In 1951, the American College of Surgeons (ACS) received a beautiful embossed parchment from Robert P. Dobbie, MD, FACS, professor of clinical surgery at the University of Buffalo, NY, and assistant surgeon at Buffalo General Hospital. Dr. Dobbie planned to present a framed copy of the parchment, printed with the words of surgeon Guy de Chauliac and entitled “What the Surgeon Should Be” to young resident surgeons. Expressing his appreciation for the “brevity, scope, and appropriateness of the subject, greatly enhanced by its source and date of origin”, Dr. Dobbie believed the statement was a potential influence for good, especially among the new surgeons.
What must the surgeon be?
The requirements for the Surgeon are four: first, he must be instructed; Second, he must be an expert; Third, he must be ingenious; and fourth, he must be able to adapt. For the First, it is required that the Surgeon should be acquainted not only with the principles of surgery, but also with those of medicine in theory and practice; for the Second, that he should have seen others operate; for the Third, that he be ingenious, of good judgment and memory to recognize conditions; and for the Fourth, that he be adaptable and able to accommodate himself to circumstances.
Let the Surgeon be bold in all safe things, and fearful in dangerous ones; let him avoid all faulty treatments and practices. He should be kind to the sick, attentive to his associates, cautious in his prognostications. Let him be modest, dignified, kind, compassionate, and merciful; not avaricious nor extortionate of money; but rather that his reward be commensurate with his work, with the means of the patient, with the quality of the problem, and with his own dignity.
At the meeting of the ACS Board of Regents on April 14, 1951, ACS Director Paul R. Hawley, MD, FACS (Hon) and Eleanor K. Grimm, Executive Administrative Secretary, Board of Regents of the ACS, reported on the letter and parchment that Dr. Dobbie had sent and his desire to have this declaration printed and presented to Junior Candidates of the ACS. The Board of Regents considered this suggestion favorably and voted unanimously to fund the production of the parchment and present a copy to young surgeons when they became Junior Candidates or Fellows of the American College of Surgeons (see Figure 1).
Figure 1. Scroll “What the Surgeon Should Be”
A father of surgery
Guy de Chauliac, widely considered the “father of surgery“, was a strong advocate for professionalism and non–technical skills (see photo). His structure of professionalism was based on four domains: being instructed, specialist, ingenious and adaptable. 3 Born in France in the late 13th century in a poor peasant family, Chauliac was supported by an ecclesiastical scholarship to study medicine. He undertook a scholarship in anatomy with Nicola Bertuccio in Bologna, Italy, and a surgical scholarship in Paris before receiving his master‘s degree in medicine in 1325 from the University of Montpellier, France. After studying in Bologna and Paris, he began to practice surgery, eventually being invited to the papal court in Avignon, where he served as a physician to three popes. 4
In 1363, Chauliac published Chirurgia Magna, a surgical text based on the ancient and contemporary thought of a variety of scholars on anatomy, surgical disease and treatment. The book is a compilation of medical history, anatomy, art and science of surgery, personal observations and recommendations to surgeons and students on how surgical operations should be conducted.5 It became the most influential surgical text for more than 200 years, particularly in France. The text was divided into seven sections: anatomy, apostema, wounds, ulcers, fractures, special diseases and an antidote. Additionally, Chauliac included a preface on the professional requirements for all surgeons, including an article on the four characteristics of a competent and proficient surgeon. A translation into English of these four characteristics was cited by GH Murphy, MD, FACS, in the Canadian Medical Association Journal in 1951, and is the text used in “What the Surgeon Ought to Be”.6
The ACS continued to print “What the Surgeon Ought to Be” at least until the early 1960s and made copies available for purchase by College members. The ACS Archives holds copies of the original printing, and the illustrated digital version is available in the Archives Catalog by visiting facs.org/archives. The College also owns La Grande Chirurgie, a French translation of Chauliac’s Chirurgia Magna, circa 1632. This small volume, brought from France in 1918, was presented to the ACS Library in 1937 by James DF Robertson, MD, FACS, of Wilmington, NC.
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