THE HISTORY OF THE SURGICAL SERVICE

THE HISTORY OF THE SURGICAL SERVICE AT SAN FRANCISCO GENERAL HOSPITAL

William Schecter, Robert Lim, George Sheldon, Norman Christensen, William Blaisdell

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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.

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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

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CONTENTS

Dedication Preface Introduction Chapter I

Chapter II

Chapter III

Chapter IV

Chapter V

The Brunn?Rixford?Eloesser Years: 1915-1945

William Blaisdell

Page i Page ii Page 1 Page 2

The Mathewson?Goldman Years: 1915-1966

William Blaisdell

Page 34

The Blaisdell Years: 1966-1978

Robert Lim, George Sheldon

Page 77

The Trunkey Years: 1978-1986

William Schecter

Page 150

The Lewis Years: 1986-1993

Norman Christensen

Page 185

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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.

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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

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