College of Surgeons

“ In this year certain Ordinances were made by the Mayor (Sir William Walderne) and Court of Aldermen which are entered in Letter-Book K. 6B. This record relates to what Mr. D’Arcy Power, in his “Memorials of the Craft of Surgery,” has termed a “Conjoint College” of the Physicians and Surgeons, and has little to do with our Company, beyond the fact that the scrutiny and oversight of persons practising Surgery is given to the Masters of the Surgeons’ Guild. The subject of these Ordinances and many very interesting remarks thereon and on the Conjoint College may be seen at p. ”

“ To speak loftily, in measured tones, and with studied stand-offishness, was no less necessary than the binaural stethoscope they never appeared without, the gold spectacles or eye-glass they usually affected, and the patronising manner they adopted towards 52 the men with whom they had been fellow-students, whose larks and escapades they had shared in with equal relish, but who, not having yet attained the dignity of membership of the College of Surgeons, and the still greater honour of house surgeon to St. ”

“ The son of a physician, after graduating from Brown University in 1855, he followed in his father's footsteps and entered the College of Physicians and Surgeons, New York, and graduated in 1858. Shortly after he entered the service of the old New York and Havre Steamship Company, and was surgeon of the Arago at the outbreak of the war in 1861, when he entered the service of the Government as a "contract surgeon." ”

“ Medicine, proclaimed the Faculty when it suited its purpose, contains the theoretical and the practical side of surgery; a surgeon is therefore but the servant of a physician. If St. Côme sought to provide lectures in surgery, the Faculty, which kept possession of teaching licenses and desired in the surgeon a docile assistant, took the teaching from the college and invited the barbers to lectures of its own. In their duplicity and conceit of caste, physicians of the Faculty condescended even to publish books on surgery, books as arid and as insincere as their lectures. ”

“ Only men who are, by thorough education and experience, especially fitted to fill their respective positions, have been chosen to serve as physicians and surgeons in this institution. After having spent a very large sum of money in erecting and furnishing this national resort for invalids with every requirement and facility for the successful treatment of all classes of chronic diseases, it is the determination of the Board of Directors that the Faculty of Physicians and Surgeons shall be superior in culture, experience and skill. ”

“ No surgeon shall be allowed to practise until he has submitted certificates in writing, of the teachers of the faculty of medicine, that he has spent at least one year in that part of medical science which gives skill in the practice of surgery, that in the college he has diligently and especially studied the anatomy of the human body, and is also thoroughly experienced in the way in which operations are successfully performed and healing afterwards brought about. ”

“ Very many with no pretense to this dexterity, and no equipment but a superabundance of assurance, graduate as surgeons and assume and aspire to a position of prominence that it has taken the true surgeon years of the hardest, closest, most untiring study, observation and work to reach. We are told as an excuse for this remarkable evolution from the student to the surgeon that the young man of today is taught so much more than the old men were ”

“ In the hurry and confusion of a war, and amidst the pressure of hundreds of new cases in a day, what can the surgeons of the hospital be expected to do for science, or even for the improvement of medical and surgical practice?—The answer is seen in the new arrangements in England, where a statistical branch has been established in the Army Medical Department. Of course, no one but the practising surgeon or physician can furnish the pathological facts in each individual case; but this is what every active and earnest practitioner does always and everywhere, when he sees reason for it. ”

“ There is no question also but that indifference to everything but surgery is responsible for many of the failures before the State Examining Boards. We must have surgeons, and they must begin their training in medical schools, and it is not my purpose to discourage earnest work and honest effort to this end. I wish, however, to say that every ethical specialist needs a thorough grounding in the general branches of medicine, and he should not in his student days neglect the other essentials to a well-rounded man. ”

“ They showed no surprise, but were wont to develop amazing confidence in the ward doctors and to discuss the merits of the various surgeons in the square. Each man thought his ward the best ward in the hospital, and his doctor the best doctor on the staff; and many boasted to visitors and at tea-parties that the worst cases in the hospital were in their ward and under their doctor. The dental surgeon, whose skill in extraction was considered marvellous, never failed to thrill the men, and she was eagerly pointed out to friends or visitors. ”

“ Kolb did not say something about the training school he had started in connection with his hospital. We sent some young officers over to learn technique and methods of handling the psycho-neurotics. We have also sent some officers to the Public Health Service clinic at the Psychopathic Institute in Boston and we hope that some of our other hospitals will start a similar school. The question of personnel is an exceedingly grave one. A great many young men want to become surgeons. ”

“ The newly graduated surgeon is not as dangerous as the man who left medical school years ago, before the students received one-third of the surgical training that they do now. Many of these men have not taken a post-graduate course, have never been associated with a hospital, nor have they had even an opportunity for moderate surgical observation; and yet they are attempting to do the work that only a skilled specialist should undertake. I am not speaking of emergency surgery for which any man should try to prepare himself, and be brave enough to undertake when human life is at stake. ”

“ In America, historians agree, the differences based on specialization of practice between surgeons and physicians soon tended to disappear, a superior education often being the only attribute or function of a physician not shared by the surgeon. ”

“ No Person ought to be appointed a Physician to the Army, or Military Hospitals, without previously undergoing the same Examination at the College of Physicians, as those do who enter Fellows and Licentiates of the College, that none but proper Persons may be employed. ”

“ Believing that those connected with other large hospitals, and in the habit of operating daily, could operate more skillfully and successfully than those whose experience was more limited, it was decided to add to the medical staff two operating surgeons, who should "perform such operations as are requested by the attending physicians, subject, however, to their own judgment and the advice of the consulting physicians and surgeons, if desired." In this manner, while the disease is studied and cared for medically, none need suffer for the lack of the best surgical aid when required. ”

“ Were all these changes made there is no doubt that the efficiency of the administration would be increased and the burden of the work lightened.
As regards clinical work other desirable changes might be made. Senior men who have been in full practice, and who come to a base hospital as physicians or surgeons with the rank of lieutenant-colonel, are apt to be entrusted with the detailed administration of medical or surgical wards. They are often unfitted by training for such administration and are frequently disinclined [192] to undertake the work. ”

“ Certainly, it would never do to give the Superior Surgeons of the Hospital no say as to the nursing. In 999 cases out of 1,000, the Superior and older Surgeon is the one who understands and cares much the most about the men, and who, therefore, in the long run, would more appreciate and be fairer to Matrons and Nurses who did their duty by them. The Superior and older Surgeons too, in general, have far more correct ideas of the importance of discipline in a ward, and of the ways of maintaining it, than the Assistant-Surgeons. ”

“ Now I am doing my own housework and in the past four weeks I have entertained forty-seven people, and I think I certainly am doing well. It is with the greatest pleasure that I recommend all who are afflicted to go to the Invalids' Hotel and Surgical Institute. The Surgeons are honorable, trustworthy gentlemen, who will do all they promise; and, being men of large experience, they know just what course of treatment to pursue from first to last, so that an invalid can rest assured that no experimenting will be done. ”

“ In 1843 he organized Rush Medical College, Chicago, assuming the duties of professor of anatomy and surgery, and remained professor of surgery up to his death, being always the leading person in the faculty. ”

“ Under such conditions there could be no such thing as the profession of the surgeon. The prejudice against dissection did not begin to abate until the thirteenth century, when a very few of the clergy dared, in a very timid manner, to perform surgical operations. Their numbers increased in the course of the fourteenth and fifteenth centuries, and in the sixteenth had become considerable. Most of the great anatomists of that period—such as Benivieni, de Carpi, Vesalius, Fallopius, and Fabricius ab Aquapendente—were great surgeons. ”

“ F.R.C.S. in 1840, when King's College developed a hospital of its own, he was appointed its senior assistant surgeon. He held this post till 1847, when he was made lecturer on pathology at 200l. a year. He eventually became surgeon at St. ”

“ The representatives of this specialty succeeded earlier than did the practical physicians in freeing themselves from the ban of scholasticism. In its development a more constant and more even progress cannot fail to be seen. The stream of literary works on surgery flows richer during this period. While the surgeons are far from being able to emancipate themselves from the ruling pathological theories, there is no doubt that in one department, that of manual technics, free observation came to occupy the first place in the effort for scientific progress. ”

“ Handyside finally agreed to admit the women to his ordinary Anatomy class and dissecting-room at Surgeons’ Hall, provided the other lecturers made no objection: and, so far the arrangements for the following winter session were made.
“Saturday, [June] 25th. Called on Dr. Watson [65] (Surgery) . He signed my petition readily. Thought if we made no difficulty, no one ought to about mixed classes,—anyone in earnest in his subject should be able to teach all students. ”

“ On the other hand, the value of surgical nursing depends on relative perfection of detail and rigorous adherence to the set rules of prophylaxis, whereas other nursing often requires that judgment which only experience can [Pg 121] give. Surgery is a fine art that has reached a high degree of development in the treatment of facts, about which good surgeons are generally right. A great deal of noise is made over surgeons' occasional mistakes, which are advertised by their detractors, but we hear little of their steady and almost constant success. ”

“ He can do the operation or direct the family as to what surgeon to choose. Bad results of operations are, sometimes, due to the operator. It is the duty of the family to choose a competent and honest surgeon. There are plenty of them all over the world,—and very few competent surgeons operate simply for the money they receive. As a rule they earn all and more than they are paid. There are more surgeons today than ever and they are also more competent, for our medical schools prepare them in the hospitals for that kind of work. ”

“ In April, 1861, he became professor of military surgery, fractures and dislocations, and professor of clinical surgery in the Bellevue Hospital Medical College. He remained in these positions until May, 1868, when, upon the resignation of Dr. James R. Wood (q. v.) , he was made professor of the principles of and practice of surgery and surgical pathology and continued in this capacity until March 15, 1875, when he resigned. ”

“ They worked at high pressure, often under difficulties, and with untrained subordinates, while surgeons and patients learnt to rely more and more upon their constant care and devotion.
Quartermaster Campbell expanded her staff to meet requirements, and the former orderlies, Miss M. E. Hodgson and Miss Isabel Lowe, were called up early to help in organising. A hundred picked young women joined up as orderlies, some for nursing and some for administrative work; while the clerical section was organised by Miss Jarvis, who had also served with the Corps in France, and by Miss Esther Hatten. ”

“ There is in many of the great clinics a disregard of the patient's feelings, of his sufferings, and even of his life, which would be impossible in an English hospital. The contact of a surgeon with his hospital patients as individuals is largely through the nursing staff, and his point of view will be largely influenced by them. There is no one in our profession, from the youngest dresser to the oldest physician, who does not owe a great part of his education to Sister. ”