Guy de Chauliac and “What the Surgeon Ought to Be”

In 1951, the American College of Surgeons (ACS) received a beautifully embossed scroll from Robert P. Dobbie, MD, FACS, professor of clinical surgery, University of Buffalo, NY, and attending surgeon, Buffalo General Hospital. Dr. Dobbie was planning to present a framed copy of the scroll, printed with the words of surgeon Guy de Chauliac and titled “What the Surgeon Ought to Be” to young graduating resident surgeons. Expressing his appreciation for the theme’s “brevity, comprehensiveness, and adequacy, greatly enhanced by its source and the date of its origin,” Dr. Dobbie believed the statement was a potential influence for good, especially among new surgeons.¹

“What the Surgeon Ought to Be”

The conditions necessary for the Surgeon are four: First, he should be learned; Second, he should be expert; Third, he must be ingenious; and Fourth, he should be able to adapt himself.

It is required for the First, that the Surgeon should know not only the principles of surgery, but also those of medicine in theory and practice; for the Second, that he should have seen others operate; for the Third, that he should 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 sure things, and fearful in dangerous things; let him avoid all faulty treatments and practices. He ought to be gracious to the sick, considerate to his associates, cautious in his prognostications. Let him be modest, dignified, gentle, pitiful, and merciful; not covetous nor an extortionist of money; but rather let his reward be according to his work, to the means of the patient, to the quality of the issue, and to his own dignity.

Ars Chirurgica

At the ACS Board of Regents meeting on April 14, 1951, ACS Director Paul R. Hawley, MD, FACS(Hon), and Eleanor K. Grimm, Administrative Executive and Secretary, ACS Board of Regents, reported on the letter and scroll that Dr. Dobbie sent and his desire to have this statement printed and presented to Junior Candidates of the ACS. The Board of Regents looked favorably on this suggestion, and unanimously voted to finance the production of the scroll and present a copy to young surgeons as they became Junior Candidates or Fellows of the American College of Surgeons (see Figure 1).²

Figure 1. “What the Surgeon Ought to Be” scroll

A “father of surgery”

Guy de Chauliac, widely regarded as a “father of surgery,” was a strong advocate for professionalism and nontechnical skills (see photo). His framework of professionalism was based on four domains: being learned, expert, ingenious, and adaptable.³ Born in France in the late 13th century to a poor peasant family, Chauliac was supported by an ecclesiastical scholarship to study medicine. He undertook a fellowship in anatomy under Nicola Bertuccio in Bologna, Italy, and a surgical fellowship in Paris before receiving his master of medicine in 1325 from the University of Montpellier, France. After studying in Bologna and Paris, he began surgical practice, eventually invited to the Papal Court in Avignon, where he served as a physician to three popes.⁴

Chauliac went on to publish Chirurgia Magna in 1363, a surgical text drawing on both antiquarian and contemporary thinking from a variety of scholars on anatomy, surgical disease, and treatment. The book is a compilation of medical history, anatomy, the art and science of surgery, personal observations, and recommendations to surgeons and students concerning 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, aposthema, wounds, ulcers, fractures, special diseases, and an antidotary. In addition, Chauliac included a preface on professional requirements for all surgeons, including a piece on the four characteristics of a competent and proficient surgeon. An English translation of those four characteristics was cited by G.H. 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 through the early 1960s and made prints available for purchase by Fellows of the College. The ACS Archives contains copies of the original print, and the pictured digital version is available through 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 D. F. Robertson, MD, FACS, of Wilmington, NC.⁷

References

1. American College of Surgeons. “What the Surgeon Ought To Be.” Bull Am Coll Surg. 1951;36(2):122.
2. American College of Surgeons. Board of Regents: Minutes April 14, 1951. Archives of the American College of Surgeons, Chicago, IL.
3. Watters DA. Guy de Chauliac: Pre-eminent surgeon of the Middle Ages. ANZ J Surg. 2013;83(4):730-734.
4. Fields A. De Chauliac and the art of surgery. Angiology. 1955;6(3):277-279.
5. Haller JD. Guy de Chauliac and his Chirurgia Magna. Surgery. 1964;55(2):337-343.
6. Murphy, GH. The surgery of Guy de Chauliac. Can Med Assoc J. 1951;65(1):68-71.
7. American College of Surgeons. Library and Department of Literary Research: The human element. Bull Am Coll Surg. 1937;22(1):28-30.