Johns Hopkins

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Although eventually he resumed operating on humans, he was no longer William Halsted, the dynamic, self-confident New York surgeon. During his fight against cocaine his personality had undergone such a radical alteration that he bore only a ghostly resemblance to his former self. Once ebullient, lightning-fast, and indefatigable, he was now quiet, deliberate, and introspective. According to Donald Fleming, one of William Welch’s biographers, “a ‘Halsted’ became a synonym for an operation drawn out to interminable length. … ‘Would you mind moving a little?’ he said to one of his assistants after a long operation. ‘You’ve been standing on my foot for the last .half hour.’ ” As Welch himself wrote much later about this dramatic change in Halsted, “While brilliancy, boldness and manual dexterity were attributes which I used to hear applied to Halsted as a surgeon in New York, these were precisely the qualities which in Baltimore he resented and desired to be substituted by conscientiousness, thoroughness and safety.”

Now Welch had his head of surgery. The next step was to find the most capable clinician in the country, if not the world.

William Osler was a Canadianborn physician who had already established an admirable record in his field by the time Welch went after him. Although attracted to theology as a youth, he abandoned this interest and switched to medical school at the age of nineteen, graduating from McGiIl in 1872. He rose swiftly in his new profession: studies in Europe were followed by a professorship at McGiIl Medical School, a fellowship in the Royal College of Physicians in London, and, finally, an appointment as professor of clinical medicine at the University of Pennsylvania. An outgoing, humorous, and extremely popular man, Osler was always playing pranks on his fellows—when he was sixteen, he and a friend answered an advertisement in the local Toronto paper put in by a hapless American looking for a wife; they dressed up in women’s clothes and met him at the station. But Osler was considered the best in his field and much sought after by hospitals all over the country. At a convention of the Association of American Physicians in Washington, B.C., in September, 1888, Billings, the hospital front man, began to court the illustrious Osler diligently, pressing him to take charge of the new medical department at Hopkins. Osler apparently was impressed, for he gave his consent to become the first physician-in-chief shortly thereafter. Welch was delighted; he wrote to his sister, saying: “[Osler] is the best man to be found in the country and it is a great acquisition for us to secure him. I know him well and have the highest opinion of him as a scientist and as a man.”

The fourth and final member of that famous “first faculty” of Hopkins, appointed in 1889, was Howard A. Kelly, an obstetrician-gynecologist from Philadelphia and a protégé of Osler’s. The only one of the four to be both American-born and Americantrained, Kelly was a graduate of the University of Pennsylvania Medical School in 1882 and thereafter its professor of obstetrics. Among his few quirks was a lifelong fascination with snakes. He was adept in the operating room but not possessed of the brilliance of his three new colleagues. Nicknamed the “Kensington colt” because of his dedication to treating the poor of that Philadelphia suburb, he was a staunch conservative who, according to one of Welch’s biographers, “always conducted a prayermeeting for nurses, surgeons, and observers before operating.”

The nucleus of the new hospital and medical school was now complete. There was considerable resentment among the local medical men that none of them had been chosen to head a department, not to mention the threat of all those outsiders taking away their business. But Welch quashed their fears. First, in 1885 he hired as his assistant pathologist a wellknown Baltimorean, Dr. William T. Councilman; then he initiated a policy whereby all professors of preclinical subjects were to be in the full-time employ of the medical school so that they would devote all their time to teaching and research and have none left over for practice. This was considered a revolutionary step in medical education.

The construction of the hospital, as has been noted, took twelve years. Billings’ plan, which aroused much interest both at home and abroad for its progressiveness, called for each ward to have an open area at the southern end, permitting the entry of lots of light and air. There would be twostory wards, each level connected by outside stairways. Billings intentionally omitted elevators in hopes of preventing “contaminated air” from passing between levels. Only the latest in heating and ventilation systems were to be installed. Those buildings to house patients with contagious diseases were to have separate cubicles for each individual, each cubicle to open onto a well-ventilated corridor that would permit breezes to blow through. Typical and impressive are these construction statistics for the year 1887: 8,200 lights, 1,200 kegs of nails, 44 miles of pipe, and more than a half mile of wrought-iron railing. When the hospital officially opened on May 7, 1889, there were seventeen buildings, among them four ward buildings, one isolation building, two private-patient buildings, a pharmacy, a nurses’ dormitory, a kitchen, a bathhouse, and an administration building. There were some two hundred beds, just over half what Johns Hopkins had called for. The public came to gape and stare, to amble through the corridors and examine the wards. Eight days later the first patient was admitted.