His injury was eventually diagnosed as an inflammation of the deltoid muscle at the point of insertion with the humerus—the bone of the upper arm. Dean had won 12 games at the All-Star break. He won one more that season and was traded the following April to the Cubs, for whom he won but 16 games in four years before he retired at 30. Of his pitching in those final humiliating seasons, Dean, ever the phrasemaker, was to say, "I couldn't break a pane of glass."
Dean also added to the lexicon of sports medicine. The " Dizzy Dean Syndrome" involves creating a second injury by favoring a first. Alas, Ol' Diz and Smokey Joe were as much victims of their time as of bad breaks (thumb and toe) and poor judgment. It is inconceivable that today any team physician would permit either of them to pitch so soon after his injury. There is also every chance that modern surgical techniques might have restored both pitchers to something approaching their former skills. The sore arm has hardly gone the way of smallpox, but it is not incurable.
"Ten to 15 years ago you didn't see many major league pitchers with scars on their arms," says Dr. Jobe. "Now you see quite a few. The players recognize that what they have is a career. Their earning capacity is so very high that they are more willing to take the risk of surgery. They are beginning to understand something about the importance of sports medicine. And I think doctors now have a better understanding of what a pitcher's arm must do. More surgeons know the game; the Baseball Physicians' Association has contributed to the exchange of knowledge and to more meticulous techniques and care.
"In the old days there was a tendency to bring a pitcher back too soon. Now we know the value of proper rest and rehabilitation, and we are working on preventative measures all the time. We are analyzing the pitcher's motion from a scientific standpoint—step by step with high-speed cameras. We'd like to find out what makes up a pitching motion, how much body, how much arm. Good body mechanics are extremely important—the position of the arm, the transfer of the weight, bringing the trunk around at the proper time. A good pitching coach can help avert injuries."
Sports medicine is scarcely a new field. The late Dr. George E. Bennett of Baltimore was treating ballplayers as early as 1910, and two of his articles, "The Prevention and Treatment of Athletic Injuries" (American Physical Education Review, May 1925) and "Shoulder and Elbow Lesions of the Professional Baseball Pitcher" (Journal of the American Medical Association, Aug. 16, 1941) are still considered important. Dr. Don O'Donoghue of the University of Oklahoma was practicing sports medicine in the early 1930s, and Dr. Kerlan himself began in 1947.
But it has been only recently that sports medicine has become a recognized discipline of its own. There are knee men now, and back men and neck men and foot men. Dr. Jobe, 52, a friendly, copper-haired orthopedist, is the ranking arm man. He has been associated since 1964 with Dr. Kerlan, who no longer performs surgery but is an invaluable diagnostician, and has been the Dodgers' team physician since 1968. But Dr. Jobe's patients are referred to him from virtually every major league team, a fact he dismisses as a mere accident of geography. "Most ballplayers seem to live in Southern California, and that is where I practice," he says. Dr. Jobe has operated on more than 100 pitching arms, including those of John, Busby, Gary Nolan, Geoff Zahn, John D'Acquisto, Bill Travers, Mike Caldwell and, early this season, Wayne Garland. "Most of the things I do can be performed by any competent orthopedic surgeon," he insists. "I've been fortunate enough to have some rather well-known patients." But as John, his most notable patient, has said, "When your Mercedes-Benz breaks down, you don't take it to the corner garage. When your arm breaks down, you don't go to any doctor. You go to Dr. Jobe."
The first of the two operations Dr. Jobe performed on John was hailed, in baseball circles at least, as a medical first. Actually, Dr. Jobe says it represented "fairly common orthopedic procedure," although he concedes that "to my knowledge, this was the first time it had been used with a pitcher." That makes John's recovery a considerable medical triumph, because it is safe to assume that none of the other patients who have undergone this "fairly common orthopedic procedure" have subsequently put anywhere near the amount of stress on his renewed limb as John has on his.
In throwing that fateful pitch to Breeden, John ruptured the medial collateral ligament of the elbow, which performs the function, in Dr. Jobe's words, of "keeping the elbow from flying apart." Thus John was not being entirely fanciful when he said he had the sense that his arm was taking leave of his body. "It is a short, stubby ligament," Dr. Jobe says, "and when I went to repair it, because of the long years of wear, there 'was nothing left to repair. I had to look elsewhere for a substitute." He found it in the palmaris longus tendon of John's right wrist, which no more than 75% of us have and which does little more than bring wrinkles to the palm of the hand.
Dr. Jobe asked Dr. Herbert Stark, a specialist in hand and wrist surgery, to assist during the operation on John's arm, which took place on Sept. 25, 1974. The tendon from the pitcher's right wrist was transferred to his left elbow and asked to disguise itself as a ligament. A tendon attaches bone to muscle; a ligament connects bone to bone. "The real worry," says Dr. Jobe, "was whether the body would accept it as a substitute."
John's body was deceived, and the tendon became part of the left elbow. Unfortunately, additional surgery was needed to arrest nerve deterioration in the afflicted area. The more critical operation to reposition the nerve in the elbow was performed on Dec. 18. John's pitching arm had been under the knife twice within three months, and the prognosis was unpromising. " Dr. Jobe advised me to look for something to do outside of baseball," John recalls. "He told me he didn't think I'd ever pitch again."