Urology’s 20th Century Battle: Securing Its Place in the Clinic and the Curriculum

Abstract

Introduction

Urology became an established specialty around the turn of the 20th century. These new genito-urinary specialists left behind their original roles as the “clap-specialist” and began to take greater ownership over urological surgery. However, in doing so, many early urologists were ostracized by general surgeons who endeavored to keep them out of the hospitals and sought the reabsorption of this breakaway field back into general surgery. We examine these conflicts with general surgery and the impact this had on the field during its infancy.

Sources and Methods

We reviewed primary sources from the late 19th century to the middle of the 20th century regarding educational practices in urology, the current status, and progress made towards gaining full acceptance as a specialty.

Results

Urology around the turn of the 20th century had a decidedly diagnostic focus. Many of the first urologists viewed the field as a diagnostic specialty before later taking ownership of genito-urinary surgery. However, in attempting to claim urological surgery for themselves, these urologists came into conflict with general surgeons who resented the continued fragmentation of their field. These conflicts were a source of bitterness as criticism between general surgeons and urologists included personal to professional accounts. Some of these conflicts would occasionally enter the academic literature and leaders of professional societies would take official stances on the disagreements. Due to this, the development of the surgical aspects of urology was delayed in the first two decades of the 20th century with this being rectified in part due to its practitioners' unceasing advocacy for their field and its legitimacy.

Conclusions

Urologists at the time of its formal establishment as a specialty had great pride in their diagnostic capabilities. However, urologists faced resistance in expanding their surgical services. Through continual advocacy, urologists were eventually able to solidify their role as complete surgical and medical genito-urinary specialists

Key Words

History, urology, general surgery, conflict, scope of practice