RALPH BINGHAM CLOWARD

Ralph Bingham Cloward, M.D. was born in Salt Lake City, Utah on September 24, 1908. His father was Ralph E. Cloward, a physician who also practiced in Hawaii. Ralph B. grew up on his grandfather’s farm in Utah.

When Ralph was nine years old, he saved money all summer in order to purchase a bicycle. He gave the money to his mother for the purchase, and instead, she came home with a clarinet. Although Ralph was gravely disappointed he got a union card at the age of 14-15 and played with the Salt Lake City Symphony. When he came to Hawaii in 1926 at 18 years of age, he played with the Honolulu Symphony, as first clarinetist,. He put himself through medical school with his earnings.

Dr. Cloward attended the University of Hawaii for two years and then returned to the mainland to finish college in Utah, in 1930. He attended two years of medical school in Utah and finished up at Rush Medical School in Chicago in 1934. He took extra courses in neurology while at Rush, due to his interest in the nervous system.

Dr. Cloward did a three-year residency at the University of Chicago with Dr. Bailey (a student of Harvey Cushing, the brain surgeon) at Billings Hospital. By this time his father had started a clinic in Hawaii, which Ralph planned to join. Prior to leaving the mainland he visited neurosurgery centers around the country for several weeks.

Dr. Cloward introduced a new field of medicine to Hawaii. Prior to his return there were no neurologists or neurosurgeons practicing. The general surgeons did all the brain and spine surgeries. In the late 1930’s, pathologists were not opening up the skull during autopsy. Dr. Cloward asked to get the brain and instituted Sunday morning brain cutting sessions where he found lots of undiagnosed brain tumors.

The general surgeons in his father’s clinic were not eager to refer patients to Dr. Cloward, so he left and set up a private practice that grew quickly. He reported the first 100 brain tumors in the Hawaii Medical Journal after two years of practice, approximately half of which were benign. In 1943 he began patching skulls he had opened up with plates made of the metal tantalum.

In 1940 doctors in Hawaii trained for an attack. On December 7, 1941 Dr. Cloward was called to Tripler for a four-day surgical marathon. Within one hour, 1200 casualties had been treated. Dr. Cloward had his own operating room for brain surgery where he performed 43 craniotomies. He remained the only neurosurgeon in Hawaii until 1944, when the Navy brought in another neurosurgeon who was stationed at Navy Hospital. Dr. Cloward was stationed in Honolulu for six years during the war. He was allowed to continue his private practice during this time. After the war he returned to being a civilian neurosurgeon again.

Dr. Cloward was chief of staff of the Neurosurgery departments of Queens, St. Francis and Kuakini hospitals and a consultant in Neurology and Neurosurgery. He developed a surgical technique using bone grafts to help fuse discs during World War II, called Posterior Lumbosacral Interbody Fusion (PLIF). Prior to that, surgeons removed the problem disc thereby improving the pain and condition of the patient’s legs, but doing nothing for their back pain or enabling the patient to return to work. Dr. Cloward worked with plantation workers, for whom a return to work was vital. His first successful operation using this technique was in 1943. In 1946 Dr. Cloward decided to use cadaver bone for the grafts and asked the Blood Bank to help him establish a Bone Bank, the first in the United States. Autopsies supplied the bone and the technique was used for twenty years. Later, bone was taken from the patient and sterilized before use. In his first 100 cases using the PLIF technique, the success rate was 94% over 10 years. Unfortunately, his peers were not impressed. The procedure was lengthy and required great technical skill.

After mastering the lumbar fusion, Dr. Cloward perfected a technique to use on cervical vertebra, the Anterior Cervical Interbody Fusion. Before this, surgeons had operated from the back of the neck. His first case was in 1956 for a patient without sciatica. The next year he performed 45 of these operations. The recovery from this procedure was rapid and the fusion arrested degenerative disease. It took almost 10 years for the procedure to be accepted.

Dr. Cloward did a lot of traveling, both nationally and internationally, into his 80’s, in order to demonstrate his techniques. Dr. Cloward innovated other techniques as well, and created over 100 new surgical tools that are widely used.

Dr. Cloward belonged to the Rotary Club for 59 years, and to the Hawaii Medical Association. He served on the HMA Library Committee and on the Public Health Committee of the Chamber of Commerce.

Before returning to Hawaii in 1938, Dr. Cloward had married and the union produced three children, son Kerry and daughters Karen and Kathleen. At the time of his death in November 2000, at the age of 92, he had 12 grandchildren and five great grandchildren.

First Posted: November 2003

Medicine in Hawaii: Oral History Series

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