Leeds General Infirmary & Urology in Leeds
Leeds began as a small village at a ford crossing the river Aire. Indeed, its name is probably derived from that lively waterway, meaning "People of the boiling river". Escaping the Conqueror’s 1069 "Harrying of the North", it became a small town by charter of King John in 1207, but the industrial revolution, in particular the manufacture of cloth, led to a population explosion. Leeds is now the largest city in Yorkshire. Leeds’s oldest hospital, the General Infirmary, began in a house for the relief of the sick in 1767. The first hospital was built in 1771 (below). Several surgical families held sway in the Leeds hospitals in the 18th and 19th centuries, including the Heys, the Teales and the Wheelhouses.
William Hey (1736 - 1819), one of the first surgeons of the Infirmary, was born in Pudsey, the grandson and great grandson of a surgeon and a physician on his mother’s side. Despite losing the sight in one eye (clearly seen in the portratit, right) aged four, due to a penknife accident, he was a good surgeon. His name is still remembered in the eponyms for his cranial saw, infantile hernia and foot amputation. His son and grandson, both Williams, continued the Hey’s Leeds surgical dynasty.
In the three editions of his book, "Practical Observations in Surgery", William Hey wrote on retention of urine (describing his methods of passing catheters) cancer of the penis, noting its relationship to congenital phimosis, and lithotomy in women avoiding incontinence.
Thomas Pridgin Teale (1801 - 1867) was born in Leeds in 1801, the son of Thomas Teale, also a Leeds doctor. He was educated at the United Borough Hospitals gaining MRCS in 1823. He was elected surgeon to the Leeds Public Dispensary in 1824 then, in 1833, surgeon to the Leeds General Infirmary and honorary surgeon in 1864. Despite also losing an eye as a child (this time from a chemistry experiment which went explosively wrong) he was said to excel in lithotomy and lithotrity. Teale invented a useful gorget for perineal lithotomy. He died on 31 December 1867. His son also named Thomas Pridgin Teale (1831 – 1924) continued his surgical legacy at the Infirmary.
The fabulously named Claudius Galen Wheelhouse (1826 – 1909) was born at Snaith, in Yorkshire, on 29 December 1826. In 1851, he was elected surgeon to the Public Dispensary and demonstrator of anatomy in the medical school, where he was successively lecturer on anatomy, physiology, and surgery. He died in Filey, on the Yorkshire coast, on 9 April 1909. Wheelhouse devised an operation to open difficult urethral strictures using a specially designed probe and Teale’s gorget (right), to cut through the strictures to access the bladder.
Arthur Fergusson McGill (1846 - 1890), pictured right, was appointed Resident Medical Officer to the Leeds Infirmary in 1869 and, in 1874, surgeon to the Leeds Public Dispensary as well as demonstrator in anatomy in the Leeds School of Medicine. In 1882 he was elected assistant surgeon at the Infirmary and in 1884 full surgeon. He became professor of surgery in 1887.
McGill is best known for who establishing prostatectomy by the suprapubic operation. He was the first surgeon to carry this out in Great Britain, on 24 March 1887 on 53-year old blacksmith Edward Ward. Whilst operating for bladder stones, he saw a tumour at the bladder neck and twisted it off. His assistant, Berkley Moynihan later, Lord Moynihan of Leeds (1865 - 1936) examined this histologically and realised it was prostate and not a bladder tumour.
McGill was quick to recognise the potential of this approach and carried out his first case of purposeful prostatectomy before the first one was discharged. Then he, and his colleagues in Leeds, performed quite a few in quick succession. According to Moynihan, Mr Edward Atkinson (1830 - 1905) was the first to enucleate a prostate completely on 15 December 1887 - a similar procedure procedure was then performed by McGill on 17 December; so, the Leeds surgeons were certainly doing complete enucleations in the late 1880’s.
In 1886, McGill began to suffer from diabetes complicated by carbuncles, and he died on 21 November 1890.
Leslie Pyrah (1899 - 1995) was appointed honorary assistant surgeon to the Infirmary in 1934. A general surgeon, he always had an interest in urology. His Braasch direct cystoscope is pictured below, this is an early model with no lens system. He pioneered urology as a speciality and in 1950 gave up general surgery for pure urology - this was almost unheard of.
He was one of the early British pioneers of the cold punch. In 1956, Pyrah took up the first ever Chair in Urological Surgery in the UK, at Leeds University. He set up the Medical Research Council Unit for the Study of Mineral Metabolism at the Leeds General Infirmary, as well as the first renal haemodialysis unit in the UK, which was run by Frank Maudsley Parsons (1918-1989). Pyrah was also the founder of the Leeds Blood Transfusion Service, establishing a list of volunteer donors in the city in 1931; one of the earliest regional services.
Braasch direct cystoscope
Another Leeds surgeon working with Pyrah was Frederick Peter Raper (1913 – 1966). Raper was born in Grassington Yorkshire, in 1913. Like Pyrah, he also gave up general surgery to become a pure urologist when the Leeds department opened in October 1950. That same year, with a travelling fellowship from United Leeds Hospitals, he spent a year training in Ann Arbor, Michigan with Reed Nesbit (1898 – 1979). Raper subsequently modified the classic Nesbit resectoscope (pictured right) and, according to Pyrah, was an excellent resectionist.
Philip Beckford Clark (1928 – 2024) succeeded Leslie Pyrah in 1964. He had an outstanding reputation for training urologists from the UK and overseas and wrote “Operations in Urology” (1985) with his trainees in which each operative step was illustrated. His RSM Presidential address on the 27 October 1983 was on radical cystectomy, where he showed that 25% of patients with lymph node involvement could achieve 5-year survival. He was also principal investigator for the first MRC trial into the role of radiotherapy and orchidectomy in the management of advanced prostate cancer.
Leeds has also played a significant part in the history of British urology, not least in providing Presidents of BAUS; Leslie Pyrah (1961-1963), Bob Williams (1990 – 1992) and Adrian Joyce (2010 – 2014) and a President of the RSM Section of Urology; Philip Clark (1983- 1984).
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