Jayant Radhakrishnan
Darien, Illinois, United States
Bangalore Jayaram
Mysuru, Karnataka, India

The Cook County Hospital in Chicago, Illinois fostered many notable American surgeons. It was also the birthplace of major medical and surgical advances. Dr. Orion Harry Stuteville (February 15, 1902 – May 26, 1994), or “Steudy”, was one such surgical giant. He had a unique life and an exceptional career. He was also ahead of his time in the surgical care he provided for patients.

His father, Calvin Howard Stuteville, was the US Indian Agent for the Oklahoma territories. While he was escorting a Native American hunting party to their reservation, Mrs. Mary Etta Stuteville went into labor and delivered a healthy boy in a covered Studebaker horse-drawn wagon in the Oklahoma plains. Mr. Stuteville requested the Chief of the tribe to name his son. As was their custom, the Chief named the boy after the first object he saw, which was a group of stars that Native American tribes know by different names. The Chief was a Harvard-educated astronomer, so he gave the child the White Man’s name for the constellation, Orion, rather than what his tribe called it. By twelve years of age, Orion was plowing fields behind a mule and driving cattle to the railhead in Kansas from his home in Okeene, Oklahoma.¹

After completing his secondary education in Carnegie, he enrolled at the Oklahoma State University (OSU) in Stillwater. He was an accomplished wrestler while in college and held American Athletic Union and Canadian National championship titles. He was also an alternate on the United States Olympic wrestling team for the 1924 Paris games in the 174-pound class. He was inducted into the OSU Wrestling Hall of Fame in 1961.² When he graduated in 1926 from Oklahoma A&M, as OSU was named in those days, promoters tried to sign him up at $12,000 a year to fight once-monthly bouts. Steudie became irritated with a promoter for using a profanity and physically threw him out of the house. He chose instead to take a position at Northwestern University in Evanston, Illinois, as a wrestling and football coach for $2,200 a year.^1,3 While working at Northwestern, he received his Doctor of Dental Surgery (DDS) degree in 1931 and Master of Science in Dentistry (MSD) in 1939⁴ but he was not yet done. In addition to practicing dentistry, he also attended Northwestern University Medical School and became a Doctor of Medicine (MD). Finally, he completed a surgical residency at St. Joseph’s Hospital in Chicago. Thus, he was one of those rare individuals who became a Fellow of both the American College of Dentists and the American College of Surgeons. From 1933 to 1970 he was Chairman of Maxillofacial and Oral Surgery at Northwestern University, but he was never paid for his services.¹

He joined the Army Medical Corps during World War II and treated many injuries to the face and neck of soldiers as he was posted in front-line units during both the North African and the Italian campaigns of the Allies. This vast exposure to war wounds made him extremely knowledgeable in managing injuries of the head, face, and neck, reconstruction after major injuries that resulted in tissue loss, and also in the removing opharyngeal cancers and in radical neck dissections.

While in Italy, he shot film footage of the costly attacks by the Allies on Monte Cassino and the Winter Line of the Axis forces, but he had to turn over that material to the Army when he was discharged. He received no credit when some of the footage he shot was shown on television after the war.¹

He returned to Chicago after World War II and practiced at Passavant Memorial Hospital. His next venture was to establish a plastic surgery program at the Cook County Hospital in 1959 at the request of Dr. Robert J. Freeark, who had just been appointed Director of Surgical Education by the Medical Superintendent, Dr. Karl Meyer. The program became a combined Cook County-Northwestern plastic surgery program in 1967 to increase the exposure of trainees to aesthetic procedures. The combined program disbanded when Dr. Stuteville retired in the mid-1970s.

In 1970 Dr. Freeark, who had become the Chief of Surgery at Loyola University, asked him to set up a plastic surgery program there. This program was also associated with the one at the County Hospital.¹

Dr. Stuteville was wholly committed to teaching. He provided instruction during operations and also conducted ward rounds, a teaching conference on Sundays, and a tumor conference. His teaching technique in the operating room rewarded the well-prepared resident. If the resident with the knife in hand could not answer his questions, the knife passed to the next senior resident and so on until it came back to him.¹ Even when he was in his seventies, he always carried a large black bag with his photographic and surgical equipment on rounds. While he carried it with ease, residents in their twenties found it rather heavy to carry.

Dr. Stuteville left plastic surgery in just as an atypical a manner as he entered it. In 1975 he took a course in cardiology and left Chicago to become a general practitioner in Leslie, Arkansas. He also worked on his farm where he used a mule to plow and roped and branded calves from atop his horse, “Doll.” While tending his farm he also wanted to improve the lives of his neighbors. To reduce fat in their diet, he tried his hand at artificial insemination of animals to produce “cattleo” and “beefalo.”¹ In 1992 he moved to Marco Island, Florida where he died two years later at ninety-two years of age.³

One of Dr. Stuteville’s great accomplishments was his early recognition of a major problem that is still controversial. He tried to help patients with gender dysphoria and transgender patients from 1967 onward.⁵ The first clinic for these patients in the United States was established in November 1966 at Johns Hopkins University but it was out of reach for most people. The University of Minnesota operated on their first patient in secret and then set up a program that opened in December 1966. It was not until 1968 that Stanford University set up a clinic in Palo Alto, California and Drs. Stanley Bieber in Trinidad, Colorado, and Benito Rish at the Yonkers Professional Hospital, New York, began to operate on these patients.^5,6

Dr. Stuteville was struck by the predicament of desperate gender dysphoria patients who would either mutilate themselves or undergo procedures by unqualified individuals and show up at Cook County Hospital with terrible complications. He convinced the authorities at the hospital that a comprehensive care unit was required. Thus, the Social Evaluation Clinic for Sexual Identity Problems (SECS) was established. It was staffed by a social worker, a psychiatrist (who was blind), a psychologist, and a plastic surgeon. The Chief of Urology was given the task of running the clinic.

A strict protocol was followed for accepting patients in the clinic. Dr. Stuteville’s expertise was in male-to-female transgender reconstruction. These patients had to be free of any psychosis and had to dress and live as women for one year, after which they received hormones for another year. They had to participate in group sessions at the SECS, be fully cognizant of what was involved in such surgery, and have a realistic idea of expectations and complications. Once the stringent criteria were met, a one-stage operation was performed in which an anteriorly placed penile flap was inverted into the space developed in the perineum to locate the vagina, while the labia were made from the scrotum.^5,7

The County Hospital was a godsend for these patients who could not obtain insurance coverage and had to pay out of their own pockets. Interestingly, in those days the County Hospital charged on a per diem basis regardless of the complexity of the medical condition or procedure employed. The plastic surgery service made every attempt to get these patients in and out of the hospital in forty-eight hours. They would be evaluated at SECS and the necessary preoperative tests were carried out as outpatients. They were admitted the night before surgery and discharged the morning after the operation to keep the patient’s expenses to a bare minimum. This was a radical approach at a time when patients were customarily kept in the hospital for inordinate periods of time for preoperative evaluation and also after the simplest of operations. Furthermore, to avoid a second hospitalization a second team would do the breast augmentation simultaneously with the genital reconstruction. All follow-up was done in the clinic.

Unfortunately, in 1978, the new Chief of the Department of Surgery summoned the then Chief of Plastic Surgery (B. Jayaram) and informed him that transgender surgery would no longer be performed at Cook County Hospital because a county hospital cannot justify using public money for such procedures. Since the patients were required to deposit $2,500 before surgery and this could have been used to pay for the procedure, one wonders about the real reason behind the move. No monetary audit was carried out and no financial data was presented. We will never know whether the decision was indeed made for financial reasons or whether the cancellation was the result of religious, social, or political beliefs.⁸ It is interesting to note that the clinic at Johns Hopkins University also closed in 1979 when Dr. Paul McHugh became the new Chief of Psychiatry and the clinic in Minneapolis closed in the late 1970s.

A vignette that exemplifies Dr. Stuteville’s compassionate nature and his concern for his trainees is that of JB, the psychiatrist who worked with the clinic. He was one of Dr. Stuteville’s first plastic surgery trainees who, when he found that he was going blind from an optic nerve problem, enrolled in a psychiatry residency. After he completed his training, Dr. Stuteville made him the SECS clinic psychiatrist.

To conclude, Dr. Stuteville was a great surgeon, an excellent teacher, and a compassionate person. Dr. Stuteville and the SECS clinic are no longer around and these patients still face barriers when seeking treatment. The operation Dr. Stuteville espoused continues to be the mainstay of male-to-female transgender reconstruction more than a half century later and the management scheme used in the SECS clinic continues to be the standard of care for these patients.

References

1. Warpeha RL (2015): Plastic Surgery in (Eds) Guinan PD, Printen KJ, Stone JL, Yao JST. A History of Surgery at Cook County Hospital. AMIKA Press, Chicago IL. First Edition, p. 359-367.
2. Wrestling Olympians – Oklahoma State University Athletics. March 17, 2015. https://okstate.com › sports › GEN_20140101161.
3. Ex-OSU grappler dies at age 92. The Oklahoman. June 28, 1994 https://oklahoman.com › article › ex-osu-grappler-dies-. Archive ID:579480.
4. Dr. OH Stuteville retires to Arkansas (1976). Northwestern University Medical Center Magazine. 2(1): Winter 1976.
5. Stuteville OH, Pandya NJ, Arieff AJ (1971): Surgical treatment of the male transexual. Transactions of the 5th International congress of Plastic and Reconstructive Surgery. Melbourne 1971 p.1279-1290.
6. A gender variance who’s who (2018): Timeline of surgery part II: 1966-1975. May 21, 2018.
7. Pandya NJ, Stuteville OH (1973): A one-stage technique for constructing female external genitalia in male transexuals. Brit J Plast Surg 26(3):277-282.
8. Abcarian H (2021). County, A Journey. Monee, IL Copyright Herand Abcarian M.D., FACS copyright number: 1-10932625461 (10/24/21) p. 94-95.