Dr. Lawrence R. Wharton Discusses Howard A. Kelly, Thomas S. Cullen et al. PREFACE Dr. Lawrence R. Wharton (1887- ) of Baltimore, Maryland has been associated with the Johns Hopkins Medical Insti­ tution since 1911, when he entered medical school. Having served on the house staff in the Department of Gynecology from 1915 until 1921, he knew and worked with both Dr. Howard A. Kelly and Dr. Thomas S. Cullen. He remained on the Attending staff after completion of his training when he entered private practice. Dr. Wharton was approached to discuss Dr. Howard A. Kelly in an interview. The interviewer in a sense took advan­ tage of Dr. Wharton's hospitality and made a number of inquiries about Dr. William S. Halsted, Professor of Sur­ gery at Johns Hopkins (1892-1922). Dr. Wharton admitted that his first-hand knowledge of Dr. Halsted was limited compared to his knowledge of Drs. Kelly, Cullen, Runner, etc. However, his comparison of Dr. Halsted with Dr. Kelly and their teaching programs provides interesting reading. The interview was held in the living room of Dr. Wharton's home in Baltimore at 4504 Roland Avenue on February 1, 1967. Dr. Wharton was a cooperative respondent. At no 2 time did he request that the tape recorder be turned off. When asked a question about a matter of which he had little or no first hand knowledge, he freely admitted same. Peter D. Olch, M.D. History of Medicine Division National Library of Medicine This is an interview with Dr. Lawrence Wharton of Baltimore, Maryland, held in Dr. Wharton's home on February 1, 1967. We hope today to discuss most informally Dr. Wharton's experiences in the early days of the Johns Hopkins Medical Institutions and in particular his relationship with Dr. Howard Kelly, the first Professor of Gynecology. The interviewer is Dr. Peter D. Olch of the National Library of Medicine. Dr. W.: My contact with Dr. Kelly extended from about 1915 until the time he retired in 1919. During that time I was an interne, an assistant resident, and after World War I, a resident. We came into very close contact with Dr. Kelly. He was very approachable. He wasn't like Dr. Halsted. Dr. Halsted was completely unapproachable, not intentionally I think but by disposition. Dr. Halsted was approachable before he got into the cocaine trouble in New York. He was a young fellow and had a big practice in New York. He had a teaching group of anatomy. He went to various hospitals all over the city. He even went up to operate on his mother in Albany, for gall stones, and saved his sister's life, I think when she had a hemorrhage after having a baby. So he was a practicing doctor, knowing people and liking 2. people. His entire career and attitudes changed after he got the cocaine habit and had to stop practicing and leave every­ thing to try and overcome it. Dr. 0: Dr. Wharton, do you feel that there is anything to the belief of some individuals that Dr. Halsted, for at least a period of time, if not throughout the Baltimore period, remained on some form of drug. Not necessarily cocaine, but any form of drug. Dr. W.: Well, my opinion wouldn't be worth anything, in answer to that question. But when we organized the Halsted Society; it was called the Halsted Club then, about 1922 or 1923, I was one of the organizers and our first meeting -- Dr. O.: May I ask you who were the other organizers of this group? Dr. W.: Oh, there was Dr. Bob Johnson, Dr. Walter Hughson in Baltimore, and in New York there was Purdy Stout and Dr. Churchill I think from Boston, and Dr. Ravdin from Philadelphia. They may not have all been originators but they were among the early 3. members. "When we had our first meeting in the old Baltimore Club on the second floor, we had a dinner and our guest was _Dr. Welch. Dr. Welch came for dinner, and after dinner we just turned the meeting over to him. I have always been sorry that someway or another we couldn't have a transcript of his informal talk. He talked about nothing but Dr. Halsted. He told, for the first time, of Dr. Halsted's work with cocaine and his addiction to it, and his terrific struggle to overcome it. This was the first public discussion of Halsted's addiction by anybody as far as he knew. Dr. O.: This certainly was before MacCallum's book was published in 1928. Dr. W.: Oh yes, because I remember, concerning Dr. MacCallum's book, I had to write a summary of Dr. Halsted's contributions, for this original meeting and Dr. Maccallum asked me to give him my article. I don't know whether he used it or not. He didn't need to, but I gave it to him in connection with his book which came out considerably later. In answer to your question as to whether Dr. Halsted ever got over cocaine, Dr. Welch stated definitely that he did. 4. Dr. O.: J It would seem that the very nature of chronic cocaine addiction is such that a man could not continue to function. It has been said by some that he had been weaned from cocaine and perhaps at some later date had become addicted to morphine. Certainly I think it is the sort of thing that cannot be proved, and people will be tossing the question back and forth through the years. Dr. W.: One thing is certain. Dr. Halsted was always reticent in prescribing morphine for his patients. He often left doses for postoperative patients, which were so small as to be useless, l one-twelfth of a grain. The residents had to follow him up and give patients what they needed. Dr. Welch told us the story of how he got Dr. Halsted down here from New York. Tfuey lived together and Dr. Halsted during this time went into sanatariums of various sorts here and elsewhere. He bribed the porters and the orderlies, got the drug and was released apparently cured once or twice. Finally according to Welch, he broke it. Dr. 0.: There is evidence in his manuscript material of his return to Providence, Rhode Island to the Butler Sanatarium on at least one occasion after coming to Baltimore. 5. Dr. W.: The effects of cocaine, however, were lasting. His change in habits, attitudes, modes of living entirely changed after leaving New York and having this terrible bout with cocaine. I think one of the most amazing conquests that he made in his life was getting over cocaine. I think there is nothing more inspiring than that one fact in his entire life. Dr. O.: His contributions to surgery thereafter were such that perhaps it was a gift to the field of surgery and to medicine in general, that he did have this episode because he was destined to be a very busy, active surgeon in private practice that would not have allowed him to spend so much time in the laboratory as he did after he came to Baltimore. Dr. W.: It shows in his literary work because before he got cocaine, he wrote these long carefully, meticulously studied contributions on the thyroid gland, on hernia, things he was working on in New York. The first article that came out after he had cocaine consisted of about one or two paragraphs. It was entirely rambling, disconnected. I don't know why they ever published it. 6. Dr. O.: Is this the one that appeared while he was still in New York? Dr. W.: It may have been while he was still in New York. Dr. O.: I know he does have an article that appears to have been really a rebuttal to a physician who had written an article in the same journal previously stating that he had used cocaine and had not been able to achieve anesthesia. It is a very brief comment by Dr. Halsted which is quite impatient. Dr. W.: Maybe, but I have the impression though I haven't looked up Dr. Halsted's monographs. I was over in the Welch Library yesterday and asked them to see, but they didn't bring it down, they brought down everything else. The article I am thinking about was on thyroid, I think. Dr. O.: This is interesting. I have not seen that. ?. Dr. W.: It's a hopeless thing. Dr. O.: It's interesting. The article probably was not one selected to go into his Collected Papers for this reason. Dr. W.: When he came to Baltimore, his whole attitude toward medicine and toward patients changed. He became a student, an investigator. He lost his eagerness to operate, his rapidity. He became meticulous in his surgical technique. Time was no element after this and his one desire after that was to study, to contribute to medicine and to train surgeons. That's all he wanted to do. Dr. O.: Dr. Halsted is generally considered to have been the epitome of the full-time professor. He accepted it quite readily when it was proposed. And yet when one reviews his manuscript material which is in the Welch Library, it would seem that he had a sizeable private practice. We have records of patient bills from about 1896 till 1903. It would seem that he did charge reasonably large fees. Also in the manuscript material one finds notes which he made at the time of Dr. Barker's paper in 1902 on 8. full-time and the university. At this time he came out very strongly for geographic full-time; in other words, working at the hospital, seeing your patients at the hospital, but being allowed to collect private fees. I have always been interested as to what possibly could have been the factor or factors effecting his change of mind from geographic full-time to a straight full-time system. Dr. W.: I couldn't answer that. We always felt that Dr. Halsted was more interested in his experimental animals, his dogs in the Hunterian, than he was in patients on the Marburg. It wasn't difficult for us to see how Dr. Halsted went over to the teaching proposition entirely. Now Dr. Cullen was different and Dr. Kelly. Dr. Cullen received a minimum salary, as he was part time, as was Dr. Kelly and all of them to start with. Dr. Kelly's salary, when he came down here, I think was 3,000 dollars a year from the University. At least I saw that yesterday. Dr. Cullen always returned that in toto. He didn't want to have anything to do with it. Dr. Welch was for straight full-time. We saw that all of these contributions that marked the first twenty or twenty five years of the hospital came from men who were active in practice. In 9. my own work, I have always been in private practice, the only salary I ever got from the Hopkins was 500 dollars during the resident year. Dr. O.: The interne and assistant resident in gynecology at that time were not paying positions. Dr. W.: No interne, no assistant resident. Dr. O.: I think that was true of all the services at Hopkins at that time. Dr. W.: Absolutely. In spite of that fact; we didn't pay anybody except the resident, there was an oversupply. Many fellows applied for positions they couldn't get. We felt that the poorer the hospital, the higher the interne pay. Dr. O.: And that still holds today. 10. Dr. W.: I think that it is an awful thing that they have gone to such extremes in paying internes, assistant residents, and residents because it must contribute to the cost of medical care tremendously. Anyhow, I haven't given any thought to the full-time business for many, many years. As a comparison of Dr. Kelly and Dr. Halsted, it was evident that there were differences, fundamental differences in their personalities and attitudes. There were also wide areas in which they were in complete unison. There were some interesting differences. For example, when Dr. Halsted came over in the morning to see his patients, to work in the dog house, or to teach, he drove over in his car or was driven over. He was dressed in grey striped trousers, frock coat, gloves, spats, cane and a stiff hat. He was formally and wonderfully dressed. Dr. Kelly usually came over on his bicycle. He often did. He breezed into the hospital about an hour before Halsted would even think of getting there and may have already done an operation or two at his own hospital. He would come in bright and rosy and airy and greeting everybody, whereas Dr. Halsted would walk along the corridors slowly and not pay any attention to anyone particularly until he got to the operating room. Here he would find his residents, Heuer or Reid, or some­ body like that, who were his pets and whom he was interested in. They would meet him, and they would spend the day together. 11. Kelly would be in the hospital two hours, do two operations before the group and then would go back to his own hospital. In those particulars of course D'.r'. Halsted and Dr. Kelly were different. Dr. Halsted was a different fellow outside the hospital and outside of Baltimore. He spent his summers down at High Hampton. I have never been there, but one of my friends in Baltimore, who belongs to a luncheon group with me, a retired man, whose family had a farm directly adjoining High Hampton in North Carolina, has been there. Hugh Benet is his name. Hugh has told me of experiences he has had with Dr. Halsted. I asked Hugh to write it out, but he never has written anything. I remember one or two things he said. He said, for example, that Dr. Halsted went to church regularly down at High Hampton. Dr. O.: Now that is interesting; that is interesting. This is not the side of Dr. Halsted that one generally hears about. Dr. W.: I have never heard Dr. Halsted mention church, religion or any­ thing else. 12. Dr. O.: He generally is considered to have been quite an agnostic. Dr. W.: But Hugh Benet says he went to church regularly. He operated on the pets of the farmers around there. He tells the story, that I have recorded, about a very sick boy who had an attack of appendicitis and he (Halsted) wanted him to go to Baltimore to be operated on, but he wouldn't do it. Halsted arranged to have an operating team, table, instruments, and nurses brought down from Baltimore. Then they decided that they wouldn't have it done in High Hampton, in North Carolina, but wanted to go back to Baltimore to have it done. So that paraphenalia was sent back, and Dr. Halsted operated upon the boy in Baltimore. Of course Dr. Halsted was a farmer in High Hampton. His hobby was dahlias. He had large beds of choice dahlias. He had no such opportunity when he lived on Eutaw Place in Baltimore. His entire attitude toward things changed down there. He was interested still in animals and sickness of any sort. He took care of one of the neighbor's dogs when he broke his leg. Another fellow in this same luncheon club, Hartman Harrison, lived on a farm outside of Baltimore. They raised horses. 13. He says that Dr. Halsted always came out to their farm when a horse died to do an autopsy. He remembers very clearly the work that Dr. Halsted did on their farm as a veterinarian. That is not mentioned in anything that I have ever read about Dr. Halsted. Dr. Halsted was interested chiefly in his residents and his upper ranking assistant residents. Dr. O.: He seems to have been far and away more interested in the talented resident rather than the not-so-talented man, and his house staff far more than the medical students. Dr. W.: He kept his residents for years and some of them stayed on for as long as 10 years after graduation. That is the reason I went into gynecology. I had earned my own way. My father was a missionary in India and every cent that I got, I earned. I couldn't go into a proposition which was as indefinite as Halsted's residency. So when I got a chance to go into gynecology, I seized it, because Dr. Kelly's service was 5 years, definitely, and at the end of the first year, you were chosen and were kept on without any break, pending good behavior 14. of course, through the resident year, four more years, then you were through. No, Dr. Halsted's men stayed on apparently until they got to be full professors someplace, some big university. A great many of our fellows did too, but practically all of them also went into practice of some sort. rr Dr. Kelly was awfully interested in, and insisted on higher training, special training. That is something he doesn't talk about very much in his clinics or talking to groups. In the operating room he was interested in the technique of the operation, the skill with which he did it, the smoothness of the team, and the result that he got. Dr. O.: I gather he was a superb technician. Dr. W.: Dr. Halsted on the contrary was always talking about his years in Berlin and his associations with Kocher and Volkmann and people like that. I was surprised the other day, after having been with Dr. Kelly for so many years, to find out how soon after he had finished his residency, at the University of Pennsylvania Hospital, he went abroad. After he finished his 15. residency in Pennsylvania, his father set up a nice office for him in a nice residential section where the other big doctors had their offices. Dr. Kelly didn't like that. He said he would rather go out on his own than be assistant to some big man. And so Dr. Kelly found that most of his house patients, free patients, came from a poor district called Kensington. There was a charity hospital in Kensington, so Kelly went out there. That brought out another trait of Kelly that was fundamental. I think it has been misunderstood a great deal. Kelly has been called a fellow who was always in the public light and did things for public display. Dr. Kelly was naturally a fellow who did brilliant things and who was investi­ gating things all the time. Even when he was in college he was reporting unusual things in botany, or experiences he had when he was out in Col,orado for his health for a year. Reptiles, or birds, or something or other in nature. He would write them up and write them up so they would be published. Dr. O.: He certainly had an extensive bibliography, something over 400 articles. Dr. W.: He did this habitually, I think. When he went to Kensington to live, it would be equivalent to a good surgeon now going into some slum area and living. 16. Kelly was not buried anywhere. He associated himself with the top men at the University of Pennsylvania and Dr. Osler used to see his patients for him on consultations. When he went to Kensington he continued to call people like Osler and the other professors over there in surgery and in medicine and kept his associations up. And the next thing you knew he was abroad. He made two or three trips abroad while he was in Kensington and studied over there a considerable length of time with the German professors. He records it all. And of course, he came back and recorded his experiences in Philadelphia, so that he was constantly under observation. Dr. Kelly did operations that had not been done successfully before. For example, he did a Caesarian section on a woman, and she lived. It was the first woman who lived after a Caesarian section for 50 years in Philadelphia. He took out a tumor that weighed 100 pounds from another woman and he reported that also. So that when it came to Baltimore, he was Osler's first choice for the professorship. Osler said, "You can see who you want to, but I think the Kensington Colt is the one I am going to vote for." So he got it. But his pay was 3,000 dollars. a year when he came here. He was only 31 when he became Professor of Gynecology. 17. Dr. O.: I gather one of the problems in the early years at the Johns Hopkins Hospital was the very limited number of private beds. Whereas Dr. Halsted could have his private patients in the Johns Hopkins Hospital, this was not a privilege accorded to Dr. Kelly. Is that correct? Dr. W.: I am not sure about that. I thought he had his patients there. In fact I am pretty sure he did. Dr. O.: I could very well be wrong on this point. Perhaps it was because there was such a limit as to the number of private patients he could admit, that he opened the private hospital on Eutaw Place to supplement the limited number of private patients in Hopkins. Dr. W.: Yes, of course that is true of all those men. Dr. Finney came down here from Boston, where he had been resident in surgery at the Massachusetts General Hospital, and he started with the hospital, but Dr. Halsted wouldn't let him have a private patient there, wouldn't let him operate on a private patient 18. there for 13 years. Well, he had to make a living and so he went over to this hospital on Division Street, the old Union Protestant Infirmary. He soon had that full. Dr. Baer had the same experience. Hopkins didn't have enough private beds for these fellows. Dr. Baer started the Children's Hospital. And Dr. Cullen had the same experience when he came down here. He sent all of his patients to the Church Home. Dr. O.: He was chief of surgery there, was he not? Dr. W.: Yes. Dr. Russell, Dr. Richardson and those men couldn't find beds at Hopkins so they built up the Woman's Hospital. So that's the story. Now that of course brings us to another thing that I know happened over there. This was before I graduated in 1915. Dr. Kelly said that he had to do something about private patients and rooms and offered the hospital a gift of money sufficient to put up an entirely new building for his private patients. Most of his private patients were in the old B ward, which is now part of the Nurses Home. Dr. Kelly never got over that, the fact that they turned him down. They didn't accept his offer, and they did not let him build 19. up his private practice at Hopkins. He didn't understand that. He resigned in 1919 as a consequence one of the consequences. During the interim he had to add to his sanatarium on Eutaw Place and he built his little library there. His interests became centered where his money and his patients were. Dr. 0.: Dr. Wharton, do you personally feel that the Flexner report, the report of Abraham Flexn.er to the General Education Board was a little rough on those individuals on the faculty who had private practices? One actually can read now in the Appendix of Volume 2 of Dr. Chesney•s combined work on the Johns Hopkins Medical Institutions, a copy of this report. I found it rather enlightening, some of the things he said, really the way he said them. He all but intimated that the state of the clinical practice was such that many men who should be spending their time teaching, were in fact spending far too much time with their private practices and that this was not doing what it should for the teaching program of the medical school. I wonder if you personally feel, as Dr. Osler did when he sent this scathing letter to President Remsen, that Flexner, on 20. the basis of a three week study, could make such a decision, + and whether he was really justified in making such a statement. ' Dr. W.: t As a practitioner and also as a fellow who was always interested in research and teaching, I could see how difficult it would be for a person to do extensive teaching and keep up a busy practice, take care of sick people and also do any amount of reading or studying or investigation on your own part. Writing for example; it isn't everybody, of course, on the clinical staff or in the research department who is qualified to do research. I mean a great many of them today are fellows employed by the government and by the hospital; fellows who want to stay around, and who are making no contribution what­ ever. But once in a great while somebody comes along like Best in Toronto and Banting, and they without any f~nds or endowment do basic work that is important. I understand the failure of a teaching department if it is done by clinical men. We haven't the time to spend with the students that we ought to. We haven't the time to spend in the dispensaries to teach. I love to do all those things, I did for years, but when you get around 50 years of age and are booked full for two or three months in advance and operating 21. all the time and have sick people to take care of, why you just can't give the time to teaching that you would like. So I have felt all the time that the organization of the depart­ ment, the business part of it, the running of it, the teaching to a large extent, routine teaching, lectures if they have them, ought to be given by people who can give more time to it than the clinician can. On the other hand I can see that some of the worst lecturers in the world are people who don't get out and see people and have practices. They have got no business trying to lecture. Their work is all from books. It reminds me of the time that I was in World War I on board ship. I went over with the Hopkins unit. I had never done any orthopedics but gynecology was not a major part of the war. Dr. Baer came to me on board ship. He was Professor of Orthopedics and was in charge of the orthopedic service in the hospital. He asked me if I would take charge of his work and be his assistant. Of course it was very fl~ttering for me to be chosen, but he was sort of up against it because there weren't so many to choose from. I took it over. He got me lots of books, French books, English books and I was helped by the general surgical staff in the surgical work. 22. Somebody had to lecture to the students, and they elected me. You see, we had 33 fourth year medical students with us. They wanted to be in the war, and so it was arranged that one-third of the fourth year class, could go over with the Hopkins unit, Base Hospital 18. All volunteered; one-third were taken. They were listed as orderlies, but worked on the wards and in the operating rooms as assistants. They were wonderful fellows; the whole class of 1918 wanted to go; we could take only one­ third. We gave them courses in all branches of medicine except obstetrics. And I had to teach them orthopedics, and try to iearn it myself. I gave them 10 or 12 lectures. After the last lecture, they thanked me and congratulated me. One of them, Hugh Morgan, who later became professor of medicine at Vanderbilt and a general in World War II, came up to me and said, "Lieutenant Wharton, the fellows want to thank you for helping them. Your lectures were fine. They sounded as if they had just come out of a book." I said, "Hugh, you are right. That's where they came from. " In June 1918, they graduated in medicine, were commissioned in the Medical Corps, and were assigned to active service. Almost all went with battalions on the front line. We cautioned them all not to mention that they were from the Johns Hopkins. 23. One fellow, "Cherub" Southworth, was a quiet, demure chap, always smiling. He wanted to go with the Marines, and that's where he went. His battalion was on the front, near Chateau­ Thierry, and the medical officer was "Bab:®" Michael. He was always called Babe because he had been on the line in the football team at the U. S. Naval Academy, was a big, husky fellow, heavy eyebrows, and rough exterior but with a big heart. When Cherub reported to Babe, the outfit was in the line, and Babe's headquarters were in a dug-out in the line. Cherub saluted, the Babe did the same. The Babe said,"where are you from?" "From Ohio," said Cherub. "I don't mean from what state. What medical school?" The Babe already had Cherub's credentials and knew he was from Hopkins, and the Babe had graduated from Hopkins himself. "From Maryland," said Cherub. "----," cursed the Marine captain Babe, "I mean what school?" "In Baltimore," replied Cherub, getting more and more frightened at the scowling Marine. "----," the Babe added a few more expletives, as only a Marine can, and said, ''What was the name of the medical school?" "Base Hospital 18" at Bazoilles Sur Meuse. "Look here," said Babe, "for the record, what was the name of the medical school." 24. "The Johns Hopkins," finally came out from the Cherub. "Thank you," said the Babe. "Now let me tell you some­ thing. For your good, don't ever mention that fact again." But to come back to Baltimore, as we did after the war. We were discussing the full-time system. I think the reactions of the members of the staff varied. None of us could conceive of any teachers more inspiring than our clinical professors, Kelly and others on the teaching staff. Nor could any men have contributed more to medicine than they did, in spite of their busy clinical lives. And I still think that the practice of medicine requires as teachers those who have learned by experience, and practice. It seems to me that the problem of medical teaching and research is big enough to give ample opportunity to those best qualified, whether in clinical research, lecturing, practicing or animal experimentation. Such opportunities are not open now, and to that extent, I think all branches of the study and practice of medicine suffer. For some of us, the decision was difficult. We had to make a living, and could not depend on a salaried job. Although we hated to give up lecturing and our contact with the students, 25. it was for the best as far as the teaching. I don't think that they have improved the amount of research that has been done, by paying full-time people. I think the amount of writing that has come from the clinicians is probably more useful clinically than a great deal of the work that is coming from the chemical laboratories and so forth. But then that is all part of the game and you have to have both. I was impressed with the similarity between Halsted and Kelly, in their insistence upon thoroughness and the long time of preparation for medicine. Kelly left his budding practice in Kensington, spent a lot of time overseas, and also met his bride over there. This probably took some time. He went back and married her. She was the daughter of a doctor in Berlin. Dr. Kelly insisted on that sort of training later on. His five year course in gynecology for the residents was more than any other place offered at that time. He did his best to help them. He helped us a great deal. His contact with his staff was not as intimate as it was between Halsted and his few residents, or assistant residents, but Kelly's contact with us on the whole, I think, was much more general. For example, we were interested in the technique of the radical operation for cancer of the uterus devised by 26. Wertheim in Germany. Dr. Kelly and Dr. John Clark, both having studied there -- Dr. John Clark was one of our first residents -- they continued their work and developed it and modified it, the operation of Wertheim. It is difficult to do an operation like that when you are getting your practice entirely from operating room patients. So one of us went to Dr. Kelly one day and said, "Dr. Kelly, Would you give us a demonstration of the radical operation 11 for cancer of the uterus?" He said, Yes, I tell you what we'll do. You see Dr. Welch or Dr. Maccallum (I think Dr. MacCallum was probably Professor of Pathology then) and you get him to furnish you with a young, thin woman, dead of some disease that will not be transmitted in an operating room, and I will do for you the cancer operation and take time to show it to you on the corpse and we will have artists and photographers there, and we will take a whole afternoon to do that job for you. 11 Dr. O.: This he did for the entire house staff? Dr. W.: The entire house staff, Yes. So before long, we got the patient for him and he came over there with Max Broedel, the 27. artist and with his private photographer and, after he made a certain part of the dissection, he would stop, have it photographed and drawn and tell us about it. Well, Dr. Halsted never did a thing like that. But that was his attitude (Kelly) toward us; he would do anything for us. We appreciated it too. We thought a great deal of Dr. Kelly. Dr. o.: It is always interesting to try and set up the four first professors and their relationships one to another. It would seem that Dr. Osler and Dr. Kelly were quite close. Dr. Halsted, for understandable reasons was quite close to Dr. Welch and to Dr. Mall. Osler I gather was not terribly close to Dr. Halsted. I imagine Welch was pretty much the father figure in a sense; he had good rapport with all of the others. I don't know how much interplay there was between Dr. Kelly and Dr. Halsted, but I have always felt that it probably wasn't as great as between Kelly and Osler. Dr. W.: Dr. Osler's acquaintance with Kelly goes way back to the Kensington hospital, in Philadelphia when they were both young men. Dr. Kelly had great respect for Dr. Halsted and his 28. work. Dr. Kelly didn't pretend to be a gynecologist outside of this hospital (Hopkins). In his sanatarium he did some surgery, included urology and his radium work involved the whole body, but in the Hopkins Hospital Dr. Kelly never did a gall bladder operation or a hernia without first getting consent of Dr. Halsted. Dr. O.: This is a very interesting point which I don't think is generally realized. Certainly amongst my generation, you always think of Dr. Kelly strictly as a gynecologist. I was aware that his radium work at the sanatarium occasionally involved areas other than the pelvis, but he did general surgery as well? Dr. W.: He did breasts I think; he did abdominal surgery. He didn't do it quite as freely as Dr. Cullen did. Dr. Cullen operated upon both men and women. I remember one day, I guess it must have been in the 30's, '35 or '40•s, Dr. Kelly had been at camp and Dr. Cullen had been up there too, (their camps were together up in Canada). Dr. Cullen was always asking, "How are you getting along? How are things going?" I would always say, "Couldn't be better Dr. Cullen" and ask him how he was getting along and he would say, "You know, I haven't operated 29. upon a woman since I have been back, but I have been busy. I have been operating on men right along." He told me that once. Of course, in those days all of them, Dr. Kelly and Dr. Halsted, Dr. Cullen and Dr. Finney, each of them had a trunk in his home in which were kept all the surgical instruments that they would need in an operation, ordinary operation, and dressings, and things like that, because they had to go out to surrounding towns. Dr. Kelly tells of the trips he made. I frequently went with Dr. Cullen to Hagerstown. Dr. Cullen also had regular appointments down at Cambridge and Easton, Maryland, the eastern shore of Maryland. Dr. O.: By the time Dr. Cullen was chief of the service, was he going to work in other hospitals? He was not operating in homes at that time was he? Dr. W.: No,no. He never gave up his connections with the Church Home. Dr. Cullen was not a full-time professor in any sense of the term. Dr. Cullen's rounds would last about an hour and he would tell funny little stories. He would tell the same JO. stories every year to every class and the house men finally learned them. He would walk through the wards and see the interesting cases. We would describe them to him and he would comment on it and that was it. His rounds were very, very informal and he rarely came over otherwise, except for the one or two days that he operated, and to see his private patients. Of course Dr. Kelly overshadowed Dr. Cullen. Dr. Cullen was not popular, he never was popular. Dr. O.: Not popular with the students or the remainder of the faculty? Dr. W.: Not with the internes or the housestaff. He was a very aggressive type of fellow. He wasn't the surgeon Dr. Kelly was. Dr. Cullen was quite rough and showy. He deliberately tried to emphasize his own position in the operating room. In the middle of an operation he would say, "Now, send somebody over to the library and get my umbilicus book or my appendix book," and so one of the housestaff would run over to the library and get it and bring it over, and he would say "And now turn to page JOO and so forth and so on and you will see a picture just like it." Dr •. Kelly would never do a thing like that. 31. Dr. Kelly tells of many interesting experiences that he had, but that brings up another interesting side of his life that we don't often see. He had to go to Albany to remove an abdominal mass which had not been diagnosed. I don't know whether Dr. Kelly had seen the woman before or not, but he took up an assistant, his operating room table, a nurse, and an anesthetist and his instruments up to Albany. That was around 1910. He went up there an operated upon this woman and there was this mass in the abdomen. He opened up the abdomen, took a look at it, and said, ''Well, this is going to be the most expensive cathartic this woman has ever had!" It was an incarcerated mass of feces. He opened up the bowel, took it out and closed up the bowel and the woman got well. He said it was the most expensive cathartic he had ever heard of. Well that brings us up to another side of the thing. All these men I think without exception operated for large fees. Their fees were bigger than most of us ever think of charging nowadays. Dr. O.: Yes, this is the impression that I have from seeing some of Dr. Halsted's fees. They're amazing. 32. Dr. W.: Talking about that. I never heard Dr. Halsted mention a fee at all. I heard Dr. Kelly and Dr. Runner (of course I worked with Dr. Runner) and Dr. Finney tell of isolated cases. Now Dr. Finney told about operating upon a woman from Washington, who was the wife of a publisher. She had hip trouble and had several operations and treatment by various surgeons. She finally came to Baltimore and Dr. Finney operated on her hip and apparently cured her. He said that it was probably the biggest fee that he ever charged, but he said the fellow who operated on her and failed had charged 12,000 dollars. He said "I charged her 13,000" and there was no apparent difficulty. And Dr. Kelly tells a story of one of his patients who came down here. She was a very wealthy woman. She had had a very painful bladder condition. It had never been diagnosed. Well, it just happened that Dr. Runner was a specialist on that, and Dr. Runner had discovered what they call the Runner ulcer. Dr. Runner called it the elusive ulcer because it was so elusive. You would see it today and tomorrow you wouldn't see it. Dr. Kelly immediately realized what she had from the story she gave. It's a thing you can practically diagnose from a history. So he cystoscoped her, found this tiny little bit of a spot, treated it, had her come back two JJ. or three more times, and he said he charged her 10,000 dollars. He never spent more than two or three minutes at a time with her, never any operation, but he cured her. Of course there was no income tax, no inheritance tax. When I started into practice, I went in with Dr. Runner and Dr. Runner's usual charge for a consultation, as was generally the charge in Baltimore by gynecologists or orthopedists, was 25 dollars. I started out with that but it seemed to me that was exorbitant so when I left Dr. Runner after two or three years and went out for myself, I reduced it to ten dollars. I felt much better. I thought at that time and still think now the average person cannot afford that kind of fee. Well, that brings up another feature of Dr. Kelly's work. His innovations and his discoveries. Now for example he was as much a urologist as he was a gynecologist. His work in urology was fundamental. He was a member of the American Urological Association, I was too. He used the knee-chest position, not devised it, but he applied it in gynecology. He devised the Kelly cystoscope which is a tubular cystoscope using air to distend the bladder, a procedure that is invaluable in some cases for removing small foreign bodies that would be rather difficult with the water cystoscope. It is interesting that Dr. Runner rarely used anything but the Kelly cystoscope. I never did either in my early years. He made important 34. discoveries, some of them in urology. Of course there is the Kelly speculum, the Kelly clamp which is used all over the world. It is difficult to tell about those things, how original they were--or the Halsted clamp, or the Ochsner clamp, or the Mayo forceps--a person who traveled as widely as Dr. Kelly did or Dr. Halsted or Dr. Bloodgood, couldn't help but see instruments that they liked and would come back and improve and modify them and the instrument maker would probably give it the name. So it would be known by the name of the surgeon who devised it and gave him the order. Dr. Kelly's great contribution, he told me, repeatedly, was not scientific, microscopic work--pathology, bacteriology or anything like that, but mechanical. His best and chief contri­ bution, he often said, was mechanical. The teaching of surgical technique and training surgeons who were technical experts, following his teachings. There never was a technician that approached him in gynecology. Dr. O.: Do you feel that there has been a good study of Dr. Kelly's life1 The only one that I am familiar with in any depth, is the one written by Audrey Davis. Speaking candidly, I have always felt that this was not the best or a really scholarly presentation. 35. Dr. W.: I don't think there has been a good biography of Dr. Kelly. It would have to be written by a physician and one who sympathized with Dr. Kelly's many avocations. A complete study of his life would be worth making and recording. As time goes on, new generations come and go, leaving very few persons who ever saw or had any contact with some of our predecessors or ancestors. Some of them made many valuable contributions but are now almost unheard of. This fact has been impressed upon me recently, since I became interested in the life of an ancestor of my wife, William Wallace Spence. Just as Kelly, Halsted, Osler and Welch contributed to the scientific development of the Hopkins, so Spence contributed to it financially, aestheti­ cally, socially and religiously. They were more or less, contemporaries, and like many of their generation are being forgotten. About 10 or 15 years ago, one of our assistant residents in gynecology, asked me to see a patient who had been under the care of one of our staff, who was referred to by the assistant as "Dr. Hunter". On questioning the patient, I immediately realized that her former physician was one of -- -- --- ---- ~ I 36. my fine old teachers, now no longer in practice, who had been internationally known as a gynecologist and urologist. When I mentioned his name, the assistant asked, "who was Dr. Runner?" The same thing is true of such persons as Harriet Lane and James; one gave the Children's Hospital building to the Hopkins, the other gave the Woman's Clinic building. The old Harriet Lane building has been replaced by a new building that cost $15,000,000 and all that reminds one of the original donor is a bronze plaque. The same fate awaits Mrs. James. Now, almost no one has ever heard of William Wallace Spence, although President Gilman stated that twice he saved the life of the university financially. Still, there are written records and letters that tell a great deal about these old heroes, if anyone will care to dig them up. But, even then, such formal records tell nothing about the home life, the friendships, the love of family, the children, and the grandchildren, - the real lives of these men. I was surprised to see how much there was about Wallace Spence, and even more delighted to find one or two of his great­ grandchildren who spent the summers with him at Northeast Harbor, Maine, went fishing with him, sailing and submitted 37. to the rigid regime of Mr. Spence's Presbyterian Sundays. It is fortunate that two or three such descendants of Mr. Spence still live, were intimate with him and remember him clearly, to tell us what a delightful life he led, in his home, his church and his numerous friends. This opportunity to recreate his real life would be missed entirely in a very few years. The correspondence between Mr. Spence and President Gilman reveals many features that have not found light before. They reveal a personal friendship which is not evident in the more or less routine reports in the newspapers, and the newspaper reports occasionally are at times almost conflict­ ing, as they are today. Therefore, I have gotten back almost all of the original correspondence between Mr. Spence and President Gilman. It concerns the details about the statue of Christ in the rotunda of the hospital, the department of Semitic languages, the several financial difficulties that were almost catastrophic and were overcome largely through the efforts and contributions of Mr. Spence. They bring to light Mr. Spence's social features, how he g1ave a large reception at his home to bring together the faculty and trustees of the Johns Hopkins University ~ -- I 38. and some of the leading citizens of Baltimore. How discouraging were some of Mr. Spence's efforts to raise money to tide the university over some of its financial storms, is news to most of us. The idea seems to be now that all any rich man has to do is to sit down and write a check for a million dollars. That is true now in some cases; it seemed much more difficult seventy-five years ago in Baltimore, when a dollar meant much more. Spence raised a million dollars at one time for the university, but it wasn't quite as easy as that. He finally gave most of it. I don't know how much remains of the correspondence of such men as Kelly, Welch, Osler and Halsted. I am afraid that their personal lives would be more difficult to f'athom; Welch and Halsted had no descendants. The status of the families of Osler and Kelly can be discovered by investigation, and the sooner that is done, the more fruitful will the results be. Kelly, of course, aside from his medical things, was a man of the town. He would come over to the hospital some morning; ''Well," he would say, "I have just come back from the Hook; I spent a little time down there this morning. I went down 39. there to see one or two of the girls." Dr. O.: The Hook? What section of town was this? Dr. W.: The houses of prostitution. At that time it was more or less centralized in certain parts of Baltimore. Dr. Kelly was just as interested in those poor women as he was in the poor women of Kensington. He would talk about his "girls" down in the Hook and he got one group of them interested in getting out of there. He moved them up to Madison Ave. which was a nice residential section. He kept a little notebook in his pocket with their addresses, all these whores. Sometimes we wondered what would happen if Dr. Kelly had an accident and they found all this in his pocket. His religion was of that sort. As a student, I used to go to Brown Memorial Church rather often. He belonged to it, a Presbyterian church. I have sat in his pew, not intentionally, but just happened to, but Dr. Kelly I don't think was a very common or frequent attendant, because he was always speaking elsewhere on Sundays. 40. Dr. O.: He was almost an evangelist. Dr. W.: Yes, he was almost an evangelist. Up in Canada at Magnetawan on Lake Ahmic, he was very frequently engaged on Sundays in taking the place of certain ministers who were on vacation. He was a good man in that way. I don't think anyone could attribute to him anything but generosity and Christianity. He was just as interested in natural things -- animals of all sorts, snakes --and mushrooms and fungi. It wasn't a hobby only of his later life. He wanted to be a botanist when he was in college and studied astronomy and those things when he was a boy. He took piano lessons as a boy. He carried that out very intensely, when he went out to Colorado Springs and the west on the ranch. He studied the fauna, the lives of the animals and things --snakes, out there in the middle west which he didn't see here. His contributions on those things are possibly good. I have heard people say that his book on fungi, beautifully illustrated by a professional artist, was really a contribution. We don't ever see those things. That was true of his studies in botany. Snakes -- You couldn't go over to the sanatarium without his showing you some snakes. 41. Dr. O.: Did he have some live specimens around the sanatarium? Dr. W.: Oh sure, he kept them in cages. Oh there were horrible things. There were rattlers, copperheads, and stuff like that. They hadn't had the fangs taken out. He gave a lecture to the Hopkins Medical Society one evening on snakes and brought a lot of them over there. I remember an incident once, one of the fellows -- it didn't happen to me, it happened to one of my friends, who went over to see Dr. Kelly. He walked in the front door and into the living room. There was a stairway going up and a snake coming down the stairway. He called Dr. Kelly's attention to it and he said, "Oh, that's Mary! We lost Mary, we didn't know where Mary was, we haven't seen her for several days. She has been around the house here." So he picked her up and put her in her cage. Dr. O.: Was Dr. Kelly's home on Eutaw Place adjacent or close to his sanatarium? Dr. W.: Yes, he bought the houses and built his library behind them, going to the library by a bridge, an overhead bridge. If you went to Dr. Kelly's home for dinner as I did several times, after dinner they would all sit down -- they would have Grace of course before the meal -- and then the whole family would be sitting there together immediately after dinner and he would tell one of the boys, "Howard or Eddie, or Olga, Go and get my bible now," They would get the bible and he would read a chapter from the bible and he also would quiz them. He would say, "Now Olga, what did we read last night?" And Olga would probably remember. And Howard and Edward, they were all there -- they took it very seriously -- they were students of the bible. This went on practically every night. In the morning the very first thing at the Sanatarium was a prayer, a little reading of the bible and a prayer before anybody took care of a patient. He was very devout. He was also a very good athlete. He was a champion swimmer. I don't know where his championship was, but it was in some eastern swimming association. Of course up at Ahmic, on the lake, he was in the water a great deal. He was always playing pranks. One day he went in swimming and dove into the water and didn't show up. Several minutes went by and 43. he didn't come up. They looked around and didn't see any sign of him and started to get worried. There was a little wooden box out there, quite a ways out. He had swam out there and stuck his head up in that wooden box and was watching the discomfiture on shore. Finally he tossed the box over and hollered at them. Dr. Kelly had a scar on his forehead that he had gotten from diving. He carried that scar for the rest of his life. Of course, out west he became quite a horseback rider on the ranch, lived on the ranch and kept up his exercises a great deal. He didn't believe in getting soft. He would bicycle over to the hospital very often. Dr. Kelly was interested in his staff. I remember one day he was operating on a woman who had a very unusual thing, - she was obviously pregnant, but with what he called an apical pregnancy, a pregnancy way up in the apex of the uterus. It wasn't a tubal pregnancy. We thought she had a tubal pregnancy. We would have taken out the tube right at the cornu of the u~erus, but he said, "No, This is a very rare thing and she will probably have her baby the normal way." Well, none of us had ever heard of it before or seen it. He turned to me and said, "Now you write this up. You write it up, go into the literature on it and study it up and you and I will report this together." Well, you know what an honor that would be 44. to have an article with Dr. Kelly. Somehow or other I never did it. I was busy and never got around to it. And the same thing happened again. I had been in practice only 3 or 4 years and Dr. Kelly called me over to his house and I went over there and he said, "I want to write a history of gynecology. I haven't got time to do it. I want you to help me. We'll publish this together." So I studied, read a lot of the literature on it, got all the histories out at the Hopkins University library. He had more than the Hopkins had. He gave me the run of his library, and I worked it up for two or three months. I wrote chapters, and then he sort of lost interest for some reason or other. Maybe it was too dead for him. So that was dropped. He didn't ever say anything about dropping it. Dr. O.: It just died a natural death. Dr. W.: The last time he came to me in the same way -- I had been in practice several years, 3, 4, or 5 years --- it was in 1926, along in there. He called me up, and I went over to see him and we went through the usual affair in the evening -- dinner, prayers, and so forth and then we went to his study and he 45. said, "I am going to write a textbook of gynecology. It will be my last book. I want you to write it with me." I said that would be wonderful, of course, so we drew up a regular contract with Appleton. Each of us was to be joint author, joint receipts if there were any receipts or royalties. We outlined the book in one or two more Visits and he knew the chapters I was to write and he knew what he was going to do. But that never went through. He got the book out, but Dr. Cullen objected to my being one of the co-authors. I didn't dream that he would do that. It was during the winter and I was going on a duck shooting trip with one of my friends, when I got this long letter from Dr. Cullen, saying that he wondered whether it would be wise for me to write that book with Dr. Kelly as it was his last book. He thought it would be nicer to have it come out from the whole staff. I didn't pay any attention to Dr. Cullen's letter. I thought it was none of his business. We had our contract and the book was well on the way. I went duck shooting, threw his letter in the waste basket and came back in a week and thought it over and got in touch with Dr. Kelly. Of course he and Dr. Cullen were lifelong friends and they "summer-camped" together. They grew up together virtually because they were both very young when they started to work here. So I yielded to Dr. Kelly and Dr. Cullen and I still had my contribution 46. in the book. He gave me credit for it though, the chapters I wrote. It was a great blow, but I didn't mind it and I could easily see how they felt. Dr. O.: Is this the two volume Operative Qynecolo~y? Dr. W.: No, this is the last thing he wrote. Just Gynecology. Dr. O.: There is one called Medical Gynecology. Dr. W.: That's earlier. It was just Gynecology. It has a few articles in there by Dr. Kelly. Most of it was done by members of the staff, the way Dr. Cullen wanted it. Dr. Cullen was Professor of Gynecology at that time. It just shows how Dr. Kelly worked with us and we worked with him. It was always very agreeable. Dr. Kelly told me when I was working on one of these things with him -- that must have been 1925, perhaps, or later maybe -- the question came up about his Operative Gynecology. I think that was written around 1896 or something like that. It was written pretty soon after he had become Professor, within 10 years 47. after that I am sure. In 1925, he said, "You know I wrote that Operative Gynecology a long time ago, but it is still paying royalties that I think are acceptable." Dr. Kelly was a fellow who realized the importance of writing, not so much from an advertising viewpoint, because that is the only method by which a doctor can bring his name to the public, but because he really had something to tell them. His Operative Gynecology was the first operative gynecology of any note. Beautifully illustrated by Max Broedel, Horn, and Becker. German artists that he brought over here with Dr. Cullen. That had never been done before, drawings like that. Of course, Dr. Kelly kept that up as long as he lived. He wrote and wrote and wrote. A tremendous bibliography. His contribution to art is another thing -- extremely important. He realized when he went over there on some of his trips, how important art was in German articles and the fact that they had medical artists over there which we didn't have. So he and Dr. Cullen took over the burden, -- Dr. Cullen more than Kelly later on -- and brought Mr. Max Broedel over here, August Horn, and Herman Becker before the days of photomicrography. These fellows had to draw illustrations of microscopic slides. As a matter of fact we were taught art in medical school, had 48. a course in art and we were taught to draw and reproduce slides and organs and things like that. It wasn't obligatory; it was something you could take electively. A great many of us did. Dr. O.: Was this course taught by Max Broedel? Dr. W.: Yes, by Max Broedel. Dr. O.: That must have been quite an experience. Dr. W.: It was indeed. Of course Max Broedel was not only a good artist, a wonderful artist, but it was during prohibition days and Max Broedel's cellar was always attractive. He made just as good beer as ever was made in Germany. He was free in letting us have it too. So I always loved to go out to his house. We felt it a great privilege to be in the company of Dr. Halsted and Dr. Kelly. We learned from them. Of course they were different, but they-both made a tremendous contribution. Of course there are a lot of other things that you could add. I haven't talked about it because I did not know much about them. Dr. Kelly's family life, now. He had a large number of children, how many, I don't remember. Anyhow, Dr. Kelly tells a story that one day he called up Bachrach the photographer and said that he wanted to have a group picture taken of his family. So the man came up and talked to Dr. Kelly and Dr. Kelly said, "How much will these pictures cost?'" Mr. Bachrach said, "Well, it will be 75 dollars a dozen." Dr. Kelly said, "Mr. Bachrach, we can't furnish quite a dozen yet, but if you come back some time later, we'll try to have a dozen for you." His family were wonderful people. Ed Kelly was the one we knew the best, because he was a doctor and graduated from medical school at Hopkins, took his internship there. Then he became interested in radium with his father. Dr. Kelly had been greatly criticized for his radium work. He was almost ostracized and almost expelled from the medical society because he used radium for the treatment of cancer. Ed Kelly went in with him. Ed Kelly was like his father, a wonderful swimmer and interested in sailing, so eventually Ed Kelly dropped medicine entirely, dropped his father's work and spend most of his time on his boat. 50. Dr. O.: Is Edmond Kelly still alive? Dr. W.: No, he died a few years ago. He had this sailboat, he had several in succession, but he would get his crew up from boys at Gilman school and places like that. My youngest son, Jack, was then in Gilman and he was a good swimmer and good athlete, liked boating, sailing and so Ed Kelly enlisted him along with one or two others. They sailed along the Atlantic Coast down through the Carribean, the Panama Canal, and the nearby Pacific. Jack had a wonderful experience sailing. I think they were foolish, but they never had any serious accidents. They went through some terrific storms. Finally, Ed Kelly's boat was wrecked on a sandbar off the Florida coast. So badly wrecked that they just left it. But Ed was one of the family. Dr. Kelly brought them up to be religious but I don't think their religion stuck with them very much. Dr. O.: Are any of Dr. Kelly's children still living? Dr. W.: Olga, Olga the daughter is still living. Maybe, she is the only one. But she lives out here on Roland Avenue not very far from us. Ed used to drop in here all the time. 51. Olga was one of his favorites, but I don't hear of any others that are living. Dr. Kelly was very much interested in the Maryland Historical Society. Dr. O.: He was interested in medical history; history of all sorts I would gather. He wrote a biography of Walter Reed. Dr. W.: Halsted was interested in sports too. Even up to his last days he could tell you the batting averages of the baseball players. I don't know if Halsted himself was an athlete. Dr. O.: Apparently he was in his college days. Certainly not after coming down to Baltimore. Dr. W.: I think he was on the various teams at Yale. Dr. Welch used to say that in those days Yale was not noted for its scientific attainments. It turned out Halsted and Welch. Dr. Kelly did not think that his gifts to the Hopkins were appreciated much. He felt rather strange toward the end, I think, but nevertheless at the end when he quit, he gave 52. Hopkins a tremendous library. He didn't give them all of t his library by any means, but he gave them a tremendous addition to their library. I think there is a separate collection that has never been brought out and put on the main library shelves. I am not so sure about that. He left his mark on the Hopkins all right, more I think probably than anybody else. Dr. O.: He certainly was the father of gynecology in this country as a true specialty. Dr. W.: We fellows have felt that he hasn't been honored as he should be over there. There isn't any building named after him. There is no operating room named after him. Dr. O.: This is very interesting. The Woman's Clinic is still the Woman's Clinic, which I suppose partly goes back to the dis­ cussions etc. of the splitting of gynecology and obstetrics and the question of bringing them back together. 53. Dr. W.: Yes, I know there was no harmony between obstetrics and gynecology, none whatever. We don't know how Kelly and Williams were personally. They always spoke to each other. T. S. Cullen, Dr. Williams used to pat him on the back and say "T. s., How are you this morning?" I don't think he got that familiar with Dr. Kelly, because Dr. Kelly was always his boss. Dr. Kelly was responsible for the institution of the department of obstetrics and giving it to Williams. But we have always felt that Dr. Williams and Dr. Kelly were not given the recognition that they should because there are buildings that are named after men who are hardly dead when they were named like Blalock. Osler has his building, Halsted has his building, but around there you never see Kelly's name or Williams' name. Williams has a little bit of a library over there named after him, thats all. Dr. O.: Is that the library in the Woman's Clinic? Dr. W.: Yes. That's all there is and that's closed a lot of the time. I am not so sure that a building is a very durable memorial. The Taj Mahal has lasted hundreds of years, but 54. they don't put up anything like that anymore. They tear them down within a man's life-time, and put up new structures that all look alike and have no individuality or beauty. But most of us don't need to worry after that. Index of Names Baer, William S., 18, 21. Barker, Lewellys F., 7. Becker, Herman, 47. Benet, Hugh, 11, 12. Broedel, Max, 26, 47, 48. Clark, John, 26. Churchill, Edward, 2. Cullen, Thomas S., 8, 18, 28-30, 45-47, 53. Davis, Audrey, 34. Finney, J. M. T., 17, 29, 32. Flexner, Abraham, 19. Gilman, Daniel C., 37. Halsted, W. S. New York period, l; drug addiction, 2-6; full-time 'Qi. private practice, 7, 8; comparison with Howard Kelly, 1, 10-14, 25, 27; relationship with Howard Kelly, 27, 28; at High Hampton, 11, 12; surgical fees, 31, 32. Harrison, Hartman, 12. Heuer, George, 10. 3 Reid, Mont, 10. Remsen, Ira, 19. Richardson, Edward H., 18. Russell, William W., 18. Southworth, John D., 23, 24. Spence, William W., 35-38. Stout, Arthur Purdy, 2. Welch, William H., 3, 26, 27. Williams, J. Whitridge, 53. Wharton, Lawrence R., 1, 3, 13, 20-22, 24, 25, 28, 43-46. 3 Reid, Mont, 10. Remsen, Ira, 19. Richardson, Edward H., 18. Russell, William W., 18. Southworth, John D., 23, 24. Spence, William W., 35-38. Stout, Arthur Purdy, 2. Welch, William H., 3, 26, 27. Williams, J. Whitridge, 53. Wharton, Lawrence R., 1, 3, 13, 20-22, 24, 25, 28, 43-46. Index of Subjects Children's Orthopedic Hospital, 18. Church Home and Hospital, 18. Full-Time clinical chairs, 7, 8, 20, 21, 24, 25. Gynecology residency program under Dr. Kelly, 9, 13, 14, 25-27. Halsted Club or Society, 2, 3. House staff salaries, 9, 10. Surgical fees, 8, 31-33. Union Protestant Infirmary, 18.