American Exceptionalism and the American Surgical Association: The Rise of Surgery in the United States.

OBJECTIVE: To explore use of the notion of American exceptionalism by fellows of the American Surgical Association (ASA) (1880 through World War I) and how this proved instrumental in the rise of surgery in the United States. BACKGROUND: American exceptionalism is the belief that the United States is innately different from other nations because of its economic, geographic, political, religious, and social foundations. Although, currently, the concept of American exceptionalism implies superiority, in its original 19th century connotation, the idea referred to the distinctive character of America as a free nation. METHODS: An analysis of published literature along with unpublished documents to provide new knowledge and unique insight into the use of American exceptionalism by members of the ASA as they promoted their specialty. RESULTS: Beginning with Samuel Gross's desire that the organization he founded represent "the genius of our republican institutions," to Frederick Dennis's declaration that "American surgery eclipses all other nations because of the wonderful adaptability of the American mind," plus Lewis Pilcher's explanation of how the "stimulating climate, prevailing religious tone, regard for learning, and pride of citizenship are the fruit of the American mind when turned to surgical problems," and ending with Edmond Souchon's 106 page article in the Transactions on surgical firsts, the ASA was the avenue that helped the nation's surgeons define and defend themselves. CONCLUSIONS: Use of the concept of American exceptionalism by fellows of the ASA was a key factor in the development of surgery in the United States.

The American Medical Association's Section on Surgery: The Beginnings of the Organization, Professionalization, and Specialization of Surgery in the United States.

OBJECTIVE: To explore the founding of the American Medical Association's Section on Surgery in 1859 and how it represented, on a national basis, the beginnings of organized surgery and the formal start of the professionalization and specialization of surgery in the United States. BACKGROUND: The broad social process of organization, professionalization, and specialization that began for various disciplines in America in the mid-19th century was a reaction to emerging economic, political, and scientific influences including industrialization, urbanization, and technology. For surgeons or, at least, those men who performed surgical operations, the efforts toward group organization provided a means to promote their skills and restrict competition. METHODS: An analysis of the published literature, and unpublished documents relating to the creation of the American Medical Association's Section on Surgery. RESULTS: During the 1850s and through the 1870s, a time when surgery was still not considered a separate branch of medicine, the organization of the American Medical Association's Section on Surgery provided the much needed encouragement to surgeons in their quest for professional and specialty recognition. CONCLUSIONS: The establishment of the American Medical Association's Section on Surgery in 1859 helped shape the nationwide future of the craft, in particular, surgery's rise as a specialty and profession.

Henry Hollingsworth Smith and His Bibliographical Index and Historical Record: The Beginning of American Surgical Historiography.

OBJECTIVE: To explore the details of Henry Hollingsworth Smith's (1815-1890) achievement as the first physician to organize in a systematic and chronologic manner the details of the history of surgery in America and prepare a register of men who performed surgical operations. BACKGROUND: The life of Smith, the earliest of the nation's surgeons to elucidate the history of American surgery, is little known. His boosting the image of the scalpel wielder helped shape the future of the craft, in particular, surgery's rise as a specialty and profession. METHODS: An analysis of the published medical literature and unpublished documents relating to Smith and his work to document the history of American surgery. RESULTS: During the 1850 s, a time when surgery was not considered a separate branch of medicine but a mere technical mode of treatment, Smith's efforts in surgical history provided much needed encouragement to surgeons in their pursuit of professional recognition. CONCLUSIONS: Although Smith's accomplishment as the nation's first compiler of the history of American surgery has long been forgotten, his effort afforded the men who performed surgical operations their earliest measure of self-respect. As such, Smith belongs in America's pantheon of surgical heroes.

Edward Bermingham and the archives of clinical surgery: America's First Surgical Journal.

OBJECTIVE: To explore the life of Edward J. Bermingham (1853-1922) and his founding, in 1876, of the Archives of Clinical Surgery, the nation's first surgical journal. BACKGROUND: Beginning in the 1870s, American medicine found itself in the middle of a revolution marked by fundamental economic, scientific, and social transformations. For those physicians who wanted to be regarded as surgeons, the push toward specialization was foremost among these changes. The rise of surgery as a specialty was accomplished through various new initiatives; among them was the development of dedicated literature in the form of specialty journals to disseminate news of surgical research and technical innovations in a timely fashion. METHODS: An analysis of the published medical and lay literature and unpublished documents relating to Edward J. Bermingham and the Archives of Clinical Surgery. RESULTS: At a time when surgery was not considered a separate branch of medicine but a mere technical mode of treatment, Bermingham's publication of the Archives of Clinical Surgery was a milestone event in the ensuing rise of surgery as a specialty within the whole of medicine. CONCLUSIONS: The long forgotten Archives of Clinical Surgery provides a unique window into the world of surgery, as it existed when the medical revolution and the process of specialization were just beginning. For this reason, the Archives is among the more important primary resources with which to gain an understanding of prescientific surgery as it reached its endpoint in America.

Samuel D. Gross, the Writing of American Surgical History.

OBJECTIVE: To explore the details of Samuel D. Gross's achievements as America's foremost historian of medicine in the mid-nineteenth century. BACKGROUND: The life of Samuel D. Gross, the most renowned of the nation's surgeons in the nineteenth century, has been extensively researched and celebrated. Despite the long-standing interest in Gross's accomplishments, there is an important and influential aspect of his career that has been forgotten. Gross was the country's first surgical historian and his boosting of the popular image of the knife bearer was crucial to shaping the future of the craft, in particular surgery's rise as a respected specialty within the whole of medicine. METHODS: An analysis of the published medical literature and unpublished documents relating to Samuel D. Gross and his status as the country's earliest historian of surgery. RESULTS: At a time when surgery was not considered a separate branch of medicine but a mere technical mode of treatment, Gross's efforts in medical and surgical history provided a much needed boost to surgeons in their pursuit of self-confidence and self-respect. CONCLUSIONS: Although Gross's accomplishments as a medical historian have been overlooked, it is undeniable that he was America's pioneer surgical historian and, as such, afforded surgeons their earliest measure of self-esteem, a critical attribute that was indispensable for the rise of surgery as a distinguished profession.

The education, training, and specialization of surgeons: turn-of-the-century America and its postgraduate medical schools.

OBJECTIVES: To understand the institutions, personnel, and events that shaped postgraduate medical schools in late 19th- and early 20th-century America. BACKGROUND: In a little remembered chapter of American surgical medical history, postgraduate medical schools played a decisive role in surgery's march toward professionalization and specialization. While William Halsted was first establishing his training program in Baltimore, medical facilities such as the New York Polyclinic and the New York Post-Graduate were already turning out thousands of physicians who considered themselves "specialists" in surgery. METHODS: An analysis of the published and unpublished medical and lay literature relating to the nation's postgraduate medical schools. RESULTS: The founding of postgraduate medical schools in turn-of-the-century America was a key event in the acceptance of surgery as a legitimate specialty within the whole of medicine. These little remembered institutions laid the foundation for the blossoming of surgical care and the extraordinary clinical advances that followed. CONCLUSIONS: Postgraduate medical schools, particularly the New York Polyclinic and the New York Post-Graduate, were dominant influences in shaping the early history of surgery in America. These institutions brought the pressure for specialization in surgery to the forefront of discussions about medical education and training. For the first time, a large number of practitioners were offered a formalized surgical experience in a busy urban medical facility. As a result, and despite their being long forgotten, the importance of postgraduate medical schools in our nation's surgical history cannot be overstated.

Joseph Lister and his 1876 tour of America.

OBJECTIVE: To explore the events and people that shaped Joseph Lister's 1876 tour of America and how the journey became a landmark episode in the history of surgery. BACKGROUND: In a little known chapter in American medical history, Joseph Lister toured the United States in 1876 in an attempt to convince physicians that they should accept his ideas about surgical antisepsis. His 2 month-long visit, which included a transcontinental railroad trip across the North American continent, sparked controversy as doctors struggled to understand the relationship between bacteria and disease. METHODS: An analysis of the published medical and lay literature and unpublished documents pertaining to Lister and antisepsis for the 15-year period, from 1865 to 1880. RESULTS: Joseph Lister's 1876 tour of America proved a turning point in the slow process of accepting the principles of antisepsis by the nation's doctors. This visit laid the foundation for the blossoming of medical care in America and the remarkable advances that followed. CONCLUSIONS: Among the most debated topics in the American medical world of 1876 was whether to accept Joseph Lister's principles of surgical antisepsis. He was invited to address the issue and gave a series of lectures in Philadelphia, Boston, and New York. The presentations marked the beginning of a significant change in American physicians' awareness of the correlation between wounds, germs, and pus. Lister's visit is a crucial milestone in the history of medicine.

Harvey Cushing and the battle of Boston common: military medical preparedness for world war one.

OBJECTIVE: To explore the events and people that shaped Harvey Cushing, one of the nation's leading surgeons, into a political actor as he rallied support for the issue of military medical preparedness for World War One. SUMMARY BACKGROUND DATA: In a little remembered episode of American medical history, for 2 years before the nation's formal entry into World War One in April 1917, Harvey Cushing attempted to garner political and professional support for the idea of military medical preparedness. His efforts, including the proposed construction of a functioning Base Hospital on Boston Common, sparked controversy in a public that was torn between maintaining neutrality and going to war. METHODS: An analysis of Harvey Cushing's unpublished letters, manuscripts, and papers located at the Yale University School of Medicine, New Haven, CT. RESULTS: While Harvey Cushing's crusade for military medical preparedness failed to win over the local public, it helped convince national military leaders that the civilian medical community was ready to assist in the war. This, in turn, laid the foundation for much of the American medical establishment's success on the battlefields of World War One. CONCLUSIONS: The disagreement surrounding the Battle of Boston Common, as Harvey Cushing had labeled the debate, reveals both how, even at the brink of war, ideas formulated on the war front could not be translated to the home front, and how early military medical preparedness, although national in character, was commanded by only a few select voices.

Homeopaths, surgery, and the Civil War: Edward C. Franklin and the struggle to achieve medical pluralism in the Union army.

An important aspect of the Union army medical corps throughout the Civil War was the clinical discord that pitted allopathic, or orthodox, physicians against sectarian, or unorthodox, physicians. Allopaths dominated the corps and its examining boards and consequently denied commissions as army surgeons to sectarian practitioners such as the homeopaths. This probably affected surgical manpower needs, since many well-trained homeopathic surgeons, like Edward C. Franklin, one of the nation's busiest and most prolific surgeons, wished to serve in the northern army but were unable to do so.

George Crile, Harvey Cushing, and the Ambulance Americaine: military medical preparedness in World War I.

In a little-remembered episode of American surgical history, more than 2 years before the nation's formal entry into World War I in April 1917, teams of surgeons and their support personnel had already been deployed in France. The surgeons' service at the Ambulance Américaine in Paris and at other smaller hospital facilities in the French countryside brought about the efficient integration of civilian American medicine into World War I's military structure. Under the leadership of George Crile and Harvey Cushing, this early American surgical presence in France created remarkable organizational and scientific advances in military medicine and prepared the United States to go to war.

A selective history of hernia surgery in the late eighteenth century: the treatises of Percivall Pott, Jean Louis Petit, D. August Gottlieb Richter, Don Antonio de Gimbernat, and Pieter Camper.

Of the different eras in the evolution of hernia surgery one of the most intriguing is the late eighteenth century, when surgeon/anatomists first began to publish their studies of the abdominal wall and the inguinal and femoral canals. It became known as the age of dissection, and many of the surgical successes of subsequent periods can be traced back to the anatomical knowledge gained from 1750 to 1800. These fifty years also served as the all-important transition era from text-only hernia treatises to lavishly illustrated monographs. The works of Percivall Pott, Jean Louis Petit, D. August Gottlieb Richter, Don Antonio de Gimbernat, and Pieter Camper were among the most influential hernia-related tomes of this time. Biographies of these five surgeons and extracts from their writings are presented in this article.

Demographic and socioeconomic aspects of hernia repair in the United States in 2003.

Data from the National Center for Health Statistics reveals that approximately 800,000 groin hernia repairs were completed in the United States in 2003. More than 90% of these operations involve the use of mesh prosthesis and are performed on an outpatient basis. The two most common groin hernia repair techniques are the Lichtenstein and plug hernioplasties. Economic evaluation of groin hernia surgery demonstrates that the most important component of cost effectiveness is the aggregate time the patient spends in the operating room, recovery room, and the length of his or her overall stay in the facility.

The PerFix plug repair for groin hernias.

Since the mid-1990s, the PerFix plug hernioplasty has become one of the mainstays of a surgeon's operative armamentarium. The repair is a technically simple surgical operation, which can be used to treat most groin hernias. To demonstrate the simplicity and effectiveness of the plug technique, a 15-year experience with over 4400 patients is reported. Technical details are presented, including an in-depth discussion concerning PerFix plug preparation and placement.