Reviewed by: A Miracle and a Privilege: Recounting a Half Century of Surgical Advance, and: A Tale of Two Citadels: Memoirs of a Surgeon and His Times C. Rollins Hanlon Francis D. Moore. A Miracle and a Privilege: Recounting a Half Century of Surgical Advance. Washington, D.C.: National Academy Press, 1995. xii + 450 pp. Ill. $29.95. Kenneth C. McKeown. A Tale of Two Citadels: Memoirs of a Surgeon and His Times. Edinburgh: Pentland Press, 1994. xiv + 276 pp. Ill. £17.50. These two surgical autobiographies provide contrasts more arresting than their similarities. Each deals with a half century of experience in surgery, one from the viewpoint of an American academician, the other from that of a senior consultant surgeon at a district general hospital in England. McKeown chronicles a distinguished operative surgical career, from his origins in Belfast through medical school at the local Queen’s University and clinical education in London. In the metropolis he saw at first hand the workings of a consultative system that gave priority to the patients of Harley Street physicians, as criticized by Cronin in his classic book, The Citadel (1937). McKeown grants a certain validity to Cronin’s picture of medical practice as an edifice for the protection of professional privilege, but he looks much more scornfully at the new Citadel of the evolving National Health Services (NHS). In his view the bureaucracy of state control has placed market forces ahead of traditional medical ethics. He fears that harsh criticism, as pictured in Cronin’s book, might well bring down on a practitioner today such personal reprisals as the termination of short-term contracts in the new Citadel of the NHS. Preceding McKeown’s own introduction are three “appreciations” by colleagues in Great Britain and Canada. They attest to his status as a master surgeon—especially in esophageal resection, which McKeown brought to a level [End Page 182] of technical excellence that matched or surpassed the results achieved in any of Britain’s academic teaching hospitals. His achievement grew out of more than forty years of developing his team concept of surgery, leading to a reputation that attracted patients and surgical observers from around the world. In later years he received many honors, traveling widely to demonstrate his methods. Predictably, he proudly lists the greatest attainment of the National Health Service as the establishment of centers of excellence other than the provincial university teaching hospitals. His own Consultant Surgical Service in Darlington was obviously a vast improvement over the hospital surgical services previously provided there only by general practitioners. McKeown’s extensive surgical travels provide interesting vignettes of experiences around the world. In the United States a short visit left him impressed with the country’s “youthful or perhaps immature outlook” (p. 187) and engendered a frank disbelief in the mortality figures for esophagectomy by a “very well known American surgeon.” Reticence to mention names did not extend to the Chicago professor who cut short McKeown’s lecture to accommodate the overall program, and who is properly dressed down for this lèse-majestè. Better editing of this fascinating, narrowly focused account of global surgical experiences, listing well-merited recognition of McKeown’s many achievements, might have elided these sour animadversions on his American professional cousins. In sharp contrast to McKeown’s story is the broad-ranging, gracefully written account by Francis D. Moore, Moseley Professor of Surgery Emeritus at Harvard and former chief of surgery at what was then “the Brigham” Hospital. Starting with an admittedly “privileged childhood” on Chicago’s North Shore, and working through anthropology, philosophy, and chemistry at Harvard College, Moore’s intellectual and artistic capabilities were expanded by studies in musical composition and by foreign travel. Research that began in medical school progressed rapidly from a single case report through more extended work on thyrotoxicosis and vagotomy for duodenal ulcer. But it was his fellowship of the National Research Council that provided the stimulus, the skills, and an entry to isotope research that would soon make him a world leader in the study of body composition and the metabolic response to injury. Active in clinical practice but increasingly seen as professorial timber because of his research...
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Apr 7, 2014
Héctor Mario Díaz Núñez 
