On September 12, 2015, in the Great Synagogue, Pilsen, Czech Republic, during the time of the Jubilee Congress, our World President, Prof. Yik-Hong Ho, delivered an excellent address entitled as shown in this special editional e-newsletter. This address is particularly noteworthy, given the celebration of the 80th anniversary of the founding of the International College of Surgeons by Dr. Max Thorek. This newsletter is dedicated in its entirety to providing the remarks made by Prof. Ho. Yik-Hong Ho; 40th World President, International College of Surgeons
(Excerpts of Festive Lecture, Jubilee World Congress, Great Synagogue at Pilsen, 12 September 2015)
On the occasion of the Jubilee World Congress held in Prague/Pilsen celebrating the 80th anniversary of the founding of the International College of Surgeons (ICS), it is my honor and appropriate to re-visit the contributions of Dr Max Thorek. After all, Stephen Embrose, renowned author and historian wrote “the past is a source of knowledge and the future is a source of hope. Love of the past implies faith in the future.” A better understanding of the history of ICS will help us appreciate the aims and directions of our College.
The history of ICS started with Dr Max Thorek, who founded the International College of Surgeons in 1935 and the International Museum of Surgical Science in 1954. He also founded the American Hospital in Chicago in 1911; the latter has been renamed the Thorek Memorial Hospital. Dr Max Thorek as a surgeon was a renowned clinician, teacher and experimenter or researcher. However, he also had multiple talents outside of medicine including music. He was a violinist on the Chicago Business Men’s Orchestra. He was a philanthropist funding the American Physician’s Association. He was also a famous photographer whose works remain on permanent display at the Smithsonian Institute Washington DC, USA.
ICS today comprises of about 4700 regular fee paying Fellows, which makes ICS the largest global surgical society. Fellows consist of surgeons living and practicing in over 100 countries all over the world. The College has Non-Governmental Organization (NGO) status on the World Health Organization (WHO) since February 12, 1975. Representatives from ICS have access to regularly attend WHO meetings. The College Journal International Surgery was established in 1938. After a later period of stagnation, new editorial leadership has brought the journal up to an impact factor of 0.248 in 2013. In 2014, the impact factor has almost doubled to 0.469. We aim to continue to improve the quality of the journal. The International Museum of Surgical Science was open to the public in 1954. It is now recognized as a historical landmark of the city of Chicago with collections including medical artefacts, instruments, paintings and 5000 books / bound journals some dating back to the 16th century. Above all, the vision that has kept the College going and will continue to keep us striving forward has been – “to improve the lives of patients through the development and education of our members and the advancement of the medical field.”
Therefore, it is important to truly understand the true spirit of the vision statement made by our founders in order to clearly grasp the design of the college and to interpret the future direction. Perhaps this is best illustrated by Dr Max Thorek himself who wrote in his book “The Camera Artist” that his purpose in taking a photograph is to “… reproduce for others, not just what his physical eye sees but the emotion which filled his soul when he saw it.” With this in mind, in order to truly understand our vision statement, it would be vital to know more of the man our ICS founder was.
Max Thorek was born on 10 March 1880. He never named his home town but said that it was in the “Tatra Mountains in Hungary”. However, there is a possibility from his descriptions of his home town half way between Vienna and Budapest, its location in the Tatra Mountains as well as the name Thorek that this home town may well be in current day Slovakia. Max Thorek was the eldest son in a Jewish Family where both his father Isaac and his mother Sarah were medical doctors. He had his early education at the Budapest Gymnasium, which was an institution specializing in preparing academically talented students for University Education. However, his brother was murdered in violent actions against Jews in 1897. For safety reasons, the family migrated to Chicago, USA on a steamship in 1898 with altogether only US$50.
Max Thorek had to play the violin to earn money to continue his education. He was encouraged at an early age to go into medicine. In view of financial difficulties, he had to enter Rush Medical College, University of Chicago through a musical scholarship. Rush Medical College did not have an orchestra but had a brass band. Therefore, Max Thorek was not able to gain a scholarship by playing the violin but had to quickly master playing the snare drum. He was at Rush Medical College from 1900 to 1904. Max Thorek did his intern year at the Marcy Home Hospital in the poverty stricken ghetto in 1904. When he went into private general practice in 1905, he declined opportunities for lucrative practice and chose instead to continue to work amongst the poor. He preferred to serve them because they were “our neighbours when we came to USA.” In addition, he also held the position of associate gynaecologist at the West Side Dispensary from 1906 to 1910; he said he continued to have “reverence for the mystery of birth.”
It was after this period that Dr Max Thorek took an interest in surgery as a speciality. He married his childhood Hungarian sweetheart Fim who had remarkably travelled the long journey alone from Hungary to join him in Chicago. During that time, he fell ill from influenza and after a long convalescence decided to specialize in surgery. He founded the American Hospital in 1911 and became the Surgeon-in-Chief there in 1912. As a surgeon, he was well recognized professionally having been appointed Consultant General Surgeon of Cook County Hospital in 1914. He was also well recognized academically with the appointment of Professor of Clinical Surgery in the Cook County Graduate School from 1934 to 1960.
As a policy maker at the American Hospital, Max Thorek was well remembered for insisting that a patient is to be treated as a person and never as a medical case. Patients were treated on their need for medical care, rather than their ability to pay. Medical and nursing staff who worked there remarked that they could never tell whether any patient was paying or of non-paying status. It was an ironical turn of fate that many of the poor that Dr Max Thorek treated grew up to be artists and performers who became rich and famous. These included Buffalo Bill the circus cowboy performer, Mae West the actress, Harry Houdini the magician and the Marx Brothers comedians. They in turn made Dr Max Thorek famous as he became known as the “Surgeon to the Stars”.
Far from striving on publicity alone, Dr Max Thorek also had many academic achievements that remain relevant to current surgical practice. Particularly notable were his academic contributions to gallbladder surgery and to plastic surgery. The advancements he made to gallbladder surgery included electrosurgical obliteration of the residual gall bladder after partial cholecystectomy to avoid the risk of liver haemorrhage in difficult cases. He also improved the technique for gallbladder surgery in the elderly and was a pioneer in partial hepatectomy for gallbladder cancer. With his artistic talent in photography and music, it was not surprising that Dr Max Thorek was amongst the first in developing plastic reconstructive surgery as a specialty. He recognized and taught about the psychological importance of aesthetics. His technique of reduction mammoplasty with free nipple graft and his principles for abdominoplasty remain very valid today.
The books he had written include “Plastic surgery of the breast and abdominal walls”, “The human testis and its diseases”, “Surgical errors and safeguards”, “Thorek’s illustrated surgical technic” and “A surgeon’s world”. The latter has been the source of much of the material in this lecture. In addition, he translated “Surgery of the brain and spinal cord” from German. “Surgical errors and safeguards” published in 1932 is of particular interest in illustrating that Max Thorek’s thinking was well ahead of his times. In this book, he stated the conviction that “surgeons can never free themselves completely from the danger of error in judgement or technique”. It is only been recently recognized that in surgery, making mistakes is inherent in human nature (Cooper M & Makary MA, Surg Clin N Am 2012). Max Thorek also wrote in that book that no two cases are alike. A surgeon “never repeats” because otherwise complacency will lead to avoidable mistakes. This can be understood to allude to the technical skills and nontechnical skills described in surgical error analysis (Gawande AA et al, Surgery 2003). Max Thorek also wrote that surgeons must “always be wary of meeting some new and unexpected peril”. Perhaps this was a pioneer effort in advocating for what we know today as the World Health Organization Surgical Safety Checklist and its variations. When “Surgical errors and safeguards” was published in 1932, his surgical colleagues were totally appalled that such a “public admission” will have suicidal effects upon the profession. Yet it is now well recognized that 44000-98000 deaths and 1 million injuries occur in American Hospitals from avoidable medical errors (Kohn K et al, Institute of Medicine 1999) and 25.1% of all 19 North Carolina Hospital patients (2002-2007) sustained harm from preventable medical mistakes (Landrigan CP et al, N Eng J Med 2010).
Despite all his achievements and successes, Dr Max Thorek continued to have a “bitterest disappointment of my life”. That was the “discovery and rediscovery that surgery can be, for some surgeons a business, not a profession” and “getting ahead is a matter of politics – not what you know but whom you know that counts.” He envisaged a “True College” with the prime function to “teach younger, older men & all who thirsted for knowledge where everyman would be at one and same time teacher and student”. This college would be like the medieval university where learning knew no national boundaries. In doing so, it will become a force making for international understanding, goodwill and peace. At the time, “every group of specialists already have national and international societies” but he was convinced there was room for a new kind of international organization built by “men of courage and vision” according to those ideals. Around 1930, Dr Max Thorek wrote personally about this vision to fellow surgeons and surgical leaders in many lands.
His efforts drew such support that the International College of Surgeons was incorporated on 28 December 1935 in Geneva, Switzerland by Professor Albert Jentzer, the Dean of the Medical University of Geneva and his colleagues there. Geneva was chosen because it was thought to represent the principles of international amity and cooperation. Leaders were appointed to inaugurate chapters of ICS in various parts of the world. Professor Arnold Jirasek, Head of the 1st Department of Surgery, Charles University in Prague became the first ICS International (World) President. Dr Max Thorek became the Secretary General/Treasurer and Editor-in-Chief of the College Journal for several years. ICS was re-incorporated under Washington DC, USA law in 1940 because of concerns for safety related to World War II. The College acquired buildings in Chicago, USA in 1947 and has since continued to progress until the present status. It is noteworthy that the Nobel Prize winning physicist Dr Albert Einstein was amongst our College’s Honorary Fellows.
Dr Max Thorek continued to work up to his last days of life. He died on 25 January 1960 of a “heart attack” at the age of 79 years. His wife Fanny (Fim) survived him until just before her 103rd birthday. Knowing Dr Max Thorek’s passion in helping the poor, his conviction for equity in surgical education particularly in less privileged lands and his dream of global surgical fellowship outreach it would not be amiss to apply the ICS vision of “improving the lives of patients…” to global humanitarian surgery. We know that the burden of global disease has shifted in recent times such that 11% of the illnesses can only be treated by surgery. (Debas HT et al Disease Control..2006). The effectiveness of vaccines, antibiotics, public health measures etc. has managed the communicable infectious diseases such that we are left with a significant volume of non-communicable diseases related to factors such as injuries, malignancies, congenital anomalies and obstetric complications (Lopez AD et al, lancet 2001). There are about 234 million major operations a year but the poorest 30% only get 3.5% of the needed surgery (Weiser TG et al, Lancet 2008).
The importance of global humanitarian surgery was recognized when the 68th World Health Assembly (WHO) passed resolution A68/31 to strengthen emergency and essential surgical care and anaesthesia, in May 2015. It was acknowledged that providing service was not enough but every effort must be focused on building resilient health systems. The local health services available must be built up to be able to deliver safe, high-quality, accessible and cost effective essential and emergency surgery on their own. The ICS will continue to work together in collaboration with WHO to strive for leadership in global humanitarian surgery. We will continue to detail the development of our actionable plans from one ICS meeting to the next, and there we will continue to appreciate input, interest and stakeholder buy-in by ICS fellows.
Thank you and the best to all of you,
Prof. Yik-Hong Ho
ICS World President