学术交流与国际差异
1.Surgeons in one town knew little or nothing of surgeons elsewhere.A surgeon from Manchester had never visited an operation theatre in Leeds, nor had ever been asked in consultation.As a consequence it was not infrequent to have to listen to disparagement of one surgeon by another; and jealousies, openly expressed, were too often heard.
—— Berkeley Moynihan, 1865——1936
【译文】一个镇上的外科医生对其他地方的外科医师知之甚少或一无所知。一位来自曼彻斯特的外科医生从未到访过利兹的手术室，也从未被邀请来参加过会诊。因此，经常听到的是外科医生之间的互相贬损，甚至公开表达的嫉妒。
【考注】普通的这几句话最早出自著名外科先驱Moynihan。据记载，早在1909年，他就对外科医生之间缺乏凝聚力感到震惊。因而在当时几位领头外科医生的倡导下，于1920年组建了大不列颠和爱尔兰外科协会（The Association of Surgeons of Great Britain and Ireland，ASGBI）。时至100多年后的今天，这段话依然出现在ASGBI 成立的历史背景介绍中。
2.In America there is some large gathering going on every week of the year,and the big men in surgery tend to attend about half of them.The same man who,in his hometown, rises at five and lies down at nine, becomes for a brief week a playboy, a cheerful companion, a retailer of delightfully humorous stories with a faintly blasphemous tinge.The meetings over, he and his fellows return, giant refreshed, to the man grim task of American surgery.
—— William Heneage Ogilivie, 1887——971
【译文】在美国，一年中每周都有一些大型学术聚会，外科大佬们可能会现身其中的一半。原本这些在家乡朝五晚九，辛勤奔波的医生，在这短短一周里变得像一个公子哥、一群快乐的伙伴，略带一点亵渎色彩地兜售着天南地北的八卦幽默，会议结束后，各自归去，大佬们个个满血复活，重新变回扛起美国外科艰巨任务的那帮人。
3.Enough of the patronizing and gratuitous comments that are made at so many surgical meetings .Let the real debate begin.
—— Donald E.Fry
【译文】在那么多的外科会议上，已经受够了那些居高临下和无厘头的评论，还是开始真正的辩论吧。
4.International congresses.There flowery speakers of all nations convene and infect one another.
—— August Bier, 1861——1949
【译文】国际外科大会上各国高手云集，满堂异彩、互相感染。
5.Surgery; like statecraft, requires an international headquarters, like the League of Nations...where all new discoveries would be demonstrated and all records filed.
—— William Heneage Ogilvie, 1887——1971
【译文】外科，如同国家治理，需要一个国际总部，就像国际联盟，所有的新发现都在这里展示，并记录存档。
6.What I inveigh against is a cursed spirit of intolerance, conceived in distrust and bred in ignorance, that makes the mental attitude perennially antagonistic, even bitterly antagonistic to everything foreign, that subordinates everywhere the race to nation, forgetting the higher claims of human brotherhood.
—— William Osler, 1849——1919
【译文】我所痛斥的是一种应受到诅咒的狭隘性，它源于不信任，孕育于无知，使人们的心态长期对立，甚至对一切外来事物都产生强烈的敌对，并让其服从于民族到国家利益的方方面面，忘却了四海一家的更高理念。
【点评】这种极端的民粹主义在医学界应该不多见。
7.The problem before us is so to exchange information, and so to educate men through travel that there shall develop a final, cosmopolitan system of medicine which will combine the best elements to be found in all countries.
—— Charles H.Mayo, 1865——1939
【译文】我们所面临的是如何进行信息交换和通过跨国交流教育培养人的问题，从而建立一个最终的、世界性的医学体系，把所有国家最好的元素都结合进来。
【点评】今天的大型国际会议，各种国际共识与指南就属于这一类成果。
8.It is worth it to go half-way round the world to watch another surgeon at work, and to bring home the requisite tools for the job.
—— Thomas Dunhill, 1876——1957
【译文】为了观摩另一位外科医生的工作，并带回开展工作所必需的器材，即使绕半个地球也是值得的。
【点评】今天中国外科的成就在很大程度上就得益于开放的中国将一批又一批的年轻外科医生送往发达国家进修学习与合作研究。
9.American hospital? With all these strange faces and these foreign accents?A thousand times yes ...for here, safe from the madness which engulfs the world,meet some of the great minds of European clinics, sharing...knowledge and their experience in a fellowship which is the very essence of democracy.
—— Max Thorek, 1880——1960
【译文】 这是美国医院吗？那么多陌生面孔和杂陈的外国口音？没错，千真万确……正是在这里，远离了被疯狂所包围的世界，来自欧洲各医院的一些伟大头脑聚集在这里……在一种能充分体现民主本质的友好氛围中分享知识和他们的经验。
【点评】的确，美国在广揽全球各类科技人才方面有着独特的优势和吸引力。
10.It is easier for doctors to reject a foreign study.
—— Fritz Beller
【译文】医生们更容易排斥国外的研究。
【点评】好像在我国情况正好相反。
11.There are really three great training systems in surgery, the British, the American and the Continental European.Each of these has its advantages and, each two of the three would admit of the third, its disadvantages.It is remarkable that,differing as they do, all three systems manage to produce the same kind of elite and the same kind of honest-to-God workaday surgeons.
—— Lan Aird, 1905——1962
【译文】有三个真正伟大的外科培训体系：英国、美国和欧洲大陆。各有其优缺点，彼此相互承认。其卓越之处在于，尽管三个体系各不相同，但都能培养出同类精英和同样的对上帝诚实、能胜任日常工作的外科医生。
12.I was through with accepting as gospel what American surgeons taught,and I was ready to explore other branches of science that might be of use in my practice.I also wanted to see in other countries what other surgeons had discovered.I no longer felt that American surgeons whether at Harvard Medical School or the Cleveland Clinic, had the answers to all questions.
—— George Crile, Jr, 1907——1992
【译文】我已经不再把美国外科医生的教诲当作真理来接受了。我准备去探索其他可能对我的实践有用的专业分支，我也想看看其他国家的外科医生都有什么新发现。我不再觉得美国外科医生，无论是哈佛医学院还是克利夫兰诊所，能回答所有问题。
【考注】George Crile, Jr就是这样一位有个性，有远见的外科医生。他为克利夫兰诊所工作超过了半个世纪，在甲状腺癌、乳腺癌的外科治疗方面都颇有建树，并极力反对不必要的手术。
13.National surgery is modified by national temperament ...German surgeons bring to their opportunities a thoroughness and industry that are wholly admirable...French surgeons lose by a certain intolerance and contempt for the knowledge and culture of other nations, whose advances they rarely assimilate ...the British surgeon ...if he seeks public recognition ...knows that he is more likely to obtain it by a beautiful motor car or a socially-minded wife than by originality or skill.
—— William Heneage Ogilvie, 1887——1971
【译文】一个民族的外科是由其民族气质所决定的……德国外科医生有机会进入一个令人钦佩不已的，彻头彻尾的工业化世界……法国外科医生的失败缘于其对外族知识和文化的排斥和蔑视，很少吸收外族先进的东西……英国外科医生……他知道如果想寻求大众的认可，一辆漂亮的汽车或者一个善于交际的妻子更能帮助他达到目的，而非通过独创性或操作技能来获得。
【点评】顺此思路，日本外科医生应该是以将一些外科疾病的病理解剖改变描述到难以复加的细致而著称，比如对内镜下消化道肿瘤黏膜外观的分型，区域淋巴结的分站、分组等。
14.It is characteristic of continental surgery that professional and national recognition is synonymous.The great surgeon is, at the same time, an honoured servant of the State and a familiar figure to the people.There is no counterpart to two types that are met in England; on the one hand the idol of the public, whose name is a household word and whose portrait is news, but whose knowledge is superficial and his reputation among his fellows small; on the other the unrecognized pioneer, whose writings are eagerly read and whose wards and operating theatre are thronged with visitors, but whose consulting-room is empty.
—— William Heneage Ogilvie, 1887——1971
【译文】欧陆外科的特点是视职业认可等同于民族认可。一个伟大的外科医生既是这个国家光荣的仆人，也是人民所熟悉的人物。在英格兰，找不到同时能满足这两个条件的人：一种是公众的偶像，他的名字家喻户晓，肖像即是新闻，但知识肤浅，在同行中的名声不高；另一种是不为人知的先驱，虽然他的著述广受追捧，病房和手术室挤满了来访者，但他的诊室却空空荡荡。(https://www.daowen.com)
【点评】那种不为人知的先驱是行业内的默默耕耘者。他们埋头做学问、踏踏实实做临床，很少抛头露面，到行业以外去捞取虚名，他们的患者可能都是同行推荐过来的，所以“他的病房和手术室挤满了来访者，但他的诊室却空空荡荡”，这可能与国外专科患者的转诊制度有关。
15.Operating as a sport is a purely British conception, and its home is the cottage hospital.
—— William Heneage Ogilvie, 1887——1971
【译文】将做手术视为一种运动是纯粹的英国概念，它缘起于乡村医院。
【点评】上述三段话都出自一位纯正的英国医生之口，难得！一位英国外科医生如此无情鞭挞英国外科学界。
16.On the continent the system of large professorial clinics, where the word of one man is law over decades, while assistants grow old and fixed in his service,tends to the perpetuation of local tradition and the cramping of true originality as against mere showmanship.
—— William Heneage Ogilvie, 1887——1971
【译文】欧洲大陆的学院派医疗机构体系内，某个人的话就是法律，统摄数十年，而助手们逐渐变老，服务一成不变，从而易导致自身传统的固化，与纯粹炫技形成对照的是真正的原创受到钳制。
【点评】深刻！
17.German surgery is based on the laboratory and operating theatre but rarely approaches the bedside; it produces superb surgical pathologists and brilliant operators, but few clinicians or clinical teachers of any importance.
—— William Heneage Ogilvie, 1887——1971
【译文】德国外科是建立在实验室和手术室基础上的，但很少走近病床边，因而诞生了卓越的外科病理学家和杰出的手术大师，但很少有重要的临床医生或临床老师。
18.If one were to generalize at all, one might say that the surgery of Germany,on the whole, has a tendency to be radical, that of England conservative, France,brilliant but provincial.
—— Owen H.Wangensteen, 1898——1981
【译文】 如果用一句概括，人们可能会说，德国的外科总体上倾向于激进，英国保守，法国辉煌但狭隘。
19.American surgery is like American football; they run about like hell for 10 minutes, and then stop and have a huddle.
—— William Heneage Ogilvie, 1887——1971
【译文】美国外科就像美式足球，他们拼命跑10分钟，然后停下来，挤成一团。
20.In America ...the orthodoxy of past generations is often wrongly condemned on insufficient grounds; treatment is largely a matter of fashion, and each innovation is accepted as an advance, till a newer method displaces it.
—— William Heneage Ogilvie, 1887——1971
【译文】在美国……过去几代人的正统观念经常基于不充分的理由而受到错误的谴责。治疗在很大程度上是一种时尚，每一项创新都被视为一种进步，直到另一种新的方法取而代之。
21.Americans, newly arrived in Austria, we were greatly amused at seeing perhaps a dozen clamps left hanging in a wound of the neck while the operator proceeded with his dissection, and were inclined to ridicule the method as being untidy and uncouth.Slowly it dawned on us that we in America were novices in the art as well as the science of surgery.
—— William Stewart Halsted, 1852——1922
【译文】刚到奥地利的美国人，看到手术者进行组织解剖时，脖子的伤口上挂着十几把钳子，我们都觉得很好笑，还嘲笑这种方法不整洁、粗野，慢慢地我们才恍然大悟，我们美国人在外科学研究与操作技艺方面都是新手。
【点评】的确，美国外科学的领跑地位也只不过是二次世界大战以后的事。
22.There is a fashion in the way we do things surgically as truly as there is a fashion in neckties and bonnets.The world has adopted the custom of taking the fashions of its clothing from Paris; and the medical world has largely adopted the custom of taking the fashion from Germany.In determining if a German fashion is true it is a good rule to let it pass through England and see what the common sense British mind has to say of it and then weigh up the two views.
—— Chalmers Da Costa, 1863——1933
【译文】外科所做的一些事也有一种时尚，就像领带和帽子的时尚一样。全世界的时装之风从巴黎而来，而医学界的大多数潮流都来自德国。为确认德国潮流是否可信，最好的办法是让它先获得英国的通过，看看英国人怎么说，然后再权衡这两种观点。
【点评】看来美国人够开放也够精明。
23.The popularity of coronary bypass surgery concords with the American culture biases of aggressive treatment and with the American view of the body as a machine.
—— Lynn Payer, 1945——2001
【译文】冠状动脉搭桥手术的流行符合偏爱侵入性治疗手段的美国文化，也与美国人将身体视作机器的观念相一致。
24.Not all French doctors are Cartesian, not all German doctors authoritarian romantics, not all English doctors kindly but paternalistic, not all American doctors aggressive.As with most caricatures, these pictures may be distorted, but they are based on truths found in the overall practices of each country.
—— Lynn Payer, 1945——2001
【译文】不是所有的法国医生都是笛卡尔式的，也不是所有的德国医生都是专横的浪漫主义者，不是所有的英国医生都和蔼可亲但有家长式作风，更不是所有的美国医生都咄咄逼人。就像大多数漫画一样，虽然图像被扭曲，但还是从每个国家的总体实践中挖掘出来的某些真相。
【点评】不同国家和民族文化对其外科学发展所形成的烙印和影响只能是一个总体印象，不可能千人一面。
25.There are many learned men in Germany who could further medical knowledge but they are so taken up with their useless labours and with poring over old books that they cannot be made to know that the real basis of medicine is "love thy neighbour".
—— Paracelsus, 1493——1541
【译文】在德国，有许多博学多才的人本可以进一步提升其医学知识，却将时间耗费在一些无用的工作和钻研旧书中。殊不知医学的基础是超越自我和功利的博爱。
26.Since the object of travel is primarily self-improvement, time should not be wasted looking for things done badly and for things to criticize.
—— William J.Mayo, 1861——1939
【译文】既然游学的主要目的是自我完善，那么就不应该浪费时间去寻找那些做得不好和值得指责的事。
27.There are countries who have ideas, hardly manage the English language,have no oil, and have no trials.There are other countries who have ideas, are artists in surgical techniques, hardly manage the English language, have no oil and no trials.There are still other countries who seldom have ideas, know how to speak English, have oil and controlled clinical trials.
—— Lynn Payer, 1945——2001
【译文】有些国家有思想，几乎不懂英语，没有石油，也没有临床试验；还有一些国家有思想，也有外科技术的高手，几乎不懂英语，没有石油，也没有临床试验；还有其他一些很少有思想，懂得说英语，有石油和对照临床试验的国家。
【点评】虽然表述很独特，但也从一个特殊的视角说明一个国家或民族的外科水平是与其文化和经济发展密不可分的。
28.The moral of all this could be summed up as: if you have low standard medical schools as in Italy, it makes no difference to have a surgeon who deserves almost a standing ovation at a meeting such as the last ACS; at the end even important people such as the Pope will benefit from the products of this culture.
—— Melchiorre Costa
【译文】所有这些德行可以概括为：即使医学院标准像意大利那样低，也丝毫不影响其外科医生在上届ACS会议上赢得大家的起立鼓掌。最后，甚至像教皇这样的重要人物也将从这种（平等）文化中受益。
【点评】国际外科界是一个平等的大家庭，不论出身，互相尊重。