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Nicholas Senn and the Origins Oj the Association Ojmilitary Surgeons Oj the United States

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Nicholas Senn and the Origins Oj the Association Ojmilitary Surgeons Oj the United States MILITARY MEDICINE, 164, 4:243, 1999 MILITARY MEDICINE ORIGINAL ARTICLES Authors alone are responsible for opinions expressed in the contribution and for its clearance through their federal health agency. If required. In Days Gone By Downloaded from https://academic.oup.com/milmed/article/164/4/243/4832094 by guest on 27 September 2021 Dale C. Smith, PhD Nicholas Senn and the Origins oj the Association ojMilitary Surgeons oj the United States n 1891, Dr.Nicholas Senn,SurgeonGeneral ofthe Wisconsin mately 2-hour meeting following the opening dinner I National Guard,invited his colleagues, the SurgeonsGeneral (8:30-10:30 p.m., September 17,1891, with Dr. Woodward of ofthe National Guardin otherstates, and theirassociatestojoin Michigan in the chair), CPT W.W. Wilson (Indiana National him for a day of intellectual exchange and discussion about Guard) moved to name the organization the Association ofMil­ establishing an organization of National Guard surgeons. Dr. itarySurgeonsofthe National Guardofthe United States. Com­ Senn was a leader of American surgery, a professor at Rush mitteeswere appointed todrafta constitutionand bylaws and to Medical College and the Chicago Polyclinic Medical School. His designa badge; Senn'sprearrangedprogram waspresentedand colleagues were not as eminentin American surgerybut were, adopted as well. Senn's invitations outlined the purpose he forthe mostpart, committed to providing the best carehumanly envisioned: "The advancement ofmilitary and accidentsurgery possible for their militia patients. Six state Surgeons General and allthingspertainingto the health and welfare ofthe civilian attended, and 15 guard organizations were represented; soldier." At the Chicago Polyclinic meeting on the afternoon of the total attendance approached 50 part-time military medical the 18th, a constitution and bylaws were adopted that estab­ officers. lished those objectives. The program ofthat organizational meeting includeda lot of Things "pertaining to the health and welfare of the civilian informal fellowship time: an opening banquet at the Leland soldier" were in a state of flux in 1891. Two members of the Hotel, a luncheon at the Union Club of Chicago, and a closing constitution committee at the meeting fully understood that reception at the Dearborne Avenue home of Dr. Senne The in­ sanitaryreform wasrapidly becoming scientific preventive med­ tellectual content included a morning clinic at Rush Medical icine. COL CharlesAlden, MC USA, was medical director ofthe College "illustrating gunshotwoundsand osteomyelitis" and an Department of Dakota and fully understood that disease was afternoon ofpapers that included J.D. Bryant's"Concerning the the great waster of armies. In 1893, when Surgeon General Organization ofthe National Guard" and C.M. Woodward's "The George Sternburg,MC USA, opened a newArmy Medical School Civilian Soldier: HisDiseases and Hygiene." in Washington, DC, he selected COL Alden as the president of The invitations were extended about September 1 for the the faculty. (Alden wasoneofmanyregularmedical officers who September 17 and 18 gathering, but it seems likely that Dr. participated in AMSUS between 1891 and 1893, whenmember­ Senn had been working with others for sometime to bring the ship was officially opened to regular officers.) Also on the com­ meeting together. Bryantwas SurgeonGeneral ofthe New York mitteewas Dr. C.A. Wheaton, the health officer for the state of National Guard and the only other attendee who, retrospec­ Minnesota and Surgeon General of the Minnesota National tively, approached Senn in stature. Woodward was the Acting Guard. UnderWheaton's direction, a public health laboratory Surgeon General of the Michigan National Guard. Both were wasestablishedbythe state and a regularprogram oflaboratory busy men, and it is reasonable to assume that they had more service and research was begun. Over time, disease and all than 3 weeks notice of Senn's intentions. Dr. Horace Brown aspects of military health care would be important parts of recalled that Senn begandiscussingthe need forsuch an orga­ AMSUS programs, but the verylack ofspecificity suggeststhat nization the previous spring. 2 theywere not Nicholas Senn's primarymotivation in calling the The business of the meeting was carried forward with dis­ meeting; changesin military and accidentsurgery, i.e., trauma patch, further suggesting previous planning. In an approxi- surgery, wereSenn's primaryconcern. 243 Military Medicine, Vol. 164, April 1999 244 Nicholas Senn and the Origins of AMSUS In 1891, trauma surgerywasin the earlystagesofa phenom­ ideas on surgical pathology and bacteriology, the techniques of enal transformation. Senior members of the National Guard modemsurgeryfrom American and Europeanclinics were dis­ medical service had practice memories of Civil War surgery, cussed at ASA meetings. Improvements in anesthesia, antisep­ whereas the younger members had been trained in the new sis and asepsis, and anatomical knowledge led to an increas­ antisepticand asepticsurgerybased on a knowledge ofspecific ingly radical American school of surgery that believed in the germs that were the etiological agents ofwound infection. The power ofthe knife to heal.Inthe mid 1880s, this enthusiasmfor recently completed Medical and Surgical History oftheWarofthe surgical therapy led to a reevaluation of surgery in trauma, Rebellion documented the real limitations ofthe expectantcon­ particularly gunshotwoundsofthe abdomen. Thereportsin the servatism that wasthe best that pre-germ-theory surgeryhad to u.S. medical journal literature illustrate this interest. In 1881, offer. Although the regular army surgeons had obtained some there was 1 reportofabdominal sectionaftergunshotwounds; limited experience in military trauma in the campaigns against in 1884, therewas another; in 1885, therewere 6; and in 1886, there were 24. the Native Americans, the majority ofmilitia surgeonshad not Downloaded from https://academic.oup.com/milmed/article/164/4/243/4832094 by guest on 27 September 2021 been mobilized sincethe end ofthe Civil War, a quarter century In 1886, Nicholas SennwasChairmanofthe Surgical Section earlier. How were the newideasand trauma surgeryexperiences ofthe AMA and gave his address from the chairon the status of to be communicated to those whomightneed them?ToSenn, abdominal surgery. He noted the changing status of surgical and to most other physicians of the later 19th century, the therapy: "During the last few years surgery has assumed a answerwas a medical society. decidedly progressive and aggressive character." In his exten­ Medical societies beganin North America as an effort to both sive discussion ofthe recentworkongunshotwounds, he noted, ensure quality and provide for professional exchange and con­ "Procrastination and transportation are dangerous factors in tinuing education. Local and colonial/state societies were sel­ the treatmentofthis classofinjuries." Henotedthat the natural dom able to meet fully all oftheir objectives in the antebellum historyofgunshot woundswas not well understood and called period, and the nationalsociety-the American Medical Associ­ for careful experimentation and clinical reporting to settle the ation (AMA)-founded in 1847 had only moral suasion to proper therapy for different groups of patients. Similarly for achieve its goals. In the last third of the century, the general wounds ofthe liver, he believed "thatwithpropersurgicaltreat­ societies were joined by specialist societies with more limited ment injuries ofthe liver would not be attended by such great objectives." mortality as has been the case on the expectantplan of treat­ The earliest specialty societies were limited associations of merit." self-selected experts, most of whom limited their practices or TheASA meeting of1887featured a discussionofthe surgical wished to do so. Medical school appointments were common treatment ofgunshot wounds, prompting a series ofpapers by among these practitioners. Ophthalmologists ledthe way, form­ Charles Nanarede of Philadelphia, R.A. Kinloch of Charleston, ingthe American Ophthalmological Society in 1864, and others and W.W. Keen ofPhiladelphia. Kinloch reported only onecase, followed as there were enough proto-specialists to sustain an notingthat "the present attitude oflaparotomy fortraumatism organization: the American Otological Society (1868), American is such that it should be regarded as imperative with the pro­ Neurological Society (1875), American Dermatological Associa­ fession to report every case occurring in practice." The discus­ tion (1876), American Gynecological Society (1876), etc. These sion illustrated the realization that simple penetrating trauma groups met annually to exchange specialized knowledge and was usuallyself-limited. T.G. Richardson ofCharity Hospital in techniques, to discuss common problems, and to enjoy the New Orleans noted that 24 of 31 patients with knife wounds fellowship of like-mind practitioners. All were initially small, recovered, whereas only 13of33 patientswithgunshotwounds usually fewer than 50 practitioners, mostly from the several recovered. Theincreasedpossibility ofvisceral injuryin gunshot largercitiesin the nation.Although self-selected and limited in wounds was the key difference, and the diagnostic challenge membership, theywere relatively inclusive becauseofthe small was identified as determining which patients had sustained number ofpractitioners choosing to limittheir practicesin the visceral injury. Moses Gunn of Chicago caught
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