Fischer’s Mastery of Surgery (2 Volume set) Sixth Edition

Book Preface

1his book comes at a critical time in surgery,a time the various enema! pressures have conspired to reduce sw:gery from a proud profession to a group of”’employees”. It was not always so. My late father-in-law. Dr. Howald L Down. one of those to whom the book is dedicated, was bom on a farm neal Odebolt. Iowa in 190L one of ten children on 640 acres of rich Missouri bottomland. All of the children survived into adulthood – a remarkable achievement. ‘lhe family still holds fiv&-year reunions on that farmland which is owned as an investment by Princeton University which generously allows the family visits. While the older boys worked the fields. as a young boy my father-in-law was assigned to help out his sisters in the house. Working in the house allowed him ample opportunities to read and develop his desire for knowledge. All of the children were offered college as an option and all but one attended at least one yew:. Howard decided to attend Morningside, a small Methodist college in Sioux City, then went on to medical school at Northwestern. He elected to train at the Mayo Clinic which he completed in 1932. He would teD me •they wanted to give me a room· which meant they wanted him to join the staft but he wanted to return home to northwest Iowa to build a practice. In fact. he was the first well-trained and exp&rienced surgeon in that vast area. On almost a weekly basis he, and later his partner. Martin Blackstone, and a nurse, rode circuit. operating in various towns; returning the following week to see how well the patients fared under the care of their general practitioner. Ihe practice expanded and eventually he established a general medi.cal practice and a busy sw:gical practice in Sioux City. population 85.000, which then and now serves as a catchment area for prosperous and relatively well-to-do farmers. Appointments were made for ·the day• not for a ·specific time·. Patients checked in. went shopping downtown and returned at the appropriate time. When Dr. Down died at the age of91 we found his account books. An office visit was 50¢. Many of the patients could not pay and later sent bushels of potatoes, wine, butter, etc., which were offered as payment and were duly noted in that account book. Some did not pay at all. When he died in 2001. Karen and I went through the house and found some of the most interesting gifts, and I might add, some of the worst liquor, obviously given as payment. For the most part he operated daiJy.. came home for dinner with the family. and then returned to make rounds. ‘lhe only way Dr. Down could get away on vacation was to get out of town. R took me a long time before I could live up to the two trips Karen made with the family when she was eleven and thirteen traveling to a variety of states so that he could get away from his practice.

Dr. Down lived very modestly in a threebedroom, two-story house with one fullbath in a very nice neighborhood. He was highly respected and beloved. He sat on a number of boards while his wife was the president of a number of oxganizations including the YWCA and Planned Parenthood. He loved music and was on the Board of the Sioux City Symphony. In this capacity as a board member. Karen and I were invited to dine with Dr. Down and soprano Victoria de Los Angeles. One of Karen’s fondest memories was watching Dr. Down “‘conduct” Tchaikovsky’s Symphony #5 in the family living room. He continued to operate until late in life and then practiced as a general internist until he was 80 yeBJ:s old. He was a tall, attractive and quiet man who never said much yet dominated a room whether or not he spoke. During his long career he served as governor of the College and President of the Iowa Sw:gical Society. Every six months he returned to the Mayo Clinic – his equivalent of CME.

He never told Karen whether he approved of me as a son-in-law. Probably the closest he came to doing so was after I gave grand rounds at one of his hospitals in Sioux City. As he walked me out to the tarmac and just before I boarded the plane to return to Boston. without a word he stuffed a quart of Johnny Walker Black Label under my arm. I must have done something right! Speaking at his memorial service I reflected that Dr. Down terrified colleagues, nurses and at least one son-in-law without saying much; everyone knew his standards were extremely high. On the day of his funeral his brother and best friend Charles. a lawyer:. told me that Howard was indeed very proud of me and he asked if he could get copies of the articles I had written and that his brother had discussed with him. As you can imagine, it was wonderful to hear this from his best friend but it would have been better to hear it while he was alive.