When he died five years later from tuberculosis, his friends recalled him as a skilled surgeon, a generous mentor, and a decent soul. “To younger practitioners and medical students, he was most considerate and kind,” said one, and to the poorest charity patients he was as courteous as to the wealthy. Hamilton’s main eulogy was delivered by his “favorite pupil,” Charles Augustus Leale. “As a tribute of love, I take pleasure in placing on record the history of my early preceptor and dear friend,” said the physician who had rushed to Lincoln’s aid at Ford’s Theatre in 1865. Leale’s “history” didn’t include their fateful bond—two surgeons linked by their roles, two decades apart, in treating a stricken president. Frank Hamilton “stood erect to the last,” Leale concluded, accomplishing “so much for the good of his profession and also of his fellow-man.” There was not a mention of James A. Garfield, Joseph Lister, or the future of antiseptic medicine.
—
As Welch and Halsted pushed the Listerian agenda at Bellevue, their bond grew stronger. Both were young and single, graduates of Yale and P&S—though their differences were substantial. Halsted was tall, lean, and athletic. A meticulous dresser, he wore tailored suits from London and expensive Italian shoes. (For a time, he actually sent his linen shirts to be washed and pressed in Paris because he couldn’t find a local laundry that met his absurdly exacting standards.) Welch, by contrast, was short, paunchy, and disheveled. He avoided physical exercise and had no interest in sports. His greatest love, aside from medicine, appeared to be eating. His longtime friend, the critic H. L. Mencken, described a lunch the two had shared when the two-hundred-plus-pound Welch was almost eighty years old. “The main dish was country ham and greens, and [he] had a large portion,” Mencken observed, “washing it down with several mugs of beer. There followed lemon meringue pie. He ate an arc of at least 75 degrees of it, and eased it into his system with a cup of coffee. Then he lighted a six-inch panatela and smoked it to the butt. And then he ambled off to a medical meeting and to prepare for dinner.”
Like Halsted, who had insisted on his own surgical space, Welch never felt truly comfortable at Bellevue. His teaching philosophy, though popular with students, was clearly out of step. “I shall make the leading features of [my] course the demonstration of fresh pathological specimens and the making of post mortem examinations,” Welch declared. “In doing this I must sacrifice to a considerable extent systematic didactic instruction.” What this meant, in simple terms, was the substitution of the microscope for the textbook, the laboratory for the lecture hall. And it included subject matter viewed by some as the “passing nonsense” of foreign minds. In the words of the ubiquitous Dr. Loomis: “The [germ] theory, which so recently has occupied medical men, especially in Germany, is rapidly being disproved, and consequently is rapidly being abandoned.”
There was more to it than the clash of teaching philosophies, however. Unlike the wealthier Halsted, Welch constantly had to scramble to make ends meet in New York. He took on so much outside work to supplement his income—performing autopsies, tutoring students, examining private patients—that there was little time left for what most interested him: laboratory research. Privately, Welch longed for the chance to pursue his academic passions without the drudgery of earning a living.
In 1884, an offer arrived from a new university in Baltimore named for its main benefactor: Johns Hopkins. At his death in 1873, Hopkins, a bachelor with no heirs, had left the largest philanthropic gift in American history to that point, $7 million, for the construction of a university and a hospital, with a medical school to follow. “What are we aiming for?” asked Daniel Coit Gilman, the university’s first president, at his inauguration. “The encouragement of research…and of individual scholars, who by their excellence will advance the sciences they pursue, and the society where they dwell.”
Welch deeply admired the Hopkins medical school model, built on German thinking, with a four-year curriculum, a major laboratory component, and a college degree required for admission. At Bellevue, a medical school had been created to serve the interests of the hospital; at Hopkins, a hospital was being built to serve the interests of the medical school. “Mr. Gilman is looking out for men to fill positions in his university,” Welch had written his father in 1876. “It seems folly to me to aspire to attaining [one] when there are so many distinguished men in the country who have already acquired great reputation.”
Eight years later, Welch was high on Gilman’s list. The report on him summed up exactly what Hopkins wanted: “a gentleman in every sense…a good lecturer…an excellent laboratory teacher [with] a keen desire for an opportunity to make original investigations.” In short, “the best man in this country.”
An offer quickly followed. Welch would receive a handsome starting salary—$4,000 a year, with raises to follow. Even better, he could count on “such laboratory facilities and assistants as may be requisite” through a personal endowment, something unheard of at an American medical school. President Gilman attached a personal plea to the offer: “You must come.”
Welch was more than flattered; he was intrigued. Staying at Bellevue had its advantages: good friends, fine museums and restaurants, and a hospital filled with brilliant, if sometimes combative, peers. “I have [tasted] the pleasures and comforts of New York,” Welch noted, “and they are not easy to relinquish.” The problem lay elsewhere. “I do not feel as if [I’m] accomplishing what I want to do,” he confessed to his father. “My energies are split in too many different directions and are likely to be [as] long as I remain here.” At Hopkins, Welch could focus on his laboratory work, free from the demands of seeing private patients, running student tutorials, and (he sheepishly admitted) “the drudgery of teaching.”
Given the unique pull of Hopkins, a serious counteroffer was required. The point man would be Frederic Dennis, a Bellevue surgeon who had known Welch since prep school and prized their companionship in ways that Welch himself did not. “Willie Welch came to see me,” Dennis would gush in his teenage diary. “Willie Welch and I went to the woods and read a book….Went swimming in Mill Pond with Willie Welch….Willie is visiting me….I went with him to New York and we walked up Broadway.” When Welch left for Yale, the fawning Dennis had flooded him with mail. “I should have answered your letter sooner if I had not been afflicted with the mumps,” Welch would eventually reply. Or, “I’ve delayed answering so long [because] I was sick with boils.” Or, “You are no doubt surprised that I have not written before this. The reason is that I have been troubled with a sore eye.” Upon exhausting all known medical excuses—a swollen foot, headaches, mental fatigue—Welch requested a break. “For if we write oftener,” he wearily explained, “I shall be obliged to expatiate upon nothing, which besides being tedious for me to do must be very uninteresting for you to hear.”
Dennis came from serious money. His family—like Halsted’s—belonged to New York City’s commercial elite. Growing up, Dennis had showered gifts upon Welch, who accepted them without complaint. The Dennis family had even paid for Welch to accompany Fred to the clinics of Europe following their Bellevue internships, and Welch had traveled to medical conferences in the Dennis railroad car, which he described as “furnished with kitchen, dining room, staterooms, balcony and every sort of luxury.” Whatever his ambivalence about Fred Dennis, Welch kept the relationship alive—partly out of need, partly out of respect. Dennis was a terrific surgeon with wide-ranging interests. He would be among the first Americans to employ Pasteur’s treatment for rabies and to grasp the importance of antibiotics in battling bacterial disease. And nobody at Bellevue had better social connections than Dennis, whose celebrated patients included Andrew Carnegie, one of the richest men in the world.
In 1884, Carnegie had yet to discover philanthropy—a failing he would acknowledge five years later by vowing, in a famous series of essays titled “The Gospel of Wealth,” to give away much of his fortune and urging fellow plutocrats to do the same. But Dennis approached him anyway, explai
ning the importance of the medical research being done in Europe and the need to bring it to the United States. The pitch was successful: Carnegie responded with a sum large enough to build the nation’s first fully equipped pathology laboratory adjoining the Bellevue Hospital grounds. “Gentlemen,” the steel king wrote his bankers, “Please pay drafts of Frederic S. Dennis upon you to the extent of fifty thousand dollars and charge same to my [account].” A week later, the Bellevue Medical Board appropriated $45,000 to buy the land on which the building would be constructed.
Carnegie’s gift was very big news. The New York Times described it as a triumph for American medical research. “In Germany,” it said, “[such] facilities are amply provided by the Government. In this country they can only be furnished by private beneficence….The purpose of Mr. Carnegie’s gift is to supply in the city of New York advantages for which now the student goes abroad….The building will belong to the Bellevue Hospital Medical College, but will be open…to members of the medical profession throughout the country.”
The Times had missed the main purpose of Carnegie’s largesse: keeping Welch at Bellevue. The rub, however, was that Hopkins had offered Welch something even more precious—a guaranteed endowment covering his laboratory expenses and an annual salary for him and his assistants. Bellevue refused to go that far. Dennis believed, no doubt correctly, that Welch’s earning potential in New York City was enormous. Students would flock to his tutorials; private patients would line up at his door. “I know in ten years his income [here] will be twenty thousand dollars and more as contrasted with a salary of ten thousand [in Baltimore] and…a life in isolation [as] a scientific recluse,” Dennis wrote Welch’s brother, begging him to intervene. “His ideas imbibed in Germany are impractical….He [will] cut himself aloof from everything in the way of sacred associations and of true friendships…for an ideal, which cannot ever be realized.”
In fact, the German research model had dramatically raised Welch’s profile in the United States. The recent discovery by Robert Koch that the causative agent of tuberculosis was a bacterium visible through a microscope had served both to demolish the Miasma Theory and propel the fields of pathology and bacteriology into the spotlight. Even the more reluctant Bellevue dons took notice. In perhaps the most remarkable turnabout, Alfred Loomis, who had publicly mocked Koch and Germ Theory only months before, now begged Welch to stay. “I shall resign my position in Bellevue Hospital within a few years and you shall be my successor,” he wrote privately. “We mean to make Bellevue the finest Medical College in this country and we wish you to help us.”
It wasn’t enough. Welch had made up his mind: Hopkins it would be. How could this happen? Why would an ambitious researcher turn down the prestige and potential of the Bellevue-Carnegie offer in favor of an infant institution in a notoriously run-down city? The answer was simple: Welch’s New York friends had either misunderstood or chosen to ignore what truly mattered to him—the chance to do his research free of distractions and to help build a medical school different from any other in the United States.
Dennis was furious. His role as intermediary having failed, he accused Welch of deceit and disloyalty in a note that Welch dutifully threw away. (“Your letter is destroyed, as you requested.”) But Welch saw no reason to apologize. Indeed, he thought himself the injured party. “I am conscious that I have acted throughout in good faith and that I have done nothing which needs defense,” he responded. “I was ready up to the last moment to stand by the conditions which I made and which I cannot consider were fulfilled.” The decision, while not an easy one, was now final. “It seems clear,” Welch added, “that the opportunity which everyone should seek in this world of doing the best which is in him is for me in Baltimore.”*2
Before Welch left for Baltimore, his remaining friends threw him a farewell party. The toasts were mostly good-natured, the guest of honor recalled, with a strong dose of amazement at what had just transpired. Who else among them would have chosen such a path? “Well, good-bye,” Welch later described the mood that evening as tongues loosened and the wine flowed. “You may become a connoisseur of terrapin and Madeira, but as a pathologist, good-bye.”
They could not have been more mistaken.
—
Halsted, meanwhile, continued to thrive. He would never be busier or happier than during his “Bellevue days” of the early 1880s, described as “the most vigorous period of his life.” Elected to the exclusive New York Surgical Society, he seemed destined, at the age of thirty, to revolutionize his field. The meticulous ledgers at Bellevue show him performing dozens of operations, from amputations to hernias, from setting fractures to draining infected joints. In one case, Halsted did extensive plastic surgery on the face of a woman who had fallen into the flames of a kerosene lamp; in another, he grafted the muscle of “a healthy dog” onto the forearm of an industrial accident victim. (The result is unclear.) Germ killers were precisely employed. Halsted’s case notes are dotted with descriptions such as “arm thoroughly cleansed and disinfected,” “dressing of carbolized gauze aseptic,” and “parts washed with Thiersch’s solution [a strong antiseptic] and powdered with iodoform.”
As one who followed the latest medical news from Europe, Halsted was especially intrigued by a paper delivered in Germany about the potential of cocaine as a numbing agent in cataract removals. The problem, in a nutshell, was that general anesthesia sometimes induced vomiting and the shakes, making it risky in cases requiring a perfectly still patient. Halsted instantly grasped the importance of the German research. A safe, easily delivered local anesthetic would benefit everyone, dentists included, whose work caused excruciating pain. In December 1884, the New York Medical Record published an article about the breakthrough, noting: “A body of gentlemen in this city composed of willing medical students and intelligent surgeons have been experimenting…to determine the hypodermic effects of cocaine.”
Halsted was among the leaders. He not only recruited these “willing medical students” and “intelligent surgeons,” he also took the drug himself, believing he had a duty to do so before experimenting on others. In 1886, he scribbled some thoughts on the subject in a piece “Practical Comments on the Use and Abuse of Cocaine; Suggested by Its Invariably Successful Employment in More Than a Thousand Minor Surgical Operations.” The writing bordered on incoherent—Halsted had become severely addicted to cocaine by this point—but the operations he listed ranged from the removal of minor skin lesions to the circumcision and even amputation of the penis.
Cocaine did, indeed, work wonders as a nerve blocker when injected locally under the skin. But those who used it liberally experienced something more: a rush of energy and exhilaration that temporarily banished depression and fatigue. As word spread, cocaine quickly became a recreational craze in Europe and the United States, available in wine and soft drinks, cough drops and cigars. People of means could now look to a host of new drug firms like Squibb, Searle, and especially Parke-Davis to satisfy their personal and professional needs. Little was known at this point about addiction. Indeed, Bellevue’s William A. Hammond cheerfully described cocaine as no more habit-forming than tea or coffee, and some doctors pushed it as a miracle drug for everything from melancholy to malaria. Its users soon included the likes of Sherlock Holmes creator Arthur Conan Doyle, the cancer-ridden former president Ulysses S. Grant, and (it was strongly hinted) Pope Leo XIII.
By 1885, Halsted was fully hooked, as were most in his inner circle. His behavior became so erratic that he failed to show up for scheduled operations and even fled Bellevue when hearing his name paged in emergencies. Word of Halsted’s trouble soon reached William Welch in Baltimore. Determined to save his friend, Welch took a short leave from Hopkins and hired a schooner to sail the two men to the Windward Islands in the Caribbean. The trip went badly. While accounts vary, it appears that Welch encouraged Halsted to bring some cocaine, hoping to decrease the dosage over time. When the supply ran out, however, Halsted broke into the ship captain’
s medicine locker in search of drugs—most likely morphine. His desperation, wrote one biographer, had turned him “from a model of patrician rectitude to a thief.”
At Welch’s urging, Halsted left New York City to seek treatment at Rhode Island’s Butler Hospital for the Insane, one of the few facilities then specializing in drug and alcohol abuse. The regimen—fresh air, long walks, good food, and daily sessions with an “alienist,” as psychiatrists were then called—lasted seven months. When it ended, Welch took Halsted to Baltimore and installed him in his laboratory as a “special graduate student” in pathology. There would be no return to Bellevue. That chapter was closed.
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