A great variety of procedures have been proposed for the cure of Sacrococcygeal pilonidal disease. Initial enthusiasm has usually given way to disappointment when it is realized that the treatment is painful, the hospitalization is prolonged, the aftercare is tedious or the original condition appears to have recurred. A technique is described which permits the total extirpation of cyst and sinus tracts while allowing for a tensionless wound closure by advancement of a buttock flap. Hospitalization is brief and the postoperative course is comfortable. Fifty such operations have been performed since November 1968. In the first group of thirty patients operated upon between three and ten years ago, a single bonafide failure occurred. An additional twenty patients have been successfully treated for an overall failure rate of 2%.

The author reviews the contributions of those individuals and major academic and professional organizations responsible for the development of the modern concepts of the premedical education of a physician. The late 19th century gave rise to scientifically-based medical education in U.S. medical education. It followed that this new emphasis, in medical schools, on laboratory investigation of disease processes demanded a sound introduction to the natural sciences by those who would be candidates for this type of challenging education. Starting with a vocal few, the message gradually was received throughout the country that a properly schooled physician must have the equivalent of a broad baccalaureate education in the natural sciences as well as in the traditional humanities. This essential was recognized by a small nucleus of individuals responsible for the creation of The Johns Hopkins University in 1876 and its school of medicine in 1893; the group was led by the university's first president, Daniel Coit GILMAN: Almost simultaneously other established academic institutions incorporated similar changes and a new era began.