Johns Hopkins

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Perhaps it could be said that Halsted’s greatest contribution to surgery was his pioneer work in the treatment of breast cancer. In the eighteenth century a French surgeon had made the connection between this form of cancer and lymphatic glands, but it was Halsted a century later who performed the first radical mastectomy. He was very successful with his surgery for hernias as well.

The one vestige of the precocaine Halsted was his expensive taste. His suits were made in London, his shoes —of which he ordered six pairs at a time—and shirts in Paris (the shirts were sent back by ship to be laundered at regular intervals), and he could often be spotted walking the hospital corridors in frock coat and tall silk hat. His love of elegance ruled the household after he married his head nurse, Caroline Hampton, in 1890; he selected the antiques and Persian rugs that filled their Baltimore town house and their summer cottage in the mountains of North Carolina, and when they entertained, he would select the china, food, linen, and flowers. Often he and Welch would dine together at the staid Maryland Club on terrapin and Chesapeake oysters.

Osler was probably the best liked of all. A small, slender man of dark complexion, he too dressed in frock coat and top hat. Consistently cheerful and outgoing, possessed of a lively sense of humor, he disliked gossip or criticism and was remarkably modest. He wrote prolifically of his clinical findings and was widely published in medical journals; once in a while he mischievously submitted articles under the unlikely nom de plume “Edgerton Y. Davis of Caughnawauga, P.Q.” He brought his students into the wards and put them to work applying dressings and keeping charts; he called his hand-picked interns “ A.A.I. copper-bottomed young graduates.” He tried to instill in these students his own love of his work, based on untiring thoroughness and the ability to reason things out. His Principles and Practice of Medicine , published in 1891, became the definitive text of internal medicine and was eventually translated into Spanish, French, German, and Chinese.

Osler’s particular bêtes noires were typhoid fever, pneumonia, and tuberculosis, and his researches led him to become an ardent public-health reformer. He cared nothing for the lucrative side of medicine and private practice, being much more concerned with bringing Johns Hopkins’ desire to life: to open the hospital to the poor and the sick, regardless of their sex, age, or race.

By the early 1900’s the hospital and medical school were solvent and universally respected, and some of those who had helped make them so could move on. Osler accepted an invitation to go to Oxford University, where he assumed the formidable title of Regius Professor of Medicine, and later that of baronet. Welch, although he remained in Baltimore the rest of his life, was satisfied that Hopkins was in a condition of relative stability and became involved with the Rockefeller Institute of Medical Research and the Carnegie Foundation as adviser and later a trustee. Intensely interested in medical and health conditions around the world, he travelled to such remote outposts as Peiping, China, and made such an impression there that he was later honored by the doctors of the Peiping Union Medical College on his eightieth birthday in 1930—and by President Hoover as well. The fact that Hopkins was never allowed to become a parochial, nonprogressive hospital is certainly due in large measure to Welch’s unceasing desire to bring international advances in the field back to Baltimore.

Halsted remained at Hopkins the rest of his life, receiving almost as many honorary degrees as Welch and Osler. His contribution is best described by Professor René Leriche, an eminent French surgeon, who said in 1914: “Halsted has created a method in surgery and he has inspired disciples. It is this that gives his clinic such vivid originality, and when one has seen intimately that admirable organization one understands why Baltimore has rapidly become the cradle of contemporary surgery in the United States.”

Construction continued into the 1930’s, often funded by the great financiers of the time: the Rockefeller and Carnegie foundations; “Diamond Jim” Brady, a grateful patient who gave over $300,000; Henry Phipps, who gave money for the psychiatric clinic that still bears his name; James Buchanan’s niece and hostess, Harriet Lane, who founded a pédiatrie clinic. When H. L. Mencken wrote a series of articles for the Baltimore Sun in !937, he discovered that a phenomenal fifteen thousand patients were admitted annually; almost half of these paid nothing whatever, just as Hopkins had ordained. Today those figures have more than doubled, and the hospital can accommodate almost eleven hundred patients at one time. In 1974 there were just under a half million outpatient visits; and the rule, according to the public-relations director, is still “pay what you can.” A new and major redevelopment program has rendered all but a few of the first plain red brick buildings into dust.