An excerpt from Dr. Koop: The Many Lives of the Surgeon General.

“I was the salesman for pediatric surgery. I have the knack of talking to an audience and convincing [them] about what I’m saying is true.”
– CEK

The early 1950s witnessed an extraordinary burst of professional activity on the part of the young surgeon, still in his 30s, as the American Academy of Pediatrics (AAP) gave him his head on a series of issues.

Though Koop’s career had been directed away from the tumor clinic he had once wished to lead, his interests had not. In 1951 we find him one of eight members of the AAP Tumor Registry Committee, the goal of which was “to further the study of cancer in childhood.” He was tasked with looking into the problem of “Shoe Fitting Fluoroscopes” (X-ray machines in children’s shoe shops, common at the time). Koop played a major role in securing state-level regulation and subsequent prohibition of this dangerous practice.

Soon after, in 1955, he played a leading role as the “surgical member” of the AAP’s Committee on Accident Prevention, for which he drafted a protocol for “The Emergency Care of Childhood Skeletal Trauma.” This was no small project – the draft required review by the American College of Surgeons, the American Red Cross, and Civilian Defense.

He was tasked by the same committee to report on “handling children hurt in an accident and being transferred to the hospital.” As the record of the meeting points out, it was (and indeed is) common for an injured child to be picked up and carried, in a manner no one would think of handling an injured adult.

What’s more, Koop has been working on the treatment of burns. At that same meeting, the committee report that Koop “has actually done much of the work that led to this statement on the treatment of burns and the treatment of skeletal trauma.” As a result, he “has been invited by the American College of Surgeons to present a paper. This is perhaps the first time that surgeons were addressed by a pediatric surgeon on how to handle childhood injuries.” The writer of the minute notes, “Dr. Koop was quite excited over that opportunity.”

Seven years later, it was Koop who took the initiative to petition the American Board of Surgery (ABS) for board recognition of pediatric surgery as a specialty. That first approach came surprisingly close to success, but ran into opposition from the Society of University Surgeons and the American Board of Neurology. “Because of their opposition, the American Board of Surgery withdrew their proposal to the Advisory Board of Medical Specialties in 1957.” This rather dramatic turn of events muddied the water for some time, though Koop fruitlessly tried again three years later.

In 1946 it was still very rare for a surgeon to specialize entirely in children. There were many “children’s hospitals,” but – bizarre as this now seems – aside from Boston none of them had a full-time surgeon. At that date, it appears that only three surgeons in the entire U.S. are known to have chosen to limit their practice to pediatric cases, so Koop was likely the fourth.

The first was Herbert Coe (1881–1968), who deserves the title of first American pediatric surgeon. Coe had chosen back in 1919 to refuse all adult general surgical patients, and at the same time he began to lobby for professional recognition of pediatric surgery, and to encourage friends and associates to join him in the specialty. He had limited success on either front.

He did secure one convert – Oswald Wyatt (1896–1957), who “went ‘all in’ for a practice devoted to pediatric surgery in 1928.” His timing was less than ideal. In 1927 he closed his office and spent time studying clinical pediatrics and children’s surgery. H. William Clatworthy later wrote that after the Crash of 1929 Wyatt “nearly starved to death!” But his practice later “became a success as pediatricians … preferred his specialized training and his full-time focus on children’s surgery over the general surgeons at the university hospital.”

Coe had made repeated requests of the leadership of the American College of Surgeons (ACS) for pediatric surgery to have a specialist place alongside ophthalmology and urology and other specialties, but to no avail. He “busily lobbied his friends and contacts in the hierarchy” to such a degree that he earned the nickname “the politician”! Yet “the College met Dr. Coe’s entreaties with an unyielding brick wall.”

Coe secured his first bite of institutional success in 1947, by coincidence the year in which Koop was appointed to the Children’s Hospital. The AAP program committee gave him two hours at its general assembly to make his case. As a result, he was appointed to chair “a committee to form a special category of membership in the AAP for surgeons.” Coe insisted on tight criteria for inclusion, including a commitment of at least ninety percent of one’s time to surgery on infants and children. “Getting Gross on board would add stature to the fledgling organization, so he offered the Bostonian a place on the new group’s steering committee.” Gross took some persuading, initially “lukewarm” about the whole idea. Coe “appealed to Gross’s notorious professional vanity” by referring to “the pre-eminence of your group” – and offering both to waive the joining fee, and halve Gross’s annual dues.

That was the context for the organizational meeting of the new “section on surgery” at the AAP conference in Atlantic City, on November 21, 1948, with twelve surgeons in attendance. Despite Coe’s efforts, the “notoriously moody Gross” decided to skip the meeting, “but Ladd was there and was the likely cause of Gross’s absence.”

Also present was a young Koop, fresh from his appointment as surgeon-in-chief. And it was Koop who, seven years later, would take the next step and first formally approach the American College of Surgeons in a bid for board recognition. He was to persist in these efforts for nearly twenty years.

Nigel Cameron is a historian and ethicist whose work has spanned the disciplines of bioethics, history, and religion over a distinguished transatlantic academic career. He currently serves as a senior fellow at the University of Ottawa and was previously a research professor of bioethics at the Illinois Institute of Technology in Chicago, where he led pioneering projects on the social and ethical impact of emerging technologies and on diabetes policy. A former Fulbright visiting research chair at the University of Ottawa’s Institute for Science, Society and Policy, he continues to explore the intersection of medicine, ethics, and public policy.

Dr. Cameron was the founding editor of the journal Ethics and Medicine and has served as a hospital consulting ethicist. He has held board roles with UK think tanks 2020health.org and BioCentre, and has testified before committees of the U.S. Congress and the European Union. He has also represented the United States in diplomatic delegations to United Nations health-related agencies and was nominated by the U.S. government to serve as UN Special Rapporteur for the Right to Health.

His books include Dr. Koop: The Many Lives of the Surgeon General, Will Robots Take Your Job? A Plea for Consensus, and The New Medicine: Life and Death After Hippocrates. His current project, Ruth: The Psychiatrist Who Saved Sylvia Plath, Until She Couldn’t, continues his exploration of complex figures in medicine.

For more about his work, visit drkoop.bio, or connect with him on Facebook and LinkedIn.