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Special Review: Millennial Memories
Surgery, Gynecology & Obstetrics
Journal of the American College of Surgeons
Seymour I Schwartz, MD, FACS
The year 2000 is here. Although some argue that the new millennium
actually dates from 2001, the focus has been on the year 2000,
fueled in part by its implication in our current age of the computer.
We are bombarded on all fronts by reflections of the past two
millennia and it seems reasonable to participate in the mass
reaction. The Journal of the American College of Surgeons,
initially Surgery, Gynecology & Obstetrics, lacks
only five years to achieve centennial status. In keeping with
society's current theme, it is of interest to reacquaint readers
with some of the focal issues published in the Journal since
its inception. The years 1975, 1950, 1925, and 1905 will be considered
in that order so that we can more dramatically provide a time
capsule of representative contributions to the Journal during
the past century.
Twenty-five years ago, evidence was
presented that the modified radical mastectomy of the Patey type
achieved the same survival rate as the standard radical mastectomy
for stage I and stage II lesions.1
Direct revascularization of acute myocardial
infarction by implantation of the internal mammary artery was
reported and came to be known as the Vineberg procedure.2
A classification of carcinoma of the hilus
of the liver was proposed.3
The technique of highly selective vagotomy,
emphasizing the "criminal nerve of Grassi," appeared
in the "Surgeon at Work" section of the Journal.4
Successful management of urinary stress
incontinence by endoscopic suspension, the Stamey procedure,
was also presented in 1975.5
Laparoscopy and splenectomy was advised
for stage I through stage III of Hodgkin's disease.6
The 10-year followup results of patients
with carcinoma of the breast reported from a cooperative clinical
trial coordinated by Bernard Fischer evaluated surgical adjuvant
chemotherapy and demonstrated an enhanced disease-free state
and urvival in those receiving the treatment.7
The natural history and experience with
diagnosis and treatment of the Zollinger-Ellison syndrome was
published by the College's president in 1975, James Thompson.8
Frank Glenn, a College president who had
a deep interest in the subject, summarized the trends in surgical
treatment of biliary calculous disease, indicating a decrease
in the delay in operation after diagnosis, a decrease in the
incidence of acute obstructive cholecystitis, and better radiologic
tools to provide critical evaluation of the entire ductal system.9
The results of emergency portacaval
shunts in 138 consecutive, unselected patients were reported.10
A totally implantable infusion pump was
introduced to provide continuous infusion of heparin.11
It is this pump that is now used for hepatic
arterial infusion of chemotherapeutic agents to treat unresectable
liver metastases. Hepatic trisegmentectomy was graphically described.12
Success was reported for direct contact
irradiation of selected cases of carcinoma of the rectum.13
Demonstration of an acute influence of portal blood hepatotrophic
factors on the canine liver and on hepatic regeneration after
surgical operations added to the evidence that insulin is the
most important specific hepatotrophic factor in portal blood.
This was one of several contributions
of Dr Starzl and colleagues14
on the subject that appeared in the Journal. Support was
also added to the authors' hypothesis that multiple hormonal
and nonhormonal factors from splanchnic viscera contribute to
hepatotrophic effects.14
The year 1975 affords an element of personal nostalgia because
I was responsible for reporting "What's New in Gastrointestinal
and Biliary Conditions." This was part of the 16th annual
program of "What's New in Surgery," presented at the
1974 Clinical Congress of the American College of Surgeons.
At the half-century mark in 1950, the first article to appear
in the January issue was written by Alfred Blalock, a College
president, and C Rollins Hanlon, who later served the American
College of Surgeons as president and director. The
authors presented the surgical treatment of complete transposition
of the aorta and the pulmonary artery, including the eponymic
Blalock-Hanlon procedure.15
Between November 30, 1944 and September 25, 1947, Dr Blalock
and his associates operated on 500 patients with congenital heart
disease and stenosis. Another of the College's
past presidents, Henry Bahnson, reported the causes of death
after operation on these patients.16
An early report on arterial anastomosis
after arterial injury appeared.17
Expanding Lester Dragstedt's introduction in 1943 of the concept
of dividing the vagus nerves to control peptic ulceration, John
Brooks and Francis D Moore studied chloride output rate as an
expression of human gastric activity in normal people and in
patients with ulcers. They noted an elevated
rate in ulcer patients and a chloride output rate that remained
low after vagotomy.18
One of America's fathers in the field
of plastic and reconstructive surgery, James Barrett Brown, presented
the technique and results of removing mixed tumors of the parotid
gland.19
The eminent New York City surgeons, John
Garlock and Leon Ginzburg, concluded that the operation of anterior
resection should not be used for cancer of the rectum proper,
based on an appraisal of their experience.20
The Lahey Clinic reported its experiences with the management
of 280 strictures of the bile ducts. Most
patients were managed by end-to-end ductal anastomosis and the
Roux limb was not used.21
The seminal article reporting experimental
maintenance of life with a mechanical heart-lung was reported
by Thomas Stokes and John H Gibbon Jr.22
The authors said then,
"We believe that experiments reported here constitute
a step forward toward the clinical application of such an apparatus
in the temporary maintenance of a part of the cardiorespiratory
functions in a patient with a failing heart or lungs, as well
as toward the ultimate goal of maintaining completely the cardiorespiratory
functions so as to permit the performance of precise operations
within the chambers of the human heart under direct vision in
a bloodless field."
Studies on acute cholecystitis by former
president J Englebert Dunphy and associates23
laid to rest the concept of an arbitrary critical period during
which operation for acute cholecystitis should be avoided. Selection of an operative procedure for patients
with medically intractable ulcerative colitis was addressed.24
The anatomy of the portal vein and its
tributaries was most precisely defined.25
The incidence of malignancy in gastric
ulcers believed preoperatively to be benign was stressed, and
it was shown that temporizing with an ulcerating lesion of the
stomach introduces a serious risk.26
In 1925's Volume 40, the growth and progress of the Journal
over 20 years was encapsulated by Sumner L Koch.
This volume was dominated by articles in the fields of obstetrics
and gynecology, orthopaedics, urology, neurologic surgery, and
plastic and reconstructive surgery. The most common theme in
general surgery was in the realm of gastric surgery. The
first contribution, a paper by HB Devine of Melbourne, Australia,
was read at the 1924 Clinical Congress and detailed basic principles
and difficulties in gastric surgery.27
The frequency of gastrojejunal ulcer attendant
on gastroenterostomy was the subject of another article.28
A future editor of the Journal
and future president of the American College of Surgeons, Loyal
E Davis, and Harvey Cushing, another former president of the
College, reported experiences with blood replacement using the
patients' suctioned and filtered blood during intracranial operations.29
The surgical treatment of typhoid carriers
was reported.30
Polyposis of the colon was surveyed.31
Articles on
what would now be considered relatively obtuse subjects—torsion
of the omentum32
and tuberculosis of the tongue33—the
latter written by John MT Finney, the college's first president
and his son, also appear in Volume 40. The spleen was the subject
of papers by two notable surgeons. Former president of the College William J
Mayo wrote on the relation of the spleen to purpura,34
and Sir Berkeley Moynihan's article discussed splenic cysts.35
Volume 41 encompasses the second half
of 1925. The volume included an analysis of 41 patients with
thromboangiitis obligerans36
1 year after Buerger's text on the subject appeared. Walter
Dandy provided a classic article describing and evaluating an
operation for total removal of cerebellopontine acoustic tumors.37
Somewhat surprisingly, the lead article
in the September 1925 issue was on endoscopy of the abdomen.38
The authors pointed out that the procedure
was actually introduced in 1901. Chronic pancreatitis was considered
a clinical entity for which surgery offered no solution.39
Rudolph Matas's presidential address focusing
on endoaneurismorraphy opened the December issue,40
which included a report on 1,000 operations
for gastric, duodenal, and jejunal ulcers performed by one French
surgeon.41
But, as was the case for Volume 40, Volume 41 was dominated by
articles under the realms of obstetrics and gynecology, orthopaedics,
and urology.
The first article in the first issue
of Surgery, Gynecology & Obstetrics, published July
1905, focused on the use of iodine as a surgical antiseptic.42
The author was Nicholas Senn, Professor of Surgery at Rush Medical
College. The paper had been read before the North Tri-State Medical
Society in Fort Wayne, IN on June 15, 1905. This is certainly
an enviable record for time of publication from receipt of manuscript.
The first volume of the Journal was made of a preponderance
of articles in the fields of obstetrics and gynecology. In
the first volume, Joseph Bloodgood of Johns Hopkins Hospital
and University presented a clinical and pathologic study of thyroid
cysts.43
Writing about appendicitis, JW Kennedy
of Philadelphia stated, "I would define appendicitis as
the most courted, most abused, and treacherous disease which
confronts our profession at the present time.44
Allen Kanavel of Northwestern University
Medical School and a College president wrote a classic paper
on acute infections of the hand,45
and Harvey Cushing, who would be president
of the College in 1922, reported on decompressive measures for
inaccessible brain tumors.46
Although the Journal of the American College of Surgeons
has not celebrated its centennial, this review is a capsule of
the progress of surgery over the past 95 years. It is tempting
to examine the first 80 years of the Journal's existence
profiled in this review and emphasize the lack of sophistication,
but this same criticism will undoubtedly be applied to modern
surgery when it is assessed in the future.
JACS
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