Franklin Martin and the standardization of American surgery 1890-1940

This dissertation examines the professionalization of surgery and the defining of surgery and general surgery in the United States between 1890 and 1940. The work draws from institutional archives, the papers and memoirs of leading surgeons, medical society records, medical directories, and a database of over 6,500 individuals who practiced surgery during this period. The importance of changing surgical epistemologies is also discussed. During this time, American surgery developed its present institutional arrangements.;At the center of the story are the efforts of Franklin Martin and the American College of Surgeons (ACS) to impose order on the surgical marketplace in the United States and Canada. Founded in 1913 by Martin, the College awarded its fellowship on surgical experience and attempted to standardize both the surgeon and the hospital. From the mid-twenties, younger members of the elite American Surgical Association (ASA), notably Evarts Graham, argued that improving surgical care meant residency trained surgeons certified by examination. This conflict culminated in the establishment of the American Board of Surgery (ABS) in 1937.;This study examines how professional boundaries were negotiated and renegotiated at the national and the local level to define the qualified surgeon. At both levels this period was dominated by a tension between a performance-based and a credential-based definition of a surgeon. Unable to establish strong disciplinary boundaries (general) surgery remained open to encroachment by both general practitioners and other specialists. Even in a single career an individual could move back and forth across these boundaries. I conclude that specialization should not be viewed as either over-determined or as a one-way process. The slow pace of transformation also justifies Martin's (and the College's) initial emphasis on the community rather than the academy as the primary locus of reform.