American College of Surgeons - Yearbook (Chicago, IL)

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8 American College of Surgeons surgical specialists to define a standard of excellence and arbitrarily to select eighty or one hundred men on the continent who will qualify for membership. Such societies are usually social as well as scientific; and they are of vast benefit to the progress of medicine, for they aid in distributing new and higher ideals of attainment. Their object is to advance some particular specialty of surgery to its highest excellence There are already in existence one or two such societies for each branch of surgery that is recognized by the American College of Surgeons. The American College of Surgeons, in contrast to these socie- ties, is a democratic and inclusive organization. It is not only interested in the advancement of some branch of surgery, but of every branch of surgery. Its special task is to insist that surgery wherever practiced on this continent shall be under the surveil- lance of an organization which is strong enough in its moral repu- tation, and strong enough in its influence upon society, to render impossible the practice of surgery on the part of men who are not educationally, scientifically, and morally equipped to do the work. Its task is to provide the pubHc with honest, competent service. . . . The first step forward was, obviously, to determine upon a standard of moral and scientific excellence for admission to Fellow- ship. Years of experience are essential to anything hke a final analysis in this matter. But we know that any right standard must command the respect of the profession at large and the con- fidence of laymen. Of necessity, we must look into the moral and intellectual soundness of each candidate. This means that we must estimate the value of the candidate ' s educational opportun- ities, as determined especially by the medical school from which he graduated. We must estimate the practical hospital training that he received, the assistantship which he served in the art and science of surgery, the value involved in the hcense which he has acquired to legalize his practice, and his actual performance as an independ- ent practitioner of surgery. Of great importance also is a knowl- edge of the methods of the hospital and of laboratory environment wherein his work is done. . . . Conscientious work as an official or a committeeman of the College soon convinces one that there is no concerted action on the part of the medical societies, medical schools, hospitals, or legisla- tures in the direction of making safe and experienced surgeons out

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Further Advance of Surgery 7 stand. These pamphlets will deal one after another with the things which make hospitals the right sort of institutions for the care of sick people. Sometimes it may be necessary to call meetings of the local commercial clubs, or of other bodies of laymen, in order to waken up the community as to the actual conditions in their hospitals. If this course is necessary, it will be followed. The day has gone by when any sort of indifferent or incompetent prac- tice can be shielded in a hospital. The day has gone by when hospital trustees may rest in an irresponsible attitude toward the trust imposed in them. Again, what is the relation of the hospital to the county or local medical society? Are the facilities of the hospital freely at the service of the society? Is the spirit which domin ates the work of the hospital an inspiration? Is it progressive and unselfish? These are merely some of the questions which the College of Sur- geons proposes to answer in the fashion already indicated. It is probable that we shall begin with a study of the training of the internes. This problem is most closely related to our needs in the administration of the College. Further, if we go right to the bottom of the problem we shall find that it is really a question of what is the proper care of the patient. A full outline of this prob- lem has already been sent to you. FURTHER ADVANCE OF SURGERY The investigation of hospitals offers one of the chief avenues of contact between the College on the one hand and the medical pro- fession and the general public on the other. Through these studies, further, the College seeks to inspire real headway toward better surgery. But the Regents are not content to rest their efforts in this single field. The following paragraphs from the re- port of the General Secretary to the Fellows, October 27, 1916, are self-explanatory in this matter, — At all times in the administration of their trust the Regents have these questions to answer: (i) What is a genuine standard of good surgery? (2) How may we recognize those who practice good surgery and invite them to ally themselves with the College? (3) By what processes shall we make headway toward better standards of surgery? It is easy for an exclusive society of eighty or one hundred

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Further Advance of Surgery 9 of medical graduates. Outside of three or four conspicuous exceptions, where a limited number of selected men are thoroughly drilled as surgeons, and where they are turned out as skilled diagnosticians, pathologists, and operators, there is no real train- ing school for surgeons. These super-trained surgeons are so few in number that they cannot fill even the teaching positions in the large centers of population. Now let me ask: Is the standard of surgery of these few men too good for the public in smaller com- munities? Is the best surgery too good for the humblest patient an5nvhere in our country? With our great faculties of medicine, with our endowed labora- tories, with our great private and public hospitals, with our founda- tions of medical research, is there not one force on this continent to say to these leading organizations: ' You must not sanction the general practice of surgery to those untrained in surgery ' ? Is there a force in better position for such leadership than the American College of Surgeons? Can any one doubt that the College, con- sisting of four thousand real surgeons of America, has any right to shirk such a responsibility? Can the College find the sHghtest reason to delegate this tremendous task to any other organization? If it is proper that some force should standardize surgery, then it is right that the College should set about the work, for the very preamble of the College insists that the standardization of surgery is our major business. Our responsibility in this direction is plain. We can meet the responsibiHty. To start with, practically all of the teachers of surgery on this continent are with us. Through clear aspirations, through genuine enthusiasm, and through untiring efforts, we have weathered all waves of criticism and perfected a powerful organiza- tion. Further, that organization is now endowed. An inspiring momentum is under way. While this initiative is with us, let us become the keepers of surgery on this continent in a fashion as yet only true in dreams. ' I am so thoroughly convinced that this tremendous undertak- ing should be assumed and directed by the American College of Surgeons that I am going to ask you to create some further machin- er y needed for the work. Every day that we neglect to provide means to prevent untrained men from operating (except in emer- gencies) we are a party in encouraging unnecessary and criminally unsafe surgery. . . .