Notable names in the history of surgery: 1. Percivall Pott (1714–1788) *

Surgery today owes much to the services of early practitioners who made their advances as a result of wide clinical experience and compassion. This two‐part series explores the careers of Percivall Pott and William Arbuthnot Lane. Percivall Pott was born in 1714 in east London. Pott was apprenticed to Nourse of St. Bartholomew's Hospital at 15 years of age. After gaining licence to practise in 1736, Pott remained as surgeon to the hospital from 1745 till his retirement aged 73. After falling from his horse in 1756, Pott sustained a fracture of his leg, confining him to bed. During this time, he wrote on his own fracture, as well as hernia and head injuries. Several diseases are named after him, viz. Pott's fracture, Pott's puffy tumour, and Pott's disease of the spine. He was the first to describe cancer of the scrotum in chimney sweepers, as the earliest occupational cancer.      

Modern ways to enhance surgical teaching skills

Extrinsic pressures are influencing ways in which medical students and trainees learn, and are taught surgery and surgical principles. As a surgical educator it is useful to understand some of the reasons for these changes and to acquire the skills necessary to provide effective teaching. This short article looks at reasons why one would wish to develop surgical teaching skills, covers basic principles associated with delivery of effective teaching sessions and briefly reviews other avenues that may enhance teaching practice.     

Notable names in the history of surgery: 2. William Arbuthnot Lane (1856–1943)

Surgery today owes much to the services of early practitioners who made their advances as a result of wide clinical experience and compassion. This two‐part series explores the careers of Percivall Pott and William Arbuthnot Lane. Sir William Arbuthnot Lane was the most brilliant technical surgeon in Britain during the first half of the 20th century. He was one of the many famous physicians and surgeons to train at Guy's Hospital in London since its founding in 1724. Although some of his ideas may be controversial, he had made many original contributions and innovations in a variety of surgical techniques. He introduced mastoid drainage in purulent otitis media with specially designed chisels and gouges; resection of the cervical oesophagus for cancer and reconstruction by skin graft; and the repair of cleft lip and palate in neonates. His greatest contribution must be the introduction of the ‘no‐touch technique’ in open reduction and plating of long bone fractures by Lane's steel plates. In later life, Lane became obsessed with the role of regular bowel motion in health. To combat various real or imagined ailments, he first short‐circuited and later resected the whole large intestine. When surgery failed to resolve the problem, Lane advised regularly taking paraffin oil for the relief of constipation. He was a firm believer as well as a pioneer in alternative or homeopathic medicine. Lane's concept of chronic intestinal stasis is a classic case of a flawless surgical technique subservient to a faulty hypothesis.      

Laying the foundation of surgical skills for trainees (Residents)

The role of the surgical skills laboratory is becoming increasingly important as surgical service needs evolve and educational processes seek to become more robust. The skills laboratory offers an opportunity to better prepare residents for their clinical rotations and to accelerate their clinical effectiveness. The Royal Australasian College of Surgeons has developed and introduced a new standardised basic surgical skills curriculum that can be delivered sustainably in centres throughout Australia and New Zealand. A technical skill set required by all surgical disciplines was compiled, and each skill was deconstructed into cognitive steps. Models were devised to simulate an application of each skill, and standardized demonstrations were created and recorded to ensure uniform teaching. Extensive resource material supports the course programme, with information for tutors, technicians, course directors and participants. Currently, clinical rotations offer inconsistent opportunities for trainees to practise their skills after the course. Recruitment and retention of tutors remains a key challenge.     

WILLIAM CHESELDEN (1688–1752): HUMANE ANATOMIST AND MASTER SURGEON

William Cheselden (1688–1752) as a young man had a considerable reputation as an anatomist. He was one of the first to give a regular series of lecture/demonstrations and he incorporated this material into a basic text The Anatomy of the Humane Body, which was extremely popular and was in print for 100 years. He was even better known as a surgeon, being on the staff of three teaching hospitals and recognized as the most skilful lithotomist of his time. His achievements are on record and he must be regarded as one of the greatest of British surgeons. Perhaps his greatest impact was his strong advocacy for the separation of surgeons from the Barber-Surgeons' Company. He realised how much this long-established relationship was delaying the advancement of surgeons and surgery, and his vigorous action resulted in an Act of Parliament that severed the old ties and established in 1745 the Corporation of Surgeons, forerunner of the Royal College of Surgeons of England.     

Learning the surgical craft: a review of skills training options

Surgical practice is undergoing fundamental changes, and this is having a significant effect on the training of surgeons. Learning the craft of surgery is threatened by reduced elective operative exposure and general service cuts within public teaching hospitals, safer working hour legislation and pressures to accelerate the training of young surgeons. Rapid technological changes mean that 'old dogs' have to teach 'young dogs' many new tricks in a relatively adverse environment. This review outlines the great variety of resources available for skills-based training outside the operating room. These resources are ready to be used as a necessary adjunct to the training of competent surgeons in Australasia.     

SIR DOUGLAS SHIELDS (1876–1952) A FORGOTTEN AUSTRALIAN SURGEON*

The remarkable and colourful career of sir douglas shields of melbourne is unparalleled among australian surgeons of his generation: murray morton describes it as a romance. He graduated in 1897 and was, in turn, a country general practitioner, the principal medical officer of an overcrowded plague-ship bringing home soldiers from the boer war, senior surgeon of st vincent's hospital. Melbourne then, in london, surgeon-in-chief of his own hospital converted to the ‘hospital for wounded officers’ with promotion to the ranks of brigadier-general and rear-admiral, then knighted and, finally, a consultant surgeon with private hospitals in park lane and in cannes, and with patients largely drawn from the aristocracy, the rich and the famous. His name is now virtually forgotten in australia but, for many years after he left melbourne in 1912, stories used to be told about his career and experiences, many of which had little basis in fact, and even the two brief biographical accounts of his career by murray morton and ormond smith contradict each other. This paper will, i hope, help to preserve the memory of sir douglas shields whom ormond smith considered ‘one of the brightest ornaments of the medical school of the melbourne university’.     

Surgical history of ancient China: part 1

Although surgery was an accepted and quite proficient craft very early on in Chinese history, it has deteriorated through the ages. Despite the fact that anaesthetic agents in major surgery were employed during the third century, Chinese surgery is conspicuous by its stagnation. Reverence for the dead, filial piety, abhorrence of shedding blood and other conservative attitudes make it impossible for any accurate knowledge of the human anatomy and physiology, without which surgery cannot progress. This article surveys some highlights in the history of surgery in ancient China and examines the factors responsible for its decline. The second concluding part deals with orthopaedics.     

Virtual teaching in the COVID era: Providing surgical core trainee teaching via online webinars and videoconferencing

ObjectiveDuring the COVID-19 pandemic, regular teaching for core surgical trainees (CSTs) in Northern Ireland was cancelled at short notice, leaving a significant gap in training. We aimed to develop an effective core surgical teaching programme, within the remit of government regulations, to ensure training was not negatively affected by COVID-19.Design, setting and participantsA novel virtual teaching programme was designed and implemented regionally across Northern Ireland. One-year free Affiliate Membership to the Royal College of Surgeons of Edinburgh (RCSEd) was provided for Northern Ireland CSTs, allowing access to RCSEd online webinars. A weekly teaching schedule based on the Member of the Royal College of Surgeons (MRCS) exam curriculum and accompanied by a webinar was created and disseminated to trainees. Senior surgeons were recruited to conduct a virtual teaching session via videoconferencing.ResultsTen teaching sessions were conducted over three months. Feedback was collated, with positive results and requests for virtual teaching to continue. As such, the Northern Ireland Medical and Dental Training Agency (NIMDTA) adopted the teaching programme as their new primary method of central teaching for Northern Ireland CSTs during the pandemic.ConclusionA novel, highly successful teaching programme was developed in Northern Ireland to meet the training needs of CSTs resulting in a sustained change to training. Virtual surgical teaching can be as effective as face-to-face didactic learning and may be imperative in a foreseeably socially distanced world.     

Surgical history of ancient China: part 2

In this second part of ancient Chinese surgical history, the practice of bone setting in China began around 3000 years ago. Throughout this period, significant progress was made, some highlights of which are cited. These methods, comparable with Western orthopaedic technique, are still being practised today. In conclusion, the possible reasons for the lack of advancement in operative surgery are discussed, within context of the cultural, social and religious background of ancient China.     

Surgical inclination and anatomy teaching at the University of Auckland

BACKGROUND: Medical graduate interest in surgery has declined and medical students are less capable in anatomy than they once were. Declining interest in surgery is because of factors, including growing number of women entering medical school. There has been less emphasis in teaching anatomy at various medical schools in recent years. The aim of this study is to quantify surgical inclination in Auckland medical students to assess whether gender differences exist in surgical inclination and determine confidence in anatomy knowledge and resources used by Auckland medical students. METHOD: Survey design was cross-sectional and included 25-point questionnaire using Likert scale response ranking and tick box replies. Two hundred and eighteen surveys were emailed to functioning addresses of fourth and fifth year students at University of Auckland, School of Medicine, New Zealand. RESULTS: Response rate was 71.6%. Twenty per cent of students were found to be surgically inclined (95% confidence interval, 0.15-0.26). The proportion of surgically inclined men was significantly higher than women (P < 0.05). Thirty-three per cent of all respondents (95% confidence interval, 0.26-0.41) felt their knowledge of anatomy was adequate to practice medicine safely. Textbooks and atlases were most commonly used to learn anatomy (P < 0.05). Radiology was the least commonly used method to learn anatomy (P < 0.05). Eighty-seven per cent (95% confidence interval, 0.81-0.92) of respondents agreed that revisiting dissection during surgical attachments would be helpful. CONCLUSION: Men are significantly more likely to be surgically inclined than women at the University of Auckland. A significantly greater proportion of students felt that their knowledge of gross anatomy was inadequate for safe medical practice. Students use traditional methods to learn anatomy more commonly than radiological methods. The majority of students surveyed would like to revisit cadaver dissection during clinical attachments in surgery.     

'MRS L.‘S CASE’: A CELEBRATED SOUTH AUSTRALIAN SURGICAL CASE

This paper concerns a dispute at the adelaide hospital in september 1896 between professor archibald watson, pathologist, honorary consulting surgeon and sole remaining university teacher at the hospital, and alexander disney leith napier. Who had arrived from england to fill the place of the honorary surgeons who had resigned from the hospital. Watson accused napier of incompetence in his management of ‘mrs l.’, who died after a femoral hernia operation. Mrs l had a form of internal hernia causing intestinal obstruction, whereas all the medical attendants, including watson, originally thought an old femoral hernia was the cause of her illness. By fortuitous coincidence the operation on the femoral hernia could have cured the internal hernia if the band of omentum attached to the femoral hernia had been divided. Watson became aware of the band at the post-mortem and then asserted that the operation should have taken it into account. Napier complained to the board of the hospital, alleging that watson had misrepresented the facts when he conducted the post-mortem on the patient and that he was disloyal to the hospital. The board found the complaint proved and invited watson to resign; he declined and was dismissed. Undaunted, watson circulated a privately printed pamphlet (entitled ‘mrs l.'s case’), which re-stated the events of the case and graphically described his post-mortem findings. It was submitted to the chairman of a select committee of the legislative council of south australia established to review the running of the hospital. The committee recommended the setting up of a royal commission but the government let the matter lapse. The opportunity for continued clinical teaching of students at the adelaide hospital, already poor when this dispute started, was lost. Only the balm of time and the spirit of compromise healed the rift and allowed clinical teaching to begin again in 1900. The lessons in this cautionary tale are considered.