TRANSCRIPT of the TALK given by Dr. CATUREGLI at PATHOLOGY GRAND ROUNDS on NOVEMBER 24, 2014
Slide 1
Colleagues and friends, good morning. Thank you very much for coming to Pathology Grand Rounds in this pre-Thanks Giving session. I thank Justin and our chair for giving me the opportunity to present my work about a very fascinating topic. It is a true honor to give this lecture, especially in 2014 because this year celebrates the 125th anniversary of the opening of the Johns Hopkins Hospital.
Slide 2
That’s how our hospital looked like a few months before the opening, in the spring of 1889. You can recognize the Administration building with the dome. And here is Monument Street and here Broadway.
Slide 3
That’s how the hospital looks like today. You can still see the dome but most of the original buildings have been replaced. So many changes.
Slide 4
My objective is to highlight some of these changes and provide a historical overview of the residency program and our department.
Slide 5
I will mainly present the work I performed while I was codirect or of the pathology residency program. The idea came in 2012 but the data collection was quite challenging and took almost 3 years. The actual writing of the manuscript was easy. We submitted it in September, it was critiqued and we revised and resubmitted it last February. The manuscript was finally accepted in April 2014 and will be published next spring in the Archives of Pathology and Laboratory Medicine. Although challenging, the data collection was perhaps the most rewarding aspect of the project because it gave me the opportunity to learn more about the history of medicine, the history of our department, and Johns Hopkins as a whole. It is indeed fascinating to study history of medicine. And no one says it better than Dr. Welch himself. Listen carefully.
Short video of Dr. Welch:
Nothing adds more to the interest and fascination of our profession than the study of this historical and cultural background of medicine and the natural sciences through the ages. And I venture to add that such study helps to make better teachers and better doctors.
Slide 6
I have organized my presentation into 3 sections. I will discuss briefly the origin of modern universities, from 1088 to the opening of JHU in 1876. I’ll then show you how the hospital, the school of medicine, and the residency programs came to light. And lastly I’ll show you my work. You should have picked up at the entrance a handout with a departmental table and a set of 15 questions. You will able to answer them after this talk.
Slide 7
This table shows you the first 10 universities of the world. The first one was in Bologna, Italy, and opened in 1088. Then we have Oxford, Paris, and Salerno, Italy, where the first medical school of the world was established. So, where are in history in 1088?
Slide 8
More or less we are around the time of the famous Battle of Hastings, which changed the fate of England forever. In this battle, the French Duke William, Duke of Normandy, sailed across the Channel, landed close to Hastings, and defeated the King of England Harold the II, naming himself the new king.
Slide 9
William made several contributions during his long reign, but perhaps the most consequential was the creation of a new English language, which fused the Germanic sounds of Old English with unmistakable Romance overtones, a language that is called Middle English.
Slide 10
Shortly after William died, in 1096, the University of Oxford opened and in that year also the First Crusade was launched. That’s climate in which Universities were born. They were built by scholars and meant to be for scholars.
Slide 11
They were modeled on the Greek and Roman mode of teaching where you had a professor that then created a school of scholars and students who were sort of devoted to him.
Slide 12
This way of teaching was certainly laudable, especially when the professor was charismatic, but as you can see already back then some students were not paying attention. It is sort of not different from what we see today.
Slide 13
So, this way of teaching, this way Universities were structured, lasted for about 8 centuries, more or less up to the time of the American Civil War.
Slide 14
Two remarkable changes occurred during the mid 19th century: the first one was the introduction of experimentation in German medical schools, later brought to America. Experimentation is a great equalizer because it brings students and teacher elbow to elbow. So rather than a vertical mode of teaching we have a horizontal transmission, which is much more conducive for learning. The person who brought this way of teaching to America is Dr. William Henry Welch, whom you saw before. He is the first and still longest serving chair of pathology in our department, as you can check in the table. He served for 28 years as chair. And he is recognized as the single most important event in the history of the Johns Hopkins.
The second event was the entrance of women in the workforce and the medical profession, and with this the start of the feminist movement. The Civil Was had opened up numerous opportunities for women in the workplace. About 623,000 young men had died during the war and 500,000 more were wounded. As Maria Weston Chapman nicely and ironically put it: “Women have leaped from their spheres”. Many women contributed to the start of the feminist movement. But for this institution the key player was Mary Elizabeth Garrett.
Slide 15
She came from the most influential in Maryland. Never married, she was passionate about reading and education. Her self-proclaimed, lifetime goal was “to help women”. Mary’s gift of over $350,000 made the school of medicine opening possible at the condition that women would be accepted on equal terms as men. She exercised her trademark scheme of “coercive philanthropy” to dismantle a century-old tradition of separate medical training for men and women.
Slide 16
This institution owns its existence to the railroad. The Garrett family, Johns Hopkins and George Peabody they all made their fortunes through the railroad.
Slide 17
I do not have time to discuss this very interesting connection between Hopkins, Garrett, and Peabody. But suffices to say that in 1866 George Peabody inaugurated its institute and transmitted to his friend Johns Hopkins a new way of doing philanthropy, based on gifts given while the donor was still alive and managed by a Board of Trustees. The next year Johns Hopkins made his will, leaving a bequest of 7 million dollars for the establishment of a University and a Hospital.
Slide 18
He suggested to use his estate, Clifton, as the site for building the University but in 1873 he died and in that year the market crashed causing the so-called “Long Depression”, a two-decade depression. So the Trustees were forced to sell Clifton to the City of Baltimore and change the site.
Slide 19
They decided to build the University downtown in a two-block area bounded by Howard, Monument, Eutaw, and Centre streets. It featured state-of-the art buildings with a Physical Laboratory, a Chemical Laboratory, and a Biological Laboratory.
Here it is. Actually, the history of our department begins here because it is in this building that Welch first started working when he came to Baltimore in September of 1885.
Slide 20
I’ll summarize now the events that led to the birth of residency programs.
Slide 21
This is site that Johns Hopkins himself purchased before he died for the construction of the hospital. The University was already open and now was the time to build the hospital. It is an area of the city that was called Loudenschlager’s Hill, which is where we are today, and it was mainly occupied by the Maryland Hospital for the Insane. This hospital was going bad and being relocated to its present location in Catonsville. You may recognize some landmarks. The street in the foreground is what will become Wolfe Street. The street running along the wall of the hospital will become Monument Street. So, our pathology building would be at this corner. You can see the blue water of Fells Point and Inner Harbor in the back. And this modern-looking building is Washington Medical College, which at that time was the main and only major competitor of the University of Maryland for teaching medicine. It was then relocated to Washington, DC to become George Washington University.
Slide 22
This is the plan of the Hospital. It was designed by Dr. John Shaw Billings and approved by the Trustees in 1877. It was a 23-buildings complex that was going to provide for 400 beds. It embodies Billings’ vision, which was this one:
You may recognize the administration building, where the dome is. These are the pay wards for males and females. The famous octagonal room where the medical “rounds” were started. But most of these buildings don’t exist anymore; they have been replaced, except for one. Can guess it is? Very good.
Slide 23
So, while the Hospital was being constructed, with difficulties because of the market crash, the University formed the first Faculty of Medicine, in June 1883. That’s what they said:
Slide 24
In January of the next year there was the first faculty meeting. They decided to hire a professor of pathology and chose Welch, whom Billings had met in Germany. They invited him here for an interview in March. And during that visit, Gilman offered him the position, which Welch accepted after a few weeks. This is the official announcement with a starting date of September 1, 1884. As Welch recalled in 1932:
Slide 25
The first 4 things that Welch did when he came to Baltimore, when he was hired, were these:
· He requested and obtained that professors of all pre-clinical subjects be appointed on a full-time basis, so that they would not rely on private practice for their living
· He modified the plan of the pathological building to accommodate instruction of medical students
· He took a year off, just after starting, he took one year sabbatical and $2,000 to travel to Europe for learning the latest in bacteriology (Dr. Welch was essentially a CP guy, mainly interested in bacteriology) and purchasing apparatuses and books for the Pathological.
· He established a friendship with the local pathologist, Dr. William Councilman, who was going to become his lieutenant for life.
Slide 26
When he came back from the year off, Welch rented a flat at 935 St. Paul Street. And, because the hospital was not yet ready, he was given space in the Biological Laboratory of the University, which you saw before. And there he prepared his teaching material, modeled on the Robert Koch’s course that was given in Berlin, and delivered his first lecture series in the spring of 1886 entitled “Micro-Organisms in Disease”.
Slide 27
A few months later, in October 1886 the Pathological was ready and Welch moved in although the hospital was still not open. That’s a photo taken from the back. So, basically you are looking north at the corner of Monument and Wolfe Street on the other side of the building. The building was a two-story high, as you can see, and had a laboratory, a photographic room, a pathological museum, and a stat-of-the-art autopsy theater. He brought with him Councilman and hired a fellow, Franklin Mall, who was going to become the first professor of Anatomy here at Hopkins.
Slide 28
This is the block plan of the building. You can see that the autopsy theater was full-height, to allow abundant light to come in. This room here, on the North side, facing Monument and Wolfe street, where Path Photo is now located, was the laboratory and that’s how it looked.
Slide 29
Very shortly this building became a hub for science in the entire country. Many people came here just to work under Welch in that building. The trio organized very popular courses for young physicians. The first 16 students are listed here. You may recognize some famous names. Dr. Halsted is there. Christian Herter was a very famous scientist as well.
Slide 30
Many people came from other places and other universities. For example, you may recognize Walter Reed, Jesse Lazear, and James Carroll of yellow fever fame. Here is another one. Dr. Williams. As you can tell, he was thinking: shall I write a book or shall I not? He decided to do it. Williams Obstetric is still in use, now in its 23rd edition, quite a popular book. Another very famous student of Welch was Lewellys Barker, who was going to replace Osler as Physician-in-Chief for the Johns Hopkins Hospital.
Slide 31
The center, the focus of that building that Welch created was research. Here you see him working with polyomyelitis rabbits, one rabbit is there in the corner, with Christian Herter who was a brilliant scientist, founded JBC, and unfortunately died prematurely.
Slide 32
There were also few women under Welch in those days. Here is one of them, Dorothy Reed, who as you know described the Reed-Stenberg cell. She married Mendenhall and had a son, John T., who came here for the residency during World War II.
Slide 33
As Welch recalled in 1932:
Slide 34
The hospital finally opened in 1889. For the first 4 years, the department of Pathology was very small, only 5 faculty members: Welch, Councilman, Abbott, Nuttall, and Flexner.
Slide 35
And it was now time for the School of Medicine to open, but money was short: $500,000 more was missing. The University had only $81 thousands or so. Mary Garrett stepped in. She organized the Women Medical School Fund, which raised over $111,000, of which she contributed almost half. And then, on Christmas Eve of December 1892 she donated the remaining $300,000 or so. So, basically she contributed over $350,000. And these $10,000 here, she paid for the famous painting The Four Doctors as well.