SURGICAL HUMANITIES DEPARTMENT of SURGERY | UNIVERSITY of SASKATCHEWAN Spring/Summer 2018 Journal of the SURGICAL HUMANITIES

Journal of the SURGICAL HUMANITIES DEPARTMENT OF SURGERY | UNIVERSITY OF SASKATCHEWAN Spring/Summer 2018 Journal of the SURGICAL HUMANITIES

EDITOR-IN-CHIEF Francis Christian CONTENTS EDITORIAL BOARD Francis Christian Ivar Mendez Taras Mycyk Justine Pearl Ronald Nguyen Haisen Marlessa Wesolowski David Swann

GRAPHIC DESIGN, COMMUNICATIONS AND MARKETING Department of Surgery University of Saskatchewan

COVER PAGE Portrait of Wilder Graves Penfield Iris Hauser We thank the artist Iris Hauser for the image of the original piece of art and the description of the painting.

Journal of the Surgical Humanities c/o Surgical Humanities Program Department of Surgery University of Saskatchewan

Health Sciences Building 107 Wiggins Road, 4th floor, Suite B419 Saskatoon SK S7N 5E5 TEL: 306.966.7323 http://medicine.usask.ca/department/clinical/surgery-pages/surgicalhumanities.php

2 | JOURNAL OF THE SURGICAL HUMANITIES 04 EDITORIAL Francis Christian

06 WILDER PENFIELD OF MONTREAL: BRAIN CARTOGRAPHER Jose Francisco Tellez Zenteno and Lady Diana Ladino

09 COVER ART: PORTRAIT OF WILDER GRAVES PENFIELD Iris Hauser

10 SIR, I REQUEST THE HONOUR OF... JOSEPH LISTER & EDINBURGH Steven Kerr

26 OSLERIUM Francis Christian

29 CHAUVINISM IN MEDICINE PART 2 Sir William Osler

32 THE HAND TIE Ronald Nguyen Haisen

38 STR8-UP FROM DESPAIR TO HOPE MOVEMENT HELPING GANG MEMBERS Fr. Andre Pollievre

44 ZHIVAGO: DOCTOR IN LITERATURE Excerpts from memoirs of R. M. Kirk Chapter 7

Portrait of Wilder Graves Penfield 50 SUBMISSION GUIDELINES by Iris Hauser (Detail)

JOURNAL OF THE SURGICAL HUMANITIES | 3 EDITORIAL

Francis Christian, FRCSEd, FRCSC Department of Surgery University of Saskatchewan

n Aldous Huxley’s original the pervasive use of search the simple rubric of enduring sci-fi novel, “Brave engine generated patterns of value through the ages, how New World,”(1931) the algorithmic behavior by modern much of the pop culture that government makes the drug man. The “directors” in the is consumed in the twenty “soma” freely available to government of the “Brave New first century through the Iits population. “Soma” has a World” have another specific search engine and online multitude of effects, including goal – that of eliminating, encyclopedias will endure? the ability to make people through the use of “soma” forget about their troubles for a the time between desire and A careful, detailed, examination while and to carry on with their fulfilment. Predictably, the of our own history is essential superficial lives as if nothing “fulfilled” desire then induces to our survival. It is not only untoward could ever affect their a sense of superficial joy that the fictional “soma” that has lives again … until of course, precludes further inquiry or achieved the objective of the time approaches for the even the proper use of logic. mass control of nations by next dose of soma and the next making its people forget their … and ever more quantities As men and women of science history. The erstwhile Soviet of “soma” are needed, with the it would be folly for us to Union forbade its citizens to dysfunction in society reaching denigrate the enormous remember or celebrate key a rising crescendo of despair. benefits to mankind that have areas of Russia’s history and the flowed from the free exchange “soma” of communism and mass This Journal shall not speculate of information on the internet. thought control was achieved - as several experts and the Its inestimable benefits to through torture, imprisonment popular press have done - as science, however, cannot and summary executions. to how accurately Huxley’s automatically be assumed The remembered Russian frightening world can be to apply in the same way to heroes who engineered the extrapolated and applied to the humanities and the arts. fall of communism are not its modern times, with widespread Pop culture has the ability to scientists – but rather its poets, uses of allegedly equivalent heavily influence the search priests and novelists, from Boris drugs. But there is no doubt engine – and the pleasure this Pasternak, and Mikhail Bulgakov whatsoever that “soma’s” apparently gives millions of to Alexander Solzhenitsyn chilling ability to induce a people every day cannot be and Joseph Brodsky; their state of repetitive, predestined wished away or judged. But common “crime” was recalling behavior can be mimicked by if we are to measure art by culture, faith and the past to

4 | JOURNAL OF THE SURGICAL HUMANITIES College and will be able to relive Lister’s eventful times anew.

Fr. Andre Pollievre’s fascinating, hopeful account of the work of STR8 UP in persuading members of gangs to abandon their gang lifestyles and “master their own destiny,” (pages 38-43) is of direct relevance to the work of the physician and surgeon and in particular, the trauma surgeon. There is an explosion of gang related trauma in our inner cities and we cannot remain isolated from the causes of gang violence and its remedies; such an inquiry is also an exercise of fundamental, deductive logic about causes and effects.

An underlying principle and pillar of Fr. Pollievre’s work with STR8 UP is the attempt to reconnect motivated gang members to the rich traditions of their historical pasts through the ancient, indigenous device of the medicine wheel. Art, poetry and literature then help ex-gang members to forge a millions under the yoke of to know about Joseph Lister’s new destiny for their lives. The totalitarianism. life and times and his great triumphs of modern trauma discovery. and intensive care give gang It has been said that Sir Joseph The history of Joseph Lister’s members, even grievously Lister’s discovery of antisepsis is association with Edinburgh and injured ones, their physical lives of such fundamental historical its Royal College of Surgeons back. But, as Louis Riel once importance as to rise to the is the subject of the College said, “My people will sleep for level of dividing the whole field librarian Steven Kerr’s elegantly a hundred years and when they of surgery into surgery before crafted historical essay in this awake, it will be the artists Lister … and … surgery after issue of the Journal of The who will give them their spirits Lister, in the same manner that Surgical Humanities. Through back.” we divide all of human history Steven Kerr’s essay (pages 10- itself into BC and AD. It must 25), readers of the Journal will behoove every person, even have access to unique images remotely connected with the and exhibits from the preserved Francis Christian Editor-in-Chief practice of medicine therefore, archives and portraits of the

JOURNAL OF THE SURGICAL HUMANITIES | 5 WILDER PENFIELD of Montreal: BRAIN CARTOGRAPHER

José Francisco Téllez-Zenteno Division of Neurology, Department of Medicine University of Saskatchewan, Saskatoon, Saskatchewan, Canada

Lady Diana Ladino Neurology Section, Hospital Pablo Tobón Uribe University of Antioquia, Medellín, Antioquia, Colombia

Training and Travels: USA, England, Spain and Square in London where he developed a special Germany interest in epilepsy while doing a fellowship in Wilder Graves Penfield was born in Spokane, clinical neurology and neurosurgery (Figure 1). Washington, in 1891. He did his premedical degree in literature at Princeton where he In 1921 he completed his fellowship at London was a top student. By a meritorious Rhode and back in the United States, began to work scholarship he was accepted for admission as an associate surgeon at the New York at Oxford in 1915, where he completed a Neurological Institute and developed his surgical bachelor’s degree in sciences. In 1915 he began skills under Allen Whipple. In 1922 Penfield an extraordinary medical career in England, began to do experimental work in animals in where illustrious doctors surrounded him. From order to study the healing process of cerebral the mastermind of Sir William Osler he gained tissues. In his attempt to stain brain scars to inspiration and the sympathetic approach. From identify the cause of posttraumatic epilepsy, he Sir Charles Sherrington, he learned to observe was disappointed because of the failure to stain and document experimental findings. It was the non-neuronal cells of the brain. Penfield then that he decided to become a surgeon that thought these cells were crucial to elucidate why specialized in the brain, or as Cushing would a healing scar leads to epilepsy. So he decided say, he was “a neurologist who did his own to travel to Madrid to learn the techniques operating.” In 1917, he returned to the United from the masters in this field, Cajal and Rio States and completed his medical degree at Hortega. During his visit Penfield completed the Johns Hopkins University. He was surgical intern characterization of the “third element” of Cajal at the Peter Bent Brigham Hospital in Boston, (non-astrocyte glial cells) with the help of his serving as assistant to Harvey Cushing. Then Spanish mentor. he returned to the National Hospital at Queen

6 | JOURNAL OF THE SURGICAL HUMANITIES Figure 1. The cartographer: Wilder Penfield has been widely regarded as a “brain explorer," and a cartographer distinguished by his "cortical travels". Before his work, the brain was an unknown land. After him, the brain functions were mapped and the stimulation of some specific areas could evoke the deepest emotions and recall precise personal experiences, including emotions, sounds, and smells.

In 1927 Penfield spent 6 months in Breslau with Montreal Neurological Institute (MNI). Whilst in the German neurosurgeon Otfrid Foerster and Montreal, Penfield created a surgical approach learned his technique of electrical stimulation that became known as the "Montreal Procedure". of the cortex in patients awake under local He developed his method while his patients anesthesia. This method became an invaluable were fully conscious. Using local anesthetics tool in Penfield’s hands. It was then that Penfield he removed the skullcap to expose the brain. came to realize that surgical excision of a brain When he stimulated certain areas of the brain, lesion, after careful mapping of the motor cortex, the patients would be able to provide him could relieve a patient of focal epilepsy without feedback on what they were experiencing at that adding to neurological deficit. By 1928, Penfield very moment, and through this he could isolate and his surgical partner, William Cone, performed the damaged part of the brain (Figure 2). He their first operation in New York, utilizing the developed surgical treatment for epilepsy based “Foerster method”. The patient, a young man on this knowledge. The procedure involved previously treated for a head injury, had as many removing a portion of the temporal lobe. It was as 20 seizures each day and improved after eventually adopted throughout the world for its surgery. success in relieving patients of temporal lobe seizures. Interestingly, this surgical procedure Move to Montreal and the “Montreal Procedure” also opened a window to the mind, giving him At the end of 1928 Penfield accepted an a glimpse of how dreaming occurs, how memory invitation to move to Montreal. In 1934 he works, and where speech comprehension resides. founded and became the first director of the Penfield continued his research with Herbert

JOURNAL OF THE SURGICAL HUMANITIES | 7 Iris Hauser is a Canadian artist and painter. She is best known for her use of narrative and symbolism within portrait paintings and works primarily with oil paints. Hauser was born in Cranbrook, BC in 1956. At age 10, the family returned to her father’s hometown in Victoria, BC. Art studies brought her to Nova Scotia (1975), Saskatoon (1977- 79) and Germany (1979-80), and in 1980 she moved Figure 2. Epilepsy surgery: The operating theatre at the Montreal to Saskatoon to take up Neurological Institute, circa 1958. Wilder Penfield (center left) permanent residence. operating, is assisted by Herbert Jasper (upper left, in the glazed Hauser has taught art at gallery studying the electrocorticogram). The epilepsy patient is the Mendel Art Gallery awake under local anesthesia, in order to identify the epileptic in Saskatoon and at the focus by brain mapping. University of Saskatchewan's The patient is supported in the lateral position with pillows Certificate of Art and Design held in place by a plexiglass backrest, which is clamped to the program. She has served operating table. The sterile drapes are arranged to give the on the board of Canadian patient a large field of view, reducing the risk of claustrophobia. Artists Representation/ The window at left allows the photographer to have full exposure Front des Artistes Canadiens, of the operative room trough a mirror held by a boom rising at forty-five degrees from the side of the window (Wilder Penfield Saskatchewan and served as MNI Archive, 1954). a juror for the Organization of Saskatchewan Arts Jasper. Dr. Jasper, who had come to Montreal in 1938, introduced Councils. Her work has Penfield to the use of electroencephalography to locate the been collected by many origin of epileptic seizures. Using a series of electrodes attached patrons, including the to the skull, an electroencephalogram could measure the Canada Council Art Bank, electrical output of the brain. Because abnormal tissue gives the Saskatchewan Arts off different patterns than healthy tissue, a surgeon could Board, the University of target unhealthy tissue for removal to relieve seizures. Penfield Regina, the Kenderdine Art retired from the McGill medical faculty in 1954, but remained gallery and the Mendel director until 1960. Wilder Penfield died in 1976 at the age of Art Gallery, and has been 85 marking the end of a brilliant era in Canadian neurology, exhibited extensively in solo neurosurgery and basic science. and group exhibitions in public and private galleries Correspondence: throughout western Canada José F. Téllez-Zenteno, Division of Neurology, Dept. of Medicine and abroad. Recent paintings Royal University Hospital, 103 Hospital Drive, Box 26, Room 1622 may be viewed at Saskatoon, SK, Canada S7N OW8 irishauser.ca. Tel: +1 306 966 8011 Fax +1 306 966 8008 Email: [email protected]

8 | JOURNAL OF THE SURGICAL HUMANITIES Cover art: PORTRAIT OF WILDER GRAVES PENFIELD By Iris Hauser

have posed Dr. Penfield in the center, between two views of operating theatres: Ito the left, the MNI where Dr. Penfield did his groundbreaking research into mapping the brain from 1934 to 1954. On the right, the current operating theatre at the Royal University hospital/Sask Epilepsy Program in Saskatoon with the surgical team depicted (Cover image). In the foreground, Dr. Penfield is presented as though about to give a public presentation, with images from his publications fanned across a carved stone dais. From the left to right there are four visible documents. The first one is a surgical sketch after a craniotomy; the second one depicts the homunculus creature discovered and published by Penfield, the third one shows the homunculus location over the brain gyrus of both hemispheres, and the last one represents an original sketch of the cortical functional areas of the non- dominant hemisphere. The tabletop rests on a carved stone ram’s skull (the astrological sign symbolizing the brain), beside a brass plaque naming the MNI, with Penfield’s name and birth and death dates carved into the stone. On the tabletop are two bronze casts of the skull, which were made during Penfield’s tenure at the MNI. To the left are a few books and journals written by Dr. Penfield, including his novel “The Torch”, and a bible to represent his religious conviction. The books are supported by a bookend in the shape of a dragon, referencing his important work in China. Dr. Penfield sports a maple leaf pin that is the symbol of membership in the Order of Canada.

JOURNAL OF THE SURGICAL HUMANITIES | 9 "Sir, I request the honour of..." JOSEPH LISTER & EDINBURGH

Steven Kerr, Librarian The Royal College of Surgeons of Edinburgh

ince our sixteenth- of a man whom this author Joseph Jackson Lister (a wine century origins, The has heard described as having merchant and microscopist) and Royal College of “saved more lives than were his wife, Isabella (née Harris). Surgeons of Edinburgh killed in all the world’s wars It is worth noting that since has awarded its put together.” Hyperbole the early eighteenth century, Sprincipal qualification - College perhaps, but there can be little the Lister family had been Fellowship - to over 46,000 argument that Lister’s initiation members of the “Religious male and female surgeons in of the antiseptic era must Society of Friends”, the Christian over 100 countries across the rank – alongside James Young denomination known popularly globe. In addition, since 1671 Simpson’s efforts in the field as “Quakers”. To a Quaker, the almost 500 Honorary Fellows, of anaesthesia and Alexander pursuit of earnest endeavor and from all walks of life, have Fleming’s work with antibiotic hard work was to meet the will been admitted to the Fellows substances – as one of the most of God, so it is hardly surprising Roll. However, only two people significant contributions to that the young Lister devoted have been elected “ordinary” medicine. himself greatly to academic Fellows before going on to pursuits, excelling in natural receive Honorary Fellowship, Although we Scots often like history as well as the collection, and the association with the to claim the man and his preparation and dissection of city of Edinburgh of the first of achievements as one of our specimens. His father’s success these surgeons – Joseph Lister – own, Lister (unlike Simpson in the wine trade meant that forms the basis for this article. and Fleming) was born south the family were financially It is, of course, impossible in of the border, in Upton, Essex secure, but Joseph was schooled any project of limited size to on 5th April 1827. Joseph was at home until the age of 11, do justice to the achievements the fourth child of seven of at his parents’ Queen Anne

10 | JOURNAL OF THE SURGICAL HUMANITIES anaesthesia (ether), but more significantly was tutored by UCL’s Professor of Physiology, William Sharpey. Sharpey, a native of Montrose, had graduated from the University of Edinburgh before travelling to Paris, where he met another Edinburgh student who was to have the greatest influence on the life and work of Joseph Lister – James Syme. Some years later in his role at UCL, Sharpey - always keen to encourage his students to broaden their perspectives and surgical experience - advised the young Lister to visit Edinburgh, and witness first-hand the work of Syme, even writing a letter of introduction to Syme on Lister’s behalf. So it was that Lister, in September 1853, one year after becoming a Fellow of The Royal College of Surgeons of England, travelled north. Joseph Lister Portrait by Dorofield Hardy, after the original by W. Ouless, which James Syme hangs in The Lister Room, Fellows Library of The Royal College of There can be few medical Surgeons of Edinburgh names so closely associated with Scotland’s capital city than that of James Syme. Born mansion, Upton House. He then re-commencing them he went on Princes Street, Edinburgh’s attended two Quaker schools, on to win medals in anatomy, main thoroughfare, in 1799, first at Hitchin and then Grove surgery and medicine, as well as Syme initially took art classes House School in Tottenham, becoming President of the UCL at the University of Edinburgh where he decided to pursue students’ medical society. He before studying anatomy a career in medicine. Lister graduated MB in 1852 and took under Robert Liston. Syme’s went to University College on the role of House Surgeon at relationship with Liston was London (UCL) in the spring of University College London. frequently quarrelsome (as, 1844, obtaining his B.A. three it must be said, it was with a years later. However, a period Although based in the English great many of Syme’s peers of ill health and a crisis of capital, it was almost certainly who took issue with his confidence, most likely related during this period that Lister often waspish approach) but to the death (most probably became strongly influenced by even when only in his 20s it from a brain tumour) in 1846 Edinburgh-trained surgeons. became clear that Syme was a of his brother John, meant that In 1846 he witnessed Robert surgeon of unparalleled skill. Lister did not resume studies Liston perform the first major By 1833, he was appointed until 1849. Nevertheless, on operation under general Professor of Clinical Surgery at

JOURNAL OF THE SURGICAL HUMANITIES | 11 "Sir, I request the honour of..." JOSEPH LISTER & EDINBURGH by Steven Kerr

Robert Liston performs the first operation under ether, December 1846. Lister can be seen in the top-left corner observing, to the left of the man with hand on hip.

Edinburgh University, and after an India rubber solvent and a the major role in his deciding Liston’s death in 1847, Syme process by which it could be to stay in Edinburgh. However, travelled to London to assume injected into cloth, thus making it is likely that the changes his vacated Chair of Clinical it waterproof. Unfortunately for underway in the city itself at Surgery at University College Syme, Glasgow chemist Charles that time also played a part. London. He was to hold the Macintosh was first to patent position for only five months the idea, thus becoming world- Although a small city, with however, before returning to the famous as the creator of the a population only around Edinburgh Chair. He served as “rubber Mac”. 200,000 in the early 1850s, President of The Royal College Edinburgh had benefited of Surgeons of Edinburgh from Arrival in Edinburgh greatly from the new transport 1849 to 1851, and was also It wasn’t Lister’s intention to system offered by the rail links Surgeon to Queen Victoria. make his stay in Edinburgh created during the previous an extended one – initially decade. Scotland’s capital was As well as being arguably the planning only a few weeks. now joined by rail to Glasgow, foremost British surgeon of As events transpired however, Carlisle, Berwick and further his time, James Syme was an he was to remain in the city south. Most significantly, a extraordinarily inventive man. for seven years. Doubtless the journey to London – previously For example, at the tender opportunity to work at length only possible via a nine-day age of 18 he had discovered with the great Syme played coach journey - could now be

12 | JOURNAL OF THE SURGICAL HUMANITIES completed in a single day. had been established in the city). Perhaps partly due to his At the same time, medical surrounding areas of the city’s Quaker upbringing, some have teaching in Edinburgh was “Old Town”. portrayed Lister as a sombre, thriving. Edinburgh University almost dour figure. Indeed, (the third oldest in Britain) was Presenting himself to John Rudd Leeson, who was home to a flourishing medical Syme with Sharpey’s letter, to serve as Dresser and House school, partly because - unlike Lister quickly established a Surgeon to Lister in Edinburgh other Scottish universities – relationship of mutual trust and in the 1870s, wrote of him, “I religion was not a condition respect with the older surgeon. never saw him elevated or knew of admission. In addition, To Lister, Syme represented him laugh…over him hung a universities in Scotland were authority and assuredness in cloud of seriousness tinged not considered the preserve of surgery, writing to his sister with sadness that tempered the wealthy. Another benefit Mary in London early in his all he did, an overwhelming could be found in the fact that stay, “Syme has his own views sense of responsibility that lay Edinburgh’s medical teaching based on great experience like a burden upon his soul.” facilities in the city were with a sound judgement and A tall, well-built man, always centrally concentrated, with a very original mind.” For his carefully and neatly-dressed, the University Medical School part, Syme was so impressed it is fair to say that Lister only a few hundred yards from by Lister that he quickly maintained a certain air of the city’s Royal Infirmary. This appointed him “Supernumerary solemnity throughout his life, in turn was a short distance Clerk” in the Royal Infirmary - a but as a younger man in 1850s from Surgeons’ Hall, designed role conceived by Syme with Edinburgh he was not without by William Henry Playfair, and duties equivalent to a House friends among his young which had been the home of Surgeon - in order to employ surgical colleagues in Syme’s The Royal College of Surgeons the young man not yet licensed wards, with whom he enjoyed of Edinburgh since 1832. In to practice in Scotland in some regular climbs of Arthur’s Seat, addition, dozens of private capacity, before appointing the legendary peak which extra-mural medical schools him to the House Surgeon in overlooks the capital. Despite January 1854. In addition, Lister these social occasions, there is became assistant to Syme at little doubt that these young his private hospital in Minto men held a distinct reverence House, Chambers Street. Such for Lister, whom they referred to was the high regard that Lister as “The Chief” (Syme, however, held for Syme, the fact that he was “The Master”). already held the prestigious FRCSEng did not deter him from By the autumn of 1854, Lister accepting such relatively junior – although fond of Edinburgh roles. It is worth noting though, – was missing his home city of that the license issues meant London. Opportunities to return it was Syme who carried out to work there were presented almost all of the actual surgery to him by the Royal Free at this time. Hospital and The Society of The two men also became close Friends, who had opened a new on a personal level, with Lister infirmary in Poplar. However, often visiting Syme at his home fate was to intervene when James Syme in The Grange in Edinburgh Richard James Mackenzie, was Portrait by Sir George Reid, held (somewhat appropriately now killed in the Crimea. Mackenzie in The Royal College of Surgeons of Edinburgh the site of the Astley Ainsley – considered Syme’s most rehabilitation hospital in the brilliant protégé prior to Lister’s

JOURNAL OF THE SURGICAL HUMANITIES | 13 "Sir, I request the honour of..." JOSEPH LISTER & EDINBURGH by Steven Kerr arrival in Edinburgh – had been Agnes Syme appointed Assistant Surgeon Agnes Syme was born to Edinburgh Royal Infirmary on 23rd November at the age of only 29, and 1834, one of nine had enhanced his reputation children born to James further by writing extensively Syme and Anne Willis. on excision of the knee joint Sadly, by the time and a modification of Syme’s Agnes was six, her own amputation procedure. mother and seven of Volunteering for army service her siblings had died, in 1854, Mackenzie served at leaving only Agnes the bloody Battle of Alma in and her younger sister September that year, performing Lucy. Syme was to 27 major operations. Sadly, he remarry, but neither contracted cholera in the days Agnes nor Lucy were following the battle, and within to become close to the a week had died. two half-brothers and Agnes Lister one half-sister that (Welcome Trust) RJ Mackenzie’s passing created resulted. a vacancy at Edinburgh Royal Although he had only Infirmary that appealed to worked with Syme for Lister, who asked for Syme’s a few months, by early 1854 “…in the case of my precious support in his application. Lister’s fondness of Agnes Agnes the outward appearance The older surgeon was by that time was evident to as I have often said before initially reticent about doing all, although his descriptions is not at all showy, but there so, believing his protégé’s of her could at times be is in her countenance an talents would be best served almost comically reserved, as ever varying expression that in London or the continent, but evidenced by his description of artlessly displays a peculiarly eventually changed his mind her in a letter to his brother-in- guileless, honest, unaffected and backed Lister’s application. law: and modest spirit…” Professionally, Syme no doubt recognised that the younger surgeon that he was so fond of would have next to no chance of landing the post without his recommendation, but it is very likely that by this time he was aware of how close Lister had become to Agnes – James Syme’s daughter. 1856 marriage certificate for Joseph and Agnes Lister

14 | JOURNAL OF THE SURGICAL HUMANITIES Surgical Residents at the Royal Infirmary of Edinburgh, 1853. Lister seated in the centre of the front-row.

Such a description of someone entered thy mind to warrant resignation from the faith, or Lister loved dearly seems them or thy judgement would expulsion from it was likely. almost fitting for a man of such at once have dismissed it as So it was that Lister – with clinical exactitude, but there incongruous…it may be well some sadness – left his family’s was no doubt that he had fallen to be on thy guard that in the church and joined the Scottish for Agnes. Indeed, word seems friendly intercourse to which Episcopal Church (although it to have reached Lister’s parents thou art kindly invited, nothing is interesting to note that he of the burgeoning relationship, in thy deportment may give any himself continued to retain when Joseph Jackson Lister ground for suspicion that thou certain Quaker characteristics wrote warningly to his son: has an intention beyond it.” for the rest of his life, such as referring to family as “thee” or “Thy dear mother tells me Regardless of his parents “thou” in writing and speaking). she has been persuading concern the courtship thee not to allow thy other continued, and by early 1856 a The wedding took place in engagms to absorb thee too wedding date of April 23 had Syme’s home Millbank, in the entirely…I do not know how been set. The Quaker language Morningside area of Edinburgh, some apprehensions of hers is evident in his father’s and the couple honeymooned that I told thee of have been writing, and the family religion for four months, including visits awakened, and I try to assure presented a problem for Joseph to the most prominent medical her they are groundless, that and Agnes. For any Quaker to schools in Europe, interviewing most probably no thought has “marry out” would require their attending professors and their

JOURNAL OF THE SURGICAL HUMANITIES | 15 "Sir, I request the honour of..." JOSEPH LISTER & EDINBURGH by Steven Kerr

hospitals. They returned to the Barbers of Edinburgh were the aisles of St Giles Cathedral, home Lister had purchased on formally incorporated as a or in the home of Deacon 11 Rutland Street, a granite Craft of the Burgh. A “Seal of (President) at the time. In Georgian terraced house. Cause” (a charter of privileges) 1697, their first purpose-built was granted to them by the Surgeons’ Hall was completed, Although the marriage Town Council of Edinburgh on having been designed by the produced no children, Joseph 1st July that year, and ratified architect James Smith. The new and Agnes enjoyed a happy, by King James IV in 1506, building contained a ‘Great devoted life together. They granting them exclusive rights Hall’, a library, a laboratory and continued to travel extensively to perform surgery, and to an anatomy theatre (for which throughout Britain and Europe, have the powers to prosecute they were granted additional collecting flowers, studying individuals who operated cadavers for teaching purposes). wildlife and keeping diaries on outside these boundaries. The Public dissections were held the subjects. Somewhat unfairly, Seal of Cause also specified there once a year. By 1722 the Agnes is often described as that any surgeon practicing surgeons had separated from merely Lister’s “scribe” or their craft should be literate; the barbers and had undertaken “secretary”. In fact, Agnes had have full knowledge of anatomy the task of establishing long assisted Syme and the and surgical procedures; and Edinburgh as the dominant many visitors who visited her that this knowledge should be centre of surgical teaching. In father’s laboratory and went on thoroughly tested at the end of 1778, King George III granted a to participate fully in Lister’s apprenticeship. new charter giving the surgeons experiments and dissections, the title “The Royal College working the same hours as her As the Incorporation grew of Surgeons of the City of husband before documenting throughout the seventeenth Edinburgh”. and sketching his work. It was century, the barber-surgeons recognised that for all his would meet in various locations By the beginning of the scientific brilliance, Lister had around Edinburgh - rented nineteenth century, the existing trouble expressing himself, rooms in Dickson’s Close; in Surgeon’s Hall had become and Agnes’ letters and diaries frequently demonstrate her linguistic skills in the scientific writing that underpin his work.

Fellowship of The Royal College of Surgeons of Edinburgh Although he had held the FRCSEng for well over a year, as mentioned this technically did not license Lister to practice in Scotland in 1855. Thus in the spring of that year he petitioned to be elected a Fellow of The Royal College of Surgeons of Edinburgh. The oldest surgical corporation of its kind in the world, RCSEd has its formal foundation in Playfair Building to The Royal College of Surgeons of Edinburgh (RCSEd Records) 1505, when the Surgeons and

16 | JOURNAL OF THE SURGICAL HUMANITIES The College’s new home formally opened in July 1832.

It must be said that Lister applied to become a Fellow of the College during a somewhat controversial period in the RCSEd Fellowship’s history. Five years earlier, in 1850, the decision had been taken by the College to discontinue a separate examination for Fellowship candidates, requiring them only to have the degree-level College Licentiateship (LRCSEd) and then allowing eligible candidates to petition for election by vote of Fellows. There can be little question that most of the surgeons admitted to Fellowship during that time were of high calibre - indeed, it has been argued that the old system of admission by examination had actually deterred surgeons of such quality from becoming Fellows, and it was only the abolition of this system that led to men like Lister using the FRCSEd post nominal. However, this policy of less than rigorous admission procedures for College Fellows was to draw widespread criticism over the years (a policy that even raised political eyebrows, given the esteem in which RCSEd Fellowship was held) and so it was little surprise

Û1855 letter from Joseph Lister to The Royal College of Surgeons of Edinburgh, requesting he be admitted as an Ordinary Fellow. (RCSEd Records) Ú1855 letter from James Syme and James Simson, recommending Lister be elected to Fellowship (RCSEd Records) inadequate, partly due to the need to provide suitable accommodation for a large collection of pathological specimens being presented to them by anatomist John Barclay. A site was acquired by the purchase of a riding school (The Royal Academy for Teaching Exercise) in Nicolson Street. William Henry Playfair (1790- 1857), the foremost Scottish architect of that era, was commissioned to design a building containing a Meeting Hall, Barclayan Hall for the specimens (which included a full size elephant and rider), Lecture Room and Library.

JOURNAL OF THE SURGICAL HUMANITIES | 17 "Sir, I request the honour of..." JOSEPH LISTER & EDINBURGH by Steven Kerr

Minutes of The Royal College of Surgeons of Edinburgh, 20 April 1855, noting Lister’s election as an Ordinary Fellow (RCSEd Records)

when a separate Fellowship consideration in the Library as or skull was too hazardous examination was reinstated in stipulated in the College Laws) to be considered but Lister October 1885. Joseph Lister was duly admitted did operate on aneurysms, as a Fellow. His College Roll hernias and occasional cases Thus Lister’s formal application Number was 445. of skin and other tumours. to become a Fellow of the With hospital gangrene and world’s oldest surgical college Work in Edinburgh erysipelas (streptococcal was a simple, even nondescript In the mid-nineteenth century infection) also prevalent, there procedure. On March 14th Edinburgh Royal Infirmary was an ever present risk to 1855 a letter was written to admitted around 4400 patients as infection spread the College President at the patients annually, although easily in the small, crowded time, Archibald Inglis, from records show that in 1854 wards of this time. James Syme and James Simson only 245 individuals had been “begging to recommend Mr treated in surgical wards. Lister was known as a Joseph Lister as a candidate The average time a surgical thorough and methodical (if for the Fellowship of the patient remained in hospital not technically outstanding) Royal College of Surgeons was seven weeks. Wards were surgeon. He was, however, of Edinburgh”. This was small, dark, crowded and, most renowned for developing new followed the next day by of all, unclean. Nursing care techniques to improve upon Lister himself writing to Inglis, was elementary; surgeons did orthodox methods and the well- simply writing, “Sir, I request not wear gloves or masks; being of his patients. One of his the honour of becoming a their instruments were often more impressive operations was Fellow of the Royal College carried in the pockets of their on treating caries of the wrist. of Surgeons of Edinburgh”. long coats, their needles It had long been thought that Minutes from the Meeting of in their coat lapels. Due to the wrist had to be amputated The Royal College of Surgeons these conditions, surgery was because of the deterioration of of Edinburgh of 19th March avoided whenever possible and the bones, but Lister devised an confirm Lister’s application it was exceptional for more operation that reduced the need “was appointed to be taken than a single operation to be for amputation, and enabled into final consideration at a performed each day, and those the patient to retain their limb. future meeting at least a month carried out were attended by To him, new research was the hence”. That meeting was held the whole of a surgeon’s staff. essence of effective teaching, on the 20th of the following Much of Lister’s early work and regardless of his abilities month when, no Fellow having there constituted the surgery of in the operating theatre, his objected to his application simple and compound fracture. skill in the lecture theatre was (which had been posted for Opening the abdomen, chest to become unmatched. It was

18 | JOURNAL OF THE SURGICAL HUMANITIES teaching in this manner that of the foremost authorities on applying carbolic acid (rather was to dominate the latter half inflammation, publishing no than heat or air filtration as of the 1850s for Lister. less than seven papers on the Pasteur described) to wounds, subject that year alone. As the in Glasgow Lister was to initiate By this time, his career during decade grew to a close however, the era of antisepsis. Querying his first spell in Edinburgh Lister – despite having been as to why patients with simple was arguably at its high point. re-elected Assistant Surgeon fractures generally recovered Newly-elected an RCSEd Fellow, to the Royal Infirmary of whereas those with compound running a respected (if not Edinburgh in November 1858 – fractures more frequently died, massively busy) consulting had begun to feel constrained Lister began to apply dressings room in Rutland Street, Lister with his lot in Edinburgh, and containing carbolic acid to the began preparing a course sought a Surgical Professorship. sites of broken skin caused of lectures in surgery in the The opportunity for this by compound fractures. His extra-mural medical school presented itself in the summer reasoning was explained when in High School Yards. Before of 1859 when Professor James he was to later write: commencing, he spent a month Lawrie, who held the Chair of in Paris studying inflammation, Surgery in Glasgow University, ‘‘In the course of the year which was the subject of retired due to ill-health. The 1864 I was much struck with his first lecture, held on 7th successful candidate of seven an account of the remarkable November 1855. It has to be who applied for the position effects produced by carbolic said that the lectures got (five from Glasgow; two acid upon the sewage of the off to a fairly ignominious from Edinburgh) Lister was town of Carlisle, the admixture start, with only seven tickets appointed Regius Professor of of a very small proportion initially taken, but those that Surgery in Scotland’s largest not only preventing all odour did attend were enthused city in January 1860. by Lister’s teaching, and the lecture formed the basis of his Glasgow paper “On the Early Stages of Concentrating as it does Inflammation” which he went on Lister’s connections on to present to the Royal with Scotland’s capital, Society of London in 1857. The it is not the intention of work described the skin-tone this piece to provide yet changes in certain frogs due another detailed account to varying concentration and of Lister’s epoch-making diffusion of pigment granules work while Professor (Lister having been of the of Surgery in Glasgow. belief that the early stages of There exist a myriad of inflammation in all species was more eloquent articles, misunderstood). books, documentaries, even poems inspired by In November 1856 Lister, newly his seminal innovation, married and settled in his role but a brief outline of the at Edinburgh Royal Infirmary, discovery is appropriate. commenced his second series of extra-mural lectures. Again Appointed Surgeon numbers were initially low, but to Glasgow Royal as Lister’s reputation continued Infirmary, and enthused Joseph Lister, c1855 to grow, so these increased. By by Pasteur’s work on (RCSEd Records) 1858 he was regarded as one purification and by

JOURNAL OF THE SURGICAL HUMANITIES | 19 "Sir, I request the honour of..." JOSEPH LISTER & EDINBURGH by Steven Kerr

large-scale draining of these was often life-threatening, Lister made openings under the protection of carbolised oil with a covering of lint, to protect the skin from the irritant properties of the carbolic acid. In April 1867, Lister applied these carbolised dressings to incised, surgical wounds for the first time. He published findings his work between March and July 1867 in the Lancet, in a paper entitled “On a New Method of Treating Compound Fracture and Abscess etc. with Observations on the Conditions of Suppuration.”

By the end of the decade Lister’s methodical approach Lister’s antiseptic spray in operative use was to bring a second major contribution to surgical practice in the development of his first sterile absorbable catgut from the lands irrigated with ligature. Catgut was readily the refuse material, but, as It is interesting that the same available, used as it was to it was stated, destroying the year as his observations in string musical instruments. entozoan which usually infest Carlisle, an opportunity to Lister’s catgut suture, when cattle fed upon such pastures.... return to Edinburgh had soaked with carbolic solution, Carbolic acid proved in various arisen when James Miller died, greatly reduced incidence of ways well adapted for the vacating the post of Professor surgical sepsis. This catgut purpose. It exercises a local of Systematic Surgery in was to be the source of great sedative influence upon the Edinburgh. Lister applied for controversy in 1869, however, sensory nerves; and hence is the role, confident of success, when the aforementioned not only almost painless in but was to lose out to James Spence – despite being an its immediate action on a raw Spence. Disappointed, he threw outspoken opponent of Lister’s surface, but speedily renders himself into greater research antiseptic theories – attempted a wound previously painful on suppuration, and within to use the ligature in an entirely free from uneasiness. half a decade, Lister’s work operation. The patient died, When employed in compound had transformed the wards at with Spence blaming the catgut fracture its caustic properties Glasgow Royal Infirmary from in a subsequent Lancet article. are mitigated so as to be some of the most unhealthy Spence’s assisting surgeon in unobjectionable by admixture in the country to models of the operation Edward Lawrie with the blood, with which it cleanliness, with post-operation (coincidentally also House forms a tenacious mass that mortality rates reduced 46% to Surgeon to James Syme), hardens into a dense crust, 15%. By October 1866, Lister perhaps unwisely responded which long retains its antiseptic was testing his theories on in the Lancet, suggesting that virtue…’’ the condition of abscess. As in actual fact the fault lay

20 | JOURNAL OF THE SURGICAL HUMANITIES with Spence who had failed to departing Syme) were aware techniques and developing carry out the catgut procedure they were in the presence of new theories. He found that a according to Lister’s teaching. greatness, and greeted the 1% solution of carbolic acid Outraged, Spence demanded lecture with rapturous applause. could be effectively applied by action be taken against Lawrie, The scene was to be repeated means of a spray, disinfecting who was thus dismissed from at each lecture, which Lister not only the wound itself but the Infirmary. could now afford to give only the environment, instruments twice a week, compared to the and dressings surrounding Return to Edinburgh daily lectures he presented in it. Despite his popularity as a In April 1869 James Syme, Glasgow. surgeon however, it would be mourning the passing of his wrong to suggest that Lister’s second wife two months earlier, After his teaching, Lister’s research innovations - although suffered a stroke from which routine would take him to the established as scientifically he was to never fully recover. Royal Infirmary around midday, sound by the mid-1870s - Although concerned for his and it was at this time that had been met with universal friend, mentor and father-in-law, the meticulous nature of his approval. Mention has already Lister needed little persuasion personality would become been made of the irascible to apply for the Chair of Clinical evident. Even the most minor James Spence, and presumably Surgery that Syme had held of dressings, if not prepared Lister cared little about the old- for over twenty years, but was by Lister’s own hand, had to be school Edinburgh surgeons who now forced to relinquish. Duly prepared under his personal would joke with their students elected to the post in August supervision. As a result his that they should shut the 1869, Lister travelled back to planned timetable of duties window of the lecture theatre Edinburgh with Agnes. Sadly, his would soon become almost “in case one of Mr Lister’s wee own father died the following meaningless, as warmly beasties might escape”, but month, at the age of eighty-four. described by Agnes in a letter it’s hard not to imagine his to her sister-in-law: being a little wounded by the After a period of living in harsh criticism his work with rented accommodation in “Joseph has only just come carbolic acid received in 1867 Abercromby Place, the Listers home from the hospital at from the legendary Sir James purchased a home for (in 4.15 and we are going to have Young Simpson, pioneer of Joseph’s own words), “a most lunch. He has to perform two anaesthesia. Simpson argued in enormous sum” in Charlotte amputations at the Infirmary the Lancet and the Edinburgh Square. The house, with superb and on coming home finds Daily Review that Jules Lemaire views of Princes Street Gardens people waiting for him. He of Paris was the first to use and the Castle, was sufficiently has an operation in private at the acid in a surgical setting, large for entertaining his many 4.30 and three patients to see and that Lister had merely students and other guests, afterwards. So it has been a brought the method to a wider while accommodating room for busy day...” UK audience. Lister’s response Lister to continue his scientific was to suggest that he was experiments, concentrating The fact that Lister’s not familiar with Lemaire’s mainly on sepsis. His first operations often ran late work, but also argued that lecture, on the “Germ Theory of was no deterrence to his he was not claiming to be Disease” was attended by a full patients. His private practice the first to use carbolic acid house of students, in contrast during his second period in in surgery, but was utilising to the poorly-attended lectures Edinburgh dwarfed any other “methods of its employment from his first period in the time in his career. In addition, with the view of protecting capital. The students (who were he continued apace with his the reparatory processed also keen to pay tribute to the research work, honing existing from disturbance by external

JOURNAL OF THE SURGICAL HUMANITIES | 21 "Sir, I request the honour of..." JOSEPH LISTER & EDINBURGH by Steven Kerr

agency.” It is a little ironic to disclaim all idea of interfering to teach, demonstrate and prove see Simpson place himself at with that which you alone have his theories. Thus in June 1877 the forefront of opposition a right to decide, we would yet he and Agnes left Edinburgh to a medical breakthrough earnestly hope that you may once more. of such importance, given long remain in that position the hostility he himself had you so greatly adorn and that London encountered when introducing the day may never come when If Lister believed his arrival in the anaesthetic properties of your name will cease to be London would be greeted with chloroform – hostility that only associated with that of the rapturous approval, he was abated when Queen Victoria Edinburgh Medical School.” disappointed. His first public herself gave birth to her lecture as a Professor there, on eighth child (Prince Leopold) Moved by their sentiment, “The Nature of Fermentation”, under its effects. That said, it Lister met with his students, was met largely with is also worth noting that in his expressing his affection for indifference, and subsequent time Simpson had quarrelled Edinburgh and the clinical lectures were not well attended, extensively with James Syme. teaching in methods in the city. often attracting no more than However, he The largest pocket of resistance also felt that to Lister’s new theories, with Syme however, was to be found in having been London. Therefore when in dead for 1877, Sir William Fergusson some seven (Professor of Clinical Surgery years and the at King’s College Hospital) overwhelming died, Lister was pleased acceptance when they approached him as of Listerian replacement. The thought that principles in this giant in his field could be Edinburgh persuaded to leave Edinburgh and Glasgow, for England horrified medical there was students in the Scottish little more capital, and some 700 of them that could be signed an eloquently-written accomplished petition urging him to stay. The north of document concluded as follows: the border. The London “The welfare of our school is so clinical intimately bound up with your fraternity presence that its withdrawal on the other must be an irreparable loss. hand had We are far from disparaging in the main that field to which you may be stubbornly called, but we would venture avoided his to submit that nowhere will research, and you find a more numerous and Lister felt this devoted band of followers than presented those who now count it their him with greatest privilege to listen to irresistible your teaching. While we entirely opportunities

22 | JOURNAL OF THE SURGICAL HUMANITIES a dozen students. His previous By this time honours were that for all the tributes Lister criticisms of London teaching bestowed on him frequently. himself received throughout methods had also not gone Most major UK Universities his life, none gave him more unnoticed in England. Now in conferred honorary doctorates pleasure than when he spoke his fifties, his reputation still (as did those in Toronto and at the celebration of Pasteur’s carried weight though, and Montreal), while in 1883 he seventieth birthday in Paris in his surgical experience was to was made a Baronet by Queen 1892. shine through in the operating Victoria, to whom he had been room. As his successes there appointed Surgeon in Ordinary By that year however, Lister’s increased, so too did his in 1878. Victoria thought highly health was beginning to fade, influence to match that which of Lister, who some years ago and he retired from practice he had attained in Glasgow and had drained a royal abscess at King’s College Hospital. In Edinburgh. By the end of the from her at Balmoral. Indeed, 1893, he and Agnes holidayed 1870s, his methods and theories many believed he would have in Italy. Sadly, Agnes, who had gained full acceptance in received Baronetcy some years had left the UK with a severe London. earlier, had he not rebuffed cold, developed pneumonia the Queen’s on the trip and died within a request for week. Lister would never truly support for recover from this devastating legislation loss. He continued to write and proposed by perform many of the duties the Royal asked of him for the rest of the Society decade (including being the for the first surgeon to be elevated Prevention to the Peerage in 1897, and of Cruelty gaining Freedom of the City of to Animals Edinburgh in June the following to limit year), but he was to cut an vivisection. increasingly lonely figure, and Two years by the dawn of the twentieth prior to the century had withdrawn Baronetcy almost entirely from public the people appearances. A stroke at the age of France of seventy-six caused his health awarded to deteriorate further. But the Lister the medical world continued to prestigious recognise the debt owed to Lord Bondet Lister. Prize for his application Honorary Fellowship of The of the Royal College of Surgeons of principles Edinburgh of Pasteur, In June 1671 it was decided by whose work the Incorporation of Surgeons 1904 Report from the Honorary Fellowships he admired and Barbers of Edinburgh (the Committee, recommending Lister as one of 7 British so much. body which would eventually Surgeons to receive the Hon FRCSEd (Minutes of The Indeed, become known as The Royal Royal College of Surgeons of Edinburgh) many College of Surgeons of believe Edinburgh) to award honorary

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Henry Parkes - who had received Fellowship by examination in 1907 and whose astounding work as Director of Medical Services for the New Zealand Expeditionary Force during World War I led to his receiving Honorary Fellowship in 1919 - has achieved the same “double”.

Joseph Lister’s name continued to be revered, and honours continued to The Lister Room, Library of The Royal be bestowed on him in his College of Surgeons of Edinburgh twilight years. London and Glasgow joined Edinburgh in making him a Freeman “freedoms” to individuals Fellowships from nine European of their city in 1907 and 1908 of political or social note countries, the USA, Canada respectively. However, now in who could help to boost the and Australia. Of the seven his eighties it was clear his reputation of the Incorporation individuals proposed from health was failing, and he was and assist it in any political the United Kingdom, six were unable to travel to Glasgow struggles. The first recipient awarded to men who happened for the commemoration. That was Andrew Ramsay, Lord to hold a prestigious position same year in a letter to his Provost of Edinburgh, on 17 at the time (namely Director- friend, Edinburgh surgeon John October 1671. By 1905 however, General of the Army and Naval Chiene, Lister mentioned his only thirty-three more had Medical Departments, and health which was “in truth very been admitted in this way, and Presidents of the other medical infirm, and on that account I none since it was conferred on Royal Colleges). In the College must ask you to excuse a most Andrew Smith, Director General Minutes , only one was listed inadequate reply to your very of the Army and Ordnance by name. No mention was kind letter.” Medical Department, in 1856. made of the fact that Lister was Of course, being founded in to become the first surgical In 1909 Lister had moved to 1505 meant RCSEd was to Fellow to also receive Honorary the Kent coast, where he passed celebrate its 400th anniversary Fellowship, but by this time, away on 10th February 1912 of in 1905, which seemed an Lister’s achievements were so pneumonia – the same illness appropriate date for new elevated above those of his that had taken his beloved Honorary Fellowships to be peers it is likely no further Agnes. It was somewhat conferred. Preparations began explanation other than his appropriate that in his last well in advance, with an name was necessary. years he was cared for by Agnes’ Honorary Fellows Committee sister, Miss Lucy Syme. approved by College President Honorary Fellowship was Patrick Heron Watson. Their bestowed on Lord Lister on Legacy report to RCSEd Council 20th July 1905, fifty years after The name of Lister has, of on 19th October 1904 he was first elected FRCSEd. course, become synonymous recommended thirty Honorary Only New Zealander William with medical and surgical

24 | JOURNAL OF THE SURGICAL HUMANITIES excellence (and - in brands like Listerine mouthwash - antiseptic cleanliness). The number of worldwide commemorations of Lister number far too many to be listed here, but an indication of the esteem in which he was held can be found in the number of times his name is utilised here at The Royal College of Surgeons of Edinburgh. The same Library Reading Room in which his 1855 application for Fellowship was Order of Service for Joseph Lister’s funeral, displayed is now named Westminster Abby, 16 February 1912 ‘The Lister Room’; the nationwide Lister Professorships, recognising undertaking, “The Lister Project” Surgical Skills Competition original research carried out seemed the natural name for gives aspiring surgeons in by younger surgeons as part the venture. their final year of UK medical of their training, and when, in Joseph Lister’s body may lie school an opportunity to 2013 Surgeons’ Hall Museum alongside Agnes in Hampstead compete in surgical challenges – the UK’s largest collection Cemetery, but his name and against their peers from of surgical pathology artefacts achievements are immortalised across the UK. In the 1980s, – was redeveloped in a hugely in this and all similar the College established Lister successful multi-million pound institutions.

Steven Kerr is Librarian of The Royal College of Surgeons of Edinburgh. The College Library team provides clinical information services to the College’s 25,000 Fellows and Members across the globe, as well as thousands of historical enquiries from researchers, academics and the media each year. Steven was born in Edinburgh, raised in Earlston in the Scottish Borders, and studied Librarianship at The Robert Gordon University in Aberdeen (having been told by his mother that she thought it would be suitable vocation for him!) He graduated with a B.A in the subject in 1996, and following a four year spell working in a private pharmaceutical research library, he joined RCSEd in the summer of 2000. Steven’s interests include cinema, reading and theatre. However, his foremost obsession is football (the European version) and in particular a lifelong love-affair with Rangers FC, despite their numerous attempts to break his heart in recent years. He lives in East Lothian with his wife, Nicola.

JOURNAL OF THE SURGICAL HUMANITIES | 25 Every issue of “Surgical Humanities” carries an excerpt from Oslerium the works of the pre-eminent Canadian physician Sir William Osler (1849-1919).

he life of William Osler in itself provides a Tfundamental justification for an education and engagement in the surgical humanities. Osler’s medical textbook, “Principles and Practice of Medicine” (first published 1892) widely used as a standard and acclaimed though it was during his lifetime, has largely been forgotten, or remembered only in relation to his other achievements. But in the other great body of his work - his speeches, his essays and his commentaries on the profession, on the business of daily living, on professionalism, on our profession’s imperative for humane practice and on the wisdom of our forbears - he has achieved immortality.

Osler’s father the Rev. Featherstone Osler was a missionary sent from Cornwall, England, to the backwoods of Ontario. William Osler was born in Bond Head, Upper Canada (now Ontario) to Featherstone and Ellen Osler on the 12th of July, 1849.

This was a remote town in an already remote country at the

26 | JOURNAL OF THE SURGICAL HUMANITIES About SIR WILLIAM OSLER time, and Osler was sent for beginning of a very fruitful Oslers made the last move of his schooling to Trinity College association with the “Big Four” their eventful lives, across the School, an independent school - the pathologist William Welch, Atlantic, once more, to England. for boys in Port Hope, Ontario. surgeon William Halstead, Another distinguished period of In the fall of 1868, Osler gynecologist Howard Kelly (and William’s career followed - he enrolled in the Toronto Osler himself). was knighted and continued to School of Medicine, but write and deliver memorable soon transferred to McGill, Together, the “big four” would addresses to distinguished because it had better clinical introduce far reaching changes audiences and societies. opportunities. He graduated in medical education that are from the McGill University still felt today - the clinical Sir William Osler died School of Medicine in 1872 and clerkship for medical students of pneumonia in 1919, a taking advantage of an older and the residency system of complication of the influenza brother’s generosity, Osler spent training were both products pandemic of 1918-1920. the next two years studying in of this association. About Europe and visiting the great this time, Osler also began a Harvey Cushing, the pioneer clinics and hospitals of Berlin, series of brilliant speeches and neurosurgeon and Osler’s Vienna and London. addresses whose impact would biographer called him, “one be felt far beyond the audiences of the most greatly beloved Upon his return to Canada, he for whom they were intended. physicians of all time.” was appointed to the faculty The “Principles and Practice of McGill University and spent of Medicine,” a monumental Sources: the next five years teaching treatise, was published in 1892. “Osler - A Life in Medicine” by physiology and pathology in Michael Bliss. Hardcover, by the winter term and clinical William Osler and Grace University of Toronto Press, medicine in the summer. Revere were married in 1892. 1999. Also available for Kindle. In 1884, Osler was appointed Their only child, Revere to the staff of the University of Osler was killed in action in Note: Pennsylvania as Professor of Belgium during one of the Sir William's brother, Edmund clinical medicine and this was many disastrous and ill-fated Osler (who was a railway baron) the start of a 21 year period of campaigns of the first world has a living connection with work and achievement in the war. Saskatchewan - the town of United States. His appointment Osler (about 20 min North of to the founding professorship In 1905, Osler was offered Saskatoon) is named for him; and and staff of the new John the prestigious Regius there is an "Osler Street" close to Hopkins Medical School in professorship of Medicine the Royal University Hospital. Baltimore in 1888 marked the in Oxford, England, and the

JOURNAL OF THE SURGICAL HUMANITIES | 27 OSLERIUM

hroughout his illustrious career, Osler distinguished himself from most of his Tpeers by the universal, broad and truly international approach he had to medicine and its practice around the world.

Chauvinism, as Osler defines it, is the very opposite of the essential humility and receptiveness that made this universal approach possible – an approach that recognized our common humanity and the close fraternity of physicians, no matter their nationality.

“Chauvinism in Medicine” was addressed to the participants of the 1902 meeting of the Canadian Medical Association in Toronto.

Of course in Osler’s time, when travel and its means were much more limited, it was mostly of Europe and its many different medical traditions that North American physicians possessed any degree of familiarity. This is reflected in Osler address, where he invokes the great contributors to medical science that Western Europe made in the 19th century.

But in spite of having lived in the age of colonialism, where students were taught that all knowledge and all science began with Greece, Osler acknowledges the great advances made by Islamic (“Arabian”) medicine in the middle ages as well as the “Alexandrian and Byzantine” schools. Readers will remember that the histories of Chinese and Indian systems of medicine were only systematically documented in the West during the 20th century and especially during its latter half.

In an age that revelled in and celebrated various degrees of anti-Semitism, Osler’s recognition of our common humanity and appreciation for the achievements of other nationalities and races, extended to his Jewish colleagues as well. Surrounded as he was by prejudice and bigotry, he wrote two very appreciative essays – “Letter father of the man,” perhaps these were attitudes he from Berlin” and “Israel and Medicine” – that learned, together with his siblings, from his parents. celebrated the achievements of the Jewish people and physicians and condemned all forms of anti- In this, the second part of the address, Osler fiercely Semitism. denounces the inability of one country – i.e. Canada or the United States - to have one uniform licensing It is generally regarded as something of a mystery body that will enable a physician to practice in any as to how Osler from rural, small-town, Bondhead, province or state. This “miserable chauvinism” that Ontario, the son of missionary parents from England, Osler describes, alas, still exists in Canada and our grew up with such a generous view of other people neighbour to the South – 116 years after Sir William and the world in defiance of the age in which he so eloquently spoke about it! lived. If we believe with Wordsworth that the “child is F.C.

28 | JOURNAL OF THE SURGICAL HUMANITIES CHAUVINISM IN MEDICINE Part 2

Sir William Osler

PROVINCIALISM IN MEDICINE of teachers and professors part is greater than the whole- between all parts of the country. does exist, but it is diminishing, While we may congratulate To better his brains the scholar and one great function of ourselves that the worst aspects goes freely where he wishes the national associations is of nationalism in medicine – to Harvard, McGill, Yale, or to foster a spirit of harmony are disappearing before the Johns Hopkins; there are no and brotherhood among the broader culture and the more restrictions. The various medical scattered units of these broad intimate knowledge brought societies of the two countries lands. But we suffer sadly from by ever-increasing intercourse, are, without exception, open to a provincialism which has yet in English-speaking the members of the profession gradually enthralled us, and countries conditions have at large. The President of which sprang originally from an favoured the growth of a very the Association of American attempt to relieve conditions unpleasant sub-variety, which Physicians this year (Dr. James insupportable in themselves. may be called provincialism or Stewart), is a resident of this I have praised the unity of the sectionalism. In one sense the city, which gave also last year profession of this continent, in profession of this continent I believe, presidents to two of so many respects remarkable, is singularly homogeneous. A the special societies. The chief and yet in another respect it young man may be prepared for journals are supported by men is the most heterogeneous his medical course in Louisiana of all sections. The text-books ever known. Democracy in full and enter McGill College, or he and manuals are everywhere circle touches tyranny, and as may enter Dalhousie College, in common; there is, in fact, a Milton remarks, the greatest ‘Halifax, from the State of remarkable homogeneity in the proclaimers of liberty may Oregon, and in either case English-speaking profession, become its greatest engrossers he will not feel strange or not only on this continent (or enslavers). The tyranny of among strangers so soon as but throughout the world. labour unions, of trusts, and he has got accustomed to his Naturally, in widely scattered of an irresponsible press may environment. In collegiate life communities sectionalism – a bear as heavily on the people there is a frequent interchange feeling or conviction that the as autocracy in its worst form.

JOURNAL OF THE SURGICAL HUMANITIES | 29 CHAUVINISM IN MEDICINE: Part 2... by Sir William Osler

And, strange irony of fate! the as organization is concerned, practitioner of this province democracy of Provincial and when the profession elects its cannot go to Manitoba, his own State Boards has imposed in a own Parliament, to which is country again, and take up his few years a yoke more grievous committed the control of all life’s work without additional than that which afflicts our matters relating to the license. payments and penalties, is, brethren in Great Britain, which The recognition, in some form, I maintain, an outrage; it is took generations to forge. of this democratic principle, provincialism run riot. That this The delightful freedom of has been one great means pestiferous condition should intercourse of which I spoke, of elevating the standard of exist throughout the various while wide and generous, is medical education, and in a provinces of this Dominion and limited to intellectual and majority of the States of the so many States of the Union, social life, and on the practical Union it has secured a minimum illustrates what I have said of side, not only are genial and period of four years of study, the tyranny of democracy and courteous facilities lacking, but and a State Examination for how great enslavers of liberty License to Practise. All this is as its chief proclaimers may be. it should be. But it is high time That the cure of this vicious that the profession realized state has to be sought in ... the bars of a the anomaly of eight boards in Dominion bills and National rigid provincialism the Dominion and some scores examining boards, indicates in the United States. One can into what debasing depths of are put up, fencing condone the iniquity in the narrow provincialism we have each State as with a latter country more readily sunk. The solution seems to be than in Canada, in which the so simple, particularly in this Chinese wall. boards have existed for a longer country, with its uniformity of period, and where there has methods of teaching and length been a greater uniformity in of curriculum. A generous spirit the bars of a rigid provincialism the medical curriculum. After that will give to local laws are put up, fencing each State all these years that a young a liberal interpretation, that as with a Chinese wall. In the man, a graduate of Toronto and limits its hostility to ignorance Dominion of Canada there are a registered practitioner in and viciousness, that has regard eight portals of entry to the Ontario, cannot practise in the as much or more for the good profession, in the United States Province of Quebec, his own of the guild as a whole as for almost as many as there are country, without submitting to the profession of any province States, in the United Kingdom vexatious penalties of mind – could such a spirit brood over nineteen, I believe, but in the and pocket, or that a graduate the waters, the raging waves of latter the license of anyone of from Montreal and a registered discord would soon be stilled. these bodies entitled a man With the attitude of mind of to registration anywhere in the general practitioner in each the kingdom. Democracy in But it is high province rests the solution of full circle has reached on this time that the the problem. Approach it in hemisphere a much worse a friendly and gracious spirit condition than that in which profession realized and the difficulties which the conservatism of many the anomaly of seem so hard will melt away. generations has entangled the Approach it in a Chauvinistic profession of Great Britain. eight boards in the mood, fully convinced that Upon the origin and growth of Dominion and the superior and unparalleled the Provincial and State Boards conditions of your province will I do not propose to touch. The some scores in the be jeopardized by reciprocity ideal has been reached so far United States. or by Federal legislation, and

30 | JOURNAL OF THE SURGICAL HUMANITIES the present antiquated and disgraceful system must await for its removal the awakening of a younger and more intelligent generation.

It would ill become me to pass from this subject – familiar to me from my student days from the interest taken in it by that far- sighted and noble- minded man, Dr. Palmer Howard – it would ill become me, I say, not to pay a tribute of words to Dr. Roddick for the zeal and persistence with which he has laboured to promote union in the compound, comminuted fracture William Osler working at his desk of the profession of this Dominion. My feeling on the subject of the time of departure, should internecine warfare existing international, intercolonial, be welcomed as a brother, on this continent, indicate how and interprovincial registration treated as such in any country, far a miserable Chauvinism can is this – a man who presents and registered upon payment of corrupt the great and gracious evidence of proper training, who the usual fee. The ungenerous ways which should characterize is a registered practitioner in treatment of English physicians a liberal profession. his own country and who brings in Switzerland, France, and credentials of good standing at Italy, and the chaotic state of … to be continued

After all these years that a young man, a graduate of Toronto and a registered practitioner in Ontario, cannot practise in the Province of Quebec, his own country, without submitting to vexatious penalties of mind and pocket, or that a graduate from Montreal and a registered practitioner of this province cannot go to Manitoba, his own country again, and take up his life’s work without additional payments and penalties, is, I maintain, an outrage; it is provincialism run riot.

JOURNAL OF THE SURGICAL HUMANITIES | 31 I entered the room and I saw a woman completely naked, chewing on ice chips, clenching the bed railing as she underwent another contraction. Her partner was off to the Ron's side, and at first, I thought it was a little strange that he was so distant, but when he went to the washroom and returned with a pale face and a dribble of saliva hanging along the edges of his Col umn lips, I understood a little better. Nine months of a bump into a breathing being.

When it came time to delivery, I came closer to the woman, assisting the physician that was delivering this baby. The woman had her legs bent towards her, and with the contractions coming in hard and closer together, she tried her best to breathe through the pain and not scream THE from the top of her lungs. I tried my best attempt at encouraging her and coaching her through this process, but after a few trials, I was the one who grew tired and felt like my words were not HAND helping very much. Some time passed, with more contractions and laboured breathing and ice chips placed inside TIE the woman’s mouth, and I thought this baby would never come. Then, suddenly, the baby’s head crowned, and it seemed to come out in a manner of seconds. The cord was pulled over Ronald Nguyen Haisen his neck, the baby was placed upon the mother’s 3rd Year Medical Student chest, then the cords were clamped and cut, and College of Medicine University of Saskatchewan the blood was sent out for investigations. I had the responsibility of delivering the placenta, and so I held onto the cord that felt like a slippery, rubber rope and pulled with the tension that the physician advised so that it would not rupture. I got the call in the early morning. The placenta eventually delivered, and I was amazed at the branching vessels, like that of a “The patient is about to deliver.” great tree, that sustained life for nine months.

I was at St. Joseph’s hospital in Estevan, and I There was a tear though, and the physician got slowly made my way from my hospital room to the suture and started to work on repairing the the delivery room, dragging my feet across the tear. He worked diligently and quickly, and I tried floor, blinking hard and often so that the picture to watch as closely as I could during these early in front of me would be more crisp. I had never hours. seen a baby before. I had never heard the cries during and after the birth, but I thought it would Then, during the middle of the procedure, the most certainly wake me up. physician turns to me and asks me to hand

32 | JOURNAL OF THE SURGICAL HUMANITIES tie. He knew that I aspired to be determined by the will and any hesitation, only with become a surgeon and so he effort that one invoked upon certainty, and with each answer, was right to me ask to do so, it. One could not depend on an underlying hope. but the problem was that I others, nor powers of a higher didn’t know how. He was okay being, but only upon one’s self Then, one day, it seemed like with that and tried to teach me, and one’s self only to achieve a fire walked into my life, but I could not get it. I placed their goals. I believed that the splitting the seams of all the my fingers over the suture, tried world was always fair and that assumptions I had for the to slip the thread through the it worked out accordingly, with world and undid the ties that hole he pointed towards, but good always triumphing over bound my thoughts. This fire I could not get it through. He even placed his hands over mine, and for a brief moment, it seemed like a knot would form, but it didn’t. He eventually gave up on this endeavour and closed the wound himself. Afterwards, he gave me a piece of suture to practice on, and I practiced the hand tie on a doorknob throughout the night and into the next morning. I’d put my hands over top, twisting them around, threading it through the hole I’ve created, but it still would not come. It would come after a good sleep, I thought, but in the morning, trying to remember each step that the physician went through and grasping my fingers as I thought I saw the physician do, I tried to create the knot. It still would not come.

As I left the room to drive back to Saskatoon that day, I left the two ends dangling on that doorknob.

When I was a boy, I had great faith in the world. I believed that if one was good and kind evil, the hard working and those spread throughout my life and honest, one would reap the with truth in their hearts being like a wildfire onto the forest rewards that life had to offer the ones to decide matters. brush, driven by the wind and you, as far as one would work I believed in these things like fuelled by the remaining debris hard for them. I believed that I believed in the word of my left upon the forest floor. The life was logical, and that one’s Father, who responded to each inferno fell upon me with a life and its outcome could only of my many questions without tremendous heat, blinding my

JOURNAL OF THE SURGICAL HUMANITIES | 33 The Hand Tie... by Ronald Nguyen Haisen

eyes with smoke, bringing me my questions, I thought. Those it was mine, but it was not. down to my knees, hiding away answers would return me to my It is the not the world that from the fury that wrangled my world again. I remembered, the life I surroundings. In the inferno, remembered, the one that I one does not see nor truly No fire lasts forever though, and hoped and dreamed for. It was act, but closes their eyes and suddenly one day, as if like I a doppelgänger, a twin world depresses themselves into the woke up from a terrible dream, that I wanted to escape from, ground. I returned to the world I once but I was stuck. The roads and knew. I returned to That fire formed a hole in the the world of green ground and then delivered me grass and the into a world that I didn’t know rumbling sound of existed. The underbelly of the lawnmowers. The world, where all the evils that I world of sprinklers only had heard of, manifested in and sunlight front of my eyes. I saw suffering, trickling through the pain of the people, and the floating beads of desperation of the lives that waters to form they often lead. I saw a world brilliant rainbows. that casted them off into a I returned to the corner, often borne into this world of freshly realm being blind and deaf and painted white dumb, and that through this fences and the depravity, these people will prim houses never find their way out from that they would this space. They will remain surround. here, the suffering, with no logic or reason as to why they should Almost everything be there. appeared exactly like it did in My belief in the world the past, except extinguished. I had no hope for something was happiness, I only had questions. slightly off. The How could this all be? How images of this can this world exist and who world would move let it exist? How can there be slightly differently such a great evil? How can such or twitch in a suffering abide? How could way you didn’t the world take away the ones notice before. we loved, like my two closest Then sometimes, childhood heroes, without any I would notice a charred edge routes that I remembered to real explanation? that wasn’t there before. Then, change things, to make yourself when I picked at that burnt flap, and the world around you As the words of my Father I saw the rotten core that I had better, led me back to the place no longer rang true to me, remembered from before and I was before. Sometimes I saw I searched for answers, for that I thought I could forget but the terrible things along these meaning. In books and tomes, I could never truly erase from routes and they would haunt in philosophy and science, my memory. me, but more often, I would there would be the answers to This new world, this existence, see a light that looked a little

34 | JOURNAL OF THE SURGICAL HUMANITIES brighter in my sight. I thought I power, and so I wandered desires for my life, faith that it might get a little further on this through this world, half dumb would all come true as it had route and that it will lead me and half asleep. I would wait up to that point. I believed in somewhere, but it doesn’t. I was and wait, for that moment, for the world and what I felt like it back in the same place, in the that special impulse to follow, could promise me. same locked room, and it feels for that sliver of truth and like I will never escape this knowledge, to wake up to my Although my dream of entering place, that I will never return to own world, to my own life. medical school had been achieved, something happened, It feels like the something terrible, and the way prairie road in I saw myself and the world was winter, with endless changed forever. My life felt and uninterrupted like that tale of Orpheus and miles of plain and Eurydice, where Orpheus can flat fields draped in bring back his dead wife from white snow, never to the underworld into the world end. All the towns again, on the condition that he seem the same, and does not turn to look back at I would feel like I any point along this trek. Then, would never reach as he has one foot out of the my destination. In underworld, he loses his faith, the winter, only the turns back and loses her forever. sky changes, the beautiful sky during That feeling of tragic loss, of a the early sunset, with faith that was just not strong its brilliant streaks enough to last, that’s how I had of varying shades of felt for so long. I just wanted blue and purple and things to work out again, for the pink, that quickly thread to slip through and to disappear into the tie down. I wanted something night. real and true, something that would last. I didn’t want to I wish I could wait anymore for something describe this feeling to happen, for the pain and better. My own disappointment to continue. description has been I wanted to be free, without heavily inspired by any doubts, without any fears. the cinematic genius I wanted to have that belief of David Lynch and again, like I believed in my Terrence Malick, and Father. I wanted to return home, the world that you once knew. I’ll leave it up to them to help to a place where I belonged. This is purgatory, which is far fill in the details if you so wish worse than the inferno, and no to know more. All I truly know I don’t think I’m the only matter how much I calculated is that it has been a long six one with this feeling. I was and analyzed, I ended up back years, when all of this started born in the early 1990s, and in that locked room. In the with medical school. My life up I could remember the dream end, the only thing that felt to that point was easy, without of the ‘90s. That dream of my real and true were impulses, much suffering and with plenty generation, the one that our as if a message from a higher of love. I had dreams and parents hoped for, that we

JOURNAL OF THE SURGICAL HUMANITIES | 35 The Hand Tie... by Ronald Nguyen Haisen

would all become educated, I was one of the last people to settling in Hong Kong. When that we would learn how to enter the church and I sat down it finally came to a slideshow love and not hate, to create on the last pew bench on the that showed pictures from a world that was different back, one amongst the filled her life, from a young woman and better from the one that church. I always knew that my to her deathbed, I thought of ravaged so many lives earlier in friend had a large family, but it how her life had turned out. the century. That dream would seemed like most of the people She was a simple woman, not come true on the belief that were not relatives. to say she was not smart or if we worked hard, if we acted intelligent, but simple in the with kindness and in truth, with The service started a few words way that there was not much to the right people in the right from family members, before living a true life beyond acting positions, that we would have the Reverend asked for the with kindness and warmth, a better world. But we don’t people in the church to join in with devotion and grace. The have a better world. We have a as a chorus on a selection of quality of mercy was above all different world, different from traditional Cantonese songs. things, and her faith to God what we expected. We continue As I listened to these songs, was unquestioned. For her to have strife in this world, a feeling of belonging, of simplicity, it seemed like God megalomaniacal leaders that being at home came over me, was not simple to her. God was are concerned with their own as I had heard these songs in complex and mysterious and to place in history rather than the my childhood and knew the be revisited again and again. people they are supposed to melodies to these songs. I did take care of. We don’t have the not know the words, but there As these stories went on, as jobs we wanted, the lives we was something incredible the beautiful cello played by wanted. I can’t give an answer seeing everyone come together, my close friend to accompany as to why the world is like this, to sing these old songs that the slideshow, I looked up to but I feel that people have brought great comfort in dire the great wood cross that was lost faith, for themselves and times. towered above all of us. I was for this world, and I share that not a Christian and was not feeling with them. After the songs, the service well-versed in the Bible, but I It was at the end of February, on proceeded to the speeches thought of a line from the Book the verge of spring that I found from family members and of Job. my faith in a church, during a close friends, all telling tales funeral service. of this woman that repeated “Where were you when I laid the kindness and warmth that the earth’s foundation? Tell me, It was an impulsive decision. I I experienced, as well as the if you understand.” did not know the person very devotion she had for her family well. She was the grandmother and for her religion. These On the road back, a sense of of one of my closest friends, and speeches would be both in wonder fell over me. I smiled I had only met her a handful Cantonese and in English, and as I drove back, as I heard the of times. That being said, each when the speech was given in words of my Father again and I time I met her, she was full Cantonese, I would read her felt that I understood faith now. of grace and warmth, with a short biography on the back I understood it as I understood simplicity and serenity that of the pamphlet. This woman this highway, the same one I I feel I can’t truly describe. I was born in the Republic of would travel back to Saskatoon thought it was only appropriate China, with her father being from Estevan. I understood to pay my respects to a person one of the Generals in the army. Truth not as an end point, but who had given me both She had married a Reverend, as a path, as a light. The same delicious food and gracious survived the perils of the light that I saw when I stopped hospitality. Cultural Revolution, before by on the side of the road once

36 | JOURNAL OF THE SURGICAL HUMANITIES on my way back to Estevan, the if one wishes to lead the life that a major vessel ran near last beam of the early setting of truth. Faith is truly a leap, it. The anatomy surrounding it sun that still shone through the and this understanding of truth was more difficult than usual broken fences and illuminated and faith and the world cannot and the gynecologist told the dead stalks of wheat that be found in one person, but in her to place her laparoscopic sunk into the Prairie snow. people, in all people, and to live instrument very close to the The same light that brought and trust in them. A person has IP ligament and to cauterize forth the brilliant golden hour to live beyond one’s self to find it. The senior resident was colours of the sky, of cobalt and truth and faith and meaning. reluctant, stating that she magenta and violet with streaks would be more comfortable of mauve pink, the background As I entered town, with that working around it and not near to white clouds that moved wonder and awe still in my it. The gynecologist repeated on paths that I couldn’t truly heart, I followed my last herself to cauterize the area. know. I thought of my life like impulse for the day. I did not The resident once again stated these white clouds, continuing go home as I had originally that she didn’t think it was to move even after the golden planned, but I decided to go possible and that she was afraid hour and the sunset has passed. to my favourite coffee shop. I she would injure the vessel. I thought of all the little events don’t know why I decided to go The gynecologist finally said, that occurred during these there at that particular time, or ‘You have to trust me, okay? You troubling years, the things that why I happened to be there at have to trust me.’ The resident didn’t go as I had wanted and all, but something happened, finally cauterized through the all the things that I thought something wonderful, and the area and the vessel was not were failures, brought forth way I saw myself and the world injured and the procedure people like Dr. C and Dr. M that changed forever... carried on routinely. gave me the opportunities to resurrect me from these failures A few weeks later, I was in When the procedure ended, I and to lead forth a life with the the operating room with a had the opportunity to close things that I needed and had gynecologist and the senior the wounds with a hand tie. As truly wanted all along. resident that was working beautiful as the divine second with her on a hysterectomy. andante movement of Mozart’s I thought of how true faith was The senior resident, who knew Piano Concerto No. 21, the ends understanding that the world all the theory and workings finally came together, the string was beyond my understanding, of the operation they were threaded through, the knot beyond my control, that one working on, encountered the finally tied down. must wade into the unknown IP ligament and understood

Ronald Nguyen Haisen is a third year medical student at the College of Medicine, University of Saskatchewan. He was born and raised in Calgary, Alberta, but has called Saskatoon his home for the past six years. His first publication, a short story entitled ‘Something Happening Somewhere’, was printed in unsettled magazine.

JOURNAL OF THE SURGICAL HUMANITIES | 37 Poetry Cor n er

38 | JOURNAL OF THE SURGICAL HUMANITIES STR8-UP FROM DESPAIR TO HOPE: Inside the movement helping gang members

By Fr. Andre Pollievre

History and beginnings killed by a rival gang and the membership in their respective In the mid 1990s, street other had two younger brothers gangs. Many members have gangs became an increasing who were following in his attended parenting classes, reality in Saskatoon and gang deadly footsteps. They then returned to school or recruitment on the street and became the first two individuals university, enrolled in various within the provincial jail was to leave their gang and work trade programs, completed rampant. with the chaplain on the streets rehabilitation and addiction of Saskatoon. recovery programs and received The coordinating chaplain at counselling and psychiatric the Saskatoon Correctional STR8 UP (pronounced, assistance. The pursuit of Centre (SCC) introduced a “straight up”) was conceived their personal goals enabled program for inmates who at the request, initiative and them to discover that to help expressed positive attitudes involvement of active gang themselves, they had to help and values, which included members wanting support to others. The search for healthy participation in speaking abandon an organization that relationships enabled them to engagements, workshops for them, had become abusive, abandon the unhealthy ones, and presentations in schools, dysfunctional and alienating. occasionally even with family treatment centres and youth members. groups. The presentations were Since those early days, STR8 UP centred around these inmates’ has delivered more than 2,000 In 2013, STR8 UP established experiences. presentations, healing and its Board of Directors and soon sharing circles and workshops after, became a registered, non- In the fall of 2002, two gang for numerous treatment centres, profit organization and received members who had both been schools, reserves, churches, its registered charitable status involved in the program at provincial and federal prisons in 2014. the SCC, had approached the and young offender centres. chaplain and confided their More than 450 individuals have desire to leave their respective associated themselves with http://str8-up.ca gangs. One’s partner had been STR8 UP who have abandoned

JOURNAL OF THE SURGICAL HUMANITIES | 39 POETRY CORNER... STR8-UP Mission and Guiding Principles own journey and not having foe of honesty is denial and impossible expectations placed deceit. The second spiritual Our mission statement is “STR8 on them or be controlled by reality is that of humility – the UP assists young men and others, their goals become opposite is arrogance. Members women to master their own realistic and attainable. must remove themselves destiny in liberating themselves from being the centre of the from gangs and criminal - An important focus of STR8 universe and drop the street lifestyles.” UP is about relationships. attitude that they are able to do Young people who are often anything they want to anybody - In STR8 UP we reject the mistreated, abandoned and they want, whenever and labels “good” or “bad.” Members’ rejected, enter a shattered however they want. behaviours may be labeled world. Their medication as such, but this cannot be for these are their various - To begin this journey, it is extrapolated to the members addictions; and one of the basic necessary to possess a vision of themselves as human beings; characteristic of addictions is new changes and possibilities. their realities that have isolation from oneself and from For our members, this vision is led to their addictions and others and from one’s Sacred the possibility of becoming a dysfunction require a different Mystery. When they enter into LOVING PARENT, a FAITHFUL interpretation. the journey of healing, they PARTNER and a RESPONSIBLE alone enter – but they cannot CITIZEN. At STR8 UP we have - We believe some individuals journey alone. realized that these are true are on a life journey that is possibilities, well within their positive and healthy, while - The healing journey is a long grasp. Through the shadow others are on a journey that and difficulty process. It is a of their past, they are able to is a painful disease, both of journey of 10,000 little steps grasp the present and achieve which might possibly find with every little step a success. their dreams for tomorrow. their origins at conception and Members’ sense of hopelessness during childhood. Children dissipates as focus is placed - The STR8 UP healing model are not born with a gun or on the progress and success of is the INDIGENOUS MEDICINE knife in their hand. Many, each member. WHEEL, which teaches us that if not all have experienced as human beings we need to abandonment, abuse, violence - STR8 UP is a SPIRITUAL nurture, develop and sustain and racism. These latter people BASED PROGRAM. Some the four aspects of our nature – are often labelled, judged and members are mainstream or physical, emotional, mental and condemned, punished. Yet, born-again Christians, some spiritual. Using the Medicine these individuals are called to are atheists or agnostics. Many Wheel model, we can identify healing, recovery and wellness. are strongly committed to the benefits of a healthy Indigenous culture, traditions pregnancy and a wholesome - The journey to hope and and ceremonies. STR8 UP childhood upbringing; as well, healing must begin where believes that every human the debilitating damages members find themselves, not being is a spiritual person. Is of an abusive, shattered from where they wish to be or our spirituality positive and life childhood. The Medicine where someone else wishes giving … or is it negative, self- Wheel becomes the model for them to be. Healing is a process, destructive and alienating? Our a healthy transformation from not an event. Addicts are locked members realize their recovery pain, sickness, abandonment into their addiction, not only by is dependent on a positive and victimization to one their hurting past but also their spiritual life. Recovery is first of self-respect, acceptance, hopeless view of the future. of all a search for honesty, truth wholesomeness and wellness. By being free to control their speaking and thinking; the arch

40 | JOURNAL OF THE SURGICAL HUMANITIES Motivation for leaving gang behind bars, the pain of missing my children and being a part of their life, the pain of losing my Members have seen too many of their friends street brothers to the penitentiary or death, the and relatives shot, stabbed, commit suicide, pain to my family and parents … all this pain overdose or die in car accident. They themselves won’t be for naught if I can save the life of one have been stabbed, shot or had various other child. I can never repair the damage done by my violent experiences. actions, but with STR8 UP, I can use the rest of my life and my story to help stop the damage.” Having joined their gang at a young age and now often in their early 20s, they are sick and STR8 UP does not actively recruit, promote or tired – tired of jails and police, tired of conflicts, advertise itself to active gang members, nor is it despair and violence, tired of an empty and futile at war with gangs. Many STR8 UP members have life. They are searching for something better. family still active in gangs: parents, brothers and sisters, their own sons and daughters and other They are now moms and dads, have a partner relatives. and a family. They do not wish for their sons and daughters to be brought up in the same manner We expect that when one becomes a STR8 UP as they were. member, he or she accepts all other members; regardless of the rivalry and conflicts of the past, Many wish to give back to their community what they must be ready to shake hands with all other they took from it. They wish to be a positive members of STR8 UP. presence rather than the negative one that characterized their gang life. Members are not expected or asked to inform police of past activities with gangs, or provide Let me quote from one of their autobiographies: names of individuals involved in their past gang “All this pain that I carry, the pain of my violent life. Any disclosure of this type would endanger childhood, the pain of all the isolation and years not only themselves but other members as well.

JOURNAL OF THE SURGICAL HUMANITIES | 41 POETRY CORNER... STR8-UP

Indian Princess

Indian princess, you look beautiful in your jingle dress, You take my mind back to the old days To when we listened to our Elders, and followed the old ways To when we pounded the drums to Mother Earth’s heartbeat Instead of losing our people to life on the streets Before the systems failed us and we fell between the cracks Before they took our language and never gave it back Before our lives revolved around using alcohol and drugs When our kids were kids, not gangsters or thugs When being a man meant protecting the tribe Not beating his wife and getting drunk or high.

Indian princess, we were meant for more than this More than dying of AIDS or hepatitis More than being just numbers and statistics; But Indian princess, it’s not too late To save our children and change our fate But first, we must let go of the pain and let go of the hate, We must move on and forgive the wrongs And teach our children that being tough does not mean being strong That strength comes from the good inside And they must use that good to protect the tribe.

by Nicholas Giroux

42 | JOURNAL OF THE SURGICAL HUMANITIES STR8-UP ACHIEVEMENTS IN LITERATURE AND ART

Literature: STR8 UP and its members have together, written a number of books. The first book, “STR8 UP and Gangs: the Untold Stories” (McNallyRobinson, 2012; available at: https:// www.mcnallyrobinson.com ) contains the true life stories of thirteen young men, who have chosen to share their hearts, their pain, hopes and successes to reach at-risk youth before they become involved in gang life. In doing so, the members who wrote this book not only reach the youth they seek to help, they educate the general public about gangs while empowering themselves. They describe their childhood experiences of abuse, violence and addictions, which ultimately were gateways to their entry into gang life and activities. About Fr. Andre Pollievre A second book, “STR8 UP, Stories of Courage,” (Hear my Heart Books Inc.2015; available Fr. Andre was trained in the area of at: https://hearmyheartbooks.myshopify.com/ adult education. After attending four products/str8up-stories-of-courage) is a follow- universities, he was involved in adult up to the first book and highlights the journeys education programs in Saskatoon. of recovering gang members. Section three of He also worked five years for Arctic this book contains poems written by several Cooperatives where he developed and recovering STR8 UP members). implemented training programs for Inuit and Dene management trainees in Videos: Several videos have been produced native owned cooperative enterprises. featuring members sharing their stories to In the mid 1980s, he joined the staff at educate youth and to anyone wanting to know Joe Duquette High School, now named “how come” these joined a gang … to later decide Oskayak, where he was a teacher, to leave the gang. counselor and chaplain for 10 years. In one video, members sing a song they wrote Following that, he became coordinating and composed, asking the question: “Where are chaplain at the Saskatoon Correctional the mothers?” Centre for seven years. Since 2002 and presently, he has been Art: An art display of poetry, visuals and short a street worker and founder of the stories dealing with dads incarcerated and the organization named STR8 UP, which is consequences of how this affected their children, a group of ex-gang members recovering was featured at SCYAP Art Centre in fall 2017. from street gang domination. The exhibit was entitled: “Dads behind bars – a project featuring the work of STR8 UP members In 2008, he was awarded the created while incarcerated in the Saskatoon Order of Canada. Correctional Centre.”

JOURNAL OF THE SURGICAL HUMANITIES | 43 In 2015, we were graciously granted permission to serialize the life story and memoir of one of the preeminent surgeons of our time, Professor ZHIVAGO: R.M. Kirk - and the Spring 2015 issue of this Journal carried Chapter 1 of his life story .

The Doctor Raymond Maurice Kirk (“Jerry” Kirk to his friends) is perhaps best known to most surgeons and surgical trainees throughout the world on in Literature account of “Kirk’s General Surgical Operations” – the textbook of operative General Surgery that has been the standard in Britain and in many other parts of the English speaking world. Now into its 6th Edition (2013), it is available in both print form and (as some of our residents know) for the ipad as well.

he doctor not only writes His other books are almost equally well known and Prof. Kirk’s elegant, practical and poetry, novels, essays and short pithy writing style and editorship are widely Tstories - he or she also lives recognized and admired. in them. This column celebrates works of literature that celebrate (or Professor Kirk’s career as Consultant academic denigrate) a physician and his or her Surgeon was spent almost continuously at work and times. Its authors will only the Royal Free Hospital and Medical School in London. Many innovators and pioneers in uncommonly be physicians - it would medicine and surgery worked in the ferment surely be a fallacious presumption of intellectual activity that was the Royal Free to assume that only a doctor can (including the pioneer hepatologist Sheila comment on his or her own life and Sherlock) and Prof. Kirk made widely recognized manners. contributions to surgery of the stomach and esophagus. During the seven years that he was Editor of the Annals of the Royal College The title is from Russian novelist of Surgeons of England, the journal rose even Boris Pasternak’s immortal, lyrical further in standing and ranking among the novel, “Dr. Zhivago.” The film, bearing surgical journals of the world. the same name was directed by David Lean and starred Omar Sharif and The story of how Jerry met Peggy is contained Julie Christie. in the “life story” and will appear in due course, in the pages of this journal. Jerry and Peggy live in Hampstead, London, not far from where The Editor that other English surgeon John Keats lived and wrote his immortal, “Ode to A Nightingale.”

The Editor is deeply grateful to Jerry for the privilege of allowing this Journal to carry serialized excerpts of his life story. And now for a continuation of Jerry’s story, Chapter 7, in his own words …

44 | JOURNAL OF THE SURGICAL HUMANITIES LIFE STORY Excerpts from the memoirs of R. M. Kirk

Chapter 7

returned to Charing Cross Hospital to work as committee but by the length of the waiting an assistant with the superb master surgeon, queue of eager trainees. Because he could not I Norman Tanner. He had initially worked only hear spoken names, Tanner called everyone, ‘Doc.’ at a London County Council (LCC) hospital, St Norman Tanner was eventually invited on to the James, in Balham, south of the River Thames. staff of the teaching hospital at Charing Cross. Deafness precluded him from joining the Royal His simple advice was, ‘Get it right first time, Army Medical Service (RAMC) during the war. Doc.’ I have spent many remorseful nights awake, There was an epidemic of wartime peptic regretting not having lived up to that mantra. ulceration. Tanner developed a standardized operative technique for dealing with perforated, I started on the clinical investigations to fill the bleeding or intractable ulcers which could be requirements for my thesis on lymphoedema safely followed by surgeons of merely average (L lympha = water + G oedema = swelling). At competency, producing outstanding results. He that time Charing Cross did not have a single attracted surgeons from all over the world to plastic surgeon on the staff and I was given, by visit his elderly, sparsely-equipped hospital. default, complete freedom to deal with burns, Initially, Tanner’s assistants arrived by word skin tumours and breast reductions. By chance of mouth, mainly from Old Commonwealth one patient was sent to me with a swollen leg countries. English graduates thought themselves from such gross lymphoedema that she could too superior to work at a mere LCC hospital. not walk. Having read the surgical literature but never having seen the operation devised My friend Michael Madigan from Adelaide came by a British surgeon Charles, I embarked on back to Britain to pursue a surgical career. He what was a flaying of the leg – removal of the had survived the war as a navigator and bomb- skin and underlying tissue down to the muscle, aimer in Lancaster bombers and then qualified followed by the application of skin grafts. With back at home in medicine. When he visited a few defects, the grafts survived but her leg Tanner’s operating theatre he was instantly looked like a patch quilt. I told her I needed and generously invited to ‘scrub-up’ and assist. to carry out a few cosmetic procedures. She Tanner was recognized as a master, not by a would have nothing of this but insisted on

JOURNAL OF THE SURGICAL HUMANITIES | 45 ZHIVAGO... The Doctor in Literature Society of Medicine library. The equipment I needed had to be manufactured or assembled by me. The hospital equipment manager was wonderfully helpful in loaning and giving me my requirements. He had previously worked at the London Hospital (now Royal London) and had created for Sir Henry Souttar a flexible tube for insertion within a malignant but inoperable oesophageal stricture, to allow fluid and finely minced solid to reach the stomach. Souttar was famous for performing the first successful splitting of a strictured heart valve – a mitral valvotomy – and to me also, for removing my mother-in-law’s gallbladder.

I gained a final training appointment at the Royal Free Hospital, the first hospital in England to accept women for clinical teaching. It was also famous for offering sick patients admission regardless of their financial state – hence ‘Free.’ In recognition, Queen Victoria gave it on her accession, the accolade of Dame Sheila Sherlock (1918-2001) and inset, her famous book, a ‘Royal’ title. I had first now in its 13th (1918) edition. heard of it as a student at Charing Cross Hospital. One of the gynaecologists, a walking out. ‘You cannot go out with the leg bachelor, introduced his first teaching session by looking like that!’ She cheerfully replied that announcing that there was a hospital in London she could wear lisle stockings (‘Lisle,’ a former where all the doctors were women. He held up spelling of the French city Lille produces an his hands as he reported, with eyes staring in opaque stocking). I never saw her again. My breathless horror, ‘They examine men – and even success in treating her stimulated me to devise pass catheters on them!’ His voice changed to and measure factors producing lymphoedema. one of determined rejection as he drew himself Every possible Saturday was spent in the Royal up to state, ‘All through the War I kept a card in

46 | JOURNAL OF THE SURGICAL HUMANITIES my breast pocket stating, “If found as a casualty, for the whole service on 5th July 1948. He do not send me to the Royal Free Hospital.”’ was no longer fully able to undertake the He did not feel the need to justify himself in challenges referred to him. He continued to use examining women. This was just as the National the registrars (unpaid), in his private clinic. He Health Service was being implemented. Very called me to assist him and when the operation soon, all teaching hospitals were made to accept became too difficult, left me to continue with, women students. ‘Jerry, I am gasping for a cigarette. I shall let you deal with the remainder.’ At this time Peggy was The most famous surgeon at the Royal Free had pregnant with our younger daughter. Having read been an international expert in thyroid surgery the1954 report on the incidence of lung cancer who was said to have a penchant for pretty in doctors who smoked cigarettes by Richard red-haired lady house-surgeons. When one of Doll and Bradford Hill, we had just made a firm them did not answer her night calls she received commitment to stop smoking. Normally I should a letter from the hospitals administrators immediately reach for a cigarette on leaving the stating that unless she mended her ways, her operating theatre but when I saw Rodney, just appointment would be withdrawn. The surgeon about to light a cigarette which would soon join walked into the House Governor’s office the next the pile of stubs in the ash tray, I was fortified morning and presented his letter of resignation, in my resolve to refuse when he offered one to stating that he would withdraw it when the me. My stimulus to refuse the proffered cigarette, hospital authorities rescinded their threat to his in lieu of an assistant’s fee, was a more valuable house surgeon. Such was his standing that she gift. Peggy and I never smoked again. was immediately reinstated. George, large and imposing, of Scandinavian ancestry, was usually Many senior surgical trainees spent at least amiable but had an occasionally explosive a year abroad, usually in America. My age, personality. He could have been the model for following 4 years wartime service, made it the character of Sir Lancelot Spratt, played by advisable to seek an early consultant post. James Robertson Justice, in a comedy film called, We had three children. Valentine, our elder ‘Doctor in the House.’ His wife, a cardiologist daughter was now 5, our son Jeremy was 4 and and Dean of the Medical School, could reduce a our younger daughter Louise was 1. We lived man to his knees at ten paces with the shard- in a block of flats so the elder two were able like cut-glass voice with which she punctured to make friends and play with the children of one’s self confidence. Together they formed the other families in the block. Living in a modest two legs of a Colossus astride the Hospital and two bedroom flat was crowded and we needed Medical School. A third pre-eminent personality to seek a house. Peggy had ceased to work while was the Professor of Medicine, later Dame, Sheila the children were small but intended to return to Sherlock. her medical career. She would eventually enter the community medical service and achieve It was alleged that Sheila Sherlock’s success as a Consultant Audiological Physician, appointment was fiercely resisted by some of the running a community adult and children’s female consultant who feared the competition. service in Tottenham, North London. When she This may have been malicious gossip but they eventually retired she was presented with a had need to face the competition which earned beautiful engraved silver tray. I was moved to her an international reputation. Rodney Maingot hear her speech. She referred to Helen Keller the former senior surgeon and notable surgical from Connecticut (1880-1968) who suffered a author was still active, with a lucrative private severe illness at the age of 19 months which left practice. He had operated on Aneurin Bevan her blind and deaf. Thanks to a devoted, loving (1897-1960) a prominent Labour government tutor, she gained an education, a degree of BA Health Minister, the architect of the National and became a prolific author. When asked which Health Service which took over responsibility she considered the greater loss between her

JOURNAL OF THE SURGICAL HUMANITIES | 47 ZHIVAGO... The Doctor in Literature

John Peters Humphrey (1905-1995) - Canadian author of the first draft of the United Nations’ Universal Declaration of Human Rights (1948)

two disabilities she stated that blindness cut members of the consultant staff – cynically her off from things but deafness cut her from labelled, ‘Trial by sherry and Twiglets.’ The contact with people. I write this just a few days senior physician approached me, carrying in after watching our younger daughter Louise, on one hand a tumbler of whisky. The other hand the television news, who, stimulated by Peggy held a cigarette between the nicotine-stained studied to become an audiological scientist. index and middle fingers. As he questioned She recently organized the fitting of cochlear me he shook out a succession of pills, flushing implants for a brave girl Malala, who in Pakistan them down with a swig of whisky. ‘Kirk, do you was shot in the head for insisting on attending intend to go into private practice?’ I had not school to become educated against the demands contemplated the possibility. He then assailed of religious extremists. She was shown switching me with his situation. He claimed to have the on cochlear implants that had been inserted largest private physician’s practice in London. for a patient whose eyesight was failing and He had just recovered from a massive coronary who had been deaf for 40 years – the recipient’s thrombosis which required hospitalization. ‘Kirk, delight was overwhelming. as I lay in bed I thought of my ongoing expenses – the suite of rooms in Harley House, the two Consultant Surgeon receptionists, two secretaries, two cars and two My initial appointment as consultant surgeon chauffeurs. I was so horrified that I nearly had was in 1961, at Willesden in West London. My another ‘coronary’ thinking about it.’ At that time colleague was George Qvist. When I applied, I we were unaware of the effects of smoking on was invited to an informal meeting with the the vascular system. Despite later warnings, the

48 | JOURNAL OF THE SURGICAL HUMANITIES physician continued to smoke heavily. He died over hated regimes. A plangent cry was, ‘We 10 years later, not from carcinoma of the lung won the War.’ Many felt, complacently, that the but from coronary artery disease. I am unsure World owed us a living. Changes were driven by how much his personal story affected me but catching up with deferred intentions and with from the first, I was reluctant to attract private fresh, emerging trends. A powerful force was practice. the Declaration of Human Rights in 1948 by the United Nations. They asserted that there were In retrospect I recognize the changes that inalienable entitlements due from society to were taking place throughout my career in the every individual. This virtually stood on its head relationship within the population and between the previous pre-eminence of the State and the doctors and patients. My generation tended to duty imposed by it, on the individuals living resist them, falling back onto the tradition in within it. Running in parallel was the increasing force when we entered the profession and the availability of information. University education, indoctrination we absorbed from our teachers. previously limited to a privileged group in There were a number of reasons for change. society became available to a larger section. After two World Wars, separated by only 21 years, The later appearance and development of many within the population were reluctant electronically stored and distributed information to accept the pre-war restraints that had been was comparable to our present-day conception exerted on ordinary people. We had taken of the ‘Big Bang’ universe. part in a period of deprivation, fear, the loss of loved ones, injury, on the promise of victory To be continued...

Eleanor Roosevelt holding the United Nations’ Universal Declaration of Human Rights (1948)

JOURNAL OF THE SURGICAL HUMANITIES | 49 Submission Guidelines

Submissions to the Journal will be acceptedSubmissions in two to thecategories: Journal will be accepted in two categories: • Written Work: poetry, essays and • historicalWritten Work: vignettes. poetry, essays and historical vignettes. • Visual and Musical Work: • submissionsVisual and Musical in digital Work : reproductions,submissions in of digital paintings, photographs,reproductions, music of paintings, and sculpture.photographs, music and sculpture.

All submissions must be accompaniedAll submissions by amust cover be letter in Microsoftaccompanied (MS) by Word a cover format, letter with in aMicrosoft short (300 (MS) words) Word biography format, with ofa shortthe author, (300 words)name, addressbiography and telephoneof the author, number. name, address and telephone number. All submissions should be sent in byAll email submissions to should be sent in [email protected] email to [email protected] If you wish to submit by traditional mail,If you please wish toaddress submit your by traditional submissionmail, please to: address your submission to: The Editor, Surgical Humanities DepartmentThe Editor, of Surgery UniversitySurgical Humanities of Saskatchewan Saskatoon,Department SK of S7N Surgery 0W8 University of Saskatchewan Saskatoon, SK S7N 0W8

50 | JOURNAL OF THE SURGICAL HUMANITIES SUBMISSION GUIDELINES

WRITTEN WORK • May include poetry, short stories, essays or historical vignettes. • Submissions must not exceed 5,000 words. • All email submissions of written work must be in MS Word format, double spaced, 12-point font, with title and page numbers clearly marked. • The work submitted should not have been published previously.

PAINTING PHOTOGRAPHY SCULPTURE AND CRAFTWORK • Photographic digital • Up to 4 photographs may be • Photographic digital reproductions of the painting submitted at a time, each of high reproductions of the sculpture submitted must be in high definition, in JPEG or TIFF formats or craftwork submitted must be definition JPEG or TIFF formats (300 dpi or higher). in high definition JPEG or TIFF (300 dpi or above). • The photographs may be linked images (300 dpi or above). • 3 photographs must be submitted: by a similar theme, but this is not • A total of 4 photographs must be • the painting as a whole; essential. submitted: • an illustrative inset/detail of the • Each photograph must be titled • The sculpture/craftwork captured painting; and appropriately - captions are in at least 3 angles, each • a photograph of the artist at work. optional; titles and captions may photograph addressing a different • Each photograph must carry a be submitted separately, in MS angle title - captions are optional. Titles Word format. • A photograph of the artist at and captions can be submitted in • An essay of approximately work. a separate, MS Word document. 1000 words to accompany the • Each photograph must carry a • An essay of approximately 1000 photographs must be submitted title - captions are optional. Titles words must accompany the separately, in MS Word format. and captions can be submitted in submission, in MS Word format, The essay can address the a separate, MS Word document. with a description of the painting photographs, or be a story of • An essay of approximately and its story/meaning, as seen by the photographer's life and 1000 words must accompany the artist. motivations. the submission, in MS Word format, with a description of the sculpture/craftwork and its story/ meaning, as seen by the artist.

PERFORMANCE COMPOSITION • Music may be of any genre, • The composition may be in any genre of music, with the composer’s provided the performer recognizes musical score sheet, in musical notation, forming the centrepiece of the his/her performance as a serious submission. art form. • The musical score sheet need not be in classical music notation - but the • Submissions must be accompanied reader must be able to reproduce the music by following the score sheet. by an essay of approximately 1000 • Singer-songwriters can submit their compositions, with the music in words on the performance itself musical notation and the words of the song accompanying the notation/ or on the importance of music in chords. the performer’s life. A YouTube link • Submissions must be accompanied by an essay of approximately 1000 to the performer must be clearly words on the composition itself or on the importance of music in the included in the essay. performer’s life. A YouTube link to the composition being performed must be clearly included in the essay.

JOURNAL OF THE SURGICAL HUMANITIES | 51 JOURNAL OF THE SURGICAL HUMANITIES

ISSN 2368-0407