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See One, Do One, Modify One: Prostate Surgery in the 1930s

Published online by Cambridge University Press:  26 July 2012

Sally Wilde
Sally Wilde
Affiliation:
Dept of History, Philosophy, Religion and Classics, University of Queensland, Queensland 4072, Australia
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The link between science, medicine and public trust has been much discussed. Surgery shared in the public confidence in the efficacy of scientific medicine and the good intentions of its practitioners. This does not seem to have been directly linked to evidence of either. Harry Marks has argued that drug manufacturers were not included in the trust accorded to medical practitioners. Regulations and restrictions on the introduction of new drugs in America from the late 1930s were linked to widespread suspicion of commercial motives. The motives of surgeons were not suspected in the same way, and surgery in the 1930s was not subjected to the same tests of safety (or efficacy) that were beginning to be applied to drugs. Surgeons were free to adopt, adapt, or invent any surgical procedure as they saw fit. Was their surgery based on what Marks has called “the vagaries of clinical opinion”, and Christopher Lawrence the “incommunicable knowledge” behind clinical judgment? Or were surgeon citizens of “the republic of science”, basing their practice on what was considered at the time to be acceptable evidence?

Type
Articles
Information
Medical History , Volume 48 , Issue 3 , 01 July 2004 , pp. 351 - 366
Copyright
Copyright © Cambridge University Press 2004

References

1 E Richard Brown, Rockefeller medicine men: medicine and capitalism in America, Berkeley, University of California Press, 1979; W F Bynum, Science and the practice of medicine in the nineteenth century, Cambridge University Press, 1994; John Harley Warner, ‘The history of science and the sciences of medicine’, Osiris, 1995, 10: 164–93.

2 Archibald L Cochrane, Effectiveness and efficiency: random reflections on health services, London, British Medical Journal and Nuffield Provincial Hospitals Trust, 1972; Ivan Illich, Limits to medicine: medical Nemesis, the expropriation of health, London, Boyars, 1976; Thomas McKeown, The role of medicine: dream, mirage or Nemesis?, London, Nuffield Provincial Hospitals Trust, 1976.

3 Harry M Marks, The progress of experiment: science and therapeutic reform in the United States, 1900–1990, Cambridge University Press, 1997, see especially pp. 38–9.

4 Ibid., p. 230; Christopher Lawrence, ‘Incommunicable knowledge: science, technology and the clinical art in Britain 1850–1914’, J. contemp. Hist., 1985, 20: 503–20; idem, ‘Still incommunicable: clinical holists and medical knowledge in interwar Britain’, in Christopher Lawrence and George Weisz (eds), Greater than the parts: holism in biomedicine, 1920–1950, London, Oxford University Press, 1998, pp. 94–111; see also Judy Sadler, ‘Ideologies of “art” and “science” in medicine: the transition from medical care to the application of technique in the British medical profession’, in Wolfgang Krohn, Edwin T Layton Jr, and Peter Weingart (eds), The dynamics of science and technology, Dordrecht, D Reidel, 1978, pp. 177–215.

5 Marks, op. cit., note 3 above, pp. 230–1.

6 In the sources used for this paper—surgical diaries, the correspondence pages of medical journals, published conference proceedings and articles in urological journals—there are only the most tantalizing glimpses of patient preferences. Interestingly, most refer to the cost of surgery. See, for example, Gershom J Thompson, ‘Transurethral operations’, J. Am. med. Ass., 1936, 107: 1954–8, p. 1958; Hermon C Bumpus, ‘Transurethral prostatic resection,’ Br. J. Urol., 1932, 4: 105–20, p. 120.

7 R Doll, ‘Controlled trials: the 1948 watershed’, Br. med. J., 1998, 317: 1217–20.

8 For the intellectual problems of controlled comparisons in the 1930s, see B H Lerner, ‘Scientific evidence versus therapeutic demand: the introduction of sulfonamides revisited’, Ann. intern. Med., 1991, 115: 315–20; Harry M Marks, ‘Notes from the underground: the social organization of therapeutic research’, in Russell C Maulitz and Diana E Long (eds), Grand rounds: one hundred years of internal medicine, Philadelphia, University of Pennsylvania Press, 1988, pp. 297–338; M L Meldrum, ‘A brief history of the randomized controlled trial: from oranges and lemons to the gold standard’, Hematology/oncology Clinics of North America, 2000, 14: 745–60.

9 Outcomes also varied according to the level of nursing care. See Janet McCalman, ‘The power of care: the Women's Hospital 1884–1914’, Nurs. Inq., 1998, 5: 204–11.

10 M S S Earlam and J W S Laidley, ‘The surgical diaries of M S S Earlam and J W S Laidley, 1936–7, 1938 and 1948’, Archives of the Urological Society of Australasia, item 78, held in the archives of the Royal Australasian College of Surgeons, Melbourne.

11 For the social construction of disease, see Charles Rosenberg and Janet Golden (eds), Framing disease: studies in cultural history, New Brunswick, Rutgers University Press, 1991.

12 National Health and Medical Research Council, Clinical practice guidelines: the management of uncomplicated lower urinary tract symptoms in men, Canberra, Commonwealth of Australia, 1996.

13 For debates over new surgical procedures that did involve a turf war between surgeons and physicians, see David S Jones, ‘Visions of a cure: visualization, clinical trials, and controversies in cardiac therapeutics, 1968–1998’, Isis, 2000, 91: 504–41; Dale C Smith, ‘Appendicitis, appendectomy, and the surgeon’, Bull. Hist. Med., 1996, 70: 414–41.

14 It should be noted that, by the 1930s, urology was already a well-established specialty in the United States. This was not the case in Britain until at least the 1950s. In the 1930s there were some specialist full-time urologists in Britain, but many general surgeons continued to perform prostate surgery. On the relatively late emergence of urology as a specialty in Britain, see John Blandy and J P Williams, The history of the British Association of Urological Surgeons 1945–1995, London, BAUS, 1995; D Shackley, ‘A century of prostatic surgery’, Br. J. Urol., 1999, 83: 776–82; Sir David Innes Williams, ‘The development of urology as a specialty in Britain’, Br. J. Urol., 1999, 84: 587–94. For a more general discussion of the differences in specialization patterns in Britain and the United States, see Rosemary Stevens, Medical practice in modern England and the impact of specialization and state medicine, New Haven, Yale University Press, 1966; idem, American medicine and the public interest, New Haven, Yale University Press, 1971.

15 Harry C Rolnick and Lester A Riskind, ‘Mortality in prostatic surgery’, J. Urol., 1937, 37: 12–17. Rolnick and Riskind discuss at some length the reasons for the very high mortality at the Cook County Hospital. Patients suffering from “prostatic obstruction” were often sick old men with impaired renal function, severely infected bladders and significant co-morbidities. In the early 1930s, the patients in the County Hospital were poor sick old men.

16 Bertram M Bernheim, The story of the Johns Hopkins, Kingswood, Surrey, World's Work,1949; A McGehee Harvey, et al., A model of its kind. Volume I: A centennial history of medicine at Johns Hopkins University, 2 vols, Baltimore, Johns Hopkins University Press, 1989; Leonard Murphy, The history of urology, Springfield, IL, Charles C Thomas, 1972, p. 132.

17 J Swift Joly, ‘Removal of the prostate: indications and methods’, Br. med. J., 1932, ii: 192–6.

18 S Harry Harris, ‘Prostatectomy with complete closure’, J. Coll. Surg. Australasia, 1928, 1: 65–7; idem, ‘Prostatectomy with complete closure’, Med. J. Aust., 1928, ii: 288; idem, ‘Suprapubic prostatectomy with closure’, Br. J. Urol., 1929, 1: 285–95.

19 Shackley, op. cit., note 14 above; Williams, op. cit., note 14 above.

20 Murphy, op. cit., note 16 above, pp. 425–6.

21 Wiebe E Bijker, Of bicycles, bakelites, and bulbs: toward a theory of sociotechnical change, Cambridge, MA, MIT Press, 1995, pp. 122–5.

22 T H Lynch and John M Fitzpatrick, ‘Energy sources in urology’, in Tony Mundy, et al. (eds), The scientific basis of urology, Oxford, Isis Medical Media, 1999, pp. 277–93, on p. 277; Reed Nesbit, Transurethral prostatectomy, Springfield, IL, Charles C Thomas, 1943, pp. 126–31; John Blandy, Transurethral resection, Tunbridge Wells, Pitman Medical, 1971.

23 Maximilian Stern, ‘Resection of obstructions at the vesical orifice’, J. Am. med. Ass., 1926, 87: 1726–30.

24 Ibid., p. 1726; Nesbit, op. cit., note 22 above, p. 135.

25 Ibid., p. 134. In the 1930s, water was used as an irrigating fluid to help keep the field of vision clear.

26 T M Davis, ‘Prostatic operation: prospects of the patient with prostatic disease in prostatectomy vs resection’, J. Am. med. Ass., 1931, 97: 1674–9; A J Crowell and T M Davis, ‘Motion picture demonstration of prostate resection’, J. Urol., 1931, 26: 629–38.

27 Crowell and Davis, ibid., p. 638; Davis, ibid., p. 1674.

28 Joseph Francis McCarthy, ‘A new apparatus for endoscopic plastic surgery of the prostate, diathermia and excision of vesical growths’, J. Urol., 1931, 26: 695–6.

29 Nesbit, op. cit., note 22 above, on p. 136.

30 James C Sargent, ‘Some dangers and difficulties of transurethral resection’, J. Urol., 1933, 30: 559–65, on p. 559.

31 Initially, it was called the College of Surgeons of Australasia. Colin Smith, ‘The shaping of the RACS 1920–1960’, in D E Thiele, P H Carter and Colin Smith (eds), Royal Australasian College of Surgeons, handbook, Melbourne, RACS, 1995, pp. 11–54.

32The College of Surgeons of Australasia (which includes New Zealand) by–laws, Dunedin, 1927, p. 3.

33 Lawrence, ‘Incommunicable knowledge’, op. cit., note 4 above; idem, ‘Still incommunicable’, op. cit., note 4 above; Sadler, op. cit., note 4 above.

34 James Elliott, ‘The complete surgeon’, Aust. N. Z. J. Surg., 1937, 7: 177–80, on p. 177.

35 Ibid., p. 180.

36 Peter D Olch, ‘Evarts A. Graham, the American College of Surgeons, and the American Board of Surgery’, J. Hist. Med. Allied Sci., 1972, 27: 247–61, on p. 250.

37 Ibid., p. 250.

38 J Stewart Rodman, History of the American Board of Surgery, 1937–1952, Philadelphia, J B Lippincott Company, 1956, p. 1.

39 W I de C Wheeler, ‘Prostatectomy’, Br. med. J., 1937, i: 581.

40 Earlam and Laidley, op. cit., note 10 above, Earlam, 30 Nov. 1936.

41 Doll, op. cit., note 7 above; Marks, op. cit., note 8 above.

42 Harris, J. Coll. Surg. Australasia, op. cit., note 18 above, p. 67.

43 Stern, op. cit., note 23 above, p. 1727.

44 Ibid., p. 1728.

45 McCarthy, op. cit., note 28 above, p. 696.

46 For example: N G Alcock, ‘Ten months experience with transurethral prostatic resection’, J. Urol., 1932, 28: 545–59; S Harry Harris, ‘Prostatectomy with closure: five years' experience’, Br. J. Surg., 1934, 21: 434–52; Joseph Francis McCarthy, ‘Further developments in the surgery of the prostate’, J. Urol., 1937, 37: 18–25; A Clifford Morson and J E Semple, ‘A study of the craftsmanship of the Harris technique for prostatectomy’, Br. J. Urol., 1934, 6: 207–19.

47 For the importance of trust in what others tell us, and the conditions under which others are trusted, see Steven Shapin, A social history of truth, University of Chicago Press, 1994.

48 Earlam and Laidley, op. cit., note 10 above, Laidley, 21 March 1938.

49 Ibid., Laidley, 21 March 1938.

50 Ibid., Earlam, 2 Nov. 1936.

51 Ibid., Laidley, 29 March 1938.

52 Ibid., Laidley, 15 May 1938.

53 Ibid., Laidley, 9 May 1938.

54 Ibid., Earlam, 4 Nov. 1936.

55 Ibid., Earlam, 30 Nov. 1936.

56 Cited in Leonard Murphy, ‘Harry Harris and his contribution to suprapubic prostatectomy’, Aust. N. Z. J. Surg., 1984, 54: 579–88.

57 In other words, where the man was in poor health and a cystotomy was performed first.

58 Channing S Swan and E Ross Mintz, ‘A review of the prostatectomies for benign hypertrophy at the Massachusetts General Hospital in the years 1926–1930, inclusive’, J. Urol., 1931, 26: 67–90, p. 86.

59 S Harry Harris, ‘Prostatectomy with closure of the bladder’, Med. J. Aust., 1932, ii: 158; Maurice Ewing, ‘A place in posterity’, Aust. N. Z. J. Surg., 1977, 47: 531–88; Peter S Lawson, ‘Origins of the Urological Society of Australasia’, Aust. N. Z. J. Surg., 1990, 60: 385–91; Murphy, op. cit., note 56 above.

60 R K Lee Brown, ‘Primary closure in prostatectomy’, Aust. N. Z. J. Surg., 1933, 2: 339–47, on p. 339.

61 Lawson, op. cit., note 59 above; Murphy, op. cit., note 56 above.

62 Terence Millin, ‘Treatment of prostatic obstruction’, Br. med. J., 1937, i: 243; Morson and Semple, op. cit., note 46 above; Eric Riches, ‘Hemiprostatectomy’, Br. med. J., 1941, ii: 824.

63 Earlam and Laidley, op. cit., note 10 above, Earlam, Feb. 1937.

64 Ibid., Earlam, Feb. 1937.

65 Ibid., Earlam, 9 Feb. 1937.

66 Canny Ryall and Terence Millin, ‘An alternative to prostatectomy’, Lancet, 1932, ii: 121–5, on p. 125.

67 The literature on the subject is enormous and there is hardly an issue of the Journal of Urology in this era which does not feature articles on the topic. For instance, B S Abeshouse, ‘A comparison of results in the treatment of prostatic obstruction by transurethral resection and prostatectomy’, J. Urol., 1939, 42: 1101–22. See also the discussion of his paper on pp. 1123–9. In Britain, the issue was debated more in the correspondence pages of the Lancet and the British Medical Journal than in papers in the British Journal of Urology. See also Hugh Lett, ‘The treatment of prostatic obstruction other than by enucleation’, Br. J. Surg., 1937, 25: 191–203.

68 John L Emmett, ‘Relief of post-prostatectomy vesical dysfunction by transurethral surgery’, J. Urol., 1937, 37: 569–78, on p. 569.

69 The classic example of the long learning curve in the late twentieth century is laparoscopic cholecystectomy: Alfred Cuschieri, ‘Whither minimal access surgery? Tribulations and expectations’, Am. J. Surg., 1995, 169: 9–19; A Hasan, M Pozzi and J R L Hamilton, ‘New surgical procedures: can we minimise the learning curve?’, Br. med. J., 2000, 320: 171–3.

70 Robert Day, ‘Endoscopic resection of the prostate: an analytical study’, J. Urol., 1932, 28: 569–79, on p. 570.

71 Earlam and Laidley, op. cit., note 10 above, Earlam, 2 Nov. 1936.

72 J W S Laidley and M S S Earlam, ‘Transurethral prostatic resection: a series of operations on one hundred patients’, Med. J. Aust., 1936, i: 80–8, on p. 87.

73 Ibid., on p. 83.

74 Ibid., on p. 88.

75 Earlam and Laidley, op. cit., note 10 above, Laidley, 30 March 1938.

76 Ibid., Earlam, 2 Nov. 1936.

77 Ibid., Earlam, 25 Nov. 1936.

78 Ibid., Earlam, 16 Nov. 1936.

79 Ibid., Earlam, Feb. 1937.

80 See, for example, Hugh Lett's comment that “these operations were not for every surgeon to undertake” following a discussion in the Section of Urology of the Royal Society of Medicine: Hugh Lett, et al., ‘Perurethral treatment of the enlarged prostate’, Lancet, 1933, i: 1180–1, on p. 1181.

81 Nesbit, op. cit., note 22 above, pp. 107–9.

82 Good published results were thus inherently suspect, while bad published results were not. In 1932, the American urologist N G Alcock made public his poor results from early attempts at resection. He described his first fifty resections as “extremely trying and somewhat discouraging” and his paper was subsequently much admired and cited by other urologists: Alcock, op. cit., note 46 above.

83 Mario Biagioli, ‘Tacit knowledge, courtliness, and the scientist's body’, in Susan Leigh Foster (ed.), Choreographing history, Bloomington, Indiana University Press, 1995, on p. 71.

84 Henry Mortensen, ‘The relief of prostatic obstruction’, Med. J. Aust., 1937, ii: 35–6.

85 Walter Galbraith, ‘Prostatectomy by the two-stage method’, Br. med. J., 1937, i: 472–3.

86 Loyal Davis, Fellowship of surgeons: a history of the American College of Surgeons, Springfield, IL, Charles C Thomas, 1960. Ira M Rutkow, American surgery: an illustrated history, Philadelphia, Lippincott-Raven, 1998, p. 248.

87 Rutkow, op. cit., note 86 above, pp. 246–7; Owen H Wangensteen, ‘Surgery and surgical travel groups’, Surgery Gynec. Obstet., 1978, 147: 246–54.

88 Sir Berkeley Moynihan founded the Chirurgical Club, a travelling club for provincial British surgeons, in 1909 and the Association of Surgeons of Great Britain and Ireland in 1920. Ibid., p. 253; Rutherford Morison, ‘Lord Moynihan, a personal appreciation’, Br. J. Surg., 1936, 24: 4–6. A number of surgeons were also making films of their operations in the 1930s, including Harry Harris, Fred Foley and T M Davis.

89 Michael Polanyi, Personal knowledge, London, Routledge & Kegan Paul, 1958; idem, The tacit dimension, New York, Anchor Books, 1967.

90 Biagioli, op. cit., note 83 above, p. 71. See also H M Collins, ‘The TEA set: tacit knowledge and scientific networks’, Science Studies, 1974, 4: 165–86; David Turnbull, Masons, tricksters and cartographers, comparative studies in the sociology of scientific and indigenous knowledge, Harwood Academic, 2000, p. 42.

91 Reed Nesbit, ‘A modification of the Stern-McCarthy resectoscope permitting third-dimensional perception during transurethral prostatectomy’, J. Urol., 1939, 41: 646–8.

92 Earlam and Laidley, op. cit., note 10 above, Laidley, 21 March and 14 Apr. 1938.

93 Ibid., Laidley, 3–5 May 1938.

94 Ibid., Laidley, 4 May 1938.

95 Ibid., Laidley, 5 May 1938.

96 Frederic E B Foley, ‘The present status of transurethral resectionists, competent and otherwise’, J. Urol., 1940, 43: 565–71, on p. 565.

97 Ibid., p. 567.

98 Ibid., p. 570.

99 Earlam and Laidley, op. cit., note 10 above, Earlam, 5 Nov. 1936.

100 Louis M Orr, ‘Discussion’, J. Urol., 1937, 37: 28–31.

101 Millin, op. cit., note 62 above; Eric Riches, ‘Prostatic obstruction, with special reference to per-urethral operations’, Lancet, 1932, ii: 858–9; Kenneth M Walker, ‘Transurethral resection of the prostate: a review of fourteen years' work’, Br. med. J., 1937, i: 901–3; R Ogier Ward, ‘Subvesical diathermy prostatectomy’, Br. med. J., 1938, ii: 175–6. It should be noted that rather more British surgeons continued to perform the cold punch operation than transurethral resection. Blandy and Williams, op. cit., note 14 above, pp. 11–16.

102 Riches, op. cit., note 62 above.

103 Ward, op. cit., note 101 above.

104 Mortensen, op. cit., note 84 above.

105 Earlam and Laidley, op. cit., note 10 above, Earlam, Feb. 1937.

106 Millin, op. cit., note 62 above; Kenneth Walker, ‘A survey of prostatic enlargement and its treatment’, Br. med. J., 1938, ii: 53–7; idem, op. cit., note 101 above.

107 Millin, op. cit., note 62 above.

108 Walker, op. cit., note 101 above.

109 Walker, op. cit., note 106 above, p. 54. In 1937, F McG Loughnane of All Saints' was advocating resection in 96 per cent of cases, but it is difficult to find other British urologists who were still enthusiastic about resection. F McG Loughnane, ‘Treatment of prostatic obstruction’, Br. med. J., 1937, i: 144–5.

110 Earlam and Laidley, op. cit., note 10 above, Earlam, 25 Nov. 1938.

111 Turnbull's concept of the contingent assemblage of knowledge seems to fit what Earlam was seeing: Turnbull, op. cit., note 90 above, p. 4.

112 Day, op. cit., note 70 above; Foley, op. cit., note 96 above, p. 571.

113 Terence Millin, ‘Retropubic prostatectomy: a new extravesical technique’, Lancet, 1945, ii: 693–6.

114 Marks, op. cit., note 8 above, p. 299.