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Howard M. Snyder III, 29th recipient of the Pediatric Urology Medal

2014; Elsevier BV; Volume: 10; Issue: 4 Linguagem: Inglês

10.1016/j.jpurol.2014.07.009

1873-4898

Douglas A. Canning,

Child and Adolescent Health

The Pediatric Urology Medal (Fig. 1a,b), awarded by the American Association of Pediatrics Urology Section in Urology is the highest award that our Section endows upon a member. The medal is awarded to only a few individuals who have made outstanding contributions to our specialty of Pediatric Urology. In 1984, Dr. Harry Spence was the first recipient. In the decades since, a host of other innovators, mentors, clinicians, researchers, teachers, authors, and leaders have been so recognized by their peers. Today we honor Dr. Howard M Snyder III. He is the 29th recipient of this medal. Dr. Snyder (Fig. 2) was born in 1943 in Carlisle, PA. In order to understand Dr. Snyder well, one must know a bit about his family. Howard's father and grandfather were decorated US Army Generals who collectively fought in five wars. In 1916, Howard's grandfather (Fig. 3) was a young Army Surgeon when he deployed to Mexico with General John J. “Black Jack” Pershing shortly after Pancho Villa attacked the small border town of Columbus in the then brand-new state of New Mexico. Not long afterward, World War II broke out. Pershing was called to Europe. Howard's grandfather assumed command of Camp Crane in Allentown, PA, where he oversaw the training of military medical personnel en route to the war. The elder Snyder was rapidly promoted through the ranks to Colonel, and then in World War II to Major General. During World War II, as an Inspector General of the Medical Corps, he was responsible for all military hospitals throughout the world and reported directly to General George C. Marshall. Near the beginning of American participation in World War II, the elder Dr. Snyder wrote an account of what he believed were poorly funded military hospitals, particularly in Africa, that angered Eisenhower, who at the time was in command of the North African Campaign. Eisenhower demanded to see the man that wrote that account, Dr. Snyder. Eisenhower and General Snyder became fast friends. Despite being technically retired due to age in 1945, the elder Snyder stayed on as a personal physician to Eisenhower until after the surrender of Germany. The two remained close while Eisenhower led Columbia University. Snyder rode Eisenhower's campaign train during Eisenhower's successful presidential campaign in 1952. He remained President Eisenhower's personal physician throughout the presidency. Snyder's influence on the president was considerable. Snyder is said to have recommended Eisenhower pursue painting in order for him to have a pastime that would ease the considerable stress he experienced during his presidency. An army act of congress kept General Snyder on active duty as the Eisenhower's physician until 1960. He remained close to the Eisenhower family until the president's death in 1969. This picture (Fig. 4) was one of only a few portraits painted by our 34th president of his friend. Howard's father, Howard M. Snyder Jr. was a graduate of the United States Military Academy at West Point Class of 1936 (Fig. 5). Howard's father was a horseman, originally in the horse cavalry. He rapidly became interested in tank warfare and was a tank officer when he met Loaine McLaughlin, Howard's mother while assigned to Fort Benning, GA. Like Howard's grandfather, his father was rapidly promoted through World War II to Colonel. As executive officer for XX Corps, the lead tank unit in Patton's 3rd Army, Howard's father helped develop the strategy that freed the members of the 101st airborne when they were cut off from allied troops at Bastogne during the Battle of the Bulge in January 1945. He received his general star in the early 1950s when he was second in command of the Second Armored Division stationed at Fort Hood, TX. After the war, Howard was granted privileges that few young boys enjoy (Fig. 6). As son of a general officer on a military reservation and the grandson of the White House physician, Howard lived a privileged life. When the family moved to Washington in 1953, Howard would spend Saturdays at the White House pool. Howard has bounced a beach ball with British Prime Minister Harold McMillan and is one of only a few US citizens who have seen a president naked. As Howard's father traveled with the military, he had Howard (then known as Howie) ride on the top of the radio on his father's jeep while his father monitored tank training exercises across the Texas plain. Howard hunted quail in Texas stream beds and fished wherever he went. This photo (Fig. 7) was taken just 2 or 3 years before Howard entered the St. Andrews School. Howard loved St. Andrews and excelled. He received the Founder's medal for first in school when he graduated in 1961. Howie as he was then known easily gained admission to Princeton (Fig. 8), where he earned a varsity letter as a member of the rifle team and raced star class sailboats on weekends with world renowned skipper C. Stanley Olgilvy. It was around that time that he began to introduce himself more frequently as Howard. Howard's sophomore year at Princeton however was special for a major event that has shaped his life. During the summer preceding sophomore year, Howard volunteered with Project HOPE. En route to a hospital mission designed to help vaccinate villagers in Ecuador, shortly after take-off in Shell Mera, as his plane circled to cross the Andes, one engine failed and the plane lost altitude and crashed in the jungle. The crew was killed upon impact. All in the plane but Howard were unconscious. Howard made his way out of the plane, then re-entered it over and over to bring the passengers out and laid them on the jungle floor to recover. His mentor and the trip leader succumbed to complications of a subdural hematoma. Hours later, villagers who had seen the smoke and heard the crash found the party and rescued them. All but the crew and the team leader survived. Howard likes to tell us that that is the only reason he was accepted to Harvard Medical School. Howard's surgical training was like few others. His residency in general and thoracic surgery at the Peter Bent Brigham Hospital under Dr. Francis Moore, his pediatric surgery residency under Dr. Robert Gross and Dr. Hardy Hendren, his urology training under Dr. Ben Gittes, and later at Boston Children's under Dr. Alan Retik was rich with volume and diversity of case load. When Howard decided he wanted to pursue pediatric urology, he traveled to Britain to spend 6 months each with Sir David Innes Williams at the Hospital for Sick Children at Great Ormond Street and Mr. J. Herbert Johnston at the Alder Hey in Liverpool. After Howard finished at the Great Ormond Street in 1980, he migrated to The Children's Hospital of Philadelphia (CHOP) at the behest of C. Everett Koop (Fig. 9) and John W. Duckett Jr. (Fig. 10), where he became half of one of the great collaborations in modern pediatric urology and where he would spend the next 34 years. Dr. Snyder's time at CHOP has resulted in 375 publications in all areas of pediatric urology. To date, at CHOP, Howard has helped launch the career of 120 residents in Urology, 36 North American and 12 foreign fellows, and many junior staff.Figure 10Snyder with Dr. John W. Duckett, Jr. on a panel together.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Howard has helped shape our current thinking in areas as diverse as care of posterior urethral valves, prune belly syndrome, ureteroceles, hypospadias, cryptorchidism, management of neuropathic bladder, andrology, and pediatric urologic oncology. Howard is known for his deep understanding and vast experience with continent reconstruction during a period when a large number of children were “undiverted” from incontinent forms of urinary diversion to internal reservoirs that allowed them to achieve dryness. He has led as a chairman or president virtually all of our national and local medical societies. He has been an active member of the American Association of Genitourinary Surgeons and the American Surgical Association and has served on the American Board of Urology as member and examiner. Howard's early life constantly exposed him to international leaders and real-life war heroes taught him courage and determination and a zeal for excellence that has been his trademark through his career. Howard once said “you don't grow timid of power when you have seen the president naked.” He has taken his lineage, part healer and part warrior, to many venues, from the operating room and clinics at CHOP to numerous lecture halls where we have heard his poignant commentary, which is steeped in data, careful thinking, enormous clinical experience, and a strong personal conviction. And we have all benefitted. As a surgeon he constantly refined the selection of each instrument, each suture placed to save time without sacrificing accuracy. As an advocate for his tiny patient, for his colleague, and for whatever cause he believes is right, he is relentless. As a teacher, he is known to his students as a friend, as a demanding mentor who always knows how to inspire them to get more out of themselves than even they know possible. In the operating room, he is known to all for his ability to break the most complex surgery down to hundreds of steps and his ability to talk throughout an entire 8-h case seemingly without ever stopping for breath. His teaching did not stop at CHOP. Howard has traveled to more than 140 invited lectureships and 42 visiting professorships in 19 countries on five continents (Fig. 11). Through all this travel, Howard has never lost his affection for England. In 2002, Howard was awarded the St. Paul's medal, an award only occasionally presented by the British Association of Urologic Surgeons to a non-British colleague for contributions to British Urology. Howard's friendship with countless surgical leaders throughout North America and worldwide has made CHOP an interesting place to work. Like his father and grandfather, Howard is a patriot with a strong commitment to his country. He has had a second career as an officer in the US Army Medical Corps. Despite the rigors of training, Howard found time to train as a reserve officer in England before accepting and assignment as an Army Surgeon at Fort McPherson in Atlanta, GA, from 1976 to 1978. While at the Brigham and through nearly his entire career at CHOP, Howard continued to train. From March through June 2003, he was deployed in support of Operation Iraqi Freedom. He continues to serve as a Professor of Surgery at the Uniformed Services University of the Health Sciences. Howard's patients are committed to him. The Howard Snyder Chair at CHOP was funded by many of Howard's grateful patients. It is designed to help fund the care of children who have been reconstructed and require transition to an adult practice. At a meeting 2 years ago, when we endowed the Chair, more than 150 of Howard's colleagues, former fellows, and patients came to honor him from 23 countries and six continents (Fig. 12). But of all of Howard's accomplishments, Howard is most proud of his family. Nearly 40 years ago, Howard and the former Mary Curtis Woodville were married (Fig. 13). In the years to follow, Mimi has applied her considerable skills as a research trained chemist and Wharton MBA to enrich their community and Howard's family life. She is known for her Le Cordon Bleu cooking, her gardening and painting, and her unending support for Howard (Fig. 14), their daughter, Emily, and their sons Curtis and Jonathan, and more recently their son-in-law Rick and daughter-in-law Nicole. And perhaps the real measure of a life well lived, now Howard and Mimi are devoted to their grandchildren Rowan, Riley, Aidyn, newborn Olivia, and Winston, who celebrated his first birthday on the day that Howard received his medal.Figure 14Howard resting with Mimi at a break during a scientific meeting.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Last week I asked Howard to tell us about what makes him most proud. He said his family, his military heritage, his commitment to service to his country, to his family, to his church, and to the countless numbers of trainees that he has had a chance to influence. Dr. Snyder, we congratulate you on your astounding career and thank you for your wisdom, your commitment, your loyalty, your courage, and your grace.