key: cord-0743810-65dw8d5h
authors: Barr, Justin; Hwang, E. Shelley; Shortell, Cynthia K.
title: Surgeons, plague, and leadership: A historical mantle to carry forward
date: 2020-05-05
journal: Am J Surg
DOI: 10.1016/j.amjsurg.2020.04.042
sha: 6ff53516fc16da8340fd588f1e328e7d42039e93
doc_id: 743810
cord_uid: 65dw8d5h

COVID-19 has sickened millions, killed hundreds of thousands, and disrupted daily life for citizens around the world. Utterly devastating, COVID-19 is but the most recent pandemic to sweep the globe. Throughout history, surgeons like Guy de Chauliac, James Lind, John Hunter, John Snow, and Walter Reed have led scientific campaigns to understand, prevent, and treat epidemics like the bubonic plague, scurvy, syphilis, cholera, and yellow fever. We as a surgical community should herald their examples and re-focus our efforts to pioneer investigations into the coronavirus, helping elucidate the biology, understand its social effects, and provide effective treatment regimens for the disease.

Sweeping throughout Europe in 1348, the bubonic plague killed an estimated one-third of the population, demolished the agrarian economy, and reconfigured the international political infrastructure for the next several centuries. Guy de Chauliac, known by historians as the "father of western surgery," practiced amidst the Black Death. Trained in both medicine and surgery in an era when the specialties were in conflict, Guy strove to unite the two fields by providing surgery with a theoretical foundation that elevated it from its association with handicrafts. 1 By 1348, he had achieved significant professional success, exemplified by his position as physician to the Papal Court. Present for the onset of the bubonic plague and the calamitous effects it had on society, he remained to minister to his patients, including Pope Clement VI. Guy eventually contracted the disease, surviving only through "god's will." He published extensively on this experience, recording the clinical and cultural consequences of the plague. Through his writings, this surgeon emerged as the contemporary authority on the condition, shaping scientific understanding of bubonic plague and medical responses to it for decades.

Guy epitomizes surgeons who have investigated novel infectious diseases and contributed significant knowledge to their causation, prevention, and treatment. Peter Lowe, a founder of the College of Physicians and Surgeons in Glasgow, drafted the definitive treatise on the plague in Scotland, dying just prior to its completion. 2 The Great Pox, also known as syphilis, ravaged the European population from the late 15 th century onwards. Desperate to clarify its etiology, John Hunter, the father of scientific surgery, injected the purulent discharge from an infected patient's penis into his own member in an effort to understand the process of transmission and attempt to discriminate it from concomitant gonorrheal infection. 3 What more can we surgeons contribute, particularly in this era of hyper-specialization?

How can we move beyond surgery-based projects and expand to the levels of engagement that Guy, Lind, Snow, and Reed exemplified? While Hunter's example of self-inoculation ought not be replicated, the opportunities that the COVID-19 pandemic presents must be seized to think more broadly and creatively. Immunology-focused transplant labs could pivot towards vaccine research, while those conducting virology or pharmaceutical experiments must redouble their efforts towards identifying and testing novel drug therapies. Similarly, teams examining health disparities must harness this opportunity to implement innovative initiatives to provide remote care to rural and underserved communities and to redress deep-seated inequities of health care delivery at an international scale, refocusing on the social determinants of health. 9 Historically, surgeons have led global efforts against pandemics, thus addressing some of humanity's most devastating health challenges. COVID-19 demands we redirect our efforts to follow in this proud tradition.

The Rational Surgery of the Middle Ages

Account of the life and works of Maister Peter Lowe, the founder of the Faculty of Physicians and Surgeons of Glasgow

The Reluctant Surgeon: a Biography of John Hunter, Medical Genius and Great Inquirer of Johnson's England

Innovation and Tribulation in the History of Randomized Controlled Trials in Surgery

Chloroform, and the Science of Medicine: a Life of John Snow

Surgery during the COVID-19 pandemic: A comprehensive overview and perioperative care

Elective surgery in the time of COVID-19

Death is a Social Disease: Public Health and Political Economy in Early Industrial France