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MEREDITH CAMPBELL MEMORIAL LECTURE

AMERICAN UROLOGIC ASSOCIATION
NEW ORLEANS, LOUISIANA

MAY 13, 1990
| FIRST HEARD THE NAME MEREDITH CAMPBELL WHEN | WENT TO
BOSTON IN THE SPRING OF 1946 TO LEARN SOMETHING ABOUT A
NEW FIELD THAT WAS DEVELOPING CALLED CHILD SURGERY.
MEREDITH CAMPBELL, TO US ON THE HOUSE STAFF AT THE
BOSTON CHILDREN'S HOSPITAL, WAS A NAME THAT CONJURED
UP THE MAGIC OF SURGERY,--RIGHT UP THERE WITH NAMES

LIKE WILLIAM E. LADD AND SIR DENNIS BROWN.
NOT EVEN THE MOST FANCIFUL FLIGHT OF IMAGINATION WOULD
HAVE LED ME TO DREAM OF GIVING THE MEREDITH CAMPBELL
MEMORIAL LECTURE ALMOST HALF A CENTURY LATER. BUT
HERE |! AM, AND HONORED INDEED TO BE AMONG YOU AND TO
HONOR THE MEMORY OF THIS PIONEER IN UROLOGY AND

ESPECIALLY THAT OF CHILDREN.
IN 1946, WE WHO WERE ON THE CUTTING EDGE OF A NEW
DISCIPLINE, LATER TO BE KNOWN AS PEDIATRIC SURGERY,
CONSIDERED OURSELVES TO BE WORKING IN A FIELD OF

ULTIMATE SURGICAL SOPHISTICATION.

EVEN HAD THAT BEEN TRUE FOR DISCIPLINES IN ADULT
SURGERY, THE ATTENTION GIVEN TO CHILDREN WITH SURGICAL

PROBLEMS WAS A DISGRACE.
IN INSTITUTIONS WHICH HAD BEEN DEVOTED TO THE CARE OF
CHILDREN, WHERE PIONEERING ADVANCES WERE MADE IN
MEDICAL PEDIATRICS, THE SURGERY OF CHILDREN LAGGED FAR
BEHIND. PEDIATRIC ORTHOPEDICS WAS IN A WAY FAR
ADVANCED OVER OTHER PEDIATRIC SURGICAL SUB-SPECIALTIES.
EARLY GIANTS IN THAT FIELD, LIKE WILLARD AND NICHOLSON,
SPENT MOST OF THEIR TIME REPAIRING THE RAVAGES OF

CHILDHOOD DISEASES NO LONGER ENCOUNTERED.
POLIO, TUBERCULOSIS OF THE BONE, AND OSTEOMYELITIS,
FILLED MOST OF THE BEDS IN SPECIALTY INSTITUTIONS
CONCERNED WITH THE ORTHOPEDIC CHALLENGES OF
CHILDHOOD. ONE SUMMER WHEN | WAS IN COLLEGE, | FELT
EXTRAORDINARILY FORTUNATE TO WORK UNDER THE AEGIS OF
FRANK S. CHILDS, AN ORTHOPEDIC SURGEON WHO, AMONG
OTHER THINGS, WAS THE CHIEF OF SURGERY AT THE ST.
CHARLES HOSPITAL FOR CRIPPLED CHILDREN, A 400-BED

INSTITUTION IN PORT JEFFERSON, NEW YORK.
MY CLINICAL DUTIES WERE SIMPLE: CHANGE EVERY
OSTEOMYELITIS DRESSING ON EVERY CHILD ONCE A WEEK. |
STARTED AT 8:00 A.M. MONDAYS, WORKED A 10-HOUR DAY, AND

USUALLY WAS FINISHED BY SATURDAY AFTERNOON.

THERE WERE NO SULFONAMIDES, NO ANTIBIOTICS. IODOFORM
GAUZE AND BALSAM OF PERU FILLED THE LARGEST CONTAINERS

ON THE DRESSING CARTS.
IN A HOSPITAL LIKE THE CHILDREN'S HOSPITAL OF PHILADELPHIA
IN THE DAYS BEFORE WORLD WAR II, SHARING THE LIMELIGHT
WITH ORTHOPEDICS, WAS OTORHINOLARYNGOLOGY, WITH
TONSILLECTOMY BEING THE MOST FREQUENT SURGICAL
PROCEDURE OF AN ELECTIVE NATURE; THE SURGICAL
EMERGENCIES WERE RADICAL MASTOIDECTOMIES AND THE

DRAINAGE OF PERITONSILLAR ABSCESSES.

UROLOGIC PROCEDURES AT THAT SAME INSTITUTION WERE
CONFINED TO THE HAPHAZARD MANAGEMENT OF GROSSLY
OBVIOUS UROLOGIC ANOMALIES BY PROCEDURES WHICH
SHOULD HAVE BEEN TEMPORIZING BUT REMAINED THROUGHOUT
THE LIFE OF THE CHILD, USUALLY SHORTENED, HOWEVER, BY

INFECTION.
EVERYONE WAS AN EXPERT IN CIRCUMCISION. THERE WERE
PROBABLY MORE GOMCO CLAMPS IN THE HOSPITAL THAN THERE

WERE ABDOMINAL RETRACTORS.

THE REAL CHALLENGE OF GENERAL PEDIATRIC SURGERY OF THE
1950S LAY IN THE CONGENITAL DEFECTS INCOMPATIBLE WITH
LIFE BUT AMENABLE TO SURGICAL CORRECTION, SUCH AS
ESOPHAGEAL ATRESIA, OMPHALOCELE, IMPERFORATE ANUS,
DIAPHRAGMATIC HERNIA, AND INTESTINAL OBSTRUCTION.

THE MORTALITY FOR A SIMPLE COLOSTOMY WAS IN THE

NEIGHBORHOOD OF 90%.
THE THOUGHT OF GIVING GENERAL ANESTHESIA TO A CHILD
STRUCK TERROR TO THE HEARTS OF MOST SURGEONS, BUT
INSTEAD OF THIS BEING AN IMPETUS TO RESEARCH INTO THE
UNIQUE RESPONSES OF INFANTS AND SMALL CHILDREN TO
PHARMACOLOGICALS, ANESTHETIC AGENTS, AND BLOOD LOSS
AND REPLACEMENT, OPERATIONS WERE POSTPONED OR NEVER
DONE RATHER THAN FACE THE PROBLEMS OF HIGH MORTALITY

FROM ANESTHESIA.
IN 1946, WILLIAM E. LADD, THE PIONEER OF PEDIATRIC SURGERY
IN THE UNITED STATES HAD RETIRED FROM THE BOSTON
CHILDREN'S HOSPITAL AND HARVARD MEDICAL SCHOOL. A
CHAIR HAD BEEN ENDOWED IN HIS NAME, FUNDED BY $6,000.
ROBERT E. GROSS OCCUPIED IT IN THE CLOSING WEEKS OF 1946,
AND THE BOSTON CHILDREN'S HOSPITAL WAS THE ONLY PLACE
IN THE UNITED STATES WHERE ONE COULD SAY THERE WAS

ANYTHING LIKE A TRAINING PROGRAM IN CHILD SURGERY.

THERE WERE A FEW MEN AROUND THE COUNTRY WHO WERE
BEGINNING TO MAKE A DIFFERENCE IN CHILD SURGERY:
OSWALD WYATT IN MINNEAPOLIS, HERBERT COE IN SEATTLE,
AND ORVAR SWENSON IN BOSTON. | WAS THE SIXTH PERSON IN
THE UNITED STATES TO CALL HIMSELF A CHILD SURGEON, AND

THE FIRST TO PRACTICE THE SPECIALTY TO THE EXCLUSION OF

ADULT PATIENTS.

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| BEGAN TO OPERATE AT THE CHILDREN'S HOSPITAL IN
PHILADELPHIA IN DECEMBER OF 1946, ACTING, INDEED, AS THE
SURGEON IN CHIEF, A TITLE |! DID NOT GET UNTIL 1948. TAGUE
CHISHOLM JOINED OSWALD WYATT IN MINNEAPOLIS SHORTLY
AFTER THAT, AND WILLIS POTTS BEGAN HIS CAREER IN CHICAGO.
LATER STALWARTS SUCH AS SANDY BILL, BILL CLATWORTHY,
AND LUTHER LONGINO WERE STILL MEMBERS OF THE HOUSE

STAFF AT BOSTON CHILDREN'S HOSPITAL.

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| LEARNED, EARLY ON, THAT IT WAS EASIER TO PUT CHILDREN
UNDER ANESTHESIA THAN IT WAS TO WAKE THEM UP. HENCE, A
LOT OF MY TIME IN THE FIRST TWO YEARS IN THIS NEW FIELD
WAS DEVOTED TO THE DEVELOPMENT OF TECHNIQUES AND
SAFEGUARDS IN PEDIATRIC ANESTHESIA. INDEED | SPENT MORE
CONCERN AND EFFORT THERE THAN | DID IN SURGERY. MANY
THINGS WERE ACCOMPLISHED, NOT THE LEAST OF WHICH WAS
THE DEVELOPMENT OF SAFE ENDOTRACHEAL ANESTHESIA, EVEN
FOR NEWBORNS. MUCH OF THE EQUIPMENT WE USED, WE MADE

OURSELVES.

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NEOPRENE HAD JUST BEGUN TO REPLACE RUBBER TUBING.
THERE WAS NO SUCH THING AS POLYETHYLENE OR TYGON
PLASTIC TUBING. NICETIES SUCH AS BUTTERFLY NEEDLES HAD
NOT BEEN INVENTED. TO START AN INTRAVENOUS IN A SCALP
VEIN ON A NEWBORN WAS TRULY A CHALLENGE, BUT KEEPING IT
RUNNING BY BUILDING MECHANICAL SUPPORTS TO HOLD IN
PLACE A RIGID NEEDLE ATTACHED TO A GLASS SYRINGE WAS AN

ACCOMPLISHMENT IN STRUCTURAL ENGINEERING.

AND YET HERE AND THERE ABOUT THE COUNTRY CHILDREN

WERE BEGINNING TO GET A FAIR SHAKE IN SURGERY.

13
BEFORE GRADUATING FROM CORNELL UNIVERSITY MEDICAL
COLLEGE IN 1941, | HAD SECURED A TWO-YEAR INTERNSHIP AT
THE PENNSYLVANIA HOSPITAL IN PHILADELPHIA AND WAS
ASSURED BY I.S. RAVDIN THAT | WOULD EVENTUALLY BE A
HARRISON FELLOW IN GENERAL SURGERY AND SURGICAL

RESEARCH.

14
THE WAR IN EUROPE, AND THE PRESUMPTION THAT WE WOULD
SOON BE IN IT, LED TO THE REDUCTION OF MY TWO-YEAR
ROTATING INTERNSHIP TO ONE YEAR. ON THE DAY AFTER PEARL
HARBOR, I.S. RAVDIN CHOPPED AT LEAST THREE YEARS OFF MY
SURGICAL TRAINING BY NOT ONLY APPOINTING ME TO THE
HARRISON FELLOWSHIP I ANTICIPATED, BUT HIS MILITARY
CONNECTIONS WITH THE ARMY MEDICAL CORPS ENABLED HIM
TO DECLARE ME ESSENTIAL TO THE UNIVERSITY OF

PENNSYLVANIA FOR THE DURATION OF THE WAR.

15
MY FIRST INTEREST IN CANCER HAD DEVELOPED WHEN | WAS A
MEDICAL STUDENT AT CORNELL. DURING THE SUMMER BETWEEN
MY JUNIOR AND SENIOR YEARS, | WORKED WITH HAYES MARTIN,
CHIEF OF THE HEAD AND NECK SERVICE AT MEMORIAL HOSPITAL,
ONA NUTRITIONAL SURVEY OF CANCER PATIENTS FROM HIS
SERVICE. THE THESIS OF THE PROJECT WAS THAT AVITAMINOSIS
B CONTRIBUTED TO THE RAVAGES OF CANCER OF THE FLOOR OF

THE MOUTH, PALATE, PHARYNX, ETC.

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MEMORIAL HOSPITAL HAD JUST MOVED TO ITS NEW LOCATION
OPPOSITE CORNELL AND THE NEW YORK HOSPITAL, AND IT WAS
THE CENTER FOR CANCER, IN THE BROADEST SENSE OF THE
TERM, ON THE EAST COAST. THE HOSPITALS DIRECTOR WAS
C.P. RHOADES, BUT JAMES EWING, WHO IS REGARDED BY MANY
AS THE FATHER OF MODERN CANCER RESEARCH AND THERAPY
IN THE UNITED STATES, WAS STILL IN A POSITION OF AWESOME

AUTHORITY IN THE HOSPITAL.

17
THE DAY CAME WHEN | HAD TO PRESENT WHAT I HAD DONE
BEFORE MEMORIAL'S CANCER RESEARCH ADVISORY COMMITTEE.
THE FACT THAT TWO NOBEL LAUREATES SAT ON THAT
COMMITTEE DID NOT MAKE IT ANY EASIER. IN THOSE DAYS |
SUFFERED FROM AN INCAPACITATING TYPE OF MIGRAINE
BROUGHT ON BY THE RELAXATION OF TENSION. MY 10-MINUTE
PRESENTATION WAS FOLLOWED BY SUCH A SENSE OF RELIEF
THAT THE SCOTOMA | DEVELOPED IMMEDIATELY WAS SO BRIGHT

THAT | COULD BARELY FIND MY WAY OFF THE PLATFORM.

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BY THE TIME | REACHED THE BACK OF THE AUDITORIUM, | FELT
AS THOUGH SOMEONE HAD BURIED A HATCHET IN THE RIGHT

SIDE OF MY SKULL.

IN PREPARATION FOR THAT OCCASION, IT WAS NECESSARY TO
PRESENT MY FINDINGS IN A PRELIMINARY FASHION TO OLD DR.
EWING. EWING ASKED ME IF | THOUGHT THE IRRITATION OF THE
MUCOSA OF THE MOUTH FROM SUCH THINGS AS DENTURES, PIPE

STEMS, AND SO FORTH, MIGHT CONTRIBUTE TO CANCER.

19
WHEN | REPLIED IN THE AFFIRMATIVE HE SAID: “WELL, IF YOURE
RIGHT, HORSES OUGHT TO HAVE CANCER OF THE JAW ALL THE
TIME.” | REPLIED: “AS A MATTER OF FACT, MY GRANDFATHERS
HORSE DIED OF CANCER OF THE JAW BUT, ON THE OTHER HAND,
IVE ONLY KNOWN TWO HORSES WELL.” TO THAT REPLY, EWING

QUIPPED, ”THAT'S NOT A BAD SERIES; 50 PERCENT.”

20
| LEFT CORNELL, MEMORIAL HOSPITAL, AND NEW YORK CITY TO
GO TO PHILADELPHIA, WITH THE PROMISE THAT AFTER
APPROPRIATE SURGICAL TRAINING | WOULD RETURN TO
MEMORIAL TO BE THE SURGICAL LIAISON IN THEIR TRAINING

PROGRAM WITH CORNELL AND THE NEW YORK HOSPITAL.

IF THERE WAS SUCH A THING AS ONCOLOGY IN THOSE DAYS, |

HAD NOT YET HEARD ABOUT IT.

21
IN THE THIRD YEAR OF MY HARRISON FELLOWSHIP, WHICH WAS
ESSENTIALLY THE SURGICAL RESIDENCY AT THE HOSPITAL OF
THE UNIVERSITY OF PENNSYLVANIA, | WAS ADMITTED TO THAT
HOSPITAL AS A PATIENT WITH A SEVERE STREP THROAT, MAKING

IT VERY DIFFICULT TO SWALLOW.

22
THE WAR WAS OVER IN EUROPE. THINGS WERE WINDING DOWN
IN THE PACIFIC BASIN. MOST OF THE UNIVERSITY'S SURGICAL
STAFF WAS STILL IN THE ARMY RUNNING THE 20TH GENERAL
HOSPITAL IN ASSAM. | WAS WAKENED FROM A DEEP SLEEP
ABOUT 5:00 A.M. BY I.S. RAVDIN BURSTING INTO MY HOSPITAL
ROOM, IN THE UNIFORM OF A COLONEL (HE WAS MADE GENERAL

BEFORE RETURNING TO INDIA).

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"CHICK! WHAT DO YOU WANT TO DO WITH YOUR LIFE?”

| DONT KNOW HOW |! GATHERED MY THOUGHTS TOGETHER, BUT |
CROAKED OUT SOMETHING THAT SOUNDED LIKE THIS: ”WELL,
DR. RAVDIN, | HAVE COME TO LOVE THE UNIVERSITY OF
PENNSYLVANIA, THIS HOSPITAL, AND PHILADELPHIA. ID LIKE TO
STAY HERE. THERE'S ONE WEAK SPOT IN YOUR PROGRAM, AND
THATS THE CANCER CLINIC. IF YOULL GIVE THAT TO ME, PLL

DEVELOP IT AND MAKE IT SING FOR YOU.”

24
RAV REPLIED: "HOW WOULD YOU LIKE TO BE SURGEON IN CHIEF
OF THE CHILDREN'S HOSPITAL INSTEAD?” | DIDNT THINK LONG
BEFORE REPLYING: "THATS MY SECOND CHOICE.” THAT BRIEF

ENCOUNTER IS THE REASON IM HERE TALKING TO YOU TODAY.

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