Even educated people have a difficult time defining what Socialism is, and are often wrong. The root word is Latin, sociare -to combine or share. We need to go back to basics and look it up in Webster’s Dictionary. Socialism’s strict definition, as found in Webster, is when a government utilizes political theory and practice of collective ownership and administration of the means of production and distribution of goods. THERE IS NO PRIVATE PROPERTY, and the means of producing goods and services are controlled by the state. There is not one mention in Webster or any other dictionary that mentions any action that helps people in need is Socialist. Somehow help for those in need gets mixed in with Socialism. I often see in defense of Socialism, the idea that anything that gives aid to those in need, is a Socialistic idea. This has been mistakenly quoted by many, including Presidents of the United States. Truman was one of those who said in a speech given in Syracuse, New York, on October 10, 1952:
“Socialism is a scare word they have hurled at every advance the people have made in the last 20 years.
Socialism is what they called public power. Socialism is what they called social security.
Socialism is what they called farm price supports.
Socialism is what they called bank deposit insurance.
Socialism is what they called the growth of free and independent labor organizations.
Socialism is their name for almost anything that helps all the people.
I must have the wrong edition of Webster’s dictionary because I do not see any reference to social welfare being Socialism. “They” whoever “they” are that called help for the needy Socialist, must have another version of Webster than I have.
Helping people in need has never been Socialism in the past. Helping people in need goes back quite a ways, even before there was Socialism. Augustus, the Roman Emperor, gave grain to Roman citizens who could not buy it. In 960 CE, China, the Song Dynasty housed the aged that were homeless. Judaism, Islam, and Christianity all have organized means of helping those in need, and are not called Socialists.
History reveals the truth! It was actually an ANTI-Socialist effort by the right-wing government of Imperial Germany under Chancellor Otto von Bismarck that “invented” social security, health insurance, workmen’s compensation, and other social welfare programs in an effort to thwart Socialism as a package of his Anti-Socialist Law of 1878. Making social welfare a Socialist invention was just a clever sleight of hand from the German system that had all the elements of a safety net of income security from “sickness” insurance, unemployment assistance, to old age assistance, that in-fact was the model on which Franklin Delano Roosevelt based the 1935 Social Security Act. Some claim that Bismarck was 65 when he introduced his social welfare program, and we still use that as the standard retirement age, the age medicare starts, and social security payments normally begin.
Because these programs were usually administered by the government, they evolved in the minds of many as Socialist ideas even though they were the opposite. The real Socialists were quite happy with the Marxist ploy of: “From each according to his abilities to each according to his needs.” There was no reason for governmental organizations that parceled out to those in need because the government, in theory, already did everything. Looking at the remaining five actual Socialist countries in the world, not one of them has a decent social welfare program. Social welfare and social security are falsely attributed to Socialism, which, as the dictionary says, requires ownership of the means of production and distribution. Social welfare in the rest of the world does not depend on the government’s ownership of all the property. Yet in all those countries where pure “Socialism” is still practiced: North Korea, Cuba, Laos, China, and Vietnam, the state does own the means of production and distribution. Indeed everything is automatically government controlled. In many of those countries, they build walls to keep the population from escaping the “worker’s paradise” despite the risks they take in climbing over the walls, and their social welfare programs don’t seem to be working all that well. In the early days of Socialism in the mid and late 1800s, Utopian Socialism even preached eugenics to create the master imperial race, which would make for better workers and better soldiers than the pale, anemic-looking young men of the times. Only the Nazi branch of Socialists kept that crackpot Socialist tenant, and thankfully you don’t hear of eugenics anymore.
Socialism has several branches. Utopian Socialism is just an early rendition. Marxist/Leninist is perhaps the most severe form if judged by the number of dead people they generated, but Hitler was a close second. Make no mistake, Hitler was a Socialist by his own admission and actions. I trust my parents infinitely more than what Wikipedia says about Stalin, Lenin, and Hitler and what they were, because they experienced those monsters up close and personal. Just like Democratic Socialism is still Socialism in word and deed. They are all blood brothers linked by who controls the total sum of product and its distribution of a nation and the need to have top-down control of people. To date, in all Socialist run nations, it has been the Central Committee run by a dictator. In order to take ownership of property, one needs guns and control of the military. Ownership is not surrendered voluntarily. The Socialist professors at the universities overlook that oxymoronic factoid.
Every government, regardless of what style of economies especially in Capitalism, provide some assistance to their population in need, be it starving people, banks that are about to close their doors for lack of funds, or workers who lost their jobs because of a global pandemic. The level of support depends on the generosity of that government, their tax structure, their compassion, and their wealth. Norway, for example, sits on huge natural gas reserves and can pay for public education up to and including college and professional schools. Sweden also has vast natural resources and can provide the same. Neither country, however, owns the major industries nor the means of distribution of their product, and by definition are not Socialist. The Saudi government can afford a baseline income for every Saudi national, yet no one would call them Socialist even though, in their case, their major product, oil, is under government control, but almost everything else is in private hands.
Socialists have cleverly adopted various unrelated issues that they then trot out and claim as their ideas. If you then disagree with a certain segment, you become a target. Ideas such as global warming, feminism, environmentalism, helping the poor (social welfare), all have different origins not emanating from Socialism. It does not, for example, make a person who wants to keep the air clean or a woman who stands up for women’s rights a Socialist. It helps to go back to the original dictionary definition of Socialism, stripping away all the ancillary supposedly “Socialistic” characteristics. Socialism and Social welfare are only connected by the word “Social” with little if any substantive resemblance. All the folks that equate social welfare with Socialism ignore or are ignorant of history and how social welfare is practiced in the world by various economic models.
As attested to on my birth certificate to the left, I was born in a hospital on Keplerstraße (Kepler street) in Linz, Austria, where Johannes Kepler lived and worked from 1612 to 1626. The name may not be familiar to you, but he was among the key men who revolutionized astronomical thinking and could be counted among the first astrophysicists. His contemporaries included Galileo Galilei, Tycho Brahe, and later Isaac Newton. Johannes Kepler was most famous for elucidating the motion of planets and adding to the theory of Copernicus, a Polish mathematician and scientist, that the sun is the center of the solar system and the earth revolves around it. Unfortunately, none of Kepler’s astronomical genius rubbed off on me despite my proximity to his spirit, undoubtedly still haunting Kepler Street.
Kepler came up with his three laws of planetary motion, although described by him with very complex mathematical formulations, they can be simply stated:
1. The orbits of the planets are not circles but ellipses
2. Planets move proportionally faster when they are nearer the sun.
3. The more distant planets take proportionally longer to orbit the sun. This third of Kepler’s laws inspired Newton to elucidate the nature of gravity, not the apple that supposedly fell on his head. Kepler also gave us the word “satellite.” Kepler worked for Tycho Brahe, the Danish astronomer, although it was a contentious relationship. Brahe was very secretive and would not share his astronomical observations that Kepler needed to finish his theories of planetary motion. When Brahe died under peculiar circumstances, even the possibility of murder, among other things, he had a secret dalliance with the Danish King’s mother. Eventually, Kepler did get access to all the data he needed. He was able to explain why Mars appeared to be reversing its revolutions around the sun and the mathematical relationships of the other planetary orbits.
Kepler discovered the optics that operate in our eyes, that binocular vision is dependent on two eyes, and the mechanism that makes us near or farsighted, which he could correct with different ground glass lenses. How the telescope works and magnifies was also one of his academic interests. Although Isaac Newton is credited with inventing Calculus, Kepler preceded him with Integral Calculus by almost fifty years. Kepler had the belief that the world was in harmony in all aspects, astronomy, nature, music, mathematics, and even snowflakes. He wrote a pamphlet, Strena Seu de Nive Sexanula (A New Year’s Gift of Hexagonal Snow), and he was the first human to observe that phenomenon. At the time, discussion of heliocentrism was heretical and almost caused Galileo to be burned at the stake. Kepler and his wife, if they were separated, communicated in code to avoid any accusations of heresy. Kepler’s mother was, in fact, accused of witchcraft. He defended her and was able to save her life by getting her sentence commuted to exile. It was Kepler who wrote the first science fiction book entitled Somnium (The Dream), where he envisioned non-human intelligent life on the moon, with large animals resembling dinosaurs roaming about. He also described what was a supernova, named for him in his book, De Stella Nova.
Johannes Kepler was a true Renaissance man before that term existed.
William A. Nolen wrote a book, The Making of a Surgeon, in 1986. It was his story of becoming a surgeon, and is still a popular book read by many aspiring surgeons to be. This is my brief take on the history of surgery and becoming a surgeon, (and a shameless ad for my new book, WE STAND ON THE SHOULDERS OF GIANTS).
Surgery has been practiced by homo sapiens for at least 8,500 years, and maybe even longer as evidence can only be gathered from materials that do not decay, such as bone. Carefully chiseled perfectly round trephination holes have been found in skulls that were buried 6500 BCE in northern France. These skulls belonging to our species survived these “operations” as the edges of the openings showed signs of healing several years after they were drilled. Surgery was practiced in ancient Egypt and India around 1500 BCE with complex procedures such as flap reconstructions of facial injuries, and sophisticated ways to stop hemorrhage and prevent infection. But then the first “Dark Ages” let down their curtains on surgical progress in 1200 BCE, probably related to climate change caused by unprecedented volcanic activity. It was the Greek culture that resurrected medicine and surgery with Hippocrates shortly after 400 BCE. He introduced the idea that illness was not caused by the gods but by our environment, and could be “cured” or at least tamed by environmental manipulations. The Romans copied from the Greeks and added their own wisdom and knowledge through physicians such as Galen and Celsus. Galen, a consummate surgeon, learned from his experience taking care of the gladiators of the Pergamum Coliseum (now in Turkey).
The second “Dark Ages” from the 5th to the 15th century CE brought down the curtains on surgery again. The Middle Ages reverted to superstition and magic to care for the sick. Illness was again seen as God’s punishment for man’s wickedness, and to help those unfortunates was going against God’s will. Ambroise Paré and Andreas Vesalius were the standard-bearers that pushed back the walls of ignorance with observation, trial, and error. Leonardo da Vinci secretly dissected human bodies and made detailed accurate drawings of how we are put together which advanced surgical knowledge dramatically. The first appendectomy for appendicitis, a major killer of humans, was by a French surgeon, Claudius Amyand, in 1735, done in London at St. George’s Hospital.
In the 19th century, surgical science exploded through the genius of people like Theodor Kocher with thyroid surgery, Berhard Langenbeck’s teachings, and Theodor Billroth’s innovations in abdominal surgery. They, in turn, were aided by the basic science contributions of Joseph Lister – with surgical asepsis, and Robert Virchow – with pathology.
It is those individuals, the giants of surgery, on whose shoulders we now stand, to see further into vistas that we could only dream of a hundred years ago. Alexis Carrel gave us the knowledge of repairing and sewing arteries and veins. He and his good friend, Charles Lindberg, of flying fame, teamed up to give us the first artificial heart pump. William Halsted, who went to Europe to glean the secrets of how to teach surgery, then came back to the US and started to produce great surgeons one after the other at Johns Hopkins Hospital. Greats like Harvey Cushing, father of neurosurgery, and Hugh Young, father of urology, founded residency programs that perpetuated “Halstedian principles” for the ages. Many more greats have given us surgery techniques, knowledge, and inspiration to do bigger and better surgical procedures. Michael DeBakey not only gave us coronary bypass and aortic surgery, but was the inspiration that created the TV series and movie “MASH.” C. Walton Lillehei, the King of Hearts, as his residents fondly called him, invented the repair of congenital heart defects, saving thousands of children that would not be alive today. Then came along Dr. Joseph Murray, with the first kidney transplant, Dr. Thomas Starzl, with the first liver transplant, and Dr, Christaan Barnard, with the first heart transplant that lived, Human ingenuity and skill are not stoppable!
Every state has different requirements for post-graduate clinical experience. The first year used to be called the Internship, but the ACGME (Accreditation Council for Graduate Medical Education) has removed that moniker. It is now called the first year of post-graduate training, the residency. Surgical Residency at this time is five years. Although, because of a new restriction on-duty hours of a resident, the person in training has less time to acquire all the necessary skills and knowledge to fulfill their mission. When I finished my residency program in the early 1980s, my average time spent a week was 100 hours, and sometimes 120 hours. The current ACGME rules allow an average of 80 hours maximum a week when spread over 4 weeks, at least 20% less time than the previous generation. If a resident complains to the ACGME about working more than 80 hours, a surgical program could be shut down. This came about through the sad case of Libby Zion. Libby was a college student that died at a Cornell affiliated Hospital in New York, the cause of which was blamed on tired residents making wrong therapeutic decisions. This was actually not the entire or even accurate story, but it nevertheless changed the rules for all of the US from then on. The traditional work hours of the past from the old days of Halsted were thrown on the heap of history, despite that it had served us well, producing surgeons that were competent and multi-talented. 80% of residents now take an additional one to three-year fellowship training. All of which makes the general surgeon more and more obsolete. The last chapter of the book, The Future of Surgery, makes predictions of what is on the horizon for surgery.
If this essay piques your interest in the History of Surgery, my most recent book, We Stand on the Shoulders of Giants, a Brief History of Surgery, is a must-read for you, available on Amazon.com or on my website https://gusiwasiuk.com under books click the book and pay through PayPal.
The village where I grew up in Austria is exactly in the geographic center of Austria. It has existed for hundreds of years, first settled by Slavic tribes who trekked upstream along alpine rivers to find a habitable home for themselves. “Stoder,” the name of the village is derived from a Slavic word meaning “Cold Stony Place.” Later in the 19th Century, the inhabitants added the word “Hinter” meaning “behind.” So the name “Hinterstoder” is “behind the cold stony place.” I have written much about that town as it has left an indelible mark on my being. It is where I learned the things that count, starting with the multiplication tables all the way to what is right and what is wrong. There is evidence that the area was known to Bronze Age people, who came from the west, a civilization called the Hallstadt culture. They lived just one mountain pass away, the Salzsteig Joch, and did climb over it to enter the Steyr valley, named for the river Steyr, a remnant of the ancient glacier. Bronze age weapons were found in our valley. The Hallstadt culture had mastered rendering metal from ore, which they worked into pots, weapons, and tools. The whole area was rich in salt, which they mined and used in trade, the alpine streams being the ideal means of transporting the salt. One of the most intact Neolithic humans was found in a frozen state not far away in the Ötztal to the south. Radiocarbon dating placed him living 5300 years ago. He had copper tools and weapons with him and even sported several elaborate tattoos on his backside.
But the “Totes Gebirge” (the dead mountain range) history goes back even further, possibly 20 thousand years ago. In 1943 a schoolteacher, Otto Körber, with archeologic interests, was alerted by two hunters who accidentally discovered a series of caves high in the mountains that had bones in them. His investigation turned up a treasure trove of bones and shells of animals that were brought there to be prepared and eaten, that he dated back to the Neolithic period. He also found cutting and scraping stone tools, as well as small bones, hollowed out like a flute that made various sounds, presumably to create music or perhaps to communicate at a greater distance.
The Alps had modern human habitation, Homo sapiens, by at least 30,000 years ago, towards the end of the last glaciation, the Würm, which lasted from 115,000 years to 11,700 years ago. It was the glaciation just before that, the Riss that advanced and receded at least four times to create most of the river valleys of the Alps.
The interglacial period was relatively short, just 15,000 years. The red line shows the valley level as carved out by the Riss, while the blue line demonstrated the earth excavated by the Würm, to create the valley floor as it is now. When that glacier receded, it left a vast lake. It was warm enough that life was possible in the lake. Shellfish were abundant in that lake and were a mainstay for the humans that came down from their higher cave dwellings and carried them up to be consumed there, where the shells can still be found. The current valley floor has petrified shells embedded in sedimentary rock, formed at the lake’s bottom that now are readily found in what is left of the large lake, a river, and flat surrounding land.
When returning from one of my visits to my old home, I brought one of those rocks back, that now sits as a reminder of those ancient times on my fireplace hearth. It was quite a challenge for me to carry the rock in my carry-on luggage. The TSA just didn’t understand what the reason was for “rocks in my carry-on.”
I cannot resist posting these two pictures in the Austrian Alps. The winter scene was just taken by my third-grade school friend, Heinz. The summer shot I took two years ago. It is at the back of a U-shaped glacial valley that has been carved out by two glaciations. The older one, the Riss, said to be 300,000 years ago, took out the upper layer of soil and rocks that are seen here as the top of the foothills. The last glaciation, the Würm, ended 12,000 years ago and took all the earth to the valley floor, which is now where a crystal clear blue-green stream, teeming with rainbow trout, springs forth from the base of the granite Massives that are the Alps. This spectacular landscape is where I came from. It is almost exactly in the center of Austria and was recently voted as the most beautiful spot in Austria. One of my recent books, Tales from my Home Town, contrasts the natural beauty of this valley to the political turmoil of the Second World War when I was born, available on Amazon.com.
Who do you think has the higher IQ, the black man on the left or the white man on the right? Race has been said to have an influence on intelligence. Before it was considered racist, race was often claimed to be a factor in the calculations of IQ. Ashkenazi Jews are reportedly the highest IQ subgroup among Caucasians. While IQ scores of Caucasians vs. Asians are very similar, but Asians universally outperform Caucasians in grade point averages and SAT’s. Is that because Asians have a higher IQ or because their parents push them harder in school? Caribbean blacks are one-third more likely to graduate from college than African-Americans as a whole, and their median household income is also one-third higher.
I have always been fascinated with intelligence. In German academic parlance, the highest title you can achieve is “Herr Professor Doctor so and so,” for example, Herr Professor Doctor Sigmund Freud or Herr Professor Doctor Albert Einstein. Neither of these gentlemen ever took an IQ test in their life, but from their sum total intellectual output, it has been claimed that Einstein’s IQ was 160 and Freud’s was 156. Both scores are well above the level of genius. I, too, achieved that German title of Professor and Doctor, so I would assume my IQ is similar. Unfortunately, when I was in eighth grade, I happened to be in the Principal’s office at the time the Stanford Benet IQ test we took came back. I snuck a peek at mine. Although I was well above average, I was still disappointed as it was not as high as I think it should have been, given my German academic title, which I eventually did attain, my life’s achievements, my net worth, my output of both scientific and non-scientific literature and my self-assessment as an intelligent human being.
I have seriously questioned the tests that claim to measure your intelligence. Much of the content of these tests look at learned knowledge, obviously an environmental trait and ability, to figure out problems, especially pertaining to finding patterns in language, math, and design, often adding another factor of how quickly you can do it, all more likely to be a genetic trait. Having been rather slow in those traits, I attribute my disappointing IQ score to that.
Some people are smarter in math, while others have a way with words, an artistic bent, or a natural ear for music. Some of us just know how to dance or throw a ball while others look like they behave very uncoordinated on the dance floor or couldn’t hit a ball with a baseball bat if their life depended on it. Howard Gardner, a Harvard Professor, claimed in his book, Multiple Intelligences, that there are nine divisions of intelligence. He has a point.
I have always considered bees to be the smartest insect. By indirect measures of looking at their ability to navigate by the sun, gather honey, transmit knowledge through very sophisticated dance moves, I would have placed their IQ at genius level. It came as a shock to me that most of the insects that drown in my pool are bees, not as smart as I thought. Perhaps there is a separate intelligence for gathering honey.
My own theory of intelligence is that the mind is compartmentalized into more than Freud’s superego, ego, and id, but there is a chessboard, a physics black board, a music chamber, a cooking nook, a surgeon’s operating room, a tailor’s quarters, an author’s writing desk, a linguist that speaks only cat or dog, etc. etc. The trick is to find the space to which each of us has been assigned and live our lives accordingly.
There is an informal survival rule amongst surgical residents passed from one generation to the next:
- Eat when you can
- Sleep when there is an opportunity
- Above all, never fool (polite form) with the pancreas
None of the greats, including Halsted, touched the pancreas. But one man did.
Allen Oldfather Whipple reported a two-stage operation for pancreatic cancer to remove the head of the pancreas in 1936, which evolved into a one-stage operation, and is essentially the same now as it was nearly 90 years ago. Pancreatic cancer is difficult to diagnose as the organ is so sheltered in the back of the abdominal cavity. It remains perhaps one of the most difficult of operations. Only 1 in 5 fortunate patients is a candidate for this major operation. It takes most surgeons that are capable of doing it, five to eight hours to accomplish it, and still has higher operative mortality than most operations, namely 2-3%. It also has a complication risk of a disappointing 30 to 40%, with a rather dismal prognosis of 20% five-year survival, making pancreatic cancers one of the most feared of all cancers.
Whipple gets all the credit, and indeed, he deserves a good bit of it, but history has a way of eventually recording what really happened. There was, however, a predecessor to Whipple. Walther Carl Eduard Kausch (1867-1928), another one of Jan Mikulicz-Radecki trainees and also son-in-law, had come up with a very similar operation in 1909, some 27 years before Whipple. His original drawing demonstrates the concept.
The operation used to be called by both names: Kausch-Whipple Pancreaticoduodenectomy, but like so many things got abbreviated to just Whipple.
KARL LANDSTEINER 1868-1943
Blood transfusions are described in the Old Testament and are the basis for prohibitions against “partaking” of someone else’s blood by some religions. Some accounts of ancient Egyptians using reeds to transfuse animal blood were not successful. The famed architect of St. Paul’s Cathedral in London, Sir Christopher Wren, described injections of blood intravenously to the Royal Society. Robert Boyle (of Boyle’s law, P ∝ 1/V) reported arterial to vein transfusion. But all of these early attempts failed to recognize that blood from an animal source, and even blood from a human source, was not in the best interest of the patient, because of the antibody-antigen phenomenon that was yet to be discovered. That would be the contribution of the Austrian pathologist, Karl Landsteiner, honored on the 1000 Shilling note, the last currency that Austria printed, before converting to the Euro. He identified that serum of some people agglutinated the red cells of other people, and from that followed the three blood types A, B, and O (the universal donor). One year later he found the rarer 4th blood type, AB (the universal recipient), which garnered him a Nobel Prize for Medicine in 1930. Without that knowledge, blood transfusions more likely harmed and even killed the recipient most of the time.
All the major operations we now do depend on the technology of typing, and crossmatching, donor blood to the recipient. Landsteiner gave the surgeon the ability to replace blood lost during surgical procedures. His other achievements were isolating the Poliovirus, as well as the first to culture Rickettsia prowazekii, the causative agent of typhus. He also identified the other blood factors, the minor blood types M, N, and P used in paternity identification, and in 1940 the Rh Factor, which led to the subsequent discovery of hemolytic disease of the newborn (HDN) by others. He discovered the dark field identification of syphilis. He came to the US in 1923 and accepted a post at the Rockefeller Institute in New York. He achieved Emeritus Professor status but continued working. He had a heart attack in his lab, with a pipette in hand, and died two days after that in 1943.
In 1894 the French President Marie François Said Carnot was assassinated in the streets of Paris. At surgery, the surgeon found that the portal vein was severed, an injury that was not deemed survivable in the late 19th century.
A young surgical resident studying in Paris at that time was greatly influenced by that event and set his mind thinking about how to repair arteries and veins. That man’s name was Alexis Carrel.
He copied a triangulation technique he had learned from an embroideress. It worked in the lab, and subsequently in the operating room, a feat that won him the Nobel Prize in medicine in 1912, eighteen years after that fateful assassination, and set the path for a new surgical specialty, vascular surgery.
World War I, from 1914 to 1918, known then as “the war to end all wars” was a killing factory. Twenty-three million military and seventeen million civilians died in that conflict, making it among the deadliest of human conflagrations, just the perfect situation that in the past has always made for surgical advances, having a large laboratory at one’s disposal. Carrel was a busy surgeon while also developing his surgical talents. But wound care was still in need of improvement. Carrel worked with an English chemist, Henry Drysdale Dakin, to create an improved and safe antiseptic solution, the Carrel-Dakin Solution, still in use today. Again, if you wish to be historically accurate in writing wound dressing orders, you should write for Carrel-Dakin Solution, and not just Dakin Solution. Carrel was also involved with inventing the very first ventricular assist pump. He associated with an inventor from a totally different field, aviator Charles Lindberg, to bring it into reality. The two became lifelong friends and even lived on adjoining islands in the Atlantic.
Carrel was a very religious man and became an alleged witness to a Lourdes miracle. This cast a shadow on his scientific credentials, and he could not get a hospital appointment. Alexis left France and got a research appointment at the Rockefeller Institute. He conducted experiments in cellular senescence, and was able to keep chicken cells alive for twenty years, much longer than the lifespan of a chicken. Some of his other ideas were not PC, especially in the realm of improvement of the human species. His support of the eugenics policies of the Vichy government, a Nazi puppet government of France during World War II, caused him to be named a Nazi collaborator but he died before his trial.
ERNST SAUERBRUCH 1875-1951
Sauerbruch was the protégé of Jan Mikulicz-Radecki. He was most interested in thoracic surgery and developed a negative pressure chamber with Mikulicz where the patient’s head was outside of the chamber, and the rest of the patient was inside the chamber with the surgeons. This allowed the chest to be opened with the continuous oxygenation of the lungs. His most favorite, and talented student, Rudolph Nissen, used it to perform the first successful pneumonectomy in 1931. Sauerbruch knew Hitler, and even treated him as a patient, commenting that he had “the potential to become the most insane criminal in the world.” Truer words have never been spoken!
Sauerbruch was the most known surgeon in Germany, at the time, and tried his best to avoid the political turmoil.
He managed to help several of his Jewish friends to escape Germany, including Rudoph Nissen, who went to Turkey, by way of Switzerland, with his family.
Among Sauerbruch’s surgical achievements were the sensational plication of a large cardiac aneurysm, also esophageal surgery, as well as inventing several instruments related to thoracic surgery.
EVARTS GRAHM 1883 – 1957
Graham is credited with the first pneumonectomy done in the United States for cancer of the lung in 1933. Dr Grahm and Dr. Cole were co-originators of the oral cholecystogram (Graham-Cole test). Iopanoic acid is administered orally, absorbed by the intestine, and excreted by the liver, and concentrated in the gall bladder, just like bile. If the gall bladder did not visualize it was evidence of a diseased gall bladder, and a reason to do a cholecystectomy, of course currently superseded by the gall bladder ultrasound. Dating myself, Dr. Waren Cole was still the Dean of the University of Illinois Medical School when I entered that institute in 1963.
Graham was a co-founder of the American Board of Surgery and edited several journals in thoracic as well as general surgery. I recall as a teenager going to medical meetings with my father, where the room was dense with smoke, as most doctors smoked at that time. In 1950 Evarts Ambrose Graham and Ernst Wynder published a large study in the Journal of the American Medical Association (JAMA) linking cigarette smoking to lung cancer. This convinced him, and many other doctors, including my father, to quit smoking. Alas, it was too late for Dr. Graham, he died of lung cancer in 1957. Ironically, Dr. James Lee Gilmore, Graham’s first pneumonectomy patient in the US done for cancer (Nissen’s operation was for infection) outlived him.
The Improper Bostonian, ERNEST A. CODMAN
He was a surgeon, and like all humans made mistakes, but unlike most, he made it his life’s mission to continually evaluate what he called “The End Result.” He followed every patient on whom he operated for at least a year postoperatively and recorded important events in their course of recovery on a 3 x 5 card. Why was he considered “improper” then? He insisted that all errors be reported, studied, presented, and become lessons from which we can benefit. Most of us find that painful, especially when we are discussing our own mistakes. But as it turns out, it is the best way to learn how not to make that mistake again.
He was the originator of the Morbidity and Mortality Conference (M&M), which is now incorporated into every teaching hospital’s weekly conference. In 1914 Massachusetts General Hospital turned down his plan for evaluating a surgeon’s competence, and they took away his hospital privileges. His response was to open his own hospital, the “End Result Hospital.” He helped to lead the founding of the American College of Surgeons and the Hospital Standardization Program, which eventually evolve into the Joint Commission on Accreditation of Healthcare Organizations.
A review of complications is so essential for learning that it is demanded by the reviewing organization of residency programs, and is immune from legal scrutiny. It must, therefore, be held outside of the public domain as a strictly “professionals only” conference. Without the M&M we would be half the surgeons we are.
LUISA GARRETT ANDERSON & FLORA MURRAY
These women physicians completed their medical education before World War I. Six weeks after Britain entered the war in 1914, the two women doctors were on their way to Paris to assist in the care of the wounded. They were immediately very busy taking care of the injured. The volume, however, was so overwhelming that the RAMC (Royal Army Medical Core) offered the two women a 1000 bed hospital, but back in London, which they accepted. The Endell Street Military Hospital in London was staffed entirely by women. The initial response of the all-male soldiers was to ask for a transfer to another hospital.
By the time the men were to be moved, to a man, they all refused, preferring to stay where they were. The female physicians broke the taboo of only men caring for injured male soldiers and proved themselves the equivalent of the male physicians. It also propelled the medical profession into accepting more women into medical schools and subsequent further training. This was all before women got the vote! It was a significant advance for the equality of women.
HARVEY WILLIAM CUSHING 1869-1939
Harvey Cushing did a surgery residency with William Halsted. He also spent time with Theodor Emil Kocher, where he described what is called the Cushing reflex, which occurs when raising levels of pressure intracranially, the heart slows down, and blood pressure increases. Cushing introduced the recording of blood pressure using a device called the sphygmomanometer, which he brought back from Italy, and added it to the routine vital signs. He was the first o describe an adenoma of the pituitary that stimulated the adrenal gland to produce cortisol, Cushing’s Disease. During World War I, Cushing developed an extraction technique for removing metal foreign bodies from the brain using a magnet. Cushing attended Lieutenant Edward Revere Osler, the son of Sir William Osler, who was mortally wounded in the third battle of Ypres, Belgium. Later Cushing wrote a Pulitzer Prize- winning book, Life of Sir William Osler. Cushing was also the first to use and later popularize the Bovie Electrocautery.
William Bovie was a Ph.D. of plant physiology at the University of Michigan when he worked on his invention of an electrocautery that could cut and cauterize. “The Bovie” is an instrument now present in every operating room.
Without it, surgery would be back in the Halsted days, tying every capillary. You will note the colors of all Bovies, blue and yellow, the colors of the University of Michigan.
I often think of my hometown, Hinterstoder, Austria. It is an idyllic spot; a U-shaped valley carved out by two glacial episodes. The last one ended 11,000 years ago. It left the valley with two levels. The older glacial episode left a terrace two to three hundred feet higher than the more recent one. The lower level is now where a crystal clear blue-green alpine stream, teeming with rainbow trout, winds its way through the valley, eventually flowing into the Danube. That stream bubbles forth from the base of the mountains that are located toward the bottom of the U in the U-shaped valley. I dream of all the beauty that is displayed there, but I also think of the evils that echo from the granite walls that National Socialism wrought there.
My parents left Romania in 1941, escaping the wrath of Joseph Stalin, another Socialist. He was a Marxist Socialist, but just as homicidal as Hitler was, if not worse. Stalin’s goons had killed my uncle, my mother’s brother, Polka Dowhanczuk, for the sin of being from the wealthy class. He had inherited large beef ranches which had supplied England with meat prior to the war, and also owned some oil wells in a town 50 miles north of Bucharest, named Ploieşti, a Renaissance city dating back to the 15th century. Being rich was enough to get a bullet in your head in that Socialist country. When the Soviets discovered that my parents had escaped their clutches, they found the closest relatives that they could punish for my parents’ political thought crimes. That fell on my paternal grandmother who was shipped off to a Gulag in Siberia, where she amazingly survived for ten years. With Khrushchev’s “de-Stalinization,” she was released to rejoin her family in Bucharest. My father spent many a sleepless night thinking of this unjust tragedy, but going back would have brought him and my mother to the end of a rope, and you would have been deprived of reading this tale.
I was born in Nazi Germany, the only country that at that moment was not going to kill my mother and my father, who had to hide his Jewish ancestry for obvious reasons. Even the good old USA would have turned my father over to Uncle Joe (Roosevelt’s name for Joseph Stalin) at that time when the USA and the USSR were still friends. I grew up in the beautiful little town, to which my father had been assigned as the town doctor. I started school there, served as an altar boy in the church that dates back to 1740, hiked in the mountains, and even picked the elusive Edelweiss flower that was protected by law, and always grew just over the cliff.
Socialism, whether Marxist, Nationalist, or Democratic, is control of the means of production of goods and control of the distribution of those goods. This is the economists’ definition of Socialism for those of you from Peoria. For Socialism to work, it also requires control of the entire economy, education, justice system, and culture. It, by the way, is a common error made by the unsophisticated that social welfare is a product of Socialism. That was Otto von Bismarck’s creation, the ultra-conservative right-wing Chancellor of Germany from 1871 to 1890 if you read your history, and Bismarck created the first welfare programs, including for health, old age, and worker disability long before the first Socialist country ever came into existence!
Socialism, on the other hand, is not social welfare. Socialism is an economic system where the state controls the productions of goods and their distribution. Social welfare, although a function of government, is not a product of Socialism. It exists in all countries and all economic systems, whether Capitalist, Socialist, or Communist. Social welfare is not the problem. Its generosity depends on the country’s wealth, its moral sense, and its tax structure. Socialism’s flaw is that the individual has few if any rights, in addition to no rights to own the means of production and distribution. Our Bill of Rights gives us an immediate standing before the courts unlike in Socialism, where the rights emanate from hierarchical Top-Down regulation of society. So strange things happen. Show trials already have the verdict ahead of the trial. In fact, trials are not even necessary, just the edict from above. Six million Jews had to be gassed to death. Eleven million Ukrainian Farmers had to be starved to death. Even what books, movies, poetry, or art you are allowed to see or read needs to be controlled to protect you from degenerate thinking. We already see this in our own “trained Marxists.” AOC tells us that if you have the incorrect political thinking in your mind, and have been an enabler of the wrong politics, you shall be placed on a list to be dealt with accordingly in the future. The Democratic Socialists think just like all the other Socialists. We will tell you what and how to think, a little clue that Maoist style re-education camps are coming.
In the National Socialistic public health system, any mental disability was also seen as heritable, and in order to purify the race, those genes needed to be erased. In my hometown, the “Bürgermeister’s” (Mayor) son had mild cerebral palsy. This is caused by a birth accident where the brain is deprived of oxygen for variable periods during the birthing process and has nothing to do with inheritance. The son was fully functional, in fact, he was quite an artist, as can be seen in two paintings right and left that his sister preserved. His sister was, by the way, my third-grade teacher who made the paintings part of her teaching curriculum. Despite that his father was the Mayor of the town, the Nazi’s “euthanized” his son with intravenous gasoline, a family tragedy.
The town saw more than one family tragedy. Both world wars decimated numerous families. My father, who was the town doctor during World War II, was also the one whose job was to bring the death notice for any soldier killed to the family. One of those was the Sturm Family. The son was killed on the Russian front and returned to his hometown in a body bag. At his funeral procession to the burial site, his sister remarked that she would rather walk behind Adolf Hitler’s coffin than her brother, a statement reported to the SS almost immediately. The arrest followed the burial. It was my father’s intervention with the SS that saved her life. He announced to the SS Commander that the girl was schizophrenic and under his treatment, an untrue statement. By that time, the euthanasia measures against psychiatric illnesses had been rescinded. She was released to his care.
This allows me to segue into the next tragic affair. On August 3, 1942, Bishop Clement August von Galen of Münster, Germany, preached a sermon that condemned the racial purifications and euthanasias as not in line with the church’s teaching. A group of aristocrats joined his warning and demanded that Hitler stop them. Among the petitioners was a very influential man, the Duke of Eulenburg, who happened to be our landlord in Hinterstoder. Hitler did stop the murders, but the Duke of Eulenburg came to his attention and into his sights. In retribution, Hitler ordered the Duke’s son to be transferred to a tank battalion that had the highest mortality of all of Rommel’s divisions, as they were in constant savage firefights against crack Russian tank divisions. Additionally, the Duke’s niece had been involved with an anti-Nazi group called the Red Chapel (Rote Kapelle) that passed out anti-Nazi pamphlets. She was arrested and, shortly after that, executed by decapitation. The family was not allowed to claim the body as it was shipped to Vienna to serve as a model for anatomic drawings in an anatomy atlas, the use of which continues to generate controversy even today. “Libertas” was her name.
So you see why I have personal reasons to abhor Socialism and Socialists regardless of their flavor, and cannot understand the lack of comprehension of people who ignore history, along with the crimes and horrors Socialists have committed, and the long list of all the failed Socialist governments that have imploded. I am also appalled by people’s lack of education as to what Socialism is. Even though Socialism and social welfare have the same root word in them, there is a vast difference between them. It is as if they never looked at a dictionary. As Shakespeare said,” A Rose by any other name would smell as sweet.” To me, Democratic Socialism smells, but not anywhere as sweet!
The meaning of Socialism is difficult to wrap your mind around. There are several ideologies at the table that all point fingers at each other and say, “we are the only real Socialists.” All those others are just not the real version. So, what is real Socialism?
The definitions are constantly evolving. It comes to self-definition and each denies being related to the others. But they all reject Capitalism. The French philosopher Henri de Saint-Simon coined the word “Socialism” in the 1800s. His followers took his ideas to develop the Socialist playbook. He did not shun private property, but did not see it as a necessity, and did see private property as a negative, especially when it was passed on as in inheritance. He felt that economic policy needed to be organized through central totalitarian control, influenced by technocratic scientists and the needs of industrialization.
Karl Marx (1818-1883) added the class struggle to the mix. He saw class as an evil that needed to be eradicated. Marx and Friedrich Engels developed their own “Scientific Socialism” in contradistinction to the earlier socialists who Marx called the “Utopian Socialists.” Marx saw Socialism as an intermediary economy between decadent Capitalism and fully evolved Communism with the state owning the means of production and distribution. He saw it as the final stage when the state would wither, and classes would disappear. The workers would administer the economy. As it turns out workers could not administer the economy because they did not have the knowledge nor the ability to do so. The state instead of withering just got stronger. It required another layer of bureaucrats run to the country. This evolved into what is called Marxist-Leninist Socialism.
There has been much written that National Socialists (Nazis) are not Socialists. Among the various arguments are that the Nazis imprisoned and killed Marxist Socialists. Nazi’s were far-right wing Fascists and could not also be Socialists. But in fact they called themselves National Socialists not because they liked the name. Hitler, himself, said in Das Zweite Buch, “I am a Socialist!” Although they did not own the means of production which remained nominally in the hands of the industrialists of Germany, the state certainly controlled industry completely. So it didn’t matter whose name was on the ownership papers. The Nazis also created the huge public works projects such as the Autoban, and they also took over health care. They put Germany under full employment, and funded major building projects with public funds. The intellectual foundations of the National Socialistic economy were based on writings by philosophers such as Friedrich Nietzsche (1844-1900), and Oswald Spengler ( 1880-1936), who by happenstance lived and wrote his major work, The Decline of the West, in my hometown of Hinterstoder, Austria, giving me a closer understanding of his thoughts. He coined a new term that connected the state to the individual – the Volksgemeinshaft – the common ownership by the people and the state, sounds like a euphemism for Socialism to me. The control of industry, the collectivization of healthcare, education, and transportation, the anti-capitalist stance, autocratic hierarchical management, and the states control of the economy makes Nazis at least a close relative of Socialism justifying their chosen name, National Socialists. If it looks like a duck, swims like a duck, and quacks like a duck, it is a duck.
The latest version is Democratic Socialism promoted by Bernie Sanders and Alexandria Ocasio-Cortez, yet another version of the ownership of the means of production. Just like the Nazis they too have a different interpretation of who should control the means of production – the workers and consumers should share ownership and control, they say. Workers in control didn’t work out so well for Marx and Engels. Adding consumers to the mix is really going to help! Or should I rewrite that sentence: Adding consumers to the mix is going to help – really?
The definitions get more complicated but the unifying philosophy of all the Socialists is that they promote Top-Down management of society’s answers to the problems, unlike what the Free Market offers – Bottom-Up solutions. All forms of Socialism are Top-Down management, and all Capitalism is Bottom-Up management. Therein lies the flaw. The Capitalistic dairy farmer knows how many cows he needs, and if the market changes he adapts quickly. The neighboring town’s dairy has gone out of business and now they need to buy milk from our Capitalist dairy farmer. He gets five more cows and milking machines almost overnight, hires two new milk maids and is all set for the new circumstances. The same situation in the Socialist dairy farm requires the farmer to appeal to the central committee to first of all allow him to exceed his quota, then to give him more cows and milk maids. The committee sends an inspector with a clipboard and a calculator (technocratic science) who makes recommendations to the central committee on the number of cows to give him. Top-Down requires multiple steps and therefore is slow and months pass. He finally gets one new cow and one milkmaid, but the farmer does not care because he never did want to do all the additional work of procuring feed and feeding five more cows anyway. The Capitalist dairy farmer does not produce milk because in his altruism realizes that milk is a necessary food for people, but because the more milk he sells the more profitable it is, and the sooner the better for him. While the Socialist dairy farmer could not care less. The milk is sold but the profits go to the state which then pays the dairy farmer according to his needs. There is very little in it for the Socialist dairy farmer if he gets five new cows. The principle is the same regardless if it is a dairy farm, an auto repair shop, or a medical clinic. People in the next town will just have to do with less milk, and get on a list to get their car fixed. And like in Canada with Socialized Medicine, people get on a list and get a cane , usually having to wait at least a year before they get a total hip or knee replacement, or they come across the border and get it in a few days if they can afford to do so. A Canadian friend of mine wanted a CT scan for his severe headaches. The average wait time in Manitoba for CT scans is 31 weeks. He explained to the keeper of the list that he was afraid that he had a brain tumor, and in 31 weeks he might be dead. The answer he got, “Well then you will not need the brain scan, and we will just cross you off the list.”
Central planning failed Marxist Communism and also National Socialism. Will it work in Democratic Socialism? Einstein’s famous quote seems to apply here: “ The definition of insanity is when you ask the same question but expect a different answer.”
It is difficult to define the start of modernity in surgery. We truly built upon the past, but so many of those “older procedures” are still being done in pretty much the same way, even if we use more modern instruments to do them. A hernia is the done using Cooper’s and Poupart’s ligaments, even if the needle is held by a robotic arm using, not only the same anatomy, but the same principles. I chose the beginning of the modern era to be when Madam Sklodowska Curie introduced a new form of energy to us. Not only did she discover two elements that emit radiation, Radium, and Polonium, but she coined the word “radioactivity.” Polonium was named by her, in honor of her country of origin, Poland.
Above she is at the table with most of the physicists that contributed to our current knowledge of the atom. Rutherford, the tall man right behind her on the right, is the man that gave us the standard model of the atomic structure, with a central nucleus, and orbiting cloud of electrons. The second from the right is Albert Einstein. Albert said of her that she is the
only human he knew that was not corrupted by money, fame, or glory. She is the first woman to win, not one, but two Nobel prizes, one for physics and one for chemistry. She gave most of the prize money (not an inconsequential amount) away to associates for research. She even returned the scholarship money to Poland, which she received as a young girl to go study in Paris. The remainder went to the founding of the Curie Institute. During World War I she developed a fleet of mobile X-ray trucks that she, and fellow Red Cross volunteers, had to drive into the battlefield,
risking her own life, picking up injured soldiers, and X-ray the injuries, before delivering the soldiers to the surgery tent to have the shrapnel fragments removed by the surgeon. She was the first to suggest that radiation should be used to treat malignancies, and for the sterilization of instruments. Even though she was not a physician, her contributions to medicine and surgery were monumental, which included the ultimate sacrifice. From the constant radiation exposure which she received from the strong radioactive emitting materials, her bone marrow was destroyed, and she died at age 67 from the ravages of aplastic anemia.
Theodor Emil Kocher
He was a Langenbeck, Virchow, and Billroth protégé, a Swiss surgeon who brought many innovations to surgery. Through personal correspondence with Lister, Kocher became a disciple of asepsis. Every infection that occurred, he meticulously looked for the reason, and his assistants were called to task. He gave us sterile catgut, and a method for relocating shoulders, but he is most remembered for his work in thyroid surgery. Even his mentor, Billroth, gave up thyroid surgery because of the very high mortality of 75%. Kocher reduced this to 0.5%, which he achieved in his 5,000 thyroidectomies (one of whom was Lenin’s wife). He still had a high incidence of hypothyroidism, but on Virchow’s suggestion, he started to leave the posterior capsule with a little bit of thyroid tissue in place, along with at least one parathyroid gland, and had outstanding results with no cretinism, and no hypocalcemia. Kocher is given credit for many eponyms:
- Kocher Clamp- used in practically all open cases
- Kocher Maneuver- to reduce a dislocated shoulder
- Kocher Incision (neck )- exposure of the thyroid
- Kocher Incision (subcostal)- exposure for open cholecystectomy
- Kocher Sign- the exophthalmos of hyperthyroidism
- Kocher Reflex- the contracting of abdominal musculature upon squeezing the testicle
- Kocherizaton- the mobilization of the duodenum
- Kocher’s Vein- the middle thyroid vein
Among his most famous students were Harvey Cushing, father of modern neurosurgery, William Halsted, father of surgical training in the USA, and Fritz de Quervain of tenosynovitis fame. Kocher received the 1909 Nobel prize for his work on the thyroid, and his discovery of the replacement of lack of thyroid hormone, with oral preparations derived from animal thyroid tissue.
Kocher is doing a thyroidectomy with Halsted assisting (Hallsted is marked with the black arrow opposite Kocher).
ERNST von BERGMANN 1836-1907
The first surgeon to introduce heat sterilization was the successor of Langenbeck at Charité (Hospital) in Berlin. He invented a steam sterilizer that was under pressure to increase the temperature. One of his senior residents, Curt Schimmelbusch, developed a drum that fits in the sterilizer and could be packed with linens, operating room gowns, assorted dressing material, and instruments. After allowing the sterilizer to cool down the drum could be removed, and placed directly on the back table.
The painting commissioned by Bergmann demonstrates the Schimmelbusch drum on the back table. This painting was stolen by Herman Göring during World War II and has not been seen again.
We owe the use of the surgical mask to Paul Berger, a French surgeon, who introduced the forequarter amputation. In 1899 he wrote: “For several years I have been worried as to the part that drops of liquid projected from the mouth of the operator, or his assistants, may exercise on the outbreaks of infection…” He put on the mask, which was ridiculed at first, but when the eminent Professor Jan Mikulicz-Radecki had a very similar publication with the same recommendation, it caught on and has been with us ever since, now even protecting the general public from giving and getting virus infections.
Edoardo Bassini was severely wounded in the battle for Rome, in 1867, under King Victor Emanuel.
He took the opportunity to become a surgeon during his recovery. He studied with Langenbeck, Lister, and Billroth, eventually becoming Chair of Surgery at the University of Padua. The Bassini operation for groin hernia is the prototype for all inguinal hernia operations. After the hernia sack is amputated, the conjoined tendon (known by other names: the conjoined aponeurosis of the internal oblique and transversus muscle or the falx inguinalis) is sutured to the inguinal ligament, closing the weak inguinal floor through which the hernia protruded. The cord is replaced in its anatomic position, and the external oblique muscle is closed over it.
Chester Mc Vay, an anatomy professor at the University of South Dakota in Yankton, South Dakota (my best friend’s anatomy professor), developed the Mc Vay repair using the conjoined tendon to Cooper’s ligament, converting to Poupart’s ligament at the neurovascular bundle.
This would be the appropriate place to discuss the other classic hernia repairs, even though it is out of order historically.
Shouldice from Canada developed the multiple layer imbrication with the continuous “silver thread,” and avoidance of mesh that has a worldwide reputation for a less than 1% recurrence rate. Lichtenstein developed the tension-free repair, which is basically a Bassini with mesh, connecting the inguinal ligament to the conjoined tendon.
Having done them all, and a few more (Stoppa, Kugel, darn, plug, etc.), I prefer the robotic retroperitoneal repair of closing the defect in the transversalis fascia, a structure I didn’t believe existed before seeing it from the peritoneal side, and reinforcing the repair with mesh.
Frederick Treves was a noted English surgeon, known for his ability to remove the appendix, for which he was well rewarded. His book on Intestinal Obstruction is a noted classic. Ironically his daughter succumbed to the disease, as well as he when he was age 70. Edward VII, the eldest son of Queen Victoria, got appendicitis before he was to be crowned king. He would not permit the operation, became steadily worse, and finally, the appendix ruptured. The abscess was palpable on the exam. Treves told the “King to Be” that if he continued to refuse the operation, there would a funeral instead of a coronation. Edward relented, and the reception salon at Buckingham Palace was readied for surgery. Treves, wisely, asked Lord Lister to consult, which he did, bringing one of his phenol atomizers from Edinburgh.
Treves did just drainage of the abscess that, by now, was pointing on the abdomen. As soon as the pus was released, Edward felt better. The next day he was sitting up in bed, smoking his favorite cigar. The coronation took place with only a minor delay, and Treves was made a Baron.
Treves befriended the so-called “Elephant Man,” Joseph Mereck. Joseph, whom he happened upon, displayed and exploited in a freak-show when Treves rescued him, and brought Mereck to his hospital in London.
It is now known as the Royal London Hospital, where Mereck spent the rest of his life. He was mistakenly thought to have an illness designated as von Recklinghausen’s disease, multiple neurofibromatosis, but in fact, it was a disease called Proteus Syndrome, an even rarer genetic disorder of uncontrolled growth of all three embryonic germ layers.
William Stewart Halsted Father of American Surgery
Halsted went to Yale, and Columbia, but had a lackluster performance until his internship at Bellevue, when he started to excel. He recognized that critical data needs to be readily available at the bedside. As an intern, he created the bedside chart for vital signs and fluid balance.
In 1878 Halsted traveled to the hollowed surgical halls of excellence in Vienna, Padua, Berlin, and Basel, to study, and learn from the icons of surgery, that included a list of surgical giants: Billroth, Esmarch, Mikulicz, Bassini, Bergmann, Chiari, Kocher, Zuckerkandl, Volkmann, and Wölfler. He came back to the US about two years later and duplicated the European method of teaching surgeons to operate.
In 1882 he performed one of the first cholecystectomies in the US on his own mother, reportedly on the kitchen table at 2 AM, and he also did the first transfusion of blood to his own sister, which saved her life. He taught many department heads, and surgeons, who became professors of surgery, such as Harvey Cushing, founder of neurosurgery, and Hugh Young, founder of urology. He was amongst the originators of Johns Hopkins Hospital, and subsequent world-class residency programs, along with William Osler.
An Austrian ophthalmologist published the use of cocaine for anesthesia in eye surgery, which Halsted emulated, and used on his patients. Unfortunately, he experimented with it on himself and his students. This led to a fierce addiction to the drug! His friends saw this disaster unfolding in front of them, and had several interventions that eventually got him off the cocaine, by using morphine, touted to cure a variety of addictions. Neither cocaine nor morphine was illegal at the time. He never got off the morphine, using up to 200 mg a day, until he died at age 70 after complications from gall bladder surgery. Despite his addiction, he continued to function as a surgeon, teacher, and innovator of surgical techniques. His principles of surgery are still applicable today:
- Handle tissue gently
- Maintain meticulous hemostasis
- Observe strict asepsis
- Minimized tissue tension
- Appose tissue accurately
- Preserve blood supply
- Eliminate dead space
Halsted introduced the radical mastectomy, which was the standard treatment for breast cancer for 100 years. When his scrub nurse developed a terrible rash on her hands, secondary to the carbolic acid they all used, he came up with the thin rubber gloves we now all use. She eventually became Mrs. Halsted.
Richard Hall was a friend, and colleague, of William Halsted. Richard came to the US from Ireland, with his family, when he was 12 years old. Hall went to school at Princeton and got his medical degree from the New York College of Physicians and Surgeons. He married into a very prominent Bostonian family, and he and his wife went to Europe for a year, where he studied at the major European medical centers.
Returning to the US in 1880, he and Halsted, became acquainted with the new drug used for local anesthesia, Cocaine. Unfortunately, both he, and Halsted, could not resist trying it out on themselves to determine the proper dosage for local, and regional, anesthesia, and both developed serious addiction problems. In 1886, Hall performed the first successful appendectomy in the US despite his drug problem, three years before Charles McBurney presented his report on operative management of appendicitis to the New York Surgical Society. Halsted continued to become a highly distinguished surgeon, and teacher, but never was able to escape his addiction problems. Hall moved to California in an attempt to rid himself of the drug’s clutches, a feat he finally accomplished. In 1889 he came to Santa Barbara, which did not have a hospital until 1891. Hall became the chief surgeon at the new hospital. In 1896 he introduced the X-ray machine at Cottage Hospital, but in 1897, by a cruel twist of fate, the man that had done the first appendectomy in the US died of a ruptured appendix.