Modern Urology in Original Contributions by American Authors: Diseases of the Bladder. Diseases of the Ureter. Diseases of the Kidney
(This book was originally published prior to 1923, and rep...)
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Hugh Cabot was an American surgeon, medical educator, and medical reformer.
Background
Hugh Cabot was born on August 11, 1872 at Beverly Farms, Massachussets, United States; the son of James Elliot and Elizabeth (Dwight) Cabot of Brookline, Massachussets. He was one of twin boys, the last of seven surviving children, all sons. His father, a graduate of the Harvard Law School, briefly practiced law and architecture, but mainly devoted himself to his interests in natural history and philosophy; he was a friend and literary executor of Ralph Waldo Emerson. Mrs. Cabot, a cousin of President Charles W. Eliot of Harvard, added her considerable talent for music to the childhood curriculum her husband prescribed for their sons. Growing up in a Unitarian household and in a strongly humanitarian environment, all seven boys emerged as highly individualistic, productive adults, usually combining idealism with their practical endeavors in their respective professions. One brother, Richard Clarke Cabot, preceded Hugh in entering medicine. Philip, Hugh's twin, was a successful public utility executive who became a philosopher of business and lectured at the Harvard School of Business Administration from 1924 until his death in 1941, blending his professional expertise with ethical fervor. Both twins were bluff, hard-working, and incisive.
Education
Hugh Cabot attended the Roxbury (Massachussets) Latin School and received the A. B. degree from Harvard in 1894 and the M. D. from the Harvard Medical School in 1898.
Career
After a year's surgical internship at the Massachusetts General Hospital, he entered practice with his cousin Arthur Tracy Cabot and from him acquired an interest in genitourinary surgery. Hugh Cabot organized a department in that field at the Massachusetts General Hospital in 1910. In that same year he began teaching at the Harvard Medical School, as instructor (1910 - 13), assistant professor (1913 - 18), and professor (1918 - 19) of genitourinary surgery. He accepted as natural obligations, along with his private practice, both teaching and charitable duties, the latter in the outpatient department of the Massachusetts General Hospital and at the Boston Dispensary.
World War I offered Cabot a temporary escape from this dilemma. In the spring of 1916 he helped recruit a "surgical unit" of fifty-seven doctors and nurses sent by Harvard to aid the British forces in France, where he served for three months. He returned to France in February 1917 as chief surgeon of General Hospital No. 22 at Camiers, and in October became the hospital's commanding officer (with temporary rank as lieutenant colonel in the Royal Army Medical Corps), a post he held until January 1919. Soon after his return to the United States, Cabot was appointed professor and director of surgery at the University of Michigan Medical School; he assumed his new duties in January 1920. Enjoying the "undivided allegiance" assured by his full-time position, Cabot implemented reforms in medical education and hospital organization, many of them initiated by Victor C. Vaughan, whom he succeeded as dean in 1921.
To integrate and humanize the medical curriculum, he introduced comprehensive examinations and substantial reductions in lecture and laboratory hours required for some courses. To obviate conflict of interest in the faculty, he placed members on a modified full-time basis, entirely forbidding private practice; each man's salary, however, was supplemented in a manner roughly commensurate with his care of patients, who, if they could afford to pay, were charged on a sliding scale at University Hospital, a state-owned institution opened in 1925. To ensure academic autonomy, Cabot and the university's president, Clarence Cook Little, refused legislative appropriations contingent on the hiring of homeopathic faculty members. Each reform effort met some opposition. A skilled diplomat might have survived; Cabot, whose unwillingness to bend with the wind was well known, was not a diplomat.
The academic community divided into his staunch supporters and bitter enemies. Seizing upon one instance of his "autocracy" (his desire, shared by a majority of the surgical faculty, to create an anesthesiology department headed by a specialist), several disgruntled faculty members joined forces with the Board of Regents, where homeopathic interests were represented, to demand his resignation.
Cabot refused, and on February 7, 1930, was "relieved" as dean. Shortly after his dismissal, he accepted an invitation from his friend William James Mayo to become consulting surgeon at the Mayo Clinic and professor of surgery at the University of Minnesota Graduate School of Medicine. There for the next nine years he gloried in the successful operation of the "full-time" idea he had advocated and of group practice.
In a period when asepsis and relatively safe anesthesia had removed much of the risk from surgery, he emphasized the psychological factors in illness and urged an "abiding scepticism" in considering surgical intervention. Through the Association of American Medical Colleges, of which he was president in 1925 and 1926, and as a member of the Commission on Medical Education, he pressed educators to include in premedical work such behavioral studies as anthropology and psychology, and to introduce clinical experience earlier in the curriculum, lest students too long in laboratories and lectures view their first patients chiefly as experimental animals.
Teachers in medical school, he firmly believed, should be clinicians, not merely researchers. Cabot retired from his Minnesota posts in 1939 and returned to Boston to resume practice and devote himself to furthering medical reforms. Many of his ideas were far in advance of their time. He advocated sex education in the schools; federal medical licensure to supersede the inequitable standards of the state boards; an "open hospital" policy for all licensed physicians; the sale of drugs under generic rather than trade names; effective measures against fee splitting in all its forms; and expansion and specialization of nursing education. It was primarily Cabot's attacks on the "antiquated fee system" that branded him a heresiarch in the eyes of orthodox medicine. Cabot became convinced that if all Americans were to receive the superb care modern knowledge and technology made possible, the federal government must assume the burden of medical school and hospital deficits and underwrite medical care for the indigent. To implement these convictions, he joined forces in the spring of 1937 with similarly concerned associates serving with him on the Medical Advisory Committee of the American Foundation. This group drafted "Principles and Proposals" which, although rejected by the American Medical Association at its convention in June and attacked editorially in its Journal (Oct. 16, 1937), received a hearing from President Roosevelt, wide attention in the lay and more liberal medical press, and considerable support within the profession. The 430 signatories whose names were listed as the "Committee of Physicians for the Improvement of Medical Care" (New York Times, Nov. 7, 1937) included many of the most distinguished figures in American medicine. Their open dissent from the position of organized medicine contributed to the atmosphere of imminent reform pervading the National Health Conference in which Dr. Cabot participated in July 1938. He also took part in the first federal action against organized medicine under the Sherman Anti-Trust Law. In October 1938 Cabot testified for the government in its indictment of the American Medical Association and the District of Columbia Medical Society on charges that their actions against the Group Health Association of Washington constituted unlawful restraint of trade. Physicians participating in this cooperative, organized in 1937 to serve low - income federal employees, had found themselves barred from Medical Society membership and denied private hospital privileges. On appeal, the United States Supreme Court unanimously upheld the guilty verdict, breaking a path for similar prepayment plans elsewhere among them Health Service, Inc. , organized in 1939 by Cabot and a group of prominent Boston laymen and physicians, and the Associated Hospital Service Corporation (the "Blue Cross"), in which many Boston doctors collaborated on a nonprofit basis.
A Republican, a Unitarian, and, according to his Harvard colleague Walter B. Cannon, "a Bostonian of the Bostonians, " Cabot in 1941 became Massachusetts chairman of the committee for Russian War Relief. Overcoming initial local hostility, he organized effective committees throughout the state and envisioned a comparable postwar organization to serve as the cornerstone of permanent peace.
He died of a coronary attack shortly after his seventy-third birthday while sailing with his wife near their summer home in Ellsworth, Maine. He was buried at Walnut Hill Cemetery in Brookline.
Achievements
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.
Among the professional honors Cabot especially prized were his election as a fellow of the American Surgical Association (1924); an LL. D. awarded by Queen's University, Belfast, Ireland, in 1925; and honorary fellowship in the Royal Society of Medicine (London). He was one of the founders of the American Board of Urology and a charter member of the American College of Surgeons. He served as president of the American Urological Association (1911) and the American Association of Genito-Urinary Surgeons (1914).
His major publication in his specialty was Modern Urology (1918 and later editions).
From the beginning of his professional career, Cabot felt "oppressed" by a "conflict of duties" : the need to support himself and his family by his practice, and the moral obligation to teach and to provide medical care to the indigent. This common predicament, he became convinced, constituted the most serious flaw in the American medical system.
Membership
He was a member and a president of the Association of American Medical Colleges; a member of the Commission on Medical Education; fellow of the American Surgical Association; fellow of the Royal Society of Medicine; a charter member of the American College of Surgeons; a member of the American Urological Association and the American Association of Genito-Urinary Surgeons.
Personality
He was short and solid in stature, and his typical stance erect, with feet solidly planted apart and the direct gaze from his austere countenance bespoke his uncompromising determination.
He implemented reforms in medical education and hospital organization. During his career, Cabot proved to be a gifted clinician and a stimulating teacher.
Connections
On September 22, 1902, he married Mary Anderson Boit of Brookline. They had four children: Hugh, Mary Anderson, John Boit, and Arthur Tracy. Cabot's first wife died in 1936, and on October 8, 1938, he married Mrs. Elizabeth (Cole) Amory of Hingham, Massachussets.
