By Dr Myint Zan
An ‘underrated’ article ‘Ivory hip prostheses for ununited fractures of the neck of femur’ by Dr San Baw (February 1970, Journal of Bone and Joint Surgery, British Volume)
IN JANUARY 1960, my father first used the ivory hip prosthesis on the then 83-yearold Burmese Buddhist nun Daw Punya. Fast forward from January 1960 to September 1969. A conference of the British Orthopaedic Association (BOA) was held from 23 to 27 September 1969 at the Royal College of Surgeons in London. My father presented his paper ‘Ivory femoral head prostheses for ununited fractures of the neck of femur’ at the conference. But sadly, at least to me as a son and for the historical record as well, only a 311word summary of my father’s paper which was presented to the BOA, was published in Volume 52 B (No 1) of The Journal of Bone and Joint Surgery (British volume) (1970).
Five years after the publication of an abstract of my late father’s paper presented at the BOA conference of September 1969 was published in the February 1975 issue of the same journal, an article written by my late father was published in full. The title is ‘The Transarticular graft for Infantile pseudarthrosis of the Tibia a New Technique’ in (1975) Volume 57 (1), Journal of Bone and Joint Surgery (hereafter JBJS) from pages 63 to 68. My father reported about a new treatment he devised in lay persons’ terms for the development of extra shin bone in children. Fourteen patients who were then children during the period of July 1964 to November 1972 were successfully treated with that new method.
In the 1975 JBJS, clinical case studies of treatment with a new technique for 14 children with extra shinbones were published in full. Ironically, clinical case studies of treatment with ivory hip prostheses from January 1960 to about June 1969 with 88% success of about 100 patients ranging from the ages of 24 to 87 were published only as an abstract in the JBJS. (These facts are in the Abstract).
In 2017 a former student of mine from the Faculty of Law, Multimedia University, Malacca, Malaysia, Ms Teo Ju-li, sent me an email from Edinburgh, the United Kingdom. Ju-li was studying then for her Master of Laws (LL.M) at the University of Edinburgh. She visited the Museum of Surgery in Edinburgh and saw an ivory prosthesis on display at the Museum.
I wrote to the personnel of the Museum of Surgery, and I thank them for sending me a few photos of the ivory prosthesis on display inside a glass case. The display ‘card’, at that time in 2017, incorrectly stated that the ivory prosthesis was from Malaysia. I wrote to the Museum that it was from Burma, and they corrected the description. Underneath the ivory prosthesis displayed at the Museum of Surgery, Royal College of Surgeons, Edinburgh, is this brief description:
‘Ivory hip prosthesis (around 1970)’
Doctor San Baw, a Burmese orthopaedic surgeon, first used an ivory hip replacement in 1960. The patient was an 83-year-old Buddhist nun. Over 20 years, he performed about 300 such operations. He found that 90% of patients could walk, squat, and play football within a few weeks.
A few specimens of ivory prostheses, including one where the ‘biological bonding’ between bone and ivory in the hip of a deceased patient, can be seen on display at the Mandalay Orthopaedic Hospital. The biological bonding between bone and ivory or creeping substitution of the bone by ivory is displayed in a glass case. This specimen was taken from the hip bone of the cadaver of a deceased person (with their prior consent and those of their relatives). The deceased person had his or her hip bone replaced by an ivory prosthesis by my late father.
Since only a 311-word summary of my late father’s article can be discerned in an obscure place in the JBJS of February 1970, no other academic journal has cited or referred to the abstract of the paper ‘Ivory femoral head pros theses for ununited fractures of the neck of femur’. There have been four academic journal citations (google scholar check, 29 June 2021) of the article by my late father on congenital pseudarthrosis of the tibia published five years later in the February 1975 issue of JBJS. Hence, in context, my late father’s article on ivory prostheses is an underrated article.
An Overrated Article: Antony Flew’s ‘Theology and Falsification’ (first published 1950) and republished 40 times!
The late Antony Flew (11 February 1923 to 8 April 2010) was a younger contemporary of my late father, Dr San Baw, by about seven months. Flew was and is many times more well-known the world over than my late father. So was his 1100-word article ‘Theology and Falsification’ first published in the now-defunct and even then-obscure journal University (affiliated with the University of Cambridge in the United Kingdom).
Compared to the now-defunct undergraduate journal where Flew’s article was first published, The Journal of Bone and Joint Surgery (British volume) (now Bone and Joint Journal) has been publishing continuously since 1948, and by no means was it an ‘ephemeral’ journal in 1970 or now in 2022.
A Myanmar Orthopaedic surgeon informed me around 2005 that my father’s new treatment for infantile pseudarthrosis of the tibia is mentioned in Campbell’s Operative Orthopaedics though I have not been able, so far, to verify it myself. I also do not know which edition of the above four volumes treatise was ‘San Baw’s technique’ (a new technique to treat the development of extra shin bone in children) mentioned. I also do not know whether or not my late father’s more important pioneering work with ivory hip prostheses made it into the august pages of Campbell’s Operative Orthopaedics.
Antony Flew stated in his Preface to the 2000 reprint of ‘Theology and Falsification’ in Philosophy Now that it ‘has some claim to have been the most widely read philosophical publication of the second half of the 20th century. Flew also stated that his article was translated into seven languages. If yours truly were to translate it into Burmese (but he may not do that) ‘Theology and Falsification’, Professor Antony Flew could no longer boast (see below) that his article has also been translated into a Southeast Asian language.
Flew concluded his introduction to the 2000 reprint of his article in Philosophy Now with this ‘gem’ (see below) of a comment by referring to a statement made by his compatriot Thomas Hobbes (5 April 1588-4 December 1679):
‘‘ To the Sober and Discreet Reader … [I] thought it fit to acquaint you that thou mightiest know what jewel thou has in thy hands, which thou must accordingly value, not by the bulk but by the preciousness.
Throughout the years, this writer has re-read Flew’s article at least seven times and most recently while writing drafts of this article. This writer cannot help but feel that Flew (to paraphrase the Bard) (‘Me thinks, The Lady protests too much’) ‘the atheist turn theist (more below) boasts too much’.
The late Stephen Hawking (8 January 1942-14 March 2018) ‘outed’ himself as an atheist in the book The Grand Design co-written with Leonard Mlodinow. This took place more than 20 years after Hawking had ‘teased’ millions of his readers about ‘knowing the mind of God’ in the last sentence of his bestseller A Brief History of Time, first published in April 1988.
My impression is that there was less publicity when Stephen Hawking stated he was an atheist around 2010 than when Flew abandoned his 60 plus years old ‘belief’ in atheism starting from around 2004. Although Antony Flew changed his mind regarding (a)theism about six years or so before he passed away, he probably would still claim that his ‘Theology and Falsification’ was a ‘jewel’ of an article.
I would assert and claim that though forgotten in an obscure two pages of JBJS and not republished even once, say on the 50th anniversary of its publication (of the abstract) in February 2020 (as was with Flew’s article for at least the 41st time in its 50th anniversary in 2000), my late father’s (abstract) of an article on ivory prostheses, notwithstanding the different fields of study, is as original as, if not more original, than Flew’s ‘Theology and Falsification’. My late father spent a year between 1959 to 1960 researching the physical, mechanical, chemical and biological properties of ivory. In the process, he consulted a physicist, a biochemist, a zoologist, and an ivory sculptor before using it on an 83-year-old Buddhist nun Daw Punya in January 1960. And at least from 1960 to 1965, when he obtained some grants for his research from the then government of Burma, at times, he had to use some of his own funds for his research.
The 311-word summary of his paper, which was read at the BOA in September 1969, was a product of over ten years of research, dedication, hard work, goodwill, ingenuity and display of compassion and scientific spirit for the welfare of humanity. I might add that during the time my late father was using ivory hip prostheses from the early 1960s to early 1980s and even after my father passed away, from the mid-1980s to the early 1990s, a few of his now aging junior colleagues in Rangoon (Yangon) and Mandalay continued to insert ivory prostheses on patients (maybe up to 30 to 50 patients), there was no (no) killing of elephants (at least in Burma/Myanmar).
Since Antony Flew’s 1100- word article of 1950 has been reprinted 40 times, perhaps even some orthopaedic surgeons might have heard about Anthony Flew and read his ‘Theology and Falsification’. Ironically, there is a possibility that though they have heard of Anthony Flew and perhaps had read ‘Theology and Falsification’, some or at least a few orthopaedic surgeons the world over may not have heard of Dr San Baw and his pioneering work with ivory prostheses.
What philosophical, albeit not ‘(non) falsifiable, theological’ (pun intended, Flew’s article is titled ‘Theology and Falsification’) solace can one take regarding what one considers to be an unfair situation?
In 1982 or 1983, this writer recalls seeing a particular episode of an American ‘sit-com’ (situational comedy) series called One Day at a Time. In one episode (around) 14-year-old boy told the single Mum (not the boy’s Mum) ‘Ann Romano’ played by the late actor Bonnie Franklin (6 January 1944-1 March 2013), that ‘Life’s not fair’. Ann Romano replied: ‘And Don’t you forget it’.
This article also commemorates the 2nd San Baw Honorary Lecture in Orthopaedic Innovation delivered by Dr Rickard Branemark at the Department of Orthopaedic Surgery at the University of Pennsylvania in the United States on 21 April 2022.
