{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,4,25]],"date-time":"2025-04-25T14:10:02Z","timestamp":1745590202438,"version":"3.40.4"},"reference-count":94,"publisher":"Cambridge University Press (CUP)","issue":"1","license":[{"start":{"date-parts":[[2025,4,7]],"date-time":"2025-04-07T00:00:00Z","timestamp":1743984000000},"content-version":"unspecified","delay-in-days":96,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Med. Hist."],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>This paper provides an account of a specific operation \u2013 the removal of the thymus gland (thymectomy) to treat the rare neurological condition myasthenia gravis \u2013 from its first performance in 1936, by the American surgeon Alfred Blalock, to the publication in 2016 of an international multicentre randomised controlled trial (RCT) of the technique. Thymectomy was the subject of a transatlantic controversy in the 1950s, in which the main players were the English surgeon Geoffrey Keynes, and American neurologists and surgeons from New York, Boston, and the Mayo Clinic. The resolution of this controversy involved the use of increasingly sophisticated statistical techniques, but also crucially other influences including the social transformation of thoracic surgery, and competition between the leading American centres. The consensus achieved after this controversy was challenged in the late 1970s, eventually prompting the implementation of a trial acceptable to twenty-first-century evidence-based medicine. This account will demonstrate that surgical innovation in the period covered required increasing attention to the statistical basis of patient selection and outcome evaluation; that the processes of technical innovation cannot be regarded as separate from developments in the professional culture of surgery, and that one of the consequences of these changes has been the gradual eclipse of the prestigious autonomous surgeon.<\/jats:p>","DOI":"10.1017\/mdh.2024.35","type":"journal-article","created":{"date-parts":[[2025,4,7]],"date-time":"2025-04-07T05:17:20Z","timestamp":1744003040000},"page":"166-182","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":0,"title":["Surgical innovation, statistical analysis, and professional culture: thymectomy for myasthenia gravis, 1936\u20132016"],"prefix":"10.1017","volume":"69","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8256-558X","authenticated-orcid":false,"given":"Mark W.","family":"Weatherall","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"56","published-online":{"date-parts":[[2025,4,7]]},"reference":[{"key":"S0025727324000358_ref24","doi-asserted-by":"publisher","DOI":"10.1017\/S0025727300030465"},{"key":"S0025727324000358_ref52","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1053\/j.semtcvs.2015.10.003","article-title":"Mayo Clinic: an Institutional History of General Thoracic Surgery","volume":"27","author":"Gillaspie","year":"2015","journal-title":"Seminars in Thoracic and Cardiovascular Surgery"},{"key":"S0025727324000358_ref18","first-page":"117","article-title":"Surgical Innovation and the Multiple Meanings of Randomized Controlled Trials: The First RCT on Minimally Invasive Cholecystectomy","volume":"72","author":"Tang","year":"2017","journal-title":"Journal of the History of Medicine and Allied Sciences"},{"key":"S0025727324000358_ref62","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1177\/003693306000501001","article-title":"Myasthenia gravis: a new hypothesis","volume":"5","author":"Simpson","year":"1960","journal-title":"Scottish Medical Journal"},{"key":"S0025727324000358_ref85","doi-asserted-by":"crossref","first-page":"1103","DOI":"10.1212\/WNL.27.12.1103","article-title":"A treatment carol: thymectomy revisited","volume":"27","author":"McQuillen","year":"1977","journal-title":"Neurology"},{"key":"S0025727324000358_ref45","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(54)92441-1"},{"key":"S0025727324000358_ref87","first-page":"52S","article-title":"Thymectomy for myasthenia gravis: Analysis of controversies regarding technique and results","volume":"48","year":"1997","journal-title":"Neurology"},{"key":"S0025727324000358_ref94","doi-asserted-by":"publisher","DOI":"10.1136\/practneurol-2016-001543"},{"key":"S0025727324000358_ref56","doi-asserted-by":"publisher","DOI":"10.1016\/j.mayocp.2014.12.008"},{"volume-title":"The Breast Cancer Wars: Fear, Hope, and the Pursuit of a Cure in Twentieth-Century America","year":"2011","author":"Lerner","key":"S0025727324000358_ref12"},{"key":"S0025727324000358_ref21","doi-asserted-by":"publisher","DOI":"10.2307\/1411377"},{"volume-title":"Medical Theory, Surgical Practice. Studies in the History of Surgery","year":"1992","author":"Lawrence","key":"S0025727324000358_ref49"},{"key":"S0025727324000358_ref63","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(59)90248-7"},{"key":"S0025727324000358_ref77","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-198707000-00013"},{"key":"S0025727324000358_ref89","article-title":"Thymectomy for non-thymomatous myasthenia gravis","volume":"10","author":"Cea","year":"2013","journal-title":"Cochrane Database of Systematic Reviews"},{"key":"S0025727324000358_ref44","doi-asserted-by":"publisher","DOI":"10.7765\/9781526156648"},{"key":"S0025727324000358_ref58","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9343(55)80012-5"},{"key":"S0025727324000358_ref84","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1055\/s-2004-829584","article-title":"A History of Treatments for Myasthenia Gravis","volume":"24","author":"Keesey","year":"2004","journal-title":"Seminars in Neurology"},{"key":"S0025727324000358_ref23","volume-title":"Neurology","volume":"2","author":"Wilson","year":"1940"},{"key":"S0025727324000358_ref3","doi-asserted-by":"publisher","DOI":"10.1093\/jhmas\/jrn055"},{"key":"S0025727324000358_ref68","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1177\/007327539803600402","article-title":"Science, Scientific Management, and the Transformation of Medicine in Britain c.1870\u20131950","volume":"36","author":"Sturdy","year":"1998","journal-title":"History of Science"},{"key":"S0025727324000358_ref29","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-193910000-00005"},{"key":"S0025727324000358_ref30","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1941.02820440037009"},{"key":"S0025727324000358_ref73","doi-asserted-by":"publisher","DOI":"10.1136\/thx.27.5.513"},{"key":"S0025727324000358_ref92","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1602489"},{"key":"S0025727324000358_ref46","first-page":"107","article-title":"The thymus and its relationship to diseases of the nervous system: study of 374 cases of myasthenia gravis and comparison of 87 eighty-seven patients undergoing thymectomy with 225 controls","volume":"32","author":"Eaton","year":"1953","journal-title":"Research publications - Association for Research in Nervous and Mental Disease"},{"key":"S0025727324000358_ref10","doi-asserted-by":"publisher","DOI":"10.1353\/bhm.2020.0070"},{"key":"S0025727324000358_ref15","doi-asserted-by":"publisher","DOI":"10.1086\/384853"},{"volume-title":"Surgery of the Thymus. Pathology, Associated Disorders, and Surgical Technique","year":"1990","author":"Givel","key":"S0025727324000358_ref19"},{"key":"S0025727324000358_ref59","first-page":"1501","article-title":"Les indications de la thymectomie au cours de la myasth\u00e9nie","volume":"60","author":"Schwab","year":"1952","journal-title":"La Presse M\u00e9dicale"},{"key":"S0025727324000358_ref64","first-page":"1245","article-title":"Autoimmunity in myasthenia gravis","volume":"i","author":"Strauss","year":"1963","journal-title":"British Medical Journal"},{"key":"S0025727324000358_ref72","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-197610000-00008"},{"key":"S0025727324000358_ref32","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1001\/jama.1953.02940230001001","article-title":"Course and management of myasthenia gravis","volume":"153","author":"Grob","year":"1953","journal-title":"JAMA"},{"key":"S0025727324000358_ref43","doi-asserted-by":"publisher","DOI":"10.1017\/9781108877237.007"},{"volume-title":"A History of Thoracic Surgery","year":"1961","author":"Meade","key":"S0025727324000358_ref55"},{"key":"S0025727324000358_ref26","doi-asserted-by":"publisher","DOI":"10.4997\/jrcpe.2019.317"},{"key":"S0025727324000358_ref6","first-page":"984","volume-title":"Companion Encyclopaedia of the History of Medicine","author":"Tr\u00f6hler","year":"1993"},{"key":"S0025727324000358_ref2","doi-asserted-by":"publisher","DOI":"10.1086\/491543"},{"key":"S0025727324000358_ref71","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1017\/S0025727300003008","article-title":"Neo-clinicians, Clinical Trials, and the Reorganisation of Medical Research in Paris Hospital after the Second World War: the Trajectory of Jean Bernard","volume":"54","author":"Rigal","year":"2008","journal-title":"Medical History"},{"key":"S0025727324000358_ref79","first-page":"1158","volume-title":"Principles of Neurology","author":"Adams","year":"1989"},{"key":"S0025727324000358_ref40","first-page":"292","volume-title":"Queen Square: A History of the National Hospital and its Institute of Neurology","author":"Shorvon","year":"2019"},{"key":"S0025727324000358_ref83","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-196701000-00015"},{"key":"S0025727324000358_ref7","doi-asserted-by":"publisher","DOI":"10.1177\/0141076815593720"},{"key":"S0025727324000358_ref13","doi-asserted-by":"publisher","DOI":"10.1017\/S0025727300007675"},{"key":"S0025727324000358_ref53","doi-asserted-by":"publisher","DOI":"10.1016\/S1569-9293(03)00190-7"},{"key":"S0025727324000358_ref81","doi-asserted-by":"publisher","DOI":"10.1177\/003591576205500114"},{"key":"S0025727324000358_ref8","doi-asserted-by":"publisher","DOI":"10.1093\/jhmas\/53.2.99"},{"volume-title":"The Progress of Experiment: Science and Therapeutic Reform, 1900-1990","year":"1997","author":"Marks","key":"S0025727324000358_ref14"},{"key":"S0025727324000358_ref66","doi-asserted-by":"crossref","first-page":"871","DOI":"10.1126\/science.180.4088.871","article-title":"Autoimmune response to acetylcholine receptor","volume":"180","author":"Patrick","year":"1973","journal-title":"Science"},{"volume-title":"Diseases of the Nervous System","year":"1933","author":"Brain","key":"S0025727324000358_ref22"},{"volume-title":"The Gates of Memory","year":"1981","author":"Keynes","key":"S0025727324000358_ref4"},{"key":"S0025727324000358_ref33","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1945.02860170001001"},{"key":"S0025727324000358_ref17","doi-asserted-by":"publisher","DOI":"10.1017\/S0025727300002994"},{"key":"S0025727324000358_ref65","doi-asserted-by":"publisher","DOI":"10.1111\/j.1749-6632.1966.tb45499.x"},{"volume-title":"Therapeutics in Neurology","year":"1975","author":"Calne","key":"S0025727324000358_ref74"},{"volume-title":"Thymectomy for Myasthenia Gravis","year":"1960","author":"Viets","key":"S0025727324000358_ref35"},{"key":"S0025727324000358_ref20","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1016\/j.thorsurg.2018.12.011","article-title":"History of Thymectomy for Myasthenia Gravis","volume":"29","author":"Cooper","year":"2019","journal-title":"Thoracic Surgery Clinics"},{"key":"S0025727324000358_ref31","first-page":"505","article-title":"Some preliminary observations on the clinical course of myasthenia gravis before and after thymectomy","volume":"24","author":"Harvey","year":"1948","journal-title":"Bulletin of the New York Academy of Medicine"},{"key":"S0025727324000358_ref36","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.1.4646.139"},{"volume-title":"The neurologists. A history of a medical speciality in modern Britain, c. 1789-2000","year":"2014","author":"Caspar","key":"S0025727324000358_ref39"},{"key":"S0025727324000358_ref16","first-page":"544","article-title":"John Wickham\u2019s New Surgery: \u2018Minimally Invasive Therapy\u2019, Innovation and Approaches to Medical Practice in Twentieth Century Britain","volume":"30","author":"Frampton","year":"2017","journal-title":"Social History of Medicine"},{"key":"S0025727324000358_ref76","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5223(19)41963-6"},{"key":"S0025727324000358_ref91","doi-asserted-by":"publisher","DOI":"10.1196\/annals.1405.014"},{"key":"S0025727324000358_ref9","doi-asserted-by":"publisher","DOI":"10.1093\/jhmas\/jrn043"},{"key":"S0025727324000358_ref60","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1953.02940310038009"},{"key":"S0025727324000358_ref38","doi-asserted-by":"crossref","first-page":"963","DOI":"10.1001\/jama.1950.02910310007002","article-title":"Thymectomy in the treatment of myasthenia gravis: results in seventy-two cases compared with one-hundred and forty-two control case","volume":"142","author":"Eaton","year":"1950","journal-title":"JAMA"},{"key":"S0025727324000358_ref78","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2016.12.074"},{"volume-title":"A History of Lung Cancer. The Recalcitrant Disease","year":"2013","author":"Timmermann","key":"S0025727324000358_ref69"},{"key":"S0025727324000358_ref42","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1093\/jsh\/shw014","article-title":"Quintessentially Modern Heroes: Surgeons, Explorers, and Empire, c.1840-1914","volume":"50","author":"Lawrence","year":"2016","journal-title":"Journal of Social History"},{"key":"S0025727324000358_ref1","doi-asserted-by":"publisher","DOI":"10.1057\/978-1-349-95260-1"},{"key":"S0025727324000358_ref48","doi-asserted-by":"publisher","DOI":"10.1016\/S1569-9293(03)00130-0"},{"key":"S0025727324000358_ref80","first-page":"1545","volume-title":"Adams and Victor\u2019s Manual of Neurology","author":"Ropper","year":"2001"},{"volume-title":"Cancer on Trial. Oncology as a New Style of Practice","year":"2012","author":"Keating","key":"S0025727324000358_ref70"},{"key":"S0025727324000358_ref41","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(52)91902-8"},{"key":"S0025727324000358_ref67","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(75)92779-8"},{"key":"S0025727324000358_ref61","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/81.1.112"},{"volume-title":"Diseases of Muscle: a Study in Pathology","year":"1962","author":"Adams","key":"S0025727324000358_ref82"},{"key":"S0025727324000358_ref90","first-page":"158","volume-title":"Contemporary Treatments in Neurology","author":"Newsom-Davis","year":"2001"},{"key":"S0025727324000358_ref93","doi-asserted-by":"publisher","DOI":"10.1017\/S0025727300026612"},{"key":"S0025727324000358_ref25","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.51.5.1433"},{"key":"S0025727324000358_ref27","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(23)00324-1"},{"key":"S0025727324000358_ref86","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.43.7.644"},{"key":"S0025727324000358_ref51","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5223(19)34287-4"},{"volume-title":"Caring for the Heart: Mayo Clinic and the Rise of Specialization","year":"2015","author":"Fye","key":"S0025727324000358_ref5"},{"key":"S0025727324000358_ref28","doi-asserted-by":"publisher","DOI":"10.1017\/S0025727300026612"},{"key":"S0025727324000358_ref34","first-page":"600","article-title":"Symposium on the Surgical Treatment of Myasthenia Gravis","volume":"40","author":"Keynes","year":"1946","journal-title":"Journal of the Royal Society of Medicine"},{"key":"S0025727324000358_ref37","first-page":"497","article-title":"Studies in myasthenia gravis: review of a twenty-year experience in over 1200 patients","volume":"38","author":"Osserman","year":"1971","journal-title":"The Mount Sinai journal of medicine, New York"},{"key":"S0025727324000358_ref47","first-page":"513","article-title":"The History of Anaesthesia for Thoracic Surgery","volume":"73","author":"Brodsky","year":"2007","journal-title":"Minerva Anastesiologica"},{"key":"S0025727324000358_ref50","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5223(96)70394-X"},{"key":"S0025727324000358_ref54","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1016\/S0003-4975(10)65270-8","article-title":"Significant Events in the History of The Society of Thoracic Surgeons","volume":"14","author":"Ellison","year":"1972","journal-title":"The Annals of Thoracic Surgery"},{"key":"S0025727324000358_ref75","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(71)90336-6"},{"key":"S0025727324000358_ref88","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.55.1.7"},{"volume-title":"Belly Rippers: Surgical Innovation and the Ovariotomy Controversy","year":"2019","author":"Frampton","key":"S0025727324000358_ref11"},{"key":"S0025727324000358_ref57","first-page":"478","article-title":"Reciprocal Development and Progressive Responsibility: the History of the Mayo Clinic Neurology Residency","volume":"4","author":"Boes","year":"2020","journal-title":"Mayo Clinic Proceedings: Innovations, Quality and Outcomes"}],"container-title":["Medical History"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0025727324000358","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,25]],"date-time":"2025-04-25T13:41:57Z","timestamp":1745588517000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0025727324000358\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1]]},"references-count":94,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2025,1]]}},"alternative-id":["S0025727324000358"],"URL":"https:\/\/doi.org\/10.1017\/mdh.2024.35","relation":{},"ISSN":["0025-7273","2048-8343"],"issn-type":[{"type":"print","value":"0025-7273"},{"type":"electronic","value":"2048-8343"}],"subject":[],"published":{"date-parts":[[2025,1]]},"assertion":[{"value":"\u00a9 The Author(s), 2025. Published by Cambridge University Press","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http:\/\/creativecommons.org\/licenses\/by\/4.0), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}]}}