Surgeon asked colleagues why they chose the profession: Giants of the era responded

Editor’s note: The information in this article was presented at the 2020 American College of Surgeons Clinical Congress History of Surgery Virtual Poster Presentation, October 3–7, 2020.

Surgical history is a product of curiosity, imagination, technical expertise, and, to some degree, willingness to share one’s ideas with other professionals. Francis Reder, MD, was a prominent surgeon in St. Louis, MO, who was elected president of the Missouri Medical Society for the 1911 term. As is often the case, Dr. Reder was perplexed as to a proper subject for his presidential oration. He decided to pose a single question to the best internationally known surgeons (in his personal view) of that era: “Why and how did you choose surgery as a career?” He received at least 44 replies, often in detail, handwritten, and, in some cases, on the physician’s personal or professional letterhead. These answers became the subject of his presidential address, which was subsequently published.¹

The multilingual responses and translations were the substance of that publication and were given to the University of Louisville School of Medicine Kornhauser Medical Library, KY. The 44 reproductions of some of this correspondence now decorate the walls of the Price Institute of Surgical Research² in the circa 1950s Medical-Dental Research Building. It should be noted that the correspondences preceded the successful efforts of Franklin H. Martin, MD, FACS, to found what has become the American College of Surgeons (ACS).³

The surgeons and their birthplaces are featured in Table 1. To include all the proposed and organized material would overwhelm the space of the Bulletin and the patience of the reader. Therefore, we have elected to highlight five surgeons with brief commentaries about each that, in some way, reflect the enduring legacy of their names, procedures, and international reputations.

TABLE 1. Birthplace and specialty of surgeons who responded to Dr. Reder’s letter

Dr. Reder’s own professional contributions are modest, but, nonetheless, still important in terms of the history and advancement of surgery. The centennial recounting of the Southern Surgical Association meetings found him weighing in on another matter of still current dispute: After right hemicolectomy, is an end-to-side or end-to-end anastomosis preferred? This discussion transpired at the annual meeting in 1918.⁴

The Mayo brothers

Charles H. Mayo, MD, FACS, responded on behalf of his brother William J. Mayo, MD, FACS, and predictably credited their father, William W. Mayo, MD, as the stimulus for entering surgery (see Figure 1). The senior Dr. Mayo encouraged his sons to visit European and British medical centers to broaden their surgical expertise. The Mayo brothers began to push the boundaries of how medicine was practiced through the creation of a multidisciplinary group, a concept unheard of at the time. This approach proved beneficial and led to the establishment of patient medical records, medical libraries, and, in 1914, the first integrated hospital, the Mayo Clinic Hospital, later to be named St. Mary’s Hospital.

FIGURE 1.

The steady flow of hundreds of cases, all managed with remarkable ingenuity and technical skill and, for the era, very low death rates, came to define the Mayo Clinic in Rochester, MN. The Mayo family generously personally signed a Deed of Gifts to the clinic, as well as its associated hospitals, which helped fund the creation of a highly viable group practice, even to the founding of a long-overdue medical school in Rochester. The winds of constant change in early 21st-century medicine have reinforced the founding principles of the senior Mayo and his sons.⁵

Harvey Cushing, MD, FACS

Dr. Cushing, who would go on to serve as an ACS President, wrote of his reverence for William Osler, MD, and the long line of other medical professionals he held in high esteem as his reasons for choosing to become a physician. He self-deprecatingly added, “[I]n the second place, I became interested in surgery owing partly to a natural inclination for handicraft—in other words, having better hands than brains” (see Figure 2).

FIGURE 2.

Regardless of his rationale for entering surgery, Dr. Cushing is considered the father of neurological surgery with his description of an eponymous syndrome as an early aspect of endocrinology. Dr. Cushing began altering modern medicine early in his career. Following the death of a patient under his care, he and his fellow classmates developed a system to monitor patient vital signs such as blood pressure, pulse, temperature, and respiration while under anesthesia.

In addition to his medical advances as a civilian, Dr. Cushing served in the military during World War I, first as a major and then as colonel. During his tenure as a colonel, he treated Lieutenant Edward Revere Osler, father of Sir William Osler, a famous physician. Dr. Cushing wrote articulately on the life of William Osler, composing a three-volume biography that was awarded the Pulitzer Prize in 1926. After discharge from the military in 1919, Dr. Cushing spent the next decade curating his library at Yale University, New Haven, CT, which now houses more than 300 articles and 13 books. Along with his decorated authorship, Dr. Cushing was known for meticulously documenting his cases, including precise, hand-drawn illustrations. His attention to detail and his dedication to accurate documentation eventually led to the establishment of the Harvey Cushing Brain Tumor Registry at the Cushing Center at Yale Medical Library, concluding his remarkable career at the institution.^6,7

Joseph Lister

Lord Joseph Lister, Baron Lister, OM, PC, PRS, FRCSEd, FFPS, wrote from Lyme Regis, Dorset, U.K., where he was infirm at the time that Dr. Reder posed his question. He wrote, with the assistance of his nephew, “In the very feeble state of my health, I must ask you to excuse me…” (see Figure 3). Dr. Lister would die 10 months after dictating this brief missive. That he mustered the strength to respond to Dr. Reder speaks highly of Dr. Lister’s dedication to the profession and to surgical patients.

FIGURE 3.

Dr. Lister’s inquiring mind was supported initially by his father-in-law, who also was chair of surgery and developer of the Syme amputation. To some degree, Dr. Lister’s work was in parallel, but slightly after, the profound efforts of Louis Pasteur and his pupils regarding the “germ theory of disease” on the continent; it is likely that Dr. Lister’s focus on carbolic acid as a germicide rose from a basic scientist directing him to Mr. Pasteur’s writing and from a German chemist’s abolition of the smells of rotting garbage in Carlisle, U.K. Interestingly, he met Mr. Pasteur only once in the very later stages of their lives.^8,9

William M. Polk, MD

William M. Polk, MD, was an early specialist in surgical treatment of diseases in women and his dedication to his specialty was reflected in his response to Dr. Reder. He wrote, “I became a surgeon because of the necessities of my work in connection with obstetrics and diseases of women” (see Figure 4).

FIGURE 4.

Dr. Polk was the author of a major annotated biography of his own father, Leonidas Polk, who, in sequence, had graduated West Point, served as Bishop of Episcopal Diocese of Louisiana and the Mississippi Valley, founded Sewanee as the University of the South, and became a feared and effective general in the Confederate Army. The bishop general was killed while inspecting the site of his last military victory.

It is less clear how the son of the Confederate general found his way to New York, NY, but he flourished intellectually in the growing city and founded gynecologic surgery alongside the better known Howard Kelley, MD, at what would become Johns Hopkins Hospital, Baltimore, MD.¹⁰

Ernst Wertheim

Austrian-born Prof. Ernst Wertheim was an internationally recognized gynecologist in the early 1900s. He responded to Dr. Reder’s query by writing, “It was chance, mere chance,” that led him to gynecologic surgery (see Figure 5).

FIGURE 5.

Professor Wertheim received his doctorate from The University of Graz in 1888; he went on to become an assistant in general and experimental pathology. After this, Professor Wertheim worked with his mentor, Prof. Otto Kahler, at the Second University Clinic of Vienna. Eventually, he moved to the Hospital of Vienna and received his training in gynecology and obstetrics. After completing his training, Dr. Wertheim became chief surgeon of the gynecological department at Bettina Pavilions der Elisabeth-Klinik in 1897, professor at the University of Vienna in 1889, and director of the first Vienna woman’s clinic in 1910. He subsequently developed techniques to treat uterine prolapse. Dr. Wertheim is most notable for treating cervical cancer by performing the first radical abdominal hysterectomy. This procedure involves removing the uterus, parametrium, tissue in the upper vagina, and pelvic lymph nodes. The ovaries are typically kept intact if the patient has not been through menopause. This operation went on to become known as the Wertheim operation. Interestingly, he was the first physician to discover Neisseria gonorrhoeae in the peritoneum.¹¹

Other contributors to Dr. Reder’s investigation

Too many medical libraries and museums are being downsized or reformatted. The availability of interlibrary loan, abetted by the convenience of Internet access, is a resource that few surgeons recognize and use. To close, the authors chose to offer a few more examples from the other respondents to exemplify the remarkable earnestness of the series and their recital.

Roswell Park, MD, FACS, was influenced at an early age by a physician in the family to enter the medical field. With this in mind, in addition to his love of working with tools, he began teaching anatomy. In his view, intellectual advancement within surgery was growing at a rapid pace compared with medicine; therefore, Dr. Park pursued a career in surgery, leading to the National Cancer Institute-designated Roswell Park Cancer Center, Buffalo, NY.

Prof. Davide Giordano, after nearly falling faint during his first operation as a surgical assistant, eventually became attracted to surgery. While studying medicine at the University of Turin, Italy, he trained under Prof. Filippo Navaro, one of the first surgeons in Italy to adopt antiseptic methods while many colleagues were steadfast in preantiseptic methods. This technique impressed Professor Giordano and, as a result, he credits his love of surgery to his training under Professor Navaro.

Robert T. Morris, MD, FACS, had every intention of making a career of studying natural history until he took a biology class at Cornell University, Ithaca, NY. With an inventive mind and a newfound interest in anatomy, he began working with animals. His first laparotomy, which was for the spaying of his friend’s dog, resulted in the dog having more pups in the next litter than in any previous litter. He initially was determined to become a neurologist, but another student performed better on the examination, leaving him with his second choice: surgery.

Prof. Hermann Küttner, founder of a German surgery clinic, was interested in the natural sciences, with a particular interest in zoology. In 1890, Professor Küttner was wounded in the abdomen during a pistol duel. He was saved by an operation conducted by surgeons, which at that time was a rare occurrence. From that point on, he devoted his life to surgery.

John A. Wyeth, MD, FACS, who studied at the University of Louisville School of Medicine, recalled always having the drive to do the jobs that others could not or were not willing to undertake. Surgery fulfilled this ambitious drive, and he was forever satisfied with his decision, describing being faced with a difficult problem during surgery and pulling through as “a feeling of elevation which takes one for the time being above ordinary, mundane things.”

Current influences for the choice of a surgical career are important for the survival of the specialty, but more importantly, for the wise and careful care of the surgical patient. We do, indeed, stand on the shoulders of giants.

Acknowledgment

This effort has been funded by a gift from Dr. and Mrs. Paul H. Young, St. Louis, MO, in addition to donations of original responses from the Mary Oxley Foundation, Tulsa, OK. This poster presentation and the full display are available at the Kornhauser Library at the University of Louisville School of Medicine, KY.

Correspondence should be addressed to Susan Galandiuk, MD, FACS, department of surgery, University of Louisville, KY 40292, e-mail s0gala01@louisville.edu.

References

1. Reder F. Journal of the Missouri State Medical Association. Volume 7; 1911. Available at: https://archive.org/details/journal7191miss/page/140/mode/2up?q=Reder. Accessed July 17, 2021.
2. The story behind the surgeons. University of Louisville. Available at: https://louisville.edu/priceinstitute/reder-posters. Accessed November 21, 2020.
3. Davis L. Fellowship of Surgeons: A History of the American College of Surgeons. Chicago, IL: American College of Surgeons; 1973.
4. Mansberger AR. Scientific presentations for the decade 1910–1919. In: Sparkman RS, ed. The Southern Surgical Association: The First 100 Years. Philadelphia: Lippincott, 1984: 91.
5. Markey H. The brilliant brothers behind the Mayo Clinic. PBC News Hour: Health and Medicine. June 29, 2018. Available at: http://to.pbs.org/2O3H2c0. Accessed July 17, 2021.
6. Cushing H. The basophil adenomas of the pituitary body and their clinical manifestations (pituitary basophilism). Obes Res. 1994;2(5):486-508.
7. Yale University. Harvey Cushing and the Cushing Center. Harvey Cushing/John Hay Whitney Medical Library. 2019. Available at: http://bit.ly/35lRK3k. Accessed July 17, 2021.
8. Cartwright FF. Joseph Lister. Encyclopedia Britannica. May 7, 2019. Available at: http://bit.ly/2D2cjWy. Accessed July 17, 2021.
9. The Joseph Lister Exhibit. The Royal College of Physicians and Surgeons of Canada. Available at: http://bit.ly/2OyNEyl. Accessed July 17, 2021.
10. Cornell University. Obituary: Dean W.M. Polk. Cornell Alumni News. Available at: https://bit.ly/3lw8C2V. Accessed July 17, 2021.
11. Thiery M. Ernst Wertheim (1864–1920) and the operation of Wertheim. Gynecol Surg. 2008;5:333-334.