Lecture Vol. 16 tab C (pst SG yrs.) May 13, 1990 cover

Meredith Campbell Memorial Lecture
       BY
  C. Everett Koop, MD, ScD

American Urologic Association
New Orleans, Louisiana

Mav 13. 1990

(From the vantage point of writing this introduction in 2003, the title of this lecture
should have been "The History of Pediatric Surgery' or it might have been "The Surgical
Training of C. Everett Koop".)

I began the lecture with a tribute to Meredith Campbell, who was, in my mind, a giant
among those that pioneered even before pediatric surgery had a name. I put him right up
there with the great names in urology, but also names such as Ladd and Gross in pediatric
surgery, called "child surgery" in its early days.

This is not only a relatively complete history of the early days of pediatric surgery and
the men who made it, but also is a description of the technical problems of doing surgery
in the days before plastics and how we overcame problems as simple as the absence of
flexible tubing as were a more serious problems, such as the lack of understanding of
pediatric anesthesia. It is also a good bit about my own surgical training, which includes
the days before sulfonamides and antibiotics and tells of my summers as a medical
student in a 400 bed orthopedic hospital for children where there were essentially four
diagnoses: poliomyelitis and its aftermath, osteomyelitis, tuberculosis of the bone, and
congenital anomalies amenable to orthopedic surgical correction - at least in part.

The student of surgical history would be interested not only in how the University of
Pennsylvania came to espouse pediatric surgery and to develop me to be the one who             *

carried its banner in Philadelphia. This also necessitated my going into the hostility of
the surgical world - and at this particular meeting, sad to say, the adult urological world -
(more than ten years later, I gave another named lecture to the same society in the same
city, the John Duckett Jr. Memorial Lecture, and once again, felt it necessary to chide the
American Urologic Association for their long hostility to the development of pediatric
urology as a specialty, the only adult surgical specialty not to recognize the need for
special training for surgeons in the very exacting art of urologic pediatric surgery).

The user of this archive should be surprised that as late as 1946 when I started at the
Children's Hospital of Philadelphia that the pediatric world knew so little about cancer.
This is all documented here including my own investigation into neuroblastoma based
upon, in the beginning, my review of all the charts in the hospitals of patients who had
been diagnosed with cancer. Hardly any were alive, except those with neuroblastoma,

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which set me off on a life-long interest in this peculiar tumor that has the ability to turn
from malignant to benign.

There are also detailed descriptions of he way we managed pediatric cancer in the days
before chemotherapy, and how much more skill it took to achieve a survival rate
inwilm's tumor of 48 per cent in those early days as compared to the relative ease of a
survival of 97 per cent fifteen years later.

There are also little hints of surgical techniques in the art of practicing pediatric surgery
that I learned at the Boston Children's Hospital, not as part of my formal training there,
but in sitting with William E. Ladd on the side of a crib with his long legs dangling to the
floor after lunch, each day, when he regaled me with anecdotes that served me well, as I
developed my own life in pediatric surgery.