The 1927 visit to Switzerland was arranged by Professor Clairmont whose bloodless no-touch technique was much admired when the group attended his Kantonspital in Zurich, where they saw frozen section pathology performed for the first time. In Basle, Professor Henschen’s clinic was visited in the Burgerspital. In Berne Professor Wildboltz – credited with the first description of the peri-renal fascia – performed a perineal prostatectomy, the audience including Professor Young from Baltimore who had devised the operation. The next stop was high in the Alps, at Dr Rollier’s Tuberculosis Clinic in Leysin, a town known as the Home of the Sun though it was frequently shrouded in mist.
In 1959 the Society again visited the 1200 bedded Kantonspital, this time welcomed by Professor Brunner who demonstrated cases of tuberculosis and internal fixation – it was after all near the end of the skiing season, and some of the doctors themselves were in plaster. There was no hospital laundry, the washing being done by the local prison. In Basle the Society saw Ciba’s research laboratories, where a skilled technician using a dental drill could remove a rat pituitary in minutes.
In Berne the urology department of the Inselspital (founded in 1350, with a new extension started in 1965) was run by Professor Wildboltz (the son of the 1927 host), described as one of the most talented and entertaining hosts the Society had met. A member of the Swiss Parliament, he was an authority on urinary TB and described Johannson’s operation for posterior urethral stricture – using scrotal skin – as fatiguing for the surgeon and requiring the precision of a Swiss watchmaker.
The fourth visit to Switzerland by the TSS was in June 2011 and the party of 36, headed by President Pierre Guillou, was based in Montreux at the Eden Palace Hotel on the north-eastern edge of Lake Geneva. Our secretary Terry Irwin arranged visits to two university hospitals. The HUG in Geneva and the CHUV (visited in 1986) in Lausanne were very spacious and modern. At each there was operating seen in the morning and papers heard from our hosts and ourselves in the afternoon. Amongst other operations (many orthopaedic, and two cardiac) in progress at the HUG we watched the da Vinci robot being used for right hemicolectomy and Professor Bruno Roche performed a laparoscopic rectopexy with fixation to the sacral promontory having already done a case of neurolysis of the left pudendal nerve. There was also a careful resection with primary anastomosis of a short traumatic stricture of the urethral bulb by Professor Iselin, followed by a patient having nephro-ureterectomy, partly laparoscopic.
At the CHUV two trainee surgeons performed an interesting cholecystectomy, the patient turning out to have intra-abdominal tuberculosis also. In another patient a multivisceral resection was planned for recurrent intra-abdominal liposarcoma. Both hospitals had excellent theatre facilities, and at the CHUV the progress of all operations was monitored throughout the bloc operatoire on computers displaying a timeline moving along the operating list, updated by staff with an app for this on their i-pod. The quality of all the afternoon papers was excellent and covered diverse topics at both hospitals. HUG staff presented sacral nerve stimulation in the treatment of faecal incontinence and constipation, Louis XIV’s anal fistula, and aspects of robotic urology whilst Price Thomas Fellows (present and past) offered a detailed review of the genetic element in prostate cancer, galanin and tachykinin expression in enteric nerves in experimental colitis, and limb salvage surgery after the Haiti earthquake.
The very professional printed programme at the CHUV bore a picture of the hospital and the topics covered were: the role of inflammatory changes in causing irritable bowel pain in diverticular disease, the local experience of introducing Enhanced Recovery After Surgery, a novel cytokine in burn wound healing, medico-legal aspects of compartment syndrome, the rationale of multimodal management of colorectal liver metastases, sentinel lymph node biopsy and isolated limb perfusion in the management of cutaneous malignant melanoma, and finally a time-constrained review by Bill Thomas of the evolution of surgical education.
Lunch at both hospitals was exquisite, Professor Roche taking us across the road from the HUG to an artists’ hostelry while Professors Nicolas Demartine and Jean-Claude Givel laid on a superb meal with wine and formal menu in the small conference facility on the twentieth floor of the CHUV, attended by some of their own staff also. The welcome and hospitality (coffee breaks included) were outstanding.
We also visited the world headquarters in Geneva of the International Committee of the Red Cross (ICRC) as guests of English surgeon Robin Coupland who with his head nurse Sabine Helbig talked about the provision of care by the ICRC. Good teamwork (EngIish was the lingua franca), adherence to strict guidelines and respect for the leadership of the chief nurse helped to ensure maximal survival using simple surgical measures mostly directed at managing and dressing wounds, mainly in tented hospitals shipped out within days of being requested. We heard about the differing approaches to managing trauma by the Red Cross, the military (Jim Ryan contributing) and civilian hospitals, with Graham Sunderland giving a well-illustrated presentation highlighting the deficiencies in trauma training in the United Kingdom.
We also saw the Red Cross museum, due for refurbishment in 2012, which detailed the origin of the Red Cross and the Red Crescent and highlighted the plight of the wounded, the dispossessed, prisoners-of-war and those currently suffering lower limb injuries (often requiring amputation) from landmines which the Red Cross has succeeded in getting banned by international treaty, thanks to careful data collection. Many of the victims were children. The cataloguing and protection of PoWs was emphasised with huge archives of files, the ICRC being strictly neutral in all conflicts. Coincidentally, during our stay ICRC personnel were staying at our hotel for a conference.
That afternoon we visited CERN where we learnt how the fundamental secrets of the universe are being unlocked in a 27 km circular tunnel deep under the border between Switzerland and France. Here super-cooled magnets accelerate protons in two tubes to almost the speed of light, using as much electricity as the city of Geneva during each ten hour experiment in which the protons are made to collide by crossing over in any of four detectors. This Hadron Collider, run by twenty participating European countries, is the most advanced in the world. During our visit, which was all above ground, our excellent guides explained particle physics (as did a dramatic display in the spherical Particle Exhibition building) and in a large hangar showed us all the equipment necessary to maintain and replace the Hadron Collider’s super-cooled tubes, though we did not see the tunnel itself. That evening we learnt that at CERN dark matter had been isolated and sustained for fifteen minutes.
Being based in Montreux gave us access to Geneva westward and towards the Alps in a north-eastern direction along the Rhone Valley where we visited Glacier 3000 at Col du Pillon by massive cable car and on another day Gstaad by GoldenPass panoramic train, returning by horse and wagon to Saanen then on by train to Gruyere where we toured its castle with astounding views across Fribourg, finally visiting the Gruyere cheese museum. After the AGM on the last day many visited the lakeside Castle Chillon (where Bonivard had been imprisoned, giving rise to Byron’s famous poem The Prisoner of Chillon which ignited interest in Switzerland leading to the development of its tourist industry) and there was the opportunity of a boat trip on Lake Geneva, a look around Vevey (where Charlie Chaplin spent his final years and is buried, and Nestle have their headquarters) and the Olympic Museum at nearby Ouchy. The formal dinner on our last night was at La Vieille Femme in Chailly on the edge of Montreux, our only guest being the Canadian Dr Joan Roberts-Yap who was working with Professor Bruno Roche on sacral nerve stimulation.
All in all, this was one of the best meetings we had had to any country in recent years. Although the cost of living in Switzerland is probably the highest in the world, so is the standard of living and level of contentment, which we shared.