Johns Hopkins

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“I begin with a salary of $4,000—the others [university professors, not medical faculty] mostly began with $3,000—I am the eighth full professor yet appointed in the history of the university,” he wrote his father. “I am to have all of the paid associates and assistants I need, so that I can be the head and not the hands for everything. I do not have to pay the running expenses of the laboratory. I can develop my field in Baltimore unhampered by traditions. The surroundings are scholarly and academic, and of a much higher order than those of Bellevue College in my opinion.” According to Simon and James Thomas Flexner, Welch’s biographers, “The New York medical profession was aghast; in all the annals of American medicine there had been no instance of so ambitious and able a young man exchanging a brilliant future in practice for an academic professorship in which the rewards were to be like the rewards of a German professor, with the difference of less opportunity for independent work and less remuneration.” Apparently some medical friends gave Welch a going-away party, sending him off with this comforting thought: “You may become a connoisseur of terrapin and madeira, but as a pathologist, good-bye.”

As a promising young doctor and thus highly eligible bachelor, Welch was keenly pursued by Baltimore hostesses. But since he was a short, portly, plain-looking man not given to frivolous conversation, the young ladies were disappointed. Nonetheless, as a genial and well-read companion he continued to be invited to dinner parties. “I accepted five dinner invitations in succession,” he told his sister, “some being very handsome affairs. I attended recently a beautiful reception at the Bonapartes. This is rather more gayety than I care for.” Like his hospital’s benefactor he remained a bachelor for the rest of his life.

It became part of Welch’s responsibility to help Billings recruit more qualified physicians for the new staff, first for the hospital and subsequently as teachers for the medical school. One man who stuck in his mind was William S. Halsted, a superb young surgeon whom he had met in New York in 1878.

Halsted had also graduated from Yale and the College of Physicians and Surgeons, two years behind Welch, and spent two years of intensive postgraduate study abroad. A member of the staffs of several hospitals in New York, including Roosevelt, Bellevue, New York, and Presbyterian, he was a tireless and driven worker who managed somehow, in his spare time, to run a sort of tutoring course for those medical students who wished to pay for it. Dr. Arthur Stout, an associate of Halsted’s during those days, recalled later that a medical student “got his real training from two sources, his preceptor and the private quiz. Every student had to be registered with a preceptor who must be a regular physician or surgeon—this practically amounted to an apprentice system …—and the young graduate’s future might be assured if his preceptor was a person of influence.” The private quiz, Halsted’s favorite teaching device, “took the place of the conferences and quizzes which exist today in the Medical School itself. From three to six doctors would associate themselves under the leadership of the most prominent member and invite the medical students to recite to them by heart the various subjects which they studied [in lecture].” This was a valuable asset to any student who could afford the hundreddollar fee, as he would be taken around to laboratories, dispensaries, and hospitals to witness practical demonstrations. The inexhaustible Halsted was also a popular host at his town house on East Twenty-fifth Street, where with his roommate, a fellow doctor, he gave dinner parties at least once a week, often with musical entertainment. Friends were welcome at a perpetual open house.

As a surgeon Halsted was incomparable. He was constantly searching out new operating techniques and partially incorporated the antiseptic theories of Joseph Lister. He became fascinated with solving the problem of trauma to the tissues during surgery, exercising great care to control bleeding and avoid cutting or tearing tissues wherever possible. Then, in 1884, he got word from Germany of a revolutionary new practice that was to change his life: he learned to inject cocaine, the first local anesthetic of its kind, into the cornea of the eye. Using himself as a guinea pig, he soon discovered that the drug enabled him to go for days on end without sleep and still feel clear-headed and exhilarated. He did not know until it was too late that he had become totally addicted. The exhilaration wore off, and Halsted became so debilitated that he could hardly function at all. Devastated, he entered the Butler Hospital for mental disorders in Providence in 1885, a human wreck.

Welch, saddened at this news of his former colleague, was determined to help him back to his feet. He went to Providence in December of 1886 and asked Halsted to come to live and work with him in Baltimore, offering him a job as a researcher in the pathology laboratory. For the next few years Halsted concentrated on his experiments, finally overcoming his dependence on cocaine. He would not touch a human patient during this time—he operated only on dogs but is said to have treated them as carefully as he would a man or woman. He discovered the benefits of silk as a suture and ligature, far better than the bulkier catgut (and still used); he experimented constantly with all sorts of new and improved clamps, scalpels, needles, and other surgical instruments.