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Scission of Urology—Cenotaph to a Subtle Offense
THE JOURNAL OJI UROLOGY
Vol. 79, No. 4, April 1958
Printed in U.S.A.
SCISSION OF UROLOGY-CENOTAPH TO A SUBTLE OFFENSE CHARLES MONTGOMERY STEWART
Around the turn of this century medical specialties were almost non-existent. One of the first and largest clinical specialties was entirely concerned with the diagnosis and treatment of the diseases of venery. Professors of surgery of this era were primarily interested in the non-venereal diseases of the genito-urinary tract. The science of urology did not emerge fullgrown as did Minerva from the head of Jupiter. It slowly developed from a painstaking union and evolution of the venereal and non-venereal disturbances of the urinary and genital systems. Urology, as we recognize it today, was guided to its position of eminence by the headwork and handcraftiness of many gifted non-conformists. These were the teacher-explorers imbued with a fanatic faith in their abilities to reach and solve the mysteries confronting them on this new but distant medical horizon. Of necessity, they had to be a specialized breed of very specialized individualism. To these self-led pioneers the credit must be given for the accumulation of the initial accurate information regarding the anatomy, physiology, pathology and embryology of the genito-urinary tract. Urology became an outstanding specialty only because of the pioneer individualism of these many dedicated, though sometimes acrimonious, teacher-leader nonconformists. In the early days urology was assumed to be a division or sub-department of general surgery. Gradually it achieved a completely independent status as a separate department in many outstanding medical schools. Recently this departmental independence of urology as a diagnostic and surgical specialty has been slowly disintegrating. At present a few teaching institutions recognize urology only as a diagnostic specialty. The surgical section of urology is being subjected to amputation. The men who introduced the original techniques of urogenital surgery, who developed the innovations, eliminated the imperfections and then made these advances known to all branches of medicine are now confounded with the bitter realization that they continue to be recognized for their diagnostic capabilities but surgically they have suddenly been found wanting. Infinity marked the boundaries in all directions of general surgery's operating latitude previous to the introduction of antibiotic and chemotherapy. The advent of orthopedics, chest, cardiac, vascular, proctology, hand and maxillofacial specialties have further decreased the original limitless confines to an area of maneuver which by comparison scarcely provides elbow room. However, general surgery's pragmatism has not developed opportunistic myopia as a result of this constant pressure of progress. No longer sovereigns of all their scalpels could scan, these argus-eyed autocrats began to cast a covetous nimble optic over the quiet grazing grounds of the neighborhood specialties. As urologists, we must heed the fact that until recently the teaching and practice of urology enjoyed a deserved and respected recognition unsurpassed by any branch of medical endeavor. But now in our teaching capacities we 659
660
CHARLES MONTGOMERY STEWART
practically always accept a decreed classification as a minor division of a major surgical specialty. Should we persist in our bland acceptance of this low pedagogic rating? If this abject persistence prevails it is obvious that our general recognition as major specialists must regress from a deserved top to an undeserved bottom level of specialized medical effort. Should we remain in our ignominious positions, kneeling as we steady the bottom of the ladder for the specialist's group who maintain that they alone deserve to occupy the top? Voicing no objection confirms that we conform. In conforming, we accept as final the mandate rendered as the ultimate in design for the teaching and practice of urology by these coutouriers of collective-effort medical patterns. Our pattern has been cut and is not subject to alteration of even minor degree. The design is final. It has been planned with care to fit us all and all of us must fit it. Changes in castings, moulds and dies of urologic practice patterns will never be wrought by conformists. Originality and conformity cannot co-exist. Individualists and craftsmen all suffer the taint of originality. Creative craftsmanship requires independence, untamed unconformed individualism. Because non-conformists lack numbers, are in evident minority, must they automatically be qualified as odd-balls? Capitulation is the commonest complication of the present-day general conformity epidemic. Capitulate and group-adjustment becomes an instinct. Be enthusiastic but completely agreeable and bend to the will of the group. Dissatisfaction is a birthmark of the perfectionist, the craftsman, the non-conformed individualist. Disagreement will impede smooth group-effort and dictated team play. Continual total agreement is the only pattern of behavior accepted as normal in anyone who plans to maintain a place in the new pedagogic pattern. Discourage the man with the dubious or inquiring mind; this attitude is hostile to collective organizational group effort. Frown on the individual instinctively driven to develop his God-given talents and latent genius. Condemn those unfortunates who uncontrollably generate the compelling excess energy they must expend in extra effort. We are all obligated to bolster the bumble-bum. We owe the nonentity the right to achieve a sense of significance as a result of our group-guided efforts. Suppression, oppression and pressured direction by the organization or the institution will reduce the urge of creative man to the sterile stature of the dictum-dominated groups, the sum of whose combined original efforts barely qualify them at the level of medicine's mental geldheads. The urinary tract contains no teeth. This may justify our edentulous gumbared whimpers of abjection faintly heard arising from our assigned position at the bottom of the surgical specialties totem pole. Our dictated choice of position on the S.S. Totem Pole is either 1) where the pole enters the ground, or 2) where the pole emerges from the ground. We have been graciously granted permission to make a free, uninhibited choice of either of these locations. This broad range of latitude might be generously termed limited and it could further support our sneaking impression that our delegated authority has even narrower limitations. These tartufish purveyors of surgery's subtle system of classified caste cate-
SCISSION OF UROLOGY
661
gories have pushed their offensive into our territory no faster than our timorous withdrawal tactics have permitted. Though our retreat has been slow, nevertheless it has been steady and each urologic retrograde step has been promptly matched, forward for backward stride, as we blissfully fade deeper into our shrinking domain. Our "division" of surgery could disappear entirely should any further "head shrinking" by "shrunken heads" prevail. Urology discovered and cleared many fruitful diagnostic and surgical pathways. Urologists pioneered and attained many memorable pinnacles in envisioning and perfecting techniques and instruments which have achieved a degree of diagnostic accuracy unrivaled by any other medical or surgical specialty. The visual instruments, electro-surgical units, and various contrast media have provided the basis for countless advances in diagnostic methods and have suggested new uses for variations of our basic instruments. These have now been adapted and adopted for use in the other specialized branches of surgery and medicine. Individualists have been responsible for the discoveries and developments that have resulted from the painfully slow, probing processes always necessary to maintain stable, sound, constant urological progress. Creative craftsmanship is an attribute singularly peculiar to the independent, unconformed individualist. His eternal, inborn, impelling curiosity will be hindered, discouraged and finally smothered by exposure to the pressures of institutional integrated group effort. The creator of the basic premise, the conceptor and proponent of revolutionary theory and practice, though often at wide variance with the old and accepted methods, has been, is now and will always be an individualist. He agrees and conforms only in conceding that the application of basic observations, and the proving and adaptation of the individualist's theories are tasks for the organized group and their unified, purposeful, integrated efforts. Now, who cares? Why object? What good will resistance accomplish? Why should we make anyone mad? We can't reverse the direction of things unless we become disagreeable. Should we keep our heads in the sand and continue to pretend that what we can't see or won't see can't hurt us? Must we continue to plummet from the heights we once attained to join at a common level of assignation with our confreres as they struggle up from the depths? Joined, we may altogether and forever wallow in the serene sea of menial medical mediocrity. Must our pedagogic cataracts be permanent? Have all the old fighting, seeing-eye urological guide dogs become extinct? Can we not seek and find a bold steady hand capable of giving us direct, determined guidance back up the ladder to the deserved level we occupied previously? Scission, fragmentation, trituration and obliteration! constitute a chain reaction that is difficult to halt early and impossible to stop later. Arniel has said, "In every union there is a mystery,-a certain invisible bond which must not be disturbed." Our survival depends on our early prevention of the fission of this bond. Continuation of our shameful, shamanistic acceptance of the strategic retreat as a protective weapon is rank madness. Urology's original principles, aims and objectives have not varied since they
662
CHARLES MONTGOMERY STEWART
were initially declared. Their existence has become obscured by the dense smoke of our abandoned pedagogic and practice bastions ignited by the burning shame of our continued "turn and run without a fight policy." There is still time to halt, face about and stand firm with a united singleness of purpose and action. We must loudly proclaim the resuscitation of our principles, aims and objectives. Be prepared to resist future dictation of our rights and privileges. Pressure by a group, groups, organizations or institutions must be promptly met by greater counter-pressure or we can abandon all hope of preventing our scheduled docile demise. We should recommend that our local, sectional and national organizations re-issue and re-declare our original declaration of rights policies. Our re-grouping and re-union must present an impenetrable, solid front or our new offense will become merely offensive and will be as potentially disastrous as is our present strategic retreat policy. Scission, fragmentation, trituration and obliteration. This could be urology's cenotaph. 2010 Wilshire Blvd., Los Angeles 57, Calif.
Vol. 79, No. 4, April 1958
Printed in U.S.A.
SCISSION OF UROLOGY-CENOTAPH TO A SUBTLE OFFENSE CHARLES MONTGOMERY STEWART
Around the turn of this century medical specialties were almost non-existent. One of the first and largest clinical specialties was entirely concerned with the diagnosis and treatment of the diseases of venery. Professors of surgery of this era were primarily interested in the non-venereal diseases of the genito-urinary tract. The science of urology did not emerge fullgrown as did Minerva from the head of Jupiter. It slowly developed from a painstaking union and evolution of the venereal and non-venereal disturbances of the urinary and genital systems. Urology, as we recognize it today, was guided to its position of eminence by the headwork and handcraftiness of many gifted non-conformists. These were the teacher-explorers imbued with a fanatic faith in their abilities to reach and solve the mysteries confronting them on this new but distant medical horizon. Of necessity, they had to be a specialized breed of very specialized individualism. To these self-led pioneers the credit must be given for the accumulation of the initial accurate information regarding the anatomy, physiology, pathology and embryology of the genito-urinary tract. Urology became an outstanding specialty only because of the pioneer individualism of these many dedicated, though sometimes acrimonious, teacher-leader nonconformists. In the early days urology was assumed to be a division or sub-department of general surgery. Gradually it achieved a completely independent status as a separate department in many outstanding medical schools. Recently this departmental independence of urology as a diagnostic and surgical specialty has been slowly disintegrating. At present a few teaching institutions recognize urology only as a diagnostic specialty. The surgical section of urology is being subjected to amputation. The men who introduced the original techniques of urogenital surgery, who developed the innovations, eliminated the imperfections and then made these advances known to all branches of medicine are now confounded with the bitter realization that they continue to be recognized for their diagnostic capabilities but surgically they have suddenly been found wanting. Infinity marked the boundaries in all directions of general surgery's operating latitude previous to the introduction of antibiotic and chemotherapy. The advent of orthopedics, chest, cardiac, vascular, proctology, hand and maxillofacial specialties have further decreased the original limitless confines to an area of maneuver which by comparison scarcely provides elbow room. However, general surgery's pragmatism has not developed opportunistic myopia as a result of this constant pressure of progress. No longer sovereigns of all their scalpels could scan, these argus-eyed autocrats began to cast a covetous nimble optic over the quiet grazing grounds of the neighborhood specialties. As urologists, we must heed the fact that until recently the teaching and practice of urology enjoyed a deserved and respected recognition unsurpassed by any branch of medical endeavor. But now in our teaching capacities we 659
660
CHARLES MONTGOMERY STEWART
practically always accept a decreed classification as a minor division of a major surgical specialty. Should we persist in our bland acceptance of this low pedagogic rating? If this abject persistence prevails it is obvious that our general recognition as major specialists must regress from a deserved top to an undeserved bottom level of specialized medical effort. Should we remain in our ignominious positions, kneeling as we steady the bottom of the ladder for the specialist's group who maintain that they alone deserve to occupy the top? Voicing no objection confirms that we conform. In conforming, we accept as final the mandate rendered as the ultimate in design for the teaching and practice of urology by these coutouriers of collective-effort medical patterns. Our pattern has been cut and is not subject to alteration of even minor degree. The design is final. It has been planned with care to fit us all and all of us must fit it. Changes in castings, moulds and dies of urologic practice patterns will never be wrought by conformists. Originality and conformity cannot co-exist. Individualists and craftsmen all suffer the taint of originality. Creative craftsmanship requires independence, untamed unconformed individualism. Because non-conformists lack numbers, are in evident minority, must they automatically be qualified as odd-balls? Capitulation is the commonest complication of the present-day general conformity epidemic. Capitulate and group-adjustment becomes an instinct. Be enthusiastic but completely agreeable and bend to the will of the group. Dissatisfaction is a birthmark of the perfectionist, the craftsman, the non-conformed individualist. Disagreement will impede smooth group-effort and dictated team play. Continual total agreement is the only pattern of behavior accepted as normal in anyone who plans to maintain a place in the new pedagogic pattern. Discourage the man with the dubious or inquiring mind; this attitude is hostile to collective organizational group effort. Frown on the individual instinctively driven to develop his God-given talents and latent genius. Condemn those unfortunates who uncontrollably generate the compelling excess energy they must expend in extra effort. We are all obligated to bolster the bumble-bum. We owe the nonentity the right to achieve a sense of significance as a result of our group-guided efforts. Suppression, oppression and pressured direction by the organization or the institution will reduce the urge of creative man to the sterile stature of the dictum-dominated groups, the sum of whose combined original efforts barely qualify them at the level of medicine's mental geldheads. The urinary tract contains no teeth. This may justify our edentulous gumbared whimpers of abjection faintly heard arising from our assigned position at the bottom of the surgical specialties totem pole. Our dictated choice of position on the S.S. Totem Pole is either 1) where the pole enters the ground, or 2) where the pole emerges from the ground. We have been graciously granted permission to make a free, uninhibited choice of either of these locations. This broad range of latitude might be generously termed limited and it could further support our sneaking impression that our delegated authority has even narrower limitations. These tartufish purveyors of surgery's subtle system of classified caste cate-
SCISSION OF UROLOGY
661
gories have pushed their offensive into our territory no faster than our timorous withdrawal tactics have permitted. Though our retreat has been slow, nevertheless it has been steady and each urologic retrograde step has been promptly matched, forward for backward stride, as we blissfully fade deeper into our shrinking domain. Our "division" of surgery could disappear entirely should any further "head shrinking" by "shrunken heads" prevail. Urology discovered and cleared many fruitful diagnostic and surgical pathways. Urologists pioneered and attained many memorable pinnacles in envisioning and perfecting techniques and instruments which have achieved a degree of diagnostic accuracy unrivaled by any other medical or surgical specialty. The visual instruments, electro-surgical units, and various contrast media have provided the basis for countless advances in diagnostic methods and have suggested new uses for variations of our basic instruments. These have now been adapted and adopted for use in the other specialized branches of surgery and medicine. Individualists have been responsible for the discoveries and developments that have resulted from the painfully slow, probing processes always necessary to maintain stable, sound, constant urological progress. Creative craftsmanship is an attribute singularly peculiar to the independent, unconformed individualist. His eternal, inborn, impelling curiosity will be hindered, discouraged and finally smothered by exposure to the pressures of institutional integrated group effort. The creator of the basic premise, the conceptor and proponent of revolutionary theory and practice, though often at wide variance with the old and accepted methods, has been, is now and will always be an individualist. He agrees and conforms only in conceding that the application of basic observations, and the proving and adaptation of the individualist's theories are tasks for the organized group and their unified, purposeful, integrated efforts. Now, who cares? Why object? What good will resistance accomplish? Why should we make anyone mad? We can't reverse the direction of things unless we become disagreeable. Should we keep our heads in the sand and continue to pretend that what we can't see or won't see can't hurt us? Must we continue to plummet from the heights we once attained to join at a common level of assignation with our confreres as they struggle up from the depths? Joined, we may altogether and forever wallow in the serene sea of menial medical mediocrity. Must our pedagogic cataracts be permanent? Have all the old fighting, seeing-eye urological guide dogs become extinct? Can we not seek and find a bold steady hand capable of giving us direct, determined guidance back up the ladder to the deserved level we occupied previously? Scission, fragmentation, trituration and obliteration! constitute a chain reaction that is difficult to halt early and impossible to stop later. Arniel has said, "In every union there is a mystery,-a certain invisible bond which must not be disturbed." Our survival depends on our early prevention of the fission of this bond. Continuation of our shameful, shamanistic acceptance of the strategic retreat as a protective weapon is rank madness. Urology's original principles, aims and objectives have not varied since they
662
CHARLES MONTGOMERY STEWART
were initially declared. Their existence has become obscured by the dense smoke of our abandoned pedagogic and practice bastions ignited by the burning shame of our continued "turn and run without a fight policy." There is still time to halt, face about and stand firm with a united singleness of purpose and action. We must loudly proclaim the resuscitation of our principles, aims and objectives. Be prepared to resist future dictation of our rights and privileges. Pressure by a group, groups, organizations or institutions must be promptly met by greater counter-pressure or we can abandon all hope of preventing our scheduled docile demise. We should recommend that our local, sectional and national organizations re-issue and re-declare our original declaration of rights policies. Our re-grouping and re-union must present an impenetrable, solid front or our new offense will become merely offensive and will be as potentially disastrous as is our present strategic retreat policy. Scission, fragmentation, trituration and obliteration. This could be urology's cenotaph. 2010 Wilshire Blvd., Los Angeles 57, Calif.