American surgical history: Finding a home at the Clinical Congress

In 2014, a newly formed group at the American College of Surgeons (ACS) began to find its place. Driven by a consensus that our rich surgical heritage was not only reflective of our past but could also serve as a guide to our future, the members of this group felt it was imperative that the College begin to collect, collate, reflect upon, and highlight how surgeons and surgery have evolved, believing that awareness of this history adds richness to our daily lives.

One of the ACS Surgical History Group’s (ACSSHG) initial goals was to make surgical history an integral part of the Clinical Congress. We were pleased that the 2014 Clinical Congress Program Committee accepted our proposal for a Panel Session titled Factors Shaping Surgery during the 20th Century—the Inaugural Session of the ACSSHG, and we are equally grateful that the Program Committee has agreed to present a second panel discussion on this subject at the upcoming Clinical Congress in Chicago, IL.

Overview of 2014 program

Recognizing the enormity of the forces at play over the last century, we thought this inaugural venture should focus on four principal topics: The Training of a Surgeon, presented by ACS Past-President John Cameron, MD, FACS; Professional Organizations and Their Impact on American Surgery, presented by ACS Distinguished Service Award recipient David Nahrwold, MD, FACS; What Surgeons Learn from Wars, presented by Basil Pruitt, MD, FACS; and A Fruitful Partnership: Surgeons and Technology, presented by Mark Talamini, MD, FACS. These distinguished experts impressed the large audience assembled on the afternoon of October 28, 2014, in San Francisco, CA. A video of the session is available at the Archives & History/Films section of the ACS website.

The evolution of training

Dr. Cameron opened the session by explaining that surgical education and training have evolved to create generations of highly skilled surgeons who are able to care for evermore complex patient cases. He provided an overview of Civil War surgery, focusing on John Shaw Billings, MD (essentially untrained as a surgeon), and the enormity of his exploits as an innovator in surgery. He then used the famous Thomas Eakins paintings of the Gross Clinic and of the Agnew Clinic to exemplify and to contrast progress in the training of surgeons.

Dr. Cameron moved on to the evolution of the surgical training program developed by William Halsted, MD, FACS, at The Johns Hopkins School of Medicine, Baltimore, MD, as the model that profoundly changed and improved surgical training over the 20th century. Dr. Cameron then pointed to modifications of the model that were implemented at other institutions, such as the move from a pyramidal to a rectangular program led by Edward Churchill, MD, FACS, at Massachusetts General Hospital, Boston.

In addition, Dr. Cameron commented on the 21st century use of fellowships following residency training, describing them as representative of a transition to a more disease-oriented approach to surgical training. He closed by noting that the progression of responsibility in surgical training and an ever-increasing focus on science are perhaps the greatest influences on American surgery in the 20th century.

Profound impact of professional organizations

Dr. Nahrwold spoke of the impact that professional organizations have had over this last century of surgical progress, particularly on ethical and moral standards and on professionalism. The formation of the American Medical Association in 1847, the founding of the American Surgical Association in 1880 and the ACS in 1913, the first surgical examining board (the American Board of Ophthalmology) in 1913, and the American Board of Surgery in 1937, along with many others, represented a remarkable change in the climate of surgical practice.

Dr. Nahrwold further remarked on the major influence of the organized medical staff at hospitals, beginning in 1917 with the first standards for hospitals promulgated by the ACS. The evolution of the Clinical Congress, along with other professional association meetings and their publications—all with a primary focus on education—have been of inestimable benefit to the field. Therefore, professional organizations have not only benefitted surgeons, but also their patients and society as a whole. Standard setting and professional education were and remain the primary strengths of our organizations, serving to bind us together as surgical professionals.

War and medicine

Opening with a quotation from Hippocrates, “he/she who wishes to be a surgeon should go to war,” Dr. Pruitt then explained the remarkable advances in surgery that have resulted from experiences in wartime, pointing out that our nation was involved in some type of military conflict for most of the 20th century. Wound care, infection control, triage and transport, shock management/resuscitation, blood transfusion, surgical technology, the evolution of certain surgical specialties, burn management, hemorrhage control, data collection and analysis, and so on, have all advanced through the laboratory of war. From (all MD, FACS) John M. T. Finney through Fred W. Rankin, I. S. Ravdin, Champ Lyons, Curtis P. Artz, and Frank C. Spencer, and many others, advances in surgical care have always accelerated during war, with resultant major impact on decreasing morbidity and mortality. These advances in surgical care ultimately are passed on to civilian patients.

Advances in technology

We all benefit daily from the marvels of technology. Dr. Talamini addressed the subject in his presentation on A Fruitful Partnership: Surgeons and Technology, depicting the often tenuous relationship between technology and hesitant surgeons that ultimately results in benefits for our patients. Dr. Talamini provided an overview of some of the major technological changes that have occurred over time, including better visualization of the operative field, dramatically improved instrumentation, heightened ability to control hemorrhage, enhanced ability to join tissues, and so on. He discussed the important relationship between industry and the surgeon and used the experience of George Berci, MD, FACS, who collaborated personally with Karl Storz, to illustrate his point.  According to Dr. Talamini, Dr. Berci believes that in a physician/industry partnership, there needs to be complete trust on both sides, creative freedom, the ability to respectfully disagree and debate details, and an understanding that the goal of the alliance is the creation of a better instrument or service—not making money. Dr. Talamini then guided us from the first Bovie to the Argon beam and gave us an appreciation for the ups and downs that have occurred along the way.

More to come this year

With the remarkable success of the inaugural panel in 2014, we now look forward to the 2015 Clinical Congress and another ACSSHG Panel Session, Factors Shaping Surgery over the 20th Century II, which builds on last year’s theme and will include the following presentations: Imaging: A Radiology and Surgery Synergism (Barry Katzen, MD); Infection Control to Purge the Scourge of Sepsis (Hiram Polk, Jr., MD, FACS); Cardiovascular Surgery: The Heart of the Matter (Alden Harken, MD, FACS); and Transplantation: Surgical Use of Used Parts (Nancy Asher, MD).

The ACSSHG welcomes your presence and participation at this event on Wednesday, October 7, 2015, at the Clinical Congress meeting in Chicago.

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