The consumption of our heritage.

From the Department of Surgery, Northwestern University Medical School. Chicago. Illinois. Requests for reprints should be addressed to David L. Nahrwold, MD, Department of Surgery, 250 East Superior Street, Suite 201, Chicago, Illinois 60611. Presented at the 31st Annual Meeting of the Society of Surgery of the Alimentary Tract, San Antonio, Texas, May 15-16, 1990. I am grateful to all of you for the privilege of serving as your President. Many people work hard on behalf of the membership and the entire digestive disease community, including the Board of Trustees and its chairman, the other officers, the members of our committees and their chairmen, and our representatives to other organizations. The many members who have had a continuing commitment to the Society have brought it to maturity. I thank all of you for this. With continued growth in membership, and careful attention to the environment in which the digestive disease community learns and works, the Society will become an increasingly important force in education, research, and patient care. Although the future of our Society is bright, the present outlook for our profession gives rise to serious concern. This is a good time to examine the heritage of our profession, to assess the factors that appear to be influencing it, and to determine what, if anything, we should do to preserve it. For the greater portion of the 20th century, the medical profession enjoyed tremendous success. During the first part of the century, doctors enjoyed respect and prestige in part because they were among the relatively few who had higher degrees. They were viewed in the same light as judges, educators, and the clergy. Physicians were willing and able community servants. Whether as individuals or as members of the local medical society, doctors were eager to provide public health information, develop and conduct community-wide immunization programs, and provide medical coverage for the high school football team, the Boy Scouts, and even the county jail, often without remuneration. Fees varied according to the patient’s ability to pay. Poor families and elderly people who had no income were not charged, nor were teachers or the clergy. Physicians often donated their services to the county welfare department, and in larger cities, they staffed and supervised the care delivered by residents on the ward services of community hospitals. Many specialists donated as much as a day or more each week to the care of patients in our country’s great city and county hospitals. For all these activities, the medical profession received generous praise and the admiration and respect of the community. During the middle of the 20th century, scientific research led to a comprehensive understanding of the natural history of most diseases. Untreatable diseases became treatable by so-called miracle drugs and by procedures generally regarded as spectacular. Antibiotics, tranquilizers, antihypertensives, anticancer drugs, and a host of surgical and other procedures and drugs cured or ameliorated many diseases and conditions, resulting in lives that were both longer and of better quality. The media thrust these advances into the living rooms and kitchens of all Americans. Correctly or not, doctors and scientists were