This feature is part of a year-long series of excerpts and special commentaries celebrating AFP's 50th year of publication. Excerpts from the two 1950 volumes of GP, AFP's predecessor, appear along with highlights of 50 years of family medicine.
This feature, titled “Nutrition in Surgical Patients,” written by Robert M. Zollinger, M.D., and Edwin H. Ellison, M.D., is reproduced from the July 1950 issue of GP. The commentary is provided by John C. Rose, M.D., who was on the AFP staff for 34 years, and editor for 27 years. Dr. Rose was also dean at Georgetown University School of Medicine.
“Often a surgeon must take into account the state of nutrition of his patient before he operates. Patients needing such care fall into two categories. First are those who are grossly overweight; second and perhaps more troublesome, are those malnourished ones whose condition results from their inability to take food or from some acute or chronic disease process.
When an operation is necessary, the improvement of the nutritional status of either of these two types of patient makes for a better surgical risk. Such preparation not only reduces morbidity and mortality but hastens the postoperative rehabilitation of the patient.” —Robert M. Zollinger, M.D. and Edwin H. Ellison, M.D.
In 1970, 20 years after the first issue of GP had appeared, the interim journal that was to become American Family Physician was published, American Family Physician/GP. In the first issue of the new publication, Mac Cahal (the American Academy of Family Physician's first Executive Director and Publisher of GP) described GP as having been “an innovative medical magazine that threw off the still-dangling shackles of the 19th century medical journalism by daring to be different.” Indeed, it was different. (Mac never referred to GP as a journal. He always called it a “magazine.”) Mac Cahal had been Executive Secretary of the American College of Radiology for more than 10 years before coming to the American Academy of General Practice (AAGP) at its founding in 1948. Ever affable and gregarious, he knew a great many of the luminaries of American medicine. Walter C. Alvarez, M.D., the distinguished Chief of Medicine at the Mayo Clinic and editor of the first volume of GP, knew the rest of them. Together, they fashioned an Editorial Advisory Board for the Academy's new venture composed of some of the best known specialists in the country. The EAB was, and remained, as it evolved, an invaluable resource for assigning articles.
The editor decided which subjects should be covered and then sought authoritative authors. Distinguished physicians and surgeons were pleased to accept these assignments. They were opportunities to reach a broad and important audience that was then not readily available to them. In experienced hands, broadly versed in medicine and, with the help of the EAB, this seemingly arbitrary process resulted in an attractive and effective program of continuing medical education, at least in the minds of the readers. (This was long before techniques for the evaluation of continuing education were conceived.)
In just the first few issues of GP, the list of authors reads like a Who's Who in medicine for that time, and remains so to this day. In the first issue, which appeared in April 1950, Alvarez himself wrote an article on abdominal and thoracic pain. Alvarez was a superb writer. Today, the American Medical Writers Association presents an annual award named for him. In the July 1950 issue, Robert Zollinger, M.D., and Edwin Ellison, M.D., contributed a small essay on nutrition in surgical patients. Five years later, these Ohio State surgeons achieved eponymous immortality by describing the syndrome that now bears their names.
Other well-known names that contributed to those first few issues included Elliot P. Joslin, M.D., (a great American diabetologist, founder of Harvard's famed Joslin Clinic and the first to demonstrate obesity as a risk factor in diabetes), Henry L. Bockus, M.D., (chairman of the Department of Medicine at the University of Pennsylvania and author of a much-consulted, three-volume textbook of gastroenterology), Howard Rusk, M.D., of New York University School of Medicine (generally regarded as the founding father of the specialty of physical medicine and rehabilitation), Derrick Vail, M.D., (chairman of the Department of Ophthalmology at Northwestern University Medical School, Chicago, and an outstanding leader in that specialty), Edward Reifenstein, Jr., M.D., (a Harvard and Sloan-Kettering endocrinologist who was to become director of research at several major pharmaceutical companies) and many more.
Neither the Publications Committee of the Academy nor the rapidly increasing readership was at all concerned about such niceties as documentation and references, formal review processes for articles or the like. Rather, all were interested in well-written, succinct articles by experts, of value in day-to-day general practice and profusely illustrated. The term “family practice” had not even come into use, there were no GPs in the medical schools, hospital privileges were hard to come by and sources of continuing education were negligible outside of the specialty journals. These were the very issues that had led to the founding of the Academy.
Hugh Hussey, M.D., became editor in 1951, and he recruited me as an associate editor soon after. I wrote “Tips From Other Journals” and edited manuscripts. I quickly learned that one of the important reasons for GP's success was the editing of the manuscripts. No matter the reputation or prominence of the author, all accepted manuscripts were subjected to severe editing. Sections were removed or moved, and “cutting to size,” clarity and practicality were the goals. After the medical editors did their part, skilled copy editors in Kansas City went over the manuscripts word by word. The results were polished articles that conformed to the style of the “magazine.”
In my many years with GP and then AFP, the universal response by authors to this process was, surprisingly, approval, often with the comment that the article had been improved. I can remember but one exception. It was some years later, when I was editor, that one erudite author objected because he noted in his galleys that the term “Procrustean bed” had been deleted, and alternative language substituted. In the face of his arguments, I made the suggestion that he could withdraw the paper, which he did not do. The correction stood. Thus, I became Procrustes.
The Academy's Publications Committee was made up of men (and a very few women) who were quite active in Academy affairs. In the early years, there were many members who had participated in the founding of the Academy. In time, the Publications Committee became a stepping stone to the Presidency. I was immensely impressed with this group of wise, politically astute leaders who had forged what became a powerful movement in American medicine.
While the Committee exercised appropriate oversight, I'm sure my predecessors would have shared my feelings that the Committee had confidence in the editors, was proud of the quality and growth of the publication and, in general, adhered to the “If it ain't broke…” principle. In 1997, during a celebration of the Academy's first 50 years, Mac Cahal visited the Congress of Delegates and paid tribute to these early leaders of the Academy. Quoting an old American Indian sentiment, he told them, “You have drunk from wells you did not dig and been warmed by fires you did not build.”
In 1988, my successor, Jay Siwek, M.D., changed a “magazine” into a medical journal that is included in Index Medicus, MEDLARS and other important bibliographic resources. In so doing, he brought one era to an end and launched a new one. Family practice had evolved into an academic discipline, and the enormous number of readers now wanted more than the promise of Mac's original, simplistic concept. Yet Jay has retained the color and visual beauty, the crisply edited articles and the easy-to-read format that characterized GP and made it so popular and successful. My warm good wishes go to Jay and to AFP for another 50 years of outstanding service to the readers and to the Academy.—john c. rose, m.d.