William WolffBMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d7254 (Published 09 November 2011) Cite this as: BMJ 2011;343:d7254
- Ned Stafford
William Wolff’s idea was simple: insert a miniature camera lens and a wire snare connected to a long, flexible fibre optic tube into a patient’s anus to examine the full length of the colon, and, if necessary, excise potentially cancerous polyps. It was a simple idea, but in 1969 it represented a radical shift in the diagnosis, treatment, and prevention of colon cancer. At the time, colon polyps were usually identified by rectal bleeding or through radiology, and removed either by abdominal surgery or repeated barium enemas.
Wolff, director of surgery at Beth Israel Medical Center in New York City, and his young protegé-associate Hiromi Shinya thought that their technique was better, but colleagues disagreed. “As word of our successes got around in the local medical community,” Wolff would later write, “we became aware of subtle criticisms that our efforts were a fluke . . . prophets of doom abounded. Articles appeared calumniating the method and mongering rumours of horrible unreported disasters.”
Three years before, in 1966, at a conference in Copenhagen Wolff had been intrigued by a demonstration of upper gastrointenstinal flexible fibre optic endoscopes. He recruited the Japan-born Shinya, who had just finished his residency, to help develop a similar technique at Beth Israel. Shinya, who still operates a clinic in New York, became technically skilled in performing the technique through the mouth for gastrointestinal procedures.
Wolff later admitted that the team had substantial reservations about the next step: “We now confess that we were not at all entranced by the prospect of pushing a stiff firm tube through a thin walled convoluted colon. The spectre of a series of malpractice suits loomed large, should a mishap occur.”
Shinya’s first forays into the colon used fibre optic endoscopes from Olympus Corporation designed for the oesophagus and able to reach only the splenic flexure, the first bend in the colon. But in 1969 with input from Wolff and Shinya, Olympus developed dedicated colonoscopes and later added an electrosurgical polypectomy snare.
Because of widespread scepticism, Wolff and Shinya delayed publishing. They performed the procedure on more than 100 patients to amass a body of overwhelming scientific evidence. Finally, in 1973, they published their groundbreaking paper in the New England Journal of Medicine: “Polypectomy via the fiberoptic colonoscope—removal of neoplasms beyond reach of the sigmoidoscope” (1973;288:329-32, doi:10.1056/NEJM197302152880701).
The US surgeon Francis Moore, winner of the 1978 Lister medal of the Royal College of Surgeons, described the technique as “a quantum advance in abdominal surgery.” The journal Seminars in Colon and Rectal Surgery in 1999 named it one of the “landmark articles of the 20th century” in the discipline.
Stephen P Haverson, who in 1969 began a surgical residency at Beth Israel, where he is now attending surgeon, said that Wolff “was instrumental in helping to perfect this technique and most importantly had the foresight to know that this was a very important advancement in medical care.”
William Irwin Wolff was born on 24 October 1916, in New York City. His father was a lawyer and his mother a maths teacher. He won the New York state junior tennis championship and aged 16 enrolled at New York University, where he was a fencing champion. He earned his medical degree in 1940 from the University of Maryland, followed by an internship and thoracic surgery residency at the Cornell and Columbia university divisions of Bellevue Hospital in Manhattan.
In 1943 he entered the US army, assigned to the first general hospital unit stationed north of London before the June 1944 Allied D Day landing in France, and after in Paris. During the Battle of the Bulge, where the US Army suffered 90 000 casualties, Wolff completed surgery on a wounded soldier in the face of advancing German troops before evacuating, narrowly missing capture.
Discharged in 1946 with the rank of major, he completed surgical training and was named chief of thoracic surgery at Deshon Veterans Hospital near Pittsburgh, Pennsylvania. In 1949 he performed one of the first successful resuscitations using open cardiac massage on a patient who had experienced a cardiac arrest. The revival was a front page newspaper story and Wolff wrote a paper for JAMA, the journal of the American Medical Association, encouraging surgeons to use the technique.
He returned in 1950 to Bellevue and, after studying open heart surgery techniques at the University of Minnesota, helped set up an animal laboratory at St Vincent’s Hospital in New York for open heart surgery research. In 1956 he became associate professor of clinical surgery at New York University School of Medicine and in 1960 professor at Mount Sinai School of Medicine.
In 1962 he was named the first full time director of surgery at Beth Israel, stepping down in 1976. Dr Haverson said of his tenure, “He promoted academic excellence in our institution comparable to that at any university teaching programme and more.” Carl A Soderstrom, a surgery resident at Beth Israel in the early 1970s and now adjunct professor at the University of Maryland School of Medicine, added, “Dr Wolff was the quintessential clinician, surgeon, scholar, teacher, and mentor. As leader he fairly critiqued and guided his residents. He exuded pure joy at the accomplishments of his residents and staff.”
The author of more than 120 papers, Wolff served as president of the New York Surgical Society and was a founding member of the Society of American Gastrointestinal and Endoscopic Surgeons, which in 1998 honoured him with its distinguished service award. Other honours include the Beth Israel Medical Center alumnus of the year in 1992 and the gold key award from the University of Maryland Alumni Association. Wolff leaves his first wife, Lillian Myrick Wolff, and their five sons and four daughters. His second wife, Rita Smith Wolff, died in 2007.
Cite this as: BMJ 2011;343:d7254
William Wolff, (b 1916; q 1940, University of Maryland), died on 20 August 2011 from natural causes.