The History of the Surgical Service at San Francisco General Hospital
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THE HISTORY OF THE SURGICAL SERVICE AT SAN FRANCISCO GENERAL HOSPITAL William Schecter, Robert Lim, George Sheldon, Norman Christensen, William Blaisdell i DEDICATION This book is dedicated to our patient and understanding wives Gisela Schecter, Carolee Lim, Ruth Sheldon, Sally Christensen, and Marilyn Blaisdell. Their help and support not only made our careers possible but also ensured that they would be successful. ii PREFACE I was delighted and honored to be asked to assist in the publication of this landmark book on the History of Surgery in the San Francisco General Hospital. The authors are to be commended on their accurate, readable and historic portrayal of the evolution of this center of excellence in trauma and general surgical patient care. As I read through the manuscript, it brought back warm and clear memories of days spent here both as a junior medical student and later as a resident in the University of California, San Francisco surgical program. It presents an impressive timeline of surgeons who have taught here, a number of whom have moved on and become outstanding leaders in the field of surgery. After 40 years of practice as a surgeon, I look back on my training here at this hospital as one of the most important contributors to my overall surgical and medical education. This hospital and its surgical staff imbued me with the essential knowledge and technical skills necessary to be an accomplished general surgeon and, most importantly, they taught me the value of seeking advice from a more experienced specialist when the occasion arose. I feel certain that every surgeon, who during their training has passed through the portals of San Francisco General Hospital, will also find in this book a powerful reminder of how important it has been in their life. Robert Albo Oakland, California September 2007 iii CONTENTS Dedication Page i Preface Page ii Introduction Page 1 Chapter I The Brunn–Rixford–Eloesser Years: Page 2 1915-1945 William Blaisdell Chapter II The Mathewson–Goldman Years: Page 34 1915-1966 William Blaisdell Chapter III The Blaisdell Years: Page 77 1966-1978 Robert Lim, George Sheldon Chapter IV The Trunkey Years: Page 150 1978-1986 William Schecter Chapter V The Lewis Years: Page 185 1986-1993 Norman Christensen 1 INTRODUCTION The authors of this history of San Francisco City and County Hospital—also known as San Francisco Hospital or San Francisco General Hospital (SFGH) by its official names over the years— have enjoyed putting this document together. It not only serves as the surgical history of this hospital, still affectionately referred to as “the County,” but it also represents the history of surgery itself during the 20th Century. This was the period described as the Age of the Surgeon, as it was during this period that our specialty emerged in full flower. Throughout almost its entire history, San Francisco General Hospital has served as a training ground for medical students, interns, and residents. In 1864, Hugh Toland built his first medical school adjacent to the original County Hospital in North Beach, and in 1865, Toland was granted permission to use the hospital for clinical instruction. In 1872, Toland Medical School became the medical school of the University of California (UC). In 1872, a new County Hospital was built on the present Potrero site. In 1879, UC negotiated an agreement with the San Francisco County Supervisors that gave the University responsibility for professional care and staff appointments and allowed medical students’ access to patients. Shortly thereafter, Cooper Medical College, which in 1908 became Stanford Medical School, developed a similar arrangement. At the same time, four internship appointments were negotiated—two for UC and two for Stanford. The number of internships was gradually expanded, but it was not until the new brick and mortar hospital opened in 1915 that the first junior residents, called house officers, were added. Formal postgraduate surgical training emerged gradually during the 1920s. Our description of the County Hospital Surgical Services starts in 1915 with the dedication of the new hospital, called the Renaissance Hospital because of its filigreed appearance. Definitive organization of the Surgical Services, including the specialties of surgery, dates from that time. Formal training programs in surgery followed shortly thereafter during the 1920s. The contribution of the hospital and its surgical staff, including its flamboyant chiefs of service, to the care of patients and to the development of surgery are the subject of this book. 2 CHAPTER I THE BRUNN–RIXFORD–ELOESSER YEARS: 1915–1945 In 1915, the new San Francisco General Hospital opened located between the Mission District and Potrero Hill. It was appropriately referred to as the Renaissance Hospital, as it was solidly built of brick in pavilion style with all the fancy accoutrements of the bricklayer’s art. The Administration Building, centered between four towers that housed patients’ wards, was three stories high. The first floor contained the administrative offices and the telephone exchange and switchboard. In addition there was a large room for the visiting staff, which was also available as a committee meeting room. The upper two floors were devoted to the use of the residents and interns. They contained a library and a billiard room in addition to the physicians’ quarters and communal bathrooms. The Receiving Building on the north end of the complex facing 22nd Street was four stories high. The first floor contained the Emergency Service— Mission Emergency—which was moved to this site from a separate building a block away and which, although administratively separate, was incorporated physically into the new hospital. This emergency room (ER) included procedure rooms, separate observation wards for men and women, and eight isolation rooms. The first floor also included an outpatient clinic, Social Service, and a dental clinic. The second floor contained the surgical pavilion. Besides standard operating rooms, the surgical pavilion included two large amphitheaters (east and west), each with seating accommodations for 50 students. On this floor were the xray department, the eye and ear, nose, and throat and the urological examination rooms, as well as a recovery room. The third floor was occupied by the amphitheater, which had seating accommodations for 200 people, and small laboratories on each side—one for 3 each of the two medical schools. The fourth floor contained the extension of the amphitheater as well as several offices. The hydrotherapy department was located in the basement. At that time it was described as “second to none in San Francisco.” It was equipped with dressing and lounging rooms and douche, steam, and irrigation rooms. There was also a pool and a “mechanical apparatus” department. The four main ward buildings were initially four stories high. Each building had four 29-bed wards, a roof garden with a penthouse, and a basement. There were 25 beds in the open ward, two isolation rooms with two beds each, a solarium, a treatment room, and a kitchen. A special feature was the sanitary tower on the middle north side of each ward, which contained the toilets, baths, wash basins, a utility station, and a laundry chute. Ultimately the roof garden was converted into an additional, fifth, floor. A separate pathology building was constructed on 22nd Street, just east of the Receiving Building. The first floor contained the autopsy amphitheater, ice boxes for the morgue, and an animal research lab. The second floor contained the pathology laboratories and offices. The third floor contained Health Department laboratories. An isolation building of three stories with 120 isolation cubicles occupied the central east area. Several years after completion of the main hospital, a 500-bed tuberculosis building was completed on the southeast corner of the property, fronting on 23rd Street. The first year the hospital was open, the annual expenditure was $333,000. The State of California subsidized 85 tuberculosis patients at $3.00 per week. HISTORY The first true San Francisco City and County Hospital was established in 1857 in a building originally constructed as a school on the north side of Telegraph Hill, in the North Beach area. Dr. Hugh H. Toland built his medical school next door in 1864 and obtained permission from the City and County to educate his medical students there in 1865. 4 Left Toland Medical School, Right County Hospital Hugh Toland arrived in San Francisco in 1852. He had been a successful physician in South Carolina, but left for California to search for gold. He found gold mining too tough and retired into the easier business of doctoring. Within a few years, he was making the unbelievable sum of $40,000 a year, the major basis of which was his large mail-order business and pharmacy. Using Wells Fargo as an intermediary, he diagnosed and prescribed by letter for countless people isolated in the remotest areas of California and Nevada. His chief remedies were kept behind the counter of his drugstore in two barrels, which were labeled anti-scrof (tuberculosis) and anti-syph (syphilis). Upon these two barrels were laid the financial foundations of the future medical departments of the University of California When the hospital exceeded its capacity, it was time to look for another site. Toland fought to have the City build on the original site or in the immediate vicinity. Unfortunately, Dr. R. Beverly Cole—Toland’s antagonist in a notorious dispute—was successful in ensuring that the hospital was located as far away as possible, out in the sand dunes south of the City on what was to become Potrero Avenue. The antagonism between the two men was the result of a difference of opinion regarding management of the wound of a crusading newspaper publisher, James King.