David B. Hoyt, MD, FACS
Few medical and surgical institutions have the legendary history associated with Cook County Hospital (now Stroger Hospital of Cook County) in Chicago, IL. Many Fellows of the American College of Surgeons (ACS), particularly trauma surgeons, can recall doing at least one rotation through Cook County Hospital (CCH), and most Americans are somewhat familiar with the institution as the model for the hospital featured in the long-running television series ER and for a cameo appearance in the movie The Fugitive.
Many Past-Presidents and other leaders of the American College of Surgeons (ACS)—including John B. Murphy, the Mayo brothers, Albert Ochsner, Allen B. Kanavel, Olga Jonasson, Robert J. Lowe, Herand Abcarian, and L.D. Britt (all MD, FACS)—trained, taught, or practiced at or have been in some way affiliated with CCH. Details about the impact that the hospital has had on all surgical specialties and its strong ties with the ACS are chronicled in a new book, A History of Surgery at Cook County Hospital, edited by ACS Fellows Patrick D. Guinan, Kenneth J. Printen, James L. Stone, and James S. T. Yao—each of whom trained and practiced at CCH. Some snippets of the institution’s fascinating history as documented in the book follow.
Service and education
The first iteration of CCH was set up in the Fort Dearborn trading post in 1803 to provide care to U.S. Army soldiers. The first surgeon at Fort Dearborn was William C. Smith, and the first recorded surgical procedure was a bilateral leg amputation performed by Elijah Dewey Harmon, MD, in 1832. That same year, Cook County was incorporated by the State of Illinois, and the hospital undertook its continuing commitment to serving the sick, injured, and medically indigent citizens of the county. From 1876 to 2002, the main building was located at 1825 W. Harrison. Over the years, it grew into what once was the largest general hospital in the world, with 4,500 beds, and one of the nation’s most highly regarded training centers.
General surgery at CCH originated with Christian Fenger, MD, a pathologist and the first chair of surgery at Northwestern University. Dr. Fenger trained ACS founders, including Dr. Murphy and William and Charles Mayo. At one point, all six Chicago-area medical schools—Rush, Northwestern, University of Illinois, Loyola, University of Chicago, and Chicago Medical School—had attending surgeons and surgical residents teaching and training at CCH with no financial compensation. CCH started as an intern hospital and gradually became a residents hospital in the late 1930s, receiving approval from the recently formed Accreditation Council for Graduate Medical Education in 1939.
As some of you may know, a common practice in the early days of surgical education was to demonstrate an operation in an amphitheater setting. Chicago’s first surgical amphitheater was built at CCH. As an attending surgeon, Dr. Murphy began conducting his well-known surgical clinics in the amphitheater on Friday mornings. Karl Meyer, MD, FACS, and Raymond McNealy, MD, FACS, went on to use the amphitheater for similar purposes, drawing crowds of physicians to observe their wet clinics.
CCH also was one of the first institutions to use night surgeons. This position was designed to hone the skills of the attending surgeon and to develop the surgical judgment of surgical residents. Robert T. Vaughn, MD, FACS, a general surgeon at St. Luke’s Hospital, was the assistant warden for night emergencies at CCH for 33 years (1917–1950), providing clinical instruction and care and making extensive contributions to the surgical literature on topics ranging from osteomyelitis of the sternum to retrograde amnesia following skull fracture.
In addition to being a leading surgical training ground, CCH was the launching pad of many medical and surgical services that have benefitted patients around the world. For example, Bernard Fantus, MD, founded the first blood bank at CCH in 1937. Also in the 1930s, Dr. Kanavel and Sumner L. Koch, MD, FACS, established a burn surgical service at CCH. Renamed in Dr. Koch’s honor in the 1960s, the burn center would prove remarkably successful in improving the survival rates and quality of life for burn victims. In addition, Drs. Kanavel and Koch played an influential role in fostering the growth of a world-class hand surgery service.
Leaders at the CCH and of the ACS also made invaluable contributions to the development of the surgical specialties, including cardiothoracic, pediatric, neurological, vascular, urological, orthopaedic, plastic, otolaryngological, oral and maxillofacial, ophthalmic, and colon-rectal surgery.
A new age
The 1960s was a period of enormous political, social, and scientific change. It also was a time when health care and medical education were becoming more intensely scrutinized. All of these factors had a significant effect on inner-city teaching hospitals like CCH.
Richard J. Freeark, MD, FACS, was appointed chair of the department of surgery at CCH in 1963 and medical superintendent in 1968. Dr. Freeark laid the groundwork for revitalizing the resources of the hospital to promote quality care and to establish a superior postgraduate training program in general surgery and the surgical specialties. He succeeded in many ways.
With respect to surgical training, Dr. Freeark made two important moves: he established a two-month rotation with surgeons at the Lahey Clinic, Burlington, MA; and he recruited renowned surgeons George Block and Don Ferguson of the University of Chicago and Otto Trippel and John J. Bergan of Northwestern (all MD, FACS) to join the volunteer attending staff.
On the clinical side, Dr. Freeark and Robert J. Baker, MD, FACS, oversaw the development of the nation’s first official dedicated trauma center—the CCH trauma unit—in 1966. The CCH trauma unit became the conceptual model for trauma systems planning, patient care, and training throughout the nation. The trauma unit also housed a computerized trauma registry developed in conjunction with the University of Illinois, Chicago. As the value of trauma registries continued to rise, John Fildes, MD, FACS, and Richard J. Fantus, MD, FACS (Bernard Fantus’s grandson), collaborated to establish the ACS National Trauma Data Bank® in 1989.
The socioeconomic turmoil affecting the city in the late 1960s and early 1970s and decades of neglect took their toll on the institution. Dr. Freeark resigned as medical superintendent in 1970. Gerald Moss, MD, FACS, from the University of Illinois took over the department of surgery in 1972 and led a significant revitalization of the surgery program. He rebuilt the freestanding residency program in general surgery by recruiting outstanding graduates of the program to lead the divisions of general and pediatric surgery. He also retained outstanding residents in general surgery and the surgical specialties to train residents and serve as attendings. For example, in 1972 he appointed Dr. Abcarian, who began his training as an intern at CCH in 1966, to serve as program director of the colon-rectal surgery residency and section chief of colon and rectal surgery at CCH—positions he would hold for 23 years of tremendous growth and advancement.
Dr. Moss was succeeded by Olga Jonasson, MD, FACS, a skillful academic, general, and transplant surgeon. As chair of surgery at CCH, Dr. Jonasson led the integration of the general surgery residency program with the University of Illinois program. A controversial move at the time, it ultimately improved surgical training at CCH. Dr. Jonasson resigned from CCH in 1986 to serve as the Zollinger Professor and Chair, department of surgery, Ohio State University, Columbus. She ended her career at the ACS headquarters as Director of Surgical Education and Research.
Her successor at CCH was Hernan M. Reyes, MD, FACS, chair of the CCH division of pediatric surgery. Under his leadership, the surgery departments were restructured, new leadership was appointed, and, to attract more competent attending staff, salaries were upgraded. Clinical improvements included better patient follow-up, reinstitution of the cardiac surgery program, recruitment of a full-time director of breast surgery service, replacement of an outdated cancer registry with an electronic record-keeping system, establishment of the Hektoen Institute for Medical Research focused on advancement in surgical technology, advancements in laparoscopic surgery, and improved survival rates among critical care patients.
A must read
The book ends with historical vignettes, and the print edition also contains photos collected from CCH alumni and the ACS Archives. This column has barely skimmed the surface of all the information covered in this book and hardly touched upon the contributions of ACS Fellows associated with CCH.
The editors are to be commended for their efforts to compile a comprehensive, compelling, and loving reflection on an institution to which the surgical profession and patients around the world are deeply indebted. I would encourage anyone who is interested in learning more about the history of our profession and the ACS to read the book.
If you have comments or suggestions about this or other issues, please send them to Dr. Hoyt at lookingforward@facs.org.
