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Reflections on reflux.

It is 60 years since I began medical school. Although the diagnosis and treatment of most surgical problems have changed radically in that time, the biggest change is in our attitude to medical science, as we realize that today’s science is often tomorrow’s nonsense. We are in good company. Isaac Newton (1642–1727) may well have been the cleverest man who ever lived. He would have won at least 3 Nobel Prizes if they had been awarded at that time. However, he spent more time on subjects that we would now regard as absurd than on gravity, calculus and light waves combined. He was convinced that the Bible contained in its numerology the date of the Second Coming and that an alchemist would soon make lead into gold. Charles Darwin (1809–1882) had the best idea, the origin of species, that any one man had but during the 19th century phrenology, studying head shape as an indicator to diseases, character and ability, was a respected tool. Darwin’s father, a prominent physician, told his son when he came back from his historic 5-year voyage that his head had altered shape because of all that he had learned. This was nonsense. It is in a spirit of warning rather than any criticism of my dwindling band of contemporaries that I speak. The late Francis Moore (1913–2001) said that “surgery is organized optimism” and so we must be on our guard. “Those who cannot remember the past are condemned to fulfill it,” said George Santayana (1863–1952). A new member of a specialty brings a handful of things about which he or she knows a lot but there are a lot of old things about which he or she may know little. This is a popular history of vesicoureteral reflux (VUR) rather than an academic one, and the conclusions may be far from popular. I speak only about primary reflux. Some may believe that this territory is heavily overgrazed but there has been much glossing over fundamental errors, faulty conclusions and nonsequitors. Reflux errors are quite compressed into 50 years.