Surgery Series Introduction

This series of oral histories with UCSF surgeons is the first publication of the newly reorganized Department of Anthropology, History, and Social Medicine (DAHSM). It demonstrates the ongoing vitality of the Oral History Program which was founded in 1991 as part of the mission of the original Department of History of Health Sciences to document UCSF's institutional memory and identity as one of the most prominent academic medical centers in the United States. UCSF Surgery in the Postwar Years is the first of our oral history projects to be devoted to a single field of clinical enterprise. Because of the prominent, but often polarized position that surgery occupies in hospitals and especially in academic medicine, surgery is an especially important and symbolically meaningful medical discipline to document rigorously from the perspective of the primary individuals involved in defining the field. More than any other category of clinician, surgeons throughout history have elicited responses from their colleagues in other clinical disciplines and from the general public ranging from admiration and gratitude to resentment, envy and scorn. It is especially important, consequently, at the turn of the twentieth century to go beyond the stereotypes and to document the clinical science of surgery in its full historical and human context directly in the voices of those who practice and research surgery.

UCSF's role in developing surgery, both nationally and internationally, is made clear in these carefully transcribed and edited individual interviews, which have been annotated and buttressed by additional bibliographical data. Nancy Rockafellar, Ph.D., the Director of the Oral History Program, personally conducted all of the interviews with skill, sensitivity, and scholarly integrity. She has created a dialogue designed to bring out the details of her narrators' science and service in a manner that is integrated with the human and social context of research and clinical practice. As a result we are able to provide future generations with valuable polished documents as well as a raw archive that captures the current state of both the art and science of surgery in the year 2000. Historians, physicians, policy makers, and patients years from now will be able to learn from this historical documentation and contextualize with greater clarity the achievements, crises, and breakthroughs that await us in the near future.

This project was undertaken as a jointly-funded collaboration with the Department of Surgery and the UC President's Office Research Initiative in the Humanities. We give special thanks to Dr. Haile Debas, Dean of the Medical School , who rendered his commitment to the preservation of UCSF history concrete through his financial assistance with bridging funds for the Oral History Program. We also thank Dr. Nancy Ascher, who became Chair of the Department of Surgery halfway through this collaboration, which had been initiated by her predecessor, Dr. Theodore Schrock. Despite the severe budget constraints on clinical departments at the time this oral history was undertaken, Dr. Ascher recognized the importance of this work and reinvigorated the collaboration to preserve the historical record of her colleagues and her department. We are also grateful to the numerous faculty members and friends of the Oral History Program whose generosity materially contributed to make the series possible, especially Lawrence Crooks. Our dedicated departmental staff provided technical assistance with special thanks to Gail Johnson whose first job as our new Management Services Officer was to ensure the financial and logistical continuity of this initiative.

Philippe Bourgois, Ph.D., June 2000

Historian's Introduction

When this series was initiated in 1998, the joint goal of the Surgery Department and the Department of the History of Health Sciences was to recapture the complexity of the story of UCSF surgery in the years following World War II. A review of the existing records revealed that several short newsletter surveys had been written and brief annual reports recorded activities of the department at various time periods. Realizing that these accounts merely touched the surface of this complicated surgical enterprise, the Chair of Surgery, Dr. Theodore Schrock, commissioned a series of oral history interviews to document the multiple firsthand perspectives of the participant surgeons themselves. In preparing these interviews, we began with a review of existing resources and faculty papers, meeting minutes, newsletters, and the project also benefited from manuscript histories compiled by Drs. Allen Johnson and Benson Roe.

These interviews contain a rich contextual picture of a postwar surgery department in one of the nation's premier academic centers. UCSF's current high rankings were not always the norm, however, for in the late 1940s the UC medical school was not considered a first-tier research institution. As the University of California expanded enrollment and developed new campuses, University President Clark Kerr turned his attention to bringing this oldest UC campus up to par with Berkeley's high-ranking departments. The subsequent role of the UCSF Department of Surgery in achieving institutional excellence is the central focus of this history. The interviews explore several important themes including more obscure economic issues such as the gradual implementation of the full-time system, the impact of Medicare and Medicaid, and concurrent patterns of federal and foundation funding. Federal policy regarding managed care and directives on drugs and medical devices are considered in these narratives, and we have also highlighted the role of imaging, laparoscopic technology, and transplantation research that in some cases prompted revolutionary changes in surgery in the past three decades.

The choice of oral history biography has been a productive one. These interviews serve as a vehicle for examining tacit knowledge among surgeons as well as the requirements imposed by the institution they served. Biography documents all human aspects of the academic life, and in these interviews, readers can see how family background, career aspirations, patient care, lab work, teaching, and politicking intersected in a single career. By choosing a group of subjects who interacted within the same department over time we can chart the results of multiple mentors, changing financial conditions, technological innovation, and the impact of different leadership styles. Finally, the interviews contain exciting accounts of the inside workings of a surgery department, which serve to remind us of the extreme physical and emotional demands of surgery as a discipline.

By adding a second phase to this series, featuring interviews with the next generation of surgeons (many of whom were taught or recruited by the interviewees in Phase One), we explore the remarkable breadth of the UCSF Department of Surgery as it evolved in the postwar years. As a composite study, these interviews trace UCSF's pioneering work in vascular surgery, transplantation, trauma service, gastrointestinal physiology, fetal surgery, laparoscopic techniques, and pediatric cardiac surgery in the context of national developments. And since many UCSF-trained surgeons left California to lead academic departments elsewhere, we can follow the process of cross-fertilization among UCSF and such leading institutions as Minnesota , Johns Hopkins, and Harvard.

Most importantly, these accounts identify a profound shift from an older tradition where surgeons were regarded as “mere operators” toward the new postwar academic ideal of the scientific surgeon who grasped research opportunities and directly linked them to the care of patients. Here we closely examine the effects of greater scientific acuity and less invasive technology on the practice of surgery in the years following World War II. During these years, surgical research expanded from more traditional applied areas such as infection control and wound healing to more basic transplant immunology, gastrointestinal physiology, fetal research, cardiovascular physiology, and molecular biology. Oral History biography allows us to track individual efforts within the institutional matrix of the academic medical center, and reveals our subjects moving deftly from bedside to laboratory to operating room and back. By creating these narratives, we are now much closer to our goal of effectively documenting the history of postwar American biomedicine.

Nancy Rockafellar, Ph.D., July, 2000