Johns Hopkins, William Osler, and the Founding of Modern American Medicine

Johns Hopkins (1795–1873) was a Maryland-born Quaker from a business family. He got early into the wholesaling business, moving manufactured goods to farm country in western Maryland and Virginia and buying the products of those regions in return. He built up enough capital to be an early investor in the Baltimore & Ohio Railroad, serving for a while as its Treasurer, and ran a bank that invested in manufacturing companies. By 1847 he had retired.

Then he did something quite remarkable. He bought thirteen acres of land east of Baltimore and set aside his whole fortune of about $7 million to found three new institutions: "Johns Hopkins University", "The Johns Hopkins Hospital", and "Johns Hopkins Colored Orphan Asylum." At the time this was the largest charitable bequest in US history. Never one to leave things to chance, Hopkins recruited twelve prominent Maryland men to serve as trustees of the new institutions and wrote detailed instructions for them to follow.

For our purposes the most important instructions governed the hospital. It should "in construction and arrangement, compare favorably with any other institution of like character in this country or in Europe." The trustees should "secure for the service of the Hospital, physicians and surgeons of the highest character and greatest skill." And they should "bear constantly in mind that it is my wish and purpose that the hospital shall ultimately form a part of the Medical School of that university for which I have made ample provision in my will."

And thus was born the modern teaching hospital. I can't find out much about the trustees, but they must have been capable fellows, because they brought Hopkins' vision to life. They recruited those top surgeons by the simple expedient of offering the highest salaries ever paid to doctors, anywhere. One of those who accepted was Canadian physician William Osler (1849-1919).

Osler was another remarkable man, one of the generation of doctors who turned medicine from a mishmash of quackery, Galenism, folk wisdom, and surgical speed into a scientific discipline. He was also, apparently, a great teacher, a man who could take something everyone sort of knew and express it in an unforgettable phrase. Like, "Listen to your patient, he is telling you the diagnosis."

Before this time, medical school consisted almost entirely of lectures and demonstrations. But Osler thought a more practical approach was needed, and he created one:

Osler, the first chief of the Department of Medicine, is credited with originating the idea of a residency, in which recently graduated physicians receive advanced training in their specialty while treating patients under supervision; then, as now, residents comprise most of the medical staff of the hospital. He also introduced the idea of bringing medical students into actual patient care early in their training; at the time medical school consisted almost entirely of lectures. Osler's contribution to practical education extends to the creation of "grand rounds", the practice of leading physicians discussing the most difficult cases in front of assembled medical students, for the benefit of patients and students. The term "rounds" derives from the circular ward where bedside teaching occurred. He once said he hoped his tombstone would say only, "He brought medical students into the wards for bedside teaching."

That last seems to have been one of his favorite lines, since it exists in several slightly different versions of different dates. And since I just witnessed my own doctors bringing students or "fellows" with them on their own rounds, I can confirm that it remains central to the teaching experience of Hopkins. (Sadly I never got to be the subject of discussion; I think I was too boring and simple a case. But the unfortunate person in the shadowed ICU room two doors down got at least two long discussions that I witnessed.)

Johns Hopkins went on to be one of the great institutions of modern medicine, launching whole branches of surgery and being the first place in the Americas to train female doctors, This, you know, is the thing that distinguishes the modern world from all that came before. In our day a man can get filthy rich in business and decide to invest his profits in creating an entirely new class of institution to solve a problem that past ages regarded as just an inevitable part of life.

I believe in a dynamic world where we try to make things better, not a bitter one in which everyone idiotically moans on about how much better things were in the old days. So I celebrate men like Johns Hopkins and William Osler who glimpsed the future and worked in concrete ways to make it real.