Significance of the American College of Surgeons to progress of surgery in America

Abstract The progress of surgery in America and the progress of the American College of Surgeons are synonomous because the College has set itself to discover needs and to shape its activities toward meeting them. It is not a membership organization whose primary object it is to protect and to promote the interests of its members individually. The purpose is rather to provide an avenue through which the members may submerge their individual and selfish interests and unitedly focus effort on improving their service to the patient. The active interest of the organization in the education and training of the surgeon and in improvement of the environment in which he works in hospitals and in industry, is centered not upon him personally but upon enabling him to obtain better surgical results. This larger concept completely coincides with the highest motive of the individual surgeon who has dedicated himself to service. The formula that the College follows is almost always the same, whether great projects like the standardization of hospitals and the organization of cancer clinics, or lesser ones like the standardization of surgical dressings and the approval of surgical equipment, are involved. First comes recognition of the problem. Second comes survey to determine the actual conditions and the extent of the need. Third, the co-operation of other groups concerned is sought, and effort is made to avoid duplication of effort. Fourth, a permanent set-up is established, either as a function of an administrative department or of a committee or committees under administrative guidance. Fifth, a standard is formulated, the meeting of which will help to correct the fault or overcome the deficiency. Sixth, the need and the way in which it can be met are publicized. Seventh, surveys are made to determine who are meeting the standard, and the approval list is publicized as a spur to competition. Eighth, assistance is given in meeting the requirements. Ninth, constant resurveys are made to assure maintenance of the standard. Tenth, progressive interpretation of the standard is made to conform with scientific, technical and ideologic advancement. Participation in the activities is possible for an exceedingly large proportion of the fellowship at any given time. There are executive, credentials and judiciary committees in every state and province, and in ninety-one different districts there are in addition committees on applicants. On the eighty-five regional fracture committees are 1,400 men. On the Board of Governors are 150 members. More than 200 Fellows are serving on the other committees, including the Committee on the Library, the Committee on Fractures and Other Traumas, the Committee on the Hall of the Art and Science of Surgery, the Committee on Bone Sarcoma, the Committee on Medical Motion Pictures, the Joint Committee on Nursing Service with American Nurses Association, the Committee on Graduate Training, the Advisory Council for Ophthalmology, the Advisory Council for Otolaryngology, the Board of Regents, Executive Committee, Finance Committee and Advisory Council to the Board of Regents. Participation in the meetings is another activity that is well supported by the entire fellowship. The roster of names of speakers, leaders of discussions, and clinical demonstrators at the Clinical Congress and Sectional Meetings through the years constitutes a roll call of the outstanding American and many foreign surgeons, and the published papers furnish year by year records of progress in surgery in general and in special fields. Looking ahead, the College faces with the rest of the nation, as it did once before, the threat of war. With the same enthusiastic response, it is rising to the needs of the national defense program. The chairman of the Board of Regents, Dr. Abell, is chairman of the committee appointed in September, 1940, to co-operate with the national defense commission of the United States on all phases of public health. Serving with him are the three Surgeons General, all Fellows of the College. The 1940–1941 president, Dr. Graham, is chairman, and Regent Alton Ochsner of New Orleans is vice chairman of the Advisory Committee on Surgery of the National Research Council, appointed in June, 1940. This committee has several subcommittees to represent the various surgical specialties and to investigate specific problems. Most of the members of the committees are Fellows of the College, so that again the organization that represents the surgical profession in action and as a whole, is in a national emergency enabling the surgeon to present a united front. There are those now who criticize the American College of Surgeons because of its size, its inclusiveness, as once there were those who feared it would be an “oriental oligarchy,” patterned after the “aristocracy of the old world.” It is true that the College fellowship roll of nearly 13,000 makes it the largest surgical organization in the world. However, the aim has never been to create an exclusive organization for the purpose of giving distinction to the members, but to set the qualifications Just high enough so that they can be attained with reasonable effort under existing circumstances by the competent surgeons upon whom the public throughout the country must rely and for whose competency an authoritative gauge is needed as a basis for public confidence. The aim “to elevate the standards of surgery” is interpreted as an obligation to elevate the standards of the greatest possible number of surgeons. Succinctly, Donald C. Balfour, in his presidential address in 1935, stated the significance of the American College of Surgeons to progress of surgery in America: “The accomplishments of the American College of Surgeons are recorded in the status attained by American surgery today.”