Sun rise 2019

Matula Thoughts Jan 4, 2019

Sun rise 2019
3734 words

 

Periodic re-explanation. This column, Matula Thoughts, recalls ancient uroscopy flasks called matulas, used for centuries to examine urine for clues to illness. People want to know “what comes next,” a question, explicit or unspoken, dominating most conversations in medical practice: “can it be fixed and what will happen to me?” Remedy and prognosis mattered more than diagnosis in ancient days, when technology and verifiable medical knowledge were sparse, and understanding pathophysiology (using today’s terms) was not as useful to a patient as remedy and prognosis. Direct examination of urine, particularly for color change, was one of the few early tools of practitioners and the matula was the dominant symbol of the medical profession for over 600 years in western art, until Laennec invented the stethoscope in 1816.

As a monthly collection of thoughts, relevant and random, from a senior genitourinary surgeon, the title seems appropriate. This electronic column began nearly 20 years ago in Allen Lichter’s dean’s office as a weekly email called What’s New. After returning full time to Jim Montie’s Urology Department in 2007, we continued What’s New as a weekly communication, published every Friday by varying members of our department, except for the first Friday of each month when I claimed the electronic podium. A parallel version began 5 years ago on the website MatulaThoughts.org. Happily, the Department of Urology will soon have a new chair with forms of communication to better match the times and people of the next decade. Nevertheless, this monthly habit will continue at MatulaThoughts.org reflecting personal observations, relevant and irrelevant, and events related to Michigan Medicine and the Department of Urology. [Above: Sun face on ceiling fresco, church of Saint Jean-Baptiste de Larbey, Southwestern France. 1610. Wikipedia. Below: variant of Nesbit log by Julian Wan.]

 

One.

Imagine just 100 years ago how different things were for our predecessors at the University of Michigan Medical School: Americans were recovering from WWI and the first two deadly waves of the 1918 influenza epidemic; Woodrow Wilson was US president, having been Princeton president when he was offered the Michigan job ten years earlier; women couldn’t vote and any adult could drink alcohol on this day in 1919, but by the end of the year women’s suffrage was secured in the 19th Amendment and prohibition came with the 20th Amendment; socialist and communist parties were on the rise; anarchists were preparing for spring bombings; and racial tensions festered nationally. Meanwhile, the University of Michigan carried on with its work at the Medical School and University Hospital, as life went on in Ann Arbor. [Above: Approaching New Year’s Eve, December, 2018, Liberty & Ashley, Ann Arbor.]

The University in 1919, already more than a century old as an organization and in Ann Arbor for around 80 years, was amidst a building binge under President Hutchins with the new Union, Art Museum, Hill Auditorium, and other defining structures. The 60-year old Medical School, which had looked quite good to Flexner on his visit in 1909, had since fallen behind its peers in terms of facilities. The hospital was badly out of date well before the war and replacement was further delayed by the national emergency. The practice of urology at UM was a little more than a single faculty effort in a surgery department consisting of a handful of other individuals.

Late in 1919, Medical School dean Victor Vaughan recruited Boston urologist Hugh Cabot, who would engineer 11 years of change bringing the Medical School back to the top of medical education internationally and at the pinnacle of state-of-the-art clinical practice for the first time. Academic urology in Ann Arbor surely began with Cabot.

 

 

Two.

Pundits and ordinary folk made predictions and resolutions when the sun rose on 1919 and we repeated these customs three days ago. Events will happen and paradigms will surely change over the next 12 months, but the only solid predictions this posting will offer for 2019 are: a new chair will begin stewardship of this fine Department of Urology sometime soon and we will celebrate the Michigan Urology Centennial later in the year. Other than those predictions, the rest is noise (to borrow the title of the book on 20th century music by Alex Ross). Sunrise each new day or year brings uncertainty and new possibilities. Predict and resolve whatever you wish, paradigm changes are usually outside your control, although the ability to recognize their inflection points is a useful gift. [Below: Encyclopaedia Biblica, 1903. Public domain.]

The centrality of the Sun to life is a fundamental feature of biology and logically a universal symbol in human civilizations. The 14th century BC image of pharaoh Akhenaten (Amenhotep IV) worshipping sun god Ra, in form of Aten, shows a partial solar disc with rays ending in little hands. Curiously, Akhnaten (1983) was one of three biographical operas written by American composer Philip Glass, the other two being Einstein on the Beach (1976) and Satyagragha (in 1979, about Mahatma Gandhi).
Inevitably, an Anthropocene imprint was added to the sun, seen in the introductory figure from Larbey and much earlier in a 4th century BC marble relief of sun god Helios driving his chariot at the Temple of Athena in Troy. [Below: Pergamon Museum, Berlin.]

The man-in-the-moon, a whimsical anthropomorphic imagination, when combined with a solar face suggests the ancient Asian complementary opposites yin and yang. [Below top: Amiens, Bibliothèques d’Amiens Métropole, manuscrit Lescalopier (Fourth Day of Creation) c. 1200. Wikipedia. Bottom: yin and yang.]

 

Janus, Roman god of beginnings, looked to both the future and the past, presiding over transitions such as war and peace,  and might be viewed as a symbol of paradigm shifts in modern times . [Below: Janus, Vatican Museum.]

Solar symbols, seen on some national flags, are ubiquitous in the Happy Face, the mother and father of all emoji, designed by commercial artist Harvey Ball in 1963. Charles Kuralt’s Sunday Morning show, launched by CBS News on January 28, 1979, continues to employ a solar disk theme throughout 40 years of reiteration by Charles Osgood and Jane Pauley, remaining a pinnacle of news and civilized commentary as each episode rolls through a set of beautifully curated solar symbols. [Below: Sunday Morning (top) & Authentic Worcester Smiley (bottom).]

 

Three.

Isaac Newton’s big paradigm shifts began inauspiciously when he was born this day in 1643. His birth date in the old-style calendar was 25 December 1642, but Gregorian conversion brings his birthday to today in the modern calendar and solar year. Bad luck shaped him from the start; father died three months before he was born and mother commented that Isaac, ar birth, could fit inside a quart mug (Wikipedia). Mother remarried, but young Isaac, unhappy at home and bullied at school, reacted by focusing on his studies, becoming a top student at Trinity College in Cambridge. Apples, gravity, planetary motion, and mathematics come to mind at first with Newton’s name, which is also celebrated in the term for a unit of force.

Newton’s color theory was another product of his astonishing ability to think about the world and find clarity about how things work. Countless people before him had seen white light refract through glass prisms into the colors of the visible spectrum and everyone sees rainbows. Yet only Newton carried those observations into a theory of color, described in a book he wrote at 71 years of age in 1704: Opticks: or, a Treatise of the Reflections, Refractions, Inflexions, and Colours of Light. [Above: double Alaska rainbow. Eric Rolph. Below: Color wheel of Goethe. Wikipedia.]

Color theory continued to attract great minds, including German polymath Johann Wolfgang von Goethe (1749-1832) and Scottish scientist James Maxwell (1831-1879) whose differential equations in 1865 explained the electromagnetic spectrum. [Below, User:penubag, Wikipedia.]

An early Apple Computer symbol (above) was perhaps an intentional play on Newton himself and Adobe’s color disk (below) fragments color into infinitesimal gradients of hue.

 

Four.

Urine may not be a window to the soul, but it’s a useful indicator of disease through color, sediment, or odor. Red is an obvious hallmark of trouble, whether renal trauma, urinary stone, kidney cancer, bladder cancer, infection, BPH, structural anomaly, metabolic dysfunction, rhabdomyolysis, or genetic mutations. Ancient uroscopists expanded color change into fanciful imaginations and medieval uroscopy charts offered wild speculations of what color, sediment, consistency, smell, and taste of urine might portend in terms of prognosis. [Below: uroscopy clinic. Hortus Sanitatis. 1491, Mainz. Courtesy Dick Wolfe, Countway Library.]

The paradigm shift from uroscopy to urology occurred over two centuries replacing sensory examination of urine by eye, nose, and occasionally tongue, with microscopy and chemical analysis. Nevertheless, persistent uroscopic fortune-tellers claimed legitimacy even in the face of emerging scientific reason. Thomas Brian’s book in 1637, The Pisse Prophet, is a classic example of rational attempts to debunk dogma and fraud.[Below: Wellcome Library, 1655 copy.]

The metabolic dysfunction porphyria (named for purple urine) affected Scottish physician, Archie Cochrane, born 110 years ago in 1909 on January 12, and the prime advocate in modern times for evidence-based health care. Later this month Guilia Lane, our FPMRS fellow, will educate us on Cochrane in What’s New. [Below: normal urine sample on left and porphyria sample on right.]

This sample below from my clinic a few years ago was oddly green, but I failed to make note of the cause. Color still matters in modern urinalysis although, since matulas gave way to microscopy and chemical analysis, physicians rarely demand to view urine themselves before it heads to a machine or laboratory.

Macroscopic uroscopy gave way nearly completely to modern urine investigation with specific gravity measurement, chemical analysis, microscopic exam of spun sediment, bacteriologic culture, antibiotic sensitivity testing, and who knows what will come next. Twentieth century urinalysis was a cornerstone of urologic practice when it was unimaginable for a patient to leave the office of a good urologist without submitting a urine for examination. Hinman’s Eight Steps to Presumptive Diagnosis constituted the basis of urologic practice, at his start in San Francisco in 1920 as the first trained urologist west of the Mississippi: history, general examination, abdominal and external genital exam, urinalysis including a stained smear, prostate exam, plain x-ray, phenolsulfonephthalein test (PSP), and residual urine. [Bloom DA, Hinman F Jr. Frank Hinman, Sr: a first generation urologist. Urology. 61:876-881, 2003.] Color and other sensory inspection still matter and while details have changed, urology is diminished somewhat when its practitioners no longer personally inspect urine grossly and microscopically, favoring instead automated readout from machine or lab.

 

Five.

The story 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 department alongside its sibling disciplines of Neurosurgery and Orthopaedic Surgery. 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 years. The new book should coincide with the Michigan Urology Centennial, beginning later this year. Urology is a microcosm of modern specialized health care, but its roots are also of particular interest as the first designated medical specialty in Hippocratic times and the stories since then of the discoverers, progression of skills, and innovations that led to 19th century genitourinary practice and 20th century urology should be retold and interpreted for each new generation.

No story is ever complete, in its recollections of the past, because only partial relevant knowledge is known to any author and myriad other details of the cultural and physical soups surrounding those facts are mostly lost to historical recollection. Lucky historians may find, reconstruct, resuscitate, or recover useful details, but all stories are largely narratives of imagination and facts, whether true facts or otherwise, in the words of the late urological scientist, Don Coffey. Stories, even as particular as one of an academic urology unit, are enriched by the context of its people, events, and circumstances. For example, it’s inconceivable to consider urology at Michigan without understanding Moses Gunn, and any appreciation of Gunn requires the context of the Civil War. In that sense, the Michigan urology story aims to be rich in context.

 

Six.

The bicentennial edition of Howard Peckham’s sesquicentennial work, The Making of the University of Michigan, by Margaret and Nicholas Steneck is indispensable to understanding this institution. The Stenecks proposed, metaphorically, that this university began with a single strand that represented the foundational aim of the university to disseminate knowledge and embracing education at all levels. This strand thickened over time and became joined by a second strand, turning around the first one, the new strand representing knowledge itself, that must be interpreted, renewed, created, and disseminated through explorations, criticism, research, and invention. The Stenecks identified yet another part of the braid.

“Now there is a third strand wound with the other two. The University 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 reading lists for club programs, lecture series for enlightenment, and musical 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 assessors, state college presidents, and refresher demonstrations for physicians and dentists. It provided radio and TV educational programs for all. Teaching–research-and service. These are the warp and woof of the University today.” [Peckham HH. The Making of the University of Michigan. 1817-1992. Edited and updated by ML Steneck and NH Steneck. University of Michigan. Ann Arbor. 1967, 1994. p. 1-2.]

A better term for “service thread” is that of public goods, and today those public goods extend far beyond the state of Michigan to the world at large. Universities, since the Middle Ages, have been the single entity in human society to attend consistently and dutifully, albeit imperfectly, to the human and planetary future. In the past few centuries the university, or the Academy as some call it, has extended from small Ivory Towers that educate a particular narrow subset of learners, to complex Multiversities with broader aims such as the Stenecks listed.

 

Seven.

Mission homeostasis. The University of Michigan entered the 20th century with a more complex, but clearer iteration of an academic medical center than it displayed at its start when medical education was the sole basis for its existence. The Chemical Laboratory in 1856 introduced the service of chemical analysis to medical education, clinical practice, and scientific discovery. A more complete linkage of medical education to clinical practice came with Michigan’s first university hospital in 1869 and by its third iteration in 1891 the triple mission of an academic medical center was fully in place, although confusion over priorities played out in such disputes as moving the medical school closer to large urban populations and hospitals, compensation of clinical faculty, and criteria for academic promotion.

Mission balance continued to confuse faculty and perplex leadership for that next century and into the present one. History brings some clarity to the matter: the University of Michigan Medical School began with an educational mission of training the next generation of physicians, research followed quickly initially to refine biochemistry in the service of the public, and clinical care was recognized as the necessary milieu for medical education and research. Among these three parts of the conjoined mission, clinical care is the moral epicenter, trumping any other part of the mission at any moment. Furthermore clinical care, a matter of complex intellectual teams, is the financial engine that currently underpins the other missions. Any great academic medical center must be first and foremost a state-of-the-art health care system that not only delivers excellent patient-centric service, but also studies and improves its systems of care and technologies along with its many scholarly and clinical disciplines. Clinical teams are the essential center and most important deliverable of academic medical centers. [Above: scribe’s heart measured against “feather of truth.” Book of the Dead, c. 1,265 BC. National Geographic, Ancient Egyptians. May 2009.]

 

Eight.

No Property in Man. January 15, 1929, the birthday of Martin Luther King, Jr., is celebrated later this month for his role in the slow, halting, and sometimes retreating movement towards universal human rights, a struggle that remains a very incomplete paradigm shift worldwide. [Above: MLK 1964.] Extending Mahatma Gandhi’s methodology of nonviolence and civil disobedience, King fought inequality through resistance that was nonviolent on his side of the bridge to change laws, public sensibility, and hearts and minds. Martin Luther King Day is celebrated around the time of Dr. King’s birthday, January 15, but the specific day this year will be January 21 according to the Uniform Monday Holiday Act. Michigan Representative John Conyers along with US Senator Edward Brook (MA) offered the first bill in Congress to honor King, but it fell short of passage by a few votes in 1979. In 1983, President Reagan signed the final bill to establish the day of remembrance, which commenced in 1986, also establishing a federal commission to oversee observance of the holiday. In 1989 President George HW Bush made Coretta Scott King a lifetime member of the commission. Toronto, Canada, Hiroshima, Japan, and Wassenaar, Netherlands also honor Dr. King with public observances.

We don’t close clinics, operating rooms, or phone lines for that day at Michigan (that would hardly have been in the spirit of Dr. King, anyway), but the occasion offers a time for reflection, study, relevant academic talks, and renewed efforts toward the unfulfilled paradigm shift to universal human rights. A good friend and Americana scholar, Jim Beuche, recommended a book called No Property in Man, by Sean Wilentz. In the spirit of this month, this is a “must-read” for 2019. Wilentz explains the issue starting at the Federal Convention (U.S. “Constitutional Convention”) in 1787.

“Descriptions of the Constitution as proslavery have misconstrued critical debates inside the convention. They have slighted the anti-slavery impulses generated by the American Revolution, to which the delegates, for better or for worse, paid heed. They have missed the crucial subtlety, which is this: although the framers agreed to compromises over slavery that blunted antislavery hopes and augmented the slaveholders’ power, they also deliberately excluded any validation of property in man.” [Wilentz. No Property in Man. Harvard University Press, 2018.]

Many forces assembled to abolish slavery in America, but Wilentz argues that the United States Constitution, the Republican Party (“an antislavery mass organization unprecedented in world history”), Proclamation 95 (Lincoln’s Emancipation Proclamation), and the 13th Amendment, legally abolished any legitimacy of the notion of “property in man” in America. [Below: page one of the five-page Emancipation Proclamation. National Archives.]

At President Kennedy’s suggestion, King led an effort to draft a Second Emancipation Proclamation, that would have outlawed segregation and expanded equality, but Kennedy’s Executive Order 11063 fell short of the draft. Lyndon Johnson’s Civil Rights Act of 1964, fulfilled more of King’s aspiration. That year King won the Nobel Peace Prize at age 35. He was assassinated in 1968 at age 39.

 

Nine.

Harvey Ball (1921-2001) designed the Happy Face to repair a decline in morale after the bumpy merger of two insurance companies. How effective the ideogram was in that instance is not clear, but Ball earned $45 for it and never applied for trademark or copyright. He never voiced regret for giving his symbol to the public, even after it became a universal symbol. Ball was born and raised in Worcester, Massachusetts, served in the Pacific Theater of WWII with a Bronze Star for heroism at Okinawa, started his own advertising company in his home town in 1959. One day, in 1963, he drew Smiley.

 

As a matter of law, copyright goes back to 1709 and the Statute of Queen Anne of Britain, the last monarch of the House of Stuart and the same Anne portrayed in the current film, The Favourite. Another current film, Mary Queen of Scots, portrays the start of the House of Stuart two centuries earlier, with the conception and birth of James, later first Stuart and first king to preside over England and Scotland.

The U.S. Constitution in 1787 includes a Copyright Clause (Article 1, Section 8), recently updated with the Copyright Act of 1976 and the Sonny Bono Copyright Term Extension Act of 1998, also called the “Mickey Mouse Protection Act” [Above: Queen Anne’s Statute. Below: Bell’s graph of US Copyright law expansion. “©1999-2008 Tom W. Bell. All rights reserved. Fully attributed noncommercial use of this document permitted if accompanied by this paragraph.” Wikipedia.]

Three days ago (Jan 1, 2019), according to U.S. copyright laws, all works published in 1923 entered the public domain. Sonny’s name was likely linked more to his music than his love of 1923 literature. (Wikipedia.) Works published then were to have entered the public domain in 1999, but were granted postponement by 20 years when Congress extended their copyright length with the Bono Act. Willa Cather’s A Lost Lady, Agatha Christie’s The Murder of the Links, Joseph Conrad’s, The Rover, Kahlil Gibran’s The Prophet, Marcel Proust’s The Prisoner (vol. 5 of In Search of Lost Time), William Carlos Williams’s The Great American Novel, and Virginia Wolfe’s Mrs. Dalloway in Bond Street were so reprieved.

[Above: copyright applied. Below: public domain.]

 

Ten.

Matula Thoughts analytics, 2018. We have no sense of the readership of the monthly What’s New delivered by email, but the web version, MatulaThoughts.org had 3454 views last year compared 3173 views in 2017. Viewers came from 89 countries, ranging from a few viewers in 35 countries, to 54 in Germany, 70 in the U.K., 87 in Canada, and 2578 in the US. Most views are cursory, but we enjoy hearing back directly from periodic careful readers who challenge our facts and alert us to errors.

[Above: analytics 2018.]
New Year 2019 began on a Tuesday and a short work week ends today for most people, but health care is a 24/7 business and by necessity we will offer more scheduled afterhours and weekend services at Michigan Medicine Urology, even though we have been doing so formally and informally for years. It is curious that most calendars begin each week on Sunday, although for most people that day is the end of the week and weekend, with the next week beginning at sunrise on Monday.

The 1902 fantasy film, Le Voyage dans la Lune, by Georges Méliés, shows an oversize spacecraft planted in the right lunar eye. We don’t have to travel 240,000 miles to stick it to a heavenly body, because Homo sapiens is doing this well enough right here at home on Earth, but possibly 2019 will be a turning point for planetary stewardship.

[Above: Schedel’s World History or Nuremburg Chronicle, 1493. Below: Earthrise, December 24, 1968. Apollo 8 astronaut William Anders.]

 

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

November rains

Matula Thoughts Nov 2, 2018

November rains


3724 words

One.

Autumn will transition from the front windshield to the rearview mirror this month, with November showers and Thanksgiving soon to follow. Colorful drives to work on Huron Drive, shown above a few weeks ago, are already memories as another seasonal foliage falls away and biological preparations begin for next season. [Below: back yard, October.]

While November rainfall is usually around the yearly average in Ann Arbor, at 3.07 inches, it bites harder than summer or earlier autumn precipitation, edging closer to snow. Last night’s rain was a taste of things to come. In contrast, November meteor showers, truly high lights, are considerably more prominent than in any other month. These falling or shooting stars are also seasonal, extraterrestrial bits of rock, usually nickel or iron, heating up and glowing as they enter the atmosphere 45-75 miles high and 45,000 miles per hour. Most night skies in the year display 5-8 sporadic meteors hourly, but in autumn, November especially, meteor storms are intense with more than 1000 shooting stars per hour. The Greek derivation of meteor means high in the air. Classification varies, with asteroids and comets as the larger interplanetary travelers while micrometeoroids and interplanetary dust are at the other end of the scale. The Meteor Data Centre lists some 900 meteor showers, but barely a dozen are well-known.

The Andromedids meteor shower first showed up soon after the University of Michigan Medical School opened its doors in 1850, when Biela’s Comet, passing near Jupiter, disintegrated into countless pieces around 1852. Earth passes through these remnants, among other celestial bits, every autumn with peak nights this year November 9-14. The Leonid shower, peaking November 15-20, contains meteoroids up to 10 mm diameter and 0.5 grams, annually depositing 12-13 tons of its stardust on Earth. The Alpha Monocerotid and Northern Taurid showers occur later in the month. Names come from the zodiac constellation locations of the origins (radiants) of the individual meteors in the night skies. [Above: all-sky fish-eye view of Leonid shower 17 November 1998, Modra Observatory, Comenius University, Bratislava. Wikipedia.] The existential threat of a large meteor strike, of course, is always “out there.”

Thanksgiving history precedes the Andromedids with origins in 16th century England where the monarchy, initially fused with Roman Catholicism, was intolerant of dissenting religions. The Church instilled many religious holidays in daily life and the calendar, 95 Church holidays not counting Sundays until 1536, when King Henry VIII, seeking an heir and other matrimonial opportunities, initiated the English Reformation. As supreme head of the Church of England, he and the new national religion were no less tolerant of dissenting religions, and pilgrims and puritans who couldn’t tolerate English intolerance relocated to North America where they initiated Thanksgiving ceremonies in Canada (1578), Virginia (1619), and Massachusetts (1621).

[Above: Shrine at Berkley Plantation, site of proposed “First Thanksgiving” December 4, 1619, in what would become Virginia. Wikipedia.]

Reforms of King Henry VIII reduced the Church holidays to 27 in 1536, but remaining dissenters argued to eliminate them entirely, calling for Days of Fasting or Days of Thanksgiving in reaction to the overwhelming burden of state-ordained religious holidays; disasters elicited fasting days while happier events, such as defeat of the Spanish Armada or birth of royal children, bringing thanksgiving days.

Independence of the United States brought separation of religion from government, and the fortunate afterthought of the First Amendment guaranteed freedom of religion and four other specified freedoms: speech, assembly, the press, and the right to lobby the government in redress of grievances. A book, The Soul of the First Amendment, by Floyd Abrams gives some of the backstory of that cornerstone of democracy, initially taken for granted in The Constitution. [Abrams F. Yale University Press. 2017.]

 

Two.

Thanksgiving and Ohio. Thanksgiving has largely avoided encroachment by the greeting card industry, which hasn’t pursued this unusual Thursday holiday as much as it has religious holidays, birthdays, Mother’s Day, or Father’s Day, to name a few. Some ingenious friends and colleagues, however, devise their own Thanksgiving greetings such as this from Nesbit alumnus, Frank Begun (1984), now at Ohio State, a few years back.

Frank looked more like a curmudgeonly surgeon than a cheerful Thanksgiving pilgrim, although his Michigan moustache in his Ohio State workplace, warmed our hearts.
I was at Ohio State last month as the Chester Winter Visiting Professor, where Cheryl Lee (1997) is the chair of urology, following Bob Bahnson.

Dr. Winter, a trainee like me from Willard Goodwin’s urology program at UCLA, led Ohio State Urology from 1960 to 1978 when Henry Wise II took over. Chester still lives in the Columbus area, but was unable to attend the education day that I greatly enjoyed in his honor. Chester got his BA and MD from the University of Iowa in 1943 and 1946 and trained in urology at UCLA. Chester co-invented radioisotope renography in 1955 and radioisotope cystography in 1960. He educated a generation of medical students and residents in urology, and cared for thousands of patients. Chester innovated procedures for priapism and incontinence, and contributed significantly to the urological literature. He has also written widely in American history, including a book on the history of Columbus, Ohio (below).

An interview with Chester online from the University of Iowa (May 16, 2017): “If you could change one thing about the practice or business of medicine, what would it be? Equality of opportunity and adequate quality in all the benefits.” [Above: Chet & Sandy, October, 2018, photo courtesy Cheryl Lee. Below: Cheryl, Emefah Loccoh medical student, Rama Jayanthi.]

Another Buckeye link, is Milwaukee pediatric urologist Jon Ellison (OSU MD and Nesbit 2013), after a stint in Seattle. Jon’s dad, Chris Ellison, was chief of surgery and medical school dean at Ohio State. Chris, Bob Bahnson, and I served together on the American College of Surgeons. The Winter Symposium was held by the Ohio State Urology Department at Nationwide Children’s Hospital, where Rama Jayanthi leads a superb pediatric urology team. Many residents and faculty, including the non-pediatric cohort, were present for the day. I’m grateful to the three chief residents who picked me as the Winter Professor and want to compliment Cheryl on the very strong OSU program and the intellectual excitement I saw there. [Below: chief residents Kristin Ebert, Joshua Ebel, Joseph Wan.]

Ohio State, Michigan’s perpetual Big Ten rival on playing fields, is a land-grant university, like most other Big Ten schools. Michigan, however, has a different origin story that began when America, at the start of the 19th century, nearly doubled in size after Thomas Jefferson’s Louisiana Purchase in 1803, that turned the American northwest into the midwest. Michigan territory got carved out in 1805 and territorial judge, Augustus Woodward, had an educational vision for the region that included a University of Michigan.

 

Three.

Higher education in America traces back, conceptually, to 1618 when Henrico College in Virginia was chartered by the London Company and given a grant of land and donation of a library, but a native American uprising killed the local colonists in 1622 before any educational program had started and the charter was revoked in 1624. Harvard College in Boston, founded in 1636 to educate the next generation of clergymen and civic leaders, fared better. The London Company and other New World ventures gave way to 13 colonies and a United States of America in 1776. After a rapid doubling of the national geography, it was evident that builders were needed, alongside the educated clergymen and civic leaders, to create national infrastructure. Rensselaer Polytechnic Institute (RPI) in 1824, introduced the German scientific/technical college, the next type of higher education in America. Stephen van Rensselaer and Amos Eaton established RPI for the “application of science to the common purposes of life.” [Wikipedia] Coincidentally (but not simultaneously) both Cheryl Lee and I graduated from RPI.

Medical education was separate from the rest of higher education in 19th century American colleges. Medicine, with little preliminary educational requirements, was taught, by lectures, cadaver demonstrations, preceptorships, and apprenticeships. The oldest public medical school, the College of Medicine of Maryland, charted in December 1807, founded the University System of Maryland and was at the time only the fifth medical school in the United States (after the University of Pennsylvania in 1765, Harvard University 1782, Dartmouth College 1798, and Columbia College of Physicians and Surgeons earlier in 1807.) Most medical schools throughout the entire 19th century were stand-alone small-scale private enterprises until after the mid-19th century when verifiable and scientific conceptual knowledge merged with new technology to bring specialized skills to clinical practice.

Augustus Woodward in 1816 published, A System of Universal Science, and proposed an epistemological framework for education, envisioning a catholepistemiad, or university, with a medical school called Iatrica and comprised of fields of anatomia, zoönomia, therapeutria, anthropiatria, chirurgia, mæeutria, zoötomia, and zoïatria. The rudimentary University of Michigania began in Detroit in 1817, but didn’t deploy Iatrica until 1848 after relocation to Ann Arbor, then calling it the Department of Medicine and Surgery. Abram Sager, the best educated of the five founders of the new medical branch, had graduated RPI in 1831 and obtained his medical degree from Castleton Medical College in Vermont before coming to Ann Arbor.

 

Four.

Land grant agricultural schools comprised the next iteration of higher education in America. Michigan State University in 1854 was a model for the federal Morrill Land-Grant Act of 1862 that allowed states to use proceeds from sales of federal lands, specifically 30,000 acres per state, to establish land-grant schools. Justin Smith Morrill, a founder of the Republican Party and US Congressman and Senator from Vermont between 1855-1898, proposed the act in 1857. [Above: Library of Congress] It was passed by Congress in 1859, but vetoed by President Buchanan. Morrill tweaked the act to include provisions for the colleges to include engineering and military instruction, and President Lincoln signed it into law on July 2, 1862, amidst the Civil War. The act was prohibited to any state “in a condition of rebellion or insurrection.”

Iowa, the first state to implement the Morrill Act, created its State Agricultural College and Model Farm in 1862, later becoming Iowa State University of Science and Technology. After the Civil War, the Morrill Act was extended to former Confederate states as well as future states and territories. If a jurisdiction claimed insufficient federal land to fulfill the land grant, the federal government authorized the state or territory to utilize federal lands in other states. Thus, New York State used Wisconsin timberland to fund Cornell University.

Ohio State University was founded in 1870 as a land-grant university and first named The Ohio Agricultural and Mechanical College, notably Ohio’s ninth higher-educational institution at the time. Its formation had been heavily promoted by Republican President Rutherford B. Hayes, against contrary lobbying by other Ohio public universities, that preceded the land-grant opportunity, namely Ohio University (opening for students in 1809) and Miami University (opening for students in 1824). In 1878, the school name in the charter changed to The Ohio State University to distinguish it from Ohio University.  [Below: National Institute of Food and Agriculture map of land grant colleges.]

 

 

Five.

The research university paradigm was a subsequent iteration of higher education, with the Doctor of Philosophy (PhD), the highest academic degree, as the distinguishing feature of the school. German educational reforms, inspired by Wilhelm von Humboldt, were embodied at the University of Berlin in 1810 under its various names before the present one. The Humboldtian model of higher education merged research, study, and education into the PhD and by mid-19th century many of America’s brightest students would go to Germany for PhDs after completing preliminary studies in America. Yale was among the first American schools to give out PhD’s and others followed. The first PhD hired at the University of Michigan was Franz Brünnow, from Berlin, whom President Henry Tappan brought to Ann Arbor in 1854 to deploy the university’s Detroit Observatory, although it was more than 20 years before Michigan awarded its first two academic PhDs. Victor Vaughan, later dean of the medical school, was one of those two recipients, later recalling:

“I had gone to Ann Arbor in 1874 some days before the sessions was to open. I was to work in the chemical laboratory, that was certain, but I wished to enter the graduate school and, if possible, secure a higher degree… In June, 1875, I was granted the degree of Master of Science. I wrote a thesis on ‘Separation of Arsenic and Antimony.’ This was published in the American Chemical Journal… In the fall of 1875 I continued in the same graduate work for the degree of Ph.D. This was the first time that this degree was offered ‘in course’ at Michigan. Hitherto it had been given, if at all, as an honorary degree, but about this time, it appears that the leading universities in this country decided to drop it as an honorary and offer it as a working degree. In this they followed the German Universities… There were two of us, the other being William H. Smith, who had graduated at Michigan and had taught one year at Vassar. Both of us received the coveted honor and entered the Medical School in the fall of 1876.” [Vaughan VC. A Doctor’s Memories. Bobbs-Merrill Company, Indianapolis, 1926. P. 94-99.]

Vaughan obtained an MD according to Michigan’s original two-year program, which soon thereafter became a three-year and then a four-year curriculum, and in time totally under the charge of Dean Victor Vaughan.

Within a century, a fifth iteration of higher education was evident here at the University of Michigan as well as some other universities that encompass all previous four iterations plus many other public goods and performing arts, including museums, athletic competitions, theaters, musical series, hospitals, health care centers, patent ownership, technology spin-off companies, and commercial partnerships. Most major universities have medical schools and, over time, many medical schools became closely tied to academic health care centers or networks, even fully integrating them as in our case at the University of Michigan.

 

Six.

The Woodward backstory. “‘Futurity,’ epigrammatically says he, ‘is an object of curiosity to all, but in some that curiosity is mingled with hope, in others with fear.’” This quotation comes from a paper called Augustus Brevoort Woodward – a citizen of two cities, and read March 5, 1900 to the Columbia Historical Society in Washington, D.C. by Charles Moore. [Records of the Columbia Historical Society. Volume 4, 1901. p. 116.] The “he” was Woodward, a curious man of obscure origins who became friends with Thomas Jefferson, then a civilian planter and politician in Virginia around 1795. After a contested election in 1796, Jefferson became Vice President under his rival John Adams on March 4, 1797. Woodward, meanwhile, had moved to Alexandria where he invested in property, with an initial $25,000, in the new Federal City. Woodward’s keen interest in government of that city likely transcended his economic interest, as judged by his numerous writings that also included matters of education and science. [Above: Golbez/maps Wikipedia Commons. Below: Judge Woodward, U.S. Department of Transportation Federal Highway Administration #68586. Woodward Avenue Action Association © 2006.]

Woodward and Jefferson continued their friendship, and after Jefferson won the subsequent presidential election, assuming office on March 4, 1801. Only 19 days later, March 23, Woodward was among the lawyers presenting themselves for admission at the first session of the Circuit Court of the District of Columbia, in the “half-finished Capital.” In a series of papers related to government of the District, Woodward argued for local representational jurisdiction, but in 1802 Congress allowed only a mayor appointed by President Jefferson and a council elected by property owners. The council would include Woodward.

Jefferson’s Louisiana Purchase required new cities, governments, and infrastructure within the Northwest Territory. A Congressional Act on 11 January, 1805, established the Territory of Michigan and required appointment of a governor and three judges. Jefferson named William Hull of Massachusetts as governor and the judges were Woodward, Frederick Bates, and John Griffin, all from Virginia. Woodward arrived in Michigan Territory, on horseback, the weekend after Detroit’s great fire.

Seven.

Woodward and Jefferson had very different personalities, but shared deep interest and expertise in education and in natural history, categorized now as science. The two men were early adaptors of the modern term. Woodward’s interests were expressed most inclusively in his 1816 book, A System of Science, that contained the basis for the University of Michigania, as named in 1817, when Michigan was still a territory. Woodward called the medical branch of knowledge Iatrica, listing its various components in on of the two curious fold-out tables at the end of the book. The grandly-named, but meagerly implemented university opened in Detroit in a modest building, but little record remains of the curriculum and students, except that activity was suspended due to cholera epidemics in 1832 and 1834. [Below: title page of Woodward’s book and fold-out table.]

 

Michigan became a state in 1837 and the University of Michigan moved from Detroit to Ann Arbor in 1838. The medical school didn’t open until 1850, and its official title was The Department of Medicine and Surgery.

 

Eight.

Faculty retention. Astronomy had a big place in the early years of the University of Michigan and its Detroit Observatory, built in 1854, was a marvel of the time. Its first director, Franz Brünnow of Berlin, had met University of Michigan president Henry Tappan who was in Berlin to acquire instruments for the new observatory. Tappan convinced Brünnow to come to Ann Arbor, although factors other than academic opportunity may have been play in the recruitment. Brünnow served from 1854 to 1863, was the first UM faculty appointee with a Ph.D., and married the president’s daughter. University politics, the firing of Tappan by the regents, and anti-German sentiments caused Brünnow to leave for the position as Astronomer Royal of Ireland and director of the Dunsink Observatory. [Above: Detroit Observatory, autumn 2018.]

His successor, James Craig Watson also became a big name in astronomy. Born in 1838, Watson came to Ann Arbor with his family from Fingal, Ontario in 1850, obtained a BA in classical languages in 1857, and then fell under the academic influence of Brünnow, succeeding him as director of the observatory in 1863 until 1878. During those years Watson discovered 22 asteroids, wrote the textbook, Theoretical Astronomy (1868), and was a member of important astronomical expeditions including trips to Iowa to see a solar eclipse in 1869 and China to see the transit of Venus in 1874. During a solar eclipse in Wyoming in 1878 Watson thought he saw planetary bodies closer to the Sun than Mercury and was convinced that a planet, he named Vulcan, existed. He believed that an underground observatory would prove Vulcan’s existence.

Michigan wanted to retain him, but didn’t commit to the odd idea of an underground observatory and Watson left for the University of Wisconsin in 1879 as inaugural director of the Washburn Observatory, with expectations of building the underground apparatus. Watson died of peritonitis, perhaps appendicitis, on November 23, 1880, and was buried in Ann Arbor at Forest Hill Cemetery, leaving a great legacy in astronomy. Vulcan proved to exist only in Star Trek and the underground observatory, built by Watson’s successor at Wisconsin, couldn’t find even the brightest stars and was declared useless. The stories of Brünnow and Watson reveal in academic astronomy, what we know so well in academic medicine: the sky is not always the limit in faculty retention. A lunar impact crater on the far side of the moon is named for Watson and underground detectors recently discovered the neutrino. [Photo below: Watson crater on moon. Acquired by Lunar Orbiter 5, 1967. Lunar Orbital Photo Gallery, NASA.]

 

Nine.

November rain. As Ann Arbor cools down and prepares for Thanksgiving, the month sometimes douses us with sobering realism, a sense captured in the musical ballad of Axl Rose, a work in progress at least since 1986 and released by Guns N’ Roses in their 1991, Use Your Illusion, I. The original album cover by Mark Kostabi evoked a detail in Raphael’s The School of Athens, although to me, the album title and the band’s name are more reflective of several works of Rene Magritte. In the larger sense November Rain, reminds us simultaneously of seasonal meteor showers, the complex nature of humanity, and the sobering reality of global environmental deterioration. The School of Athens detail gives some hope that human intellect, best stewarded in schools and universities, can improve the human condition and lead it forward in some harmony with its resource bank and engine, Earth.

[Above: Raphael (1483-1520) Vatican Collections. Below: detail.]

[Below: Use Your Illusion, I, Guns N’Roses, Geffen Records. 1991.]

[Above: Magritte. The Human Condition, 1933. National Gallery of Art, Washington. Below: Magritte, The Survivor, 1950.]

 

Ten.

Biela’s comet was zipping around Earth for a long, long time before it was identified and named by human beings. Baron Wilhelm von Biela (1782-1856), a German-Austrian military officer who fought in the Austrian Army in military campaigns against Napoleon, provided the name. An amateur astronomer, Biela had a keen interest in comets and sunspots. His comet, 3D/Biela, was recorded as an object in the sky in 1772 by French astronomer Charles Messier, but it was Biela who, in 1826, recognized it as a comet with periodicity of 6.6 years. It was spotted next by John Herschel on September 24, 1832, and calculations indicated that it would pass through the Earth’s orbit October 29, leading to dire predictions of catastrophic collision. Only two other comets had been recognized as periodic at that time, Halley and Encke. Biela also identified the Great Comet of 1823, as did Nell de Bréauté in Dieppe, France, and Jean-Louis Pons working in Italy. Biela’s Comet didn’t crash into the Earth, but rather started to break up before its 1845 return and by 1852 it came back in two large distinct sections, both identified by Otto Wilhelm von Struve, a family name familiar to urologists. [Above: von Biela. Below: drawing of Comet 3D/Biela in February 1846 after split into 2 pieces. 1888 book by E. Weiss, Bilderatlas der Sternenwelt. Sources, Wikipedia.]

The comet pieces were not seen on expected return in 1859 or 1865, but on November 27, 1872 a brilliant meteor shower with 3,000 pieces per hour was seen radiating from the predicted comet position and these meteors became known as the Andromedids, for their position relative to the imaginary Zodiac figure, or historically more precisely as the Bielids.

An intact Biela was making its rounds around Earth when the University of Michigan formed in Detroit in 1817, even if not observed in the sky and recorded by anyone at that particular time, yet shortly after the University Medical Department opened up the comet had been replaced by the Andromedids meteor shower a nightly spectacle of hot November rain witnessed by many if not most Michigan medical graduates over the past 168 years.

 

 

October correction: an earlier edition of October Matula Thoughts mistakenly noted Daylight Savings adjustment would end that month, when in fact it ends this weekend on November 4.

 

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