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The Pioneer Urologist
THE PIONEER UROLOGIST ALBERT E. MAcKAY Portland, Oregon
The title of this paper was merely used, I believe, by some of my friends to induce a rather personal reminiscence of early experiences in the genito-urinary specialty in this Northwest. It is now almost a quarter of a century since the American Urological Association met in Portland, and since that time science has advanced at such a furious pace, we seem to accept today as common-place the discoveries made but yesterday, so that looking backward in my practice forty years, the progress in urology has seemed to me well nigh incredible. Forty years may seem a long time to some of you younger men but in this delightful western land with its rapid development time has passed so pleasantly, keeping up with the new discoveries from year to year, and passing on the work to my students has been such good sport,_that I can truly say I enjoy the game today more thoroughly than at any period in my life. In 1887 the l\!edical Department of the University of Oregon was organized in Portland and in June of that year Dr. W. H. Saylor was appointed professor of genito-urinary diseases and clinical surgery so that our speciality was early recognized in Oregon long before urology became a well defined department in our scholastic system. However, when I came to Oregon in 1889 imbued with recent experience at St. Peters in London, it seemed a most difficult task to assume practice as a genito-urinary specialist. It was really only accomplished after several years of general practice with the constant effort to show my colleagues that genito-urinary work as a speciality was worthy of acceptance, for it was unquestionably a fact that, at that time, in America and especially in the far West, the advertising quack in men's diseases dominated the field so that even the honest medical doc329
330
ALBERT MACKAY
tor and the ordinary laymen were often too prone to call the budding urologist by a name more euphonious than elegant. The surgeons' efforts at that time to determine the condition of the upper urinary tract were largely clinical for the cystoscope then was quite a rare instrument and I recall that my first efforts with a Nitze type of cystoscope were quite futile, so that the alluring instrument was quickly discarded. Then came the era of the urinary segregator. The Harris instrument always gave me a thrill for I wondered which injury I would do first, rupture the rectum or puncture the bladder. And then the Cathelin segregator, more alluring because of its French origin, but eventually proving rather useless and only discarded when a large portion of the. rubber separator W!tS almost left in a suffering viscus. Then came my first Casper cystoscope which gave some satisfaction from a scenic point of view, and then several types of air distending cystoscopes, which were interesting experiments, if not very illuminating. Early in the century a Tilden Brown direct new cystoscope came to hand and then to me a new field of endeavor seemed to unfold itself in urology. The finding of ureters became fairly easy but even as late as 1903 one had to travel carefully as we read in Keyes work on Surgical Diseases of the Genito-urinary Organs in that year "A conservative attitude has been adopted upon some questions of surgical treatment, such for instance as ureter catheterization, a subject not yet logically judged by experience nor sufficiently tried in the furnace of statistics." With startling rapidity then came the discoveries and modifications of Bransford Lewis, Buerger, McCarthy and others more modern, but it seems to me American urologists owe a large meed of praise to that artist mechanic Reinhold Wappler who made possible the rapid adaptation of ideas presented. About this time in Portland there was quite a sprinkling of geni,to-urinary enthusiasts, largely of my own planting, and then in 1903 came George S. Whiteside of pleasant memory who helped largely to spread the faith. Then in Seattle in 1901 came the only Peterkin who did so much to lend dignity and learning to our speciality, and later with him
THE PIONEER UROLOGIST
331
our accomplished Secretary Alex Peacock, so that now we have quite a flourishing society. I have dwelt largely upon my own efforts to keep up with cystoscopic advances because I believe, beginning with the great discovery of Max Nitze and the subsequent development of the cystoscope, urology has become an exact science making its surgery secure and many modern achievement possible, such as the development of renal tests, the x-ray visualization of the urinary tract, the use of endovesical diathermy, the positive demonstration of a tuberculous kidney and a host of other possibilities too obvious to mention. However, if we are to continue to maintain the dignity. of our speciality and bring within our field all the lesions of the urinary tract in men, women and children, we must not adhere too closely to the irrigating nozzle or the optical end of a cystoscope, but so prepare ourselves by training and experience in the surgical clinic to do all major operative work better than the general surgeon to the end that urology may become as thoroughly and well established in the public and professional mind as gynecology, otology, or opthalmology.
The title of this paper was merely used, I believe, by some of my friends to induce a rather personal reminiscence of early experiences in the genito-urinary specialty in this Northwest. It is now almost a quarter of a century since the American Urological Association met in Portland, and since that time science has advanced at such a furious pace, we seem to accept today as common-place the discoveries made but yesterday, so that looking backward in my practice forty years, the progress in urology has seemed to me well nigh incredible. Forty years may seem a long time to some of you younger men but in this delightful western land with its rapid development time has passed so pleasantly, keeping up with the new discoveries from year to year, and passing on the work to my students has been such good sport,_that I can truly say I enjoy the game today more thoroughly than at any period in my life. In 1887 the l\!edical Department of the University of Oregon was organized in Portland and in June of that year Dr. W. H. Saylor was appointed professor of genito-urinary diseases and clinical surgery so that our speciality was early recognized in Oregon long before urology became a well defined department in our scholastic system. However, when I came to Oregon in 1889 imbued with recent experience at St. Peters in London, it seemed a most difficult task to assume practice as a genito-urinary specialist. It was really only accomplished after several years of general practice with the constant effort to show my colleagues that genito-urinary work as a speciality was worthy of acceptance, for it was unquestionably a fact that, at that time, in America and especially in the far West, the advertising quack in men's diseases dominated the field so that even the honest medical doc329
330
ALBERT MACKAY
tor and the ordinary laymen were often too prone to call the budding urologist by a name more euphonious than elegant. The surgeons' efforts at that time to determine the condition of the upper urinary tract were largely clinical for the cystoscope then was quite a rare instrument and I recall that my first efforts with a Nitze type of cystoscope were quite futile, so that the alluring instrument was quickly discarded. Then came the era of the urinary segregator. The Harris instrument always gave me a thrill for I wondered which injury I would do first, rupture the rectum or puncture the bladder. And then the Cathelin segregator, more alluring because of its French origin, but eventually proving rather useless and only discarded when a large portion of the. rubber separator W!tS almost left in a suffering viscus. Then came my first Casper cystoscope which gave some satisfaction from a scenic point of view, and then several types of air distending cystoscopes, which were interesting experiments, if not very illuminating. Early in the century a Tilden Brown direct new cystoscope came to hand and then to me a new field of endeavor seemed to unfold itself in urology. The finding of ureters became fairly easy but even as late as 1903 one had to travel carefully as we read in Keyes work on Surgical Diseases of the Genito-urinary Organs in that year "A conservative attitude has been adopted upon some questions of surgical treatment, such for instance as ureter catheterization, a subject not yet logically judged by experience nor sufficiently tried in the furnace of statistics." With startling rapidity then came the discoveries and modifications of Bransford Lewis, Buerger, McCarthy and others more modern, but it seems to me American urologists owe a large meed of praise to that artist mechanic Reinhold Wappler who made possible the rapid adaptation of ideas presented. About this time in Portland there was quite a sprinkling of geni,to-urinary enthusiasts, largely of my own planting, and then in 1903 came George S. Whiteside of pleasant memory who helped largely to spread the faith. Then in Seattle in 1901 came the only Peterkin who did so much to lend dignity and learning to our speciality, and later with him
THE PIONEER UROLOGIST
331
our accomplished Secretary Alex Peacock, so that now we have quite a flourishing society. I have dwelt largely upon my own efforts to keep up with cystoscopic advances because I believe, beginning with the great discovery of Max Nitze and the subsequent development of the cystoscope, urology has become an exact science making its surgery secure and many modern achievement possible, such as the development of renal tests, the x-ray visualization of the urinary tract, the use of endovesical diathermy, the positive demonstration of a tuberculous kidney and a host of other possibilities too obvious to mention. However, if we are to continue to maintain the dignity. of our speciality and bring within our field all the lesions of the urinary tract in men, women and children, we must not adhere too closely to the irrigating nozzle or the optical end of a cystoscope, but so prepare ourselves by training and experience in the surgical clinic to do all major operative work better than the general surgeon to the end that urology may become as thoroughly and well established in the public and professional mind as gynecology, otology, or opthalmology.