Chairman, 1897-1941

Hugh Hampton Young was born September 18, 1870, in San Antonio, Texas, and was only 27 years of age when he took over the Department of Genito-Urinary Diseases of the Dispensary on November 29, 1897. His grandfather, Hugh Franklin Young, and his father, William Hugh Young, were officers in the Confederate Army. His mother, Frances Michie Kemper, was from Virginia, and after her marriage settled in San Antonio. Hugh's early life was spent in that city.

Hugh's father had attended the University of Virginia prior to the outbreak of the Civil War, and some 35 years later Hugh enrolled there. By dint of hard work, he was awarded not only a B.A. and an M.A., but an M.D., all in the four years ending in 1891. This was the first, and probably last, time such a feat had been accomplished. Returning home, he began practice in San Antonio but quickly learned that he needed more training if he were to be a successful surgeon and went to Baltimore in the same year of his graduation. In Chesney's words:

How he was given an opportunity by Dr. Finney to work in the Surgical Dispensary, how the occurrence of a vacancy in the resident staff gave him an opportunity to substitute for the man who was away, what mental anguish he suffered because of Dr. Halsted's aloofness and apparent indifference to Young's fate and how he spent his early years in the Hospital, has all been told so delightfully by Young himself that it would be presumptuous to attempt to paraphrase it in this chronicle. In order to relate how he came to be placed in charge of the genito-urinary work of the Out-Patient Department, however, which is what concerns us most at this point, we cannot do better than quote from his own account of the event. [1]

Young wrote in 1940:

In the fall of 1896 I was transferred to the ward devoted to urological cases (those of the genital and urinary organs). A patient had complained of frequency of urination for years. His bladder held only a tablespoonful (15 cubic centimeters) and he had to void every fifteen minutes. It occurred to me that it might be possible by hydraulic pressure to increase gradually the size of the bladder. I rigged up a fifteen-foot pole on which a fountain syringe was suspended. By holding the nozzle tightly into the end of the urinary tract (penile urethra), by hydraulic pressure I was able to force the fluid through the urethra (the canal carrying urine from the bladder) and into the bladder. At first it was possible to introduce only 15 cubic centimeters, but by repeated dilatations several times a day the bladder became more tolerant, and it slowly commenced to get larger. In a week the bladder held two ounces of fluid; in two weeks, three ounces. Simultaneously the intervals between voidings in creased to forty minutes. At the end of the month the patient was voiding about every three hours. In six weeks his bladder was half the normal size, and he was voiding at intervals of four hours, and eventually he was quite normal. This discovery was applied to other cases that appeared about the same time, and with equally good results.

The question arose whether hydraulic pressure might not cause fluid to pass up the ureters (ducts through which urine passes from kidneys to bladder) into the kidneys and carry infection with it. To determine this it was necessary to conduct a series of experiments on animals and on cadavers, and to search the world's literature on the subject. One day Dr. Welch was doing an autopsy. He had removed all the abdominal organs except the urinary tract, and I begged him to allow me to introduce deep-blue solution by hydraulic pressure through the urethra, as I had done in patients, to see whether any of the dye would pass up to the kidneys. The bladder became larger and larger, and the deep-blue liquid could be distinctly seen within. A pint was introduced, and then a quart, and still the bladder continued to expand. It looked as if it might burst any minute. Dr. Welch and his staff beat a hasty retreat. When we opened the bladder, we found that none of the fluid had gone beyond it. Hydraulic pressure could be employed without danger of the fluid's reaching the kidneys and setting up inflammation. These studies furnished material for a paper that I presented to the Johns Hopkins Medical Society, with many charts and anatomical and pathological illustrations.

While attending the genitourinary cases in Ward E, I became greatly interested in their bacteriology. One of these patients was a milkman who for eight years had carried the typhoid bacillus in his urinary tract, and probably had transmitted the infection to many of the homes where he carried milk. This case furnished the material for my first foreign publication, which I presented to the Tenth International Congress in Paris on August 9, 1900. This case and additional ones afforded material for an extensive paper in Volume 8 of the Johns Hopkins Hospital Reports, which, under the editorship of Dr. Osler, was devoted entirely to typhoid fever and its complications. I subsequently found the typhoid bacillus in the center of a stone taken from a kidney in a patient who had had typhoid fever many years before.

In my bacteriological studies I ran across some remarkable gonococcal infections and published several papers on them. I had the good fortune to be the first to demonstrate that chronic inflammation of the bladder and also of the kidney could be due solely to the gonococcus (the bacterium causing gonorrhea), and that the same organism could be responsible for a general peritonitis. These cases were published in extenso in an article contributed to a memorial volume to Dr. Welch by his students in 1900.

But all this time my interest was in general surgery. I almost never visited the genitourinary outpatient clinic conducted by Dr. James Brown, and what urological work I had done was while I was an intern on Ward E. I had looked forward to being transferred to wards devoted to other forms of surgery.

One day in October, 1897, I was walking rapidly down the long corridor of the hospital. As I turned the corner, I ran into Dr. Halsted with great force and almost knocked him down. I caught him just before he hit the floor and began to apologize profusely. Dr. Halsted, still out of breath, said: 'Don't apologize, Young. I was looking for you, to tell you we want you to take charge of the Department of Genito-Urinary Surgery.' I thanked him and said: 'This is a great surprise. I know nothing about genitourinary surgery. Whereupon Dr. Halsted replied, 'Welch and I said you didn't know anything about it, but we believe you could learn. [2]

Thus, we have the beginning of Young's long and illustrious tenure as professor of urology at Johns Hopkins.

Young's contributions to urology, medicine, and the community were most substantial and numerous, and again it would be presumptuous to attempt to single out the most important one or even just a few. Consequently, we will present a chronology of a number of his achievements which history suggests have been of considerable importance. These will include his operation of "radical prostatectomy" for prostatic cancer, his establishment of the Brady residency, and his book, Young's Practice of Urology, coauthored with D.M. Davis and his participation in the affairs of the city, state, and nation. The essentials of the funding, building, and dedication of the Brady Building are covered in the final chapter devoted to funds for building and research and his founding of the Journal of Urology in a separate chapter devoted to it which immediately follows this.

Radical Perineal Prostatectomy

Again according to Young, the first radical perineal prostatectomy for cancer of the prostate was done in Johns Hopkins Hospital on April 7, 1904, by him with the assistance of his chief, Dr. William S. Halsted. In 1903, having developed the operation of perineal prostatectomy for the relief of bladder-outlet obstruction, Young encountered two patients in whom the area of prostatic cancer was small. He wrote:

"I was struck by the fact that had the entire prostate gland been removed with its capsule, it would have been possible to cure both these patients." Continuing, As a study of the literature revealed that no such radical operation had ever been attempted, I made careful sketches of what I thought would be necessary and showed them to my chief, Dr. William S. Halsted, whose reputation was world-wide because of a very radical operation for cancer of the breast with which he had cured a large percentage of the patients brought to him. After examining the (first) patient, Dr. Halsted carefully reviewed my sketches. He appeared greatly impressed, strongly advised me to carry out the operation, and said he would like to assist.

Young performing perineal prostatectomy at the time the American Urological Association met in Baltimore, 1927.

The radical perineal prostatectomy procedure was established, and unquestionably the originator was Hugh H. Young.

 Subsequently, many radical perineal prostatectomies for early prostatic cancer were performed at Hopkins by Young and, later, by J.A.C. Colston and Hugh Jewett. The Brady Institute became one of the main referral centers for early prostatic cancer and has remained so for many years. Hugh Jewett, in one of several reviews from Hopkins, established that when a nodule of cancer was confined to one lobe of the gland, radical perineal prostatectomy resulted in a 15-year survivorship of close to 50 percent, these survivors showing no clinical evidence of recurrence of their cancers. [3]

The Brady Residency

We will first concern ourselves with the beginnings of this residency. We found no better source of information than a talk entitled, "The Beginnings of the Urological Residency at Johns Hopkins," prepared and delivered by David M. Davis before the American Urological Association's Forum on History of Urology, May 30, 1966, in Chicago. To our knowledge this has never been published. We obtained our copy from one sent by Davis to the Dean's Office at Johns Hopkins in 1966. Davis, who died in 1982 at the age of 96, certainly was familiar with the early developments in the Brady, having been designated as head of pathology on the research staff in the published proposed organization of the institute, and having served as head resident between October 1921 and September 1922 and having co-authored Young's Practice of Urology published in 1926 with the collaboration of Franklin P. Johnson.

The following is the entire text of Davis's talk:

When in 1874 Johns Hopkins gave the money and composed the directive for his University, the execution of his wishes, insofar as the Medical School and Hospital are concerned, fell into the hands of a remarkable group of men, whose extraordinary talents affected, and still continue to affect, the ranks of those who succeeded the pioneers.

First, the twelve trustees selected by Mr. Hopkins were extraordinarily cultured, educated and perceptive. Refusing to be bemused by the thought of the unprecedently great sum of money they controlled, they sought the best advice, and consulted the presidents of Harvard, Yale and Cornell. These gentlemen unanimously recommended Daniel Coit Gilman, then president of the University of California, to be president of Johns Hopkins University. Gilman proposed that the new university provide the scholars and the facilities for postgraduate studies of a sort which existed nowhere else in this country, and the trustees enthusiastically agreed. Thus in 1875 Gilman began a task of organization which demanded that the finest scholars be found, and that they in their turn have the knowledge, the judgment and the discernment to select their own juniors according to the same high ideals. His success is legendary. The bases of medical science were represented by Henry Rowland in Physics, Ira Remsen in Chemistry, and Newell Martin in Biology. John Shaw Billings was chosen in 1876 to advise and plan as to the Medical School and Hospital, but it was not until 1886 that William Henry Welch became Professor of Pathology, and the guiding influence in the Medical School. Gilman, Welch and Billings added Osler, Kelly and Halsted to the slowly growing faculty group.

It is well at this time to consider the atmosphere created in this new and unique institution. With more than adequate funds at hand, there was no hurry. Gilman wanted to establish first rate graduate studies, and he had seen and thoroughly investigated the European models of what he wanted- the facilities, the teachers, and the scholarships, fellowships, residencies, private docents, and so forth, which enabled vigorous young men to pursue their studies in Germany, Switzerland, France, England and elsewhere. Other young men, if they could afford to do so, had gone abroad for advanced work. William H. Welch heard of what was going on in Baltimore, and went to Europe in 1876 with the hope of a position at Johns Hopkins already exciting him. His years abroad, spent with the very topmost figures in the rapidly developing science of medicine, were amazingly fruitful, but it was not until 1884 that Gilman and Billings finally decided on his appointment. The hospital opened in 1889, at which time Osler arrived to be Professor of Medicine.

William Steward Halsted, who had had two years of study in Europe, left a busy surgical practice in New York in 1886 to work with Dr. Welch. In 1889, he was made Acting Surgeon to the hospital, shortly later Surgeon-in-chief, and in 1892 Professor of Surgery.

Although the leaders of the University were men of substance and discrimination they displayed a remarkable lack of prevision in financial matters- they were taken by surprise when the Baltimore and Ohio Railroad suspended dividend payments in 1887.

The opening of the Medical School was delayed by these financial difficulties, and did not take place until 1893. There was therefore a period of nine years during which everything pertaining to scientific medicine investigation of all kinds and the care of patients was developed by a most carefully selected group of men, practically all of whom had had extended experience in Europe. During this entire period the successive strata of selectees had continued to show their skill and foresight in choosing their juniors.

Osler and Halsted determined to give every opportunity to those who wanted to go on to become teachers or investigators, and from this arose what we now call the Resident System. This was devised by combining the concepts of the German system of private docents and of the British fellowships. The extensive European experience of the two chiefs and their friends on the faculty were essential to this enterprise, so important to the future development of Medicine in America. Since Urology lies in what we may call the Surgical succession, we must be interested in Dr. Halsted's methods of carrying on the detection of competence in its early stages, wonderfully demonstrated through the years since the Trustees had selected their first President.

Halsted permitted, in an informal way, many aspirants to present themselves. Being in no way obligated, he watched them and their work until his mind was made up; then acted suddenly, often to the astonishment of the candidate. In this manner he chose Finney, Bloodgood, Cushing, Dandy, Mitchell, Baer and Hugh Young for his group at Hopkins as well as men like Reid, Carter, Heuer and others who went elsewhere.

As to Dr. Young, he applied to Dr. Halsted and received no encouragement. However he persisted and was finally rewarded by appointment as a house officer in Surgery. His good work was quietly observed, and when James Brown through tragic circumstances died, Hugh Young was quickly propelled b y Dr. Halsted into Urology, where he certainly justified the expectations his chief evidently entertained. This occurred in November 1897. There was a genito-urinary outpatient clinic, and the genito-urinary hospital patients were mostly in Ward E, with others in the colored wards and in the private rooms.

From 1897 until 1915 (a period of 18 years) Dr. Halsted made it possible for Dr. Young to recommend young and aspiring Urologists for appointment as Assistant Resident Surgeons in the Johns Hopkins Hospital. Research was carried on, and the growing fame of the service soon brought adequate numbers of patients and of doctors. Dr. Young lists his young men of that period as Hugh H. Trout, Joseph Hume, Alfred I. Mitchell, Harry A. Fowler, John T. Geraghty, Louis C. Lehr, Charles M. Remsen, A.R. Stevens, John W. Churchman, Frank Hinman, Alexander Randall, John R. Caulk, Montague L. Boyd, H.W. Plaggemeyer, Arthur B. Cecil and William A. Frontz.

The Brady Urological Institute, given through the generosity of James Buchanan Brady, opened January 21, 1915 and gave Dr. Young the opportunity of organizing a complete clinical and research staff for Urology. The plan of long-term in-hospital training brought from abroad and pioneered by Osler and Halsted had been such an immediate and resounding success that its adaptation and extension to a special branch was the realization of a long-held ambition. As to the residents, the comprehensive plan for their thorough training and experience was described by Dr. Young as follows: 'he is appointed from the Urological Department to spend twelve months as a rotating intern in urology, surgery, and gynecology at the Johns Hopkins Hospital. The next year he serves as a fellow in pathology under Dr. William G. MacCallum. During the next year he works in general surgical service, preferably with Dr. T. F. Riggs at St. Mary's Hospital, Pierre, South Dakota, where, as resident surgeon, he assists in Dr. Riggs' splendid operations and has an opportunity to do many himself. He then returns to the Brady Urological Institute as second assistant resident. During this year he takes an important part in operations, the conduct of the clinic, teaching, and research. The next year he becomes first assistant resident in urology, doing more important work and having an opportunity to make publications. From there he goes to Ancker Hospital in St. Paul, Minnesota, as resident urologist under Dr. F.E.B. Foley, one of the most skillful of American urologists. His year there adds greatly to his surgical and urological skill and may furnish subjects for publication. He then comes back to be resident urologist at the Brady Institute. During this, his last year, he takes an important part in the direction of the institute in teaching and research and does nearly all the operations on patients in the public wards. These men have given so many years to this long and arduous preparation to become residents that I consider it my duty to see that they get as much operative experience as possible. On this account my associates on the staff and I rarely operate upon cases in the public wards, although we occasionally assist in very difficult or interesting cases. As the entire staff is present daily at the institute, group discussions of cases, particularly the important or puzzling ones, are held with the resident and the younger men on the staff.'

The story of the development of the Urological Residency is a most impressive example of how a fine new concept can echo down through the years and spread its beneficial effects far and wide.

On the more personal side, all my memories reinforce the impression of Dr. Young's own powerful influence on his residents. Discipline was strict-woe to the man whose cases were not worked up, and kept up to the minute, or whose charts were not ready for the weekly history meeting. Dr. Young's pockets were always filled with clippings from the Journal of the American Medical Association, or other journals. These he distributed generously to the members of the resident staff, accompanying each such gift with an injunction to 'get to work on this, it seems to be interesting.' One was constantly urged to write and publish, but not to write unless there was something important to say. 'Never write a "pot-boiler"; it doesn't do you any good' was an oft-quoted maxim. Many, I am sure, never realized until later how much this never ceasing stimulation contributed to the development of habits of industry, thoroughness, precision, and of ability to express one's self in speech or on paper. With all this the 'Professor' expected each one to go on to success and eminence and manifested it by treating all, 'off-hours,' with perfect courtesy and frequent extension of the generous hospitality of Cold Spring Lane and Gibson Island.

All this adds up to competence, confidence, and self-respect, and the record shows that these qualities in 'The Brady Alumni' have been appreciated and sought after.

The increasing demands of exploding population, growing prosperity, and expansion of medical knowledge and technology have had a tendency to dilute the intensity of training programs. Let each one of us do whatever he can to counteract this trend, and struggle hard, against no matter what difficulties, to keep up the quality of any training programs he may be concerned with.

Testimonial dinner for Hugh Young in 1927 at the Belvedere Hotel in Baltimore, MD.

Unfortunately, Davis does not provide a chronicle of the chief residents in urology at Johns Hopkins. Later on in this section, we provide such a listing according to available hospital records. It will be noted then that Frank Hinman and William A. Frontz were chief residents, not simply assistant resident surgeons.

Young's Practice of Urology

In 1926 Young published his textbook, Young's Practice of Urology, which was co-authored by David M. Davis with the help of Franklin P. Johnson and published in two volumes by W. B. Saunders. Actually, it represented a treatise on the diagnosis and treatment of many urological conditions based on the experience gained in the care of 12,500 patients seen in the Brady Institute.

We are fortunate in having access to Hugh Young's copies of this two-volume work. These were in Young's office when Scott assumed the chair in 1946 and he had them placed in a so-called "rare books collection" for the Hugh H. Young Library. These copies are of particular interest because Bertha Trott, in her fine hand, had pencilled-in the BUI history numbers in appropriate places. Until some 10 years ago this duplicate history system was kept up to date and totalled approximately 68,000 history numbers.

Young's textbook along with Hinman's The Principles and Practice of Urology, and Cabot's Modern Urology, enjoyed wide sales, as they represented the first efforts to provide comprehensive coverage of the field of urology.

Citizen Young

Beyond his distinguished career in urology was his involvement in causes for civic enhancement, the armed forces, and for the arts. It is truly remarkable that one man could accomplish so much. Time and space does not permit a detailed accounting of Young's participation in such, but a brief recounting is in order. The interested reader will find delightful accounts of these activities in Hugh Young: A Surgeon's Autobiography, and in an as yet unpublished address by Dr. James H. Semans, one of Young's last chief residents, entitled simply "Doctor Hugh Hampton Young." This was given March 18, 1986, in the Marburg Conference Room of The Johns Hopkins Hospital on the occasion of Semans' visit to Baltimore as joint visiting professor of the Departments of Urology and the History of Medicine.

In his autobiography, Young devotes well over 100 pages to World War I and especially to venereal diseases. A declaration of war was demanded by President Wilson of the Senate on April 6, 1917, and by May 29th Young was on board the Baltic en route to Birkenhead opposite Liverpool. In July, the chief surgeon had notified Young that he had been put in charge of all the urological and venereal disease work with the official title, Director of the Division of Urology. Among other things, this resulted in Young's authorization to prepare a book on military urology. This volume of almost 300 pages was completed in January 1918. Known as the Manual of Military Urology it was the first on any medical subject in the American Expeditionary Force.

Whether or not Young's interest in aviation began with his service in the army is uncertain, but it is established that by 1929 a law providing for the creation of an aviation committee in Maryland was passed by the legislature and Governor Ritchie had asked Dr. Young to become its first chairman and to assist him in the selection of the members of the commission. Semans tells that later Young became chairman of a planning committee for Friendship Airport (which later became the Baltimore Washington International Airport). It will be recalled that early in Young's professional life he had formed a close friendship with Albert Cabell Ritchie. In 1932, Young was one of the delegates from Maryland to the National Convention in Chicago when Maryland placed the name of her adored son for the presidency. The final vote was close but Ritchie lost to Franklin Delano Roosevelt.

Young's participation in community activities became legendary. His interest in music may well have been engendered by his wife, Bessy Colston Young, who was one of the four daughters of Captain and Mrs. Colston. Mrs. Colston was the daughter of John Archibald Campbell. Bessy Colston was J.A.C. Colston's sister.

Captain Colston was apparently secretary of the company that originally built the Lyric Theater in Baltimore and he and Mr. Frank Frick had been the chief propagandists. It is not hard to imagine that this early experience prompted Hugh Young to work very hard at a later date to raise money to purchase and renovate the Lyric in order that the Metropolitan Opera Company could continue to perform in Baltimore.

Among his many state and civic activities was his legislation for tuberculosis and for the insane and for the establishment of a Municipal Hospital overlooking Lake Montebello. His support of the necessary legislation also helped in the establishment of the School of Engineering at the Johns Hopkins University in 1912 'Lastly, in this regard, the reader is again referred to Young's autobiography for descriptions of many more of his civic and social accomplishments. His acquisition of the portraits of the Lords Baltimore in 1933 is particularly informative. On loan from the Baltimore Museum of Art, they presently hang in the Enoch Pratt Free Library in Baltimore.

There is also the anecdote concerning the commissioning of Young's bust by his friend, Robert "Bob" Worth Bingham, its execution by the famous British sculptor, Claire Sheridan, its original unveiling at the University of Virginia with a speech by Dr. John N. Neff, and the ending repartee between a young woman in the audience and Dr. Young. "I hope you appreciate that I have come fifty miles to see your bust unveiled." Whereupon with a bow, Young said, "I would go a thousand to see yours." This bust now resides in the Hugh Young Library and, on occasion, appears in the back row of one of the annual photographs of the staff.

Honors and Awards

Hugh Young was president of many medical organizations as well as the recipient of numerous awards. In 1908, as president of the American Urological Association, he presided over its annual meeting in Chicago. Two years later he was president of the American Association of Genito-Urinary Surgeons; in 1912, president of the Medical and Chirurgical Faculty of the State of Maryland; and in 1925, president of the Clinical Society. He was one of the few urologists to receive the Francis Amory Prize, sharing it one year with Joseph McCarthy of New York and Carl Moore, the anatomist-embryologist-endocrinologist, at the University of Chicago.

Testimonial dinner for Hugh Young in 1927 at the Belvedere Hotel in Baltimore, MD.

 In 1937, the American Association of Genito-Surgery awarded him their Keyes Medal.

In his autobiography, Hugh Young listed a number of men who served as his assistant beginning in 1899 and ending in 1913. There follows a simple listing of these men and the years concerned.

• William E. Huger, 1899-1901
• Joseph Hume, 1901-1902
• Hugh H. Trout, 1902
• Harry Atwood Fowler, 1902-1903
• John T. Geraghty
• Alex Raymond Stevens, 1903-1905
• John W. Churchman, 1903-1905
• Alexander Randall, 1907-1908
• John R. Caulk, 1907-1908, 1909-1910
• Harry Ward Plaggemyer, 1912-1913
• Arthur Cecil, 1912-1913
• Oswald S. Lowsley, 1912-1913

It is fitting to follow this brief summation of his accomplishments with an accounting of the many residents he helped to train, which is possibly his greatest accomplishment of all.

References

1. Chesney, A. M.: The Johns Hopkins Hospital and The Johns Hopkins University School of Medicine, volume II, 1893-1905. The Johns Hopkins Press, Baltimore pp. 109-110.
2. Young, H. H.: Hugh Young: A Surgeons Autobiography. Harcourt, Brace and Company, New York, 1940, p. 76.
3. Jewett, H. J.: The Case for Radical Perineal Prostatec- tomy. J. Urol. 103:195-199, 1970.