Section III
Medical Schools, Urology Training Programs, and VA Hospitals
University of Miami | Veterans Hospital | University of Florida
Tampa and University of South Florida
University of Miami, School of Medicine
by Milton M. Coplan, M.D., Ernest Costantino, Jr., M.D., and Victor A. Politano, M.D.
Although one of the youngest medical schools in the nation, the University of Miami, School of Medicine has earned national acclaim for research efforts, clinical care, and biomedical innovations. It has helped establish the University of Miami-Jackson Memorial Medical Center as one of the twenty-five best hospitals in the United States.
The medical center had its beginnings in the spring of 1896 when Dr. James Jackson, Jr. (for whom Jackson Memorial Hospital is named) arrived in Miami and became the city’s first resident physician.¹ Seeing no future in his north Florida hometown of Bronson, the young doctor had tentatively accepted a post as surgeon for Henry Flagler’s Florida East Coast Railroad, with residence in Miami, the railway’s southern terminus. In 1905 he built the city’s first hospital on a lot on Twelfth Street. The original building is an historic site which has been moved to Twelfth Terrace and is protected by the Dade Heritage Trust.
Shortly after recovering from a serious intestinal disorder in 1923, Dr. Jackson developed bronchopneumonia and had to travel to Baltimore, Maryland, to consult a specialist friend. Soon after, he was forced to enter Johns Hopkins Hospital and submit to painful Mercurochrome therapy.
Dr. E. Clay Shaw was then a house officer and an expert in this technique. He so impressed Dr. Jackson that Dr. Jackson persuaded him to move to Miami upon completion of his urology residency. Dr. Shaw moved to Miami in 1925 and quickly established a successful practice. For many years Dr. Shaw was the prominent urologist in south Florida. (Note: For more on Dr. Shaw see Section IL)
In 1917 the City of Miami established a public hospital at the site presently occupied by the Jackson Memorial Medical Center and the University of Miami, School of Medicine and named it City Hospital. The original building is located in front of the Central Building. For many years it housed interns and residents, who named it the “Alamo” because of its striking resemblance to the historic Alamo in San Antonio, Texas. The city’s first physician, Dr. James Jackson, Jr., was recognized for his continuous involvement in community affairs, particularly its health needs. When he died in 1924, the city of Miami named City Hospital after him. It then became Jackson Memorial Hospital. By mutual consent of the City of Miami and Dade County, Jackson Memorial Hospital became a county-owned and operated facility in 1949.
During the 1940’s University of Miami President Bowman Foster Ashe, State Senator R. Bunn Gautier, and a handful of others had a dream--one that critics called an impossible dream. They wanted to establish a medical school in Miami. Fortunately, their timing was perfect in that Florida was the only state in the southeast without a medical school. Lawmakers were long tired of sending education money out of state. The University of Miami overcame enormous political odds, withstood several legal challenges and, finally, in 1952 established the first medical school in the State of Florida.
The Medical School had its modest beginning with 28 students, a dean and four faculty members. The first classes were held in a building formerly occupied by the Biltmore Hotel in Coral Gables, Florida. After the Great Hurricane of September 1926, the Biltmore Hotel struggled to continue as a hotel, and at the beginning of WWII the U.S. Army opened it as a hospital and later turned it over to the Veterans Administration. Classes were held in the former servants’ quarters, and the grand ballroom was used for the animal laboratory. Mickey P. Demos, M. D. of Miami is a graduate of the class of 1957. He was the school’s first graduate to become a urologist.
The University of Miami, School of Medicine quickly expanded and became the large premiere medical institution of today. Several factors have been the keys in this expansion. The most important have been, first of all, the existence in Dade County of an excellent teaching hospital with abundant clinical material and, secondly, the early, fine support of the medical profession in the Miami area. The international diversity of the Medical Center has also contributed to this development. The first president of the University of Miami, Dr. Bowman Ashe, recognized that Miami is at the crossroads of the Americas, and is a natural site for answers to the medical problems of Latin America. He encouraged the young clinical staff of the Medical School to learn Spanish and to become involved in the health care of Latin America. The faculty rernonded appropriately, and now, the facilities draw hundreds of medical gradi ·es from Central and South America for graduate training and millions of visitors for diagnosis and treatment.
Urology Residency Programs And Early Urology In Miami
The earliest urologists in Miami were primarily venereologists and included Dr. C. S. Hassell, who was practicing several years before 1924; Dr. Olin McKenzie, who opened an office in 1922; and Dr. D. W. Harris, who came to the city in 1923. The first resident — trained urologists to come into the State of Florida were Dr. Roy J. Holmes, who opened an office in Miami in 1924, and Dr. Milton M. Coplan, who joined him in 1925. Dr. Holmes had his urological training at the Alexion Brothers Hospital in Chicago, Illinois, under the direction of the department of urology of Rush Medical College.
Dr. Coplan did his urological training at St. Thomas Hospital in Nashville, Tennessee, under the direction of the Department of Urology of Vanderbilt University. In those early days the urological residency was for only one year, but one year of rotating internship was required in order to qualify for the residency training program. Dr. E. Clay Shaw came to Miami in 1925. He was an exceptionally well trained urologist, having trained under Hugh Hampton Young at Johns Hopkins Medical School in Baltimore, Maryland. Dr. Shaw became the most notable urologist in southern Florida.
The patients requiring urological surgery prior to the arrival of Dr. Holmes and Dr. Coplan were sent north for their surgery, unless it was of an emergent nature. Emergency urological surgery was done by several general surgeons of good reputation in the community: Dr. Edgar Peters, Dr. C. F. Sayles, Dr. R. 0. Lyell, Dr. E. J. Thomas, and Dr. J. C. Turner. A prostatectomy had never been done in Miami until Dr. Holmes and Dr. Coplan operated on the father of Dr. C. F. Roche, one of the few doctors on Miami Beach in 1925. The operation was done at Jackson Memorial Hospital with a successful outcome.
In 1926 the entire southeast coast of Florida was at the peak of the great real estate boom, and the tremendous influx of people from all over the country put terrible pressure on all the hospitals. The emergency room at Jackson Memorial Hospital required an organized urological service for the treatment of the many urological emergencies. The administration of the hospital asked Dr. Roy J. Holmes to organize such a service. He developed the urology service (or department as we know it today) with Dr. Holmes, Dr. Coplan, Dr. Harris, and Dr. Shaw each agreeing to provide urological services to patients in the emergency room at Jackson Memorial Hospital. Dr. Holmes became Chief of the urological services. At the time the hospital had interns but no residents. The interns were taught as much urology as they could learn. The attending urologist on the urological service would teach the interns and provide the emergency care when the problem could not be treated by the intern.
In September 1926 and October 1928 the southeast coast of Florida was hit by severe hurricanes. The resultant destruction caused a temporary halt in the great Florida land boom and influx of people, including physicians. In 1931 Dr. W. L. Fitzgerald came to Miami and was added to the urological service, which then also provided emergency care at a Dade County Hospital in Kendall. Dr. Fitzgerald trained in urology at Tulane University. His son, Dr. Joseph Fitzgerald is presently practicing urology in Miami. In 1937 Dr. Perry D. Melvin completed his urological training at the University of Pennsylvania, came to Miami to begin his practice, and joined the urology service at Jackson Memorial Hospital.
Residency Training
In 1934 Jackson Memorial Hospital had interns, a general surgery residency, abundant clinical material, well-trained urologists, and a urological service, which began to attract physicians who wanted to become urologists. The earliest requirements were an internship, a year of general surgery residency, and six months of urology residency. Afterwards, the physician would often affiliate with an experienced urological surgeon, who was a preceptor, and would continue the training. Dr. Jack McKenzie was the first urological trainee in 1934, followed by Dr. Frank Woods in 1936, and Dr. Donald Bashline in 1937. According to hospital records Dr. Bashline was the last surgical resident to train specifically for urology until the three-year urological residency program was established in 1948.
In 1948 under the leadership of Dr. Milton M. Coplan, the urology service at Jackson Memorial Hospital sought and received approval from the American Board of Urology, the American Urological Association, and the American Medical Association for an accredited, three-year, urology residency training program. At first the national organizations doubted the credibility of the program, and final approval required a visit to Miami by Dr. Rubin Flocks. After evaluating the urology service, Dr. Flocks made a very favorable report and recommended that the program be approved. The urological attending staff at the time consisted of Dr. Coplan, Dr. Fitzgerald, Dr. Goldman, Dr. Kohen, Dr. Melvin, and Dr. Woods. Dr. Shaw did not wish to participate in the early program. However, he joined the clinical faculty in 1952, when the University of Miami, School of Medicine was opened with Jackson Memorial Hospital as its teaching hospital. The first resident selected for the three-year program was Dr. Henry C. Hardin. Dr. Hardin would later serve many years with distinction as the Executive Secretary of the SESAUA and of the Florida Urological Society. Dr. Albert M. Hyde, Dr. H. A. P. Leininger, Dr. John Langstaff, and Dr. S. A. Moses Shashy were other early residents.
In 1950 Dr. Park Smith, Professor of Urology at the University of Cincinnati, and Dr. Meredith Campbell, author of the text book of urology and Professor of Urology at the New York College of Medicine, came to Miami to retire but soon opened offices and began to practice urology. They did not wish to do indigent care and would not join the urology service at Jackson Memorial Hospital. Dr. Jack Sloane came to Miami in 1949, followed by Dr. Ben Harrow in 1952, after completing approved, three-year residency programs. Being well qualified, both doctors joined the urology staff at Jackson Memorial Hospital.
The opening of the University of Miami, School of Medicine in September 1952 and its teaching affiliation with Jackson Memorial Hospital increased the responsibilities and challenges for Dr. Coplan. In addition to being Chief of Urology, he was President of the Medical Staff and Chairman of the Medical Board of Jackson Memorial Hospital. Many of the physician staff members of the hospital did not want the Medical School to control the hospital. They were fearful that the “full-time” faculty would “push out” and absorb the practices of the local doctors, who had faithfully served the needs of patients and the hospital for many years. There was also a segment of the public, who feared that the cost of operating Jackson Memorial Hospital would be greatly increased by assuming some of the Medical School’s cost of operation.
In 1954 after two years of basic science teaching, the Medical School appointed its clinical faculty. Dr. W. D. Fitzgerald (father of Dr. Joseph Fitzgerald) and Dr. Coplan were named co-acting Chairmen of the Division of Urology and worked well together. However, they soon felt that the division of urology had developed to the degree that a full time faculty head should be obtained. They advised Dr. John Farrell, Chairman of the Department of Surgery, and Dr. Homer F. Marsh, Dean of the Medical School, of the need for a full time Chairman. Dr. George Prout, at Memorial Hospital and Sloan Kettering Institute in New York, was recommended for the position by Dr. Victor Marshall of Sloan Kettering. Dr. Prout was interviewed by Dr. Coplan, Dr. Farrell, and Dr. Marsh and was offered the position of Chairman of the Division of Urology and Assistant Professor of Urology. Dr. Prout accepted and began his duties in the summer of 1957. He served until 1960, when he resigned and moved to Boston to become Chairman of the Department of Urology at Massachusetts General Hospital. Dr. Coplan was asked to serve as interim chairman until a new one could be selected.
Again, a request was made to bring a full time urologist into the division, and once more, Dr. Coplan was asked to make a search for a qualified, suitable person to fill the chair of the division chief. A number of prospects were brought to Miami at the expense of the University for interviews. In that group were: Dr. Donald McDonald, then in California but later Chairman of the Division of Urology, University of Texas at Galveston, Texas; Dr. Charles A. Hooks from the University of Texas at Galveston, Texas; Dr. John Clark of Boston, Massachusetts; Dr. John Benjamin of the University of Rochester, New York; Dr. Chester Winter, who became Chairman of the Department of Urology at Ohio State University, Columbus, Ohio; Dr. Lester Persky, Chairman of the Department of Urology, Western Reserve Medical School, in Cleveland, Ohio; and Dr. Victor A. Politano, then of Duke University. All had the opportunity to meet Dr. Farrell, Dean Marsh and the local urologists serving on the clinical faculty.
Finally, the clinical faculty was asked to express an opinion of preference from among these men. The faculty selected Dr. Persky and Dr. Politano but could not decide between the two. The final selection was made by Dr. Farrell and Dr. Marsh. Dr. Politano was chosen and became Chairman of the Department of Urology. He has proven himself to be a great asset to the University of Miami, School of Medicine. Dr. Politano’s numerous contributions have included developing a large referral practice of patients from Central and South America, by going to those countries and meeting their doctors. He prepared himself by taking intensive courses in Spanish in order to make the Medical School known to those countries as Dr. Bowman Ashe, the first President of the University of Miami, had requested.
Dr. Politano did his residency training at Duke University and then went to Harvard University and Massachusetts General Hospital for a fellowship in urology with Dr. Wyland Leadbetter. After training he continued to practice urology in Boston, where he became an associate professor of urology at Massachusetts General Hospital and an instructor in surgery at Harvard Medical School. He distinguished himself in pediatric surgery, especially with his contributions to the treatment of vesicoureteral reflux, before returning to Duke University as an associate professor of urology in the Department of Surgery.
Dr. Politano became the second full time Professor and Chairman of the Department of Urology at the University of Miami, School of Medicine in 1962 and continued as Chairman until 1991. He was one of several talented young chairmen who came to the fledgling medical school at that time. They quickly earned national acclaim for their clinical care and research, and established the University of Miami — Jackson Memorial Medical Center as one of the twenty-five best hospitals in the United States. Dr. Politano made frequent visits to Central and South America where he lectured in Spanish and developed a large referral practice of Hispanic patients to the University of Miami, School of Medicine.
The new Chairman had excellent surgical and diagnostic skills and quickly developed a large referral practice of adult and pediatric patients. Consequently, the training program continued to emphasize clinical urology and the training of physicians for the general practice of urology. Dr. Politano’ s close fellowship with prominent urologists of the day, who frequently visited him at his home and participated in his seminars, was a notable benefit for the teaching program.
In 1969 the Department held the First Annual Postgraduate Seminar in Adult and Pediatric Urology, which was continued by Dr. Politano until his retirement in 1991. Participants in the seminar included: Dr. Wyland F. Leadbetter, Dr. Joseph J. Kaufman, Dr. Willet F. Whitmore, Dr. Ruben H. Flocks, Dr. Victor Marshall, Dr. Donald Skinner, Dr. Arthur Smith, Dr. Hardy Hendron, Dr. John Duckett, Dr. John McGovern, Dr. John Donahue, Dr. Harry Spence, Dr. John Libertino, Dr. John Grayhack, Dr. Eugene Carlton, Dr. Vincent O’Conner, Jr., Dr. Carl Olsen and Dr. Paul Peters. International participants included: from the U. K. — Mr. Geoffrey Chisholm, Mr. David Innes Williams, Mr. William Turner Warwick, Mr. John Blandly, and Mr. Herbert Johnson; from Germany — Dr. Hans Reuter; from France — Dr. Jacob Cukier; from Italy — Dr. Vito Ponsidoro; and from Spain — Dr. Marie Gil-Vernet, and Dr. Rafael Gosalbez.
Dr. Politano is the first chairman who recruited urologists for full time teaching positions. He is largely responsible for developing the Department of Urology as we know it today. His first selection was Dr. John Harper, who completed his urology residency at Duke University. Dr. Harper came to the University of Miami in 1963 as an assistant professor. He assisted Dr. Politano in his work on the treatment of urinary incontinence with periurethral injection of Teflon in adults. He continued teaching residents and practicing at the University until 1968, when he moved to private practice in Fort Lauderdale. Dr. Michael Small joined the department in 1967 as an assistant professor and soon became an associate professor. He came from Wayne State University and Duke University, where he was an assistant professor and instructor. After several years Dr. Small left the department to enter private practice in Miami but continued as a clinical professor of urology until 1996. Dr. Charles M. Lynne completed his residency at the University of Miami in 1971 and joined the full time faculty. Dr. Lynne was the first resident from the program to choose an academic career. He is still at the University, where he is director of the Neurourology, Urodynamics and Male Infertility Programs. Dr. Norman L. Block joined the faculty in 1972, after having completed a fellowship in urological oncology at the Sloan Kettering Institute of New York City. He immediately established a urology research laboratory and has continued as full professor and Director of the Research Laboratory. He is responsible for the Department’s participation in several national pharmaceutical clinical studies.
In 1969 the program had the good fortune of selecting Dr. Hernan M. Carrion of Peru, South America, as a resident. He was a general surgeon in Peru for several years and began the University of Miami urology program, after having spent a year in urology training at Rosewell Park Memorial Hospital in Buffalo, New York. Dr. Carrion joined the faculty in 1973, after he had completed the residency program. Dr. Carrion and Dr. Small developed the Small-Carrion penile prosthesis and the technique of intracavernous placement, innovations which laid the foundations for current penile prosthesis surgery. Dr. Carrion has lectured in Central and South America and has been president of several of their national urological societies. In 1980 he received the Outstanding Teacher Award, University of Miami, School of Medicine, House Staff Physicians Association. In 1981 he left the full time faculty, and entered private practice in Miami. The University gave Dr. Carrion the Special Recognition Award as Resident and Faculty Member, Department of Urology, 1969-1981.
Dr. Jorge L. Lockhart joined the Department in 1978, after he had completed a residency and fellowship at Duke University. From Uruguay, South America, Dr. Lockhart continued the Department’s tradition of teaching urologists in South America and attracting Hispanic patients to the University. Dr. Lockhart is especially known for his work in urodynamics, reconstructive surgery and continent urinary diversion. (He and Dr. Bejany developed the Miami Pouch). He soon became a full professor. In 1987 he left Miami to become Chairman of the Division of Urology at the University of South Florida, College of Medicine in Tampa, Florida.
Dr. Robert Rhamy joined the Department in 1983. He had been an assistant professor at Indiana University Medical School, Department of Urology and Professor and Chairman, Department of Urology, Vanderbilt University, Medical School. His special interests were pediatric urology and neurourology. Dr. Rhamy is now Chief of the Spinal Cord Injury Clinic at the VA Hospital in Miami. Dr. Bert Vortsman, a urologist from New Zealand, joined the Department in 1982 as a research fellow. From 1983 to 1985 he did a fellowship in pediatric and reconstructive surgery with Dr. Horton and Dr. DeVine of Norfolk, Virginia. He returned to the Department in 1985 as an assistant professor and left for private practice in 1987. Dr. Darwich E. Bejany joined the Department in 1985 and continued on the faculty until 1994, when the left to do private practice in Miami.
Nearing retirement as Chairman in 1991, Dr. Politano wisely recruited Dr. Rafael Gosalbez to join the faculty as Director of Pediatric Urology. Dr. Gosalbez’s father, a close friend of Dr. Politano, was a pediatric urologist in Barcelona, Spain. He and young Rafael made frequent trips to Miami, where he was greatly influenced by Dr. Politano. Dr. Gosalbez did a residency and fellowship at Emory University Medical Center in pediatric urology and reconstructive urology. He joined the faculty in 1992.
The University of Miami and, especially, the Department of Urology were nationally recognized as centers of excellence at the time of Dr. Politano’s retirement. A search was begun for an appropriate replacement. The Search Committee selected Dr. Mark S. Soloway, who at the time was a full professor of urology at the University of Tennessee in Memphis, Tennessee. Dr. Soloway is a leader in urological oncology. He received training at Case Western Reserve and University Hospital of Cleveland in Cleveland, Ohio, and at the National Cancer Institute in Bethesda, Maryland. Dr. Soloway became Chairman of the Department of Urology in 1991, and quickly developed large clinical and research programs in urological oncology.
Dr. Rafael A. Antun also joined the Department in 1991. He has a special interest in general and female urology. In 1992 Dr. Amon Krongrad joined the Department and became Chief, Section of Urology at the VA Hospital in Miami. He did a fellowship at the University of Texas, Southwestern Medical Center and has a special interest in carcinoma of the prostate. Dr. Lawrence S. Hakim joined the faculty in 1993. His subspecialty is erectile dysfunction and male infertility. The Pediatric Urological Section added Dr. Andrew Labbie in 1995. He did a fellowship at Baylor University in Houston, Texas.
In 1995 Dr. Raymond J. Leveille was a notable addition to the Department. A skillful endourologist, he was recruited to be Director of Endourology and Laparoscopy. He completed his urology residency at Brown University Medical Center and did a fellowship in endourology at the University of Minnesota, Department of Urology. In June 1997 Dr. Leveille and Dr. K. Kirby conducted the Department’s first instructional seminar on endourology with applications of the Holmium Laser.
Over the years the department’s research laboratory expanded and added Balakrishna L. Lokeshwar, Ph.D., Vinata B. Lokeshwar, Ph.D., and Ge Ball, M.D., Ph.D.
Several urologists, including Dr. Richard L. Fein, Dr. Jerrold Sharkey, Dr. Richard F. Power, and Dr. George M. Suarez, were full time faculty members for short periods before going into private practice.
The University of Miami, School of Medicine, Department of Urology has two endowed chairs. The Lavistin Weeks Family Endowment for Urological Research honors Dr. Norman L. Block. The Chair was funded in 1980 by Dr. Block’s grateful patient, Lavistin Weeks. The Victor A. Politano, M.D. Endowed Chair was created in 1982 to honor Dr. Politano and his work. The Chair, which is perpetual, was funded by friends, patients, and residents, and is administered by the Board of Trustees of The University of Miami.
Veterans Hospital — Miami
At the beginning of WWII the U.S. Army opened a hospital in buildings formerly occupied by the Biltmore Hotel in Coral Gables, Florida. The hospital soon became a Veterans Administration Hospital. Dr. Schneider was the first urologist at the hospital. At the time the hospital had an accredited general surgery residency program with the surgical residents rotating through the urology service. Dr. Coplan, Dr. Woods, and Dr. Melvin of Miami would make weekly rounds and participate in the urological care of the patients and teaching of the residents.
The Biltmore Hotel was a grand hotel with an ornate swimming pool, grand ballroom, luxury rooms, and a golf course. Several years after its conversion to a VA Hospital, it provided an early home for the newly established University of Miami, School of Medicine. Classes were held in the former servants’ quarters, and the grand ballroom was used for the animal laboratory.
Ben Schwarcz, M.D. arrived at the VA Hospital in 1947 and replaced Dr. Schneider as attending urologist. He graduated from Loyala Medical School in 1932, completed a rotating internship at St. Bernard’s hospital, and started private practice in Chicago. After struggling unsuccessfully to establish a practice during the depression, Dr. Schwarcz was advised to apply for a job as a physician in the VA system. He was hired and started at Hines Hospital in Chicago. He was assigned to the surgical section and was a surgeon for two years on a busy cancer service, which was a training service for other VA hospital physicians. He was offered a better paying position at a VA hospital in Memphis, Tennessee, and accepted the position there as a general surgeon. The surgical service included urology, and he was assigned to work with the urological surgeon, Charles Allen, M.D. After some time Dr. Allen convinced Dr. Schwarcz to do four years of preceptorial training with him, which would then qualify him as a urological surgeon. During WWII Dr. Schwarcz was relocated to a VA hospital in Alexandria, Louisiana. After the war Dr. Schwarcz took a few months of additional training at Kennedy VA Hospital in Memphis, Tennessee, which made him eligible to take the examination of the American Board of Urology. He passed the Urology Boards and became a member of the American College of Surgeons in 1950.
Dr. Schwarcz was an active teacher of urology and taught the residents in Miami for almost 50 years. He is best remembered for his constant presence and supervision during endoscopic procedures. He would patiently sit beside the resident physician for the entire procedure. At regular intervals he would look into the cystoscope for an evaluation and instruction about what was done and what should be done. He was a hypnotist and regularly practiced his skill using hypnotherapy as anesthesia for endoscopic procedures. In 1957 he performed a suprapubic prostatectomy using hypnotherapy as the only anesthesia.² An epidural catheter was placed preoperatively, to be used if the hypnotherapy failed during the surgery, but never had to be used. He was a pioneer in continent urinary diversions and successfully used the Gursuney rectal pouch as urinary diversion in six patients requiring cystectomy.
Dr. Charles M. Lynne followed Dr. Schwarcz as director of the urological service. In 1977 Dr. Norman L. Block replaced Dr. Lynne and continued in that position until 1987 when Dr. Robert Rhamy became director. Dr. Amon Krongrad became director in 1992.
The VA Hospital has an outstanding Spinal Cord Injury Clinic, which for many years was directed by Dr. Marilyn Wells. In conjunction with the Paralyzed Veterans Association of Florida, the Clinic sponsors an annual meeting and instructional course on Neurogenic Voiding Dysfunction and Urodynamics. The VA Hospital has an outstanding urodynamics laboratory, which is directed by Mr. David Weinstein, a bin-engineer. Dr. Robert Rhamy replaced Dr. Wells in 1987 as director of the clinic.
History of Urology at the University of Florida College of Medicine
by David M. Drylie, M.D.
The idea of the State of Florida having a medical school was first seriously considered in the early 1940’s. At that time Florida’s population was less than a tenth of that existing in 1995. Even so, there was only one physician for 911 persons. The legislature proposed the school in 1943. Ten years of planning followed with much infighting about whether the school would be in Tampa, Gainesville, or Jacksonville. Senator William A. Shands from Gainesville was the leader in securing the school for Gainesville. Located in Gainesville it could be an integral part of the University of Florida, the state’s senior and largest university. The Teaching Hospital, named for Senator Shands, is now known throughout the state and region as a center of excellence for medical care. Ground was broken for the hospital in 1956. The first patient was admitted in the fall of 1958. In 1956 the Medical Sciences Building opened, and the first class of medical students was admitted to be the first graduating class in 1960.
The clinical faculties were chosen between 1956 and 1958. Dr. Edward R. Woodward from the University of Chicago was picked as the Professor of Surgery. It was natural for him to pick most of the division chiefs from the University of Chicago. His long time mentor, Dr. Lester Dragstedt, became the director of research. Dr. George H. Miller, Jr. was a junior faculty member in the Division of Urology at Chicago. Under the tutelage of Dr. Charles Huggins, Dr. Rover Baker, and later Dr. Cornelius Vermeulen, he studied the pathogenesis of renal calculi and actively pursued this in the laboratory. Dr. Miller enjoyed a reputation as an excellent surgeon and teacher. He was Dr. Woodward’s first choice to head the new Division of Urology. He founded the Division of Urology, University of Florida, College of Medicine and was the first Chief of Urology, at the VA Hospital, Gainesville.
Dr. Miller began his medical training at the University of Pennsylvania Medical School. In 1948 he went to the University of Chicago as an intern and stayed to complete his residency in the Division of Urology under the direction of Nobel Laureate, Charles Huggins. He joined the University Chicago Faculty and worked in the research laboratory on urolithiasis with Dr. Cornelius Vermeulen. Birdwell Finlayson was a medical student at the University of Chicago Medical School at the time. After spending a two-week elective rotation in the urolithiasis laboratory, he returned annually until his graduation from medical school. Dr. Finlayson and Dr. Miller became close friends. Dr. Finlayson continued his interest in urolithiasis by obtaining a doctorate degree in biophysics and also completing a residency in urology at the University of Chicago.
In 1958 Dr. Miller joined the faculty at the University of Florida, College of Medicine as assistant professor. He made several notable contributions to the fledgling medical school. Dr. Miller organized the Division of Urology, established a urolithiasis laboratory, and was an assistant dean of the College of Medicine. He became a full professor of surgery in 1962 and Chief of Staff at the VA Hospital in Gainesville. In 1967 Dr. Miller brought Dr. Birdwell Finlayson to the University of Florida, where he was to continue his urolithiasis research. Dr. Finlayson eventually established the first extracorporeal shock wave lithotriptors in Florida.
A friend of Dr. Miller at the University of Florida, College of Medicine was Dr. Robert Cade, a nephrologist in the Department of Medicine. He developed “Gatorade” in his basement as an electrolyte drink for the football players during the “Spurrier Years.” Dr. Cade’s idea was to sell the drink and use the money to finance dialysis units throughout the state for patients awaiting renal transplantation. The University rejected the idea but after Stokley-Vancamp bought the “Gatorade,” the University claimed the money, which has been placed in an escrow account.
It was somewhat by design that the school’s surgical leaders were chosen from the University of Chicago. They were familiar with the organization envisioned for the new Florida school. This system stressed total group practice within a strictly full-time faculty. It also stressed a complete amalgamation of the “private” and “clinic” services, unlike many teaching hospitals of the time. Residents and faculty worked together all day as a team sharing responsibilities for teaching and patient care. Under this system surgical residents received a rich surgical experience. This tradition continues to the present.
Elliot Klorfein became the first urology resident July 1, 1959. Three years later he began what was to be a successful and lifelong practice in West Palm Beach. The second resident starting July 1, 1960, was David Drylie, who, ultimately, would succeed Dr. Miller as Chief of Urology. Dr. Thomas McLaughlin was also an early resident. After a vascular fellowship at the Cleveland Clinic, he joined the Watson Clinic in Lakeland, Florida, one of the state’s premier group practices. He went on to head the urology group at the Clinic. He became President of the Florida Urological Society and President of the Southeastern Section of the AUA. Another early resident, Dr. William Clayton chose a Navy career and, ultimately, became Commander for the Medical Services in the Pacific. Dr. William Jordan helped found and was the CEO of Lithotriptors, Inc., the first company to provide mobile lithotriptors. This company is still the dominant force in that market. Virtually all of the residents going into private practice have been highly successful medically. They have also seen it as their privilege to be involved in the life of their communities and medical associations. It was gratifying to note that 75% of those at the 1995 Florida Urological Society Board Meeting were former residents from the University of Florida.
It became apparent that Shands Hospital attracted a strictly tertiary care clientele. The College therefore entered an affiliation with the Veterans Hospital in Lake City, Florida, 45 miles north. Surgical house staff also used close-by state prisons to the benefit of both the prisons and themselves. These affiliations became unnecessary in 1967 with the opening of the Gainesville Veterans Hospital. This hospital, a Dean’s Committee hospital, was sited directly across the street from Shand’s Hospital. From the outset this proved to be the answer to the slanted surgical experience. This facility has consistently been very understanding of urology’s needs and, to this day, provides an excellent complement to the training program.
Dr. George Miller became the Chief of Staff of the hospital in 1970. He also served as the first Chief of Urology for many years at the University of Florida. Dr. Miller left the University of Florida in 1976 and became Chief of Urology and Chief of Staff at the VA Hospital in Togus, Maine. He retired in 1990 and enjoys living on Moosehead Lake in Maine, where he raises sheep on his “ancient farm” purchased in 1976.
Dr. David Drylie joined Dr. Miller as a junior faculty member in 1963. In 1965 he was awarded an NIH Special Fellowship and worked in the immunology laboratory of the Pediatric Department. Early research was done on the immunology of prostate cryosurgery and the effect of various perfusates on kidneys to be used for transplantation. Feeling that the University of Florida program had failed to become known within the State, Dr. Drylie decided to become active in medical politics. He became a delegate to the Florida Medical Association, an officer, and President of the Alachua County Medical Society. He was chosen as a member of the Board of the Southeastern Section of the AUA by the Florida Urological Society. Service on the Section Committee for Science and Education led to his election as an officer and, ultimately, President in 1989.
During this time the Florida Urological Society was used to accomplish a partial solution to problems confronting this program and urology in general. The first was a resolution that an individual must have had a urological residency before being granted privileges to do pediatric urology. Having this sent to all hospitals in Florida had a tremendous impact on the inroads which Pediatric Surgery sought. A similar resolution, passed several years later, had the same impact when Radiology attempted to take over the prostate biopsy business. Dr. Drylie urged the Society to threaten forming its own section should the AVA not accede to the one man, one vote principle. This stance has been softened during later years as many more important issues have emerged in medicine’s total arena. Dr. Drylie became Chief of the Division Urology in 1971, a position he held until 1994.
An important event in the development of the urology program took place in 1967, when Dr. Miller recruited Dr. Birdwell Finlayson from the University of Chicago. Upon completion of his urology residency at that institution, Dr. Finlayson embarked upon and completed work for his Ph.D. in biophysics. He wished to apply the principles of biophysics and, in particular, the ability to construct mathematical models to a study of the pathogenesis of renal calculous disease. Before his premature death in 1988, he became a world renowned scientist, a pioneering surgeon, a beloved teacher, and the inspiration for many students and peers. His influence in the development of the urology program is inestimable.
In the late 1960’s pediatric surgery was developing the expertise and the surgeons who could ultimately wrest pediatric urology from the urology specialty. Today we recognize that this was merely the first of many outside threats that our specialty would see. Dixon Walker III, M.D., an early urology resident and native of Gainesville, was known to be an excellent surgeon and a person with whom others worked well. He had an interest in pediatric urology and agreed to return to the faculty to develop a Pediatric Urology Service in 1970. Such a specialized service was rare in a general hospital and on a general urology service. Reluctantly, but with enthusiasm, the three existing faculty members agreed to give up their pediatric practices. Dr. Walker was afforded a brief fellowship with Mr. David Innes Williams in London. Upon his return he rapidly developed what has become one of the premier pediatric urology services in the nation. His accomplishments were recognized by his ascendance to the presidency of several national pediatric organizations and the Florida Urological Society. He is currently Editor of the Pediatric Urology Section, The Journal of Urology. (Note: For more on Dr. Walker see Section IV.)
The area of oncology was the next perceived deficiency. An old friend of the program, Dr. Harry Grabstald, was consulted as to possible individuals to fill this void. Much to our delight, Dr. Grabstald answered with a query about whether he would fulfill our needs. Some short cuts in the usually arduous, University hiring policies allowed Dr. Grabstald to become our first urological oncologist. This was our first true contact with the “specialty“ of oncology and brought a new dimension to our program. In many respects the three years that Dr. Grabstald was on the faculty were growing and maturing years. Dr. Grabstald left in 1975 to assume the position of Chief of Urology at the University of South Florida. Oncology reverted to the direction of Dr. Drylie and then a short-term new faculty member, Dr. Francis Deture. After Dr. Deture left for private practice, an immediate search was begun for a replacement.
Academic urologists proved hard to find until Dr. Zev Wajsman was interviewed. He was just the kind of individual the Division sought. He ultimately joined the program from his staff position at Roswell Park. Dr. Wajsman brought modern ideas, membership in various study groups, and much knowledge of clinical research to the Division. The Oncology Section, as well as the Pediatric Section, flourished. Dr. Wajsman established a fellowship and voluminous clinical material is now available to the residents.
Urodynamics and female urology were at least partially developed as a section when a former resident, Dr. Ira Klimberg, joined the faculty in 1987. He left for private practice in 1990. Dr. Howard Epstein took over this effort and the leadership of the VA service, which had consisted of a joint effort by the faculty after Dr. Miller had left for a position in Maine. Dr. Epstein completed his residency in 1989 and joined the faculty of our affiliated institution in Jacksonville. He has shown how vital a dedicated person can be to an academic VA’s educational and service functions. A sympathetic VA administration provided facilities only dreamed of previously. Dr. Epstein also proved to be very adept in the conduct of clinical research, using his engineering background to further our urodynamics efforts. In 1994 he returned to our Jacksonville affiliate and continues to be valuable to the program in the training of general surgery residents rotating through that institution.
At the time of his death in 1988, Dr. Finlayson had established a stone disease fellowship. Several of the individuals completing the fellowship went on to academic careers elsewhere. One of his last fellows was Dr. Robert Newman, who had just joined the faculty to allow Dr. Finlayson to spend more time conducting his basic research interests. Dr. Newman went on to develop the clinical stone service and proved especially adept with endourology which was developing at that time. He has since carried these abilities forward to the logical extension of laparoscopic surgery. These two areas of specialization have been augmented by the addition of Dr. Mark Cohen to the faculty in 1989. Dr. Cohen hoped to carry on urology’s share of the Stone Center Grant, left behind by Dr. Finlayson and newly funded for five years. Dr. Cohen’s interests in basic research became less intriguing when compared with the highly interesting clinical work being done by Dr. Newman. They became a very cohesive team in the pursuit of endourology and laparoscopy. Dr. Cohen also exhibited a talent for the study of the process of medical education, the utilization of the CQI techniques for problem solving, and a study of method to teach and improve patient-physician communication. These interests have made him a unique and valuable faculty member. In his spare time, Dr. Newman obtained an M.B.A. in Hospital Administration to facilitate his interest in this area.
Since Gainesville is relatively isolated, residents and faculty could become insular in their thinking. There was no exposure to the realities of private practice. Dr. Donald Jablonski left his general and pediatric practice at Wayne State University in 1969 to join a good friend’s private practice in Orlando. One of his first activities was to come to Gainesville and inquire as to the possibility of a clinical faculty appointment. With the aforementioned problem in mind, Dr. Miller and Dr. Drylie developed a visiting faculty program. There are currently thirty clinical faculty appointments with representation from a diverse geographical area of the State. These individuals contribute heavily to the educational program and, in turn, have proven to be frequent recruiters of graduating house staff. A number of them have been regular attendees of, and contributors at the weekly Journal Club. They have also taught surgical techniques by attending and scrubbing on cases at the Gainesville VA. They give up their own practice time and travel here at their own expense to provide this service.
A particularly noteworthy tradition was the establishment in 1973 of the annual Topics in Urology, postgraduate seminar. Because of Gainesville’s isolated location, and lack of funding sources in the early years, it was difficult to bring visiting professors to Gainesville. Limited funding also made it mandatory that this conference be held in Gainesville so all of the faculty and residents could attend. This seminar allowed us to bring an excellent visiting faculty to Gainesville annually. With the passage of the years, suggestions to hold the seminar in a more choice geographical area generated negative feelings by the alumni residents, who constituted a significant percentage of attendees. They used this as a chance to reunite and experience the educational program. The 23rd annual seminar in 1996 promised to be another good experience.
As Dr. Drylie neared retirement age, it was felt that the Division needed to start looking toward the future, and that the Division should be given Departmental status. It was believed that the change to Departmental status could best be accomplished by a chairman recruited from outside the University. The College honored us with as complete a search as they would have for a Department Chairperson. Many highly qualified individuals applied and six were interviewed. Emerging from this arduous process was Dr. Perinchery Narayan, who was the current Chief of Urology at the San Francisco Veterans Hospital. His training and experience, especially his expertise as an oncologist with a strong research involvement and transportable funding, appeared to be a perfect fit with the individuals for whom the search was designed. Dr. Narayan assumed his responsibilities October 1, 1994. The faculty has shown him total support and is excited about the future under his direction.
To date, improved resources include an easily accessible freestanding community clinic building, improved laboratory space, new equipment, new conference facilities, new offices and renovations to old ones. These are the basics necessary to expand the scope and mission of urology into the new century. They would appear to now be in place at the University of Florida.
History of Urology: Tampa and the College of Medicine University of South Florida
By Edgar J. Sanford, M.D. and Linus Hewit, M.D.
Dr. Clifford Vinson was the first urologist in Tampa. Born in Georgia in 1884, he graduated from the Atlanta Medical School in 1907. After graduation he served his internship and opened a practice in Tampa in 1908. Dr. Vinson was an innovative pioneer in urology in Florida. He pursued clinical research studies which he reported at various meetings and established a Section of Urology and Dermatology at Bayside Hospital, Tampa, Florida. (Note: For more on Dr. Vinson and the papers he wrote see Sections I and II.)
Dr. E. S. Gilmer came to Tampa in 1913 as a general practitioner. He pursued post graduate urological training with Dr. Randall at the University of Pennsylvania and received preceptorial training under Dr. Harry Plaggmeyer and Dr. Robert Comings of Detroit. Dr. Plaggmeyer and Dr. Comings had urological training at Johns Hopkins under Dr. Hugh Young. Dr. Gilmer eventually became board certified in urology in 1936.
Dr. Gideon Timberlake was a noted urologist and inventor of several urological instruments, including the Timberlake deflecting obturator which is still used to guide a resectoscpe into the urinary bladder. For a time he served as Chief of the Department of Urology, Walter Reed Hospital in Washington, D.C. After World War I Dr. Timberlake became a professor of urology at the University of Maryland, School of Medicine. In 1928 he moved to St. Petersburg, Florida, where he practiced urology for more than two decades.
The Southeastern Section of the American Urological Association had its origin in 1932. Dr. James L. Estes of Tampa was one of the founding members. Dr. Estes had trained at the County Hospital in Chicago. Ironically Dr. Estes died of metastatic hypernephroma in 1951.
Dr. Arthur Knouf came to Tampa in 1925 after training at the Mayo Clinic in Rochester, Minnesota. He obtained his urological boards in 1936. Dr. Knouf had a special interest in perinea} prostatectomy.
Dr. Linus Hewit came to Tampa in 1941, having trained at the Detroit Receiving Hospital and Henry Ford Hospital. After serving in the military, he returned to Tampa in 1946. He continued to have an active practice, and played an important role in the development of urological residency training in Tampa.
Dr. Louis Spicola came to Tampa in 1947 having trained with Dr. McCarthy in New York City. Dr. Spicola also played a major role in developing residency training in Tampa.
Urological Training Programs In Tampa.
The hospitals involved with the training of urology residents in Tampa originally included the Tampa Municipal Hospital, which is presently Tampa General Hospital, and St. Joseph’s Hospital. The early program was developed largely through the efforts of Dr. Linus Hewit and Dr. Joseph Spicola, who were the first directors of the program.
In 1957 with the growing population in the city, Tampa General was expanded. Dr. Roy Finney, who had trained at Johns Hopkins Hospital, came to Tampa in 1958 and went into practice with Dr. Alan Stevenson. Dr. Finney immediately gained a reputation as having an unusually inquisitive and inventive mind. In 1960 the residency program was approved by the Joint Commission on Hospital Accreditation, the American Medical Association, and the American Board of Urology. The residency program was based at Tampa General Hospital and St. Joseph’s Hospital with rotations through the Veterans Administration Hospital at Bay Pines. One resident a year completed the program from 1960 until 1973.
Dr. Antonio Duany was the first urological resident, 1957 to 1958. He served for six months and then moved to Tarpon Springs. He later returned to Tampa and went into general practice. Dr. Mercado was the first to complete the program, after the residency was actually approved in 1958 to 1959. After his second year of residency, he left Tampa to return to his home in Puerto Rico. Dr. Mercado was later President of the Urological Society of Puerto Rico. Dr. Woody York finished his residency in 1965 and was the first resident to complete the entire program. He went into practice with Dr. Hewit. In 1973 the residency program became affiliated with the new James Haley Veterans Hospital in Tampa.
College Of Medicine of The University Of South Florida
In 1971 the College of Medicine of the University of South Florida admitted the first class of medical students. In less than thirty years the college has established itself as a dynamic center for medical education, research, and patient care. Tampa General Hospital opened in 1927 and is now the College’s 1,000 bed teaching hospital, which includes a Level I trauma center. The H. Lee Moffitt Cancer Center opened in October 1986 as a 162 - bed hospital, devoted entirely to cancer through patient care, education, and research. The building was constructed with proceeds from the state cigarette tax. Other teaching hospitals include the James A. Haley Veterans Hospital, which opened in 1972, with 577 operational beds, and Bay Pines Veterans Hospital, which has 1,118 beds.
In 1971 the residency program became part of the University training system. Dr. Roy Finney became the original Chief of Urology at the University of South Florida, College of Medicine with Dr. Woody York as Associate Professor. Dr. John Sharpe and Dr. Ron Sadlowski were Assistant Professors. The training program continued to graduate one resident a year.
Following Dr. Finney’s retirement, Dr. Harry Grabstald became Chairman of the Division of Urology at the University of South Florida, College of Medicine from 1983 through 1986. During these years Dr. Dennis Hoover came to Tampa to practice pediatric urology, after he had completed training at the University of Pennsylvania. Dr. Stanley Hopkins was also added to the staff. Dr. Bryon Hodges joined the faculty as an oncologist for a few years, prior to entering private practice in Orlando.
In 1986 Dr. Herbert Brendler became Chairman of Urology but, unfortunately, died a short time after his appointment. Following Dr. Brendler’s death, the urology residency lost accreditation.
In 1987 Dr. Jorge L. Lockhart, who had trained at Duke University Medical Center and was on the Staff at the University of Miami, was recruited to establish a new residency program at the University of South Florida. Dr. Lester Persky, previously Chairman of Case-Western Reserve in Cleveland, joined Dr. Lockhart as Chief of Urology at the James A. Haley Veterans Hospital. Dr. Julio Pow-Sang joined the faculty as a urological oncologist at the new H. Lee Moffitt Cancer Center and Research Institute. Dr. Edgar Sanford, who trained at Duke University and was previously on the faculty at Pennsylvania State University Medical School, joined the program in 1988.
Subsequently, Dr. Ernesto Fiquero, who trained with Dr. Perlmutter in Detroit, became a member of the faculty in pediatric urology. Dr. Mohamed Helal, with a special interest in endourology and stone disease, was added in 1990. In 1995 Dr. Yves Homsy joined the faculty as Chief of Pediatric Urology.
The VA Hospital was always an important part of the urology teaching program. From the mid 1970’s to 1985, Dr. Roy P. Finney was the director of the VA Hospital urology program. Dr. Lester R. Persky became director in 1985, and continued in the position until 1996 when Dr. Raul Ordorica became the director.
¹Florida’s Past, Gene Burnett, Vol. 3, page 24, 1991.
²The Surgical Clinics of North America, Vol.45, No. 6, Dec. 1965.