The lights go out in Europe during the 1914 Clinical Congress

The American College of Surgeons (ACS) convened its first Convocation in November 1913 in Chicago, IL. The second Convocation would take place the following June, followed by the Clinical Congress in London, U.K., at the end of July 1914. While American surgeons were traveling to and attending the Clinical Congress, unexpected events on the European continent led to the outbreak of World War I. This article explores the ACS’ ties to Europe at the time and the political and military developments that overshadowed the Clinical Congress in 1914.

The ACS’ European roots

The College’s European heritage was recognized at the first Convocation by conferring Honorary Fellowship upon Rickman Godlee, MD, FRCS, FACS(Hon), the nephew of Joseph Lister, MD, FRCS, and President of the Royal College of Surgeons of England (see photo).¹ Professor Godlee conveyed the good wishes of the Royal College and proposed that the next North American Clinical Congress take place in London, U.K.

Honorary ACS Fellowship also was awarded at the first Convocation to William S. Halsted, MD, FACS, of Johns Hopkins University, Baltimore, MD. Dr. Halsted’s many connections to the German-speaking parts of Europe had led recently to a resident exchange with Prof. Hermann Küttner of Breslau (then part of the German Empire, today Wrocław, Poland). Professor Küttner’s assistant, Albert Bauer, had already visited Baltimore, and another assistant, Felix Landois, would arrive in January 1914; Hopkins resident George Heuer, MD, was to take the place of Landois in Breslau later that year.^2,3

The Société Internationale de Chirurgie (SIC) hosted its meeting in New York, NY, in April 1914, providing further evidence that American surgery was gaining the attention of European physicians. The SIC was a predominantly French-speaking organization that had met three times previously in Brussels, Belgium. Prof. Antoine Depage (see photo), who had led a Belgian humanitarian mission (that included his wife Marie, a nurse) during the localized Balkan Wars of 1912–1913, delivered the presidential address on war surgery.⁴ The editor of the Annals of Surgery later recalled that the topic came as a surprise, “for nothing was farther from the thought of the scientific world at that moment than War.”⁵

The ACS convened its second Convocation in Philadelphia, PA, on June 22, 1914 (see photo). A week later, the Austrian Archduke Franz Ferdinand was assassinated by a Serbian nationalist in Sarajevo, Bosnia (a province that had been annexed to the Austrian Empire in 1908 with considerable controversy). However, for millions of ordinary Europeans, and certainly for Americans, one more disturbance in the troubled Balkan Peninsula initially did not seem to be a cause for alarm.^6,7 On the day after the assassination, Dr. Heuer wrote to Dr. Halsted about his enthusiastic welcome in Breslau, which had included Dr. Bauer meeting him at the railroad station waving an American flag.² Dr. Halsted, who had attended the Deutsche Gesellschaft für Chirurgie Congress in April (receiving another honorary fellowship), crossed the Atlantic again in July to visit his friend Prof. Anton von Eiselsberg (see photo), the successor to Theodor Billroth, MD, in Vienna.⁸

Approximately 1,500 other American surgeons made the transatlantic journey to attend the Clinical Congress in London, scheduled for the last week of July.⁹ ACS founder Franklin Martin, MD, FACS, and his wife were accompanied to Europe by their niece, who went on to visit school friends in Munich.¹⁰

After Dr. Halsted’s visit in July, Professor Eiselsberg traveled to England with his 10-year-old daughter, who was recuperating from an appendectomy; while papa was at the Clinical Congress, she would stay with her older sister, who had been studying English on the Isle of Wight for the past year.¹¹ Many Americans intended to visit Germany, Austria, or Switzerland during their time in Europe, as these countries were the acknowledged leaders in surgical science and education.

Also among those traveling to London were “50 women, who are reckoned among the most skillful surgeons in the United States.”¹² King George V had expressed an interest in meeting some of the visiting surgeons but had been advised that this would be unwise because “it is difficult to avoid the presence of militant suffragettes in any large gathering of strangers in the palace.”⁹

Tensions in Europe build

An unexpected and more serious threat to these peaceful social and scientific arrangements occurred July 23, when the Austrian government sent an ultimatum to Serbia. Members of the American Gynecological Club visiting Freiburg, Germany, were struck by the apparent enthusiasm of university students for a possible war.¹³ On July 26, Serbia agreed to most of Austria’s demands, but the Austrians were still dissatisfied. The Russian government reiterated its long-standing support of Serbia, and Germany confirmed its support of Austria; everyone knew that France had a military alliance with Russia. However, similar crises had been managed diplomatically in recent years.⁶

The ominous events of the weekend were reported in The London Times on Monday, July 27, along with a feature story about the opening of the Clinical Congress. “We are a democratic body working for the good of the average surgeon,” Dr. Martin explained to a reporter. “If there is anything new in London, we shall soon be doing it in the United States.”¹² Participants observed operative procedures at many of London’s historic hospitals during the day, and a select group met for dinner at the Cecil Hotel. After welcoming statements by Congress President J. B. Murphy, MD, FACS, U.S. Ambassador Walter Hines Page, Professor Godlee, and others, Professor Eiselsberg led the scientific session by discussing operations for stomach ulcer.¹⁴

The clinical program for Tuesday focused on cancer surgery, with special presentations about X rays, anesthesia, and physical therapy. After dinner, Liverpool orthopaedist Robert Jones, MD, FRCS (see photo), gave a lighthearted talk about knee injuries, a topic he had decided was important for American surgeons, according to The Times, “because their games, like our own, were rough and we in England knew to our cost that American youths were very skilled and strenuous. [Professor Jones] was credibly informed that the anatomy of the knee joints of American youths differed but little from our own, and he was forced to conclude that either their cartilages were more securely placed than ours or, which was most unlikely, that the situation was not so generally recognized as it should be.”¹⁵ That evening, July 28, Austria declared war on Serbia.

Professor Eiselsberg rose early Wednesday morning, collected his daughters from the Isle of Wight, took the first available ferry across the English Channel to Belgium (where porters heard them speaking German and refused to help them with their luggage), and eventually made his way home to Vienna.¹¹ Back in London, the Clinical Congress proceeded with a visit to the Royal College of Surgeons and its famous museum, along with surgical presentations at several London hospitals and formal evening papers read at the Cecil and Savoy Hotels. Charles Mayo, MD, FACS, described his experience with several thousand thyroidectomies.¹⁴ Dr. Martin was again interviewed by the Times and rendered a favorable opinion of British surgeons, but he regretted the inconsistent hospital facilities available to patients of different social classes.¹⁶ Austria bombarded Belgrade, the Serbian capital, and the British fleet concentrated at its base on the North Sea.⁶

The Thursday sessions of the Clinical Congress continued to emphasize practical surgery. “At University College Hospital, Mr. Herbert Tilley showed a number of foreign bodies removed from the lungs and gullet by the bloodless method of introducing through the mouth an electrically illuminated tube.”¹⁷ Treatment of inoperable cancer using radiation was discussed, although the application of heat was felt to be more promising. In the middle of a discussion about breast cancer, a woman in the audience stood up on a chair, “began to make a suffrage speech,” and had to be forcibly removed.¹⁴ On this day, July 30, the Russian Army began to mobilize, while the French Army took the unusual step of withdrawing 10 kilometers from the German border to avoid any pretext for hostile action.⁶

“It is a great satisfaction to know that British surgery has emerged from the ordeal of the Clinical Congress, which has been held in London this week, with its old reputation enhanced rather than impaired,” according to an editorial in The Times Friday, July 31.¹⁸ “Science is said to know no international boundaries and to be free from those jealousies which have today once more summoned the awful spectre of war between the nations. It is not wholly true.”

War impedes travel home

Despite all these diplomatic and military distractions, the Clinical Congress completed its scheduled activities August 1. The Lancet published a summary that day stating, “Alas! the political condition in Europe compelled the hasty return to the continent of some of our distinguished confrères.”¹⁴ Nevertheless, the New York Times reported the same day that “scores of Americans are still going to Austria, including many surgeons attending the Clinical Congress, who are sticking to their original plans and say they are determined to see the famous clinics of Vienna, war or no war.”¹⁹

On the same day, Germany declared war on Russia and demanded that France remain neutral and surrender her border fortifications as a guarantee. After France refused, Germany began an invasion through neutral Belgium, a treaty violation that would lead Great Britain to join the Allies August 3.⁶

Approximately 20,000 Americans were now stranded in London,²⁰ including many of those surgeons and their families who had come to England for the Clinical Congress. Americans who had crossed the Atlantic on German ships found that their return reservations had been canceled, and there was a scramble to find other transportation.¹⁹ The Savoy Hotel became headquarters for Ambassador Page and for the volunteer organizations who came to the travelers’ aid. Herbert Hoover, an expatriate American mining engineer and businessman who lived nearby, soon took charge of this effort, his first venture into the humanitarian activities and public service that would make him famous.⁷ Dr. Martin’s dramatic trip home, first crossing the supply lines of the German Army to retrieve his niece from Munich, was described in the July 2018 issue of the Bulletin.^10,21

As the German Army was overrunning his country, Professor Depage’s presidential address from the April meeting of the SIC was published in the August issue of the Annals of Surgery, along with English translations of the principal scientific papers.²² The Depages were able to escape occupied Belgium through neutral Holland and organized a military hospital in the small southwestern corner of Belgian territory that remained behind Allied lines.²³ Marie Depage embarked on a fundraising trip to the U.S., from which she was destined not to return home, lost along with other passengers on the Lusitania in May 1915.

The exchange residents in Baltimore and Breslau also hurried back to their home countries. When Dr. Halsted heard that Landois’ ship had been detained at Gibraltar, he contacted his former colleague William Osler, MD, who agreed to intervene with the British authorities to have him released.³ By the end of the year, Landois would be on the staff of a field hospital in Ledeghem, Belgium, just across the trenches from Professor Depage’s hospital, and he managed to send a letter of thanks back to Dr. Halsted.³ Dr. Bauer was serving in occupied France, where he would be killed a few months later.^3,24

During the first few months of the war, most American surgeons officially adhered to the neutrality proclaimed by President Woodrow Wilson. In November, the ACS held its third Convocation in Washington, DC. Edward H. Bradford, MD, FACS, of Boston, MA, honored French and British surgical pioneers of the 19th century but equitably acknowledged “the wonderful rise of German surgery to which we are all such debtors.”²⁵ 1914 has been the only year with two ACS Convocations, and its eventful Clinical Congress remains the only one ever held outside of the U.S. or Canada.

Lights out

“The lamps are going out all over Europe,” the British Foreign Secretary had remarked on August 3.⁶ The European continent would indeed pass through a dark age, and it was fortunate that American surgery had developed a durable organizational structure in time to carry the torch forward.

Acknowledgment

Dr. Clark’s research was supported in part by the 2018–2019 History and Archives Committee of the ACS Archives Fellowship.

References

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