Splenic anemia (1900-1930s)

“The encounter between turn-of-the-century surgeons and the spleen provides us, then, with a glimpse of how these specialists used techniques and technology to construct a new identity for an unknown organ and a new disease and to fashion a new identity for themselves” (48). . . . The construction of splenic anemia depended in part on the use of hematological tools by surgeons, and its movement through time depended upon evolving debates about the proper use and interpretation of such tools” (51). . . . By embracing hematological observation and statistical analysis, surgeons self-consciously fashioned themselves as surgeon-scientists. They used these tools to show that they could regulate themselves, legitimate their practice, and put splenectomy on a more rational basis. Careful blood analysis separated the overzealous craftsman from the scientific surgeon, according to Warbasse” (55). . . . For this generation of practitioners, technologies of blood counting using hemacytometers [they took blood counts before and after splenectomy to show that the operation produced a surge in the body’s red blood cell production] and techniques of abdominal surgery legitimized this leading sector of scientific medicine” (57). From 1908-1928, Mayo Clinic surgeons performed some 500 splenectomies for expanding range of diseases: “Proof of the existence of splenic anemia depended upon the availability of patients for splenic surgery, surgical autonomy in diagnosis and therapy, and a favorable increase in the blood count and the patient’s health after the splenectomy. . . . [William] Mayo knew that splenic anemia could exist only if surgeon remained free to engage in splenectomy and blood analysis” (61). . . . one eventual by-product of the disciplining of the surgeon [by 1915] was the decline of splenic anemia as a legitimate disease. As surgeons were brought into a more corporate and bureaucratic practice, they released their grasp on the spleen, handed over the practice of to laboratory-based pathologists and a growing number of hematological specialists, and thereby abandoned one of the disease concepts that had helped to endorse their modern identity (68) . . . In truth, splenic anemia was an indefensible outpost – defended only by surgical autonomy and by the rhetoric of postoperative hematological and statistical evaluation” (69) . . . By embracing hematological observation and statistical analysis, surgeons self-consciously fashion themselves as surgeon-scientists. They used these tools to show that they could regulate themselves, legitimate their practice, and put splenectomy on a more rational basis” (84).