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The origins of today's surgical societies are the guilds of medieval London. The Company of Barbers and the Guild of Surgeons vied for dominance no different from the scores of conflicts between rival artisans and merchants whose trades overlapped. The Company dates from 1308, when the council of London passed ordinances that installed its first master, Richard le Barber. When the surgeons received ordinances of their own in 1368, the barbers had the Council reassert theirs in 1376, 1390, 1415, and 1424. Faced with a vigorous organization with greater numbers the surgeons aligned with the physicians in 1423 to form a short-lived ruling "commonalty" with an elite membership based on educational achievement and proven ability that excluded the barbers. The surgeons were thereby granted authority over all of surgery, including that practiced by barbers, an arrangement that failed after only a year. The surgeons formed a guild in 1435 but could not compete with the barbers. The barbers' primacy became complete in 1462 when Edward IV chartered them to govern all aspects of surgery, along with the power to fine and imprison. From then barbers and surgeons amiably coexisted, likely because the rapidly growing population and the democratization of the practice of physic provided plenty of work. Henry VIII formally united the barbers and surgeons in 1540 under the Worshipful Company of Barbers and Surgeons, an amalgamation that lasted for two centuries until the surgeons broke away in 1745., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Gertrude Marianne Amalia Herzfeld (1890-1981), the first practicing female surgeon in Scotland, overcame bias against women in medicine and pediatric specialists in surgery. After her graduation from the University of Edinburgh Medical School (1914), she became the first female house surgeon at the Royal Hospital for Sick Children, Edinburgh. In 1920, she became the first practicing woman surgeon to become a Fellow of the Royal College of Surgeons of Edinburgh. She left a handful of publications in pediatric surgery: a "radical cure" for inguinal hernia, i.e., early surgery (1925); a review of abdominal surgery in infancy and childhood (1937); surgery for the acute abdomen (1939); and intestinal obstruction (1945). They offer a twenty-year window into how children's surgery was once practiced, when operations were done in patients' homes, and decisions for operation depended solely on the history and physical exam without laboratory testing and radiological imaging. As a series of snapshots over two decades, they reveal how her practice evolved in such areas as fluid resuscitation and radiological reduction of intussusception. She remained steadfast to a careful physical examination and early operation. While she did not document her practice in the care of children with ambiguous genitalia and intersex conditions, she approached the formidable anatomic, psychological, and social challenges of her patients and their families with patience and understanding. Herzfeld was devoted to the care of yet another marginalized population that today is subsumed by the acronym LGBTQIA, yet another area where she was far ahead of her time. Level of evidence: Level VII., Competing Interests: Declaration of Competing Interest None of the authors has any conflict of interest to report., (Copyright © 2022 Elsevier Inc. All rights reserved.)

The inaugural certifying examination for special competence in pediatric surgery in North America was given by the American Board of Surgery (ABS) in April 1975, the day before the sixth meeting of the American Pediatric Surgical Association at a resort near San Juan, PR. The event came after failed applications before the ABS and the Advisory Board for Medical Specialties in 1957, 1961, and 1967. The specialty had matured with a scholarly publication devoted to the field (Journal of Pediatric Surgery, 1965), the establishment of standards for training and training programs (1966), and a society independent of pediatrics and devoted solely to pediatric surgery (American Pediatric Surgical Association, first meeting 1970). Harvey Beardmore had guided the successful campaign for a certificate for pediatric surgery under the aegis of the ABS that was approved in June 1972. Pediatric surgery had thus gained full recognition as a specialty of surgery. A group photograph of its participants became one of the iconic images in our specialty. Thanks to Jim and Nancy Hopkins of Windsor Heights, IA, and to their many friends and colleagues, nearly half (71 of 151) of the pediatric surgeons in the photo were identified, marking their places in the history of pediatric surgery., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Until the successful repair of esophageal atresia (EA) and distal tracheoesophageal fistula (TEF) in 1941 by Cameron Haight of Ann Arbor, MI, every infant operated upon for this anomaly died within days and often hours of surgery. A key step was the posterior extrapleural approach to the mediastinum pioneered by Charles Mixter of Boston in 1929 that gave direct exposure of the anomaly without entering the pleural cavity and collapsing the lung. From 1936 to 1939 Thomas Lanman, also of Boston, made five unsuccessful attempts at primary repair of EA. His experience established the basic principles of early radiological diagnosis and prompt surgical intervention to minimize the risks of aspiration pneumonia, dehydration, and inanition. In 1939 N. Logan Leven of Minneapolis and William Ladd of Boston independently had the first long-term survivors of EA with a series of operations to construct skin-lined tubes on the anterior chest wall that connected an esophagostomy to a gastrostomy. Haight first tried primary repair in 1939, finally succeeding in his fourth case in March 1941. In their publications Lanman (1940), Haight (1943 and 1944), and Ladd (1944 and 1947) presented case-by-case chronologies. The evolution of surgical management thus can be traced from a fatal condition to one where survival became the expected outcome. History recognizes Haight for his work with EA, not only for its first successful primary repair, but also his lifelong dedication to its surgical management., (Copyright © 2020 Elsevier Inc. All rights reserved.)

High salaries indicate a demand for pediatric surgeons in excess of the supply, despite only a slight growth in the pediatric-age population and a sharp increase in numbers of trainees. Top-level neonatal intensive care units require 24-hour-7-day pediatric surgical availability, so hospitals are willing to pay surgeons a premium and engage high-priced locum tenens surgeons to fill vacancies in coverage. With increased supply comes an erosion of the numbers of cases performed by trainees and surgeons in practice. Caseloads may be inadequate to gain expertise and maintain skills. A quality initiative sponsored by the American College of Surgeons and the American Pediatric Surgical Association will discourage underresourced community facilities and surgeons without specialty training from performing operations on children, mostly common conditions such as appendicitis. This will further increase demand for specialty-trained practitioners. Receiving less attention are considerations of value, the ratio of quality per dollar cost. Cost concerns, paramount among buyers of health care (businesses, insurance companies, and governmental health agencies), will prefer community hospitals that have lower cost structures than specialty children's facilities. Less recognized are the costs to families, who for a myriad of reasons would prefer closer alternatives. Cost considerations support providing pediatric surgical services in local facilities. Quality considerations may be addressed by a tiered system where top centers would care for conditions that require technical expertise and advanced modalities. Evidence indicates that pediatric surgeons already direct such cases to more specialized centers.

Georgia and the Atlanta area are associated with three important figures in the history of surgery. Crawford Long (1815-1878) discovered the anesthetic effects of ether while in practice in Jefferson. Born in Culloden, Alfred Blalock (1899-1964) was a pioneer researcher in shock and resuscitation, and developed the Blalock-Taussig shunt for Tetralogy of Fallot. His technician, African-American Vivien Thomas (1910-1985), was a full partner in the landmark advances. Louis T. Wright (1891-1952) was born in LaGrange and grew up in the Jim Crow South. As the country's leading black surgeon, he led the integration of major hospitals and helped lay the groundwork for the landmark civil rights legislation of the 1960s that integrated American medicine. Their stories, with roots in small towns in Georgia, reveal the deep surgical traditions of the South.

Employment, either by an academic entity or a hospital, is increasingly becoming a feature of surgical practice. Independent practices receive indirect subsidies to support their revenue. A survey of the extent of employment and the forms of indirect subsidies by which hospitals support independent practices, not previously done, would be of interest to all clinicians. A 2012 Internet survey of pediatric surgeons, asking practice description, hospital support, governance and management, conditions of compensation, selected contractual obligations, and arrangements for part-time coverage was conducted. Response rate was 21.8 per cent (253 of 1,163). Employed surgeons comprised 80 per cent: 60 per cent academic (152 of 253) and 20 per cent nonacademic (51). Only eight per cent (19) were in private practice. Half (47% [106 of 226]) had administrative tasks. One-fifth (20% [45 of 223]) was in a system without physician input in governance. The rest were in practices with physicians involved in management: on boards of directors (35% [78]), in management positions (31% [69]), and entirely physician-run (14% [31]). Most salaries were independent of external benchmarks. Productivity measures, when applied to compensation (54% [117 of 218]), used relative value units (71% [83 of 117]) more often than revenue production (29% [34]). Patient contact minimums (4% [nine of 217]) and penalties were less common (20% [43 of 218]) than bonus provisions (53% [116 of 218]). Most surgeons in private practice (75% [14 of 19]) received nonsalary hospital support. Pediatric surgery reflects the current trend of physician employment and hospital subsidies. Surgeon participation in governance and strategic system decisions will be necessary as healthcare systems evolve.

The article focuses on the physician Andreas Vesalius. Topics include the chair of surgery at the University of Padua and has accepted a position as physician to the imperial household of Charles V the Holy Roman Emperor, the transition of treatment of gunshot wounds from boiling oil to more benign concoctions for which the latter became famous, and death changed the course of the history of Western Europe.

President James A. Garfield suffered two gunshots on July 2, 1881, but did not die until 80 days later of complications from sepsis. He might have survived had his injuries not been contaminated, either by the gunshots themselves or the interventions that followed. "Yes, I shot the president," said Charles Guiteau, Garfield's assassin, "but his physicians killed him." The drama of Garfield's struggle to survive his injuries evoked enormous national interest, a harbinger of the medical dramas and documentaries of today. D. Willard Bliss, a former Civil War surgeon, and his handpicked consultants underwent daily scrutiny by the professional community and lay press. As the President died because of his injuries, the surgeons' reputations suffered. A primary criticism was the supposed lack of antiseptic interventions in Garfield's care, especially when probing the wound with unwashed hands. Inserting a finger into the wound, however, was a basic part of examination of a gunshot wound at the time. Many American surgeons had not accepted Listerian antisepsis at the time of the event, and aseptic techniques, such as scrupulous handwashing and surgical gloves, had not yet been developed. In the context of surgical practice of the era, his surgeons followed the standards of care of the time. [ABSTRACT FROM AUTHOR]