William H. Welch
Author: Donald Fleming
William Welch is not a familiar name even in medical circles, and this is a travesty of medical history which this book set out to correct. The biography is an incisive exploration of the enormous influence the understated pathologist wielded in setting American medical education in the direction that made his institution, the Johns Hopkins Hospital, a world leader. The biography is narrated within the historical context of the development of medicine in America, and the picture that emerges is of how one man applied his passion, humility and tact to establish and nurture the processes that almost singularity set the course of medicine and medical education firmly in the right direction. The book succeeded in conveying the sense of the leading role Welch played in making the Johns Hopkins Medical School ‘the best system of medical instruction in the world’ such that ‘early in the twentieth century all other medical schools in America were advised to make themselves over on the Hopkins pattern‘ (pages 103 and 110).
The journey which Welch took to medicine appeared almost predetermined in view of his strong medical family lineage. Remarking that Welch was ‘the last and greatest of a line of Welch doctors’, the book chronicled his education from entrance to Yale College at the age of 16 years where ‘his real enthusiasm’ was ‘for the classics‘. However, failing to get a post as a Greek tutor on graduation, the author said ‘he turned at last to medicine…the last resort of a man thwarted in his ambition and beaten down by circumstances into conforming with family tradition‘. The book provided an excellent account of his medical training after he enrolled into the College of Physicians and Surgeons in New York, ‘the oldest and best and most arrogant of the three quarrelsome medical schools‘ in that city. It was perhaps a testimony to his abilities as a student that the author said Welch was appointed ‘prosector to the professors of anatomy’, and, on qualifying, was readily appointed an intern, and then a resident, at Bellevue Hospital (pages 12-28).
In assessing his remarkable impact on medical education, the author conceived of Welch as ‘the leading Influential of American science’ in 1900, and as a successor to Benjamin Franklin and Benjamin Silliman. Asserting that ‘with the possible exception of Benjamin Franklin, no one had ever occupied a more central place in the life of science in America’, the author explored the varied leadership roles Welch played in his profession: from President or Chairman of the American Association of Physicians, the American Medical Association, and the National Academy of Sciences, to membership of the Board of Scientific Directors of the Rockefeller Institute, the Executive Committee of the Carnegie Institution, and the Advisory Council of the Milibank Memorial Fund. Welch also wielded direct influence on the direction of health policy through the access he had to successive American Presidents Franklin Roosevelt and Woodrow Wilson, and to the American Congress. The book also illustrated Welch’s indirect influence through his trainees who spread out to become leaders of key institutions across the world. Indeed such was his power that the author said Welch was able to deny ‘full entry into the scientific consensus of ideas of men greater than himself in research and inspiration‘ (pages 131-135, 148-160 and 188).
Welch’s most important impact was undoubtedly in reforming medical education, and in this regard the book demonstrated how he skilfully ‘transformed American medical schools from the worst to the best in the world in one generation‘. In discussing this achievement, the book attributed Welch’s success to his ability to make ‘the right choice of precursors, colleagues, and successors’, and to his ‘personality that breathed comfort, serenity, and ease, with a deep and overriding intellectual commitment to rebellion against the status quo‘. The book also referred to the influence of his ‘large-minded, tolerant, and undogmatic‘ nature; his ‘self-knowledge and unfailing humility in the presence of research’; and ‘his genius to be well-liked without making any concessions in principle’. The biography however detailed several shortcomings and failings of its subject, for example his inability to keep up with his administrative paperwork, and his ‘large number of researches with no unifying theme and no great cumulative effect‘. The author particularly noted the declining output of his research work over time, pointing out that Welch ‘carried through to completion only one piece of investigation‘ at the Johns Hopkins, which ‘was not of great importance’. Explaining how his ‘habit of research…slipped away from him forever’, the author said Welch ‘was not fitted to be a philosopher of the biological sciences’ and he inevitably became ‘too deeply involved in other things’ (pages 3-6, 65, 80-83, 119-130, 151-160 and 202).
Apart from his career as a medical administrator and education reformer, the biography also detailed his profession as a pathologist. In doing this, the book traced his earliest interest in pathology to winning a microscope in medical school, something the author said he desired ‘more than anything else’. Although his experience as a resident with the pathologist Francis Delafield, ‘a commanding figure in the hospital morgues‘, set him on course to become an excellent pathologist, it was his subsequent training in Europe that the author said enabled him to ‘get the feel of the current situation in science, and to try his hand at genuine research‘. Portraying the scientific atmosphere in Germany at the time as a ‘rich human and historical situation’ which had ‘the art of producing creative investigators in depth’, the author described how the training system introduced Welch ‘to possible themes, methods, and purposes of research’. Perhaps more importantly, the book noted how he benefited from his contact with such giants of nineteenth century pathology as Carl Ludwig, ‘the founder of the most flourishing school of physiologists of his time’, and Julius Cohnheim, with whom Welch ‘carried through by far the most important investigation of his career to date’. Of the research breakthroughs Welch made during this time, the author specifically highlighted his work on ‘the problem of edema‘ with which he ‘entered fully into the community of productive scientists’, and his discovery of the Clostridium bacillus which now bears his name. Welch, the book added, also set up ‘the first teaching laboratory for pathology in America’ at Bellevue, an achievement that enabled ‘his myth’ to ‘take shape’ (pages 26-39, 47-52, 59-60 and 191).
The Johns Hopkins was where Welch stamped his authority on medical reform, and the book referred to his appointment at the institution as ‘the pivot on which the whole success turned’. Pointing out that Welch was appointed on the recommendation John Shaw Billings, ‘the chief figure in planning for the new medical school’, the author explained that Billings found Welch to be ‘the best man in this country for the Hopkins’. Welch’s own wise recruitment choices also helped to establish the reputation of the Johns Hopkins, and the book illustrated this with his selection of Franklin P Mall, ‘the greatest American anatomist and by far the most distinguished scientist on the medical faculty’. The book also documented Welch’s harmonious and productive working relationship with the other founding physicians of the Johns Hopkins with whom the author said he ‘held his own‘ as a non-clinician. But the author maintained that it was Welch ‘more than anyone else‘ who ‘made the Johns Hopkins a new kind of hospital in American experience – the home not only of charity but of science‘. The book further described the distinctive ethos of the Johns Hopkins Hospital which it said was ‘notable for four things‘ – its nursing school, its scientific publications, its unique patient care practices, and its ‘commitment to research and laboratory work‘ (pages 55, 66, 92-95, 100-115 and 161-165).
This biography portrays the life and motivations of a principal actor in the transformation of American medical practice and education. Just as it portrays Welch’s life and works, the book also helpfully set it in the context of the history of his specialty of pathology. It particularly highlighted how his training with the European leaders of the field moulded his worldview and set him up for his future success at the Johns Hopkins. The biography extracted wide-ranging lessons from Welch’s life, from his leadership and conflict resolution, to his collaboration and networking. The book’s main shortcoming was the author’s attempt to provide a unifying philosophy behind his subject’s works, what turned out to be a convoluted and conjectural commentary. This was however well compensated for by the book’s excellent setting of Welch’s life within the context of the wider scientific advances of the time, and of the the history of the Johns Hopkins Hospital.
The worthy subject of this biography has, perhaps more than the better-known giants of the Johns Hopkins, exerted a deeper and more lasting influence on the course of modern medicine on a global scale. Beyond his steering leadership of the Johns Hopkins Hospital, the book demonstrated how Welch also influenced health policy at several national levels, a feat he achieved by his unique set of personal qualities which the author exhaustively explored. This book has done an excellent job of encapsulating the impact and lessons of Welch’s life for healthcare, and I recommend it to all doctors.
Publisher, Place, Year: Little, Brown and Company, Boston, 1954
Number of chapters: 13
Number of pages: 216
Star rating: 5