By Sally Wilde*
The inspiration for the founding of the Urological Society of Australasia was the work of Sydney urologist Harry Harris (1887-1936). In 1914, Harris was appointed as the first full time specialist urologist in Australasia at the Lewisham, a Catholic hospital in a southern Sydney suburb. He became the first Australasian urologist to achieve an international reputation, publishing 37 papers, many of them in major international journals, before his untimely death in December 1936.
From at least 1916, Harris’ primary interest was prostatic surgery and in 1927 he published his revised version of the Fryer technique for suprapubic prostatectomy. Harris’ mortality rate for his own operation was 2.8%, the lowest internationally published rate at the time, and for many years afterwards, for any method of open prostatectomy. In 1935, he embarked on a tour to Europe, demonstrating his technique in London, Edinburgh and Vienna.
Shortly after Harris departed for London, Keith Kirkland, a urologist based at the Sydney Hospital, wrote to nine Sydney urologists, inviting them to form a Sydney Urological Association. Eight of those invited were practicing exclusively as urologists and had honorary appointments as urologists at one or more of Sydney’s public hospitals. The ninth, G.H. Pfeiffer, had undertaken specialist training in urology at St Peter’s Hospital for Stone in London, but continued to perform some general surgery. Soon after this initial approach, it was decided to restrict membership to full-time urologists, a principle to which Keith Kirkland in particular remained firmly committed. Accordingly, the founding members of the Sydney Urological Association were Harry Harris, Keith Kirkland, Reginald Bridge, Malcolm Earlam, Colin Edwards, Richard Harris (brother of Harry), John Laidley, Bobby Silverton and Angus Walker-Smith.
Including New Zealand urologists
By the end of 1935, the Sydney Urological Association was beginning to discuss expanding the geographical scope of the organization and urologists from Brisbane and New Zealand attended a meeting in March the following year. At the time, most antipodean medical organizations, including the Royal Australasian College of Surgeons (RACS), included New Zealand as a matter of course. Accordingly, it was proposed to found a Urological Society of Australasia. (The name was changed to the Urological Society of Australia and New Zealand in 2006).
Despite a long running struggle to persuade general surgeons against performing urological procedures, it was initially assumed that the Urological Society would hold its annual meetings at the same time and in the same city as the annual congresses of the general-surgeon-dominated RACS. However, this did not always happen, even in the Society’s formative years, and the inaugural meeting of the Urological Society was held in Sydney on 7 January 1937, rather than in Auckland in conjunction with the RACS meeting of January that year. One New Zealander, Edgar Reay, attended.
Keith Kirkland in Sydney, Henry Mortensen in Melbourne and Jack Power in Brisbane played an important role in the late 1940s and early 1950s as annual meetings rotated between these three cities. The first annual meeting with a scientific program was held in Sydney in 1944 and the popular social programs were initiated by Henry Mortensen in Melbourne the following year. The Society was incorporated in 1948. The aim of the Society was to ‘further the science of urology’ and despite considerable debate over the years, full membership remained strictly limited to those practicing exclusively as urologists. Those with urological training, but practicing urology in conjunction with general surgery, were only eligible for associate membership. At first, this strict limitation threatened the viability of the Society but in the 1950s, as the number of specialist urologists in Australasia increased dramatically, the Society went from strength to strength.
The first overseas guest to an annual meeting was Eric Riches from London in 1949, but it was another ten years before trade exhibitions began to be held at meetings, and the early guests paid their own way. From 1959, however, increasing membership and trade sponsorship facilitated paying the expenses of guests, most of whom came from Britain and the United States. Until 1958, all the meetings were held in New South Wales, Victoria or Queensland but in 1958, a meeting was held in Christchurch, New Zealand. Attendance was small (only 15), but it was a start and thereafter the Society began to rotate its annual scientific meetings around all the Australian States and Territories, as well as New Zealand. A meeting was held in Canberra for the first time in 1963 and it was attended by the first woman to join the Society, Lorna Sisely, an Associate Member from Melbourne. Her presence forced the Society to end its tradition of holding men-only black tie dinners at the annual meetings (with a separate dinner for their wives). From the 1960s, membership rose rapidly. There were only 42 full members in 1947, just before incorporation. By 1991 this had risen to 251 and by 2010 there were 413 members in Australia and 70 in New Zealand. Of these, about 5% were women, but the proportion of female urologists is set to rise rapidly as in 2010, about 20% of trainees were women.
Training and accrediting urologists
In the early years of the Society, British training had a major impact on Australian and New Zealand urologists. Six of the twelve founding members had spent time as residents at St Peter’s Hospital for Stone in London, and St Peter’s and its associated institutions remained influential for many years. When, in 1968, the Society set up fellowships for those wishing to train as urologists, it seemed natural that they take the form of travelling scholarships to the Institute of Urology in London, which by then encompassed St Pauls’ and St Phillip’s as well as St Peter’s. However, the British influence was far broader than just St Peter’s Hospital for Stone as until the 1970s, the majority of Australian and New Zealand urologists held a fellowship of one of the British colleges of surgeons. Although examiners in the specialty of urology for the Fellowship of the RACS were appointed as early as 1947 in New Zealand (Frank Macky, Edgar Reay and Bruce Rennie) and 1948 in Australia (Henry Mortensen and John Laidley), very little formal training in urology was available in either country until the 1970s. The major exception was the program of training at the Royal Prince Alfred Hospital in Sydney.
In 1926, Robert Gordon Craig, who had set up a urology unit at the Royal Alexandra Hospital for Children in 1918 and the Department of Urology at the Royal Prince Alfred Hospital in 1925, provided the enormous sum of £20,000 to the University of Sydney to establish a fellowship in urology. Gordon Craig was much influenced by American models of training through his regular visits there, and he sponsored a training program that involved research as well as practical urology. Three of the founding members of the Urological Society had been Gordon Craig Fellows and although the money that Gordon Craig provided had run out by the 1950s, the traditions of training that he established remained in place at the Royal Prince Alfred Hospital.
Systematic training in urology elsewhere in Australia and New Zealand did not really get underway until the RACS began to set up Specialist Surgical Training Committees in 1970. Many would date the beginning of an organized program even later. In 1976, the RACS training committees became Surgical Boards and the Board of Urology was set up that year, giving far greater control over the examinations for the Fellowship of the RACS in Urology to urologists. By 1979, there were 23 urological training positions at various hospitals and the Society’s Training, Accreditation and Education Sub-committee was coming to grips with the complex problems of providing a coherent training program through accredited posts across Australia and New Zealand. Since 2008, the Society has administered the Surgical Education and Training Program (SET) in Urology via the RACS. By 2010, there were 57 official training posts in urology in Australia and 9 in New Zealand.
The Public face of Urology in Australia and New Zealand
From its earliest years, the Society has been widely accepted by government and other organisations as the official representative of Australian and New Zealand urologists. As early as 1948, the Society was consulted by the Australian Department of Trade and Customs on the importation of urological instruments and from 1953, the Society was also consulted on the drugs listed under the Pharmaceutical Benefits Scheme. In the 1950s, the Society also became involved in consultations with governments and the British Medical Association and its successor in Australia, the Australian Medical Association, over rebates under the various Commonwealth Government health schemes. The volume of this work increased dramatically in the late 1960s and early 1970s, with debates over fees, rebates and methods of funding and in 1975/6, a separate organization, the Australia and New Zealand Association of Urological Surgeons, was formed to deal with medico-political matters. The Society, meanwhile, was dealing with an increasing workload as the body representing urologists to a wide range of organizations such as the Pharmaceutical Benefits Advisory Committee and the Australian Kidney Foundation, whilst continuing as the main point of contact for the introduction of technological innovations in urology such as Extra-corporeal Shock Wave Lithotripsy in the 1980s.
From the beginning, much of the workload of the Executive of the Society was physically based around Macquarie Street in Sydney, especially at the headquarters of the Royal Australasian College of Physicians at number 145. Secretarial work was initially performed by the secretaries of various members of the executive and then by arrangement with the RACP on a part time basis. In 1987, Gail Hill was appointed as the Society’s own secretary and in 1999, following a period as tenant of the RACS in Albion Street, the Society moved to its own premises in Edgecliff. A full-time CEO was appointed in 2002, reflecting the enormous growth in the size of the Society, the complexities of running the training program and the annual scientific meetings, and the wider role of the Society as the representative of Australian and New Zealand urologists.
S Harry Harris, ‘Suprapubic prostatectomy with closure,’ British Journal of Urology, 1929, 1: 285-295.
Peter Lawson, ‘Origins of the Urological Society of Australasia,’ Australia and New Zealand Journal of Surgery, 1990, 60:385-91.
Leonard J. Murphy, ‘Harry Harris and his contribution to supra-pubic prostatectomy,’ Australia and New Zealand Journal of Surgery, 1984, 54: 579-88.
*Sally Wilde, Joined Across the Water, A History of the Urological Society of Australasia (Melbourne: Hyland House, 1999).
Sally Wilde, ‘See One, Do One, Modify One, Prostate Surgery in the 1930s,’ Medical History, 2004, 48: 351-366.
This history, Joined Across the Water: A History of the Urological Society of Australasia is available from the Society office.
Call +61 29362 8644 or email email@example.com to enquire about receiving a copy.