November

Autumn leaves and certitude

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Matula Thoughts 6 November 2020
4129 words



One.

Autumn leaves and Nobel Prizes normally highlight this season, although Covid, climate, and a consequential national election dominated our attention this year. The award in Medicine or Physiology last month, however, went for discoveries relating to the hepatitis C virus.

That curious terminology of medicine or physiology is a historic reminder how science was disrupting health care when the Nobel awards began in 1901. A new certainty of physiology and other scientific disciplines, explaining the basis of normal biological function and disease back then, is now widely accepted in the 21st century, although we realize that the optimal practice of medicine in addition to its scientific basis also requires art and humanism. [Above: autumn leaves, Ann Arbor westside, 2020. Below: Nobel Prize medal.]

Politics are also in the air this month, even more unpleasantly than usual, and the Nobel awards are no less political than other human enterprises. Conflicts over these prizes have involved nearly all fields including that of Medicine or Physiology. The 1923 prize to Frederick Banting and John Macleod for the discovery of insulin outrageously excluded Charles Best and James Collip. Honorably, the two named prizewinners independently split their monetary shares with Best and Collip. No award was presented in 1925; the two main contenders, Johannes Fibiger and Katsusaburo Yamagiwa, had been proposed separately as the first to induce cancer in laboratory animals, but both were branded “undeserving” with great certainty by a key member of the award committee. Fibiger had used a roundworm he called Spiroptera carcinoma (Gongylonema neoplasticum) to cause stomach cancer in rats and Yamagiwa used coal tar to create cancer on rabbit ears. After further deliberation the following year, the prize went to Fibiger, although in durable fact Yamagiwa’s work was by far the better proof of principle of chemical carcinogenesis. Nonetheless, Fibiger was the first to get this Nobel Prize for work related to cancer. The second time this happened was in 1966 when Reed Nesbit’s first urology trainee, Charles Huggins, shared the award with Peyton Rous.

The Nobel Foundation offended Adolf Hitler when it awarded the Peace Prize in 1935 to Carl von Ossietzky, the journalist who exposed the clandestine German rearmament, illegal according to the Treaty of Versailles. von Ossietzky, a Roman Catholic, had been detained and beaten in German prisons and concentration camps since February, 1933, and was hospitalized with tuberculosis when the award was announced. Hermann Göring ordered von Ossietzky to refuse the award and the Nazi regime prevented travel to Stockholm but, in an act of civil disobedience, von Ossietzky issued a note accepting the Peace Prize. The ugly politics caused two committee members to resign and Norwegian King Haakon VII dodged the ceremony, even though the recipient could not attend. von Ossietzky died in 1938 while hospitalized under Gestapo surveillance.

In February 1953 Watson and Crick assembled an accurate model of the structure of deoxyribonucleic acid (DNA). Rosalind Franklin’s x-ray diffraction images, shown to Watson by Wilkins, provided the “eureka moment” in which the double helix configuration was realized. Watson and Crick were recognized for this with a Nobel Prize in 1962, that they shared with Wilkins. Franklin, however, having died of ovarian cancer in 1958, never learned of her role in the breakthrough and, by virtue of the rules of the Nobel Prize, was ineligible because she was no longer living.


Two.

[Above: Newton, by William Blake, 1805. Tate Museum.]

Certainty 1.0. Craving certainty, we derived it for most of human history from personal observations, beliefs, and the authorities of the times. A Matula Thoughts correspondent from Georgia raised the matter of moral certainty last month, quoting H.L. Mencken on the issue:

“Moral certainty is always a matter of cultural inferiority. The more uncivilized the man, the surer he is that he knows precisely what is right and what is wrong. All human progress, even in morals, has been the work of men who have doubted the current moral values, not of men who have whooped them up and tried to enforce them. The truly civilized man is always skeptical and tolerant, in this field as in all others. His culture is based on ‘I am not too sure.’” [Minority Report: H.L. Mencken’s Notebooks (1956).]

Morality and certainty, historically, were inseparable for most of humanity, hardwired in cultures and written into laws of churches, states, and organizations. Morality, as a topic, is far beyond scholarly consideration of this set of essays, but certainty is a matter of keen concern in health care. Philosophers, religious leaders, royalty, politicians, have offered their versions of certainty over millennia, but certitude challenges easy universal agreement, as one’s certainty on an issue is based on one’s origin, belief system, willingness to reason, and livelihood. Mencken, Lewis Sinclair, C.E.M. Joad, and others have variably said: “It is difficult to get a man to understand something, when his salary depends on his not understanding it.”

From a practical perspective as a physician, certainty means belief without rational grounds for distrust. Medical practice demands that conclusions must be drawn with certainty, for example, from urine specimens whether in matulas, under microscopes, via chemical strips, or on culture plates. Urologists, as all practitioners, depend upon certainty in diagnosis and therapy, yet we cannot be absolutely certain about everything that passes under our visage. Relative certainty is a practical and essential qualification. [Below: Constantine examines urine in matulas. 11th c. Wikipedia.]

Mencken (1880-1956), influential journalist and social critic known as the Sage of Baltimore, could turn a phrase well, but he represented a peculiar elitism and exceptionalism of the first half of the American 20th century. Self-assured in his certainty, he often was acerbic and dismissive to those he perceived as lesser intellect or “lower caste,” although he didn’t use that terminology. Mencken was contemptuous of Franklin Roosevelt, argued against the New Deal, objected to U.S. participation in WWII, and harbored admiration for the Nazi regime. Ayn Rand was one of his great admirers, but other influential voices were critical. Christopher Hitchens later offered a scathing opinion of Mencken in a book review.

“How did one of America’s seemingly great rationalists and modernists come to regard Roosevelt as more worthy of condemnation than Hitler? The answer, on the evidence of this and other studies, is that Mencken was a German nationalist, an insecure small-town petit-bourgeois, a childless hypochondriac with what seems on the evidence of these pages to have been a room temperature libido, an anti humanist as much as an atheist, a man prone to hyperbole and sensationalism he distrusted in others and not as easy with the modern world and its many temptations and diversions as he liked it to be supposed.”

Hitchens also turned his phrases well, but when he hit, he struck hard and unsparingly. [Hitchens, “A Smart Set of One,” The New York Times (17 November 2002), book review of The Skeptic: A Life of H. L. Mencken (2002) by Terry Teachout.]

Certainty, although personally comforting, closes the mind to new ideas and leads to smugness. It is irrational to expect 7 billion people to share the same certainties about all matters, short of a limited number of generally-accepted facts, such as that days follow nights, the moon has phases, eclipses occur occasionally, kindness and civility are nice, and some things such as infanticide and cannibalism are grotesque. The first rule of certainty, however, is that change is inevitable and accordingly, uncertainty rules above all.


Three.

Uncertainty. Werner Heisenberg made uncertainty respectable when his concept of indeterminacy (on a very small scale) in 1927 garnered him the 1932 Nobel Prize. Erwin Schrödinger carried the idea to the visible world in 1935 with his famous thought-experiment and paradoxical cat. [Above: Heisenberg c. 1901; Below: Schrödinger c. 1933. Wikipedia.]




[Above: Movable silhouette of Schrödinger’s fictional cat in the garden at Huttenstrasse 9, in Zurich where he once lived; visitors outside the walls cannot know the cat’s position or its direction, at any moment. Wikipedia.]

Uncertainty entered the moral dimension and popular culture, it could be argued, with Bryan Cranston’s fictional character Walter White in the Vince Gilligan television series of 2008. White, a modern-day high school chemistry teacher, is followed over five television seasons “breaking bad” into a dark world of the manufacture and distribution of 96% “pure” methamphetamine. White’s nickname Heisenberg initially conveyed his good state as a brilliant chemistry teacher, but the full irony came out when Walter turned to his dark side as a meth kingpin. [Below: Breaking Bad publicity still, Walter White.]

Mencken’s caution of self-certainty and promotion of “I’m not too sure” belied a number of other outrageous statements, defaulting to intemperate self-certainty, and forgetting his own restraint of “I’m not too sure.” Some Menckenisms reflected primal certainty that trumped morality and civility, such as “Every normal man must be tempted, at times, to spit upon his hands, hoist the black flag, and begin slitting throats.” [Mencken, The New Poetry Movement, Chapter 6.] [Below: Jolly Roger Flag.]

Momentary reversion to the primitive pirate in everyman – casting off the morality and mores of humanity, whether in thought-experiment or actuality – can’t be blamed on Mencken. He articulated the idea well, but it hardly originated or ended with him, and homicide remains widely evident in fact and fiction; even if we do not choose to be murderous outlaws, we relish them in our entertainment.

It comes as a surprise, now, 20 years into the 21st century, to find widespread craving for authoritarian rule. Possibly, this is propelled by a growing sense of nihilism where too many people prefer the certainty of “I don’t really care except for what’s good for me” over the uncertainty of “I’m not too sure.”


Four.

Independent thought. Modern society seemed to be gravitating toward the intellectual relativism of “I’m not too sure,” although maybe that was my wishful thinking.

It is reasonable to believe that throughout human history most people prayed for relief from authoritarian subjugation by clan leaders, priests, pharaohs, princes, kings, queens, and dictators. Those few leaders dictated their personal certainties to everyone else, claiming authority derived from physical strength, bullying, divine authorization, bloodline, caste, national exceptionalism, political sectarianism, or other “isms.” Physical intimidation in authoritarian societies suppresses expression of uncertainty and even more effectively, the memes of sectarian “isms” act as ideological viruses replicating the certainty of patterned thoughts in individual minds and crowds, precluding reasoning and doubt.

People, perhaps most, chafe under authoritarian rule, although they may do so silently. The contrary meme of the pirate, openly rebuking authority of the establishment, always finds sympathy in regulated societies, even those not authoritarian and repressive. An interesting example is the island of Corsica, variably contested by many authoritarian nations over the centuries and now French, proudly displays its counter-cultural pirate symbol on flag and coat of arms. [Below: Corsican symbols of independence.]


Mental acrobatics that lead to certainty are sometimes called heuristics and, aside from crude mapping by functional MRI, the neural gymnastics at play defy our best imagination and science. It is more convenient to be told what things are certain than to be figuring them out in every step of life’s way. Our historic predecessors – early humans lacking today’s sharpened tools of logic, science, and debate – must have found comfort to be given explanations for solar eclipses, earthquakes, or monsoons by tribal leaders or village priests, rather than tremble at the uncertainty of it all.

The problem with human thinking nowadays seems to be the matter of how people deal with their sense of “I’m not too sure.” Methodological thinking, analysis of information, and fair discussion can help people understand what to be sure of, what to question, and how to decide. However, these instruments of education, science and free speech are only effective when we step outside the comfort of our particular certainties and open our minds to other opinions, information, rational debate, and experiments of thought and science. Too often, we revert to the easier dogma of our sects and certainty our leaders.

The Good Doctor, a new book by our Georgian colleague, examines the importance of uncertainty in medical practice; no good physician can be a know-it-all. On the other hand, nobody wants an ambivalent doctor who offers a list of ten possible diagnoses and ten potential remedies and tells us to choose what we prefer. [K. Brigham, M.M.E. Johns, The Good Doctor, Why Medical Uncertainty Matters. Seven Stories Press, NY, 2020.]

A relevant thought comes from professor Sarah Buss here in the UM Philosophy Department who explains to her students that they can’t gain a deeper understanding of issues they consider in class without becoming less certain where they stand on those issues: “I aim to help them gain clarity, knowing that the result will often be a loss of certainty.” Professor Buss, in turn, quotes colleague Kieran Setiya:

“The patience to ask and to keep asking questions, without the assurance of agreement or the availability of methods apt to elicit it, is the philosopher’s gift. It is an expression of intellectual hope, and the repudiation of philosophy is a counsel of despair.”

[K. Setiya. Monk Justice. London Review of Books. 42 (16), 30 Aug. 2018.]

For everyday events on the human scale, in space and time, things are usually one way or another. We are used to uncertainty in life, but we prefer predictability, whether in elections, horseracing, or surgical outcomes. In fact, we depend on some degree of certainty, even if it is the probability of knowing the odds of a specific throw of dice or hand of cards, assuming fairness of the event. Statistics for a condition or certain state within a group, however, doesn’t translate well to a particular person for whom having the condition or state is a personal possibility of “yes” or “no,” that is a 50% probably in their mental calculus.

Adjectives and numbers help arbitrate uncertainty. Even simple adjectives, as in the world of genetic diseases, may offer precision. For example, “rare” conditions are said to affect less than 62/100,000 people while “ultrarare” has come to mean fewer than 2/100,000. [J.M. Friedman et al, “Exome sequencing and clinical diagnosis,” JAMA, 324:627, 2020.] By this terminology hypospadias is not so rare (2 in 500 male births), while cloacal exstrophy is ultrarare (1 in 250,000 births). A recent zoom visiting professorship to our pediatric urology division from Katherine Hubert Chan of Riley Children’s Hospital, offered a lesson on graphics in surgical decision-making, utilizing icon arrays to demonstrate frequency of a given condition. Pictographs nicely convey a sense of likelihood or unlikelihood without the abstruse jargon of high-voltage statistical tools. [Below: an icon array.]

Five.

Certainty 2.0. At some point we humans admitted a new form of certainty into our minds, basing belief on rational argument, verifiable evidence, and experiment, rather than anecdote and authority. Paradoxically, this new certainty is based on acceptance of some uncertainty that facts and models change as we interrogate them. Nonetheless this should not allow a lazy retreat to anarchy and nihilism where nothing is held true.

Certainty is desirable in surgical practice; when treating stones, congenital malformations, or malignancies, specific identification of a problem is closely linked to beneficial solution. Yet knowledge and technologies change and yesterday’s certainty becomes today’s uncertainty, thereby reintroducing the questions, how do we know what is correct and how should we act today?

Hugh Cabot, founder of urology at Michigan and man of great certainty, took wide interest in medicine, often crossing epistemological boundaries to study and collaborate outside of his field. Working with pathologists on a paper on gastric cancer in the era of the Nobel controversy, Cabot and fellow faculty member George Adie had published their thoughts on its etiology in 1925, quoting views of their colleague, Aldred Warthin. [H. Cabot and G. C. Adie, “Etiology of Cancer of the Stomach,” Annals of Surgery 82 (1925): 86–108.] William Mayo, another physician with an Ann Arbor connection (UMMS, 1883), was also interested in the topic, writing a lead article in Surgery, Gynecology and Obstetrics in 1912 that discussed treatment from his point of view: “Cancer of the stomach: its surgical cure.” [SG&O, 14 (2): 115-119.] Mayo criticized lengthy diagnostic interludes that allow the disease to progress from “week to week” until by the time a practitioner has absolute certainty of the diagnosis before referring to patient to Rochester, “This is not a case for the surgeon, but for the undertaker.” Mayo concluded: “Cancer of the stomach is the most frequent and most hopeless form of cancer in the human body. Early operation affords the victim the only chance of a cure.” Time and discovery have altered the certainty of those conclusions. Ironically, gastric cancer took Mayo’s life at age 78.

The rapidly changing conditions, information, and misinformation surrounding Covid-19 have challenged medical certainty and public certainty. Political iniquity and social media mischief accelerate the uncertainty and miscertainty. Rather than dwell on this here, we offer two essential articles from NEJM, both accessible at no charge on the internet.
One editorial says it all. “Dying in a leadership vacuum,” [NEJM, 2020; 383:1479-1480.] A perspective by J.N. Rosenquist, “The stress of Bayesian medicine – uncomfortable uncertainty in the face of Covid-19.” [https://www.nejm.org/doi/pdf/10.1056/NEJMp2018857?articleTools=true]

Postscript.

Frank Legacki, legendary Michigan Swim Team Captain of the Class of 1961, successful businessman, and friend of the University of Michigan Musical Society and Department of Urology, passed away last month on 10/16/2020, leaving his wife, Alicia Torres. [Above: Frank at Steve’s Deli, September 23, 2020.]

Born 9/28/1939, Frank grew up in a tough Philadelphia neighborhood, the oldest of eight children – six boys and two girls. His parents, of modest means, believed in education and raised the children firmly and proud of their background and opportunities. Dad, a Polish immigrant, was a carpenter. Mom, daughter of Irish immigrants, deftly managed the large family. Frank attended Father Judge High School, where by luck and hard work, joined the rudimentary swimming team his freshman year. Lacking a pool at the school, Frank and teammates trained at pools as much as 1.5 hours away. Swimming was the glue that kept him focused in high school and he became a National Catholic High School Champion and a Scholastic All-American, earning athletic scholarships at several universities. Narrowing his choices to the University of Michigan and Ohio State University, both with top Collegiate Swimming programs, Frank asked his high school coach which school to attend. The coach answered, “Probably Ohio State, Michigan is far more difficult academically and you may have problems getting through at Michigan.” Frank decided on the spot to go to Michigan. 

Education and swimming at UM shaped his life. Eligible for the team in his sophomore year, 1959, Frank became NCAA Champion in the 100-yard freestyle and anchored the winning 400-yard freestyle relay. Two weeks later at the US Open Championship (later called the National AAU Championships) he set the American record in the butterfly. Michigan’s score of 95.5 at that competition was a new record and solidified the UM 1959 Swim Team as the greatest in NCAA history. Frank and his team continued to win and set records, and he was elected captain in his senior year, receiving other honors and leadership positions outside of athletics. Frank married after graduation in 1961 and stayed in Ann Arbor for an additional year to get an M.B.A. The couple would have four daughters, divorcing after 23 years.

A business career took Frank to New York City at Ogilvy & Mather Advertising. He went on to executive positions as: Managing Director of the Strategic Consulting Group of Marketing Corporation of America; VP of Marketing for Converse Athletic Footwear; Founder and President of the Andover Consulting Group; and President of Kaepa Athletic Footwear. Frank led a buy-out of this last company and eventually sold Kaepa to Umbro Sports Apparel. During these years he returned to UM for an M.B.A., graduating in the top quarter of the class.

In the business world Frank met Alicia Torres in San Antonio in the autumn of 1993 and they became business friends and then partners. Organizing a leveraged buyout of software products, and they formed Rosebud Solutions, generating outside investments, building a skilled team, and growing the business. Their partnership became personal and they grew close, marrying in Philadelphia on August 8, 1998, and then relocating in Ann Arbor. Rosebud was acquired by McKesson, Inc. (NYSE: MCK) in 2008. Frank went on to work part-time with Fletcher Spaght, Inc., a Boston venture capital firm, eventually retiring fully.

Frank, always loyal and grateful to UM, often said: “I was born at the University of Michigan; it was here I learned how to think.” In Ann Arbor, Frank and Alicia immersed themselves deeply in university matters and the community, enlarging their network of friends and interests. Frank was recognized for his achievements by induction into the University of Michigan Hall of Honor and The Pennsylvania Sports Hall of Fame. He stayed active with the University as President of the Grey Whales (Swim Boosters); Board of M Club Letter winners; UM Alumni Association Board; UM Urology Department Board; and Chair of the Marketing Committee of the University Musical Society. Frank was also President of the Barton Hills Maintenance Corporation. Frank and Alicia regularly attended over 20 UMS performances annually as well as School of Music Theater and Dance events. They generously supported Michigan Theater and were regular presences at UM athletic events, with season tickets for Football, Basketball, Hockey, Wrestling, Softball, and Swimming meets. Active fishermen, they cast lines in Florida and exotic locations around the world. Frank loved his time with grandchildren, Sam, Sophia, and Noah, taking them fishing, to UM events, and cooking together. The kids loved “GP Frank.”

Frank shared his rich and full years generously with friends, family, neighbors, and the University of Michigan. Alicia recounts:

“Frank had an amazing life. He gave much more than was given to him, and celebrated life like very few. He loved keeping in touch with elementary, high school, and college friends and those he met during his career and travels. Frank asked strangers about their life, where they were from and then, they too became Frank’s friends. Through his travels, Frank always carried an extra U of M cap, which he would give to people who captured his heart. When Frank entered a room, he owned it, you knew he was there, in a good way.”

Paul Legacki from Sacramento, Frank’s last living brother, was a frequent visitor to Ann Arbor in Frank’s final year. Frank anticipated his final days gracefully and with good humor, requesting his epitaph be borrowed from the last lines in Edmond Rostand’s great play, Cyrano de Bergerac. In the final scene Cyrano lies in Roxanne’s arms, mortally wounded and weakening, as he looks at Roxanne and says his final words; “They have taken my life, but they have not taken my panache.” Frank lived an active and interesting life, with extraordinary panache.

In one of the sweet coincidences of life, the lovely home of Frank and Alicia is situated exactly between those of Ananias Diokno (Nesbit 1970) and Kate Kraft (Nesbit faculty 2011), and across the street from the former home of Ed McGuire who succeeded Nesbit’s direct successor as Urology Section Chief in 1983, Jack Lapides (Nesbit 1950). Ananias and Kate’s family looked over Frank in his last days. Many of us lost an extraordinary friend when Frank died. His passing, at a young and robust 81 years of age of metastatic prostate cancer, reminds us painfully that we still have a long way to go in our work in urology.


Additional Postscripts.

The Lasker Awards were held back this year due to the Covid-19 pandemic. These are awarded annually since 1945 to living persons who have made major contributions to medical science or performed public service on behalf of medicine. This year the Foundation instead highlighted the 29 awards given in the past that recognized advances in infectious diseases, the first of those going to John F. Mahoney in 1946 for treatment of syphilis with penicillin and the most recent to Douglas Lowy and John Schiller for vaccination to prevent HPV in 2017. [J.L. Goldstein, JAMA September 25, 2020.]. My bet for a 2021 Lasker Award will be on Anthony Fauci for his tireless and courageous representation of scientific truth in the public interest in turbulent times.

Apocryphal Keynes quotations: “When the facts change, I change my mind. What do you do sir?” or “When someone persuades me that I am wrong, I change my mind. What do you do?” Variants of these have been attributed to redoubtable British economist John Maynard Keynes (1883 -1946), but no direct sourcing has been found. Nobel laureate Paul Samuelson and others alluded to versions of the remark, long after Keynes died. Whatever actual the source, it is an enlightened human idea.

True fact. Face masks diminish respiratory germ transmission by respiratory droplets. This is certain and has been clear to every surgeon, nurse, and OR worker on the planet for well over a century. Argument on this point is futile and malintented.

[Above: Justin Dimick and Hari Nathan, UM Surgery Department. Below: Aditya Pandey & Paul Park UM Neurosurgery Department.]

Thanks for looking at Matula Thoughts this November, 2020.
David A. Bloom
Department of Urology, University of Michigan

November one

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DAB Matula Thoughts November 1, 2019

One hundred years of urology
2615 words

One.

The origin of urology at the University of Michigan centers around its first three urologists Hugh Cabot, Charles Huggins, and Reed Nesbit, each having enormous impact in their individual ways. Cabot’s impact was academic, clinical, and organizational. Huggins came to Michigan for what was then called “postgraduate training” under Cabot and was inspired to a career in urology that took him to the University of Chicago as chief of urology and eventually to a Nobel Prize. Nesbit, roommate of Huggins as trainees, became Cabot’s successor and a noteworthy urologist, whose clinical innovation, organization leadership, and education of future leaders of his century, had few equals.

The story of genitourinary surgery, of course, actually began much earlier, with pre-Hippocratic roots and slow evolution until the second half of the 19th century when health sciences, modern technology, and medical subspecialties emerged and revolutionized medical care. The University of Michigan story is entwined with those changes, as one of the earliest public universities and in 1869 it was the first university to own and operate a teaching hospital. By the early 20th century the University of Michigan Medical School was noteworthy among its peers in teaching and research, but lagged behind in the clinical arena, a fact that some viewed as due to its small-town location. After the 1902 neologism by Ramon Guiteras the term ii replaced that of genitourinary surgery, although not until many years later in Ann Arbor.

Exactly one hundred years ago, on November 1, 1919, the University of Michigan Medical School, although still stuck in educational and clinical paradigms of the previous century, was on the precipice of major change that would launch it into the major leagues of 20th century academic medicine. Dean Victor Vaughan, an immeasurable influence since his arrival in 1874 as one of Michigan’s first two Ph.D. candidates, had been distracted by duties in Washington during WWI and was reeling from the death of one of his sons who had been about to return home from his service in Europe on the Western Front. Vaughan had other national leadership responsibilities on his plate in addition to the war effort and his inattention to Michigan had left the Medical School without chairs for its two main departments – internal medicine and surgery. In Boston Hugh Cabot had recently returned home from 2.5 years of service overseas to find his private surgical and urologic practice “evaporated.” He discovered the Ann Arbor opportunity for a fulltime salaried job as chair of surgery and jumped at it. Beginning work on October 12, 1919, he initially stayed at the Michigan Union, but soon convinced the regents to allow him with his wife and four children to live in the unoccupied University’s President House until a new president was in place.

Cabot was a necessary change agent for the Medical School. He was a top-of-the-line international urologic celebrity even before his 1918 textbook Modern Urology. It is telling that his predecessors in genitourinary teaching and practice at Michigan, interim surgery chair Cyrenus Darling and clinical professor Ira Dean Loree, had been holding on to the older name for the field. Cabot was a self-declared urologist. A prolific speaker and writer, he was assiduous in connecting with new ideas, other specialties, and novel technologies. During the war he became a skillful administrator, ultimately rising to Commanding Officer (CO) of a British Expeditionary Force (BEF) hospital with over 2,000 beds near the front. While he would bring leadership and modernity to Ann Arbor, his brusque style had already created detractors on the national scene, as evident in files at the Bentley Library where a letter to Victor Vaughan from Bostonian Dr. Frederick Shattuck on September 30, 1919 commented:

“Dear Vaughan:
I am greatly interested in your capture of Hugh Cabot for whom I have high regard and much affection, not so much because he is a first cousin of my wife, though very much younger, as for himself and what he is. His departure will be a loss to me, personally, and I think a loss to this community; but the more I reflect on the matter the more I feel that he can render greater service, and thus derive greater satisfaction from life by accepting your offer. Like other strong, positive men, he has made enemies, but I think his capacity to deal with men developed markedly during his service as C.O. of Base Hospital No. 22, B.E.F. There were difficulties connected with that practice which do not appear upon the surface, and it is my belief that, taking all things into consideration, he handled the job extremely well…”

Shattuck concluded the note offering condolence to Vaughan on the recent loss of a son in Europe, referring to the actual moment Vaughan got the terrible news just about as he was to preside over a session of the AMA at its Atlantic City meeting that summer. Cabot also must have been at that meeting, according to the correspondence, and it is likely that it was when and where he first learned of the Ann Arbor job, perhaps directly from Vaughan (letter below).

 

Two.

The first century of urology in Ann Arbor: October 1919 to October 2020. Michigan Urology now entertains a year-long celebration of its centennial. Cabot introduced modern urology to the University of Michigan when he arrived on October 12, 1919, and began to build a formidable clinical engine. He recognized that clinical practice is the essential piece of the tripartite mission of academic medicine, providing the milieu for medical education, factory for new knowledge, and regional reference point for clinical expertise. The clinical milieu generates inquiry and provides a testing ground for the ideas and technology to improve healthcare, and it is the spiritual center of the organization. Clinical programs provide the essential deliverable of academic medical centers. The clinical enterprise is also the financial engine.

Since 1972, Michigan Urology has called its alumni group the Nesbit Society, not from ingratitude to Cabot, but out of respect to his trainee Reed M. Nesbit who became the first Section Head of Urology, after Cabot’s abrupt departure in February, 1930. Over the next 37 years Nesbit made Ann Arbor an epicenter for medical education and clinical innovation. Nesbit trained nearly 80 residents and fellows (we are still trying to determine the exact number), and an extraordinary number of them became leaders in academia and their communities. As a principal innovator and master of transurethral prostatectomy, Nesbit made Ann Arbor a destination for doctors wanting to learn the operation as well as for “patients in-the-know” to get treatment. A number of Cabot’s other clinical faculty also became internationally dominant figures in their newly evolving clinical arenas, of thoracic surgery, neurosurgery, and orthopaedics as well as general surgery, thus bringing the University of Michigan to the center stage of clinical medicine for the first time in its evolution. Nevertheless, Cabot’s vision of a synchronous multispecialty academic health system eluded the University because the hospital functions and professional units (the clinical faculty) were competitive rather than synchronized.

 

Three.

The Nesbit 2019 Scientific Day last month was packed: Peggy Pearle from UT Southwestern in Dallas (above, with Stu Wolf from Dell Medical School in Austin, and Rod Dunn from our Dow Health Services Division) was featured as our Nesbit Visiting Professor with one talk on controversies in medical management of stones as well as another on ureteroscopy; UM President Emeritus Jim Duderstadt discussed the unique impact of the University looking back and looking forward; Jim Cogswell of the School of Art and Design gave a multimedia presentation on the mysteries of dark matter; Dan Dierdorf UM offensive lineman from the famed 1969 team and famed sportscaster presented his Michigan Memories; Stuart Wolf our own star faculty alumnus described the Michigan lessons he is deploying at the new Dell Medical School in Austin, and our departmental leaders gave updates on their divisions including Program Director Kate Kraft and CopMich Co-chair Jens Sønksen. This writer presented Centennial Thoughts and Ganesh Palapattu gave the State of the Department address. We had many wonderful returning alumni and I wish I could have shown them all on these pages, but more pictures can be found on the Nesbit100.com website. I also wish we could have had our traditional alumni talks, but we deferred those for this special Centennial Program, save for Peter Fisher’s unique talk of his personal experience that was both terrifying and uplifting: Everyone should experience sudden cardiac death —- and live. [Below from the top: Dan Dierdorf, Pete Fisher between Will Roberts and Phil Sweetser, Ganesh & Manfred Stöhrer.]

Manfred Stöhrer from Germany, Jens Sønsken from Denmark, and Kash Siddiqi from the UAE travelled far for this meeting. Some of us had been with Jens just a few weeks earlier in Copenhagen, and our ties to him and his team in Copenhagen go back nearly 30 years. The association with Manfred is just as long, with strong ties through Ed McGuire (below) and myself. Our actual but geographically distant faculty included Sherman Silber, now adjunct professor from St. Louis (below with postdoc Yuting Fan – Fanny), and Brian Stork and Jessica Phelps of our Muskegon West Shore Urology practice.

We consider UMMS graduates, residency trainees and alumni, faculty, regional colleagues, and other friends of the Department of Urology as Nesbit Society members, and many joined us to enrich the meeting. Bruce Bracken, John Hall, Phil Sweetser, Betty Newsom, the Chang duo of Cheng-Yang and Ted, Mike Rashid, Dave Morris, the Taub duo of Marc and David, the Kozminski duo of Mike and Michael, C. Peter Fischer, Howard Usitalo, Stan Swierzewski, Charles Gershon, Charles Reynolds, Jay Hollander, Amy Li, Parth Shah, Hugh Solomon, Joanne Dale, George Schade, Noah Canvasser, Katy Konkle, Bert Chen, Tim Schuster, Craig Kozler with son Oliver, Pete Fisher with son Jake who was interviewing for medical school, Brian Lane, Herk Khaira, Atreya Dash, Ray Tan, Ron Suh, and Scott Gilbert. Rebekah Beach, Frank Begun, Tim Bradford, David Burks, Ward Gillett, David Harold, Will Johnston, Earl Koenig, Surendra Kumar, Amy Luckenbaugh, David Perlow, Paul Sonda, and Nick Styn. Ed Kleer and Elena Gimenez from St. Joseph’s Hospital. Samir Basata, Bob Isacksen, Andre King, David Lutchka, Konda Mouli, Eric Stockall, and David Wenzler. UMMS alumnus Richard Tsou came from Hawaii Pacific Health. Jim Peabody and Nesbit alum Hans Stricker from Henry Ford Health System. From East Lansing we were honored to have Shirley Harding from Michigan State and Nesbit alum Len Zuckerman and Sparrow Residents Margeaux Dennis, Eric McKeever, Andrew Schwinn, Alex Shannon, and Ross Voelker. David Miller won the Konnak Faculty Service Award.

The evening reception at Zingerman’s Greyline event space at the Marriott was terrific with Thad Polk and Red Berenson who offered stories of hockey and Putin. Next year’s meeting will conclude this year-long Centennial Celebration of Michigan Urology and will center around the Wisconsin football contest. The dates will be September 24-26, 2020.

 

Four.

The game. The tailgate at Nub Turner’s GTH Investments provided a more relaxed social gathering point than the scientific program of the previous day. With the concurrent Homecoming Weekend and Parent’s Weekend, Ann Arbor was hopping. The victory over Iowa was a modest win, and it was largely won by our defense. The B-52 flyover was a crowd-pleaser, and the Veteran of the Game was a UM graduate named Thomas Houdek (below).

Michigan Urology has many notable veterans, although none more distinguished than Edward J. McGuire, the man who succeeded Jack Lapides in 1983 and hired me in 1984. Courtesy of Julian Wan we sat in the Club seats with Khaled and Mary Ellen Hafez (below).

 

Five.

Seasonal note. Autumn is fishing season in academic medicine when senior medical students prowl the nation’s training programs for residency education to select where they hope to learn their lives’ work. This process of residency training, postgraduate medical education, was quite informal in Cabot’s time, a century ago – a sort of “arrange-it-yourself” process for periods of time from weeks to years in length. Now the process has been standardized and is regulated by professional organizations including the AUA, ABU, ABMS, and ACGME.

Training programs simultaneously audition medical students in clinical clerkships in summer and fall of the senior years and interview them formally in fall and winter. Each party then submits their “rank lists” to a national site and matches are made for urology residency training positions. The process of interviews, selection, and then the actual residency training of 5-8 years is delegated to the Program Director, a position that has grown increasingly complex over the years since the terms of Gary Faerber, Khaled Hafez, and now Kate Kraft. Selection, education, and supervision of residents requires a small village of helpers and Kate is assisted by Sapan Ambani and a team of committees. This year Michigan Urology had over 375 applicants, offered around 66 interviews, and will end up matching with four trainees who will begin their residency training next July 1. Michigan Urology matched five last year, one of whom will have an 8-year period that will include a substantial research component, and this is Joel Berends. Ganesh, Khaled, Kate, and Sapan plan to alternate 4 and 5 year classes.

 

Postscript.

Vaughan’s reply to Shattuck. Only two days after Shattuck’s revealing response to the dean’s reference inquiry, Vaughan replied:

“My dear Friend:-
I am fully aware of the fact that Dr. Hugh Cabot being as strong a man as he is has made enemies and their criticisms have not failed to reach my ear, at least some of them. However I believe in Dr. Hugh Cabot and am greatly pleased that the prospect lies before me of having him as my colleague in work which I believe to be of the greatest importance to the future of American medicine. I congratulate myself and my school upon being able to obtain his services.

I wish to thank you for your words of sympathy. I had five sons in the Army and it seemed that the good fortune of having all of them returned to us was about to be accomplished. My eldest son was Chief of the Medical Service in the Roosevelt Hospital at Chaumont during the entire period of the war. After the armistice he was detailed to work up typhoid fever in the American Expeditionary Force. He had collected all of his data and was on his way home when he was accidentally drowned in a small river in France. It is the first time that death has visited our family. Time alone will assuage the sorrow but words of sympathy from such a dear friend as you will do much to mitigate our sorrow. Yours sincerely, V.C. Vaughan” [letter below]

 

PPS

In little over a decade Cabot brought the University of Michigan Medical School into the top tier of academic health centers. He recognized that a superb, attractive, and financially robust clinical engine was at the center of medical academia and he delivered on that necessity. Yet he spent down political capital rather than building it and he had a tin ear for the faculty and staff he led; it was not quite like his successful, albeit shorter-lived, experience as commanding officer at the Western Front of WWI. His successors in urology at Michigan continued to build one of the finest urology programs in the world, and Cabot surely would have been astonished to see what it looked like 100 years after he first set foot in Ann Arbor as its one and only urologist. [Below: Faculty, residents, alumni, guests at Nesbit Society meeting 2019.]

We thank those who joined us for this kick off for our Urology Centennial Celebration and invite you and those who couldn’t make it this year to the conclusion in 2020, September 24-26.

Best wishes as we begin November, 2019.
David A. Bloom
University of Michigan, Department of Urology, Ann Arbor

November rains

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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