Hand surgery may be one of medicine’s most overlooked specialties and in this episode it becomes a riveting story of innovation, war, adventure, and the remarkable life of Dr. Sterling Bunnell, the founding father of the field. Dr. Denise Millstine sits down with Mayo Clinic hand surgeon, Dr. Anthony Smith to explore Bunnell’s extraordinary path from bird obsessed boyhood naturalist to World War I neurosurgery trainee, pioneering combat surgeon, and ultimately the architect of modern hand surgery. Dr. Smith reveals how Bunnell’s curiosity, precision, and relentless commitment shaped a specialty that blends orthopedics, plastic surgery, and neurosurgery into one intricate art. The episode celebrates both the history of the field and the passion that continues to drive hand surgeons today.
The Remarkable Life of Dr. Sterling Bunnell: Father of Hand Surgery
Meet the pioneer who shaped an entire field. In this episode, Dr. Denise Millstine and Dr. Anthony Smith dive into the extraordinary life of Dr. Sterling Bunnell — adventurer, innovator, and the founding father of hand surgery.
This episode was made possible by the generous support of Ken Stevens.
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Dr. Denise Millstine
Welcome to the “Read. Talk. Grow.” podcast, where we explore health topics through books. Our topic is hand surgery, and our book is “Dr. Sterling Bunnell: From Son of the Gold Rush to Founding Father of Hand Surgery” by Dr. Anthony Smith and Dr. Steven McCabe. I'm your host, Dr. Denise Millstine. I'm an assistant professor of medicine at Mayo Clinic, where I practice women's health, internal medicine and integrative medicine.
Stay with me, listeners, we have a long introduction here. My guest today is my Mayo Clinic colleague, Dr. Anthony Smith, who's a professor of plastic surgery at Mayo Clinic in Arizona. Dr. Smith graduated from the University of Illinois College of Medicine, then volunteered for service in the U.S. Army. He completed general surgery training, then plastic surgery residency at Wayne State University, then a hand surgery fellowship in the Department of Orthopedics at the University of South Florida, and a micro surgery fellowship at the University of Toronto. Dr. Smith joined the Mayo Clinic in Arizona in 1995 as the first full-time hand surgeon. He has served as chief of the Division of Plastic Surgery. He's the founding program director of the Plastic Surgery Residency, and he was the director of selectives when the Arizona mayo Medical School was established. He and his wife live here in Arizona and have two adult children.
Tony, welcome to the show.
Dr. Anthony Smith
Thank you. Thanks for having me.
Dr. Denise Millstine
“Dr. Sterling Bunnell: From Son of the Gold Rush to Founding Father of Hand Surgery,” is medical history nonfiction book about a true pioneer in a field of medicine that's perhaps unknown to our listeners. We're going to be talking about hand surgery today. Tony, tell us first what it's like to be a hand surgeon. What is your day to day, week to week look like?
Dr. Anthony Smith
Well, I think kind of returning back to Bunnell, one of Bunnell's major contributions was in the preface of his 1944 textbook, and Bunnell said that a hand surgeon had to be a composite surgeon; a hand surgeon had to combine the skills of an orthopedic surgeon, the skills of a plastic surgeon, and the skills of a neurosurgeon. And so what I did was, in preparation for our discussion, I reflected back on my cases on Friday. So Friday I did seven cases. Two involved bone and joint, i.e. the skills of an orthopedic surgeon, two involve nerves surgery, i.e. the skills of a neurosurgeon, and three involve tendon surgery. So you can see there that Bunnell was right, hand surgery is a geographic specialty. It's not a tissue specialty.
Dr. Denise Millstine
How interesting. When you say cases, you mean patients that you actually saw in the operating room?
Dr. Anthony Smith
Those are all patients I operated on Friday. So I did seven cases.
Dr. Denise Millstine
In one day.
Dr. Anthony Smith
In one day. They were short, but I think that it shows the breadth of hand surgery in that you're doing bone and joint, nerve and tendon.
Dr. Denise Millstine
And there are days that you're not in the O.R., that you're in the clinic, or at least a portion of your day is in the clinic. And what type of patients are coming through the door to see you?
Dr. Anthony Smith
So, yeah, so we do spend a lot of time in clinic. You know, I think it's all across the board. So that it's a chance to evaluate patients that they may present with an arthritic condition. They could present with the tendon condition, something as simple as a trigger finger. They could have a nerve compression syndrome, the most common being carpal tunnel syndrome. They could have some sort of traumatic injury. We see a lot of patients that fall on an outstretched hand and break their distal radius, and we fix a lot of distal radius fractures. You know, once in a while we'll have an open injury. I know that later this week, I'm operating on the 18 year old son of a surgery scheduler who lacerated his thumb and has two tendons that are transacted that need to be fixed.
Dr. Denise Millstine
You used a few technical terms there. So just for our listeners who aren't trained in medicine, you said distal radius. That's one of the bones of the arm. And distal means it's closer to the hand. So kind of coming close to the wrist.
Dr. Anthony Smith
Yeah, so the radius is one of the two bones in the forearm where you flex and extend your wrist, move it up and down. That's the distal radius where it articulates with your eight wrist bones.
Dr. Denise Millstine
So interesting and so many structures coming together right at that point. We probably don't respect our hands as much as we should, but they really are our access to the world. I want to hear from you. What inspired you to write this book?
Dr. Anthony Smith
So in 2002, the American Society of Surgery Hand met in Phoenix, and I attended the meeting and there was what's called the Residents and Fellows Conference. The keynote is at noon. It's the Richard J. Smith Memorial Lecture, and it was Peter Carter. And so Peter Carter, I knew Peter Carter, a hand surgeon from Dallas, worked at the Shrine. And he talked to all of us in the audience about the interaction between three people FDR, the surgeon general of the Army, Norman Kirk. And he called the third person and a duck hunter, and the duck hunter was Sterling Bunnell. And so it was a wonderful story how the three of them interacted, how FDR had been affected by his polio, The surgeon general of the Army had always been a general surgeon because of FDR’s interest in orthopedics, he picked an orthopedic surgeon, Norman Kirk. And then Norman Kirk had actually met Bunnell in the 30s when he was the chief of surgery at Letterman in San Francisco. And then when Norman Kirk was the surgeon general of the Army, he made a trip to Valley Forge Army Hospital in the fall of 1944. And he saw all these patients who had crippled hands. And Kirk knew a lot about crippling injuries in World War I. He became an expert in lower extremity injuries and actually made a name for himself as being an expert on amputations. He was the first orthopedic surgeon that became board certified in the United States Army, and so that interaction between the three of them really introduced me to Kirk, Bunnell, and Roosevelt. And just the idea of Bunnell making such a contribution to the country and to the development of hand surgery, just stayed with me for years.
Dr. Denise Millstine
I think you and I both appreciate how story is so powerful. Here you are going to this conference, probably thinking you're going to learn new surgical techniques or updates and perioperative management and then somebody tells you the story, and it all kind of coalesces to understanding how you ended up in this field, how this field ended up being what it is which you've already said is this confluence of orthopedic surgery, plastic surgery, and neurosurgery. Actually, this was news to me. I had never understood that that is how hand surgery came to be. Will you talk even more about that.
Dr. Anthony Smith
So Bunnell went into World War I, he was on active duty, and the U.S. Army was late getting into World War I, so they were benefiting from the experiences of the French and the British. And because World War I was basically close combat, they knew there were going to be a lot of head injuries, a lot of maxillofacial injuries. So they created basically neurosurgery schools and young surgeons were recommended. A thousand were recommended, 250 were picked. Bunnell was one of the 250 picked, and he was in the first neurosurgery school, and that was in Philadelphia and it was intense. It was ten weeks. They acquired the nickname the 70 Day Brain Surgeons. And then when they all got done, they were ranked. And if you were rank at the very top, you could function as an independent neurosurgeon. Bunnell got ranked at the very top in that top group. And then when he went to Europe, he had two jobs. He was the chief of surgery at Base Hospital #47, and then he was actually the leader of operating team #101; and that was seven medical people and they operated very close to the front. And in both of those positions, he did a lot of orthopedic surgery and he did a lot of plastic surgery. And so really, if you look and say, where did this idea of handsfree as a composite, where did it come from? It came from combining Bunnell’s experience in the U.S. Army neurosurgery school with his experience as a combat surgeon in World War I.
Dr. Denise Millstine
And his experience of working on these very fine, detailed structures, actually goes back to his childhood and his interest in anatomy as it pertains predominantly to birds. Will you comment on that?
Dr. Anthony Smith
So Bunnell’s sister, Mary Lee Charles Keeler and Charles Keeler there they were from San Francisco. Charles Keeler was a member of the Academy of Sciences, was an employee, which is kind of a well known institution in San Francisco. And he was an ornithologist. And he basically took his brother-in-law, who was quite a bit younger, and introduced Sterling Bunnell to ornithology. And so this is something that Sterling took too. We have seen his collection. He started collecting them as an early teenager. We've seen a bird in his collection, which is 662 specimens, is now at the Academy of Natural Sciences in Philadelphia and we visited that collection. But Bunnell, basically through that experience, he became adept at dissection because you're dissecting small birds, bigger birds. And he also became an expert in comparative anatomy because you're not dissecting birds of just one species. And so I think that really prepared him for success, because we both know that something that's a real rite of passage in medical school is cadaver lab gross anatomy. And he was very comfortable with dissecting. And he also knew the anatomy terms because he had done all that dissection on birds and even some mammals.
Dr. Denise Millstine
And he was quite the adventurer. Will you talk about his life as a young adult and some of the adventures he went on.
Dr. Anthony Smith
So when he was 11, his family moved from downtown San Francisco to Berkeley. And so they lived on Dwight Way, and we visited his two childhood homes on Dwight Way. And if you just walk up, Dwight Way, you get up on the Strawberry Hills. And so his dad was very much into nature. His dad was an officer in the Sierra Club. That's where Bunnell got interested in really, the outdoors. And then what he did is, as he got a little bit older, the ornithology and love of nature came together. So his first big adventure, he was 20, he took two of his college classmates, and they spent 77 days in Yosemite. And the intriguing thing about this is that Bunnell, unbeknownst to us when we started our research, and our research, started at the Bunnell archives in San Francisco, it's where some of the Bunnell artifacts are stored, was Bunnell kept notebooks, and we found the notebook from those 77 days. It was a combination of narrative and drawing. And Bunnell, as a very, very young child, had gotten interested in art and drawing. There's a wonderful quote where his uncle comments about when Bunnell is ten years old, that he had looked at Bunnell's drawings. And so Bunnell's mother was interesting. She was raised in a family in the East Coast in New York, where she was educated by governesses, and so she was taught art and drawing as a child. And there's no question his mother influenced her son to be interested in art and drawing and acquired that capability.
Dr. Denise Millstine
And he even had the opportunity to include a few of them in the book itself, which is really quite lovely, because of course, a picture is worth a thousand words. What about his medical school experience? I think in the 2020’s, we think of medical school, at least in the U.S., as being this very clear pattern, you typically go for an undergraduate degree, you might get something like a master's degree or a Masters of Public Health in the in between. And then most people are going to an accredited medical school that lasts for four years. But that wasn't the era that Bunnell was trained in. Will you talk a bit about that?
Dr. Anthony Smith
So Bunnell was fortunate. So, you know, what you're alluding to is in the pre 1900s, medical schools were proprietary. So the proprietor, the founder basically owned the medical school and there was no uniformity of curriculum. We've included an ad in our section on Bunnell's medical school, an ad from the 1905 Blue and Gold. So that's the yearbook at UC Berkeley. And this is actually from Cooper Medical School, which was the first medical school in the West. Cooper would go on to become Stanford, but basically the ad says there's two semesters, they’re eight months each, requirement to get in is a high school diploma and that there's no patient contact.
So the thing that Bunnell was fortunate about the other medical school that was proprietary, the second medical school in the West was Toland. So Hugh Toland was a South Carolina surgeon. He came to the West seeking his fame and fortune, the gold rush. He wasn't successful as a miner and returned to doing surgery. So he had the second proprietary medical school in San Francisco, but he realized he needed to merge with the university. So Toland Medical School ultimately became UCSF. And then the one thing that was really, I think eye opening was how far ahead of the other schools in the country the University of California was.
So about that time was the time we've all heard of the Flexner Report. Abraham Flexner was commissioned by the Carnegie Commission to look at medical education in the United States. And we were fortunate enough to get the Flexner Report from the visit in 1907. So the University of California, at that time was rapidly changing. They were, requiring people to have done at least two years of college. Bunnell was different. He got a degree in chemistry, so he was more educated than his classmates. And the University of California also was very quickly a school to adopt the two and two, two years of preclinical and then two years of clinical. And, you know, Berkeley had been around since, like 1858. So the way it was when Bunnell went to UCSF, he did two years of Berkeley, two years in the city, but he got a great undergraduate medical education.
Dr. Denise Millstine
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And then went on to his postgraduate education, which we've talked about, and then had his clinical experience, which started predominantly in his military service. But one thing that struck me in the book is that he doesn't just go practice and stay learning his techniques and kind of applying them to the one-on-one patient’s that he's operating on or caring for. He actually develops this whole system where he then is bringing that knowledge, that experience, those advancements, literally across the country. Can you talk about how important it is to go on to then educate, especially as a pioneer in this field.
Dr. Anthony Smith
One thing that was very important in Bunnell's medical education. So he gets out of medical school in 1908. He interns at St. Luke's in San Francisco in 1908 and 1909, and his mentor Wallace Terry, who ultimately became the chief of surgery at UCSF, had done a traveling experience himself. Wallace Terry had gone to Bern, Switzerland, had actually interacted with Kocher, who would later win the Nobel Prize for his work on the thyroid. Bunnell traveled to all the prominent places in the States. He was at Hopkins. He was at the Mass General. He was with George Crile, who founded the Cleveland Clinic. This was after his internship year. He ended it, his travels at the Mayo Clinic, so he is at Rochester, Minnesota. And so particularly his time with Crile in Cleveland was very important because he learned the technique of direct blood transfusion. So George Crile was one of the founders of the Cleveland Clinic in 1900 he mastered that technique. And then when Bunnell came back, he had a little more time at UCSF. And then very quickly was World War I. But he applied those techniques, direct blood transfusion to World War I. And then when he came back after the war, he took the idea of medical triage and reversed it. In general, patients who are injured go from the outlying areas to the cities. Bunnell learned how to fly, and he became the flying surgeon of San Francisco, and he would then fly his plane, initially it was a biplane, and he would fly to outlying areas and perform emergency surgery, frequently administering direct blood transfusions.
Dr. Denise Millstine
And what does that mean, a direct blood transfusion. I think probably our listeners can envision donating blood or a bag of blood being transfused, maybe in an emergency situation. What do you mean by direct blood transfusion?
Dr. Anthony Smith
So a direct blood transfusion is a surgical procedure where the donor actually has a surgical procedure and their radial artery is exposed in the operating room and the recipient, there's a cephalic vein, which is a large vein in the forearm is exposed and then a surgical connection between the two is created. And so this was again, this was a technique that was developed by George Crile. And it's interesting that this was done before there was magnification. They would use a handheld magnifying glass. Bunnell used this extensively on it’s times as the flying surgeon.
Dr. Denise Millstine
He's almost like a superhero. We talked about the importance of blood transfusions in episode 61, when we talked to Sebastian Junger about his book, “In My Time of Dying.” So listeners interested in that topic can go back to that episode.
So his time of flying around the country did not last a long time, unfortunately. Should we leave that for our listeners to discover when they read the book themselves or do you mind sharing what happens.
Dr. Anthony Smith
It was a very traumatic event in Bunnell's life, there's no question at least from a reader standpoint, it was the worst day of his life. He was piloting a plane with a rider and an adventurer, LeRoy Jeffers, who had come to San Francisco to write about the Sierra Nevada mountains. He couldn't get another pilot to take him to the Sierra Nevadas, and Bunnell volunteered, and he was flying Jeffers from San Francisco to the Hotel Wawona in Wawona, California and Bunnell banked to the right and he lost consciousness and Jeffers died on impact. They fell 100 feet straight down. Bunnell sustained a fracture dislocation of the hip. That certainly was the worst day of Bunnell's life from a reader standpoint. His fractured hip did not heal. He had a bone graft a year later, and that actually was the end of the flying surgeon. He never flew a plane again until his travels in World War II. He did for a very short period of time pilot a plane, of course with the pilot there, but never again solo.
Dr. Denise Millstine
Yeah. And interesting especially as a physician to then become a patient and have that experience obviously not in his hand but in his hip. That was a long course that he had to navigate and recover from, right?
Dr. Anthony Smith
It was long. The year from the injury, the three months in traction, the convalescence, the short period of time that he was pain free and then the pain and then going through the operation with another three-month recovery. So it was months and months.
Dr. Denise Millstine
And what do you think is his most significant impact in the field besides the formation of the field at this time? What do you think really was his most impactful contribution?
Dr. Anthony Smith
I would say that there were two. So one was during World War II, when he got recruited by Kirk. And Kirk recognized this need for hand surgeons in the military. Bunnell took young surgeons; they could be after an internship. They could be after a couple of years of residency. And he assembled them in nine hand centers in the continental United States. And Bunnell traveled from late 1944 to early 1947. He traveled to these nine centers, and many other Army hospitals, and basically educated these young surgeons about the discipline that he defined, and that was the discipline of hand surgery. Those became really the first dedicated hand surgeons in the United States
At the end of the war, those surgeons, which basically were his disciples, they really wanted to keep it going. And they wanted to form, particularly Joe Boyes, who had been Bunnell’s partner in the 30s. Joe Boyes wanted to found the American Society of Surgery the Hand with Bunnell as the president. And Bunnell was the first president, 1946. And then a year later, he gave his presidential address. And in his presidential address, he predicted the development of hand societies across the globe and so the first society for hand surgery was the American Society for Surgery of the Hand. Now there are hand surgery societies in 82 countries. So I would say Bunnell’s major contribution was the development of the specialty. But what followed very closely was passing that discipline on to others so there could be other surgeons who function as hand surgeons. And then finally, spreading through the American Society of Surgery of the Hand, the discipline across the world.
Dr. Denise Millstine
Will you talk to our listeners about what the training for a hand surgeon looks like today. Is it still you can come through plastic surgery or you can come through orthopedic surgery. How do most hand surgeons become trained and how long does that take?
Dr. Anthony Smith
So you have to do a basic residency. So you could do a basic residency in general surgery, which would be five years, orthopedic surgery which would be five years, or plastic surgery, which would be six years. And then in your second to last year you would apply and there's a match, and then you would be accepted into a one-year hand surgery fellowship. And then hand surgery has matured to the point that there is now board certification in hand surgery. So, you know, like other board certifications, there's a written exam. And I think the one thing that hand surgery has done a nice job with, they really look at the experience, you know you have to submit cases and this sort of thing. There is not yet an oral exam in hand surgery, but there is a written examination.
Dr. Denise Millstine
And what's the difference if I were to need carpal tunnel surgery, could I have that done by a general surgeon or an orthopedic surgeon? Or do I need to see a hand surgeon? And when do I absolutely need to see a subspecialty surgeon?
Dr. Anthony Smith
I think it's like anything else. You have to find out what the surgeon is doing. So if a general surgeon is in a rural area and they're doing 89% what we would call bread and butter general surgery, laparotomies, things like this…
Dr. Denise Millstine
A laparotomy would be abdominal surgery, like maybe appendix or something like that.
Dr. Anthony Smith
Taking out the gallbladder, stomach surgery and they do just a few hand cases a month, then I would be suspect. So I think, like anything else, everything is driven by the experience of the surgeons. So I think in general I would say particularly in the metropolitan areas, and surgery is generally done by people whose practice is very much limited to surgery of the hand and upper extremity.
Dr. Denise Millstine
So would you go so far as to say Dr. Sterling Bunnell is your hero.
Dr. Anthony Smith
Well, we mentioned that in the book, as you know. So we brought that up in the introduction, and we ended the book with the afterword, which was written by my coauthor, Steve McCabe. And that's the last lines of the book, …that indeed he started as our hero and he ended as our hero, yes.
Dr. Denise Millstine
And in terms of your professional life as a surgeon, as a medical doctor, but would you say also as an author, since his book, “Surgery of the Hand,” is the foundational text for the beginning of the field, right?
Dr. Anthony Smith
Oh, I don't think his textbook went through seven editions and you know his textbook. It was his good friend, Leo Mayer from New York City said it was the Bible of hand surgery. And so I think that most people recognized that for decades and decades, that indeed was true. So it was the first comprehensive text. It was in 800 page single author text published in early 1944. It changed the field. And then the interesting thing was then when Bunnell became the civilian consultant in hand surgery to the Secretary of War, the U.S. Army adopted Bunnell’s textbook as the textbook for the surgeons at the nine hand centers.
Dr. Denise Millstine
Would you say most hand surgeons still have a copy of the textbook in their office?
Dr. Anthony Smith
A little tough to get, but, you know, many of them have been given copies of the book by older colleagues.
Dr. Denise Millstine
It's like Harrison's in internal medicine. We have a classic textbook called Harrison's as well, though most of us do a lot of our learning and reading digitally now.
I just want you to talk a little bit more about the American Society for Surgery of the Hand. So they are the organization that sponsored creating this book and allowed for this to actually come to be. Who are they? What do they do?
Dr. Anthony Smith
As I mentioned earlier, Bunnell was the first president. They were founded shortly after World War II. Their headquarters are in Chicago, and you can join it as a candidate member when you're a trainee. You can join it as an active member when you've achieved board certification in hand surgery. They have to be interesting to, as I recall, I think about 2400 active members. I might be a little bit short on that, but they basically have their own in-house publishing house. And our biggest difficulty was finding a publisher, and they agreed to publish the book for us. We had to give up a little bit. We had to give up the copyright. If it makes any money, it goes to their foundation. But I think that they were very supportive. Olivia Williams and Elaine Stewart helped us immeasurably. And then when we got closer to publishing, they got us a developmental editor. And so, yeah, they were very supportive. But they, you know, they host an annual meeting, they host webinars, and they are really the glue that basically keeps the hand surgeons of America kind of under an umbrella. There's a second organization which was founded much later, the American Association of Hand Surgery, and it was founded probably 20 years later.
Dr. Denise Millstine
So interesting. And it's really important that we continue to learn and capture and know about medical history. Right?
Dr. Anthony Smith
You know, I would say like the famous quote, right. If you don't understand history, you're condemned to repeat it. Right. And so I think reading Bunnell’s textbooks from cover to cover made it very clear that one, he was really way ahead of everybody else. And number two, many of the things that we thought in our era are new, were not.
Dr. Denise Millstine
Oh how interesting. Yeah. What other wisdom do you want to share with our listeners?
Dr. Anthony Smith
Well, I think as clinicians it is something that we just do. We go to work, we see the patients. For me, I operate on the patients. But I think when you find something like this and you do indeed have a “labor of love,” I know it's a cliche, but this was a wonderful six-year experience. Dr. McCabe, and I got to be very close. We traveled the country. We did a zoom every Saturday morning at 10:00 for three years. So I would say that for physicians, find something just like this, because it's tremendous, was a tremendous source of fulfillment, of enjoyment, of learning. And I wouldn't be on this podcast had I not written the book.
Dr. Denise Millstine
You might have been, you might have been. But still, I wholeheartedly agree. It's so important to have a passion project and to think creatively about what that could actually look like.
Listeners are encouraged to go out and read “Dr. Sterling Bunnell: From Son of the Gold Rush to Founding Father of Hand Surgery” by Dr. Anthony Smith and Dr. Steven McCabe.
Tony, thanks for being on the show.
Dr. Anthony Smith
So I'm just going to give you one last pitch. The e-book is available on Amazon. The hard copy can be obtained through the American Society for Surgery of the Hand.
Dr. Denise Millstine
Excellent. Thank you for that. Keep reading everyone!
“Read. Talk. Grow.” is a product of the Women's Health Center at Mayo Clinic. This episode was made possible by the generous support of Ken Stevens. Our producer is Lisa Speckhard Pasque and our recording engineer is Rick Andresen.
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