A Brief history of the Department of Surgery

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Part of Acta Medica Philippina

Title: A Brief history of the Department of Surgery
Creator: Recio, Porfirio M.
Language: English
Year: 1961
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Fulltext: A BRIEF HISTORY OF THE DEPARTMENT OF SURGERY* PORFIRIO M. RECIO, F.P.C.S. College of Medicine University of the Philippines "Ang hindi lumilingon sa pinanggalingan, ay di makakarating sa paroroonan" - Tagalog proverb. The paucity and unavailability of records has made the task of writing a history of the Department of Surgery rather difficult, but from the meager information we were able to gather we shall try to give a brief account of the Department of Surgery of our medical center. The present Department of Surgery may be said to have started as the Surgical Department of the Philippine Civil Hospital which was established by Act No. 247 of the Philippine Commission. As early as 1900, Dean C. Worcester. then Secretary of Interior in the Philippines, envisioned the establishment in Manila of a central govemm~nt laboratory, a medical coUege and a general hospital. Later that year, Major John R. McDill, M.C., U.S.A., made recommendations for such a general hospital. On October 1, 1901, Act No. 247 passed by the Philippine Commission established the Philippine Civil Hospital, which was opened in Ca1zada de lriz. Azcarraga Street was in the fashion of the times named in three portions - Azcarraga proper, Calzada de Iris and Calzada de la Paz. The Philippine Civil Hospital used to stand in what is now the site of the University of the East. In 1905, Act No. 1415, passed by the Philippine Commis~ion. authorized the establishment of a medical school. In 1906, Consulting Architect W. C. Parsons drew. plans for a pavilion type of hospital patterned after the E_ppendorf Hos•Delivered during the Fourth Teaching Institute (Teaching of Surgery), College of Medicine, April 8, 19.59, at the Philippine General Hospital Science Hall 45 46 ACTA MEDlCA PHIUPPINA pital in Hamburg. Among the original buildings were included a surgical pavilion with two operating rooms and a male and female surgical ward of sixty beds each. On June 10, 1907, the Philippine Medical School opened in the former building of the School for the Deaf and Blind on Malecon Drive. This school was under the supervision of a Board of Control, all of whose members were American civil government of"ficials ex~ cept a lone Filipino, Dr. Trinidad H. Pardo de Tavera, who represented the Philippine Commission. Years earlier, this Board of Control had been meeting, laying down the ground work for the school. In 1907, first to fifth year students were admitted and the first graduating class was that of 1908. The second, third, fourth and fifth year students who enrolled in 1907 were students who transferred from the University of Sto. Tomas. Faculty of Medicine and Surgery, where they finished courses in "ampliacion de medicina'', forerunner of the preparatory medical curriculum. They passed entrance examinations in various subjects among which were Botany, ChemiStry and Latin. There were set requirements for first year students. These were generally graduates of the Philippine Normal School, the Licea de Manila, and Manila and provincial high schools. Surgery as a subject was taught from the third to the fifth year - in every semester. Before the establishment of the Philippine General Hospital, the clinical material from St. Paul's Hospital in Intramuros was used by virtue of a contract between the Philippine Medical School and St. Paul's Hospital. The free clinic (out-patient department or dispensary) was held in St. Paul's Hospital till June 1, 1911 when it was transferred to the Philippine General Hospital. In the Philippine General Hospital, surgical out-patients were originally dressed in the Surgical Pavilion but by June 16, 1911, the Free Dispensary was used. The hours were 8:30 to 9:30 A.M., and after a break of one hour, dressings were resumed from 10:30 to 11 :30 A.M. The subject taught was mostly clinical surgery, but a course in dog surgery was given to supplement operating room experience and practice. This was in line with ihe-policies instituted at that time in the newly established. Johns Hopkins Medical School. FOURTH TEACHING INSTITUTE 47 The original staff was composed of Dr. John R. McDill, professor and chief of the department of surgery at the Phil· ippine Civil Hospital (receiving PS,000 a year); GregOrio Sin~ gian as associate professor of surgery; and Dr. Dudley, an· other associate professor. The surgical interns in the Philip· pine Civil Hospital served as assistants in lecturing (at Pl,000 a year) inasmuch as the students' knowledge of English wac; rather deficient. The first surgical intern was Dr. Potenciano C. Guazon who later become the first Filipino professor and head of any department of surgery. The Department was not to be headed by an American ~gain till 1952 to 1953 when an honorary department head was named in the person of Dr. William F. Reinhoff, Jr. A manual or guide for use of surgical interns, the scrcalled "Blue Book", was written by Hans Schiffbauer who was the first' senior resident in surgery. We cannot trace any copy of this now. Dr. Schiffbauer passed away a few years ago, spending the last years of his life as Professor Emeritus in Surgery at the University of California in Los Angeles. The first postgraduate clinical courses for nurses in our country were given in the Department of Surgery. The subjects dealt with operating room nursing and anesthesia. Flora Gutierrez, R.N., D.D.S., whose name was to become synonymous with anesthesia in the Philippines for forty years, was an early product of suc.h a program. The surgical con. fcrences we!'e published as a regular feature of the Philippine Medical Association Journal from 1928 to 1941 under the edi· torship of Carmelo M. Reyes. In July 1910 the Philippine Medical School transferred to the new medical building on Herran Street, west of the Bureau of Science (The Central Government Laboratories), in what was known as the Exposition Grounds. On September l, 1910, ten patients were lransfcrred from the Civil Hospital to the Philippine General Hospital. Before the day was over, forty· three patients were admitte<l. On December 8, 191P, the Philippine Medical School was forma11y affiliated with the University of the Philippines located on the adjoining campus across Padre Faura SLrcct. The name of the school Wa£ then changf.d to Co11egc of Medicine and Surgery, which name was. shorttiii.cd again to College of Medicine in 1923. In 1914, with 48 . ACTA MEDICA PHILIPPINA the general reorganization of the Philippine General Hospital as instituted Oy the Secretary of Interior, Winifred Dennison, the staff of the Philippine General Hospital became identical with that of the Department of Surgery of the medical school, with corresponding academic ranks given to those in the hospital st1:1.ff. This anomaly arose because the staff of the Philippine Civil Hospital became the staff of the Philippine General Hospital, while the medical school had a staff of its own. During the First World War, the surgical staff was commissioned into the Philippine National Guard. The chief, Doctor Guazon, was commissioned as lieutenant colonel, the con-sultant staff were designated as majors and residents were captains. In 1924, the Guazon Memorial Amphitheater and Operating Room were built from funds provided by the University of the Philippines and Dr. Maria Paz Mendoza-Guazon, widow of the first professor and head of the Department and also the first locally graduated Filipino female physician. The gynecological service was separated as a distinct department with its own staff in 1923 headed by Dr. Fernando Calderonfor a while the Surgical Department was called the Department of Surgery and Gynecology. It is interesting to note that the first assistant resident, Dr. Potenciano C. Guazon, who was assigned to the female ward became a proficient gynecologist while the ·other one, Dr. Jose Eduque, assigned to the male ward, became a pioneer urologist. The first Cancer Diagnostic Clinic in the country, originally called th .. · Tumor Cli.1i<.: \';::'._; op~ratcd by the Department 'Of Surgery in the dispensary in 1941. The Venereal Clinic which used to be with Urology Clinic was the only evening clinic in the Philippine General Hospital Out-patient Department but was subsequently made to operate in daytime. Tutorship classes were 5tartcd in 1937 for the first time in the medical school when two-thirds of Class 1937 failed in Surgery. These classes were authorized by the University; tuition fees were paid by the students and instruction given by the non-resident instructors. In 1938 to 1941, owing to the modernization and expansion of the Philippine General Hospital, apparently spurred by the unwholesome conditions observed by the then Commonwealth President Manuel L. Quezon, who a year before FOURTH TEACHING INSTITUTE 49 underwent an emergency operation for acute appendicitis, and upon request by Dean Antonio G. Sison, who was also Director of the Hospital, the South or Surgical Laboratories with facilities for both students and faculty were constructed. This also included space for a surgical museum (which has not been reconstructed since its destruction in 1945) and a dark room or photography laboratory. The Cancer Institute was also established this time and its surgical staff came from the Department. With the darkening of the war clouds presaging the Greater East Asia War, other residents were called or \'oluntccred for military service. This gave a chance for new blood to be infused into the Department. During the Japanese Occupation from 1942 to 1945, the Department was host to numerous Japanese surgeons. It even had space for what was termed as an adviser, Colonel Kamada, who would occasionally visit the operating room and make rounds. At the same time, the Department rendered service to American internees kept in Ward Numbers 4 and 9 for charity and Ward Number 21 for private cases. Some operations were done, the more memorable of which include what is probably the first locally performed cervico-thoracic sympathectomy, and the first 1ocally operated case of carotid body tumor. In another case, an erroneous interpretation of aspiration biopsy material condemned the man as having pulmonary malignancy but this turned out later to be an empyerna. The Department J.lso was instrumental in the treatment of the late Jose P. Laurel, when he was President of the Republic. The staff experimented for some time with what could really have been crude penicillin infusions - quite successfully used for infected war wounds. During the war the resourcefulness of the staff was taxed to the outmost. Bandages were later replaced by tiny strips of cloth from the National Development Company. To remove adhesive tape, coconut oil was used. Adhesive tape was replaced with narrow strips of cloth whenever possible. • During the month of December 1941, before the surrender ot Manila, the Philippine General Hospital resident staff was impressed into service under the supervision of the Depart~ meq.t of Surgery. Ward Number 3 was set up as an infected ward for Clostridium infection. Operating rooms for infected 50 ACTA MEDICA PHIUPPINA patients were set up. During the siege of the hospital, the last weeks before the complete liberation of Manila, the whole hospital was populated by refugees from the neighborhood and each of the various wards was placed under the direct supervision and control of a surgical resident. Each ward was a self-contained emergency unit of its own, with ample facilities to carry out emergency work. It may be mentioned that two faculty members of the Department suffered injuries during the siege. One was the late Professor Manuel N. Tuazon who was injured by shrapnel which hit him while he was treating a patient in the Emergency Room. He had also the distinction of being confined in Fort Santiago as a political prisoner. The other injured faculty member was Dr. Enrique M. Garcia who still carries shrapnel in his leg muscles. After liberation, many staff members were active in various P.C.A.U.'s in Manila. The present National Orthopcdi.:: Ho!.pital grew out from P.C.A.U. Number 1 whose members were mostly from the Philippine General Hospital led by Dr. Ambrosio F. Tangco. P.C.A.U. Number 5 was under Dr. Antonio Vazquez and was origina1ly housed in the Philiopine· Women's University, eventually to become the Philippine Gen· eral Hospital Provisional Hospital, and finally reorganized lo· the Philippine General Hospital again. P.C.A.U. Number 6,. which was ultimately to become the North General Hospital, was also staffed by formel' members of the Department - Drs. Carmelo M. Reyes, Francisco C, de Guzman, and Pablo Morales. The Department of Surgery grand rounds of the chief started by Dr. Guazon in 1917 have been abolished. Increased size of the Department and the creation of semi-autonomous services has rendered this difficult and possibly un-· necessary. Semi-autonomous surgical services were created in• 1939 in an effort of the chief to share responsibility in management of cases. It is noteworthy that as early as 1924 an orthopedic service was created, headed by Dr. Antonio Vazquez. Dr. Vazquez used to give the only lectures in orthopedics. He was sent abroad subsequently to study thoracic surgery and1 brought back with him the first thoracoscope in the country. Sections on specialty surgery were created - the first one was. FOURTH TEACHING INSTITUTE 51 UroJogy (even during the Japanese Occupation) followed by Orthopedics, Neurosurgery, Plastic Surgery, and Thoracic Surgery. A s~ction on Anesthesia, the first so organized in our country, was initiated-in 1949. The first exploratory craniotomy, exploratory thoracotomy, and mitral commissurotomy in the country were done in the Department. Increasing supervised responsibility and operative activity are granted to residents as part of their training program. In their final years as residents, the latter are allowed to perform major operations guided or assisted by consultants. There have also been a few changes in the academic aspects or in teaching surgery. More and more demonstrations are being given with fewer lectures compared to previous years. Operative Clinics, wherein the students watched operations from some distance have been abolished. Dog surgery has been abolished - it is said thru efforts of dog lovers. It may interest you to know that there has been a clamor for this subject in recent years - the students feeling probably that no amount of reading and didactic lectures can replace actual performance of these procedures in order to get the feel and the practical experience. The course in surgical anatomy has also been abolished, supposedly because of the difficulty of securing cadavers. The Department has had very distinguished members whose names are bywords in Philippine surgery. We may mention Guazon, first Filipino professor of surgery; Eduque, pioneer Filipino urologist; Abue1, pioneer Filipino neuro-surgeon; and others, such as Estrada. Vazquez, Mandanas, Reyes, and Santos-Cuyugan.