Sir Peter Freyer (2 July 1851 – 9 September 1921) was an Irish surgeon with an expertise in genitourinary surgery, best known at first as an Indian Medical Service (IMS) officer, for making popular the procedure for crushing

bladder stones A bladder stone is a stone found in the urinary bladder. Signs and symptoms Bladder stones are small mineral deposits that can form in the bladder. In most cases bladder stones develop when the urine becomes very concentrated or when one is d ...

to allow them to be evacuated through the natural passages, a procedure known as a litholapaxy. Following retirement from the IMS after 20 years of service in India, he returned to England and popularized a procedure for benign large prostates. This was known as the suprapubic prostatectomy, a transvesical prostatectomy or the Freyer operation, where the prostate is removed through an abdominal incision above the pubic bone but below the umbilicus and through the bladder, and it included using suprapubic drainage post-operatively. He entered the

Bengal Medical Service The Indian Medical Service (IMS) was a military medical service in British India, which also had some civilian functions. It served during the two World Wars, and remained in existence until the independence of India in 1947. Many of its officer ...

as a surgeon in 1875 and served almost exclusively in civil employment in the North-Western Provinces and Oudh in the United Provinces of India. While based at

Moradabad Moradabad () is a city, commissionary and municipal corporation in Moradabad district of Indian state of Uttar Pradesh. Moradabad is situated on the banks of the Ramganga river, at a distance of from the national capital, New Delhi and 344 ...

in 1888, he successfully operated on

Muhammad Mushtaq Ali Khan Nawab Muhammad Mushtaq Ali Khan Bahadur, (1856-25 February 1889) was a Nawab of the princely state of Rampur from 1887 to 1889, succeeding his father Sir Nawab Kalb Ali Khan Bahadur. Owing to continued ill-health, he was unable to properly rule ...

, the

Nawab of Rampur Rampur State was a 15 gun-salute princely state of British India. It came into existence on 7 October 1774 as a result of a treaty with Oudh. Following independence in 1947, Rampur State and other princely states of the area, such as Bena ...

, crushing his bladder stone with a

lithotrite The lithotrite was an early medical device, invented by Al-Zahrawi, an early form of which he called "Michaab". He was able to crush the stone inside the bladder without the need for a surgical incision. It was later modified by Jean Civiale, and ...

. Freyer defended the remuneration he received from the Nawab, which had caused a controversy with the British establishment in India at the time. This and an eye injury caused while serving the civil surgeoncy of Benares contributed to Freyer taking early retirement and returning to England in 1896. In England he set up a private practice in Harley Street and was appointed a consulting surgeon in the surgery of the urinary organs at St Peter's Hospital for stone, London. He first performed the procedure of suprapubic prostatectomy in 1900, on a man who then survived 12 years. Although Freyer was not the first to introduce this operation, despite his claim otherwise causing the second significant controversy in his career, he is credited with popularising it. In 1920, he was elected the first president of the section of urology of the

Royal Society of Medicine The Royal Society of Medicine (RSM) is a medical society in the United Kingdom, headquartered in London. History The Society was established in 1805 as Medical and Chirurgical Society of London, meeting in two rooms in barristers’ chambers ...

and in his presidential address, claimed to have performed 1,674 of these operations with a low mortality. The Department of Surgery, NUI Galway, hosts the annual Sir Peter Freyer Memorial Lecture and Surgical Symposium in his honour, and the

James Hardiman Library The James Hardiman Library ( ga, Leabharlann Shéamais Uí Argadáin) serves the University of Galway in Republic of Ireland, Ireland. It is a legal deposit or "copyright library", which means that publishers in the country must deposit a copy of ...

at the NUI hold around 660 items of his memorabilia.

Early life and education

Peter Johnson Freyer, named after his paternal grandfather who was a chief officer in the Irish Coast Guard, was born in

County Galway "Righteousness and Justice" , anthem = () , image_map = Island of Ireland location map Galway.svg , map_caption = Location in Ireland , area_footnotes = , area_total_km2 = ...

on 2 July 1851, the eldest child of landholder Samuel Freyer and his wife Celia Burke, who was a

Roman Catholic Roman or Romans most often refers to: *Rome, the capital city of Italy *Ancient Rome, Roman civilization from 8th century BC to 5th century AD *Roman people, the people of ancient Rome *'' Epistle to the Romans'', shortened to ''Romans'', a lette ...

. Freyer and his siblings however, were brought up as

Protestant Protestantism is a Christian denomination, branch of Christianity that follows the theological tenets of the Reformation, Protestant Reformation, a movement that began seeking to reform the Catholic Church from within in the 16th century agai ...

, a likely effect of the influence of the Irish Church Missionss (ICM) on the people in the area at that time. On 26 July of that year, he was baptised in

Ballinakill Ballinakill () is a small village in County Laois, Ireland on the R432 regional road between Abbeyleix, Ballyragget and Castlecomer, County Kilkenny. As of the 2016 census, there were 445 people living in Ballinakill. History From 1613 until ...

's parish church. In 1855, his father, who was a tenant of the ICM supporter Sir Christopher Lighton, had in possession 17 acres of land at Moorneen and property and land in Knockbrack, both of which are located in Clifden. Twenty one years later, in 1876, when a list of those owning more than one acre was compiled, he was recorded as owning 210 acres. Freyer was educated at Erasmus Smith's College,

Galway Galway ( ; ga, Gaillimh, ) is a City status in Ireland, city in the West Region, Ireland, West of Ireland, in the Provinces of Ireland, province of Connacht, which is the county town of County Galway. It lies on the River Corrib between Lo ...

, and won a scholarship to attend Queen's College (now NUI Galway). He graduated in 1872 with a gold medal and a first class honors degree in Arts. Two years later, in 1874, he earned his MD and M.Ch. having won another gold medal. While a medical student he also spent some time as a resident pupil at Dr Steevens' Hospital in Dublin. Following a short time working in Paris, he returned to sit the competitive examination of the Indian Medical Service.Sir Peter Freyer's Papers
1805-1987. NUI Galway. Reference code P57.

Indian Medical Service

Admission to the Bengal Medical Service

Freyer came first in the competitive examination for a commission as a

medical officer A physician (American English), medical practitioner (Commonwealth English), medical doctor, or simply doctor, is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through the ...

in the

, which later became part of the IMS. Entering the service as a surgeon on 30 September 1875, he became a civil surgeon in

Azamgarh Azamgarh is a city in the Indian state of Uttar Pradesh. It is the headquarters of Azamgarh division, which consists of Ballia, Mau and Azamgarh districts. Azamgarh is situated on the bank of Tamsa River (Tons). It is located east of the st ...

in April 1877. He started publishing his medical articles in ''

The Indian Medical Gazette ''The Indian Medical Gazette'' is an Indian medical journal established in 1866.The Indian Medical Gazette. ...

'' in 1878. Subsequently, he became a surgeon-major and surgeon lieutenant-colonel after 12 and 20 years' service respectively and retired from service on 3 May 1896. He served almost exclusively in civil employment in the North-Western Provinces and Oudh in the United Provinces of India, where he then held the civil surgeoncies successively of

Bareilly Bareilly () is a city in Bareilly district in the Indian state of Uttar Pradesh. It is among the largest metropolises in Western Uttar Pradesh and is the centre of the Bareilly division as well as the historical region of Rohilkhand. The city ...

Allahabad Allahabad (), officially known as Prayagraj, also known as Ilahabad, is a metropolis in the Indian state of Uttar Pradesh.The other five cities were: Agra, Kanpur (Cawnpore), Lucknow, Meerut, and Varanasi (Benares). It is the administrat ...

, Mussoorie and Benares, and was also for a short time surgeon on the staff of the Lieutenant-Governor.

The controversy in India

During his time in India, he became reputable in cataract surgery and the operation of removing bladder stones, litholapaxy. Ellis, Harold
"The Birth of Modern Surgery"
in ''A History of Surgery''. Greenwich Medical Media Limited, London (2001), p. 121-122. In 1888,Goddard, J. C
Sir Peter Freyer"
''Urology News''. Vol, 16, No. 4 (May/June 2012), p. 24. while based at

, Freyer operated on the

,Fitzpatrick, Kieran
Tense Networks: Exploring medical professionalization, career making and practice in an age of global empire, through the lives and careers of Irish surgeons in the Indian Medical Service, c. 1850- 1920
Thesis for Doctor of Philosophy in the Faculty of History at the University of Oxford. St John’s College, University of Oxford (2016) crushing his bladder stone with a

. In return for his services, the Nawab gave Freyer a lakh (100,000) of rupees, equivalent to £10,000, or £598,900 at the time. He also treated General Azim Uddin Khan, the Nawab's chief administrator. This remuneration caused conflict between Freyer and his superiors in the Indian Government of the time, the British administrative authority in India. Freyer had been attending to the Nawab for over 16 months, providing regular treatment including the operation. The government of India raised objections to the receipt by a medical officer of so large a sum of money, and first ordered him to return the money to the Nawab, and later either to do so or to retire from the service. Arguing that there were no grounds in any regulation of the time, he refused to either return the fees or to resign. He was of the opinion that he had earned the money and in doing so had broken no role of the service, but had only done what he was entitled to do. In the end, his view of the case prevailed. The grant and receipt of this large fee, however, was what gave rise to the rules and regulations regarding acceptance of fees from Indian chiefs and gentlemen of high position, which although were later amended on fairly reasonable terms, proved unpopular with IMS officers who in turn put the blame on Freyer.

Later years in India

In 1894, Freyer represented the

Indian government The Government of India (ISO 15919, ISO: ; often abbreviated as GoI), known as the Union Government or Central Government but often simply as the Centre, is the Government, national government of the Republic of India, a federal democracy lo ...

at the International Medical and Surgical Congress in Rome, where he presented his study on 598 cases of bladder stone removal by transurethral lithopaxy, using the same technique as

Henry Jacob Bigelow Henry Jacob Bigelow (March 11, 1818October 30, 1890) was an American surgeon and Professor of Surgery at Harvard University. A dominating figure in Boston medicine for many decades, he is remembered for the Bigelow maneuver for hip dislocation ...

. At the time, the mortality for open lithotomy was 12.5%, but Freyer demonstrated a 1.84% mortality. Following a promotion to the civil surgeoncy of Benares, he became surgeon to the Prince of Wales Hospital in Benares, later renamed the Shiv Prasad Gupta Hospital. His troubles with his superiors in India and an eye injury from an assault by a patient at the Benares asylum contributed to Freyer taking early retirement in 1896 and he returned to England. He had served in the IMS for more than 20 years.

Career in London

In 1897, Freyer was appointed a consulting surgeon in the surgery of the urinary organs at St Peter's Hospital for stone, London, at a time when it was customary for young surgeons to tour French and English surgical centres. In August 1900, on route to Paris from New York,

Ramon Guiteras Ramon Guiteras (August 17, 1858 – December 13, 1917) was a pioneering surgeon who specialized in urology and founded the American Urological Association. Early life and education He was born in Bristol, Rhode Island, and graduated from Harv ...

made a stopover in London. Guiteras presented his suprapubic prostatectomy, which he modified from Eugene Fuller's version and then wrote to Fuller that "Dr. Freyer was very much pleased with the description of the operations, and said that he would try the method". The following year, in 1901 in the ''

British Medical Journal ''The BMJ'' is a weekly peer-reviewed medical trade journal, published by the trade union the British Medical Association (BMA). ''The BMJ'' has editorial freedom from the BMA. It is one of the world's oldest general medical journals. Origi ...

'', Freyer published his first four cases of suprapubic prostatectomy. Zorgniotti, Adrian W.br>Chapter 7. Suprapubic prostatectomy: An Anglo-Indian success story
in ''Benign Prostatic Hypertrophy'' edited by Frank Hinman.

Springer-Verlag Springer Science+Business Media, commonly known as Springer, is a German multinational publishing company of books, e-books and peer-reviewed journals in science, humanities, technical and medical (STM) publishing. Originally founded in 1842 in ...

, New York (1983), pp. 51- 54. . Crane, Genevieve and Bloom, David (1 August 2010
Ramon Guiteras: Founder of the American Urological Association, Surgeon, Sportsman and Statesman
'' The Journal of Urology''. Vol. 184, No. 1, pp. 447-452. . He became an immediate success and was referred to by

Lord Moynihan Baron Moynihan, of Leeds in the County of York, is a title in the Peerage of the United Kingdom. It was created on 19 March 1929 for the surgeon Sir Berkeley Moynihan, 1st Baronet, the son of the Victoria Cross recipient Andrew Moynihan. Sir B ...

as a "Pee Free-er". Freyer performed before international audiences, running his own commentary and even speaking Hindi and French with some visiting surgeons.Morson, Clifford (1 August 1949
"Sir Peter Freyer and Sir John Thomson Walker"
Editorial in the ''Postgraduate Medical Journal''. pp. 353-358. His claims of introducing the surgery without credit to Fuller led Fuller to later state that "if he wishes to claim to be the original scratcher in connection with suprapubic prostatectomy, I certainly will not protest against that his only valid claim." In 1905, Astley Paston Cooper Ashhurst, with an introductory letter from Richard Harte, stopped over in London to observe Freyer. He described Freyer in a letter to his brother, as a "brusque, blunt, rather aggressive man in manner...He seems to have rather a high opinion of himself and I certainly thought him a skilful operator". He continued in his letter that Freyer "showed me his large collection of prostates, over a hundred in all" and pointed out a number from notable men including one from Lord Kelvin.

William Belfield William T. Belfield (June 1, 1856 – October 4, 1929) was an American urologist who is credited with having performed the first intentional prostatectomy (via the suprapubic route) in 1885, 1886 or 1887 at Cook County Hospital. It is possible he ...

, Arthur McGill and Eugene Fuller had all performed, for benign large prostates, the operation of removing the prostate through an incision made above the pubic bone but below the umbilicus and through the bladder. However it remained unpopular. Although Freyer was not the first to introduce this procedure, he is credited with popularising it, particularly following his report in 1920, presented at the RSM, on the low mortality of 1,674 cases of suprapubic prostatectomies, utilising suprapubic drainage post-operatively. He stated;

On December 1, 1900, I performed for the first time my operation of total enucleation of the prostate, and in July, 1901, published in the ''British Medical Journal'', for the consideration of the profession at large, a lecture delivered by me at the Medical Graduates' College, giving a full description. of the operation, with details of four successful cases. I have now completed 1,674 cases of the operation, details of 1,550 of which have been recorded in the numerous papers published in the medical journals. I believe I may say that this operation is now almost universally practised by surgeons.

Morson, however, later stated that Freyer performed a total of 1,337 prostatectomies.Morson, Clifford (1946)
The Catheter and the Prostate
Corresppondance in

. P. 888. The number of articles and lectures Freyer gave, in addition to the publicity surrounding the controversies regarding his claims that he had introduced the operation, likely helped make the procedure widely known. In addition to the scandal in India caused by receiving fees from the Nawab, being accepted into the London's medical circles was not likely helped by being Irish. A. Clifford Morson had later noted that Freyer was just one of two surgeons appointed without a FRCS. He also recounted a story where a general practitioner referred to Freyer as a "quack". Morson, Clifford (30 December 1961
The Case of the Plastic Surgeons
Corresppondance in

. P. 1780. However, the operation had a lower mortality in Freyer’s hands compared to others, at a time before antibiotics and with only basic anaesthesia. Freyer’s skill lay in his speed. "Tre Treatment of Benign Enlargement of Prostate"
British Association of Urological Surgeons Scientific held at the Royal College of Surgeons, Lincoln’s Inn Fields on 28 June 1946. The British Journal of Urology. Vol. 18, No. 3 (September 1946), pp. 105-121. John Thomson-Walker, first honorary secretary of the section of urology at the RSM, later described Freyer's surgery as "decided, purposive and rapid, and in some operations, especially that of litholapaxy, the manipulation was graceful". When

Cuthbert Dukes Cuthbert Esquire Dukes OBE (24 July 1890 – 3 February 1977) was an English physician, pathologist and author, for whom the Dukes classification for colorectal cancer is named. Career Dukes was educated at Caterham School. He graduated with a ...

became president of the urology section of the RSM in 1956, he disclosed that when he took up the appointment of pathologist at St Peters 26 years previously, he had come to be in possession of the medical notes and pathological specimen of the prostate removed from Freyer's first transvesical prostatectomy case of John Thomas in 1900. Thomas survived 12 years, and wrote to Freyer in 1912 "I must say I am perfectly right in my urinary organs and for which I shall never be able to thank you enough". The procedure was later superseded by the retropubic prostatectomy popularised by

Terence Millin Terence John Millin FRCSI FRCS LRCP (9 January 1903 - 1980) was a British-born Irish urology, urological surgeon, who in 1945, introduced a surgical treatment of benign prostatic hypertrophy, benign large prostates using the retropubic prostatec ...

following his publication of the technique in 1945.

Other roles

In 1902, he became examiner in surgery at the

University of Durham Durham University (legally the University of Durham) is a collegiate university, collegiate public university, public research university in Durham, England, Durham, England, founded by an Act of Parliament in 1832 and incorporated by royal charte ...

and from 1904 to 1909 he was a member of the honorary medical staff of

King Edward VII's Hospital for Officers King Edward VII's Hospital (formal name: King Edward VII's Hospital Sister Agnes) is a private hospital located on Beaumont Street in the Marylebone district of central London. Agnes Keyser, later known as Sister Agnes, established the hospit ...

. Thereafter he was appointed a consulting surgeon to the

Queen Alexandra Military Hospital The Queen Alexandra Military Hospital (QAMH) opened in July 1905. It was constructed immediately to the north of the Tate Britain (across a side-street) adjacent to the River Thames on the borders of the neighbourhoods of Millbank and Pimlico, W ...

, Millbank, London. In 1904, he was awarded the Arnott Memorial Medal for original surgical work.

First World War

When the

First World War World War I (28 July 1914 11 November 1918), often abbreviated as WWI, was one of the deadliest global conflicts in history. Belligerents included much of Europe, the Russian Empire, the United States, and the Ottoman Empire, with fightin ...

began in 1914, Freyer rejoined for service as consulting surgeon to Queen Alexandria's military hospital, to be Indian hospitals in England, and to the eastern command in general. He received the CB on 1 January 1917 and the KCB six months later on 4 June 1917. Between 10 April 1918 and 10 April 1919, he held a temporary colonelcy in the

Royal Army Medical Corps The Royal Army Medical Corps (RAMC) is a specialist corps in the British Army which provides medical services to all Army personnel and their families, in war and in peace. The RAMC, the Royal Army Veterinary Corps, the Royal Army Dental Corps a ...

and upon resignation of post was promoted to an honorary full colonelcy on the retired list. In October 1919, he received an honorary doctorate from the National University of Ireland.

Later career

After the war and with a greater recognition of urology as a specialty, Freyer at the age of 69, was elected the first president of the section of urology of the RSM in 1920, when the RSM's president was

Sir Humphry Rolleston Sir Humphry Davy Rolleston, 1st Baronet, (21 June 1862 – 23 September 1944) was a prominent English physician. Rolleston was the son of George Rolleston (Linacre Professor of Physiology at Oxford) and Grace Davy, daughter of John Davy an ...

. Goddard, J. C. (September/October 2017
"Vis Unita Fortior united strength is stronger"
''

Trends in Urology and Men's Health ''Trends in Urology and Men's Health'' is a peer-reviewed academic journal of urology and men's health, aimed at urologists, HIV consultants, hospital doctors, selected GPs and specialist nurses, covering subjects that particularly affect men, in ...

'', pp. 31-33. His presidential address covered the achievements in urology over the previous 45 years and he hoped the section would result in a co-ordination of work in the field of urology. Freyer was succeeded the following year by Lord Horder, and the section continued with meetings and with its annual president’s address.

Personal and family

Freyer married Isabelle McVittie, daughter of Robert McVittie of Dublin, and they had one son, Dermot Johnston and one daughter, Kathleen Mary. In 1914, Isabelle died. Freyer was seen to be a "staunch Home Ruler", and the papers held at the NUI, Galway, provide evidence that he was friends with the Redmond brothers,

William William is a male given name of Germanic origin.Hanks, Hardcastle and Hodges, ''Oxford Dictionary of First Names'', Oxford University Press, 2nd edition, , p. 276. It became very popular in the English language after the Norman conquest of Engl ...

and John, who he operated on in March 1918. John subsequently died post-operatively. He was also friends with T P O'Connor, an Irish Nationalist member of Parliament.

Death and legacy

Freyer died from a

cerebral haemorrhage Intracerebral hemorrhage (ICH), also known as cerebral bleed, intraparenchymal bleed, and hemorrhagic stroke, or haemorrhagic stroke, is a sudden bleeding into the tissues of the brain, into its ventricles, or into both. It is one kind of bleed ...

at 27 Harley St., London, on 9 September 1921, aged 70 years. He was buried beside his father in the Church of Ireland cemetery at Clifden,

County Galway "Righteousness and Justice" , anthem = () , image_map = Island of Ireland location map Galway.svg , map_caption = Location in Ireland , area_footnotes = , area_total_km2 = ...

. A portrait of Freyer, painted by Alice Grant in 1919, hangs in the boardroom of St Peter's Hospital for Stone. Harold Ellis later recalled that Freyer's procedure remained popular for some time, recounting that in 1948, as a house surgeon, he assisted in many of these. Every year, the Sir Peter Freyer Memorial Lecture and Surgical Symposium, established in 1975 by professor O'Beirn, is hosted by the Department of Surgery, NUI Galway. Past lecturers have included Peter Froggatt in 1984, Thomas E. Starzl in 1985, Mutsuo Sugiura in 1986, Thomas J. Fogarty in 1987,

Bernard Fisher (scientist) Bernard Fisher (August 23, 1918 – October 16, 2019) was an American surgeon and a pioneer in the biology and treatment of breast cancer. He was a native of Pittsburgh. He was Chairman of the National Surgical Adjuvant Breast Project at the Uni ...

in 1988,

Norman Stanley Williams Professor Sir Norman Stanley Williams (born 15 March 1947) is a British surgeon and former President of the Royal College of Surgeons of England (2011–14). History Born in Leeds, he was educated at Roundhay School, Leeds, and at the London ...

in 1989,

Geoffrey Duncan Chisholm Geoffrey Duncan Chisholm, CBE, FRCS, MRCS (30 September 1931 – 10 November 1994) was a New Zealand-born, British urologist. He made extensive advances in renal x-rays. He was also a strong advocate of kidney transplants, promoting the advantag ...

in 1991, Patrick J. Kelly in 2001,

Ara Darzi ARA may refer to: Media and the arts * American-Romanian Academy of Arts and Sciences * '' Artistička Radna Akcija'', compilation album released in former Yugoslavia * Associate of the Royal Academy, denoting membership in the British Royal Acad ...

in 2002, Steven D. Wexner in 2004, Peter T. Scardino in 2006 and Patrick Gullane in 2009. A detailed account of Freyer is given in C. P. MacLoughlin's "From Sellerna to Harley Street". In 1980, the Department of Surgery at NUI Galway acquired Freyer's personal papers and memorabilia from his grandsons. Subsequently, in 2002, the

at the NUI acquired them and now hold around 660 items consisting of his letters, newspaper cuttings, official records, photographs, memorabilia and publications. Other items have also been added. The Freyer Unit in

Galway Clinic The Galway Clinic ( ga, Clinic na Gaillimhe) is a private hospital in Galway, Ireland. History The hospital was founded by surgeons Joseph Sheehan and Jimmy Sheehan, who had established the Blackrock Clinic in Dublin. It was built at a cost of ...

is named in his honour.

Selected publications

Articles

"On the Instruments Required in the Operation of Litholapaxy"
''