Highlights Of The History Of Urology In Florida
by Russell B. Carson M. D.
Discovered by Ponce de Leon in 1513, Florida remained under Spanish rule until its cession to England in 1763. It was returned to Spain in 1783 and was purchased by the United States in 1819, becoming a state in 1845. The Spanish possession was a large land mass known as the Territory of Florida and included the areas of Tennessee, Kentucky, the Carolinas, Georgia, Alabama, Louisiana and Mississippi. As these areas were carved out of the Territory of Florida, their more favorable geographic and climatic features fostered an early and rapid development of their cities, universities and medical communities. Florida languished behind until the 1920’s when it began a slow and interrupted growth that quickly accelerated in the 1940’s.
In the Proceedings of the Florida Medical Association of 1879 we find one of the earliest papers on a urological subject to be presented and published in this State. E. T. Sabal, M.D. of Jacksonville read a paper before the Duval County Medical Society on April 2, 1877. He repeated this paper before the Florida State Medical Association on April 19, 1879. It was entitled “Partial Paralysis from Reflex Irritation Caused by Congenital Phimosis, also Congenital Phimosis as the Cause of Impotency, with Case Reports.” Dr. Sabal reported four cases in which he succeeded in promoting a grateful cure by the performance of circumcision for phimosis. Two years later another author, Angus A. Gillis, M.D., also presented a paper on circumcision, “the curative treatment of a class of nervous diseases that follow as a sequella to the local infections, the primary cause of which is subprepucial irritation--chancroid, adhesions of the prepuce to the glans, presence of calculi underneath the foreskin, etc.” In the same issue of the Proceedings, J. B. Mahoney, M.D. presented a successful amputation of the penis for epithelioma with a ten month follow up and no evidence of recurrence.
A considerable period of time elapsed in the principal medical publications of Florida before another article was presented to the Association. In 1899 Edward N. Liell, M.D. of Jacksonville presented an interesting paper entitled “Cystoscopy and Ureteral Catheterization in the Female.”(1) Dr. Liell stated, “The researchers of Pawlik, Boseman, Kelly, Reynolds and others have shed light and added greatly to our knowledge as to the diagnosis and treatment of diseases relative to the bladder, urethra and pelvis of the Kidney.” “Shed light,” it was, too, for he described it as, “the illumination is derived from an electric lamp with a head reflector.”
It is interesting to note in this article that Dr. Liell described the vaginal approach to the calculi in the lower third of the ureter in the female: “In the case of a calculus situation in the lower third of the ureter in females, its position being located either through a cystoscope, vaginal or rectal examination, it can frequently be removed by incisions through the vaginal vault, as witnessed by a case reported by Dr. Munde of New York City.” (Note: Later this operation was extensively described and used by a Miamian, and our friend, E. Clay Shaw, M.D.)
Before the migration of anesthesia from Atlanta and Boston in the early days, the treatment of venereal disease occupied much more time of the physician-urologist than did the use of the knife, except for the major surgical conditions such as stone, renal flank abscesses and surgical affections of the external genitalia. Therefore, we find many of the writings of the latter part of the 19th century dealing with the social diseases and their complications.
Physicians, urologists and surgeons of the VD Century, between 1850 and 1950, were much concerned with the social diseases. The voluminous literature of the period accented this concern with all aspects of the cause, spread, diagnosis, and treatment of syphilis and Neisseria infections. Continuing this concern with VD, is an illuminating discourse by C. E. Terry, M.D. on “The Social Evils.”(2) Dr. Terry stated, “Social evil is born in secret and fostered by the cloak of ignorance and willful disregard and here, as elsewhere, the light of sane knowledge and unrestricted truth is needed. The American Society of Sanitary and Moral Prophylaxis has undertaken this task.”
Typical of this concern is an editorial which appeared in the Florida Medical and Surgical Journal of January 1886 entitled, “The Relationship of the Surgeon to the Patient in the Treatment of Urethritis.” I would like to quote the editorial, for it points up some of the trials and tribulations of the
practicing physician of that day: “There is no subject so vexing to the practitioner as the treatment of urethral inflammations. There is nothing that anyone knows so much about as gonorrhea. Scarcely a day passes without the appearance in the surgeon’s office of some wiseacre who declares he would as soon have a case of ‘clap as a bad cold’ and that he has a prescription that ‘will knock it cold with one injection.’ What a pity it is, that the profession has been deprived of these recipes. How hard hearted must be the persons who would withhold such a boon for humanity as ‘a sure cure for the clap.’ We have heard of these all of our lives and yet the urethra still weeps over its transgressions and does penance in the same old way.“
Continuing with some of the earlier dissertations on urology, another paper by Dr. Liell was entitled “Anchoring the Kidney for Dislocations or Displacement.”(3) Dr. Liell described in some detail the placement of the patient on the table in the lateral prone position over a sandbag. He described the oblique incision which is not more than 3 inches in length, extending from the last rib downward and forward to the crest of the ilium. The fibrous capsule of the kidney is gently incised along the convex border about 2 inches in length and reflected backward for a half inch on each side. Two chromicized catgut (sutures) are then passed through the aponeurotic tissues of the wound and attached the kidney in place.
One of the earlier urology specialists in the middle part of Florida was J. C. Vinson, M.D. of Tampa. Dr. Vinson contributed to the literature of urology, writing on “Cystitis, a Symptom; Report of Cases,” which was read before the 41st annual meeting of the Florida Medical Association in Orlando, Florida, in 1914. Dr. Vinson started his discourse by stating “Cystitis has been for a very long time the most popular diagnosis of urinary disorders. No doubt, the cause of this peculiar fact has been our inability through lack of instruments of precision to understand the different disease conditions of the urinary tract. Another important factor has been the persistence in which all textbooks have described cystitis as being a disease per se.” He also stated, “The cystoscope, ureteral catheter and x-ray have made it possible to reach a scientific conclusion and it has been possible by these means to prove the absurdity of making a diagnosis of cystitis and treating as such, those cases that present the classical symptoms of vesical irritability.” Dr. Vinson then presented four cases in which by cystoscopic examination he was able to discover 1) a vesicovaginal fistula, 2) a stone the size of a walnut, 3) a villous papilloma, 4) a trabeculated bladder with a diverticula and a diagnosis of tabes, and 5) a case of renal tuberculosis of the right kidney.
In 1916 J. H. Fellers, M.D. of Pensacola presented a paper entitled “Kidney Disorders of Childhood” which also appeared in the Florida Medical Association Journal.(4) Harry Peyton, M.D. also presented a paper read before the Duval County Medical Society in September 1915 entitled “Pyelitis its Symptomatology, Diagnosis and Treatment.” Under the treatment recommended it is interesting to note: “The treatment of acute cases is so well standardized that it is hardly necessary for more than mention that rest in bed, correction of dietetic errors, establishment especially in children of forced water, adequate doses of Exmethyleneamin or in certain cases Potassium Citrate is usually all that is required. Aynesworth reports several cases of acute pyelitis treated by pelvic lavage with Argyrol and in one case by simple catheterization of the ureter with excellent results.” Dr. Peyton continued, “Surgical procedures become absolutely necessary to correct conditions rendering the kidney liable to infection, thus stones either in the kidney or ureter should be removed, ureteral strictures dilated, kinks due to moveable kidney corrected by suspension of the kidney, pressure from the uterine fibroids corrected, etc.”
Dr. J. Clifford Vinson published an article on “Hematuria” in the Journal of the Florida Medical Association, October, 1920.(5) At this time Dr. Vinson had become Head of the Section of Urology and Dermatology, Division of Surgery, Bayside Hospital, Tampa, Florida. Ninety-eight cases were collected from his clinic. It is interesting to note that of the renal causes of hematuria, he listed calculus as the cause of 10 cases and hypemephroma that of 3 cases out of 37. In the ureter, calculus accounted for 13 cases, and in the bladder, there were 10 cases of papilloma of the bladder, 8 of calculus, 6 of malignant tumor and 2 foreign bodies for a total of 26.
The boom time period of Florida began about 1920, a period which saw the influx of a tremendous number of persons from the north. The population of the state more than doubled within a five-year period and, by the end of the boom, had reached a population of approximately two and a half million. From this time specialists in the treatment of genitourinary disease increased rapidly in number. However, an organized Section on Urology of the Florida Medical Association had to wait until after World War II before coming into being. In the meantime, the Southeastern Section of the American Urological Association was created in 1932. At the initial meeting of that organization were Louis M. Orr, M.D. of Orlando, who later became President of the American Medical Association, and James L. Estes, M.D. of Tampa, who began practice there in 1925. There were three urologists attending from Miami: Roy Holmes, M.D., who had been in practice since approximately 1924; Milton M. Coplan, M.D., who had joined Dr. Holmes in 1925; and E. Clay Shaw, M.D., who had come from Baltimore.
In October 1931 the roster of the American Urological Association showed that there were forty-four members of the American Urological Association residing in the southeastern states, thirteen of whom, resided in Florida. A petition was drafted for permission to establish the Southeastern Branch Society. On that application the following signatures appear: George H. Day, John E. Hall, Roy J. Holmes, and E. Clay Shaw of Miami; Louis M. Orr of Orlando; Charles E. Barnett of St. Petersburg; James L. Estes, E. S. Gilmer, and Arthur R. Knauf of Tampa; R. W. Blackmar, and B. F. Woolsey of Jacksonville.
A roster of the Southeastern Branch in 1936 showed a membership in Florida of eighteen regular members and six associate members. Notable among those added were Dr. Maximilian Stern of Daytona Beach, recently from New York; Dr. Robert B. Mciver of Jacksonville; Dr. W. L. Fitzgerald of Miami; and Dr. Gideon Timberlake of St. Petersburg.
- Transactions of the Florida Medical Association, 1899, pp. 113-117.
- Transactions of the Florida Medical Association, 1907, pp. 158-165.
- Transactions of the Florida Medical Association, 1910, pp. 184-186.
- Florida Medical Association Journal, Vol. II, No. 10, pp. 6-7.
- Florida Medical Association Journal, Oct. 1920, Vol. VII, pp. 55-56.