William Edwards Ladd

Biography

• Born on September 8, 1880 in Massachusetts as the sixth of seven children
• 1906 – Graduated with an MD from Harvard Medical School
• 1910-1913 Assistant Visiting Surgeon to the Boston City Hospital, Infant’s Hospital, Children’s Hospital and Milton Hospital
• 1912 – Assistant in Surgery at Harvard Medical School
• 1917 – On December 6, in Halifax harbour, Canada, the French cargo ship the S.S. Mont-Blanc, filled with wartime explosives, collided with the S.S. Nimo, a Norwegian ship. The detonation resulted in 2,000 deaths and 9,000 injured. Ladd arrived on scene within 24-hours in charge of a Red Cross Unit with enough equipment for a 500-bed hospital. He treated thousands of the injured, including hundreds of children with burns and lacerations. On returning to Boston, Ladd devoted himself entirely to the surgical care of infants and children
• 1927 – Surgeon-in-Chief at Boston Children’s Hospital
• 1941 – co-authored the first modern American paediatric surgical textbook (Abdominal Surgery of Infancy and Childhood) with Robert E. Gross (1905-1988)
• Died on April 15, 1967

Medical Eponyms

Ladd bands (1932)

Anomalous congenital peritoneal bands attaching the caecum to the posterior abdominal wall in cases of intestinal malrotation

In 1932, Ladd published an article in the New England Journal of Medicine entitled ‘‘Congenital Obstruction of the Duodenum in Children.’’ Such cases had been described previously, however this condition was often overlooked by doctors. Ladd described the embryological cause of the disease, attributing it to the incomplete rotation of the intestines, leading to the attachment of the caecum to the posterior abdominal wall by the ‘mesenteric attachments,’ resulting in duodenal obstruction.

These attachments were later referred to as Ladd bands.

Ladd’s syndrome (1932)

Congenital obstruction of the duodenum secondary to peritoneal bands (Ladd’s bands) resulting from a malrotated caecum. Infants usually present place shortly after birth or after the first feeding with severe usually bilious vomiting.

Intractable bilious vomiting indicates complete obstruction. There is visible distension of the epigastrium, meconium may be excreted, and jaundice is present in 30% of cases.

Partial obstruction manifests with intermittent vomiting in the days, weeks, months, or years following birth.

The most important feature leading to a diagnosis of this condition is vomiting. In the patients with complete atresia, it begins shortly after birth. The vomiting is explosive in character resembling that of pyloric stenosis. It differs from that of pyloric stenosis in its time of onset. The content of the vomitus in duodenal obstruction contains bile, whereas that in pyloric stenosis does not. On physical examination, visible, gastric peristalsis can be seen and occasionally duodenal peristalsis is obvious. The pyloric tumor, of course, is absent. Confirmatory evidence of the obstruction may be obtained by x-ray with or without a barium meal.

NEJM 1932

Ladd’s operation (1930)

Incision of Ladd’s bands to relieve duodenal obstruction in malrotation of the intestine

Ladd-Gross syndrome – Icterus neonatorum associated with atresia of the bile ducts. 

Key medical attributions

• From 1911, published multiple papers regarding his experience of intussusception and its management [Boston Med Surg J 1911, Boston Med Surg J 1913, Arch. Surg 1934]
• Pioneered the surgical management of Wilm’s tumour, including promoting the abdominal surgical approach over the posterior approach. ‘Embryoma of the kidney (Wilm’s tumour)‘
• Made key contributions in the surgical management of cleft palate and bladder exstrophy [N Eng J Med 1940]
• Also contributed to the surgical management of biliary atresia, tracheoesophageal fistulas/atresias, and anorectal malformations [American Journal of Surgery 1934]
• A number of Ladd’s trainees went on to achieve notable milestones in paediatric surgery including;
  • Orvar Swenson (1909-2012) – best known for his work with Hirschsprung disease
  • Robert E. Gross – credited for being one of the first to report successful closure of a Patent Ductus Arteriosus (1939) and pioneering treatment of aortic coarctation, co-author of Ladd’s Paediatric Surgery textbook mentioned above, and Ladd’s successor as Chair of Surgery at Boston Children’s Hospital (1945)

Major Publications

• Ladd WE. The acute surgical abdomen in children. Pennsylvania medical journal 1930; 34: 153-159
• Ladd WE. Congenital obstruction of the duodenum in children. New England Journal of Medicine 1932; 206: 277-283. [Ladd’s syndrome]
• Ladd WE. Surgical disease of the alimentary tract in infants. New England Journal of Medicine 1936;215:705–8.
• Ladd WE, Gross RE. Abdominal Surgery of Infancy and Childhood. 1941 Saunders

References

Biography

• Harvard Alumni Association. Harvard Men at the Halifax Disaster. Harvard alumni bulletin. 1917;20:337-338
• Bill H. William E. Ladd, M.D.: great pioneer of North American pediatric surgery. Progress in pediatric surgery 1986;20:52–9.
• Wiedemann HR. William E. Ladd. European Journal of Pediatrics, 1990;149(10):669

Eponymous terms

• Xydas. S, Widmann. W, Hardy. M. William E. Ladd: Father of Pediatric Surgery. Curr Surg. 2003 Jan-Feb; 60 (1):47-50
• Lim PW, Martin ND, Hicks BA, Yeo CJ, Cowan SW. William Edwards Ladd, M.D. (1880-1967): the description of his bands. Am Surg. 2013 Jan;79(1):11-3.
• Nakayama DK. William Ladd before the Halifax explosion. J Pediatr Surg. 2017 Dec;52(12):2093-2096