The Pioneer Prostatectomist
The end to Goodfellow’s time in Tombstone arrived in this most dramatic of fashions. When Dr. John C. Handy, then Surgeon of the Southern Pacific Railroad in Tucson, was shot by his wife’s lawyer, Francis J. Heney, he requested Goodfellow, who drove the train himself with the throttle wide open to the scene of the tragedy in an unsuccessful attempt to save his colleague. Goodfellow was named his colleague’s successor. He moved to Tucson in 1891, followed by a short interlude in Los Angeles in 1896, before he joined General William Shafter in 1898 as surgeon on his staff at the start of the Spanish-American War. It was said that his knowledge of Spanish, perfected in the Arizona Territory, was instrumental in brokering peace deals for which he was awarded a Distinguished Service Order for especially meritorious service, professional and military, during the campaign in Cuba.
Upon recovering from dysentery contracted in Cuba, Goodfellow relocated to San Francisco, where he remained for 8 years in a lucrative private practice focused on urology.
While he left the bravado of gunfights behind him, George Goodfellow brought the same pioneering spirit to defining himself and a surgical field that was in its infancy – urology - and centered his work on prostatic disease, which was in the lime-light of the surgical theater. Goodfellow’s most significant contribution to urology—the perineal prostatectomy—was reported to be performed by him upon his arrival in Tucson on October 13, 1891 (likely at St. Mary’s Hospital) almost 13 years prior to his formal publications claiming credit for performing a pure perineal prostatectomy, the first so far as known to me, deliberately devised and carried out.
The delay in presenting his methods contributed to the controversy surrounding Goodfellow’s claim. Though he submitted his surgical outcomes in 1896, Goodfellow was not available to present his data, and the paper was not published. The year after Goodfellow presented his results at the fifty-fifth session of the American Medical Association, Section on Surgery and Anatomy in 1904, Dr. W. N. Wishard claimed he had predated Goodfellow’s perineal prostatectomy by several months. Wishard used a similar technique that he had learned from Gouley, although Gouley himself detailed a procedure that he admitted he had never done. Goodfellow himself, while asserting that he was the first to deliberately plan and execute (perineal prostatectomy), recognized the work of others more or less independently along the same lines.
In some ways settling the debate, Dr. Hugh Hampton Young credited Goodfellow with being among the first to make prostatectomy a “successful surgery”, as Goodfellow had influenced how Dr. Young would practice urology. Unbeknownst to many, Goodfellow participated in a visiting professorship in Baltimore following his return from the Spanish-American War, and demonstrated his surgical technique for perineal prostatectomy with Dr. H.H. Young, Professor of Urology at Johns Hopkins. Young confided in Goodfellow's nephew, Dr. George Fish, also a prominent NY urologist, that had he not modified Goodfellow's operation by no longer ligating the seminal ducts, "no one would have ever heard of [Goodfellow] as a prostatectomist." In addition to visiting Young, Goodfellow displayed his operation at medical centers across the country and, in doing so, attracted many patients to his San Francisco practice.
Goodfellow’s commitment to prostate surgery stemmed from a true empathy for those managed by prolonged catheterization, which he saw as a means of “inducing euthanasia.” He saw the reliance on the catheter as imperfect, for the catheter was:
…the implement in the surgical armamentarium most relied on to alleviate the almost unendurable pangs experienced day and night by those unfortunate afflicted with the results of prostatic hypertrophy… the catheter ultimately added to their torments, although temporarily of benefit.
In the prostate, Goodfellow saw a challenge as he struggled to reconcile how such an innocuous gland could inflict so much damage since the prostate has no physiologic function commensurate with its importance as a pathologic factor.
His contemporaries were pursuing the suprapubic approach, and Goodfellow himself was similarly using this approach with “good results”; however, by his own assessment, the outcome—as presume[d] was the experience of most of those who adopted that method—was not satisfactory, and drove him to consider the perineal approach, which he saw emerge out of the chaos of operative methods recommended… as essentially curative in almost every case at least [with] no mortality as a result of the operation, based on his case series of 78 patients.
Dr. Goodfellow detailed his surgical technique for the perineal approach as such:
With the patient in the lithotomy position, the legs held by an assistant, the bladder being empty or full as the case may be, the lithotomy staff is introduced, the legs elevated somewhat, a median incision from the base of the scrotum to the margin of the anus is made (through the bulbar) and carried to the membranous urethra which is entered with a straight lithotomy knife and the opening extended into the bladder, the staff removed, and the moderate flexion of the legs on the abdomen and thorax increased to as great an extent as possible.
Then with the hand on the hypogastrium, the bladder is depressed and the enucleation beginning at the beak of the prostate below and working upward next to the bladder or from above on either side downward is carried on. The time consumed for complete enucleation of the gland rarely being over five or ten minutes, the resulting hemorrhage being virtually nothing. The gland may be removed entire or lobe by lobe. If the bladder has been full of pus sometimes it is washed out.
Additionally, Goodfellow adapted his practice by no longer ligating the seminal ducts to the benefit of his patients’ “sexual vigor”, although Goodfellow also recognized the limitations of self-reported sexual performance as pride of occupation will cause men to make misleading statements concerning power in that direction. Out of a case series of 78, Dr. Goodfellow noted only two strictures and two deaths.
A Man to Match Our Mountains
The well-rounded history of pioneers of the Southwest, Men to Match My Mountains, detailed the exploits of men such as George Emery Goodfellow who embodied the pioneering spirit that characterized the Southwest Territory in the late 18 th century. Goodfellow paired his restless adventurous spirit with a keen scientific eye, directing his curious energy towards uncovering the mysteries of the abdomen after a gunshot and the obstructive prostate gland. Regardless of who is credited for performing the first perineal prostatectomy, Goodfellow’s contribution to the urologic surgical lexicon is well established, and he was almost prescient in his appreciation of treatments for prostatic enlargement, noting that in the entire field of medicine, none other has had so many and such diverse modes of treatment recommended.
His steadfast dedication to the practice of medicine did not prevent Goodfellow from being as lively as his Tombstone neighbors. He was said to have a rule about the drinking surgeon, that in order to operate he must be able, with the tips of thumbs and forefingers covered with tape, to bring the heads of two needles together at arm’s length and hold them there before operating.
Dr. George Emery Goodfellow’s untimely end - succumbing to the effects of a multiple neuritis contracted while working as Chief Surgeon for the Southern Pacific Railroad in Mexico - occurred in Los Angeles in 1910 and did little to diminish the impact of his life. The vigor with which Dr. Goodfellow approached life defined his approach to surgery. It should serve as a reminder to us all to allow our passions to drive forward our craft, and is best encompassed by his poetic words on the focus of many urologists, the prostate:
We soon become tired of everything in life, riches fatigue the possessor, ambition when satisfied leaves only remorse behind; the joys of love are but transient joys; so with the prostate gland; soon, too soon, it tires us; all too quickly does it become superfluous wealth; the ambition to remain as we were vanishes and if we insist too long, remorse follows; the joys of love only increase the troubles; and desire to remodel that part of the anatomy about the neck of the bladder becomes the dominating and insistent object of our existence.
Unwanaobong Nseyo, MD, MHS
Western Section, AUA
Fellow, Female Pelvic Medicine & Reconstructive Surgery
USC Institute of Urology
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