William Welch, and what a Norfolk cemetery tells us

I like cemeteries. It may seem morbid, but I do. Norfolk’s cemetery is a fine and private place. But to a student of infectious disease, it is a stone-marked history of wrenching loss and medical helplessness. I found the graves of young women of the 19th century. One was dead at 23. Childbirth probably took her or puerperal fever in its aftermath. Tuberculosis, too, could carry off a young adult. There were children who died at 2 or 4 probably of diphtheria or whooping cough. Their physicians were not armed with an understanding of infection, with vaccines (except for smallpox) or with antibiotics.One of the men who changed this dire state of medicine is buried in Norfolk. When William H. Welch died in 1934, Harvey Cushing, one of the greatest of American physicians, said in his eulogy that he was “just another of the many Doctors Welch of Norfolk” — “all apparently men of very similar type, good judges of people and good public servants, men able to instill confidence and win regard.” But William Welch was not just another Welch doctor serving Norfolk. Graduating from Yale in 1870, he attended the College of Physicians and Surgeons in New York and did not come back.At that time a college degree was not necessary to go to medical school, and the course was two years long. Most American medical schools were low-standard affairs that admitted anyone who could pay. Medical schools were not tied to universities and they were not dedicated to doing the research that cures disease or prevents it. In Europe the best physicians practiced in universities and had founded the science of pathology to describe disease processes — usually at autopsy to be sure, but at least there was an attempt at understanding. These physicians had faith in knowledge, but until the last third of the 19th century and the advent of the germ theory of disease, they usually despaired of treatment. William Welch did not heed calls to practice with his physician father in Norfolk. In 1876, aged 26, with the encouragement of his stepmother, who saw a different future for him, he went to study in Germany, becoming a master not only of pathology, but of the new science of bacteriology.When he came back to the United States, Welch was determined to found a medical school on the German model — where research would be incorporated into the purpose of the school, where students would have to have an undergraduate degree and be able to read the latest papers in French or German, where they would study for four years under a professional faculty. The medical school and a new hospital would be tied to a university, as in Europe, which would have the power to enforce high standards. Excellent scholars would be recruited, and the school would not depend on local physicians whose practices left them no time for research. Depending on a professional full-time faculty was unique in American medical education and much opposed in the 1880s. Apprenticeship had always served. When Johns Hopkins University opened its medical school in 1893, Welch had been supervising the construction of the hospital, the development of the curriculum and recruiting scholars since 1885. With Welch’s support, it was one of the first medical schools to encourage women to be doctors.It was not so much that Welch made great discoveries — although the organism that causes gangrene, Clostridium welchii, is named for him (we scientists think that is an honor) — but rather, as the first dean of the Johns Hopkins Medical School, he and others changed the direction of American medicine, raised its standards and caused it to turn toward science. Welch and his colleagues established accreditation boards and forced substandard medical schools to close. Welch was a founder of the Rockefeller Institute (now University), dedicated to pure research. By the time he died in 1934, aged 84, diphtheria vaccine had started to wipe out that fearful disease, surgery was safer and so was childbirth. Antibiotics were on the horizon. Horrendous nutritional deficiencies had yielded to vitamin treatment. Public health measures were preventing disease. There was (and is) a long way to go, but when Welch died, the expectation was for progress, not stasis. If we no longer fear as much for women in labor or children with infections, we owe some of that relief to William Welch. He would be proud that Johns Hopkins is one of the pre-eminent medical schools in the world — and that the Norfolk cemetery no longer claims so many of the young. Richard Kessin, Ph.D, is professor of pathology and cell biology at the College of Physicians and Surgeons of Columbia University. He and his wife, Galene, live in Norfolk. He can be contacted at rhk2@columbia.edu. An earlier form of this article appeared in the Newsletter of the Norfolk Historical Society.