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Cabot, Hugh (1872-1945)

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Beginning in his youth, Hugh Cabot’s varied interests included music, activities in the Unitarian Church, and outdoor endeavors. The following celebration of his life (published in Urology 50.4, 1997) is an abridged form of an article written by four of his colleagues: W. Scott McDougal, David Bloom, Harry Spence, and Gretchen Uznis.

hc1 cabot1The Early Years– Childhood,
Education, and Professional Training

Hugh Cabot and his identical twin brother Philip were born in 1872 in Beverly Farms, Massachusetts, a town 20 miles northeast of Boston. They grew up with five older brothers in a household in which structure and discipline were not strictly enforced, and at times the environment was somewhat chaotic. Indeed, their mother Elizabeth lamented that her sons, although “not wicked,” were “rude, inconsiderate, careless and full of little reckless tricks!” She further remarked that she was endlessly “trying to civilize (her) barbarians, to mend their clothes and their manners,” but succeeded much better with the clothes than with the manners. Others in the community observed that “the Cabots are a tribe indigenous to Brookline … they have customs but no manners.”

Hugh’s father, James Elliot Cabot, was a scholarly man and a close friend of the great American philosopher Ralph Waldo Emerson, who was well known in the Cabot home during Hugh’s formative years. Perhaps influenced by Emerson, Hugh Cabot developed a strong inclination to speak honestly, pungently, and bluntly no matter what the consequence. He was known for his “direct and forceful way of talking well larded with expletives and figures of speech.” He maintained these characteristics throughout his career, sometimes at the cost of interpersonal relationships. Cabot’s writing style reflected the Emersonian epigrammatic unit of thought.

In addition to his earthy self-expression, Hugh acquired leadership qualities and a spirit of independence during his early years. His interest in the out-of-doors was kindled by his father, an excellent naturalist. As a teenager, Hugh Cabot explored the Adirondacks, British Columbia, and Alaska, often living off the land, accompanied only by Native American guides. He worked as a fisherman off the Great Banks from the port of Gloucester, on a vessel solely dependent on sail. Because those first in with the catch got the money, he developed prodigious sailing skills and remained an ardent and talented sailor throughout his life.

Cabot was educated at the Boston Latin School and Harvard College. Elected to Phi Beta Kappa and Sigma Xi, he graduated in 1894. He followed the path of his older brother Richard Clarke Cabot to Harvard Medical School, graduating Alpha Omega Alpha and cum laude in 1898. Hugh and Richard were polar opposites. Richard was considered by some as a “contender to sainthood.” Richard became an internist and founder of the Archives of Internal Medicine. Hugh’s personality, on the other hand, was never described as saintly, and he was to make his mark in the surgical arena. Appointed to the surgical service at the Massachusetts General Hospital (MGH) as a House Pupil, Hugh came under the influence of his older cousin, Arthur Tracy Cabot (1852-1912). Arthur, also a graduate of Harvard Medical School, had undertaken postgraduate studies in Berlin, London, and Vienna. Returning to Boston, Arthur attended at Children’s Hospital and the MGH, where he became the protege of Henry J. Bigelow, a master surgeon and early genitourinary specialist. Arthur’s influence was strong, as evident years later in the dedication of Hugh Cabot’s two-volume book Modern Urology: “To the memory of Arthur Tracy Cabot to whose skill and integrity as a surgeon and to whose wisdom, gentleness, and force of character I desire to express my debt and gratitude.” Hugh wrote a posthumous vignette on Arthur for the master surgeons in America series in Surgery, Gynecology and Obstetrics in 1914.

Practice in Boston and Wartime Experiences

On completion of formal training, Hugh remained in Boston and entered surgical practice with Arthur. Hugh Cabot’s first paper, ‘A contribution to the study of catgut as a suture and ligature material,” was published in 1901 in the Boston Medical and Surgical Journal. In 1902 Hugh married Mary Anderson Boit, and they had four children: Hugh Jr., May Anderson, John Boit, and Arthur Tracy. Hugh Cabot’s second paper, “The interrelation of medicine and surgery in the treatment of gastric ulcer,” published in the Boston journal in 1904, gave an early glimpse of his larger-than-average view of medicine that extended across the artificial boundaries of specialties. Except for 1919, Cabot never again missed a year of publication in his career.

hc2 cabotquoteDuring his years of practice at the MGH, Hugh Cabot recognized the need for separating genitourinary surgery from general surgery, although he never limited his practice exclusively to urologic surgery. In 1910 the trustees at the MGH voted to establish a genitourinary outpatient service, with Cabot, at 38 years of age, as surgeon in charge. He was successful in obtaining designated beds for the genitourinary service and in 1911 admitted the first inpatient to the service, a man with urethral stricture. Stricture became something of a special interest for Cabot, who wrote four papers on the topic. Cabot was the first Chief of the Genito-Urinary Surgical Service in 1912 and, after establishing a residency training program in genitourinary surgery, was appointed the first resident in 1914. Hugh Cabot rose to the rank of Clinical Professor of Genito-Urinary Surgery at Harvard Medical School.

Cabot had been on the forefront of the recognition that urology should be a distinct specialty, and this interest carried through to the training of urologists. His paper in 1915, “Medicine—profession or a trade,” contained these uncompromising thoughts: “To me a profession is an occupation requiring an education in science, and which is pursued for its own sake. It must have advancement of science or the benefit of mankind as its chief end, pecuniary advantage always being a secondary or subordinate consideration.” Cabot’s economic philosophy was to define much of his career.

The second decade of the 20th century was also the second decade of Hugh Cabot’s practice, and by then he had developed a substantial reputation as a surgeon and educator. He began to compile his clinical experience for his book, Modern Urology, first published in 1918.

Even before his book, Cabot had established himself as a national figure in urology. In 1916 the global conflict that was to become World War I was well underway. Hugh Cabot recognized American responsibilities and organized the Harvard Medical Unit before the United States entered the war. Cabot became honorary lieutenant colonel in the Royal Army Medical Corps (1916-1919) and commanding officer of the No. 22 General Hospital of the British Expeditionary Forces (1917- 1919), which he led to France. The British Government named him Companion of the Order of St. Michael and St. George.

When the war ended, Hugh returned to the MGH as Chief of the Genito-Urinary Surgical Service, but his private practice had, according to Lowell, “evaporated” when an opportune offer came from Ann Arbor. Cabot later recalled his readiness for this change:

I was oppressed by the conflict of duties—duties which, on the one hand, required the devotion of something like one-half my time to the teaching of medicine and the care of indigent patients at the Hospital. These duties were obvious and pressing. On the other hand, not much less obvious and at times quite pressing, were the obligations to one’s family in the way of providing the wherewithal to carry on a successful struggle for existence.

This conflict—for which no solution appeared—took me, just after the war, to the University of Michigan as Professor of Surgery on “full time,” and later as Dean of the Medical School. Here was the opportunity, under the auspices of this tax-supported University in a state relatively free from traditions of the more strangling type and thus in step with the changing aspect of democratic government, to carry on free from conflict and with undivided allegiance.

The Ann Arbor Years

In 1919, at 47 years of age, Cabot left Boston for the University of Michigan to become Professor and Director of Surgery. In 1921, the university regents turned to Cabot as the next dean of the medical school. Cabot’s organizational ability, innovative ideas, and love of teaching were given full expression in Ann Arbor. He oversaw the building of a modern university teaching hospital and assembled a faculty of outstanding specialists in the various medical and surgical fields.

The University of Michigan had been the first university to own and operate a hospital. When the regents first organized the department of medicine and surgery in Ann Arbor in 1848, medical education was generally a proprietary activity wherein professors owned a medical school taught a series of lectures, and granted degrees. The model of a university assuming responsibility for medical education was somewhat of a novelty in the mid-19th century. A medical building opened in Ann Arbor in 1850 with five faculty members teaching a class of 92 students by October of that year.” In 1869, a professor’s house ‘was fitted up and occupied as a University Hospital” and was in turn replaced in 1878 by a 60-bed hospital, constructed according to the Civil War pavilion plan. A new West Hospital, a $75,000 facility that opened in 1892, was what Cabot found on arrival in 1919. During his tenure, a revolutionary modern facility with 1000 beds was conceived and built by 1925. Cabot played a key part in that process.

hc3 cabot2Cabot was later described by Henry K. Ransom, one of Cabot’s young trainees who eventually became a professor of surgery at Michigan: “Doctor Cabot was short and stocky in build with a sturdy physique, a brusque manner and a domineering attitude. He almost invariably wore a dark blue serge suit with no vest (unusual in those days) and a white shirt with a stiffly starched detachable collar. He visited on Wards in a business suit and almost never wore a white coat. Doctor Cabot was usually referred to by members of the Staff as “the Chief,” a designation of which he obviously approved.”

In addition to his educational and administrative duties, Cabot remained academically productive. In 1926, Cabot induced a young Stanford graduate, Reed Nesbit, to come to Ann Arbor to study urology. Nesbit, and another Cabot protege, Charles Huggins, shared a room their first year, and each went on to a distinguished career. Huggins won the Nobel Prize for his work on the hormonal basis of prostate cancer, and Nesbit, his roommate and mentor, became as great a force in urology. Cabot worked with Reed Nesbit on a variety of topics, including treatment of undescended testis.

Hugh Cabot’s ideas regarding the organization and purpose of the new university hospital eventually caused him difficulty. Private practitioners, threatened by his economic concepts, enlisted the support of colleagues in the Michigan State Medical Society. A committee headed by Richard Smith of Grand Rapids, was formed to study the Cabot problem. At its September 1928 meeting, the committee recommended that the society request the university regents to abandon the “full-time” concept at the hospital and, furthermore, prohibit the admission of private patients to the university hospital. Cabot did not acquiesce to the requests, and the pressure only strengthened his resolve. He remained adamant in his demand that physicians at the hospital devote full time to the practice of medicine at the university. Because the university was supported by tax dollars, he believed that the facility should be open to all patients from the state. The political pressure proved too great, and the regents forced Cabot’s resignation as dean in 1930 “in the interests of greater harmony in the Medical School.” This turn of events prompted an editorial in the Michigan State Digest, which summed up the situation as “Politics of the cheapest, most selfish kind—and vicious too because it strikes at the very fundamentals of … a great democratic university.” With Cabot gone, the faculty voted to abolish the mandatory full-time requirement.

The Mayo Clinic and Retirement

Cabot’s good friend William Mayo, a graduate of the University of Michigan Medical School, encouraged him to come to the Mayo Clinic. Cabot arrived at the Mayo Clinic in June of 1930 as Professor of Surgery and head of a surgical section. He was 58 years of age. In Rochester, Cabot was a respected clinician at a clinic that operated in accord with his paradigm of medical economics. Cabot later commented: “Finally, during the last ten years I have been a consultant and teacher at the Mayo Clinic, the greatest organization for supplying high-grade medical care that the world-to-date has seen. Here also was a rare opportunity to associate daily—and nightly—with a highly selected group of well-trained, nippy, young physicians, a group whom one both loved and feared.”

The Mayo Clinic

The Mayo Clinic

In 1932, as America was reeling from the effects of the Great Depression, Cabot read an insightful paper called “Some Economic Considerations Influencing the Future of the Practice of Medicine” before the Annual Congress of Medical Education. Cabot clearly held a warm spot for group medicine when organized according to the university student health service model. One of the paper’s discussants, Morris Fishbein, said, “I do not believe that any of us is foolish enough to suggest that the medical profession turn over to big business the question of controlling medical practice.” Cabot’s final comment summarized his medical economic philosophy:

I am not sure that we quite visualize our own position in relation to the state … The state has not set up the medical profession as a practical, legal monopoly for the purpose of benefiting the medical profession. It sets it up, and I think we will all agree, wisely, for the sake of benefiting the public. The question of the extent to which the state will invade the practice of medicine will not be decided by those for whom the monopoly has been created but by those who created the monopoly. In other words, we would not be consulted on this matter. I believe that we shall, particularly in times of depression and if these depressions are going to continue, find the thing done very suddenly and without very much forethought.

Similar opinions were conveyed in his first book for the public, The Doctor’s Bill, which was published in 1935.

In 1936, his wife, Mary, died.

The 1937 edition of Physicians of the Mayo Foundation listed 158 items in Cabot’s bibliography. In October 1938 he married Elizabeth Cole Amory, a vivacious widow 30 years his junior. That same month found him in Washington, DC, testifying for the government against the American Medical Association and the District of Columbia Medical Society in their actions in restraint of trade against a cooperative known as the Group Health Association of Washington. A guilty verdict was upheld by the Supreme Court, thereby preparing the way for further prepayment plans.

Hugh Cabot remained at the Mayo Clinic until 1939, when he retired and returned to Boston. He resumed private practice but mainly seemed to immerse himself in medical reforms and public affairs. In 1940 he published a second book for the public, The Patient’s Dilemma: The Quest for Medical Security in America. Cabot continued to advocate group practice of medicine and budgeted prepayment systems to alter the fee system of private medical practice that he condemned as antiquated. His public efforts were not limited to American medical practice. He became chairman of the Massachusetts State Committee for Russian Relief and thereby provoked a fair degree of local hostility. Cabot’s support of the newly formed American Euthanasia Society may have been stimulated by an unfortunate bit of family history. In 1893 it had been likely that an older brother, Edward Twistelton Cabot, abetted by Richard, chose to end his life because of unrelenting headaches and diabetes. Richard Cabot died in 1939 after an exceptionally distinguished career in internal medicine. Hugh’s twin, Philip, a successful business executive, died in 1941.

Hugh Cabot died of a heart attack in August of 1945 at the age of 74 while sailing with his wife Elizabeth off the coast of Maine in Frenchman’s Bay. After his death, friends raised money to establish a penicillin plant in Russia in his memory.

He was buried in Brookline, Massachusetts.

A key figure in the formative years of the 20th century specialty of urology, Hugh Cabot was also a visionary in medical education, medical practice, medical economics, and sex education.