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Inch by Inch; Row by Row


Thorp, John M., Jr. (2021). Inch by Inch; Row by Row. BJOG: An International Journal of Obstetrics & Gynaecology, 128(3), 469.


Progress in medicine is slow, incremental, and unpredictable. In 1961 the discoverers of messenger RNA had no idea that this worker molecule would be the platform for vaccines to save the world from pandemic in 2021. The gardener’s slogan as she toils daily – ‘inch by inch, row by row’ – holds true for the biomedical. Enjoying the articles in this month’s BJOG brought that truism to mind as I compared my training in a ‘state of the art’ gynecology residency in the 1980s to what I read. In that era, women with advanced ovarian cancer underwent daunting (for the individual) and heroic (for the surgeon) debulking operations only to spend the last few months of their lives recovering from their surgery. Cervical cytology was a crude screening tool dooming many women to unnecessary excisional ‘cold knife cones’ imperiling cervical function and their fertility and ability to carry a pregnancy to term. Our program had a day each week of operating time devoted to that procedure and I wonder how many preterm births I caused. ‘Rule out ectopic’ dominated my time spent in the emergency department and the once weekly quantitative HCG run on Fridays at noon forced us to rely on the painful diagnostic test of culdocentesis. While doing one armored against critique in the M and M conferences, it hurt so much that I imagine many women waited until their ectopic ruptured before presenting to avoid it.


Reference Type

Journal Article

Article Type


Year Published


Journal Title

BJOG: An International Journal of Obstetrics & Gynaecology


Thorp, John M., Jr.