Origin stories

WN/MT July 3, 2020
Origin stories
2518 words



One.

Hunkering down this spring, we explored Ann Arbor’s Water Hill neighborhood during social-distanced walks and saw flags that anticipated the Fourth of July. Tomorrow’s holiday brings to mind Danielle Allen’s book, Our Declaration. The American national origin story centers around a representative democracy formed disruptively when 13 colony-states spun off from a parliamentary monarchy. Even at the start, the story was complicated by the colonial expropriation of lands from their indigenous inhabitants and enslavement of abducted Africans to build the economy. These matters remain unreconciled, and so some Americans today will display the flag upside down, take a knee, or illuminate irreconciliation in other ways.

As the number of states increased in America, state sovereignty contested federal authority over a variety of issues amidst economic crises, wars, environmental catastrophes, epidemics, and paradigm shifts in technology. Life got more complex with technology, subspecialization, regional interdependency, and the sheer scale of rising population. Many matters transcended state boundaries and demanded federal solutions. Consider, for example, a public debate in 1820 on the role of federal government in matters of personal health, public health, medical licensure, specialty certification, and health care economics versus a similar debate today. The debaters in 1820 would have scratched their heads wondering what possible business the government could claim in such issues, except possibly a limited responsibility for public health.

The basic Jeffersonian aspirations within the Declaration, however, seem to hold true and anchor most of the attempted solutions to the nation’s big and little problems. Those personal aspirations – life, liberty, and the pursuit of happiness – bear repetition, especially now in July, 2020. It now takes great rhetorical acrobatics to discount the role of equitable public and personal health care in life, liberty, and the pursuit of happiness in today’s complex world. A debate in 2020 over the roles of federal government in matters of personal health, public health, medical licensure, specialty certification, and health care economics would be quite different than that imagined debate of 1820.

One big effect of this pandemic may be that the public may find a way to build a new vision of government “by the people and for the people” that will fine-tune the aspiration of “life, liberty, and the pursuit of happiness” to the complexities of 21st century civilization. Governmental responsibility for “life, liberty, and the pursuit of happiness” entails securities of personal freedoms, food, and employment, as well as public safety and public health. Any line placed between public health and personal health, or between public safety and personal safety is an arbitrary choice. These basic securities should be expected of any state or society, worthy of the term civilization.


Two.

Baseball comes to mind now, but this season is off to a slow start, if it happens at all. So meanwhile, a bit of time travel to the past is in order: a little more than ninety years ago (May, 1930) Ty Cobb threw out the first pitch at a new baseball park in Hamtramck, Michigan. [Picture below: 1928 International Newsreel photograph of Lou Gehrig on left, Tris Speaker, Ty Cobb, & Babe Ruth taken in April 1928.]

Cobb was a national celebrity who had retired from the Detroit Tigers in 1928 after 22 seasons and came back for opening day at Hamtramck, although he never actually played a game there. The new stadium, replacing Mack Park, would serve as one of the historic Negro League venues through 1951.

Mack Park had been home to the Detroit Stars, but after the grandstand burned down in 1929 the venue was relocated to the Hamtramck site, opening in May 1930. The Detroit Wolves took over for the Stars, in a new East-West league in 1932, but folded in the unfavorable economic times. The Detroit Stars was resurrected in 1933, but lasted only one more season at Hamtramck, that then lay empty. The Stars had a third life in 1937, but that too lasted only one more season. Detroit city acquired Hamtramck Stadium in 1940 and renovated it through Roosevelt’s Works Progress Administration as part of a larger Veterans Park project. Hamtramck Stadium has since hosted high school and Little League games, but after 2012 it fell into disrepair and neglect. Of the 12 remaining Negro League stadiums only Hinchliffe Stadium in Paterson, New Jersey and Rickwood Field in Birmingham, Alabama were in use longer than Hamtramck.

Michigan has some puzzling names, in that the historic contexts of their origins have been lost to most people today. Hamtramck, more than most American communities, reflects dominating effects of immigration and displacement of native people. [Below: Site marker installed August 2014.]



Three.

Hamtramck, a tiny city surrounded by Detroit, had little commonality with Ann Arbor, only 44 miles away, in that spring of 1930 when the University of Michigan Medical School was reeling from the firing of Hugh Cabot in February as dean and chief of surgery. No dean would replace him for three years and the school’s executive committee assumed the role of dean. Frederick Coller was named chair of surgery and appointed Reed Nesbit as the head of urology, but he was a “head” with a single deputy. It’s unlikely that Nesbit and the University of Michigan community knew much about Hamtramck Stadium when it opened that May 1930, although Nesbit became a devoted fan of the Detroit Tigers and certainly knew the name, Ty Cobb. Hamtramck Stadium would become one of the important Negro League venues and is listed on the National Register of Historic Places. [Below: Col. John Francis Hamtramck takes possession of Fort Lernout, part of mural at Detroit Water Building. Wikipedia.]

Jean-Francois Hamtramck (1756-1803), a French-Canadian soldier born in Montreal, came south to join the Continental Army and became a decorated officer in the Revolutionary War. He then served in the Northwest Indian War, displacing native American communities, and was the first commandant of Fort Wayne (Indiana). In 1796 he transferred to Fort Lernoult and the settlement of Detroit, where he died seven years later.

The Jay Treaty, designed by Alexander Hamilton and negotiated by John Jay in 1794, had ceded the fort from Britain to the United States effective 1796, when Col. Hamtramck moved there with 300 troops. Britain reclaimed the fort, by then named Fort Detroit, in the War of 1812. After the Battle of Lake Erie, the fort was returned to the U.S. and renamed Fort Shelby. In the aftermath of this and the Northwest Ordinance Act, territorial judge Augustus Woodward came to Detroit from Virginia with radical ideas on education that he deployed in the University of Michigania in 1817.

The town within Detroit that took Hamtramck’s name began as a farming community of German immigrants and incorporated as a village in 1901. There, the burgeoning Detroit Stove Works attracted industrial workers and shifted the demography from rural farmers to immigrant urban factory workers. By 1910 the Dodge Main Assembly Plant dominated the town, attracting new immigrants and within 20 years the town became heavily Polish and middle class. Of the thousands of factory workers in the 1920s, nearly 80% owned or were buying their own homes. Attracting a new generation of different immigrants, the town (2 square miles and 23,000 people) is now the most densely-populated and most ethnically diverse in the state and in 2015 became the first in the United States to elect a Muslim-majority city council.


Four.

Lessons of history. Each season brings particular infectious risks and in those days when Ty Cobb threw out that opening pitch at Hamtramck 90 years ago, parents were anxious about the summertime threat of polio to their children. Much less commonly, “infantile paralysis” also affected adults and such a victim, it was widely believed, was Mr. Franklin D. Roosevelt, a successful politician when it struck him in 1921 at age 39. He spent years in recuperation, and even afterward continued to struggle with the sequelae of severe lower extremity weakness, that he masked from the public when re-entering the political world as Governor of New York in 1928 and ascending to presidency in 1933. In retrospect, it is more likely that Guillain-Barre was the cause of his neuropathy. The polio story would intersect with the University of Michigan story two decades later. [Below: Photo: Two early-1950s March of Dimes “Fight Infantile Paralysis” posters designed by artist John Falter (of Falls City, Nebraska). (History Nebraska 10645-1197, 10645-4333)]

In the summer of 1953, many children throughout the northern hemisphere contracted polio, a seasonal fear of parents. Two children of a UM faculty member in the Surgery Department and practitioner at St. Joe’s were among those diagnosed. They were hospitalized for three weeks in the old “Contagious Hospital” during the presumed infectious period and then transferred, when afebrile, to a large ward of 32 beds in University Hospital (Old Main) on 10 West for the next five months of complete bed rest wearing knee-high boots, to prevent contractions, 24 hours a day.

One of the children, our colleague Skip Campbell, recalls watching Medical Sciences I Building being built from the ground up as he lay in bed. The “Sister Kenney Treatment” involved hot steaming under wool blankets twice daily. Both Campbell children recovered, although Skip’s sister had a life-long limp due to unilateral muscle atrophy. Skip recalled: “Quite a few kids in that place died, including a little girl in our room. Remarkably, I don’t remember a single nurse, doctor or my parents wearing mask!” [Personal recollection, Darrell Campbell, Jr., May 1, 2020.]

Sister Elizabeth Kenney (1880-1952) was a self-trained Australian nurse. After experience in WWI and with the 1918 influenza epidemic who in 1942 opened a clinic in Brisbane where she utilized heat packs and exercise among other regimens for polio. She brought her ideas to the US and settled in Minneapolis where the city gave her a house and she taught and practiced for 11 years. That work would lead into a new field variously called Rehabilitation Medicine, Physical Therapy, and Physiotherapy. [Below, Nurse Kenney, August 4, 1915 enroute to service in the Great War. Wikipedia, John Oxley Library, State Library of Queensland.] 



The Salk vaccine and enormous clinical trial (largely funded by FDR’s March of Dimes) coordinated by his professor Thomas Francis at the University of Michigan in 1954 largely eliminated the risk and fear of polio in North America. Salk used “killed virus” in his vaccine and despite safety testing, some batches from Cuter Laboratories contained live virus later linked to over 250 cases of iatrogenic polio. Greater government oversight of vaccine production was called for, but ultimately an oral vaccine from Albert Sabin’s team proved safer and gave more lasting immunity, although U.S. authorities were not initially interested in anything but the Salk series of injections and Sabin had to conduct his first large scale trial in the Soviet Union in 1959. [Below: Photo: Nebraska clinical trial of the Salk polio vaccine, May 1954. From KOLN/KGIN-TV, Lincoln and Grand Island. (History Nebraska RG809-51)]

Polio testing children, May, 1954.


Five.

Shimomura Crossing the Delaware, a provocative self-portrait of the artist Roger Shimomura, is prominently displayed at the National Portrait Gallery in Washington DC, – a wonderful place to visit when museums open to the public again.

At first glance Shimomura seems to turn history upside down, but with a little contemplation his work amplifies the idea of the American Dream. The artist fairly claims that America is his country too in 2010 as much as it was that of George Washington, who is more traditionally envisioned crossing the Delaware River on December 25, 1776. Shimomura’s large and striking painting, created nearly 70 years after Executive Order 9066, recapitulates the 1851 work of Emanuel Leutze at the Metropolitan Museum of Art (Washington Crossing the Delaware), but replaces Washington with Shimomura, the colonial troops with samurai warriors, and the geographical location with San Francisco Harbor and Angel Island, once a processing point for Asian immigrants.

In 1942, Shimomura, was not quite three years old when he and his family were forcibly relocated from their home in Seattle to an internment camp in Idaho. Franklin Roosevelt’s Executive Order 9066, signed two months after Pearl Harbor, caused this horrible trauma. That single presidential action designated military commanders to designate exclusion zones from which any American citizens or non-citizens could be excluded and relocated. Census data helped compile lists of such persons. Ultimately, 120,000 people, around two-thirds being U.S. citizens, were relocated to around 50 internment camps.

Ultimately, it is clear that the executive order and resulting program were based on “willful historical inaccuracies and intentional falsehoods,” according to a 1942 Naval Intelligence report that was suppressed by Roosevelt’s solicitor general Charles Fahey. The relocated people had posed no security threat, it was evident even at the time. Fear and ethnic bias left this terrible blemish on Roosevelt’s administration and the American narrative. 

The point here is that each of us creates their own origin story from their history as they know it – built on individual identities, beliefs, and aspirations. George Washington and Roger Shimomura had theirs, you and I have ours, and George Floyd had his. Each is as remarkably different as they are similar, sharing remarkable fundamentalities. John F. Kennedy may have said it best in his speech at The American University, Washington, D.C., June 10, 1963: “For in the final analysis, our most basic common link is that we all inhabit this small planet, we all breathe the same air, we all cherish our children’s future, and we are all mortal.”


Postscripts.

Another Shimomura. 

Osamu Shimomura (1928-2018) is a name that rings a bell for biological scientists. Not directly related to the American painter, Osamu was born near Kyoto he was a 17-year-old living in the Nagasaki area when the atomic bomb exploded 25 km away, blinding him for about 30 seconds and then drenching him with the black rain of the fallout. Against the odds he survived, was educated, and achieved great academic success, culminating in a Nobel Prize in chemistry in 2008 for his discovery of aequorin and green fluorescent protein. 

 

Ed Tank reminiscences.

Sherman Silber: “I am very sorry to hear of Ed Tank’s passing.  He taught me a lot from gender assignment in intersex cases to high diversion with pediatric hydronephrosis, which got me in deep trouble with some very opinionated and obstinate people.  He taught me a lot about adrenogenital and testicular feminization, and the bigger issue of the origin of gender identity and SEX preference.”  

Paul DeRidder: “I just read your latest “Matula Thoughts” and saw the article on Ed Tank.  In my senior year of medical school, 1971, I took a rotation in Urology.  Ed Tank was more or less my mentor.  I remember him well.  He was a determined surgeon, strong personality and great mentor.  I remember his suggestion that I review a text in pediatric urology, which I diligently went to the library to review many times.  He saw me in the library and was surprised that I was diligent enough to spent time reading the suggested text in my free time at the library. It was because of Ed, my feeling, that I was accepted to the Urology program as an intern, 1972.  When I completed my training, Ed had moved to Portland and as I was looking West to set up practice, I contacted Ed and asked if there were any openings in the Portland region.  HIs comment was “oh, no it is paradise here and we are saturated with Urologists.” He suggested I look elsewhere. Great guy!”


Thanks for reading Matula Thoughts, this July, 2020.
David A. Bloom

Independence

Matula Thoughts July 5, 2019

Independence Day

2055 words

Above: American flag. Copyright: Sticks Object Art & Furniture, Des Moines, Iowa.
Private collection, with permission.

“Paul Revere? Ain’t he the Yankee who had to go for help?” – old Texas joke. [DH Fischer. Paul Revere’s Ride. Oxford University Press, 1994.]

 

One.

July 4, 1776, meant different things to different people of the time. The British Parliament, indigenous peoples, enslaved workers in colonial states, southern planters, northern industrialists, loyalists of King George III, colonial rabble rousers, federalists, antifederalists, abolitionists, France, Spain, Irish Protestants, or Irish Catholics – to consider just some of the stakeholders – each had their own view of the matter.

Paul Revere’s midnight ride on April 18, 1775, was an iconic event leading up to Independence Day the following year, although its role as an actual tipping point between colonial discomfort with Britain’s royal authority over it and explosion into full-blown revolutionary action is beyond this essay. Causality aside, Revere’s ride inspired popular imagination, legend, and poetry. Henry Wadsworth Longfellow’s poem, published nearly 85 years later in January, 1861, in The Atlantic Magazine, reverberates in my brain, having learned it in my grade school yet another century later: “Listen my children and you shall hear of the midnight ride of Paul Revere …” That meme had legs and the idea of 13 United States of America became a reality and eventually transformed into the idea of a nation.

American regionalist painter Grant Wood (1892-1942) imagined the midnight ride from a bird’s-eye perspective in 1931 (above). You can view the original in Washington DC at the SAAM. The tiny detail in front of the church repeats the once-common misperception that horses gallop with all four legs in the air, extended front and back (below, top). Grant Wood either didn’t know better or else was deliberately naïve in using the archaic style. He was not really a student of the art of motion, his work only occasionally depicting moving objects such as the impending calamity in Death on the Ridge Road, painted in 1935 (below, bottom).

 

Two.

We celebrated independence for our chief residents and fellows  last month at the Art Museum of the University of Michigan. [Above: chiefs, courtesy Ankita Shah] The Museum had its origin in 1910 as Alumni Hall and I have fond attachments to it, not just because of the appearance, the contents, and its generous uses to the university and the public, but personally as well because our youngest daughter was married there, the Shirley Chang Gallery is housed there, and my late friend Helmut Stern left much of his great collection there as well.

Most graduations are moments of personal liberation and independence. Residents and fellows usually jump from an intense paradigm of responsibilities, schedules, and education to the freedom of their practices of urology, although that world has become more constrained than a generation ago. The idea of the “private practitioner” in health care, especially for surgical specialists is ancient history, although even back in those old days when most urologists entered small groups, they carried the discipline and professionalism of their training mentors and programs with them, out into the world.

Our graduation at the Art Museum was much more about character and culture than personal liberation. Junior residents presented the life stories of the graduating chiefs with grace and humor. Ella Doerge (story told by Rita Jen) will go to London for fellowship with Tim O’Brien at Guy’s Hospital. Ted Lee (story told by Matt Lee) will undertake a three-year Boston Children’s Hospital Fellowship. Zach Koloff (story told by Chris Russell) will also go to Boston to a first-rate Lahey Clinic – affiliated practice. Parth Shah (story told by Michael Fenstermaker) will join the excellent USMD Urology group in Dallas-Fort Worth. Over the five years these chiefs spent with us they became physicians, surgeons, and urologists that I’d trust in a heartbeat with the care of friends, family, or myself.

Our fellows were profiled two weeks ago in What’s New. Deborah Kaye (Society of Urologic Oncology/Health Services Research Fellow) will join the Duke faculty. Nnenaya Agochukwu (Global Health Services Research/RWJ Fellow) will undertake a second fellowship, this being at the University of California in San Francisco in reconstructive urology. Irene Crescenze (Female Pelvic Medicine Reconstructive Surgery Fellow) will join the Ohio State University faculty, under chair Cheryl Lee (Nesbit 1977).

Faculty awards went to Professors Matt Davenport and Jim Shields of the Department of Radiology and Chris Sonnenday of the Department of Surgery who have been essential collaborators with urology. Professor Alon Weizer was recognized as the Team Player of the Year. Among his many gifts, Alon is both a great virtuoso surgeon and a selfless team player, a very rare combination of talents. Vesna Ivancic, the embodiment of professionalism, was recognized for that crucial characteristic of a physician-teacher. The residents presented two awards to faculty: Sapan Ambani was given the Silver Cystoscope Award and Khaled Hafez was given the Julian Wan Award for Excellence in Resident Mentorship.

Chair Palapattu supervised a great evening and the new awards were wonderful additions. Kudos to Program Directors Kate Kraft and Sapan Ambani, Nesbit Society President Mike Kozminski, and Lora Allen. The evening was especially enjoyable for me, freed of responsibility for being sure all went well and the bill was paid.

 

Three.

New folks. Here in Ann Arbor we didn’t need a Paul Revere to announce the good news that our new residents and fellows joined us a few days ago and thankfully no calamities were encountered enroute. Joel Berends from San Antonio is the first-ever recipient of the American Urological Association and Urology Care Foundation Physician Scientist Training Award that will take him from now through June 20, 2027. Anna Faris from Cleveland Clinic, Mahir Maruf from Ross University in Florida, Catherine Nam from Emory, and Alexander Zhu from Des Moines University have also joined Michigan Urology and their program will go through 2024. The annual residency refreshment of July is always eagerly anticipated, although why it happens this particular month of the year and not at the beginning of the fall semester, as is usual in academics, is an interesting question, possibly due to coincidence with start of the common fiscal year of hospitals.  [Below: AA Farmers’ Market]

 

Four.

Chang Lecture. From 2007 to 2018 the Urology Department held a series of yearly lectures on art and medicine, to celebrate Dr. Cheng-Yang Chang for his educational and clinical roles at Michigan Urology and his work in pediatric urology. Dr. Chang’s father, Chang Ku-Nien, was a master painter of 20th century Chinese art and much of his work resides at the UM Art Museum. The Shirley Chang Gallery, named for Dr. Chang’s late wife, is a peaceful and beautiful refuge. [below: Shirley Chang Gallery]

Dr. Chang began training under Reed Nesbit and completed the program here under Reed Nesbit and Jack Lapides in 1967. His two Chang sons remain closely tied to Michigan Urology. Ted completed training in urology under Ed McGuire in 1996 and is now in practice in Albany, working near another great Michigan urology alumnus Barry Kogan. Ted’s older son, Kevin, recently graduated from UM, but is headed for the business/informational technology world. Hamilton, UM 1989, is an investment banker in Chicago and one of Michigan urology’s greatest advocates. [Below: Ku-Nien Chang. Taiwan Cross Island Highway, 1967. UMMA.] While it seemed appropriate to sunset the yearly Chang Lecture series when the urology chair turned over to Ganesh Palapattu, the idea of intertwined art and medicine lives on in our department and periodic Chang art and medicine events are likely to appear.

The Chang Lectures had three objectives. The first two were: celebration of an important and worthy Michigan Urology family and the responsibilities of universities to offer “public goods” – open lectures on general topics (even from a specialized department such as urology). The third goal relates to a belief that discussions of the conjunctions of art and medicine belong in medical schools and health care training programs. Art and medicine converge at the human interior. For artists, that interior is a matter of intellect, soul, hope, aspiration, fear, grief, love, and beauty. For those of us who tend to the contingencies of physical bodies, the interior is a matter of brains, bones, organs, fluids, cells, systems, and naturally includes our visible integument. When we began the lectures, visual art took center stage, although no art form was out of bounds and Joel Howell’s inspiring talk in 2009 focused on music.

 

Five.

The Smithsonian American Art Museum (acronym, SAAM) is a favorite stop in Washington, DC. Once known as the National Portrait Gallery, SAAM is a wonderful place for a quick visit, something less feasible at most other Smithsonian museums, but you certainly can spend a day at the SAAM where Paul Revere’s Ride by Grant Wood resides. When you happen by there, the Daguerre monument on the museum’s Seventh Street side is worth a look. Daguerre’s work grew into modern photography that would show how horses actually gallop.

Leland Stanford, a horseman among other things, commissioned photographer Eadweard Muybridge (1830-1904) to study galloping horses photographically. The gallop is too fast for human eyes to analyze and for centuries visual artists depicted all four legs were simultaneously in the air, extended forwards in the front and backwards in the rear, during a gallop. On June 15, 1878 Muybridge depicted Sallie Gardner at a Gallop, a series of 24 pictures in rapid succession and its 24 frames constitute the first moving picture. The gait analysis showed that when all four feet were simultaneously in the air the legs were gathered below the belly of the horse rather than extended front and back. Sallie Gardner was Stanford’s Kentucky-bred mare and the jockey was named Gilbert Domm.

 

[May 4, 2019; Louisville, KY, USA; Luis Saez aboard Maximum Security (7) crosses the finish line during the 145th running of the Kentucky Derby at Churchill Downs. Mandatory Credit: Jerry Lai-USA TODAY Sports – 12643976]

Luis Saez riding Maximum Security crossed the finish line at the 145th Kentucky Derby at Churchill Downs, May 4, 2019, ahead of the thundering herd, but was disqualified for interference with other horses. [Above: Reuters photograph] One hopes the interference was accidental, but rules are rules, the photographic evidence of the interference was self-evident, and it’s reassuring to find occasional evidence that the end doesn’t always justify the means. The arc of the moral universe may be long, but sometimes we live long enough to see it bend toward truth.

 

Postscript

Independence Day celebrates the first days of the American nation, as proclaimed in the astonishing Declaration of Independence, a beautiful piece of prose hammered out by committee with compromises made. The Constitution, produced also by a team, is a clunkier set of rules and regulations that was amended more than a year later with some ideas many of its signers took for granted and assumed the original Constitution offered no constraints on essential freedoms in a democracy. James Madison, principal author, finally was convinced that certain amendments were necessary including explicit enumerations of specific freedoms that people needed from government. The original Bill of Rights listed explicit protection for freedom of speech, religion, the press, assembly, and the right to lobby the government for redress of grievances. These were listed in the Third Article of the Bill of Rights that became incorporated in the First Amendment of the first ten amendments to the Constitution. The original First Article of the Bill of Rights dealt with the formula for representation in the House of Representatives and the Second Article specified details of laws related to compensation of the representatives.

Historian Gordon Wood, who once taught at Michigan and was popularized in a scene of a Harvard Square tavern argument in the 1997 film Good Will Hunting, once wrote: “… it was Madison’s personal prestige and his dogged persistence that saw the amendments through the Congress. There might have been a federal Constitution without Madison but certainly no Bill of Rights.” [Representation in the American Revolution, University of Virginia Press (Charlottesville, VA), 1969. (ISBN 978-0813927220)]

Human potential – with its science, technology, knowledge, and truth – is severely deformed and stunted when government restricts freedom of speech. Freedom of religion, the press, assembly, and the right to petition actions of government necessarily follow freedom of speech. Truth, equality, and the rights of The First Amendment come close to being the most basic secular principles of humanity and are always at risk and threatened in every civilization.

David A. Bloom
University of Michigan, Department of Urology, Ann Arbor