Operative Innovation and Surgical Conservatism in Twentieth-Century Ulcer Surgery.

Abstract

Peptic ulcers were a common, and seemingly intractable, problem for surgeons in the US through the early twentieth century. Initial surgical efforts reduced operative mortality and achieved short term successes but failed to establish a definitive solution. The flawed successes of early ulcer surgery drove sustained effort to improve, producing a stream of novel operations over the decades. An examination of the history of ulcer surgery confirms the recent observation that surgical operations of this period were malleable entities subject to constant tinkering and repurposing. Yet, this dynamism in surgical practice remained in tension with conservative pressures, as surgeons hung on to familiar practices and sought to codify agreement on which operation served best for which purpose. Ulcer surgery became a workshop for attempts to resolve this tension. In this context, a canon of recognized operations emerged that accommodated novelties while preserving in surgical discourse an awareness of older operations. Established operations that fell from use literally remained on the books for decades. This compromise between innovation and operative conservatism favored the creative reuse of older ulcer operations, some repurposed, and some combined with other operations in new modular configurations. Ulcer surgery demonstrated recurring patterns of operative repurposing, reconfiguration, and modular recombination. This feature of twentieth-century ulcer surgery also highlights the attachment in modern surgical culture to the historicity of their endeavor, manifested for example in the wide use of eponyms and a fondness for deep genealogies of mentoring and training.