Dr. Kelly of Hopkins
Author: Audrey W. Davis
This almost strictly chronological account provides a revealing insight into the motivations and achievements of a giant reformer of nineteenth century American medicine. The book portrays gynaecologist Howard Kelly as one of the major architects, along with William Welch, William Osler, and William Halsted, of the Johns Hopkins Hospital and Medical School. Comparatively the least publicly known of the four so-called founding physicians, this biography engenders a full appreciation of Kelly’s unique character as ‘a man of fine mind, liberal education, unbounded curiosity, and surgical genius‘. The biography is set within the context of the ‘revolutionary changes’ occurring in medicine at the time – a period when ‘the very foundations of medicine were being built anew’. Beyond chronicling the advances made by this most altruistic and spiritually-minded physician, the book also reviewed the history of gynaecology, noting that it was ‘the long-neglected specialty’, but was ‘on the threshold of great advances’ with the works of such pioneers as James Marion Sims. The narrative is also set within a much wider perspective of the medical breakthroughs of the time, such as the cellular theory of Rudolf Virchow, the rapid growth of ‘the science of bacteriology’ under the influence of Robert Koch; and the innovation of antisepsis by Louis Pasteur and Joseph Lister (pages 3, 46-50 and 68).
In chronicling Kelly’s medical journey, the author charted his enrolment to the University of Pennsylvania Medical School in 1877, noting that the school ‘offered opportunities for instruction in medicine unsurpassed in this country at the time’, and that the teachers there were renowned for being the ‘authors of standard textbooks on their respective subjects’. Beyond the advantages of attending the school, the author said Kelly also made ‘consistent, steady application‘ in his academic studies, and this was reflected in his excellent performance at examinations; his election as class president; and his winning two prizes at graduation. It was revealing that even as a student, Kelly’s interests extended to research and education, the author explaining that he ‘was less impressed by the clinicians than by those devoted to research’. A further sign of Kelly’s brilliance and endeavour was his work as a resident at the prestigious Episcopal Hospital at Kensington where he soon established ‘a remarkably good gynaecological clinic and demonstrated what could be done for a greatly neglected class of patients’. The book also illustrated his innovative bent with examples of how he devised novel surgical procedures such as ‘a combined vaginal and abdominal method of examination’, and how he treated such conditions as rectal tears, fibroids, and vesicovaginal fistula with new gynaecological approaches (pages 23-27, 36-38, 42-46 and 79).
Kelly’s enigmatic personality formed a major theme of the book, and the biography explored several qualities of his public and private character. One such prominent feature of his nature was his intellectual leaning, a quality which the book said manifested as a precocious zeal for ‘information on a wide variety of subjects’. Asserting that ‘his curiosity in the natural world was insatiable’, the author said this made him decide early in his life that ‘he would be a naturalist’. She went further to demonstrate how ‘a thirst for knowledge about every form of life’ got him involved, at the young age of seventeen, with the Academy of Natural Sciences where he studied to become a naturalist. Indeed the author showed that he sustained his interest in natural history throughout his life, maintaining that his choice of medicine as a career only came about because he ‘yielded to his father’s judgment’ to consider ‘a field that offered greater certainty of a livelihood and promised fair financial return’. Other qualities to which the author attributed his professional success included ‘curiosity and observational powers of the true scientist and the boldness and daring of the explorer, an acutely sensitive touch, great manual dexterity, and an extraordinary ingenuity in adapting means to ends’ (pages 9-26 and 51).
It was not surprising that his ‘marked ability‘ as a gynaecologist attracted the attention of William Osler who recommended him for a post at the Johns Hopkins Hospital, an appointment which the author said marked the beginning of ‘the period of modern gynaecology at Baltimore’. A key feature of this period was the productive collaboration it engendered between him and his colleagues which made the hospital a famed centre of clinical excellence and educational reform. The author further described how this partnership was characterised by their ‘contagious love of work for its own sake’; a shared ‘cordial mutual liking; enthusiasm for each other’s work’; a keen sense of responsibility toward the great undertaking in which they were jointly engaged’; and an ardent striving ‘to attain the high goals they had assigned themselves’. The author remarked that between them ‘there were no jealousies, cliques, or politics‘, and that ‘criticisms were always kindly and constructive’. In her assessment of Kelly’s teaching methods, the author noted that he preferred practical patient demonstrations over ‘didactic lectures’, and she referred to him as ‘a born teacher‘ who was ‘lucid, ingenious, masterly, conclusive, inspiring‘. The author added that he gave running commentaries during his operations in which ‘he described each procedure…and what he intended doing at each step and why’. She also documented his unique surgical practices such as his tendency ‘to operate by the clock‘ because he was keen to ‘reduce shock to the patient’ (pages 62-69, 73-75 and 82-83).
Beyond his academic qualities, the book also explored Kelly’s very strong religious sentiment, a feature that dominated both his personal and professional lives. In tracing the genesis of this outlook, the author referred to his upbringing within a deeply religious family where ‘the Bible was daily guide, comfort, and textbook’. She illustrated the strength of his Christian faith when she said ‘never did Kelly pick up a scalpel without prayer that his hand be guided to restore to health the patient awaiting his surgical intervention’. This spiritual perspective became a major determining factor in all his future endeavours, and it perhaps expectedly became a talking point amongst his colleagues, some of whom the author said variously saw him as an enigma or a hypocrite; indeed the author asserted that his religious stance unfortunately became a barrier for them ‘to understand the man himself’. She however noted that ‘his faith affected and illuminated his professional practice and all its contacts’, and it undoubtedly led to his vigorous and very public campaign against societal vice and lawlessness (pages 8-9, 70, 83, 142-156 and 160-174).
Kelly’s altruism, which manifested throughout his life, was also a key theme of the biography. In his early years for example, the author narrated how he organised summer camps for boys, remarking that he was ‘never so happy as when working out a plan to benefit others’. Similarly, as a medical student, she said he volunteered as a demonstrator in anatomy because ‘he was always interested in helping younger men just beginning the study of medicine’. Whilst his altruism was undoubtedly an extension of his spiritual leaning, the author said it was intensified by his experience as a young doctor when he was brought ‘into intimate touch with the problems of humanity‘, and came to believe that his career was ‘a shining path of service replete with rich, spiritual rewards‘. The author attributed his decision to work amongst the poor, and not to pursue a lucrative office practice, to this charitable outlook. The author symbolically referred to this choice as a decision to ‘go into the highways and hedges where laborers were few and the need was great‘. It is remarkable that he continued his generosity even at the Johns Hopkins where the author said he made large charitable donations to improve the gynaecology operating theatre; he charged no fees for 75% of the private work he did for the poor; and he set up a rotating fund ‘to enable needy students to complete their medical education’ (pages 22, 36-41, 77-82 and 93).
This book provides a reasonably objective insight into one of the lesser known giants of the Johns Hopkins Hospital. As with any biographer who was close to their subject, in this case his devoted secretary, their objectivity is always likely to be swayed and this is evident in the book’s almost uncritical attitude to the life of Kelly, failing to list any of his negative qualities. The book nevertheless brings out those aspects of his life which guided his work and drove his achievements. His laudable single-minded commitment to patient care, his inspiring teaching and research, and his admirable empathy and charity, were the bedrocks of his personal and professional philosophy, and are worthy of emulation.
This is not just the biography of a remarkable surgeon, innovator, reformer, and altruist; it is also a commentary on the medical developments at a critical time in the evolution of medicine. By setting the life of its subject in the context of the wider scientific and medical reform advances of the time, the biography brings out the lessons of Kelly’s life and works which extend beyond his just being a clinician, and to encompass his collaboration with colleagues to achieve objectives beyond their personal interests. The biography is also a lesson in the highest ideals of medicine, the pursuit of excellence in the service of humanity, and the value of collaborative work in the pursuit of lofty objectives. The book highlights the relevance to healthcare of the altruistic and professional standards symbolised by Kelly’s life, and I recommend it to all doctors.
Publisher, Place, Year: The Johns Hopkins Press, Baltimore, 1959
Number of chapters: 9
Number of pages: 242
Star rating: 4