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The William Osler Papers

Letter from Howard A. Kelly to William Osler pdf (5,483,620 Bytes) transcript of pdf
Letter from Howard A. Kelly to William Osler
In this letter, Kelly talks about the latest faculty discussions of the full-time clinical faculty proposal, his anger/hurt at Flexner's seeming accusations re: Kelly's (and others) exploiting the teaching hospital to enrich themselves.
Number of Image Pages:
9 (5,483,620 Bytes)
1911-05-29 (May 29, 1911)
Kelly, Howard A.
Osler, William
Original Repository: Osler Library of the History of Medicine, McGill University. Bibliotheca Osleriana
BO #7651
This item is in the public domain. It may be used without permission.
Exhibit Category:
Sir William: Regius Professor at Oxford, 1905-1919
Unique Identifier:
Document Type:
Letters (correspondence)
Physical Condition:
May 29, 1911
Dear Dr. Osler,
I write as I run over to Washington to see Dr. Boyd's (USN) wife upon whom I operated on Thursday for a fibroid uterus and a bad case of old cholecystitis, with gall stones impacted in the cystic duct.
We had our faculty meeting yesterday and all were present including Barker and Halsted, who were absent last time. We discussed whether a student had paid his board bill, and many other minor matters, but nothing was said about the great pending changes. Welch and Williams deprecated Parker's new associate appointments as "such radical changes would quite certainly take place in the near future in the medical school," (Welch). I found on walking home with him that Welch is working the problem out with the trustees and it seems to be merely a matter of finances. If the money is forthcoming, Barker will have to take $7,500 a year and work exclusively in and for the hospital or get out. Meyer will have to give up his liberty which, having "lived under a contract work system so many years", he is distressed about, and I shall have to give my chair to Williams, who will thus realize his openly expressed ambition of years, and who will receive a salary over 300 percent greater than he now gets for giving up an insignificant private practice.
The laboratory men will rejoice to a man as there is no assignable reason why a clinical man should receive more than they, so their prospects are receiving $2,500 more than at present, possibly in the near future. Dr. Hurd is all the time more or less venomous, with occasional relapses, in his personal dealings, into his old good humor.
At the risk of repeating I would observe that there are abuses in all services, and we all want to concentrate and to give more time to the hospital work, but salary of $3,000 a year and nine children going to school do not justify all one's time being spent there.
Again, my present assistants could do great work in the hospital in developing my department, but a salary of $300 a year which is Dr. Cullen's maximum does not go far to support a family and forces him to seek outside resources. Dr. Hurd is hard on Cullen because he takes his private patients to the Church Home, but Cullen has very few well-to-do patients, and if you put them all in Ward B there would be nothing left to pay him for his services. The trouble is we only have places for the rich and the poor. I felt the need for a place for those of moderate circumstances many years ago.
Had brother Abraham Flexner come out and simply said "if your clinical man will go on the laboratory basis and you will lead in the new era dawning in medicine and surgery and do better work", we might have differed with him but we could not have resented his opinion nor could we well have blamed the majority for siding with him.
I think myself that this after all is the one real issue and the true view, and this is fortunately the only side the medical world outside will see and discuss.
But for those of us who have lived here from the first and loved and labored and squandered health and life, it was distressing to have him give the reasons he did. The very secret report is a hard personal arraignment!
He says,
1) that we exploited the hospital for the money we got out of it, as you will see by the paper I sent you,
2) that we were defunct scientifically, and it hurt me to have him declare that
3) the Obstetric Department to swallow up the Gynecological, when, as it is on all sides believed, that he took his information and opinions from Dr. Williams alone and never took the pains to call on me. This was even made the more pointed by the fact that Williams made a special call upon me to ask me to prepare for Flexner's coming.
Welch too has "threatened" to call upon me for weeks when he did not come I went to see him, but he was out. (It is the case of "Taffy was a Welch-man" reversed!)
The question of greed of wealth is easily disposed of. As to the productiveness of the departments, that too is easily shown: in my department we have had a tremendous output of work - books - and articles - thorough, good scientific work. In addition to many articles (four just in the hands of the publishers) the Biographical Cyclopedia is just halfway through the press (at letter L). A book of old doctors who were botanists is ready, on Wistar (Wistaria), Kuhn (Kuhnia), Marshall (Marshallia), Mitchell (Mitchella), Kahn (Kahnia), Darlington, (Darlingtonia), Garden (Gardenia), Bigelow (Bigelowia), Short (Shortia), etc. and I have another on doctors as artists. The big Renal Surgery book many years prepared will be in the hands of the publishers by October, and a lot of good new work is going forward in various stages.
I am hampered as I have been for fifteen years because no one has ever asked "What are your ideals for your department?" "What are your difficulties?" "Can we help you?" There has been but one dominant idea in the hospital and medical school and that is to save petty expenditures, while once in a while making a splurge, as in that wretchedly constructed surgical building.
My greatest hindrance has been the wall of petty obstructions erected by Dr. Hurd. Did I write you of his intense excitement when I went to see him and have a friendly talk? He pitched in to me for two things, only two, -
1) the fee charged Alexander Brown years ago
2) the fact that I gave Cullen my Saturday hour without consulting him (Hurd). He slurred Dr. Cullen's work "Cancer of the Uterus" is nothing but "cataloguing cases".
I further object to Dr. Welch's stirring up such an investigation in a Democratic body like our Faculty, and presenting such a report without consulting us first. Then I object to the thing being put through without investigating the truth or falsity of the damaging premises of the report which led to the conclusion.
I am seriously accused, a momentary courteous attention is given to my statement, but there is no answer or discussion and the matter is forgotten the next moment. Had I assailed Dr. Welch's department in such terms and on the grounds of non-productiveness I would have retracted publicly when shown my error.
Then, as you will notice, to report includes under its ban men like Finney, Young, Bloodgood, etc., who would one and all have to go on the same laboratory basis, as they readily perceived when they read it. When this side of the question became acute and pressing without any conference or discussion with Faculty, Dr. Williams and Dr. Welch made up their minds that it would not do to let them go, so Dr. Williams told them "Your position will not be affected." This is a high-handed way of running things surely!
It seems actually dishonorable to me to have brought Barker and Meyer among us, away from other well-established physicians, and so soon after getting them here, to make changes so radical that there positions become almost if not entirely untenable. Barker was not at a single meeting where these things were being discussed. Dr. Welch's dogma that individuals do not count in adjusting important business problems smacks very much of the Guggenheims and I have met them in the smelters in Mexico, and calls up a picture of the train of suicides which followed Rockefeller's early days as he was building up the Standard Oil monopoly. If we could see all the little white stones which mark the graves for which the Rockefeller and Carnegie interests have been responsible, I wonder if the mountainsides would not look as if a snowstorm had struck them. Meyer whispered in my ear recently that he was appalled that the Standard Oil was acquiring such a large interest in our activities. Abel said the same thing a few years ago.
Dr. Welch as I said before is now working the problem out with the Trustees and the question simply seems to be "Can we get enough money?"
If they adopt the Report (Alternative I) as I feel sure they will, I am out it once, ipso facto. Alternative II, is turning the money into the laboratories does not appear to be bona fide as we were plainly told "No money is promised whatever you adopt"; and Mr. Gates prefers Alternative I. We were practically told he would listen to nothing else.
Anyway, they cannot take away my reputation or my very dear friends who have come nearer and grown dearer in all this fussing and discussion. If I have any ability and strength left, although hampered by lack of the place for my poor patients, I can still work and I fully realize that if there is really anything in me it will come out in spite of (perhaps better because of) the trials we are going through.
If they do make the changes, I will try to hold in my younger men, who are inclined to be too emphatic in their stand, and I will try to give it all the hearty, moral backing that lies in my power, that the trial may be a fair one. For after all, injustice seems to be a part of all readjustments in human affairs and what am I and what are my interests and activities in comparison, if we really work out some better plans for relieving more of the sick and the suffering.
There is a strong undertone of criticism of Welch and Halsted, asking very pertinently what original work they themselves have done. Mall tells me that the Faculty had a sort of revival in January while I was in Mexico; I believe that Welch has been lecturing and attending to business at the hospital much better since then.
Burnam is roused and indignant because one of his idols (Dr. Welch) has been shattered. Cullen just recently raised $15,000 to keep Brodel teaching art applied to medicine for three years. I would never have known the fact had I not been able to learn it from Cullen; in spite of the present activities which will probably throw him (Cullen) out, he goes straight on with his endeavors to raise $100,000 to endow the chair. So much for fine disinterestedness!
Doubtless Welch's viewpoint in many of the questions raised above is different from mine. I hope he writes you fully; then between the two you can form a clearer judgment.
Forgive another long, personal letter like this, but do you know the human sympathy counts for so much and I know I have a kindly, sympathetic ear into which to pour my woes. I do not mean to say that I know you agree with me: it would not lessen my appreciation of your sympathetic interest one bit even though you believed heartily in all the changes that are likely to be made.
It is this kindly interest which each man had any other man's work which seems gone out of the Hospital, and which to one who believes more in the spiritual man in the material value of life it looks ominous.
Well, is a great thing to believe that our Father knows it all and governs us all and brings it about that "all things work together for good" for His children. I don't know what your faith is now, but I'm sure, old man, is a great thing to be definite and positive about it, and it is a great thing to have it resting in a Person- Christ, and it is a great thing to have it a matter of grace and forgiveness of sin and not of merit based on works.
There you see I have not changed, but have to poke a little bit of my heart even into a business letter.
Affectionate regards to Mrs. Osler. Revere, of course, won't remember me.
Affectionately yours,
Howard A. Kelly
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