UROLOGY AT THE UNIVERSITY OF VIRGINIA

0022-5347/04/1726-2525/0 THE JOURNAL OF UROLOGY® Copyright © 2004 by AMERICAN UROLOGICAL ASSOCIATION

Vol. 172, 2525–2527, December 2004 Printed in U.S.A.

DOI: 10.1097/01.ju.0000144129.73745.22

Historical Article UROLOGY AT THE UNIVERSITY OF VIRGINIA EMILY BRADLEY

AND

STUART S. HOWARDS

From the Department of Urology, University of Virginia Health Sciences Center, Charlottesville, Virginia

The Department of Urology at the University of Virginia was among the first departments of its kind in the United States. From its inception in 1917 it has continued to be a rich and diverse department, producing some of the most outstanding figures in the history of the specialty of urology. The University of Virginia is itself a historically important institution. Founded by Thomas Jefferson in 1825, it was planned as an academic village representing all of the major disciplines of learning including medicine and law. It currently is regarded as one of the best public universities in the country. THE FIRST PHYSICIAN

At the university’s inception, Dr. Robley Dunglison was appointed the first professor of anatomy and medicine. He was 1 of 7 initial university faculty. In addition, his appointment marked the first full-time medical professorship in the United States. No hospital or clinic existed, and so most of Dunglison’s duties were in the classroom. Notably, Dunglison was called on to treat Thomas Jefferson. Dunglison wrote in his memoirs, “Mr. Jefferson found it necessary to consult me in regard to a condition of great irritability of the bladder under which he had suffered for some time . . . This required the use of the bougie, which he soon learned to pass himself.”1 Thus, one of the first, and most esteemed patients at the university was seen primarily for a classic urological problem. THE MEDICAL SCHOOL

As medical education in the United States progressed, so did the University of Virginia medical school. In 1881 the course of study was increased from 1 to 2 years. Again in 1899 the curriculum changed and the school was increased to 4 years of study. The hospital itself opened in 1901 and the first patient records were recorded in 1907. HUGH HAMPTON YOUNG

Hugh Hampton Young, often called the father of modern urology, graduated from the University of Virginia in 1894. He attended the university for 4 years and in that time earned a B.A., M.A. and M.D. Without any training in urology and with little experience of any kind, he was appointed chief of genitourinary surgery at Johns Hopkins University in 1897. His subsequent contributions to the field of urology were outstanding. He founded The Journal of Urology in 1917. In addition, for many years he retained an active role in training other prominent urologists. He was instrumental in the development of the department of urology at the University of Virginia as he trained the first 2 chairmen. JOHN HENRY NEFF, JR.

Born September 12, 1887 in Harrisonburg, Virginia, John Henry Neff, Jr., became the first chairman of urology at the University of Virginia. He attended the University of Virginia

for college and medical school, earning an A.B. in 1907 and a M.D. in 1910. Notably, in 1909 he coached the university football team to its best ever record of 7-1-0. He remained at the medical center from 1910 to 1916 to train in surgery under Dr. Steven H. Watts, then chairman of the surgical department. Watts established the departments of urology and proctology in 1917, and appointed Neff as the chairman of urology. To offer some perspective, the next surgical department established was the department of orthopedics in 1921. Neurosurgery did not become its own department until 1941, and obstetrics and gynecology followed even later in 1948. With little to no experience in urology, Neff visited Johns Hopkins and Young to learn what he could about the burgeoning field. In addition, he enlisted one of his attendants, “Big Louis,” as a subject for cystoscopy training. “Big Louis” was paid 50 cents for each examination, and so presumably the situation was mutually beneficial.2 Dr. Victor Marshall embarked on a career in urology based on his interactions as a medical student with Neff. Marshall graduated from the University of Virginia medical school in 1937 and became an extremely prominent figure in urology and chairman of urology at Cornell University. After his retirement from Cornell, he returned to the University of Virginia and assisted the residents in their clinic.

SAMUEL ALEXANDER VEST

Samuel Alexander Vest was recruited to the University of Virginia as chairman and professor of urology in July 1939. He was born in Haw River, North Carolina on January 21, 1905. He received his M.D. at Johns Hopkins University in 1930 where he trained under Young. He completed his residency in 1936 and then served as an associate professor in urology at Johns Hopkins from 1937 to 1939. He did important work during that time on sulfanilamides and synthetic male hormones. During his tenure as chairman, other faculty included Edgar W. Kirby and (1939 to 1946) and Hugh Warren (1946 to 1958).3 Vest was responsible for training many residents who went on to become leaders in the field of urology including Drs. William Boyce and Patrick Devine. In addition, Vest’s own career was extremely productive. He made contributions in microbiology, endocrinology, acid base balance and urodynamics. In addition, he was responsible for multiple technical innovations including, along with Boyce, new methods for the treatment of bladder exstrophy. Vest died of a myocardial infarction in 1958. Vest was known to have a gregarious personality and was extremely well liked. During rounds with one of his residents, he was called to the operating room to assist Doctor Warren with a difficult nephrectomy. After leaving the operating suite, bleeding controlled, he picked up his cigar, turned to the resident accompanying him, and said, “you always have to remember one thing . . . where you left your cigar.”4

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UROLOGY AT UNIVERSITY OF VIRGINIA ALBERT J. PAQUIN, JR.

Albert J. Paquin, Jr. was born in Prescott, Arizona on February 22, 1921. He received his M.D. from St. Louis University in 1944 and stayed there for general surgery training from 1944 to 1946. He subsequently served as a Captain in the United States Army in Europe from 1946 to 1948. On his return from active service, Paquin went to New York Hospital at Cornell University where he was a urology resident from 1949 to 1952. He remained on faculty at Cornell until 1959, when he was recruited to the University of Virginia as chairman of urology.5 Paquin is best known for his work on urological problems of childhood including reconstruction of congenital defects. In addition, he did important work on metabolic derangements induced by surgical trauma. Perhaps most notably, under Paquin’s leadership, the department of urology began to grow into the modern day department that it is now. Paquin appointed 3 important faculty members: Dr. Arthur W. Wyker, Jr. in 1960, Dr. Myron P. Walzak in 1964 and Dr. Jay Y. Gillenwater in 1965. Wyker would eventually go on to a productive career at the university. Walzak went on to become the chief of urology at Creighton University and then the University of Connecticut. On April 21, 1966 the Vest lectureship, a visiting professorship at the University of Virginia, was also started by Paquin. The first visiting professor was Dr. William Boyce. Paquin was known for being a self-characterized, “compulsive worker.” Under his direction the department continued to gain national renown. He is remembered as remarking whenever accepting an accolade or recognition, “It was an honor to be asked, for it shows that the University of Virginia is recognized there as doing worthwhile work in the field of urology.” (Alumni news letter July–August 1961, pg. 2) He was widely liked and respected. In Paquin’s obituary, Dr. Victor Marshall wrote, “The appearance of Al’s sporty Mercedes at one’s doorstep meant lively and gay hours ahead. His wit varied from often benign to occasionally knife-like . . . .” Paquin died in 1967 at the age of 46. JAY Y. GILLENWATER

At Paquin’s death the department was left at a critical moment with no one at the helm. After some debate the very young, and as of yet untested, Jay Gillenwater was appointed chairman. Born July 27, 1933 in Kingsport, Tennessee, he was 34 years old. He had attended the University of Tennessee where he obtained a B.S. in 1954 and an M.D. in 1957. He then trained in internal medicine at the University of Pennsylvania from 1958 to 1960. For the next 2 years he served as chief of the renal and body fluid section of the physiology division in the United States Army and as an instructor in internal medicine at the University of Louisville. During this period he became fascinated with renal physiology and disenchanted with internal medicine. He decided to train in urology and spent 1962 to 1964 as a urology resident at the graduate hospital of the University of Pennsylvania. He came to the University of Virginia under Paquin in 1965 where he remained on staff in a full-time capacity until his retirement in 2003. He was notably the first chairman in the history of the department to retire. The list of Gillenwater’s achievements is impressive, and include important contributions to the study of renal physiology and obstruction, urological oncology, microbiology, pediatric urology and benign prostatic hyperplasia. He was instrumental in university’s acquisition of one of the first 6 lithotriptors in the country and helped to advance the spread of this now integral part of urological practice. One of the keys to Gillenwater’s success was his ability to create an environment in which others could succeed. He

became chairman at a very young age, yet had the foresight to recruit other phenomenally talented individuals and support their individual success, not only his own. During his chairmanship he recruited many of the current faculty at the University of Virginia, including Drs. Stuart Howards, Alan Jenkins, Margueritte Lippert, William Steers and Dan Theodorescu. In addition, Drs. Darracott Vaughan, Jackson Fowler and Victor Marshall all served on the faculty during some part of his chairmanship. Gillenwater also made important contributions to the Virginia medical community. He helped establish the Health Science Foundation at the University of Virginia and was its President from 1980 to 1991. He founded the Virginia Kidney Stone Foundation. Under Doctor Gillenwater’s leadership, the residency evolved to include an away rotation in Roanoke and the AUA Basic Science Conference for junior residents in urology from all over the country. Any list of Gillenwater’s accomplishments is extremely impressive, but they do not adequately encompass his personality and presence. In his 40 years of practice he has had enormous impact on many patients, colleagues, residents and students. Although a giant in the field of urology, on meeting him he is modest, respectful and approachable. He is known for his Tennessee small-town mannerisms and quaint sayings. Those of us who have had the honor and opportunity to work with him will continue to be inspired by his honesty and integrity as well as by his drive and incredible stamina. His success was made possible by his ability to maintain an open mind and an insatiable curiosity. The story of how Gillenwater obtained the HM-3 lithotriptor is important. Not only was it a pivotal moment in the department’s history, it is a clear illustration of how he used his talents to succeed. Having learned about the lithotriptor, a device never used before in the United States, Gillenwater had the foresight and vision to recognize that it would revolutionize urological practice. Dornier had decided that it would place 5 machines in the United States for the Food and Drug Administration trials. Gillenwater campaigned for one from the American primary investigator and Dornier but was turned down by both. Multiple meetings and machinations ensued. Ultimately, after using his connections in the congress and the Army, he convinced Dornier that it would be in their best interest to allow the University of Virginia to purchase a sixth machine. However, the university refused to pay for it. Still determined, Gillenwater raised the money himself. Installing the lithotriptor meant revising the entire structure of the department, and the urology department as it currently stands was built along with an operating room suite for the HM-3 lithotriptor to reside. Obviously, the lithotriptor was a huge success. Patients were referred from all over the region and soon the machine was banging away, doing 14 to 16 cases a day. THE DEPARTMENT TODAY

Gillenwater’s legacy of scientific exploration, excellence in patient care and pursuing the cutting edge of technology has been continued with the appointment of Dr. William D. Steers as chairman in 1995. The University of Virginia continues to be on the forefront of urology with important research in cancer, neurourology, pediatrics and infertility. Patients continue to benefit from the HM-3 lithotriptor in addition to prostate and renal cryotherapy, brachytherapy and robotic surgery. From its earliest inceptions, the University of Virginia has been a center of excellence. The Department of Urology is proud to be a part of that important heritage. It is through the leadership of individuals starting with Hugh Hampton Young to the outstanding faculty of today that the department has continued to thrive.

UROLOGY AT UNIVERSITY OF VIRGINIA

Multiple alumni and faculty members contributed to this report through their correspondence and conversations with the authors. REFERENCES

1. Radbill, S. X.: The Autobiographical Ana of Robley Dunglison, M.D. Trans Am Philosophical Soc, 53: 26, 1963

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2. Wyker, A.: History of urology at the University of Virginia. Unpublished data 3. Wyker, A.: Samuel Alexander Vest, Jr. Unpublished data 4. Personal communication: Euclid Hanbury to William Steers, January 23, 2003 5. Marshall, V. F.: Albert J. Paquin, Jr. 1921–1967. Trans Am Assoc Genito-Urin Surg, 59: 10, 1967