Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

H. Glenn Bell, MD: The Epitome of a General Surgeon

H. Glenn Bell, MD: The Epitome of a General Surgeon In the current age of specialization, which includes minimally invasive and robotic techniques, general surgery has seen its field of practice primarily contracted to trauma and abdominal surgery. Even these 2 areas have undergone a remarkable degree of specialization. There was a time 6 decades ago when a general surgeon was truly the finest example of an all-encompassing physician who could successfully treat any disease that might afflict a patient. No one personified this distinguished title of general surgeon more than Dr H. (Harry) Glenn Bell. View LargeDownload H. Glenn Bell, MD His life began on a small family farm in Hillsboro, Ohio, on March 2, 1893.1 His early exposure to his family physician and later as a medical corpsman with the US Army in France and Germany during World War I stimulated his desire to be a physician. After receiving his MD degree in 1923, he proceeded directly into the rigorous 6-year surgical program at the University of Cincinnati College of Medicine, Cincinnati, Ohio, under the auspices of professor and chairman Dr Mont R. Reid. In 1930, shortly after completing his training, Bell received a job offer from Dr Howard C. Naffziger, chairman of the department of surgery at The University of California, San Francisco, Medical School. He offered Bell the position of associate professor of surgery and acting chief resident, with the provision that he develop a resident training program similar to the program established by Dr William S. Halsted at The Johns Hopkins Hospital, Baltimore, Md. Bell accepted the position enthusiastically. Reid, Bell’s mentor at Cincinnati, and Dr Harvey W. Cushing, Naffziger’s mentor in Boston, Mass, had received their surgical training under Halsted. Halsted had revolutionized American surgery by emphasizing that gentle, meticulous handling of tissue led to an improved surgical outcome. At the same time, he organized the country’s first formal surgical training program based on the German model. Bell, with Naffziger’s encouragement, proceeded to develop the new surgical training program at The University of California, San Francisco, along “halstedian” concepts. This involved a 4- to 5-year pyramidal system emphasizing academic principles and delicate operative surgery. When Bell came to San Francisco from Cincinnati, he brought with him an advanced electrocautery unit, called a “Bovie” after its inventor, an electrical engineer and physicist by the name of Dr William T. Bovie. This unit could coagulate small vessels and, in the deft hands of Bell, could dissect tissue with amazing clarity and precision. Operating with Bell was often described as performing surgery in the Sahara Desert because the operative field was so dry. Bell’s cauterization unit was less charitably referred to throughout the remainder of the United States as the “western barbecue.” Within a short time of his arrival in San Francisco, Bell performed a gastrectomy in his usual flawless, avascular manner under intense scrutiny of the faculty, house staff, and local clinical surgeons. In the era of highly volatile anesthetics, the observers were anticipating that the patient, surgeon, and entire operating suite would blow up or erupt in flames. Following the uneventful operation, Bell was summoned to Naffziger’s office. As Bell admitted later, he was concerned that his academic career and appointment as chief of general surgery might be in jeopardy. Naffziger looked him straight in the eye and said, “I think that coagulation unit is ideal for use in neurosurgical procedures. I would like to have that in the neurosurgical department, and perhaps you could order another one for your use in your department (Dr Bell, verbal communication, 1962).” Six months later, Bell had a new Bovie! One of the most frequent operations performed at this time was the Halsted radical mastectomy, which typically required a skin graft and several units of blood. On the day of surgery, a breast biopsy was performed and the specimen was analyzed pathologically. If this proved to be malignant, the first unit of blood was transfused concurrent with the skin incision for the mastectomy. Bell, however, believed that therapeutic bloodletting had become antiquated during the Civil War, and thanks to his using the electrocautery unit to minimize blood loss, his patients rarely required transfusion. Another technical contribution he made to the operation was to use the “dog-ears” that occurred in the skin flaps following most mastectomies as skin grafts, rather than harvesting extensive skin grafts from the thigh. Assisting Bell at his various surgical procedures was an exceptional learning experience. An assistant resident, intern, and medical student were involved in all aspects of the procedure. Nothing ever seemed rushed, and there was no wasted motion. Every movement appeared effortless, never hesitant, and the operation always progressed at a steady pace to its logical completion. If something unexpected occurred, nothing changed. The demeanor, rhythm, presence, and voice remained calm. Everything flowed so smoothly that his assistants were never aware of the passage of time. During the 1960s, Dr George W. Crile, chief of surgery at The Cleveland Clinic, Cleveland, Ohio, was advocating a type of mastectomy for cancer that was far less radical than that of Halsted. The University of California, San Francisco, surgical program, like the Halsted program on which it had been based, had weekly presentations of topics in surgery. These were prepared by the resident surgeons and delivered in an auditorium filled with medical students, interns, residents, attending staff, and visiting surgeons from the area. As such, I was asked to analyze our current concept of the Halsted radical mastectomy. Following extensive reading and research on the topic in preparation for this presentation, I began to doubt that the radical operation proposed by Halsted should be the procedure of choice. It seemed even more certain that super-radical and extended radical mastectomies had little to offer the patient with breast cancer. I confidently concluded my presentation by stating that we should consider performing a more limited resection than the standard Halsted or extended radical mastectomy. The hush in the audience at the completion of my presentation was daunting. The surgical residency consisted of a pyramidal system in which multiple residents started the program and a lucky few finished as chief residents (again, as advocated by Halsted). I was certain that my days within the department of surgery as a general surgical resident were numbered. To my astonishment, Bell rose and said, “I have long felt that there are many choices of operation for cancer of the breast, and I think this brings to light a number of things that we should seriously consider in our surgical approach to this malignancy.” Later, he took me aside and said, “I liked your presentation, and hopefully many of the surgeons in attendance will rethink their surgical approach.” What a relief that was to hear! I recall another incident when Bell was admitted to the hospital in preparation for a hernioplasty that was to be performed on him the following day. It fell to a lowly surgical resident to perform the preoperative history and physical examination. The resident completed the examination and then rather sheepishly and with fear and trepidation said to him, “I’m sorry, Dr Bell, but I’m going to have to do a rectal examination.” Bell looked him in the eye and said, “Young man, if you had not done it, you would not be in the program tomorrow!” Bell succeeded Naffziger as chairman of surgery in 1947 and remained head of the department until 1956, when he stepped down. He was pleased to see Dr Leon Goldman appointed as his successor. Goldman was the first resident he had trained and was imbued with the same halstedian precepts that he and Naffziger had established almost 30 years previously.2 Bell continued teaching and maintaining an active surgical practice, performing 3 or 4 major operations a day, until his retirement in 1968, at age 75. Thereafter, he continued to devote his spare time to gardening and golf, the 2 pastimes he enjoyed most, until his death at the age of 87, in 1981. Bell’s progressive approach continuously and constructively challenged surgical dogma. His management of hemostasis and his development of the electrocautery technique, as well as numerous other technical aspects of surgical operations, were innovative and creative. He shed new thought and light on the procedures that were being done. He did pioneering work in the surgical treatment of cancer, especially that of the breast, stomach, and colon. His interests included biliary tract disease and managing the complications related thereto. His ethics, integrity, instruction, demeanor, thinking, and technical skill set the standard for his numerous trainees, his faculty, and community surgeons. His influence as a teacher is best reflected in these 2 quotations from a 1932 article by him and Naffziger on postgraduate training of students in surgery.3 “Our obligation [as teachers] does not end with diagnosis or treatment. Even more important is the imprint we leave upon the developing character [of the house staff].”3(p384) “The point to be made is that it is one thing to train our residents in existing knowledge. This is not so difficult. It is another matter to prepare them to extend our knowledge.”3(p387) I believe, like many others who came to know Bell, that he was a cornerstone not only of the resident house staff’s surgical training and teaching but also of the entire faculty of the department of surgery at the University of California, San Francisco. Bell was the epitome of a general surgeon. Correspondence: Dr Albo, 418 30th St, Oakland, CA 94609. Previous Presentation: This paper was presented at the Howard C. Naffziger Surgical Society Meeting; March 26, 2004; San Francisco, Calif. References 1. H. Glenn Bell. Surgery: San Francisco [In Memoriam]. University of California San Francisco1986; 2. Bell HG Recollections by H. Glenn Bell. Tales and Traditions. Vol 1.1954;44- 52University of California at San Francisco LibraryGoogle Scholar 3. Naffziger HCBell HG The postgraduate training of students in surgery at The University of California. West J Surg 1932;40384- 389Google Scholar http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

H. Glenn Bell, MD: The Epitome of a General Surgeon

Archives of Surgery , Volume 140 (7) – Jul 1, 2005

Loading next page...
 
/lp/american-medical-association/h-glenn-bell-md-the-epitome-of-a-general-surgeon-7UbPYC6xBz
Publisher
American Medical Association
Copyright
Copyright © 2005 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.140.7.702
Publisher site
See Article on Publisher Site

Abstract

In the current age of specialization, which includes minimally invasive and robotic techniques, general surgery has seen its field of practice primarily contracted to trauma and abdominal surgery. Even these 2 areas have undergone a remarkable degree of specialization. There was a time 6 decades ago when a general surgeon was truly the finest example of an all-encompassing physician who could successfully treat any disease that might afflict a patient. No one personified this distinguished title of general surgeon more than Dr H. (Harry) Glenn Bell. View LargeDownload H. Glenn Bell, MD His life began on a small family farm in Hillsboro, Ohio, on March 2, 1893.1 His early exposure to his family physician and later as a medical corpsman with the US Army in France and Germany during World War I stimulated his desire to be a physician. After receiving his MD degree in 1923, he proceeded directly into the rigorous 6-year surgical program at the University of Cincinnati College of Medicine, Cincinnati, Ohio, under the auspices of professor and chairman Dr Mont R. Reid. In 1930, shortly after completing his training, Bell received a job offer from Dr Howard C. Naffziger, chairman of the department of surgery at The University of California, San Francisco, Medical School. He offered Bell the position of associate professor of surgery and acting chief resident, with the provision that he develop a resident training program similar to the program established by Dr William S. Halsted at The Johns Hopkins Hospital, Baltimore, Md. Bell accepted the position enthusiastically. Reid, Bell’s mentor at Cincinnati, and Dr Harvey W. Cushing, Naffziger’s mentor in Boston, Mass, had received their surgical training under Halsted. Halsted had revolutionized American surgery by emphasizing that gentle, meticulous handling of tissue led to an improved surgical outcome. At the same time, he organized the country’s first formal surgical training program based on the German model. Bell, with Naffziger’s encouragement, proceeded to develop the new surgical training program at The University of California, San Francisco, along “halstedian” concepts. This involved a 4- to 5-year pyramidal system emphasizing academic principles and delicate operative surgery. When Bell came to San Francisco from Cincinnati, he brought with him an advanced electrocautery unit, called a “Bovie” after its inventor, an electrical engineer and physicist by the name of Dr William T. Bovie. This unit could coagulate small vessels and, in the deft hands of Bell, could dissect tissue with amazing clarity and precision. Operating with Bell was often described as performing surgery in the Sahara Desert because the operative field was so dry. Bell’s cauterization unit was less charitably referred to throughout the remainder of the United States as the “western barbecue.” Within a short time of his arrival in San Francisco, Bell performed a gastrectomy in his usual flawless, avascular manner under intense scrutiny of the faculty, house staff, and local clinical surgeons. In the era of highly volatile anesthetics, the observers were anticipating that the patient, surgeon, and entire operating suite would blow up or erupt in flames. Following the uneventful operation, Bell was summoned to Naffziger’s office. As Bell admitted later, he was concerned that his academic career and appointment as chief of general surgery might be in jeopardy. Naffziger looked him straight in the eye and said, “I think that coagulation unit is ideal for use in neurosurgical procedures. I would like to have that in the neurosurgical department, and perhaps you could order another one for your use in your department (Dr Bell, verbal communication, 1962).” Six months later, Bell had a new Bovie! One of the most frequent operations performed at this time was the Halsted radical mastectomy, which typically required a skin graft and several units of blood. On the day of surgery, a breast biopsy was performed and the specimen was analyzed pathologically. If this proved to be malignant, the first unit of blood was transfused concurrent with the skin incision for the mastectomy. Bell, however, believed that therapeutic bloodletting had become antiquated during the Civil War, and thanks to his using the electrocautery unit to minimize blood loss, his patients rarely required transfusion. Another technical contribution he made to the operation was to use the “dog-ears” that occurred in the skin flaps following most mastectomies as skin grafts, rather than harvesting extensive skin grafts from the thigh. Assisting Bell at his various surgical procedures was an exceptional learning experience. An assistant resident, intern, and medical student were involved in all aspects of the procedure. Nothing ever seemed rushed, and there was no wasted motion. Every movement appeared effortless, never hesitant, and the operation always progressed at a steady pace to its logical completion. If something unexpected occurred, nothing changed. The demeanor, rhythm, presence, and voice remained calm. Everything flowed so smoothly that his assistants were never aware of the passage of time. During the 1960s, Dr George W. Crile, chief of surgery at The Cleveland Clinic, Cleveland, Ohio, was advocating a type of mastectomy for cancer that was far less radical than that of Halsted. The University of California, San Francisco, surgical program, like the Halsted program on which it had been based, had weekly presentations of topics in surgery. These were prepared by the resident surgeons and delivered in an auditorium filled with medical students, interns, residents, attending staff, and visiting surgeons from the area. As such, I was asked to analyze our current concept of the Halsted radical mastectomy. Following extensive reading and research on the topic in preparation for this presentation, I began to doubt that the radical operation proposed by Halsted should be the procedure of choice. It seemed even more certain that super-radical and extended radical mastectomies had little to offer the patient with breast cancer. I confidently concluded my presentation by stating that we should consider performing a more limited resection than the standard Halsted or extended radical mastectomy. The hush in the audience at the completion of my presentation was daunting. The surgical residency consisted of a pyramidal system in which multiple residents started the program and a lucky few finished as chief residents (again, as advocated by Halsted). I was certain that my days within the department of surgery as a general surgical resident were numbered. To my astonishment, Bell rose and said, “I have long felt that there are many choices of operation for cancer of the breast, and I think this brings to light a number of things that we should seriously consider in our surgical approach to this malignancy.” Later, he took me aside and said, “I liked your presentation, and hopefully many of the surgeons in attendance will rethink their surgical approach.” What a relief that was to hear! I recall another incident when Bell was admitted to the hospital in preparation for a hernioplasty that was to be performed on him the following day. It fell to a lowly surgical resident to perform the preoperative history and physical examination. The resident completed the examination and then rather sheepishly and with fear and trepidation said to him, “I’m sorry, Dr Bell, but I’m going to have to do a rectal examination.” Bell looked him in the eye and said, “Young man, if you had not done it, you would not be in the program tomorrow!” Bell succeeded Naffziger as chairman of surgery in 1947 and remained head of the department until 1956, when he stepped down. He was pleased to see Dr Leon Goldman appointed as his successor. Goldman was the first resident he had trained and was imbued with the same halstedian precepts that he and Naffziger had established almost 30 years previously.2 Bell continued teaching and maintaining an active surgical practice, performing 3 or 4 major operations a day, until his retirement in 1968, at age 75. Thereafter, he continued to devote his spare time to gardening and golf, the 2 pastimes he enjoyed most, until his death at the age of 87, in 1981. Bell’s progressive approach continuously and constructively challenged surgical dogma. His management of hemostasis and his development of the electrocautery technique, as well as numerous other technical aspects of surgical operations, were innovative and creative. He shed new thought and light on the procedures that were being done. He did pioneering work in the surgical treatment of cancer, especially that of the breast, stomach, and colon. His interests included biliary tract disease and managing the complications related thereto. His ethics, integrity, instruction, demeanor, thinking, and technical skill set the standard for his numerous trainees, his faculty, and community surgeons. His influence as a teacher is best reflected in these 2 quotations from a 1932 article by him and Naffziger on postgraduate training of students in surgery.3 “Our obligation [as teachers] does not end with diagnosis or treatment. Even more important is the imprint we leave upon the developing character [of the house staff].”3(p384) “The point to be made is that it is one thing to train our residents in existing knowledge. This is not so difficult. It is another matter to prepare them to extend our knowledge.”3(p387) I believe, like many others who came to know Bell, that he was a cornerstone not only of the resident house staff’s surgical training and teaching but also of the entire faculty of the department of surgery at the University of California, San Francisco. Bell was the epitome of a general surgeon. Correspondence: Dr Albo, 418 30th St, Oakland, CA 94609. Previous Presentation: This paper was presented at the Howard C. Naffziger Surgical Society Meeting; March 26, 2004; San Francisco, Calif. References 1. H. Glenn Bell. Surgery: San Francisco [In Memoriam]. University of California San Francisco1986; 2. Bell HG Recollections by H. Glenn Bell. Tales and Traditions. Vol 1.1954;44- 52University of California at San Francisco LibraryGoogle Scholar 3. Naffziger HCBell HG The postgraduate training of students in surgery at The University of California. West J Surg 1932;40384- 389Google Scholar

Journal

Archives of SurgeryAmerican Medical Association

Published: Jul 1, 2005

References