gain admission to the Council. Before election to the Council, Dr Kay Kirkpatrick had already led the Georgia Orthopaedic Society and spent five years legislating as a Georgia State Senator. Her focus was on practice management and insurance issues affecting hand surgeons.
Encouraged by the few female role models before her, Dr Julie Katarincic (Mayo Clinic Hand Surgery Fellowship, Class of 1995) wanted to encourage others like her to get involved. She has worked with multiple committees within the society to improve diversity, including the Nominations Committee, and now heads the Outreach Division and advocates for sustainable education outreach and volunteering through Touching Hands. She is a professor at Albert Medical School at Brown University.
Dr Anne Miller (Tufts Hand Surgery Fellowship, Class of 1989) joined the board of the American Foundation of Surgery of the Hand early on and rose to leadership by serving on the board, including as President for four years. She helped create the bylaws and the criteria for the nominating committee and lead the Future in Hand Capital Campaign. In the 1980s, navigating Orthopedic and Hand Surgery was rife with obstacles--accessing residency, fellowship, family planning, and starting practice. Dr Miller is in private practice and volunteers with the Healing the Children Group, who honored her for her work with children with congenital hand differences. She has always wanted to have a voice and to promote fairness in society leadership. She currently serves as the RVS Update Committee for the American Medical Association advisor for Hand Surgery, and as chair of the ASSH Coding Committee.
Dr Michelle Carlson (Hospital for Special Surgery Hand Surgery Fellowship, Class of 1993) served on the ASSH Board for six years and as treasurer from 2014 to 2017, and is cited as a role model by many women. Throughout her career, Dr Carlson has won several prestigious awards, including the Ruth Jackson Orthopaedic Society/Zimmer Research Grant, the Lewis Clark Wagner Research Award, the T. Campbell Thompson Prize, and the Glasgow Memorial Achievement Citation. Dr Carlson is the director and founder of the Children and Adolescent Hand and Arm Center, the official second opinion physician for the NBA, as well as consultant hand surgeon for several professional sports teams.
Member-at-large on Council, Dr Dawn Laporte (Curtis National Hand Center Hand Surgery Fellowship, Class of 2001) has mentored innumerable trainees, particularly through her work with the resident education committee, resident educator workshop, and resident and fellow review courses. She is a Section Editor for the Journal of Hand Surgery, residency program director at Johns Hopkins University, and was Vice Chair for the ACGME Orthopaedic Surgery Residency Review Committee.
In 2022, Dr Jennifer Wolf (Mayo Clinic Hand Surgery Fellowship, Class of 2003) became the second female president of the ASSH. A full professor, she directs the Hand Surgery fellowship at the University of Chicago and serves as Vice Chair for faculty mentoring and diversity. Throughout her career, she was often the only woman in the room—the only female Hand Surgery fellow, the only female faculty member. Since being recruited to Chicago, she has hired seven women onto faculty and makes a point to invest in her juniors.
American Association for Hand Surgery
Since its inception, female hand therapists have had a much more prominent position, visibility, and leadership in AAHS than female hand surgeons.
Their story is no less important, but beyond the scope of this article. In 1978, Dr Mary H. McGrath was the first woman to win the resident essay award; two years later, Elizabeth J. Hall (renowned now as Dr Hall-Findlay) was the second female awardee, in third place. Dr McGrath, who would later become the first female president of the ASPS, started her years-long tenure heading the education committee (1983–1987), and Jean Kiefer began editing the newsletter committee (1983). Kristin Steuber was the first woman to head the Resident Essay Committee (1986) and the first woman to head the Nominating Committee (1988). Dr Stueber later became Chief of Plastic Surgery at Temple University Hospital, the second woman to hold such chairmanship in the country.
It was not until 2005, 35 years after the founding of AAHS, that Susan E. Mackinnon (Fig. 6) became the first woman to serve as president, and she remains singular in that accomplishment. Her scientific contributions are separately discussed. When she was chosen, “Christine Novak PT, PhD was a natural choice as the first therapist/Program Chair.” With the intention of increasing the visibility of the Association and advancing the science of hand care beyond Hand Surgery, Dr Mackinnon conceived and initiated HAND as the Association’s Journal. Since the first issue in 2007, HAND has grown to six issues a year and is indexed in Medline.
Furthermore, during her leadership, the inaugural Alan Freeland Award was established to honor his relentless and selfless dedication to promoting the best Hand Surgery and hand therapy care around the world.
Fig. 6Dr Susan Mackinnon, right, with Program Chair Christine Novak, PT, PhD, at the 2006 Annual Meeting.
(Courtesy of Susan Mackinnon, MD and Christine Novak, PT, PhD.)
Don't come if you're looking for a husband”You’re coming because [Dr. X] wants you… I don't believe women belong in Orthopaedics…I will never take a woman. Over my dead body…If you get pregnant, have a complication and are out for more than four weeks- I will fire you—Various Faculty and Chairmen, 1980sHow should we contact you when you’re out [on maternity leave]call the beauty shop?—Private Practice, Midwest, 1980sResidency Interviewer: “Won't it be difficult to work if you have your menses?”Female Applicant (Future Hand Surgeon): “I have it right now…”-Fellowship Interview, 1990s.—Quotes from female Hand surgeons interviewed for this article.
The accessibility of Hand Surgery fellowships to women has evolved over the decades. Once a rarity, female surgeons now represent one-quarter of Hand Surgery fellowship graduates.
Before efforts to standardize Hand Surgery fellowships, access to training was gated, and one could practice Hand Surgery without subspecialty training. A third-party algorithm now services the current “match” system, whereas historically, a phone call with an offer would be extended, with an assigned grace period (often quoted at 24 hours) to accept the position. The CAQ examination was subsequently developed as a certification to gain admission to ASSH membership, the first examination being administered in 1989. It is now known as the Subspecialty Certificate in Surgery of the Hand (SCC). SSC was open to Diplomats of the 3 boards- General Surgery, Plastic Surgery, and Orthopaedic Surgery, with a trilateral committee overseeing the content, review, and standardized passing score. The first woman on the board of the ABOS, Dr Ezaki chaired this committee while on the ABOS, before serving as the director of the ABOS, Chair of the Maintenance of Certification (MOC) committee, and has made major contributions to the current American Hand Surgery fellowship structure and board examination process. Dr Ezaki was recently honored as a Pioneer in Hand Surgery by the IFSSH in 2022.
In the 1980s, female Hand Surgery fellows were scarce. So much so, multiple facilities still required them to wear the traditional scrub dress reserved for women (Fig. 7). Dr Michelle James and Dr Jeanne DelSignore (first female Hand Surgery fellows, Indiana Hand Center, 1988) remember the lack of changing facilities for female physicians. A broom closet was converted into a locker space for the two women, eventually guarded by a specialty lock designed to limit immediate entrance from the hallway. Similarly, Dr Ann Miller (Tufts, 1989) recounts the only entry to the dictation room required passage through the male locker room.
Fig. 7Orthopaedic Surgery attending surgeon and resident wore “scrub dresses” in a during Halloween at the hospital. This “scrub dress” was common attire for female surgeons in the Northeast United States during the 1970s-1980s. (Courtesy of Eric Sides, MD, Danny Gurba, MD, and Liza Lattanza, MD, FAOA, FAAOS.)
Applying to Hand Surgery fellowship in the 1990s, Dr Lattanza (Chair of Orthopaedics, Yale University, current; St. Lukes Roosevelt, 1999) was told letters of recommendation were not written for women. Even so, multiple surgeons who trained during this era agreed that so long as you did the work, you were regarded in a gender-neutral fashion. In the military, Dr Charlotte E. Alexander (Captain, Medical Corps, US Navy; Navy Sterling-Bunnell Hand Surgery Fellowship, 1983) felt highly supported and encouraged during her fellowship years.
In recent years, we have started to see instances of all-female fellowship classes, maternity leave policies, and lactation rooms.
Formation of Interest Groups
In 1983, the Ruth Jackson Orthopaedic Society was established “to promote professional development of and for women in orthopedics throughout all stages of their career.” The founding members included Dr Jackson herself, Dr Liebe S. Diamond, and four other female Orthopedic surgeons.
Multiple female Hand surgeons have served as President of this society, including Dr Mary Lynn Newport (1998), Dr Ouellette (2007), Dr Ann Van Heest (2009), Dr Michelle James (2012), Dr Lisa Lattanza (2017), and Dr Dawn LaPorte (2020). In 2019, the society implemented a new award (“He For She”) to recognize a male Orthopedic surgeon who serves as a strong mentor and sponsor for women in orthopedics, supporting and empowering females at all stages of their careers to achieve their professional goals.
At the 2012 ASSH meeting, Drs Michelle Carlson, Dawn Laporte, Jennifer Wolf, Julie Katarincic, and Ann Van Heest decided there was a need for networking among the few existing female Hand surgeons, and the Women in Hand Surgery (WISH) group was born in a hallway in Chicago. After that first unofficial gathering, the ASSH has since adopted and funded the group.
Last, most recently, social media (Instagram, Facebook) has also served as a vehicle for female Hand surgeons of various training backgrounds to coalesce.
Mentorship
Mentors give advice, listen to you whine and celebrate your wins, help with career decisions, and a sponsor is someone who gives you a hand and pulls you forward. Marybeth [Ezaki] was doing this behind the scenes for me without me even knowing…—Dr. Lisa Lattanza
With so few women, the history of mentorship of female hand surgeons has largely relied on male allies, from accessing residency training, to navigating early practice and research, to leadership positions.
In 2009, while bonding over how to succeed in male-dominated fields, the Perry Initiative (named after Dr Jaquelin Perry) was conceived by Dr Jennie Buckley, PhD, a biomechanical engineer at the University of California at San Francisco (UCSF) and Dr Lisa Lattanza. This nonprofit began as a weekend program for 18 girls, and has since grown to a national outreach program with more than 14,000 young women participating in the program since its inception. In 2021, 60 women who matched into orthopedics had been graduates of the Perry Program. Students from high school to medical school attend the program, and more than 85% have pursued medicine or engineering studies. Professor Lattanza regards this as “probably the most important thing [she] did in [her] career.” She is currently the Chair of Orthopaedic Surgery at Yale University, and at UCSF served as Chief of Hand and Upper Extremity Surgery; Fellowship Director; Vice Chair of Diversity, Equity, and Inclusion (DEI); Vice Chair of Faculty Affairs; National Board Member of Shriners; and President of RJOS, among other positions. She also received the AAOS Diversity Award in 2021 for her work with the Perry Initiative among other achievements.
In 2014, Dr Megan Conti Mica, who serves as cochair for the Diversity Committee for the ASSH, was a part of the first female-dominated class of Hand Surgery fellows at Mayo Clinic. She is a part of the first All-Female Hand Surgeons Travel Club, with the aim of mutual mentorship and support.
On the shoulders of women: notable names in history
In telling the story of female surgeons in upper extremity maladies, the following investigators are highlighted. This list is by no means comprehensive, and the authors regret they could not include all notable names in this article.
Augusta Klumpke: Klumpke Palsy
Dr Dejerine-Klumpke (Fig. 8) was a physician and neuroanatomist in the 1800s known for describing lower plexus paralysis and the oculopapillary signs associated with them, a palsy that bears her name.
Born in San Francisco (1959), she studied medicine in Paris, “where she was a key figure in the development of the French school of neurology that burgeoned in Paris at the turn of the 20th century. She was just 26 years old when she described Klumpke’s brachial plexus palsy. Beyond her contributions to neurology, Dr. Déjerine-Klumpke is seen as a pioneer in the history of French feminism, having struggled against prejudice to become the first female intern in Paris. She is also remembered as an innovator in spinal cord injury rehabilitation.”
For her work as an officer during World War I, she was awarded the French Medal of Recognition and promoted to Officer of the Legion of Honour. She was the first female member (1901), vice president (1913), then president (1914) of the Paris Society of Neurology, and the first female member of the Society of Biology (1923). At 68 years, Dr Klumpke died of breast cancer in Paris, France (1927). “She was a person who did not take no for an answer (Lynda Jun-San Yang, neurosurgeon, University of Michigan), and is the only woman discussed in Boyes’ 1976 “On the Shoulders of Giants: Notable Names in Hand Surgery.”
Fig. 8(Left) Dr Augusta Klumpke. (Right) 22-Year-old Dr Augusta Klumpke surrounded by male colleagues at a Paris clinic, 1881.
(From Madame Déjerine 1859-1924 : Déjérine-Klumpke, Augusta Marie, 1859-1927. Internet Archive. Available at https://archive.org/details/b29931630/page/39/mode/2up; and Plate V, La Clinique du Charité, 1881 from “Le Professeur J. Dejerine,” 1922. Gauckler, E. Le Professeur J. Dejerine, 1849-1947, by Paris: Masson et Cie, 1922; with permission.)
Pediatric Residency Program Receives $1 Million Gift from Celebrated Surgeon and Educator Liebe Sokol Diamond, MD. Changing Lives through Philanthropy at LifeBridge Health. Summer 2017 Issue.
(Fig. 9) was one of the nation’s leading pediatric Orthopedic surgeons and the first female member of Pediatric Orthopaedic Society, and was the 12th board certified female orthopedist in the United States (1964). Born in Baltimore (1931) as a first-generation Jewish immigrant, Dr Sokol Diamond’s family was deeply involved in helping Eastern European Jewish refugees resettle in this country.
Dr Sokol Diamond was the first female orthopedic resident at the University of Pennsylvania (1960), hired when she was the only candidate who knew the difference between a cross-cut and a rip saw, distinguishing her from the men. “In retrospect, maybe some of my rough times were because I was a woman,” Sokol Diamond said in an interview. “We were tolerated, in a physical sense, but I can’t say I was discriminated against in any sense. Out of 200 [interns and residents], there were only five women. You took what was dished out, and you shut up and drank your beer. We all thought that if we made any noise, we’d be kicked out.”
Born with multiple hand and foot deformities (amniotic band syndrome), she later started her own congenital practice at the very hospital that had first cared for her. Yet, she never felt this was a limitation—to accommodate her own partial finger amputations, her family commissioned a custom porcelain glove model, from which her surgical gloves were then made.
Her career and research focused on pediatric limb deformities and orthopedic aspects of genetic diseases, where her own anatomy helped patients and parents facing difficult diagnoses and medical situations. “It takes away some of the aloneness…the fear of the future,” she said. She was known for her innovative techniques for correcting limb deformities. She also served the State Health Department, the Jewish Family and Children’s Society, and was inducted into the Jewish Hall of Fame (2013). Dr Sokol Diamond passed away from leukemia in 2017.
Dr Julia Terzis: Reconstructive Microsurgery and "Babysitter" Procedure
Born in Thessaloniki, Greece, Dr Terzis grew up in post-World War II Salonica. Her father died when she was 5 years old, so her grandmother raised her and her sister while her mother struggled to provide for the family.
Dr Terzis arrived in Pennsylvania in 1961, where she attended university and medical school, before earning her PhD studying neurophysiology of mechanoreceptors from McGill University. She was the first female resident at the Royal Victoria Hospital (Montreal, Canada), one of the birthplaces of microsurgery. She fought to ensure her performance did not reflect poorly on her gender, even returning to work only two days after she gave birth to her only daughter.
When she rotated through Plastic Surgery, Rollin Daniel and Bruce Williams influenced her to pursue Plastic Surgery and, specifically, Peripheral Nerve surgery. She is recognized worldwide for her vanguard contributions to restorative, reconstructive microsurgery and peripheral nerve paralysis, including involvement in the first neurovascular free flap (1974), the revolutionary concept of the “babysitter” procedure (1984),
the first free pectoralis minor muscle for smile restoration, and the first vascularized nerve grafts, and for obstetric brachial plexus injury treatment, the dynamic scapula stabilization procedure, and the selective ipsilateral and contralateral C7 technique.
Dr Terzis (Figs. 10 and 11) was a founding member of the International Society for Reconstructive Microsurgery and one of the founders of the American Society for Reconstructive Microsurgery. She has led the Plastic Surgery Research Council (PSRC), the International Microsurgical Society, and the World Society for Reconstructive Microsurgery. Dr Terzis currently resides in New York.
Fig. 10(Left) Dr Julia Terzis. (Right) In 1984, the American Society for Reconstructive Microsurgery (ASRM) was established. Photograph of the attendees of the first annual meeting of the ASRM. There are two women: Dr Jane Petro (first row, second from left) and Dr Julia Terzis (second row, seventh from the left).
Fig. 11(Left) Dr Terzis (right) and Dr Manktelow (center) transferring the first pectoralis minor flap at Royal Victoria hospital on January 26, 1981. (Right) 2001 Inaugural Congress of the WSRM, Taipei, Taiwan (Dr Terzis is first/lower row, fourth from left).
After completing medical school, residency, and research in Canada, she trained at the Raymond Curtis Hand Center (Union Memorial Hospital, Baltimore, 1982). In 1984, Dr Mackinnon began experimenting with pretreated nerve allografts and host immunosuppression, and, as she has repeated throughout her career, translated this bench research into clinical applications, reconstructing a child’s sciatica nerve in 1988.
She also conceived and developed the concept of nerve transfers to reinnervate muscles denervated by injury at a higher level, creating a monumental paradigm shift in how surgeons treat nerve injuries.
In addition to publishing hundreds of articles and book chapters, with her colleague Dr Ida Fox, she developed a military-funded Web site to democratize and educate surgeons everywhere in surgical techniques.
This content has generated millions of views over hundreds of countries around the world. Dr Mackinnon has also been outspoken in developing female surgeons through role modeling, mentorship, and most importantly, sponsorship. Her life and work have impacted incalculable legions of patients, surgeons, and female physicians, globally.
Dr Mackinnon is the recipient of multiple prestigious awards and leadership positions, including but not limited to, the Gold Medal Award in Surgery by the Royal College of Physicians and Surgeons; fellow of the Institute of Medicine of the National Academy of Sciences; President of AAPS, AAHS, ASPN, and PSRC; AAPS Honorary Award; Clinician of the Year, Research Achievement Award in Basic Science; and Distinguished Fellow. She was awarded the Jacobson award in innovation for the American College of Surgeons. She was the Chief of her division for nearly 25 years before stepping down in 2020. Dr Mackinnon was recently honored as a Pioneer in Hand Surgery by the IFSSH in 2022.
Dr Jacquelin Perry: Mentor and Role Model
Born May 31, 1918, in Colorado Dr Jacquelin Perry (Fig. 12) was raised in Los Angeles.
The daughter of a clothing shop clerk and salesman, she was determined to become a physician from a very young age. She committed herself to reading every textbook in the Los Angeles library from childhood. After receiving her bachelor's degree in Physical Education from the University of California Los Angeles (UCLA) in 1940, she joined the US Army and trained as a physical therapist, which gave her a background of working with polio recovery patients. Following World War II, she pursued medicine with the G.I. Bill, and graduated as the first female Orthopedic surgeon from UCSF. Known colloquially as “The Grand Dame of Orthopaedics” she became one of the first ten women certified by the ABOS. The foremost expert in the United States on gait analysis, her research and expertise were founded on decades of working with post-poliomyelitis patients at Los Angeles Rancho Los Amigos Medical Center. The Jacquelin Perry Neuro-Trauma Institute and Rehabilitation Center at Rancho Los Amigos was dedicated in 1996 in her honor, and multiple awards and initiative are named in her honor, including a research award in her name, as well as The Perry Initiative, a national engineering and medicine outreach program responsible for building a pipeline today of women in medicine and engineering. She is responsible for pioneering our current understanding of neuro-orthopedics, functional assist devices, and training leaders in the field of neuro-orthopedics today, including Dr Mary Ann Keenan and Dr Lattanza.
Among the first generation of female Orthopedic surgeons, you would be hard pressed to find one who does not mention Dr Perry as an influence, inspiration, or mentor.
from 1995 to 2012 regarding ethnic and gender diversity in Hand Surgery trainees. Statistically significant yet minimal linear growth of 0.61%, 0.48%, and 0.66% per year (P < .05 for all) was found for proportions of female trainees in Hand, Orthopedic, and Plastic Surgery, respectively. Encouragingly, the proportion of US women in the ASSH has grown from 9.3% in 2010% to 14.3% in 2016, and the percentage of US female presenters at the annual meeting has increased to 15.9%.
Increased gender diversity correlates with improvement in quality of medical education, research productivity and health care accessibility.—MA Simon, JY Reede
Racial, ethnic, and gender diversity and the resident operative experience. How can the Academic Orthopaedic Society shape the future of orthopaedic surgery?.
It actually doesn't take much to be considered a difficult woman. That's why there are so many of us.—Jane GoodallWhen I'm sometimes asked when will there be enough [women on the Supreme Court] and I say, 'When there are nine,' people are shocked. But there'd been nine men, and nobody's ever raised a question about that.—Ruth Bader Ginsburg
Women in medical school, in surgery, and women in Hand Surgery, no matter the pace, are undoubtedly increasing.
These small incremental gains are not an eventuality; each annual 0.5% (or less) increase represents a Sisyphean and hard-won token of the cumulative grit and emotionally erosive micro/macroaggressions our foremothers have endured. Although times may be changing (slowly), we must not only remember the legacy of female surgeons who have contributed to the profession but also the history of hardship that has not yet earned women complete inclusion and belonging in our specialty. Mindful, intentional sponsorship and abandonment of “othering” behavior can only serve to better our specialty and outcomes for our patients.We all need friends and mentors - not so much to show the way, but to share the way.—Marybeth Ezaki
Acknowledgments
The authors are grateful to the women who generously and courageously shared their time and lived experiences. This is a modest, incomplete representation of what was uncovered through oral history, historical documents, and photographs, about the legacy of female hand surgeons. It is impossible to fully honor the strength, wisdom, and accomplishments of these women. The authors hope this is the first step in future investigations to document the history and impact female surgeons have had on Hand Surgery and on the lives of innumerable patients.
Disclosure
Dr W. Chen is a paid consultant for Allergan for the LIMITLESS initiative for female surgeons. Dr A. Topaz has nothing to disclose.
References
Wirtzfeld D.A.
The history of women in surgery.
Can J Surg.2009; 52 (PMID: 19680519; PMCID: PMC2724816): 317-320
SYM06: Women in Hand Surgery: Challenges We Face. Session Handout. Moderated by Melissa A. : Sonya P. Agnew D, Megan A. Conti M, Erika G. Gantt, MD, and Diane E S. Payne, MD, MPT. 75th Annual Meeting of ASSH, Virtual Meeting. October 1-3, 2020.
The embryogenesis of the specialty of Hand Surgery: a story of three great Americans – a politician, a general, and a duck hunter: The 2002 Richard J Smith memorial lecture.
The Upper Hand: Chuck & Chris Talk Hand Surgery Interview 3: Marybeth Ezaki. Past ASSH President, Current Mentor and Sage. Published May 10, 2020. Season 1. Episode 18.
Pediatric Residency Program Receives $1 Million Gift from Celebrated Surgeon and Educator Liebe Sokol Diamond, MD. Changing Lives through Philanthropy at LifeBridge Health. Summer 2017 Issue.
Racial, ethnic, and gender diversity and the resident operative experience. How can the Academic Orthopaedic Society shape the future of orthopaedic surgery?.
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