Urology at Michigan: The Origin Story Copyright © 2020 by the Regents of the University of Michigan Some rights reserved This work is licensed under the Creative Commons Attribution- NonCommercial-NoDerivatives 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/ by-nc-nd/4.0/ or send a letter to Creative Commons, PO Box 1866, Mountain View, California, 94042, USA. Published in the United States of America by Michigan Publishing Manufactured in the United States of America DOI: http://dx.doi.org/10.3998/mpub9470414 ISBN 978-1-60785-523-1 (paper) ISBN 978-1-60785-524-8 (e-book) ISBN 978-1-60785-634-4 (OA) An imprint of Michigan Publishing, Maize Books serves the pub - lishing needs of the University of Michigan community by making high-quality scholarship widely available in print and online. It represents a new model for authors seeking to share their work within and beyond the academy, off ering streamlined selection, production, and distribution processes. Maize Books is intended as a complement to more formal modes of publication in a wide range of disciplinary areas. http://www.maizebooks.org Urology at Michigan: The Origin Story Emergence of a Medical Subspecialty and Its Deployment at the University of Michigan David A. Bloom, Julian Wan, John W. Konnak, Dev S. Pardanani, and Meidee Goh Contents PREFACE vii PART I An Ancient Medical Specialty Reiterated and the University of Michigan 1 Introduction to a Medical Specialty 3 Medical Education, Practice, and the University of Michigan in Early America 17 The Department of Medicine and Surgery, Moses Gunn, and Civil War 27 A Medical School Hospital and Scientific Curriculum 40 Victor Vaughan’s Time 48 PART II A New Medical Subspecialty in North America and Ann Arbor 57 Origin Claims for Genitourinary Surgery in North America 59 The Bumpy Path to Charles de Nancrede and the Fulltime Salary Model 77 Challenges and Changes in a New Century 87 vi Contents Cyrenus Darling and Ira Dean Loree 94 The Post-Flexnerian Decade and Hugh Cabot 100 PART III The Roaring Twenties, Ann Arbor, and Hugh Cabot 119 Hugh Cabot: Family and Early Career 121 Hugh Cabot Comes to Ann Arbor, 1919 135 Hugh Cabot, President Burton, and 1920 143 Dean Cabot, 1921 151 Hugh Cabot, 1922–1926 160 Hugh Cabot, 1927–1930 179 The Medical School after Cabot 201 Cabot after Michigan 207 The Curious Connection of Howard Kelly to the University of Michigan 221 Epilogue 226 Index 228 Preface The story of the practice and discipline of urology at the University of Michigan was last told 20 years ago just after the Urology Section in the Medical School Department of Surgery emerged as a full-fledged depart- ment alongside its sibling disciplines of Neurosurgery and Orthopaedic Surgery on July 1, 2001. Much happened in the next 20 years to justify a new rendition of the story and additionally much more has been learned about the earlier times. Urology is a microcosm of modern specialized health care, but its story is also of particular interest for its ancient root as the single designated medical subspecialty set apart by the Hippocratic Oath 2,400 years ago from all other parts of medical care and education. The progression of skills and ideas, as well as stories of the people who advanced primitive healing arts to nineteenth-century genitourinary practice and then to twentieth-century urology, will be recounted as a primer on this field. We want to reinforce this part of medical historical literacy for new generations of learners while refreshing it for veterans. Just as urology training programs have had to provide basic surgical edu- cation for resident trainees, since most medical schools no longer reli- ably impart basic surgical skills, medical cultural literacy also must be taught, by default after medical school, in graduate medical educational levels of residency training and through continuing medical education for practitioners. No story is ever complete in its recollections of the past. An author has only partial relevant knowledge of any story, and the myriad other details of the cultural and physical soups that surrounded those facts are mostly lost to historical recollection. Lucky historians recover, recon- struct, or resuscitate useful information, but all stories are mainly nar- ratives of imagination and facts, whether true facts or otherwise. Don Coffey, the great urological scientist at Johns Hopkins Medical School, used to instruct his research trainees: “You have to learn to tell the differ- ence between facts and true facts.” Historical studies no less than scien- tific investigations aim to discern truth, although the sciences may strive vii viii Preface to reduce facts and observations to laws and principles, whereas histori- cal understanding is broadened by context. Stories, even as particular as this one of a single academic urology unit, are enriched by the context of their people, events, and circumstances. For example, it’s inconceivable to consider urology at Michigan without understanding the roles of early founders and university leaders in shaping the institution, the political tensions of the times, relationships with state and community, and the generous philanthropy that built and sustains the school, its faculty, and its programs. No less important are certain individuals such as Moses Gunn, present at the start of the University of Michigan Medical School in 1848, and any appreciation of Gunn requires the context of the Civil War. Tension between the clinical enterprise, so essential to medical education, and the other two elements of medical academia, teaching and research, first manifested at Michigan with Gunn, driving his practice to Detroit and ultimately to Chicago. The mission balance dilemma continues to per- plex medical schools today. Victor Vaughan was another towering figure at the University of Michigan from his awkward arrival in 1874 to the end of his life in 1927. His big career opportunity came with the Rose- Douglas controversy, when he was the right person in the right place, and throughout the years that followed the homeopathy issue bubbled to the top, collapsed, and resurfaced again. These stories are interwoven deeply in the Michigan urology narrative just as all medical specialties and academic organizational structures have their own relevant intersect- ing stories. The small detail of a genito-urinary surgery title on a University of Michigan Hospital letterhead from 1919 (on next page) signaled the transition from a small clinical practice of genitourinary surgery to modern academic urology. Hugh Cabot was the reason for that transi- tion, as the Konnak and Pardanani book slyly reveals, with the section “Why is Hugh Cabot included?” While it was a well-known fact that the Cabot era began in the 1920 academic year, the letter just mentioned and other documents to follow show the true fact of his actual arrival in Ann Arbor and work in the medical school to have begun in the autumn term of 1919. The contentious Cabot decade that followed defined urology at Michi- gan for the next century and brought the first two urology trainees to Ann Arbor: Charles Huggins would win a Nobel Prize in medicine for his work with prostate cancer, and Reed Nesbit would achieve nearly equivalent international prominence for clinical innovation and post- graduate education. Nesbit led Michigan’s first Section of Urology within the Department of Surgery and his fifth successor, Jim Montie, inaugu- rated an independent Department of Urology, in concert with Dean Allen Preface ix Lichter and surgery chair Lazar Greenfield, in 2001. Over the next two decades, the Department of Urology became one of the leaders and best of academic urologic departments according to surveys, rankings, patient preferences, learners, and faculty recruits. With those relevant details, and many others, this story aims to be rich in contextual factors. This volume entwines the stories of one medical subspecialty and a public university medical school within a single narrative. Other works probe the distinct stories of urology in America, the University of Michi- gan, and American medicine with far greater depth. Margaret and Nicholas Steneck’s bicentennial edition of Howard Peckham’s sesquicen- tennial work, The Making of the University of Michigan, is particularly Surgery department letterhead, Bentley Library collection of President Hutchins’ papers. x Preface indispensable to understanding this institution and is a model that its urology story herein seeks to emulate. The Stenecks proposed, metaphor- ically, that this university began with a single strand that represented the university’s foundational aim of teaching, to disseminate knowledge and embrace education at all levels. This strand thickened over time and was joined by a second strand, representing the knowledge itself, that must be interpreted, renewed, and rebutted, through exploration, criticism, research, and invention, while winding around the first strand of teach- ing. The Stenecks then added another part to the braid: Now there is a third strand wound with the other two. The Univer- sity touches more than just its young students and faculty. It gives services to the State that help maintain it; it aids citizens who never enroll. These services began when its hospitals received perplexing cases from all over the State. It continued with the upgrading of high schools, the testing of municipal water supplies, with experiments in reforestation, testing programs for state highways. It supplied read- ing lists for club programs, lecture series for enlightenment, and musi- cal concerts for entertainment. It expanded to research contracts for Michigan industries, development of new products for manufacture in Michigan, seminars for business executives, realtors and asses- sors, state college presidents, and refresher demonstrations for physi- cians and dentists. It provided radio and TV educational programs for all . Teaching—research—and service.