When the American College of Surgeons (ACS) was founded in 1913, the German-speaking countries of Europe were the preeminent leaders in biomedical science. Abraham Flexner, MD, and other U.S. physicians admired the principles of German medical education, including national standards for students and universities, academic freedom, the expectation of postgraduate training, and an adventurous tradition in which “the student wanders from place to place, seeking new teachers.”1 World War I would have a devastating impact on Germany’s reputation following the war, but we should acknowledge its influences on the genesis of our College.
During the latter 19th century, more than 15,000 U.S. physicians traveled to Germany, Austria, and Switzerland for postgraduate education.2 Visiting physicians and scholars praised German dedication to research, innovation, and teaching, but disliked how European professors treated patients as social inferiors.2 Conversely, German surgeons who visited the U.S. during the early 20th century were impressed by the practical skills, excellent nurses, private philanthropy, and respect for patients they found.2
Meanwhile, millions of people dissatisfied with life in central Europe were migrating to the U.S. Among these European immigrants were dozens of German-educated surgeons, including Christian Fenger, MD, and Carl Beck, MD, in Chicago, IL, who further influenced Americans unable to afford a European tour. Many of these immigrants remained members of the German Surgical Society (also known as DGCH), which William S. Halsted, MD, FACS; Roswell Park, MD, FACS; and John B. Murphy, MD, FACS, also joined.
Admission to the American Surgical Association (ASA), founded by German-American Samuel Gross, MD, in 1880, was limited to 125 members. In 1903, younger American academic surgeons founded the Society for Clinical Surgery (SCS), whose even smaller membership included ACS founders and leaders Dr. Murphy; George Crile, MD, FACS; Harvey Cushing, MD, FACS; Charles Mayo, MD, FACS; J.M.T. Finney, MD, FACS, the first President of the ACS; and A.J. Ochsner, MD, FACS, all of whom had studied in Germany. Following the German “wanderlust” tradition, members of the SCS traveled from place to place to observe surgical centers at home and abroad.3
In 1904, Dr. Halsted described his residency program at the Johns Hopkins Hospital, Baltimore, MD, as designed “to adopt as closely as feasible the German plan.”4 He also criticized the exclusive surgical societies in America and advocated for a broad-based organization like the DGCH, which “admits to its fellowship any reputable surgeon of any country of the world, and its halls at each Congress are filled and overflowing.”4 Dr. Park had made a similar recommendation in his role as ASA President in 1901.5
In 1905, ACS founder Franklin H. Martin, MD, FACS, established Surgery, Gynecology & Obstetrics (SG&O, now the Journal of the American College of Surgeons), with Swiss-American Nicholas Senn, MD, FACS, as Editor-in-Chief. During its first decade, more than 40 percent of the literature cited in SG&O was in German. After the SCS proposed a translated abstract publication like the Zentralblatt für Chirurgie,3 Dr. Martin expanded SG&O to include the International Abstract of Surgery. Dr. Martin explicitly intended the initial Clinical Congresses as a way to make the SCS model more widely available.
Within a few years, the Clinical Congresses were “filled and overflowing” and evolved into the ACS. Other than Dr. Martin, most of the initial ACS Regents and Presidents were SCS and ASA members. The new organization adopted the name and some traditions of the British Royal Colleges, ties that would be strengthened by wartime alliance, but in 1913, it owed at least as much to Germany as to Great Britain.
- Flexner A. The German side of medical education. Atlantic Monthly. 1913;112:654-662.
- Bonner TN. American Doctors and German Universities. Lincoln, NB: University of Nebraska Press; 1963.
- Cushing H. The Society of Clinical Surgery in retrospect. Ann Surg. 1969;169(1):1-9.
- Halsted WS. The training of the surgeon. Bull Johns Hopkins Hosp. 1904;15:267-275.
- Sparkman RS, Shires GT, eds. Minutes of the American Surgical Association. Dallas TX: Taylor Publishing Co; 1972.