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The past, the present and the future
Cobyright, 1951 by The Americm Jmmal of Surgery, Inc.
A
PRACTICAL
JOURNAL Sixtieth
VOL. LXXX1
‘Year
BUILT
ON
MERIT
Publication
of
JANUARY,
1951
NUMBER ONE
jhsidential Rddress THE PAST, THE PRESENT AND THE FUTURE LOUIS E. MOON,
M.D.
Kansas City, Missouri
T
beIieved that the membership of our society was too Iimited, that we shouId have a provision for admitting any ethica physician who is interested in proctoIogy. Our AfliIiate and Associate memberships have provided that opportunity to a11 who are interested in proctoIogy. FeIIow membership is for the physician who wishes to devote his entire time to proctoIogy. Provisions for our membership at the present time are adequate. Our Society has had a heaIthy increase in its membership in this Iast year. The Iack of a suitabIe pubIication or a journa1 for our Society repeatedIy appeared. The publication of the transactions of our Society began in book form in Igog and continued unti1 1947. It was at that time that The American Journal of Surgery took over the pubIication of the papers which were presented at the meetings of the American ProctoIogic Society. During the years 1947 and 1948 there were no bound voIumes, but the proceedings of the 1949 meeting have been pubIished in book form. The recommendations in regard to a pubIication for our Society have now been carried out adequateIy. The arrangement with The American Journal of Surgery provides a means of publishing our deIiberations which cannot at present be bettered. This pubIication arrangement wiI1 aIso faciIitate the pubIication of our transactions in the future. There has been a division among our mem-
HE fina duty of the retiring president is to present a report to the Society. I believe that the report shouId concern itseIf with matters pertaining to the present status, to the improvement and to the future of our Society. In 1948 at the CoIumbus meeting a historica review was given of the organization of our society from its inception. In my review I wiI1 consider some of the many recommendations which have been made by past presidents. I have reviewed their addresses since Igog. I wish to comment upon what has been done in regard to the accompIishment of the things recommended. AI1 recommendations pertain in a way to the acquiring of our present status. About every third or fourth year the definition of proctoIogy was discussed, and it was sIow in being defined to the satisfaction of aI1. A fuI1 and compIete definition of what we beIieve now constitutes proctoIogy was not decided upon unti1 the charter for the American Board of ProctoIogy was obtained. In that charter proctoIogy is defined as that branch of medica practice which deaIs with diseases of the coIon, rectum and anus. At the present time this definition seems to be adequate. RepeatedIy, past Presidents have made recommendations in regard to the size of the membership of our Society, each time urging that it shouId be enIarged so that proctoIogy couId be disseminated more widely. Many 1
2
PresidentiaI
bers during these years in regard to when and where we shouId meet. In the past the majority has been in favor of meeting at the same time and in the same city with the American Medical Association so that members of our Society might register and attend the meeting of the Section of GastroenteroIogy and ProctoIogy. However, severa meetings have been heId separateIy and independentIy of the American MedicaI Association, and each meeting so heId has been reported as having been we11 attended and a very successfu1 meeting. It is my recommendation that the American ProctoIogic Society shouId hoId meetings at a time when the American MedicaI Association is not in convention. If a meeting must be heId in conjunction with the American MedicaI Association, it shouId be in a nearby city immediateIy preceding the American MedicaI Association. The membership of our Society is Iarge and the importance of our meeting has become such that it should no Ionger be one of convenience; it shouId be a proctoIogic business meeting. The probIems of our Society shouId receive your undivided thought and attention at this annua1 meeting. The meeting is a report of the work and thought that members have given to the Society during the preceding year. Our aim wiI1 never be accompIished unIess the FeIIows and Associates assume responsibiIity for the assignments given to them by the President. The affairs of our Society shouId be thought of other than at this meeting. It is a year-round job. In IgIz it was suggested that we ask for a Section of ProctoIogy in the American MedicaI Association. In 1913 a Section of GastroenteroIogy and ProctoIogy was authorized. In 1916 Dwight Murray presented a resoIution to the House of DeIegates asking that a Section of ProctoIogy be estabIished. A Section of StomatoIogy then existed, and the House of DeIegates agreed to incIude GastroenteroIogy and ProctoIogy in this Section. It was caIIed the Section of StomatoIogy, GastroenteroIogy and ProctoIogy. In I 917 the name was changed to the Section of GastroenteroIogy and Proctology. However, it was 1947 before proctoIogy was accorded fuI1 recognition as a speciaIty by the Committee on MedicaI Education and HospitaIs of the American MedicaI Association. They then Iisted proctoIogy as a speciaIty in a11 of their pubIications. Our reIationship with the CounciI on Medical Education and Hos-
Address pitaIs of the American MedicaI Association has aIways been exceIIent. GastroenteroIogy is a medica speciaIty. ProctoIogy is a surgica1 speciaIty. Internists and proctoIogists do not beIong in the same section. When proper teaching faciIities have been estabIished in more schooIs, we should ask that we be granted a Section of ProctoIogy. In 1937 the Southern MedicaI Association authorized the estabIishment of a Section of ProctoIogy, and this section has been we11 attended and its estabIishment justified. In 1928 the high cost of medica care was mentioned, and it is stiI1 with us. With the increase of cost there has been an improvement in the care of the patient. The cost is high today, but the better care of the patient has justified an increase. In 1931 we were warned about the possibility of state medicine. In 1938 sociaIized medicine reared its head and our Society sent a resoIution to the House of Delegates of the American MedicaI Association voicing its unanimous opposition to sociaIized medicine. SociaIization pIans are yet with us, but BIue Cross and BIue ShieId and other voIuntary insurance programs are demonstrating to the pubIic that adequate medica care is avaiIabIe to a11 for a nornina fee, with free choice of physicians and without bureaucratic contro1. I beIieve that our Society shouId cooperate in every way possibIe with the American MedicaI Association in its constructive programs. We shouId join them in every possibIe way in combating the sociaIization of medicine, and we shouId participate in the NationaI Education Campaign. In 1916 the American CoIIege of Surgeons permitted the submission of proctoIogic case records in the fuIfXIment of requirements when appIicants were asked to submit case records. In 1930 they recognized proctoIogy as a speciaIty, and within the Iast year they have approved two hospitaIs as being suitabIe for proctoIogic residency training. In 1932 the PhiIadeIphia ProctoIogic Society was organized. This was the first regiona society. In 1935 the New York ProctoIogic Society was organized, and since that time fourteen regiona societies have been organized making a tota of sixteen. These are Iocated throughout a11 parts of the country, and each is an independent society and not a subsidiary of the American ProctoIogic Society. AImost every year some part of the address American
Journal
of Surgery
PresidentiaI was spent regretting the fact that teaching faciIities were not adequate. In rgzo C. F. Martin said, “Let us make this society the mouthpiece of authoritative American proctoIogy in so far as it represents good usage.” The next year he reported that proctoIogy was being taught in the Graduate SchooI of Medicine of the University of PennsyIvania as a two- and three-year course, a provision having been made for teaching proctoIogy, and four specia1 students had been enroIIed. In 1929 Buie reported that the Mayo Foundation was permitting students to major in proctoIogy for which they were to receive the degree of Master of Science. The course prescribed was for a three- or four-year period and Buie said, “I beIieve that if you can properIy arrange for post graduate instruction, that the undergraduate instruction wiI1 take care of itseIf.” He pointed out that the Iack of progress in the past had always been due to the Iack of teaching faciIities. The University of PennsyIvania and the University of Minnesota were the first schooIs to present acceptabIe postgraduate teaching programs. Surveys in regard to the faciIities for teaching proctoIogy in medica schooIs began in 191 o. Dwight Murray made the first survey. Fiftytwo questionnaires were sent out and thirtytwo repIies were received. ProctoIogy was taught as a speciaIty in one schoo1. It was included in genera1 surgery in twenty-nine. It was taught by specia1 instructors in ten schools. Hibschman made the second survey in I 934. Seventy-seven questionnaires were sent out and sixty-five repIies were received. ProctoIogy was taught as a speciaIty in tweIve schools. It was incIuded in genera1 surgery in fifty-three. The number of special instructors was not given. HamiIton made the Iast survey in 1948. Eighty-two questionnaires were sent out and sixty-six repIies were received. ProctoIogy was taught as a speciaIty in thirty-five schooIs. It was incIuded in genera1 surgery in fifty-five, and instruction was given by a proctoIogist in thirty-eight schooIs. ProctoIogy is combined with genera1 surgery in the majority of medica schooIs. Instruction in proctoIogy shouId be given in a11 medica schooIs. The department or subdivision of surgery under which it is taught shouId be headed by a proctologist, preferabIy one who has been certified. To bring about improvement I wouId Iike to see our certified men, who are Iocated in
January,
I 95 I
Address
3
cities where there are medica schooIs in which proctoIogy is not adequateIy taught, become associated with genera1 surgery. It behooves us to work more cIoseIy with the surgical departments in a11 medica schools. We shouId aIign ourseIves with the Ieaders in surgery and work with them. Many of them know our probIems and are wiIIing to assist us, and we in turn can be of service to them. ProctoIogy is essentiaIIy a surgical speciaIty. Let us have a harmonious coaIition with our surgery departments but ask tha.t proctoIogy be supervised and taught by a proctoIogist. George H. Meeker, Dean of the Graduate SchooI of Medicine of the University of PennSyIvania, in an address of weIcome to our Society in rg3 I suggested that our Society appIy for an examining board of its own to certify to the proficiency of men desiring to practice proctoIogy. In 1933 Rosser recommended that we appIy for a Board, and in 1935 a charter was obtained. In 1939 a Board was permitted to organize and to function and was caIIed the CentraI Certifying Committee. This Board was a subsidiary of the American Board of Surgery. In 1942 the first examinations by the CentraI Certifying Committee were given. The Committee functioned as a subsidiary of the American Board of Surgery unti1 1949 at which time proctoIogy was granted an independent Board by the Advisory Board of MedicaI SpeciaIties and the CounciI on MedicaI Education and Hospitals of the American MedicaI Association. Proctology attained fuI1 recognition when it was granted this Board which is known as the American Board of ProctoIogy. The Board has five functions. The first is to encourage the study, improve the teaching and eIevate the standards of that science of medica practice which deaIs with diseases of the coIon, rectum and anus, and which branch of practice is known as proctoIogy. The recognition and approva1 of proctoIogy as a speciaIty by the Advisory Board of MedicaI SpeciaIties and the CounciI on Medical Education has done more toward the advancement, eIevation and deveIopment of our speciaIty than any other one thing up to the present time. The task of improving the teaching and training faciIities wiI1 faI1 to you who are certified. You are the ones who must Iead the way and make an effort to have proctoIogy recognized in your hospitaIs and in your medica schooIs. With
PresidentiaI your heIp in the teaching and training programs the standards wiII be eIevated. The second function is to estabIish appropriate educationa and training standards and to determine that candidates for certification receive adequate preparation. This is a function to be activated by the Board. Action has been taken by the Board toward defining what the educationa training standards shaI1 be. Each year the CounciI on MedicaI Education and HospitaIs issues a bookIet entitIed “EssentiaIs of Approved Residencies and FeIIowships.” In this wiI1 be found the requirements which have been prescribed by the Board. The third function is to encourage the study, improve the practice and eIevate the standards of proctoIogy by assisting in perfecting the quaIity of graduate education. We are deliniteIy in a period of changing times. What in the past was recognized as graduate training now no Ionger suffices. CoIIier F. Martin in his address in 1920 had this to say: “To teach students to be effective, sureIy requires more than six or tweIve weeks.” You wiI1 recaI1 that graduate training was started in rgz~ in the University of PennsyIvania, and in 1929 at the Mayo Foundation, and in 1946 the CounciI on MedicaI Education and HospitaIs gave approva1 for estabIishing residencies in proctoIogy in approved hospitaIs. We now have ten hospitaIs approved by this counci1 which have provisions for conducting a residency training program. These ten residencies accommodate approximateIy eighteen men and they are Iocated as foIIows: AIIentown, PennsyIvania; BuffaIo, New York; Chicago, IIIinois; Detroit, Michigan; MiIwaukee, Wisconsin; Pittsburgh, PennsyIvania; Reading, PennsyIvania; Rochester, Minnesota; Youngstown, Ohio; and two in PhiIadeIphia, PennsyIvania. We shouId encourage a11 surgica1 residents whom we contact to quaIify for proctoIogy by spending the Iast two years in proctoIogy. We are fortunate in having as many residencies as we do, but some of the most vaIuabIe teaching faciIities in the Iarger cities have not been made avaiIabIe to us. Some of you in each of the Iarge medica centers shouId voIunteer to caI1 the FeIIows and Associates of our Society and any surgeon interested in proctoIogy together to study the possibiIity of getting the cooperation of your hospitaIs and chnics and medica schooIs.
Address ExtramuraI preceptors were suggested by C. F. Martin to assist in compIeting the training of students who had enroIIed in the Graduate SchooI of the University of PennsyIvania. In 1947 and 1949 the estabIishment of preceptorships was again suggested. Provisions shouId be made for finding preceptors for residents who have had a year of forma1 proctoIogic training and are desirous of having a second year of practica1 training. The job of determining who can be preceptors and of defining the duties of preceptors is yet to be compIeted. Short postgraduate training courses are being given by seven different groups-two by medica schooIs and five by postgraduate divisions of medica schooIs. Credit toward certification cannot be given for attending these courses. There are many in the Society who have no desire to Iimit their work to proctoIogy, but they are desirous of increasing their knowledge of the field. These men shouId attend postgraduate courses of the aforementioned type, visit proctoIogic cIinics and attend proctoIogic meetings. The fourth function is to determine the abiIity and fitness of candidates who seek certification by subjecting them to comprehensive examinations. This is a Board function but you can heIp. Those of you who appIy for certification shouId come prepared so that it wiI1 be a pIeasure for the Board to examine you rather than a regret. The examining function has been estabIished and is in operation. The first examinations were heId in PhiIadeIphia, November 12, 1949, and two examinations have been heId since then. The fifth function is to award certificates of approva1 to those candidates who fuIfiI1 a11 requirements, and to prepare and maintain a registry of dipIomates of the board which wiI1 be avaiIabIe to a11 who may be interested in its contents. This is a Board function. The estabIishment of the Board brought many ob1igation.s to a11members of this Society. The rea1 responsibiIity rests upon the shouIders of you who have been certified. You are the members who must assume the responsibiIity. The American Board of ProctoIogy is your representative. The Board has a job to do. It needs your heIp and depends upon you. Our Society needs a permanent secretary. We are asking too much when we ask one of our members to conduct the secretaria duties
Ameri’can Journal of Surgery
PresidentiaI incident to a Society of this size. It is hoped that in the future some arrangement can be made whereby a fuII-time secretary can be empIoyed by our Society, and that in the secretary’s offrce it wiII be possibIe to carry on some of the duties of the secretary of the American Board of ProctoIogy. A centraI offrce of that type wouId provide a repository for our records and a library for proctoIogic books and proctologic literature which could be used as a reference Iibrary by our members. In rg4g Bacon said, “Our society is anxious to establish and to maintain a flow and exchange of ideas with professiona coIIeagues from other parts of the worId.” This internationa reIationship shouId be encouraged. We profited Iast year by the presence of our foreign guests. Our Society shouId extend invitations to the members of al1 proctologic sections and societies throughout the worId for each of our meetings. I wouId Iike to see the number of regiona societies increased. More physicians each year are expressing an interest in proctoIogy, and many are asking how they can enter proctoIogy and where they can obtain instruction. Your regional society shouId provide teaching faciIities for the general practitioners in your area. You shouId give Iectures in proctoIogy to interns and residents in hospitals which do not have proctologic sections. I wouId Iike to see a committee appointed by the regiona societies to correIate the activities of their societies. In rg2o CoIIier F. Martin had this to say: “Your president feeIs strongIy that a true progress rests upon a basis of constructive criticism. At the present time our country is passing through a wave of reform, which unfortunateIy seems to trend toward deformity
Address
3
and disintegration. Everything that we formerIy beIieved in is being investigated and reorganized, taxed and reguIated. The resuIting uncertainty in economic conditions is even being feIt by the medica profession.” According to that our probIems or diffrcuIties today are no different from those of thirty years ago. We do have some very serious probIems for our Society to soIve today. We are Iiving in a troubled period of the worhl’s history. Our responsibiIity as a Society has never been so great and the probIems we face have never been more diffrcuIt. Our biggest probIem is stiI1, How are we to provide adequate postgraduate and undergraduate teaching faciIities for those desiring instruction in proctoIogy? We cannot provide these faciIities without your heIp. Our duty at present is to do that which Iies cIearIy at hand, but we must aIso have perspective and a11 pIans should provide for the future expansion of our Society. We shouId be Iooking ahead and each estabIished teaching unit shouId act as a research Iaboratory in pIanning for the future. You who head teaching positions and residencies shouId assist those who are trying to estabIish teaching units. You shouId work with the Education Committee since our Society shouId be a schoo1 in which the schoIars teach each other. The opportunity is at hand for each of us. Our past Board members never accepted faiIure as permanent and thus obtained a Board, so we now must not accept success as permanent. When contentment enters progress ceases, and defeat is for those who acknowIedge it. A Iot of hard work is yet to be done. Constructive ideas are such funny things; they never work unIess you do.
A
PRACTICAL
JOURNAL Sixtieth
VOL. LXXX1
‘Year
BUILT
ON
MERIT
Publication
of
JANUARY,
1951
NUMBER ONE
jhsidential Rddress THE PAST, THE PRESENT AND THE FUTURE LOUIS E. MOON,
M.D.
Kansas City, Missouri
T
beIieved that the membership of our society was too Iimited, that we shouId have a provision for admitting any ethica physician who is interested in proctoIogy. Our AfliIiate and Associate memberships have provided that opportunity to a11 who are interested in proctoIogy. FeIIow membership is for the physician who wishes to devote his entire time to proctoIogy. Provisions for our membership at the present time are adequate. Our Society has had a heaIthy increase in its membership in this Iast year. The Iack of a suitabIe pubIication or a journa1 for our Society repeatedIy appeared. The publication of the transactions of our Society began in book form in Igog and continued unti1 1947. It was at that time that The American Journal of Surgery took over the pubIication of the papers which were presented at the meetings of the American ProctoIogic Society. During the years 1947 and 1948 there were no bound voIumes, but the proceedings of the 1949 meeting have been pubIished in book form. The recommendations in regard to a pubIication for our Society have now been carried out adequateIy. The arrangement with The American Journal of Surgery provides a means of publishing our deIiberations which cannot at present be bettered. This pubIication arrangement wiI1 aIso faciIitate the pubIication of our transactions in the future. There has been a division among our mem-
HE fina duty of the retiring president is to present a report to the Society. I believe that the report shouId concern itseIf with matters pertaining to the present status, to the improvement and to the future of our Society. In 1948 at the CoIumbus meeting a historica review was given of the organization of our society from its inception. In my review I wiI1 consider some of the many recommendations which have been made by past presidents. I have reviewed their addresses since Igog. I wish to comment upon what has been done in regard to the accompIishment of the things recommended. AI1 recommendations pertain in a way to the acquiring of our present status. About every third or fourth year the definition of proctoIogy was discussed, and it was sIow in being defined to the satisfaction of aI1. A fuI1 and compIete definition of what we beIieve now constitutes proctoIogy was not decided upon unti1 the charter for the American Board of ProctoIogy was obtained. In that charter proctoIogy is defined as that branch of medica practice which deaIs with diseases of the coIon, rectum and anus. At the present time this definition seems to be adequate. RepeatedIy, past Presidents have made recommendations in regard to the size of the membership of our Society, each time urging that it shouId be enIarged so that proctoIogy couId be disseminated more widely. Many 1
2
PresidentiaI
bers during these years in regard to when and where we shouId meet. In the past the majority has been in favor of meeting at the same time and in the same city with the American Medical Association so that members of our Society might register and attend the meeting of the Section of GastroenteroIogy and ProctoIogy. However, severa meetings have been heId separateIy and independentIy of the American MedicaI Association, and each meeting so heId has been reported as having been we11 attended and a very successfu1 meeting. It is my recommendation that the American ProctoIogic Society shouId hoId meetings at a time when the American MedicaI Association is not in convention. If a meeting must be heId in conjunction with the American MedicaI Association, it shouId be in a nearby city immediateIy preceding the American MedicaI Association. The membership of our Society is Iarge and the importance of our meeting has become such that it should no Ionger be one of convenience; it shouId be a proctoIogic business meeting. The probIems of our Society shouId receive your undivided thought and attention at this annua1 meeting. The meeting is a report of the work and thought that members have given to the Society during the preceding year. Our aim wiI1 never be accompIished unIess the FeIIows and Associates assume responsibiIity for the assignments given to them by the President. The affairs of our Society shouId be thought of other than at this meeting. It is a year-round job. In IgIz it was suggested that we ask for a Section of ProctoIogy in the American MedicaI Association. In 1913 a Section of GastroenteroIogy and ProctoIogy was authorized. In 1916 Dwight Murray presented a resoIution to the House of DeIegates asking that a Section of ProctoIogy be estabIished. A Section of StomatoIogy then existed, and the House of DeIegates agreed to incIude GastroenteroIogy and ProctoIogy in this Section. It was caIIed the Section of StomatoIogy, GastroenteroIogy and ProctoIogy. In I 917 the name was changed to the Section of GastroenteroIogy and Proctology. However, it was 1947 before proctoIogy was accorded fuI1 recognition as a speciaIty by the Committee on MedicaI Education and HospitaIs of the American MedicaI Association. They then Iisted proctoIogy as a speciaIty in a11 of their pubIications. Our reIationship with the CounciI on Medical Education and Hos-
Address pitaIs of the American MedicaI Association has aIways been exceIIent. GastroenteroIogy is a medica speciaIty. ProctoIogy is a surgica1 speciaIty. Internists and proctoIogists do not beIong in the same section. When proper teaching faciIities have been estabIished in more schooIs, we should ask that we be granted a Section of ProctoIogy. In 1937 the Southern MedicaI Association authorized the estabIishment of a Section of ProctoIogy, and this section has been we11 attended and its estabIishment justified. In 1928 the high cost of medica care was mentioned, and it is stiI1 with us. With the increase of cost there has been an improvement in the care of the patient. The cost is high today, but the better care of the patient has justified an increase. In 1931 we were warned about the possibility of state medicine. In 1938 sociaIized medicine reared its head and our Society sent a resoIution to the House of Delegates of the American MedicaI Association voicing its unanimous opposition to sociaIized medicine. SociaIization pIans are yet with us, but BIue Cross and BIue ShieId and other voIuntary insurance programs are demonstrating to the pubIic that adequate medica care is avaiIabIe to a11 for a nornina fee, with free choice of physicians and without bureaucratic contro1. I beIieve that our Society shouId cooperate in every way possibIe with the American MedicaI Association in its constructive programs. We shouId join them in every possibIe way in combating the sociaIization of medicine, and we shouId participate in the NationaI Education Campaign. In 1916 the American CoIIege of Surgeons permitted the submission of proctoIogic case records in the fuIfXIment of requirements when appIicants were asked to submit case records. In 1930 they recognized proctoIogy as a speciaIty, and within the Iast year they have approved two hospitaIs as being suitabIe for proctoIogic residency training. In 1932 the PhiIadeIphia ProctoIogic Society was organized. This was the first regiona society. In 1935 the New York ProctoIogic Society was organized, and since that time fourteen regiona societies have been organized making a tota of sixteen. These are Iocated throughout a11 parts of the country, and each is an independent society and not a subsidiary of the American ProctoIogic Society. AImost every year some part of the address American
Journal
of Surgery
PresidentiaI was spent regretting the fact that teaching faciIities were not adequate. In rgzo C. F. Martin said, “Let us make this society the mouthpiece of authoritative American proctoIogy in so far as it represents good usage.” The next year he reported that proctoIogy was being taught in the Graduate SchooI of Medicine of the University of PennsyIvania as a two- and three-year course, a provision having been made for teaching proctoIogy, and four specia1 students had been enroIIed. In 1929 Buie reported that the Mayo Foundation was permitting students to major in proctoIogy for which they were to receive the degree of Master of Science. The course prescribed was for a three- or four-year period and Buie said, “I beIieve that if you can properIy arrange for post graduate instruction, that the undergraduate instruction wiI1 take care of itseIf.” He pointed out that the Iack of progress in the past had always been due to the Iack of teaching faciIities. The University of PennsyIvania and the University of Minnesota were the first schooIs to present acceptabIe postgraduate teaching programs. Surveys in regard to the faciIities for teaching proctoIogy in medica schooIs began in 191 o. Dwight Murray made the first survey. Fiftytwo questionnaires were sent out and thirtytwo repIies were received. ProctoIogy was taught as a speciaIty in one schoo1. It was included in genera1 surgery in twenty-nine. It was taught by specia1 instructors in ten schools. Hibschman made the second survey in I 934. Seventy-seven questionnaires were sent out and sixty-five repIies were received. ProctoIogy was taught as a speciaIty in tweIve schools. It was incIuded in genera1 surgery in fifty-three. The number of special instructors was not given. HamiIton made the Iast survey in 1948. Eighty-two questionnaires were sent out and sixty-six repIies were received. ProctoIogy was taught as a speciaIty in thirty-five schooIs. It was incIuded in genera1 surgery in fifty-five, and instruction was given by a proctoIogist in thirty-eight schooIs. ProctoIogy is combined with genera1 surgery in the majority of medica schooIs. Instruction in proctoIogy shouId be given in a11 medica schooIs. The department or subdivision of surgery under which it is taught shouId be headed by a proctologist, preferabIy one who has been certified. To bring about improvement I wouId Iike to see our certified men, who are Iocated in
January,
I 95 I
Address
3
cities where there are medica schooIs in which proctoIogy is not adequateIy taught, become associated with genera1 surgery. It behooves us to work more cIoseIy with the surgical departments in a11 medica schools. We shouId aIign ourseIves with the Ieaders in surgery and work with them. Many of them know our probIems and are wiIIing to assist us, and we in turn can be of service to them. ProctoIogy is essentiaIIy a surgical speciaIty. Let us have a harmonious coaIition with our surgery departments but ask tha.t proctoIogy be supervised and taught by a proctoIogist. George H. Meeker, Dean of the Graduate SchooI of Medicine of the University of PennSyIvania, in an address of weIcome to our Society in rg3 I suggested that our Society appIy for an examining board of its own to certify to the proficiency of men desiring to practice proctoIogy. In 1933 Rosser recommended that we appIy for a Board, and in 1935 a charter was obtained. In 1939 a Board was permitted to organize and to function and was caIIed the CentraI Certifying Committee. This Board was a subsidiary of the American Board of Surgery. In 1942 the first examinations by the CentraI Certifying Committee were given. The Committee functioned as a subsidiary of the American Board of Surgery unti1 1949 at which time proctoIogy was granted an independent Board by the Advisory Board of MedicaI SpeciaIties and the CounciI on MedicaI Education and Hospitals of the American MedicaI Association. Proctology attained fuI1 recognition when it was granted this Board which is known as the American Board of ProctoIogy. The Board has five functions. The first is to encourage the study, improve the teaching and eIevate the standards of that science of medica practice which deaIs with diseases of the coIon, rectum and anus, and which branch of practice is known as proctoIogy. The recognition and approva1 of proctoIogy as a speciaIty by the Advisory Board of MedicaI SpeciaIties and the CounciI on Medical Education has done more toward the advancement, eIevation and deveIopment of our speciaIty than any other one thing up to the present time. The task of improving the teaching and training faciIities wiI1 faI1 to you who are certified. You are the ones who must Iead the way and make an effort to have proctoIogy recognized in your hospitaIs and in your medica schooIs. With
PresidentiaI your heIp in the teaching and training programs the standards wiII be eIevated. The second function is to estabIish appropriate educationa and training standards and to determine that candidates for certification receive adequate preparation. This is a function to be activated by the Board. Action has been taken by the Board toward defining what the educationa training standards shaI1 be. Each year the CounciI on MedicaI Education and HospitaIs issues a bookIet entitIed “EssentiaIs of Approved Residencies and FeIIowships.” In this wiI1 be found the requirements which have been prescribed by the Board. The third function is to encourage the study, improve the practice and eIevate the standards of proctoIogy by assisting in perfecting the quaIity of graduate education. We are deliniteIy in a period of changing times. What in the past was recognized as graduate training now no Ionger suffices. CoIIier F. Martin in his address in 1920 had this to say: “To teach students to be effective, sureIy requires more than six or tweIve weeks.” You wiI1 recaI1 that graduate training was started in rgz~ in the University of PennsyIvania, and in 1929 at the Mayo Foundation, and in 1946 the CounciI on MedicaI Education and HospitaIs gave approva1 for estabIishing residencies in proctoIogy in approved hospitaIs. We now have ten hospitaIs approved by this counci1 which have provisions for conducting a residency training program. These ten residencies accommodate approximateIy eighteen men and they are Iocated as foIIows: AIIentown, PennsyIvania; BuffaIo, New York; Chicago, IIIinois; Detroit, Michigan; MiIwaukee, Wisconsin; Pittsburgh, PennsyIvania; Reading, PennsyIvania; Rochester, Minnesota; Youngstown, Ohio; and two in PhiIadeIphia, PennsyIvania. We shouId encourage a11 surgica1 residents whom we contact to quaIify for proctoIogy by spending the Iast two years in proctoIogy. We are fortunate in having as many residencies as we do, but some of the most vaIuabIe teaching faciIities in the Iarger cities have not been made avaiIabIe to us. Some of you in each of the Iarge medica centers shouId voIunteer to caI1 the FeIIows and Associates of our Society and any surgeon interested in proctoIogy together to study the possibiIity of getting the cooperation of your hospitaIs and chnics and medica schooIs.
Address ExtramuraI preceptors were suggested by C. F. Martin to assist in compIeting the training of students who had enroIIed in the Graduate SchooI of the University of PennsyIvania. In 1947 and 1949 the estabIishment of preceptorships was again suggested. Provisions shouId be made for finding preceptors for residents who have had a year of forma1 proctoIogic training and are desirous of having a second year of practica1 training. The job of determining who can be preceptors and of defining the duties of preceptors is yet to be compIeted. Short postgraduate training courses are being given by seven different groups-two by medica schooIs and five by postgraduate divisions of medica schooIs. Credit toward certification cannot be given for attending these courses. There are many in the Society who have no desire to Iimit their work to proctoIogy, but they are desirous of increasing their knowledge of the field. These men shouId attend postgraduate courses of the aforementioned type, visit proctoIogic cIinics and attend proctoIogic meetings. The fourth function is to determine the abiIity and fitness of candidates who seek certification by subjecting them to comprehensive examinations. This is a Board function but you can heIp. Those of you who appIy for certification shouId come prepared so that it wiI1 be a pIeasure for the Board to examine you rather than a regret. The examining function has been estabIished and is in operation. The first examinations were heId in PhiIadeIphia, November 12, 1949, and two examinations have been heId since then. The fifth function is to award certificates of approva1 to those candidates who fuIfiI1 a11 requirements, and to prepare and maintain a registry of dipIomates of the board which wiI1 be avaiIabIe to a11 who may be interested in its contents. This is a Board function. The estabIishment of the Board brought many ob1igation.s to a11members of this Society. The rea1 responsibiIity rests upon the shouIders of you who have been certified. You are the members who must assume the responsibiIity. The American Board of ProctoIogy is your representative. The Board has a job to do. It needs your heIp and depends upon you. Our Society needs a permanent secretary. We are asking too much when we ask one of our members to conduct the secretaria duties
Ameri’can Journal of Surgery
PresidentiaI incident to a Society of this size. It is hoped that in the future some arrangement can be made whereby a fuII-time secretary can be empIoyed by our Society, and that in the secretary’s offrce it wiII be possibIe to carry on some of the duties of the secretary of the American Board of ProctoIogy. A centraI offrce of that type wouId provide a repository for our records and a library for proctoIogic books and proctologic literature which could be used as a reference Iibrary by our members. In rg4g Bacon said, “Our society is anxious to establish and to maintain a flow and exchange of ideas with professiona coIIeagues from other parts of the worId.” This internationa reIationship shouId be encouraged. We profited Iast year by the presence of our foreign guests. Our Society shouId extend invitations to the members of al1 proctologic sections and societies throughout the worId for each of our meetings. I wouId Iike to see the number of regiona societies increased. More physicians each year are expressing an interest in proctoIogy, and many are asking how they can enter proctoIogy and where they can obtain instruction. Your regional society shouId provide teaching faciIities for the general practitioners in your area. You shouId give Iectures in proctoIogy to interns and residents in hospitals which do not have proctologic sections. I wouId Iike to see a committee appointed by the regiona societies to correIate the activities of their societies. In rg2o CoIIier F. Martin had this to say: “Your president feeIs strongIy that a true progress rests upon a basis of constructive criticism. At the present time our country is passing through a wave of reform, which unfortunateIy seems to trend toward deformity
Address
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and disintegration. Everything that we formerIy beIieved in is being investigated and reorganized, taxed and reguIated. The resuIting uncertainty in economic conditions is even being feIt by the medica profession.” According to that our probIems or diffrcuIties today are no different from those of thirty years ago. We do have some very serious probIems for our Society to soIve today. We are Iiving in a troubled period of the worhl’s history. Our responsibiIity as a Society has never been so great and the probIems we face have never been more diffrcuIt. Our biggest probIem is stiI1, How are we to provide adequate postgraduate and undergraduate teaching faciIities for those desiring instruction in proctoIogy? We cannot provide these faciIities without your heIp. Our duty at present is to do that which Iies cIearIy at hand, but we must aIso have perspective and a11 pIans should provide for the future expansion of our Society. We shouId be Iooking ahead and each estabIished teaching unit shouId act as a research Iaboratory in pIanning for the future. You who head teaching positions and residencies shouId assist those who are trying to estabIish teaching units. You shouId work with the Education Committee since our Society shouId be a schoo1 in which the schoIars teach each other. The opportunity is at hand for each of us. Our past Board members never accepted faiIure as permanent and thus obtained a Board, so we now must not accept success as permanent. When contentment enters progress ceases, and defeat is for those who acknowIedge it. A Iot of hard work is yet to be done. Constructive ideas are such funny things; they never work unIess you do.