Innovation and Ovarian Surgery in Britain 1740-1920
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'The Most Startling Innovation': Ovarian Surgery in Britain, c.1740-1939. Sally Frampton PhD History of Medicine UCL 2013 P a g e | 2 I, Sally Frampton, confirm that the work presented in this thesis is my own. Where information has been derived from other sources, I confirm that this has been indicated in the thesis. Signed: __________________________ Date: ____________________________ P a g e | 3 Abstract Ovarian surgery was a topic of considerable interest to European surgeons during the late eighteenth and early nineteenth centuries. In the 1830s extirpation of the diseased ovary became the first major abdominal procedure to come into use in Britain and in 1843 the term ‘ovariotomy’ was coined to describe the procedure. Yet the operation’s ‘establishment’ was fraught with anxieties that went to the heart of surgical morality. Alternatively framed as a triumphant episode of surgical progress and a symbol of Victorian surgeons’ attempts to ‘control’ female patients with brutal and unnecessary surgery, this thesis adopts a different approach by considering what ovarian surgery can tell us about innovation. With the procedure at its centre, this thesis traces the intricacies particular to negotiating novelty in operative surgery, and how the use of ovariotomy raised significant questions regarding risk, responsibility, credit, economics and surgical language. What emerges is a history that challenges not only previous historicization of ovarian surgery, but also histories of innovation which imagine novel products as stable entities and the innovation process as one that follows a linear pattern. Ovarian surgery, on the contrary, followed no such pattern. At the heart of the debate – and at the heart of this thesis – is the question of definition. The integration of ovariotomy, I argue, was a complex process because the meaning and definition of the innovation was continually contested as the operation was repeatedly re-shaped technically, philosophically and linguistically. P a g e | 4 Acknowledgements I would like to thank my supervisor Roger Cooter whose feedback and advice has so often opened my eyes to new ways of approaching this thesis. Thanks also to my secondary supervisor Nick Hopwood. I am grateful to both for believing in the validity of this project. It was Christopher Lawrence who inspired much of my initial interest in the history of surgery and I’ve been extremely fortunate to have had his support, friendship and feedback throughout. I am also indebted to the following academic colleagues, who have provided illuminating discussion along the way: Stephanie Eichberg, Sheldon Gosline, Stephen Jacyna, Bill MacLehose, Sarah Marks, John Mathew, Corina Palasan, Tom Quick, Steve Ridge, Helga Satzinger, Jane Seymour, Sonu Shamsadani, Emma Sutton and Andrew Wear. An extra special thanks to Sarah Chaney and Carole Reeves for their kindness, friendship and exceptionally helpful feedback. I have been helped enormously by the staff of all the various libraries and archives I have used over the years. But in particular I would like to thank Thalia Knight and the team at the Royal College of Surgeons of England, Jonathan Evans and the team at the Royal London Hospital Archives and Jérôme van Wijland and the team at l'Académie Nationale de Médecine. My family and friends have been a source of tireless support, providing a listening ear whenever I’ve needed one, as well much needed time away from the history of surgery! In particular I would like to thank my parents Bob and Susan Frampton for their kindness, generosity and continued willingness to undertake emergency proofreading. And thank you to James Thorniley. For everything. P a g e | 5 I gratefully acknowledge the support of the Wellcome Trust whose funding enabled me to undertake this research. P a g e | 6 Contents Introduction .................................................................................................................. 9 Chapter One: Pathologies, Actions, Ideas ....................................................... 32 Chapter Two: Representations of Practice ....................................................... 84 Chapter Three: Intellectual Ownership ............................................................ 139 Chapter Four: Business .................................................................................. 181 Chapter Five: The Afterlife of an Operation.................................................. 224 Conclusion ............................................................................................................... 271 Bibliography ............................................................................................................. 281 P a g e | 7 List of Figures Fig. 1. Dropsy Courting Consumption (1810) ........................................................... 51 Fig. 2. A diseased ovary cut for dissection. (1824) .................................................... 61 Fig. 3. The Lecturer (1829) ...................................................................................... 100 Fig. 4. Grave of Thomas Spencer Wells, Brompton Cemetery ............................... 166 Fig. 5. The Medical Chirurgical Tariffs, Jukes de Styrap (1890) ............................ 202 Fig. 6.Number of articles in which ‘ovariotomy’ is cited in The Lancet and British Medical Journal (1880-1939). ................................................................................. 234 Fig. 7. Arthur Giles A Study of the After-Results of Abdominal Operations on the Pelvic Organs: Based on a Series of 1,000 Consecutive Cases (1910). .................. 242 Fig. 8. Howard Kelly Operative Gynecology (1906) ............................................... 249 P a g e | 8 He wrote succinctly and would not tolerate misuse of the English language – to the patient who asked ‘Do I need surgery, Sir?’ he replied, ‘Everyone needs surgery, Madam, what you need is an operation!’1 Obituary of Lord Russell Brock, surgeon. (1903-1980). 1‘Lives of the Fellows: Brock, Russell Claude, Lord Brock of Wimbledon (1903 - 1980)’ (The Royal College of Surgeons of England: created: 1 June 2006, Last modified: 21 March 2007) http://livesonline.rcseng.ac.uk/biogs/E000235b.htm (accessed 27th August 2013). P a g e | 9 Introduction Overview ‘It is…an interesting question to be decided as to why and wherefore a poor little Fallopian tube or withered ovary should possess the power of setting men by the ears’ commented an editorial in the Medical Press in 1888.2 Looking back to the nineteenth century, historians may be inclined to wonder the same thing. During this time the ovary, as an object of physiological and pathological enquiry, and as a site of surgical intervention, engendered more debate and controversy within the medical profession than any other bodily organ. In the late 1830s the removal of diseased ovaries, usually those afflicted with large non- malignant tumours, became the first surgical procedure involving major peritoneal section to be performed frequently, and in 1842 the Manchester surgeon Charles Clay (1801-1893) began a long and unbroken series of the procedures. During this decade the operation was given an appellation that would come to be etched upon the history of the Victorian era: ‘ovariotomy’, a neologism coined by the Edinburgh obstetrician Sir James Young Simpson (1811-1870) in 1843 to describe Clay’s work. For the next twenty-five years, the justifiability of opening the abdomen to treat ovarian disease would remain contested, causing deep schisms in the profession, in which reputations could be lost and careers ruined just as often as fortunes were gained. In the late 1860s, mortality rates for the operation began to decline significantly, in part due to the work 2 ‘The Militant Spirit in Gynaecology Societies.’ Medical Press and Circular 45 (May 9th, 1888) 495. P a g e | 10 of two exceptionally prolific and skilful practitioners, the Edinburgh obstetrician Thomas Keith (1827-1895) and London surgeon Thomas Spencer Wells (1818-1897). Keith had begun performing ovariotomy in 1862 and five years later had published the striking results of his first fifty-one cases: forty of his patients had recovered, with all but one of them seemingly completely cured.3 His recovery rate of around eighty per cent was equal if not better than those of other established ‘capital’ operations – major operations deemed to hold a relatively high risk of death.4 By the 1870s, ovariotomy was beginning to be depicted as one of the major surgical innovations of the past decades, gaining a status similar to that of the discovery of anaesthesia or the introduction of antiseptic techniques. The arguments surrounding the operation did not dissipate, however, as more women survived it. On the contrary, ovarian surgery remained a frequent catalyst for debates. From the priority disputes and accusations of greed that were directed at specialists in the operation during the 1860s, to the controversies of the 1870s and 1880s when a number of surgeons began removing both ovaries as a means of curing diseases other than ovarian tumours. Thus, ovarian surgery is one of the most significant and most accessible historical examples of the complexities of innovation in surgery; symbolic of the hopes and fears of the surgical profession, its performance was embedded in a network of ideas and ideals about the role of surgery in society. As increasing experience with the procedure re-shaped viewpoints, as egos clashed and professional territories were defended, those who