Made in United States of America

Reprinted from BuLuerin or tHE Jouns Hopxins Hosprrau
Vol. 87, No. 2, pp. 28-36, August, 1950

DR. WELCH’S INFLUENCE ON MEDICAL EDUCATION

ALAN GREGG
Director, The Medical Sciences, The Rockefeller Foundation, New Vork

Dr. Welch’s influence on Medical Education could readily be shown
by a list of his positions and accomplishments. But I take it that
within the general theme of Dr. Welch’s influence there will be room
for surmise and speculation as well as demonstrable fact and direct
inference. At any rate, I shall begin with the recital of some relation-
ships, any one of which would deserve mention as an important in-
fluence on medical education. To this simple recital of facts I shall
then add surmise, speculation and opinion in gradually increasing
amounts in the hope of formulating a general concept that might
indeed be applied to all of today’s exercises.

As one of the earliest of his influences on medical education, Dr.
Welch shared with President Gilman the task of finding and attract-
ing to the new Faculty of Medicine of a young university these profes-
sors—Osler, Halsted, Mall, Abel, Howell and Hurd. Osler was forty
at the time of his appointment, the others were all in their thirties,
as was Welch. Gilman’s performance, and Welch’s share in it, was
remarkable because it is harder to pick first-raters in their thirties
than later when limitations as well as abilities have declared them-
selves. As I hope to point out later, Welch not only discerned the
individual merits of these men: he accomplished still more because he
brought them together and kept them together harmoniously at. work.

Perhaps more personal and individual an influence on medical edu-
cation is to be found in Dr. Welch’s selection and training of a group
of pupils. To the volume in honor of Dr. Welch’s fiftieth birthday in
1900 there were 38 contributors. To read all their names would ex-
haust your patience without greatly deepening your conviction that
the list of Dr. Welch’s pupils could itself present a powerful argument
for his influence on medical education—Councilman, Mall, Halsted,
Barker, Abbott, McCallum, Flexner, Opie, Thayer, Nuttall, Howard,
Carroll, Lazear, Walter Reed, Gorgas and in a later generation
Whipple and Winternitz and Goodpasture. That is a list of men
singularly influential in American medicine.

28
DR. WELCH’S INFLUENCE ON MEDICAL EDUCATION 29

But to list only the men trained by Dr. Welch is to ignore a still
larger number of young men who were placed in important positions
entirely or partly because of Dr. Welch’s recommendation. Of this
group Dr. Rufus Cole, the physician placed in charge of the Hospital
of the Rockefeller Institute, is a sample from what must be a long and
significant array. And then, of course, there is the still larger roster
of graduates of the Johns Hopkins Medical School and the students
of the School of Public Health, who, if they heard even but once Dr.
Welch at his best, remember the experience as one of the passages of
excellence in a journey through a world of comparative mediocrity.
Welch not only placed his well trained pupils: one of his greatest
services was that he had much to do with creating the demand for
their services by the reputation that grew up around what he was
building in Baltimore for the medical sciences.

In still another capacity Welch was destined to serve medical edu-
cation; namely, as the President of the Board of Scientific Directors
of the Rockefeller Institute from 1901 to 1933 and as a Trustee from
1910 to 1933. During those years the role of the Rockefeller Institute
as a source of trained medical scientists was extraordinary. For the
very reason that it was successful in staffing many other centers, it
could hardly be expected to continue just this form of leadership
forever. Consequently, no one institution exists today with an equal
distinction of current pioneering. American universities that had no
long tradition of adding to knowledge were startled and at times ex-
hilarated by the single-minded devotion of the Rockefeller Institute
to research. Simon Flexner credits the Rockefeller Institute with
having been a considerable factor in the creation of the Kaiser Wil-
helm Gesellschaft. In that way one might claim Welch’s indebtedness
to German science was in generous measure paid, for Welch was
Flexner’s most far-sighted and influential adviser.

In an advisory capacity Welch served also the Carnegie Institution
of Washington as a member of the Board from 1909 to 1934 and as
Chairman of the Executive Committee for the first seven of those
years, the Milbank Memorial Fund as Chairman of the Advisory
Council from 1922 to 1932, the Rockefeller Sanitary Commission and
its successor, the International Health Board of The Rockefeller
Foundation, for 18 years, beginning in 1909. He was President of the
30 ALAN GREGG

National Academy of Sciences from 1913 to 1916. It was during his
presidency that the National Research Council was organized—cer-
tainly an event of profound influence on medical education as well as
science generally. Besides these stipulated advisory services, Dr.
Welch’s advice was sought informally by Abraham Flexner, Wallace
Buttrick and Frederick T. Gates of the General Education Board.

Out of his contact with officers of the Rockefeller Boards came Dr.
Welch’s membership on the Board of Trustees of the Peking Union
Medical College which began in 1915 with a visit to Japan and China
and continued till 1931. In the work of that medical school, staffed
and equipped as no other medical school in the Far East, Welch’s
wide horizons in medicine were soon and long an influence for medical
education of a superior range and quality.

“Two further contributions to medical education were made by Dr.
ey Welch when he was already at an age when few men undertake new
i aw it din y enterprises. At 68 he witnessed the opening of the School of Public
oy ae Health! awith a faculty selected by himself and Howell, "The-School
Yoo opened with the same numberof students-—t7—as-had entered the
first--class-.of-the-Jehns—Hopkins-Medieal School 25- years. before.
Welch was its leader. He had planned or influenced the planning of
probably every important aspect of its policy. In this enterprise, as
\ in the Peking Union Medical College, Dr. Welch’s influence went far

   

r The Rockefeller: Foundation and other foreign visitors found in Pro-
“be . fessor William H. Welch an unforgettable Patriarch of World Medi-
| <~\cine. They venerated him, and they carried back a vivid memory of

| fim to all points of the world—or nearly all.
~ Then in 1930, after three years of preparation for a quite different
enterprise, Dr. Welch had the satisfaction at the age of 80 of seeing
his hope for an Institute for the History of Medicine assured, and
two years later the appointment of Professor Sigerist dispelled any
misgivings he might have had as to the life expectancy of this child
of his old age. The older he grew, the more Welch got ahead of his
contemporaries: not a common phenomenon. One has the impression
that Dr. Welch was more deeply delighted by the success of this last
institutional project than by almost any other undertaking he had
laid his hand to. Perhaps this delight expressed the all-too-under-
DR. WELCH’S INFLUENCE ON MEDICAL EDUCATION 31

standable impatience of an old man, or perhaps Welch’s natural re-
serve in expressing his enthusiasms had diminished by the time he
was 80. But I think the chance equally likely that Dr. Welch’s extra-
ordinary range of curiosity and erudition found in History the breadth
and inexhaustible riches of the World and of the Past—dimensions
and distances and a universal relatedness more satisfying to his mind
than any one field of medicine had ever offered him. Besides, as we
all near the status of the great majority, it is natural that their ac-
complishments fall into the far more mellow and tolerant perspectives
of one about to join their number, even if not confident of
their company. +**

Such, then, were the major directions in which Dr. Welch influenced
medical education in what was to him as well as to his immediate
juniors an almost unbelievably rewarding age in medicine. I have not
mentioned some thirty-three other associations, mostly in the field
of medicine, in which he was an officer or an active member. That
these services were appreciated by his contemporaries seems clear
from the number of honorary degrees, decorations and honorary
memberships given him—forty-one honorary memberships, eighteen
honorary degrees and twelve decorations and medals. The breadth of
his interests and his erudition, and his skill as an adviser and ne-
gotiator made him more impressively effective among his contempo-
raries than he could later appear to anyone but a close student of his
life and times.

These are facts—not all the facts—but some of the facts about the
imprint of an evidently extraordinary man. Are there any circum-
stances which might help to explain more clearly the exceptional
influence that this man exerted over his contemporaries, his juniors
and even today their successors? I could name two such circumstances
but I hope at no risk of being accused of trying to detract from the
accomplishments of a great man. But his very impersonality in ap-
praising others prompts a comparable response in this appraisal of
his own influence.

It seems to me that we all owe a special debt first to the circum-
stance of Welch’s remaining a bachelor, and second to the fact that
he lived to attain a patriarchial status. By so much as the compan-
ionship of a wife would have shortened his time available for conver-

iy |
32 ALAN GREGG

sation or reading at clubs, for travel, for work, for committee meetings
and for study, her non existence has been the gain of his friends and
medicine everywhere. Perhaps this is only the old argument for a
celibate priesthood but I feel that Welch was far more effective and
happy as a bachelor...and perhaps I should promptly rest my
somewhat delicate case by noting that he seems to have had the same
opinion. On the point of his living to the age of 84, there will be per-
haps less difference of opinion. If you live until your devoted pupils
and juniors have themselves become elder statesmen, you are almost
assured of a legendary status while still alive: Welch became a living,
genial legend. In civilizations as competitive as ours, old age, though
not always honored, is usually respected if there be no signs of petu-
lance, garrulousness, vanity or failing health. Instead of petulance
Welch showed good-natured tactful generosity; though he liked to
talk, it was always with a suave impersonality and from a well exer-
cised and thus wonderfully rich memory; instead of vanity Welch
showed a more modest estimate of his work than almost any man of
his station in life; and his health and alertness of mind gave no cause
for anything but admiring wonder even into the last year of his life.

It may be claimed, and plausibly enough, that Dr. Welch happened
to live at a time in American history and in the development of medi-
cal science that would have made demigods out of mediocrities any-
how. That I do not believe: the only machinery for turning
mediocrities into demigods is dictatorship, the ballot box or the law
of primogeniture, and even such machinery needs the services of
public relations experts to keep running smoothly. Admittedly, the
growing wealth of America extended Dr. Welch’s influence in direc-
tions and to distances that would otherwise not have been possible.
And certainly the fundamental medical discoveries of 1880 to 1900
offered further research opportunities to persons who would have re-
mained unknown if they had been born twenty years earlier. But
neither of these factors explains the situation.

What explains more completely the magnitude and extent of Welch’s
influence on medical education is the remarkable combination of per-
sonal qualities he possessed. To match, and perhaps to protect him
from, his hospitable generosity and general kindliness, he had an aloof-
ness, a detachment and an impersonality that enabled him to be a
DR. WELCH’S INFLUENCE ON MEDICAL EDUCATION 33

shrewd judge of men. He was able in his thirties to select a faculty
with extraordinary discernment. Then came into play his remarkable
ability as a conciliator. Inclined himself to take the middle path and
follow the golden mean, he could mediate, buffer and persuade more
naturally than utter ultimatums or mutter imprecations. In con-
tentious matters he rarely took an extreme or irrevocable position.
He must have had an unusual sense of timing and a keen conviction
of its importance, for he would neglect everything for the sake of
pushing some one matter at exactly the appropriate moment. And

as a natural corollary of a good sense of timing, he had both patience.

and tenacity. To me his most impressive traits were, first, that he
seemed to regard the faculty of memory as something calling for
constant exercise and, second, that he assumed his companions to
have the capacity to be interested in great themes and fine endeavor.
With great natural dignity he elicited the interest of others by the
high quality of his own curiosity, wonder and delight at knowing a
subject thoroughly enough to be able to relate it to all manner of
other aspects of living. Ingenuous himself, he drew out the best there
was in others—the best. Hardly a more satisfactory combination of
traits could have been found for the small collection of superior per-
sons that was the Johns Hopkins of his day. I would repeat—the small
collection of superior persons.

Tf I have made a convincing case for believing that Welch had a
considerable influence on medical education, I owe some time to the
task of describing in what directions this influence pointed. Remem-
ber that influence is not always triumphant—it sometimes meets de-
feat from opposition or apathy or unfavorable circumstance. None
the less, it is influence and not without issue. In at least four direc-
tions Welch influenced medical education in this and other countries.
_ By conviction and by example Welch saw the tremendous gain it
would be to medicine if travel, interchange and merit (regardless of
point of origin) were to become characteristic of medical education
and the criteria for promotion and praise. He opposed the parochial-
ism and the clannishness that still smoulder in narrow minds in
whatever washrooms they congregate. First a Connecticut Yankee,
later a New Yorker, in going to Baltimore he went himself, as later
he sent his pupils, to new environments—adventurously.

vidya gre!
W-&

34 ALAN GREGG

Welch exemplified as well as insisted upon the importance to medi-
cine of science, of scientific methods, of scientific thinking and modes
of expression. He championed the construction and the maximum
use of laboratories and especially he worked for the creation of careers
for young men who wanted to become full-time medical scientists.
And he was a medical scientist when that was a suspicious sort. of
thing to be, with little but youth and logic to support its future. The
significance of Welch’s convictions is brought into sharp relief by
Lester Carr’s account of Professor Loomis standing on the platform.
lecturing to medical students in New York and saying derisively,
“People say there are bacteria in the air, but I cannot see them,” —a
witty remark in 1884 and greeted with a burst of applause from the
students. Welch, who had just returned from Europe convinced of
the truth of the germ theory, remarked when told of Loomis’ witti-
cism, ‘“‘That’s too bad. Loomis is such a nice man.” In some ways
this insistence on the importance of what we now call the medical
sciences was Welch’s most significant contribution to medical educa-
tion. If so, it is because more evident success attended it than met
two other of Welch’s influences.

I refer, of course, to the fact that Welch’s weight was in favor of
treating students as though they were mature—as though they could
wisely be given full liberty even though such an attitude seemed to
the student like studied neglect. One could hardly prove that Welch
was permanently successful in inducing maturity in the average Ameri-
can medical student, but I imagine that few of his pupils were unaware
of the tonic value of this method of teaching—and there is even some
evidence that they have practiced it on subsequent generations of
students with memorable effects. It was, however, new in its time—
“a voice crying in the wilderness” . . .

~ “But the greatest influence that appears to me from the sum total

of Welch’s impact on medical education seems to have been his in-
fluence in recognizing the comprehensiveness of medicine, the fas-
cinating interrelatedness of an almost unlimited number of
ascertainable facts. It was the man’s horizons as well as his adventure-
someness that were so startlingly grand, horizons that seem to have
lifted apparently with every one of 83 years. To Dr. Welch, I believe,
American Medicine owes, unconsciously, a peculiar debt—namely, a
debt for being shown that the horizons of medicine can be almost
DR. WELCH’S INFLUENCE ON MEDICAL EDUCATION 35

limitless. Dr. Welch had Vision—and would entertain a Vision with
the hospitality and the patient alertness he would bestow upon a
chosen guest at the Maryland Club. He enfertained Visions. He had
the wit to know that unless thus entertained, Visions slip out of town
sedulously resolved never to return. Finicky things, Visions: high

infant mortality, embarrassingly dependent on human beings, never |

}
seem to care who they visit, but they never overstay their welcome. ... J

Let me begin the final section of this paper with a rather stark

question. Can you think of some part of the world where there is a
college or a university but where the establishment of a six-thousand-
dollar fellowship without closely defined objective but tenable for six
successive years would almost certainly be an inexcusable waste of
money? If you can think of such a university, you will agree that
there are, on the other hand, universities where such a fellowship
would be magnificently used. What is the probable principal differ-
ence between a university that could not safely be given such a fellow-
ship and another university that would be able to use so much money
to the greatest advantage? I think it is that the first university lacks
what I would call the heritage of excellence and the second has it.
* T must admit that in the phrase “heritage of excellence” I am in-
venting a name for what I have sensed but never seen. I am sure it
has been recognized, but has it ever been described? Though I believe
it is a psychological reality, I shall introduce it as a hypothesis—as
befits this audience.

I suggest that something extraordinarily precious comes out of the
close but entirely free association of really superior people. To this
emergent quality I give the name—the heritage of excellence, mostly
because it lasts so long and because it never comes from, nor appeals
to, mediocrities. I doubt if a human being can maintain really close
relationships with more than six or seven people. Therefore large
numbers of excellent persons are not necessary to create it. By really
superior people J mean persons so spirited and yet so balanced, so
gifted and yet so incomplete, so mature and yet so eager that they can
remain in close contact with but a few of their kind and yet experi-
ence no surfeit, boredom or friction.

The exact nature of the contacts between a few absolutely first-rate
people is completely unpredictable except in point of its astonishing
quality. All you can know about it in advance is that it will be memo-
36 ALAN GREGG

rable and that it will spread outward and afterward. This almost
unearthly and certainly intangible product of the interchange between
superior persons cannot be seen but it can be felt and truly like an
atmosphere it can be breathed. Indeed, it is an inspiration.

Have you ever sat in with three or four really witty people who
knew that to play ball you have to catch as well as pitch and that
enchanted listening and attuned response invite and fully reward in-
spired talking? The result for you was almost certainly a memorable
evening—an evening that transcends your abilities at description.
That is a bit of what I mean by the heritage of excellence. But think
of what this heritage of excellence would mean if applied not merely
to wit but to the fields of friendship, of scholarship, of all medicine
and of aspiration for the future.

What Welch and his colleagues did and believed and wrote is not
as important now—nor anywhere near as important—as the heritage
of excellence their contacts with each other have left us. We are met
today to talk about Dr. Welch and his influence. What we are talking
about is not Dr. Welch alone but the quality of interchange among
a relatively small number of first-rate human beings—an atmosphere
in which Dr. Welch was Popsy—a relationship whose larval form was
eager work and whose imago I have tried to name as the heritage of
excellence. It does not depend on numbers; it depends on the quality
of the participants in the life of the university. Subjects may come and
subjects may be removed from the curriculum; professors may turn
out to have been egregiously mistaken, but if they were first-raters
and in eagerly honest relationships with each other whether at work
or at play, the result is the heritage of excellence.

In this sense Johns Hopkins is enviably rich. The legend, the herit-
age of excellence that came from the unflagging interchange between
Welch and Osler and Halsted and Abel and Howell and Mall and a
few others—in this you have what makes a generous fellowship a
safe investment here at Hopkins, safer than in a university that has
never witnessed the contagious companionship of excellence. What
more do men of superior character and capacity require for their
association than freedom, responsibility and expectation? The wisdom
of the university is to provide those three—freedom, responsibility
and expectation. It is the interaction of such men that attracts great
young men, leads to great living and itself lives on long afterwards
as a heritage of excellence ready at any time to burst into bloom again.