Thomas Spencer Wells, Bt FRCS (1818-97) and his contributions to naval medicine

Sir Thomas Spencer Wells (1818-97) is best remembered both as a gynaecological surgeon, who introduced ovariectomy, and as the one who introduced the surgical forceps named after him. Far less is known of his career in the Royal Navy (RN) as an assistant surgeon and then a surgeon, and his contributions to naval medicine. Wells enlisted for the RN at the age of 23 years and for most of his naval career (1841-56) he served at the Naval Hospital, Malta (1841-48). However, from 1851 to 1853 he was surgeon and sanitary officer on the sloop, HMS Modeste. Most of Wells' contributions to the health of sailors were of a preventive nature, especially involving ventilation, in RN ships. He was also an enthusiast for quarantine and vaccination.

Georg Kelling (1866-1945): the root of modern day minimal invasive surgery. A forgotten legend?

On 23 September 1901, at the 73rd meeting of the Society of German Natural Scientists and Physicians in Hamburg, following his lecture "On the inspection of the gullet and the stomach with flexible instruments", the surgeon and gastroenterologist Georg Kelling from Dresden performed a laparoscopy on a dog. He called this procedure coelioscopy. Kelling's ingenious idea to connect his oral insufflation device with the Fiedler trocar and the Nitze cystocope, led to the coelioscopy in 1901 and marked the hour of birth of laparoscopy. Until today, Georg Kelling has not experienced the appreciation he is entitled to. He is the forgotten pioneer of a method that today plays an important role in diagnostics and therapeutics. The present standard of endoscopy has confirmed the anticipations of Georg Kelling that he had hundred years ago. His name therefore deserves a fixed place in the history of medicine and especially in the history of endoscopy. Georg Kelling and his wife were killed during the heavy air raids on Dresden on 13 and 14 February 1945, but his vague footprints are still in the sands of medical history.

[Mexican surgery in gynecology and obstetrics during the 19th century]

We present a historical framework for the initiation and development of obstetrical-gynecological (OB-Gyn) surgery during the 19th century in Mexico. The importance of a new vision is underlined, and the founders of medical science, the Romanticist surgeons who initiated the teaching of modern medicine and surgery, supported the change. The French influenced the advent of anesthesia, asepsis, antisepsis and transfusion, which has a major significance for the accomplishment of OB-Gyn Surgery. Important persons in this field of medicine are mentioned and we conclude with techniques of contemporary surgery in the next century, integrated with medical care.

The "ineffable freemasonry of sex": feminist surgeons and the establishment of radiotherapy in early twentieth-century Britain

In 1924 the London Committee of the Medical Women's Federation was instrumental in establishing a clinic for the purpose of investigating the radium treatment of cervical cancer. The scheme was later to evolve into a hospital, the Marie Curie, where adherence to the methods developed in Stockholm served to establish radiotherapy as an alternative to surgery in cancer of the cervix. This article examines the women's contribution in the light of feminist and professional struggles over the relative merits of surgery and radiotherapy. It argues that radiotherapy was an issue of special interest to women surgeons, not only because of the long history of feminist opposition to gynecological surgery, but also because it could widen women's access to the medical profession in the face of male exclusion from training posts and honorary appointments at voluntary hospitals.

The Sims' speculum

An instrument that is taken for granted in gynaecological clinics, operating theatres and GP surgeries all over the world is the humble Sims' speculum. How would we manage without it? In the fourth article of this biographical series, Professor Ellis looks at the work of James Marion Sims.

The forgotten hysterectomy: the first successful abdominal hysterectomy and bilateral salpingo-oophorectomy in the United States

BACKGROUND

The history of gynecology and surgery in America has been well documented. However, a landmark operation took place in 1856 that has gone unrecognized in modern surgical texts.

CASE

William J. Baker and associates performed the first successful abdominal hysterectomy with bilateral salpingo-oophorectomy in Knoxville, Tennessee on November 13, 1856. The patient recovered uneventfully and lived for 34 years after her procedure.

CONCLUSION

This case has yet to be noted in modern medical history texts. It is important that the accomplishments of Dr. Baker and his associates be recognized among the surgical pioneers of their day.

Gender and cancer in Britain, 1860-1910: the emergence of cancer as a public health concern

Historical work on cancer has suggested that a range of political, social, and medical concerns stimulated the emergence of cancer as a public health problem in the early 20th century.I argue that anxiety about cervical cancer mortality was instrumental in establishing cancer as a major focus of concern for the British public health service. This development was closely bound to assumptions about the association of gender with cancer, the redefinition of cancer as a surgical problem, the politics of empire, and the climate of public and medical disquiet about gynecological surgery engendered by feminist and antivivisectionist critiques of medical science.

J. Marion Sims, the father of gynecology: hero or villain?

J. Marion Sims (1813-1884) has been called the "Father of Gynecology" for his revolutionary approach to treating the diseases of women. He rose from humble origins to become a successful surgeon, teacher, and writer. His innovations included the first successful treatment for vesicovaginal fistula, the first gallbladder surgery, and the introduction of antiseptic principles in all areas of surgical treatment. The "Sims position" and "Sims speculum" are eponymic tributes to his accomplishments. In recent years Sims has, however, become a focus of controversy because of his experimental surgeries on slave women. His powerful personality and messianic attitude led him to minimize moral problems, and to bristle against opposition. Ethical principles of autonomy and beneficence are important criteria for evaluating Sims' research. An exploration of the nature of Sims' work and the atmosphere in which he practiced will illuminate the critical ethical questions surrounding Sims' use of slave women as experimental subjects.

The Pfannenstiel or so called "bikini cut": still effective more than 100 years after first description

The original Pfannenstiel incision is discussed including the technique, history, current indications, advantages, and disadvantages. Excellent cosmetic results, principles of less traumatic surgery, and a rare incisional hernia complication rate of about 0-2%, as well as long-time use characterise this access path to the pelvic organs first described by the German gynaecologist in 1900. Complications of nerve damage, however, should be recognised, especially when extending the incision too far laterally.

[History of vaginal reconstruction]

The paper presents the outline of the history of vaginal reconstruction since antiquity, mainly in vaginal agenesis. The review presents first concepts of vaginoplasty originating from Hippocrates and Celsus, a few attempts of vaginal reconstruction in 18th-19th centuries nad moderate advances in the USA in 19th century. A breakthrough in this field was related to introduction of split thickness skin graft for covering neovaginal channel by Abbe at the turn of 19th and 20th century. Subsequent evolution of surgical techniques was based on Abbe's concept and was directed to finding an ideal material accelerating the epitheliazation of vaginal channel. At the turn of 20 and 21st century medical technology development e.g. laparoscopy played its role in this field of surgery too. Tissue engineering and molecular biology will definitely play increasing role in vaginal reconstruction. Conservative and minimally invasive methods of vaginal creation were also briefly discussed. The considerable input of Polish scientist into the development of both experimental and clinical problems of vaginoplasty is presented.

The Manchester Procedure

This article describes the historical development for the Manchester Surgical Procedure for the correction of genital prolapse.

[Gynecologic surgery evolution during the 50 years of professional career in surgery]

This is a retrospective analysis of how gynecological surgery has changed over the last 50 years; these practices have been modified from mutilative and extirpative to conservative and with the least invasion possible. The major breakthroughs-apart from changes in pathology-have been those with use of microsurgery techniques, endoscopic surgery, and assisted reproductive techniques; this highlights the fact that each day surgeon gynecologists are better prepared. Also, there has occurred the notable evolution of methods of detection and diagnosis such as laboratory test, MRI, ultrasound, CT, etc. as well as anesthetic procedures. We describe the most notable changes of gynecological surgery techniques with different examples and figures. Surgical obstetric procedures will be shown in another communication.