The P&S Journal: Spring 1998, Vol.18, No.2
George F. Cahill 1890-1959
By Nicholas P. Christy'51
George Cahill, arguably the outstanding urological surgeon of his era, became P&S's professor and chairman of urology in 1939: The Depression was easing and America would enter the second world war 21/2 years later. A few words about local and world history may convey some sense of the New York medical school scene before and during Cahill's incumbency. In 1890, the year he was born, the now obscure Hugh Grant and David Hill were, respectively, mayor of New York City and governor of the Empire State. America's presidency rested in the hands of Benjamin Harrison, not one of our luminous leaders. Victoria was enjoying her 53rd year as Queen of England, and Alexander III, the next-to-last Romanoff czar, reigned in Russia. The government of China, not then a world power, lay with a dynasty dating back to 1644. The chiefs of state in France and Germany were Carnot and Kaiser Wilhelm II. Our medical center would not be open for patients until 1928.
In the seemingly stabler atmosphere of 1939's Washington Heights, clinical department chairmen were chosen for their clinical reputations; a candidate's scientific achievements had not yet entered seriously into the process of choice. Academic life moved slowly at Columbia then: 20 years elapsed between George Cahill's first P&S appointment and his chairmanship; no modern medical academic would wait that long.
Dr. Cahill never claimed to be a laboratory person. Yet while he was chairman, the urology department grew very considerably in stature, earning an international reputation for clinical prowess and research, and strength and influence at CPMC, out of proportion to its small size and the minor role allotted to it in the P&S curriculum. What follows attempts to show how these changes came about.
The explanation is not difficult: the timely coming together of favorable circumstances and gifted, energetic people. Soon after 1939, medical school funding began to increase; during the Cahill years Washington's medical research budget grew enormously, largely in response to World War II; CPMC's reputation as a referral center had spread throughout the nation and beyond; the close relation of Presbyterian with a superior medical school sparked joint investigative efforts; and the large body of medical students, residents, and research fellows, constantly growing and renewing itself, provided the continual intellectual stimulus that makes working in a medical center productive and delightful.
Dr. Cahill's background fitted him well for success in this hard and challenging environment. His father had immigrated to New Haven in 1876 from rural Ireland-a wind-blown, infertile bog area in County Clare. Young George attended New Haven's Hillhouse High School, working evenings as a railway express hand at the railroad station. He starred in football and track, graduated at 16, and immediately entered Yale's medical school-in those days college was not a requirement for a medical education. Receiving his M.D. in 1911, he moved to New York, where he trained in pathology, medicine, surgery, and urology at Bellevue and postgraduate medical school. Joining the U.S. armed forces in 1917, before the United States entered World War I, he served in field hospitals, first with the French, later with the American armies. From 1919 to 1939 Cahill worked as surgeon and teacher at 10 or more New York City and suburban hospitals, including Bellevue, Presbyterian, Willard Parker, Tuxedo, Mount Vernon, and several P&S affiliates. From this broad and varied experience came a detailed and sophisticated knowledge of general surgery. In contrast to many-perhaps most-surgical specialists, he was able to cope with extra-urological emergencies when they arose during a procedure without having to call in a generalist. This facility accounted in part for the extraordinary speed for which he was known as an operator, a speed allied with gentle thoroughness.
As a teacher of medical students Cahill was effective, admired, and well-liked. Unfailingly good-humored, he had a pithy way of expressing himself. He could explain in moments the intricate reasons why men with benign prostatic hypertrophy had special difficulties in passing urine when the bladder was full. He possessed rich thespian gifts. He could mime perfectly-unforgettably-the gait of a man entering the urologist's office as acute urinary retention overtook him: the mincing delicate placing of the feet to minimize the shock of the lightest footstep; the wincing, the grimacing; each soft footfall a fiery jab up the urethra. This display expressed the clinical syndrome with special vividness because it differed so sharply from Cahill's usual rapid military stride down the hospital corridors, heels clicking, a resident struggling alongside to keep up with the chief's quick pace. Some few observers felt that his bearing seemed self-important. Not so. Underneath lay a deeply humble man.
Students derived much fun from Dr. Cahill's neologisms-some might say malapropisms, known as "Cahillisms" to the young. Sometimes "urinary sediment" became "urinary sentiment." For the then-new sulfonamides he coined "sulfanoamols." If an injudicious staff member offered a correction, Dr. Cahill simply stared him down.
For a man with no laboratory experience, George Cahill made-or caused to be made-extraordinary scientific contributions. A natural leader, he also showed great perspicacity in choosing collaborators and getting them to work together harmoniously, in recognizing new fields for investigation and encouraging and supporting people to study them, in identifying new leads and pushing them into national prominence, and in filling gaps previously neglected. He hired Meyer Melicow, a mild, diffident internist and helped him to convert himself into a skilled and eventually revered uropathologist. With biochemist Erwin Brand and others Cahill himself made many studies of cystine stones and cystinuria. Dr. Cahill became a pioneer in the surgical treatment of hormone-producing tumors, e.g., androgenic neoplasms of the testis and adrenal cortex, and corticoid-secreting adrenocortical lesions (Cushing's syndrome), a task requiring teamwork with medical and endocrine co-workers like Joseph W. Jailer and others; and, especially difficult, management of the skittish pheochromocytoma, in collaboration with pharmacologists, anesthesiologists, and internists, e.g., Marcel Goldenberg and Henry Aranow Jr. Taking note of the discovery by Earl T. Engle, a P&S professor of anatomy, that human chorionic gonadotropin (hCG) could often cure cryptorchidism in adolescent boys, Cahill publicized the observation vigorously, playing a large part in causing this treatment to become nationally accepted as effective.
George Cahill was much honored by invited lectureships, participation in prestigious meetings and in the writing of learned treatises, by honorary degrees, and membership in and leadership of several medical and urological societies. Still, throughout his medical life, he willingly transferred a patient from gurney to operating table, removed a bedpan, cleaned up a soiled patient. When he officially retired in 1950 he could bequeath to his successor, John K. Lattimer, a department eminently ready to enter the new age of sophisticated biochemical and electron microscopic research, closely linked to a well-established tradition of clinical and pedagogic excellence.