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THE custom of printing acknowledgments in books which purport in any way to be scientific, seems to me an excellent one, since it obliges the author to reflect on his relatively small share in the opus, which, at this stage, he may be inclined to think magnum. He is always, I presume, highly elated at having finished something of which he has become intolerably weary, and it must ease his descent to a normal state of mind to list those who have labored for him, although his superiority complex may wilt too rapidly when he realizes the number of co-workers to whom he is indebted. He must also admit to himself the assistance which has come from various impersonal sources, such as the era in which he lives, his inheritances, environment, opportunities, etc., and then try to estimate the degree of excellence which might well be expected in his achievement. Consideration of my own exceptional advantages makes me feel quite humble, but a look at the list of those who have thought it worth while to help me, has just the contrary effect.
The writer of a medical book, when he thinks that he has just completed it, should also reflect on his own education and on the trouble and annoyance he has caused his parents, teachers and fellow students. It is to be hoped that he may answer at least one new question in return for the innumerable painstaking answers he has received. His book will seem a poor return, through science, for the patient efforts of those who taught him the fundamentals of his subject or to those who, bit by bit, built up the basic sciences on which his branch was founded. Not he, but these hosts of individuals prepared most of the book; in fact, all but the doubtful parts which he has presented for possible confirmation.
In my case there is also a great debt to be acknowledged to those whose enthusiasm has built up the esprit de corps of the three institutions so often mentioned in these pages. In spite of my gibes I take great pride in having been a product of the Harvard Medical School and of the Massachusetts General Hospital, and in being a member of the American College of Surgeons, which I have seen arise and grow in strength. The latter has already developed a sense of loyalty among its members, which will, some day, take on the indestructible qualities which the spirits of the two former institutions have long possessed. Woe to the writer who permanently offends the sensibilities of such spirits, but temporary opposition is to be expected from them when improvements are suggested. Such conservatism is wholesome, until a demonstrated truth remains unrecognized.
An author usually admits that there are individuals "without-whose-help-this-book-would-or-could-not-have-been-written." This does not refer to those who discovered the printing press, the microscope, the X-ray, or the dictionary, but to living friends, who by timely flattery, by adverse criticism, by the loaning of talents or money, or, harder still, by faithful drudgery, have contributed to his achievement. I have a long list of such helpers. For instance, I know that I should not have attempted this task had it not been for the blarney of Dr. Francis D. Donoghue, the wise medical director of our Industrial Accident Board. Dr. Henry C. Marble, director of the medical department of the American Mutual Liability Insurance Company, is hardly less responsible than Dr. Donoghue, for he made me convince him by actual demonstration on individual cases, that my essential claims were correct. As for the talents and money and hours I have borrowed, other paragraphs are required.
My cousin, Lady Carter, with a twinkle in her eye, made for me the little sketches in chapter two; Philip Hale, hurriedly but effectively, did the first cartoon on some brown wrapping paper; Miss Piotti and Mr. Aitken have used their recognized talents; Charles D. Vaillant has done most of the other drawings, including not only the second cartoon, but the marvelous lettering beneath it. Dr. Akerson is among my artists as well as among my "without-whom's," for he has illustrated, as well as contributed, essential and enduring evidence for my argument. Dr. Fordyce Coburn gave his experience to a review of my manuscripts and has diminished my literary blunders, and so has Professor Lewis in the case of two chapters which relate to his field of anatomy. Professors Ewing, Mallory and Wolbach have helped me to study the pathology, especially that of bone tumors. I also register my thanks to two assistants who contributed many hours of drudgery, although I am sure it did them no harm. Dr. William M. Stevenson reviewed for me the literature on fractures and dislocations about the shoulder, and Dr. Roy E. Mabrey prepared much of the chapter on Rare Lesions. And think of the hours which Dr. Stevens must have spent on his chapter!
A dog may bark up a tree a long time before any one comes to see what is up in the branches. For twenty years I bayed, though not continuously, about the frequency and importance of rupture of the supraspinatus, and I owe a debt to Dr. Philip L. Wilson, the first prominent surgeon to take time enough to study the evidence that there was something at which to bay.   His paper, three years ago, definitely put this lesion on the list of those which industrial and orthopedic surgeons should recognize and treat. Who will now put it on lists in order that the family doctor may not only promptly recognize it, but may know who, in his locality, has studied the subject enough to be qualified to suture the tendon?

There is a firm of printers in Boston, old and respected, and noted for its reliable work. Thomas Todd and Company are not publishers, although they have printed many books, usually for private circulation. They have not interfered with what I have written, but have painstakingly, graciously and cheerfully aided me in every way. Their staff and employees have shown the greatest consideration for my foibles and fussiness, and have let me superintend, in every detail, the arrangement of the text, charts, tables and illustrations. They are not to be censured for any of the offences herein displayed, against conventional book structure or content, and are only responsible for the printing, and for loaning the money to have it done. I hereby record my gratitude, and hope to return the money.

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