Past Presidents

Past Presidents | ASCRS

1980 to 1981

"To laugh often and much, to win the respect of intelligent people and the affection of children, to earn the appreciation of honest critics and endure the trial of false friends. To appreciate beauty, to find the best in others. To leave the world a bit better whether by a healthy child or redeemed social condition or a job well done, to know even one other life has breathed easier because you lived--this is to have succeeded."

Tomorrow my son, Richard, is to use this quotation by Bessie Anderson Stanley as he gives his high school graduation address. Yet surely the expressions here "respect," "appreciation," "job well done," and "one other life breathing easier" are mandates for those of us who have chosen the medical profession for our life's work. Our very calling offers us the soul-satisfying fulfillment expressed by these words, but one cannot bask in the sunshine of such an idyllic life-style without having prepared oneself to accept the awesome responsibilities associated with manipulation of the bodies and minds of sick people.


We, as practitioners of the art and science of medicine, do not achieve this role as a result of some single-standing, God-given talent. The knowledge we possess and the application of this knowledge to the care of the sick patient have not been obtained solely by the individual effort of any one of us but are, rather, the results of an accumulation of information provided by others who have preceded us.

1979 to 1980

"Ask not what your society can do for you, ask what you can do for your society", sets the theme of my remarks today. As some of you may recall, this theme is a paraphrase from "Ask not what your country can do for you, ask what you can do for your country." These stirring words are not only traceable to a famous son of a famous physician, namely Oliver Wendel Holmes,Jr., the Supreme Court Justice, but to Kahlil Gabran the philosopher author,as were later used again by President John F. Kennedy in one of his addresses to the nation in one his State of the Union Address.


Happily for you I hope my remarks will be brief and to the point. Perhaps not quite as laconic, and certainly not as poignant as those of another Presidential speech namely the Gettysburg Address.


My message is not only addressed to all members of the American Society of Colon and Rectal Surgeons, of whom I'm proud to be serving as your presiding officer, but they are particularly aimed at the younger members of our society, for after all, in the long run and in time, it is they who will stand to benefit the most.

1977 to 1978

A tornado, a devastating spiral, will uproot most anything in its pathway and bring it crashing down somewhere. Medicine finds itself in the midst of the tornado of bureaucracy, now spiraling as a political football to fall in the midst of chaos and diminished health benefits.


In 1972, the year I was elected Secretary of this illustrious organization, Dr. Walter Birnbaum spoke of the sigmoid curve. I would like today to project this curve into a spiral, a spiral being a "curve traced by a point moving round a fixed point in the same plane, while steadily increasing or diminishing its distance from it."


Perhaps the principal reason for my thinking of a spiral is the general reference to this type of curve in relation to our inflationary behavior, not only from the economic standpoint, but also from the point of view of practically every facet of life itself, beginning with the spiral of the DNA molecule, to the trajectory of the world around the sun. As we progress in our endeavors, we say we progress upwards, not downwards, nor in a straight line, but more commonly in a spiral; sometimes retreating, sometimes approaching, but always with at least some progress towards perfection. So it has been with medical progress through the years; we have had our dark moments, but most have been bright and shiny, just as our halos should be. Yet it is principally due to this progress that we must blame ourselves for our present situation. The American way of life has taught us to "help the underdog" and to refrain from "beating a man when he is down"; but in the heights we as physicians have achieved, we are an ideal target for anyone who would like to throw a missile our way. It is neither profitable nor edifying to degrade or deride an undefined or unfortunate person or group.

1976 to 1977

Seventy-eight years ago, Doctor Joseph M. Mathews and 12 of his medical colleagues brought forth, in Columbus, Ohio, the Society of which we are now so pleased to be members. Progress of the Society, and consequently of our Specialty, with which there has always been a close relationship, has often been painfully slow during those 78 years. Yet, in the more than 30 years of my association with both Specialty and Society, I am certain that I have seen significant advances in a number of ways. My opinions are obviously biased by my own experiences, but I am confident that in the main they are based on reality.


It is agreed that our Society has been fortunate from the beginning in that it was founded by a group of surgeons who had lofty ideals, and it has continued to be fortunate in always having a nucleus of members who have been devoted not only to maintaining high standards, but also to improving them at every opportunity. Moreover, we are lucky that this nucleus of dedicated members has grown somewhat, because the problems to be solved for our Specialty have also become more complex.


During the next few minutes I will mention what I believe the principal achievements of this Society for our Specialty have been and then speak briefly of matters that concern the Council of the Society today. In doing this I will not attempt to keep things in chronological order, or in order of importance.

1975 to 1976

Members, ladies, and guests:

I am very grateful for the recognition you have bestowed upon me by electing me to serve as your President. I am profoundly humble in following in the footsteps of our distinguished past presidents. I am most appreciative of this distinct honor.


During this bicentennial celebration of our country, we recall the meeting held on June 6 and 7, 1899, when 15 prominent surgeons founded our society and elected Joseph M. Mathews president. If we reflect on the last 77 years, we can appreciate the growth and accomplishments our society has made. The success was made possible through the determination and dedication of our members, who have developed our society into one of the nation's great surgical specialties, a recognition that extends worldwide. If we meditate on the government's intervention in medicine, the world-wide violence, and the daily slanted interpretive reporting of information by the press, radio, and television, it engenders a feeling of apprehension and anxiety about the future. However, our specialty has risen to its present eminence during difficult times, and although the present time is filled with uncertainties, our future is brighter than at any time in our history. If we are to continue to grow and make substantial contributions to medicine, our members must be willing to come to grips with reality and to give financial support for our educational program--not simply to meet the requirements of HEW but to make our members more competent and efficient.

1974 to 1975
1973 to 1974

It is indeed a singular honor and privilege to address this most august assemblage, members of the American Society of Colon and Rectal Surgeons, and distinguished guest from across the seas, members of the Section of Proctology of the Royal Society of Medicine, and members of the Section of Colonic and Rectal Surgery of the Royal Australasian College of Surgeons who have traveled some 3,000 miles from the east and 10,000 miles from the west to participate in this 75th anniversary meeting.


The president of an organization who by tradition is asked to deliver a presidential address has a built-in, perhaps unfair, advantage. Regardless of the topic he has chosen to present, he is, because of respect for the office he holds, assured of an audience. This is good and this can be bad. This is good for trim because the topic and the subject matter he presents do not have to be submitted to a program chairman and his committee for prior approval or likely rejection. It may be bad, not for him, but for the audience, who perhaps must patiently and politely wait for the last, long, drawn-out sentence. I will try to spare you this.

1972 to 1973

An anal fissure is an ulcer of the anal canal which may extend from the anal verge to the dentate line. It is usually exquisitely painful, so the best treatment is that which is the most expedient but also provides negligible recurrence and minimal disability of anal function. Lateral subcutaneous internal anal sphincterotomy best fulfills these criteria and we strongly recommend it as the primary operation for anal fissure.

Technique

Using caudal or local anesthesia, with the patient in the prone jack-knife position, the perianal region is prepared. The fissure is assessed by inspection and palpation. Special note is taken of any large sentinel tag or hypertrophied anal papilla, as they will be dealt with also.


An intersphincteric abscess underlying the fissure is a contraindication to the operation and, if present, a dorsal sphincterotomy is done. This is not common. An anal retractor is inserted. The lower edge of the internal sphincter becomes easily palpable as a prominent band and is also often visible.

1971 to 1972
1970 to 1971

In selecting a title for the address of your 64th president, whose predecessors in the past 72 years have always had intriguing captions, I have arrived at one which, I must confess, may have lured you here under false pretenses. "The Sigmoidal Curve" does not refer to the anatomic structure of that name, and my paper will reveal no new surgical information about the terminal gut. The curve referred to is a mathematical one--the "S"-shaped curve of logistic elegance which graphically illustrates so many inorganic and biologic phenomena (Fig. 1). It is the curve of saturation, of the process of crystallization, of atomic chain reactions, of biologic growth, of economic cycles, and of population increases, to cite but a few examples.


The exponential law is the mathematical consequence of having a quantity that increases so that, the bigger it is, the faster it grows. A colony of rabbits or fruit flies which breed among themselves grows rapidly until some natural upper Emit is reached. Then the curve begins to level off at the top to make it "S"-shaped, otherwise known as a logistic curve or sigmoid. I shall refer to it here as it might relate to the history and future of medical specialties, with especial application to proctology, in the hope that it may, however faintly, illuminate our path and allow us to take the right turnings.

1969 to 1970

Because of my long association with The American Proctologic Society and my complete involvement in it, I want to confine my remarks to some historical facts and some unmentionable observations about it.


The American Proctologic Society was founded in 1899 by a small group of men who managed to hold it together through all its difficult years and until such developmental events as The American Board of Colon and Rectal Surgery assured its continuation.


The American College of Surgeons, founded in 1913, was the "first national organization to function somewhat as a qualifying Board in a specialty."


The National Board of Medical Examiners, from which the Advisory Board for Medical Specialties developed, was formed in 1915. In that year the young American Proctologic Society slept. The American Board of Ophthalmology was incorporated in 1917, followed by The American Board of Otalaryngology in 1924, the American Board of Obstetrics and Gynecology in 1930, the American Board of Dermatology in 1932.


Sporadic attempts to get the "specialty" movement underway, being made all through these years, ultimately were spearheaded by a committee of the four established specialty Boards which I have just mentioned. Thus, the Advisory Board for Medical Specialties was formed in 1933, at which time twelve suitable fields for certification of specialties were defined, and proctology was not among them.

1968 to 1969

It seems appropriate at this, the 68th annual meeting of our Society, to review some of the contributions that colon and rectal surgeons have made in the field of medical education, to analyze some of the changing concepts in medical education as they affect our specialty, and to offer suggestions that, hopefully, will elevate the standards of medical care of patients with diseases of the colon and rectum and improve the influence and the image of our group.


The American Proctologic Society can be proud of its contributions to medical education. Its contributions to the congress of the American College of Surgeons, regional meetings, and the American Medical Association have been well received. The postgraduate teaching seminars given by the University of Minnesota, the Cleveland Clinic, the Ford group, and the Lahey Clinic Foundation have been beneficial to many. The Amer'can Board of Colon and Rectal Surgery has been responsible for the high standards that have been maintained by its diplomats and for the development of training programs.


Much remains to be done. As of September 1, 1967, there were 306 active certified colon and rectal surgeons in the United States; from July 1, 1966, to June 30, 1967, only eight diplomates were certified.

1967 to 1968

Diagnosis and treatment of anorectal fistulas at times presents the simplest and at other times the most challenging problems encountered in surgery, is this sinus actually an anorectal fistula? Or does it originate elsewhere, such as in a region of sigmoidal diverticulitis or ileocolitis? Or does it connect with an infected precoccygeal cyst? What keeps the sinus or fistula active when the primary source has healed over spontaneously or has been erased by a previous operation? In what situations might the surgeon anticipate fecal incontinence after fistulectomy, and what can be done about it?


The purpose of this presentation is to attempt to answer these and similar questions that, in my opinion, have been inadequately answered in medical literature. I shall not dwell on the simple uncomplicated fistula with a definite primary source and secondary opening, since the principles of dealing with such a lesion have been well established.
 

Etiology Anorectal fistulas comprise 85 per cent of sinuses opening onto the perineum. The other 15 per cent result from hidradenitis suppurativa, pilonidal disease, and other less common causes. There are many types of anorectal fstulas, but the one feature that they have in common is that they originated inside the anus or rectum. (I use the past tense because the anorectal site of origin, the primary lesion, may have healed over, but at one time it was present.) All anorectal fistulas and most perianal sinuses originate as abscesses.

1965 to 1966

I appreciate deeply the honor which the American Proctologic Society conferred upon me in electing me President a year ago. I accepted it with gratitude and I have found it a very pleasant and satisfying experience, due entirely to the fine cooperation of the officers and other members of the Society.
 

The office of the President has many benefits, not the least of which is the privilege of addressing members of the Society under conditions which, from the speaker's point of view, are ideal. He may select his subject, he may say more or less what he pleases without a time limit, and he has a receptive audience. This certainly provides a rare opportunity and I grasp it to discuss certain aspects of the subject, Complete Rectal Prolapse, a condition which poses a challenge to all who undertake its management.


Complete rectal prolapse has attracted the attention of surgeons for a long time, but little progress was made in the understanding of it until the beginning of this century. Since then, it has been of special interest to some of our most outstanding surgeons. A review of their published reports reveals a striking variety of concepts and operations which deal with all phases of the problem.
 

An important development in the past decade is recognition of the diversity of rectal prolapse. It appears that the deficiency is not always the same and that this results in more than one type of rectal prolapse.

1964 to 1965

Since its inception, in 1899, the American Proctologic Society has been a creative organization. Its members have not been satisfied with past accomplishments, but are intensely concerned with, and deeply involved in, the quality of medical care provided by their membership. Their concern is not only with the present status of American medicine, but plans, efforts and commitments are constantly directed toward elevating standards of the practice of proctology. This voluntary pursuit of excellence led to creation of the American Board of Colon and Rectal Surgery, which examines and certifies specialists in colon and rectal surgery. It is the only recognized examining and certifying board in this specialty.


Activities of the Board and the Society have been intimately associated with the development of proctology for more than 25 years, and I have prepared a history of the Board as a testimonial to our colleagues.
 

1935 to 1940

More than 30 years ago, during the nadir of the great depression, eight members of the American Proctologic Society, inspired by a desire to develop and advance proctology, organized the American Board of Proctology. 

1963 to 1964

By the simple process of election to the office of president of a society, the recipient of this high honor supposedly is capable of sudden metamorphosis from his former modest status to that of a learned essayist -- a wise philosopher, a knowledgeable historian, an orator possessed of keen wit and eloquence. An apology for my own obvious lack of these enviable qualities would be redundant.


Yet this moment thrusts upon me a responsibility which transcends the customary annual address of the president of the American Proctologic Society. For there are here assembled in joint meeting, members of the Section of Proctology of the Royal Society of Medicine and illustrious physicians from 55 other countries of the world.


Our prime purpose is to share and freely exchange whatever knowledge and experience we may possess, so that we may return to our homes - wherever they may be - with augmented ability to minister to the physical afflictions of the infirm. Yet, above and beyond this, there is most assuredly in the mind and in the heart of each and everyone of us, the earnest desire that this assemblage will serve to further a common goal of universal peace with security, health and happiness for all the peoples of the world.


It is of this that I would speak, though only as a physician, ignorant of the ways of politics and diplomacy, of social and economic pressures within and between nations, and of the military mights and rights which appear to threaten us all.

1962 to 1963

The American Proctologic Society is one of the oldest specialty organizations in the United States. Its first meeting was held at the Chittenden Hotel in Columbus, Ohio, in 1899. Fifteen persons attended that meeting but only 13, those who presented scientific papers, were admitted to membership. Even during that period of nascency, the highest standards were set for its activities, principles and policies. Since that first meeting, the Society has continued to hold meetings annually, with the exception of the wartime years--1918, 1943 and 1945.


In 1946 I attended my first meeting. It was held in San Francisco and, by coincidence, it has become my privilege and honor to attend this 62nd annual meeting again in San Francisco, acting in the capacity of the Society's President. It has been my privilege to serve as an official of the Society for the past five years, during which period I have experienced much pleasure and have enjoyed immeasurable benefits. I have learned much from the accomplishments of my illustrious predecessors and have developed a profound respect and deep affection, not only for them, but for all those who have become worthy of membership and fellowship in the Society.

1961 to 1962

To have served as your president during the past year has been a privileged honor. It was with much trepidation that i agreed to try to follow my illustrious predecessors. I have tried to serve our Society to the best of my ability under the watchful eyes of the Council, and have made no decisions without its approval. During this time I have taken only one liberty and that is to express my thoughts here today about the training and certification of a proctologist. This training, even today, is largely postgraduate; the undergraduate medical student receives little specific proctologic instruction. It is my opinion that more should be available. 


When the American Proctologic Society was founded in 1899, there were no opportunities for training proctologists in this country. The English were a half century ahead of us in this regard. With the founding of this Society, however, postgraduate training in proctology began, and it has been fostered by this organization since that time. Annual meetings at which scientific papers, basic science lectures, and symposiums on diseases of the colon and rectum have been presented, have contributed much to the knowledge of the entire medical profession.

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