In this letter, Kelly voices his own objections to the proposed full-time clinical faculty system at the Johns Hopkins School
Number of Image Pages:
7 (3,470,499 Bytes)
1911-05-01 (May 1, 1911)
Kelly, Howard A.
Original Repository: Osler Library of the History of Medicine, McGill University. Bibliotheca Osleriana
This item is in the public domain. It may be used without permission.
Sir William: Regius Professor at Oxford, 1905-1919
May 1, 1911
Dear Mr. Osler,
I have many times wished for your presence and council these past days. We have had some stirring times in the University
Medical Board, including, of course, Hospital. We have some of us had a feeling for the last several years that there was
a decided need of improvement in our Hospital service and in our handling of the students. This came to a head recently when
Dr. Welch on his own initiative saw Mr. Gates in New York and invited Simon Flexner to come over and investigate and report
upon the situation in the Medical School. Flexner spent two or more weeks here getting data, first visiting the Laboratories
and then the Clinical men. Dr. Williams called to inform me of his projected visit to me but unfortunately he never came and
I did not see him until he issued a printed statement to Mr. Gates which was circulated among us and the Trustees. This pamphlet
you have doubtless received. If you have not, I will gladly send you a copy, if I can.
It was most frankly critical and of course most private and confidential, but the bunch of copies sent over by Dr. Flexner
lay for a week or ten days on Dr. Welch's desk at the Hospital, was opened and three copies abstracted. The tenor of the
whole report, its general conclusions were, I think, such as we all agree to. The difficulty comes in working out the situation
in a practical way without doing unnecessary injustice to individuals. A million dollars is available if we adopt either of
the plans suggested in the report. These are in the nature of two alternatives,
No. 2 is the second in preference, and also second in Mr. Gates' arid Mr.. Flexner's preference, and is that the Laboratories
should mainly benefit by the fund, leaving the Clinical Chairs where they are now. There is no doubt but that the Laboratories
need the fund, but I think this is the poorest solution.
No. 1 demands that the clinical men shall their entire time to Hospital service, receiving a salary of $7,500, yearly. It
also demands that they shall turn over all the private practice which has been coming to them through the Hospital for the
purpose of raising this fund and carrying out the plan. It also demands the fusion of my Department with Obstetrics, as a
matter of economy in uniting two small cognate specialties. You will at once see the difficulties the situation presents to
Barker and me individually and to no others on the Staff; Halstead having his private fortune has never cultivated private
practice and is independent of it; Williams is also independent of it, having private resources. Barker is not independent,
but having, taken a house and a family and keeping an automobile, a going away in the summer has raised a standard of fixed
charges which the income could not possibly meet. Living expenses have increased enormously here in Baltimore since you have
left us. Let me here say, and I shall not return to it again, that Barker has taken a stand diametrically opposite that he
took when he wrote that little paper for Chicago. Let me add, also that any abuses such as they employed in the newspaper
statements a while back which I forwarded marked to you would very readily be cleared by a simple, friendly admonition, I
feel that there has been more or less jealousy in the criticism of Barker in this matter.
Finally, as to my personal position. You will recall that I had Ward B exclusively for the Gynecological Department, and kept
my patients there, and kept it full until the Hospital began to make its own charges for Surgical service, I found that I
could not stand the comparison between the Hospital charges and my charges, say in two patients coming from the same town,
so I felt forced to enlarge my Private Hospital facilities and gradually, as far as possible, transferred all my private work
to my Sanatorium here, I did not foresee that this would be such a heavy burden or would really seriously interfere with my
services to the Hospital and the students, This is no manifest, and I am anxious to correct it.
I wish to return to the status quo ante having Ward B again and controlling my own private patients. I do not wish to fuse
with the Obstetrics Department again and to obviate this have shown in the first place that our Department has in two years
had 797 abdominal operations while the General Surgical has had 545, thus disposing of the notion that the work in our Department
was small. Is all that I, with a Staff of 7 assistants living in the Hospital, can possibly carry and do justice to.
In the second place, I have pointed out that while there are genetic and anatomical associations with Obstetrics, the whole
genus of gynecological work is in the major surgical field. It is for this reason that on the whole general surgeons have
(and I think with perfect right) been encroaching upon our territory, doing as many operations as they could get. I insist
that no academic discussion of this question as to what our affiliations are, can possibly alter this natural evolutionary
tendency. A gynecological surgeon when he opens the abdomen must be prepared to do any kind of abdominal operation. This is
my almost daily experience.
The historical, natural evolution of gynecology in this country and England has been to develop it as a separate specialty.
In its growth we have not followed any precedent of any country but simply natural, healthy tendencies. As to the question
of the propriety of the Hospital using its surgeons and medical men as milch cows, I call that a system of peonage similar
to nothing else in the world, and inquiring for the reason for such a ruling, I am told that the making of money is dangerous
and involves an attitude towards the work which is unscientific and hurtful. This is the only reason I can exact from Dr.
Welch or any one else.
It was naturally, then, my opportunity and duty to show just what effect the making of money had had upon me personally, inasmuch
as the discussion had narrowed itself to Barker's and my position.
I went carefully over my accounts for a period of 14 years back and found that in this time I had received from the Hospital
in salary, $42,000.00. I have returned to the hospital $92,000.00 +.
$71,000.00 of this went to my artist whose work has never been productive in a pecuniary way but has gone to increase the
reputation of my Chair there.
Not counting best $71,000.00, which manifestly cannot properly be called charity, I have actually given away for various philanthropic
purposes in this time, $131,000.00 besides other thousands not accounted for here owing to the lack of time and the fact that
no special records were made.
Furthermore, before any of these discussions came up, a year ago after talking with Mrs. Kelly and the older children and
consulting with my lawyer Mr. Brune. I had arranged that for the future I would save no more money but use my surplus for
You will please forgive these personal details but it was necessary to show that this greed and love of money had not contaminated
me in the way suggested by my colleagues. I must add to the above that I have saved enough to just half meet my living expenses,
I want to move the Sanatorium over to the Hospital, I want better provision for my Gynecological service in a large building
for economy of time on the part of visiting physicians and students in going from one to the other, as well as for more adequate
administration of our Board. I want a command of salaries enough to have men like Cullen and Burnam to help me, and to engage
an artist, a photographer, or what not, as my interests in my work over there seem to demand.
I write you thus fully as a warm friend, who whatever your views of this particular situation may be, has always been and
will remain true. I do not know what your views may be but I am interested to hear. A general meeting will take place tomorrow
I feel often and have felt for years, as if the old spirit of our Institution were rapidly departing. There is less hearty
regard for the work of others in in the various Departments, more of an undercurrent of criticism, occasional little outbreaks
of hostility, and on the side of the Hospital management persistent opposition to any expenditures, however small. In fact
this wall of opposition has been the hardest thing I have had to deal with and. greatly hinders the development of our service.
Please give my affectionate regards to Mrs. Osler.