My presentation about W.E. Ladd.

1. Dr. Oğuz Kızılkaya
Trakya University Pediatric Surgery Clinic
W.E. LADD

3. Stethoscope by Laennec in 1816
Ether anesthesia by Long 1840
Antiseptic surgical techniques by Lister in 1865
Roentgen’s discovery of x-rays in 1895

4. Survival was rare for a newborn child with a significant congenital anomaly or any
child requiring major surgery
Blood transfusions were not safe
Intravenous fluids did not exist
Monitoring was not introduced into anesthetic management
No antibiotics to help prevent or treat infections
Few effective medications other than digitalis, aspirin, and opiates
Major elective operations were more feared and talked about than performed

5. Dr. C. Everett Koop
“Surgeons in general were frightened of children
and distrusted anesthetists to wake them up after putting them to sleep.”

6. LADD
Born in 1880
MD from Harvard 1906
General Surgeon from Boston City Hospital 1908
Volunteer at Boston Children’s Hospital 1910
Chief of Surgery of the Children’s Hospital in 1927-
1950
1 of 3 full time pediatric surgeons in USA 1936

7. Pediatric Surgeons Part-time consultants
Technician for pediatricians
General Surgeons Thinking «Adequate for all ages»
Hostile to Pediatric Surgeons
Children are little adults
Ladd strongly opposed

10. Reported 6 cases of malrotation with volvulus and 4 cases of duodenal atresia 1932
Described the treatment of malrotation with volvulus by counterclockwise detorsion

11. Described Ladd’s procedure in 21 operative cases, 16 of which survived
1936
Importance of dividing the (Ladd) bands over the duodenum
Placing the cecum in the left upper quadrant

12. In 1908, Dr. James S. Stone at Boston Children's Hospital reported an operative mortality from
intussusception of nearly 90%
Dr. Ernest A. Codman, reported 27 patients of all ages with intussusception, including 11 infants (10 of whom
died), 15 different surgeons were involved, employing 14 different treatments.
“Operate early and not after exhausting the patient by attempted palliation and delay, but as soon as the
diagnosis is made;”
Keep the infant warm by wrapping the extremities and body with bandages
Use a right paramedian incision and remove the intestine to expose the lesion
Reduce the intussusceptum by pushing it from below
By 1913 reduced the mortality to 45%

13. Ladd was the first to use a contrast enema in the diagnosis and therapy of intussusception
Used a bismuth slurry to outline the lesion on radiographic images in two patients and partially reduced it
before surgery
Attempts at complete reduction using the techniques available at the time were unduly hazardous and
served only to delay surgery
Goal was to push it proximally to a point where it could be easily reached through the right paramedian
incision
In a third patient, he used the bismuth enema to prove that a child did not have intussusception and,
thus, he avoided an unnecessary operation

15. Ladd performed the first extramucosal pyloromyotomy done at the Boston
Children's Hospital. By 1918, he had a series of 26 cases and reported a
mortality of 15%

16. Pioneer in the surgery for Wilms’ tumor, Advocating a transabdominal approach

17. Founding member of the American Board of Plastic Surgery
Contributed immensely to the treatment of cleft lip and palate
Associate member of the Academy of Pediatrics,
Executive committee member of Surgical Section from 1947
Pioneer in the treatment of exstrophy of the bladder
Demonstrating the efficacy of ureterosigmoidostomy for the diversion
of the urinary stream
Saved an infant with esophageal atresia in 1939
Dividing the tracheoesophageal fistula
Marsupializing the upper esophagus to the neck
Creating a feeding gastrostomy

19. Ladd is credited with popularizing the concept;
children and infants should not be treated as miniature adults
their problems and physiologic responses are distinct
Children and infants are best cared for by those who are well versed in and exclusively dedicated to
their care
Professor of Children’s Surgery at Harvard Medical School in 1941-1945
Lead to the recognition of the discipline as distinct from general surgery and pediatrics
With the help of Ladd, creation of the Surgical Section of the American Academy of Pediatrics
Also among the first to recommend to the newly established American Board of Surgery
Means for accrediting pediatric surgeons

20. William Stewart Halsted:
Father of the model for our current surgical training programs
Trainees had to be available 24 hours a day, seven days a week
Reside in the hospital and be unmarried
Only men were accepted
No set length of training
Halsted’s decision when a trainee was ready for practice,
assessment of capabilities, talent, and skill
“graduated responsibility”
Established a hierarchy of junior assistant residents,
assistant residents, residents
Halsted selected only the best, only the best would finish

21. Ladd trained the leaders of the next generation of pediatric surgeons
Best known was Robert E. Gross
First surgeon to perform successful congenital heart
surgery by
successfully ligating a patent ductus arteriosus 1938
performed the operation on a relatively healthy 7-year
old child while Ladd was on vacation
“permanent rift” between Ladd and Gross
Slowed the speedy development of child surgery more
than we will ever know

22. Orvar Swenson

23. Participated in the teaching of embryology and pathology to the first and second-
year students
Ran weekly Saturday morning conferences for medical students and housestaff to
discuss interesting surgical cases at the Children’s Hospital
Fourth-year elective for students included a month-long rotation on Ladd’s surgical
service
In 1954, the American Academy of Pediatrics established the William E. Ladd Medal as
the
“highest recognition an American pediatric surgeon can receive.”
In 1997, genealogy showed a direct line of descent from Ladd to 75% of all accredited
pediatric surgeons