April 1, 2019
International relationships in medicine have played a significant role in scientific progress. The exchange of ideas derived from several cultural and historical backgrounds offers the possibility to view the same situation from different perspectives. Inevitably, this form of scientific collaboration often overcomes the limits of medicine and allows for the formation of personal connections.
In this column, the authors review the importance of international collaborations that have led to significant progress for surgical development in what is now known as the Sapienza University of Rome. This column briefly underscores the importance of international relationships between surgeons, with an emphasis on the Italian surgeons who contributed to this movement.
The Sapienza University of Rome was founded in 1303 by Pope Boniface VIII, and in 1905 the university hospital, Policlinico Umberto I, opened with 1,000 beds. The first chief of surgery, Francesco Durante, MD, played a major role in the construction and organization of the hospital. Dr. Durante graduated from the University of Medicine in Naples in 1866. In 1868, he went to work in Wien, Germany, with Theodor Billroth, MD, and then to Berlin to collaborate with Bernhard Langenbeck, MD, and Rudolf Virchow, MD. Dr. Durante followed Dr. Virchow and began treating patients from the Franco-Prussian War, working in an ambulance, and received a medal from the King of Prussia. Dr. Durante then moved to Paris, France, and London, U.K. In 1883, he returned to Rome as professor of surgery. In 1887, after a boat trip lasting 40 days, he went to the U.S. to present a paper at the International Medical Congress in Washington, DC.1 The paper described the first reported successful removal of a frontal meningioma. In this report, Dr. Durante hypothesized that the frontal lobes are active, disrupting previous thought, and that likely many cerebral functions, including emotions and feelings, which are at the basis of our behavior, are located in these lobes.
On this occasion, he visited several hospitals, including the Johns Hopkins Hospital, Baltimore, MD, which was under construction. Dr. Durante noted many details applied in building the hospital, which he later introduced in the construction of the new Policlinico Umberto I. One piece of knowledge he gathered from his international travels was the Langenbeck’s German surgical training system and aseptic surgical technique, which he introduced to his colleagues. Dr. Durante also hired a British nurse to head the nursing school in his hospital, introducing the Nightingale nursing system to Italy. He was a founder of the Italian Society of Surgery, and he wrote a three-volume textbook that represented the basis for surgical practice in Italy.
Neurosurgeon and ACS Past-President Harvey Cushing, MD, FACS, after his surgical training at the Johns Hopkins Hospital, made a trip to Europe, visiting major medical centers. In Italy, he went to Pavia where he met Scipione Riva-Rocci, MD. Dr. Riva-Rocci had developed the mercury sphygmomanometer, but the instrument was rejected in Italy and the rest of Europe. Dr. Cushing took the instrument with him when he returned to Hopkins, which led to the practical diffusion of the device in the U.S. The sphygmomanometer was then successfully reintroduced in Europe.
During his visit to Rome, Dr. Cushing met Dr. Durante and his assistant Roberto Alessandri, MD, who became chief of surgery at the University of Medicine, succeeding Dr. Durante in that role. Drs. Cushing and Alessandri, who continued to have a deep interest in neurosurgery,2 started a lifelong friendship. During World War I, Dr. Cushing worked in a hospital in Paris and Dr. Alessandri worked in an ambulance. Dr. Alessandri received a silver medal from the Italian Army.
Dr. Alessandri’s successor as chief of surgery was Raffaele Paolucci, MD. Dr. Paolucci was a hero in World War I, receiving the golden medal from the Italian government, the U.S. Navy’s Distinguished Service Medal, and the Distinguished Service Order from the U.K. Royal Navy. He was a precise surgeon who sought to avoid any possible blood loss. He believed there was no substitute for a patient’s own blood and that disease could be easily transmitted during a blood transfusion. Other outstanding surgeons followed Dr. Paolucci as chief of surgery, including Pietro Valdoni, MD, who introduced cardiac surgery in Italy. All of them encouraged international relationships and the exchange of ideas. To spend some time in a foreign hospital, including the U.S., the U.K., France, or Germany, became routine for resident surgeons in Rome and at all Italian training programs.
Sergio Stipa, MD, FACS, was one of the chiefs of surgery who was a great inspiration for developing international relationships between physicians. In 1965, Dr. Stipa spent one year at the Massachusetts General Hospital, Boston. He made long-lasting friendships with several of the chief residents and young staff members, including such luminaries as Gerald Austen, Ronald Malt, and David Skinner (all MD, FACS). He remained in close contact with Dr. Skinner. Dr. Skinner traveled to Bristol, U.K., in order to spend one year as an overseas senior fellow with Ronald Belsey, MD, FACS—as did many of the residents in cardiothoracic surgery from Massachusetts General Hospital and later from the Johns Hopkins Hospital. Dr. Stipa decided to visit Dr. Belsey for few days and grew fascinated with Dr. Belsey’s technique for performing esophageal surgery.3
Dr. Ronald Belsey (center, front row) with his staff, Frenchay Hospital-Bristol, 1960
Dr. Belsey trained at St. Thomas Hospital and Brompton Hospital, London, working with pioneers of thoracic surgery, including J.E.H. Roberts, MBBS, and Tudor Edwards, MBBS. Norman Barrett, MBBS, had a major influence in molding Dr. Belsey’s interest in esophageal surgery. In 1936, Dr. Belsey spent one year as research fellow and assistant to Edward Churchill, MD, FACS, at Massachusetts General Hospital. Returning to the U.K., Dr. Belsey contributed to the development of one of the most important thoracic surgical centers in the U.K.—the Frenchay Hospital in Bristol. He took the place of Robert J. Shaw, MD, FACS. Dr. Shaw enlisted in the U.S. Army in 1941 and served as chief of thoracic surgery at the Frenchay Hospital. Dr. Shaw later moved to the American Hospital of Paris, and Dr. Belsey succeeded him. After World War II, Dr. Shaw returned to the U.S., settling in Dallas, TX, where he established with Donald Paulson, MD, PhD, FACS, the largest and most important center for thoracic surgery in the world at Baylor University. Interestingly, during World War II, Dr. Churchill was the chief surgical consultant for the European and North African surgical theaters, and Michael DeBakey, MD, FACS, was his assistant for communicating with the surgeon general, Fred Rankin, MD, FACS, in Washington, DC.
Dr. Belsey continued a close collaboration with U.S. thoracic surgeons and operated several times in our hospital. The friendship between Drs. Skinner, Belsey, and Stipa was enduring.4 Dr. Belsey loved to go hunting and fishing, so he made many friends in Rome outside the field of surgery.
Dr. Stipa became a well-known esophageal surgeon. Dr. Stipa, assisted by two co-authors of this column, operated on Elio Toaff, head Rabbi of the Italian-Jewish community, performing an Ivory-Lewis esophagectomy for cancer of the middle esophagus, a procedure he learned from Dr. Belsey. A few years after the operation, Rabbi Toaff would lead a historical step in the brotherhood between the Roman Catholic Church and the Italian-Jewish community, meeting Pope John Paul II in the Great Synagogue of Rome. Rabbi Toaff survived the operation for almost 40 years in good general condition, dying two years ago at the age of 100. For this reason, several Jewish residents have trained alongside several surgeons from Palestine.
The international exchange of surgical knowledge and skills has led to a number of important advances in resident training and patient care. This column has underscored the role of Italian surgeons in this movement, and the authors are committed to ensuring its continued growth.