The Great Influenza (10 page)

Yet he had no family to support and others did magnificent science under far greater burdens. No scientist had faced more adverse conditions than George Sternberg, an autodidact whom Welch called 'the real pioneer of modern bacteriologic work in this country' [who] mastered the technique and literature by sheer persistence and native ability.'

In 1878, as Welch met Billings in the same beer hall where legend had Faust meeting the Devil, Sternberg was an army medical officer in combat with the Nez Perce Indians. From there he traveled by stagecoach for four hundred and fifty miles (enduring day after day after day of the stink of sweat, of bone-shattering bumps that shot up the spine, of choking on the dust) only to reach a train, then by train for another twenty-five hundred miles of steaming discomfort, jostling elbows, and inedible food. He endured all this to attend a meeting of the American Public Health Association. While Welch was bemoaning his lack of facilities in New York, Sternberg was building a laboratory largely at his own expense at a frontier army post. In 1881 he became the first to isolate the pneumococcus, a few weeks before Pasteur and Koch. (None of the three recognized the bacteria's full importance.) Sternberg also first observed that white blood cells engulfed bacteria, a key to understanding the immune system. He failed to follow up on these observations, but many of his other achievements were remarkable, especially his pioneering work taking photographs through microscopes and his careful experiments that determined both the temperature at which various kinds of bacteria died and the power of different disinfectants to kill them. That information allowed the creation of antiseptic conditions in both laboratory and public health work. Sternberg began that work too in a frontier post.

Meanwhile, in New York City Welch was swearing that if only he were free of economic worries his own research would flower.

In Baltimore his work did not flower. For there, even with talented young investigators helping him, his failing began to demonstrate itself.

His failing was this: in science as in the rest of his life, he lived upon the surface and did not root. His attention never settled upon one important or profound question.

The research he did was first-rate. But it was only first-rate (thorough, rounded, and even irrefutable, but not deep enough or provocative enough or profound enough to set himself or others down new paths, to show the world in a new way, to make sense out of great mysteries. His most important discoveries would be the bacteria now called
Bacillus welchii,
the cause of gas gangrene, and the finding that staphylococci live in layers of the skin, which meant that a surgeon had to disinfect not only the skin surface during an operation but layers beneath it. These were not unimportant findings, and, even in the absence of any single more brilliant success, if they had represented a tiny piece of a large body of comparable work, they might have added up to enough to rank Welch as a giant.

Instead they would be the only truly significant results of his research. In the context of an entire lifetime, especially at a time when an entire universe lay naked to exploration, this work did not amount to much.

The greatest challenge of science, its art, lies in asking an important question and framing it in a way that allows it to be broken into manageable pieces, into experiments that can be conducted that ultimately lead to answers. To do this requires a certain kind of genius, one that probes vertically and sees horizontally.

Horizontal vision allows someone to assimilate and weave together seemingly unconnected bits of information. It allows an investigator to see what others do not see, and to make leaps of connectivity and creativity. Probing vertically, going deeper and deeper into something, creates new information. Sometimes what one finds will shine brilliantly enough to illuminate the whole world.

At least one question connects the vertical and the horizontal. That question is 'So what?' Like a word on a Scrabble board, this question can connect with and prompt movement in many directions. It can eliminate a piece of information as unimportant or, at least to the investigator asking the question, irrelevant. It can push an investigator to probe more deeply to understand a piece of information. It can also force an investigator to step back and see how to fit a finding into a broader context. To see questions in these ways requires a
wonder,
a deep wonder focused by discipline, like a lens focusing the sun's rays on a spot of paper until it bursts into flame. It requires a kind of conjury.

Einstein reportedly once said that his own major scientific talent was his ability to look at an enormous number of experiments and journal articles, select the very few that were both correct and important, ignore the rest, and build a theory on the right ones. In that assessment of his own abilities, Einstein was very likely overly modest. But part of his genius was an instinct for what mattered and the ability to pursue it vertically and connect it horizontally.

Welch had a vital and wide curiosity, but he did not have this deeper wonder. The large aroused him. But he could not see the large in the small. No question ever aroused a great passion in him, no question ever became a compulsion, no question ever forced him to pursue it until it was either exhausted or led him to new questions. Instead he examined a problem, then moved on.

In his first years at the Hopkins he would constantly refer to his work, refer to his need to return to the laboratory. Later he abandoned the pretense and ceased even attempting to do research. Yet he never fully accepted his choice; to the end of his life he would sometimes express the wish that he had devoted himself to the laboratory.

Nonetheless, despite this lack of scientific achievement, Welch did not live one of those lives that began with great promise and ended in bitterness and disappointment. Despite his minimal production in the laboratory, people like Mall were drawn to him. As a prominent scientist said, 'Everyone agrees that Welch himself was the great attraction at the Pathological' . [H]is example, his intelligence, and his comprehensive knowledge formed the keystone of the arch of scientific medicine in America.'

For William Welch's real genius lay in two areas.

* 

First, he had not only knowledge but judgment. He had an extraordinary ability to hear someone describe his or her experiments, or read a paper, and immediately define the crucial points still obscure, the crucial series of experiments needed to clarify them. It was as if, although he could not himself conjure, he knew the techniques of conjuring and could teach others conjury.

He had an equally extraordinary ability to judge people, to identify those with the promise to do what he had not done. He largely chose the medical school faculty, and he chose brilliantly. All were young when appointed. Welch was thirty-four; William Osler, a Canadian and arguably the most famous clinical physician of the modern era, forty; William Halsted, a surgeon who changed the way surgeons thought, thirty-seven; Howard Kelly, a gynecologist and pioneer in radiation therapy, thirty-one; J. J. Abel, a chemist and pharmacologist who would discover adrenaline and help revolutionize pharmacopoeia, thirty-six; W. H. Howell, a physiologist, thirty-three; and Mall, thirty-one. (Howell, Abel, and Mall had been graduate students at the Hopkins.)

Second, Welch inspired. He inspired unconsciously, simply by being himself. In the early days of the school, Welch was heavy but not yet fat, short, with bright blue eyes that flashed above a dark beard called an 'imperial' - a mustache and pointed goatee. He dressed conservatively but well in dark clothes and often carried a derby hat in his hand. Despite his bulk, his hands and feet were conspicuously small and made him appear almost delicate. But his most singular quality was not physical. He seemed so centered and comfortable with himself that he gave comfort to those around him. He exuded confidence without arrogance, smugness, or pomposity. In his disputes (and he had many with those outsiders who resisted changes) he never raised his voice, never seemed to feel, according to a man who watched him for decades, 'the exuberant joy of putting an opponent down.'

Everything about him was positive. His intelligence and the depth and breadth of his knowledge stimulated his teaching as well. He walked into the classroom without notes or preparation, often not knowing what subject he was to lecture on, and in an instant began discoursing lucidly and logically in ways that provoked thought and excitement. He was paternal without being paternalistic. Physicians sent him pathology samples for analysis and paid a hefty fee. His assistants did the work; he wrote up the results and gave them the money. He loved to eat and hosted lavish dinners at his club, the Maryland Club, often inviting junior colleagues or graduate students; one of them called these dinners among his 'rosiest memories' because of Welch's conversation, his ability to make students feel 'the richness of the world' - the world of art and literature as well as science.

The total effect, said Simon Flexner, 'made for an atmosphere of achievement' The desire to be like Welch, the desire to win his approval, these were the principal incentives of the eager young men who crowded his lab.'

Finally, a certain mystery clung to Welch. Although this was not part of his genius it explained part of his impact. For all his cordiality he remained distant. The cordiality itself was a barrier others could not penetrate. He paid little, and decreasing, attention to students until they did something significant enough to get his attention. He seemed casual, even sloppy. He would get so animated in conversation that his cigar ash would routinely drop onto his coat, where it would lie unnoticed. He was never on time. His desk would be piled with months of unanswered correspondence. Younger colleagues gave him a nickname, a nickname that spread from the Hopkins to younger scientists everywhere. They called him, never to his face, 'Popsy.'

It was a comfortable, paternal, and warm nickname. But if he gave comfort, he took comfort from no one. Although he helped all whom he deemed worthy, although he surrounded himself with people, he neither encouraged nor allowed anyone to confide personal troubles to him. And he confided in no one. Mall once wrote his sister that he longed for a real friendship with Welch, not just an acquaintanceship. Even Mall would not get it. Welch took vacations alone in Atlantic City, where he enjoyed its tackiness.

The students had a chant: 'Nobody knows where Popsy eats / Nobody knows where Popsy sleeps / Nobody knows whom Popsy keeps / But Popsy.'

* 

The Hopkins medical school sat on the city's outskirts atop a hill, miles from the main campus of the university and downtown. The main building, the Pathological Laboratory, was ugly and squat, two stories of stone, with six tall windows on each floor, and square chimneys towering above the building itself. Inside, an amphitheater for autopsies hollowed out the building, and students on the top floor could peer down over railings; a long narrow room lined each floor, a pathology laboratory on the first floor, a bacteriology laboratory on the second.

Even without the school, once the hospital opened in 1889, with sixteen buildings on fourteen acres, a small community began to develop. People breakfasted together and lunched together every day, and often met in the evening. Every Monday night a slightly more formal group of thirty to forty people gathered, including faculty, students who already had an M.D. or Ph.D., and clinicians. They would discuss current research or cases, and comments routinely generated new questions. Senior faculty sometimes dined in evening clothes at the 'high table' in a bay window overlooking the grounds. The younger men played poker together, entertained each other, and went to the 'Church' together - Hanselmann's restaurant and bar, at Wolfe and Monument, where they drank beer. A Harvard professor compared the Hopkins to a monastery. Harvey Cushing said, 'In the history of medicine there was never anything quite like it.' And they did have a mission.

Elias Canetti, a Nobel laureate in literature, observed in his book
Crowds and Power
that large movements were often generated by what he called 'crowd crystals,' the small, rigid groups of men, strictly delimited and of great constancy, which serve to precipitate crowds. Their structure is such that they can be comprehended and taken in at a glance. Their unity is more important than their size. Their role must be familiar; people must know what they are there for'. The crowd crystal is
constant'.
Its members are trained in both action and faith'. The clarity, isolation, and constancy of the crystal form an uncanny contrast with the excited flux of the surrounding crowd.'

In the same way that precipitates fall out of solution and coalesce around a crystal, individuals with extraordinary abilities and a shared vision had now coalesced about Welch at the Hopkins. Together, with a handful of others around the country, they intended to precipitate a revolution.

CHAPTER FOUR

A
MERICAN MEDICAL EDUCATION
needed a revolution. When the Hopkins medical school did at last open in 1893, most American medical schools had still not established any affiliation with either a teaching hospital or a university, most faculty salaries were still paid by student fees, and students still often graduated without ever touching a patient. Nor did Welch exaggerate when he said that, other than the Hopkins, no American 'medical school requires for admission knowledge approaching that necessary for entrance into the freshman class of a respectable college' . [S]ome require no evidence of preliminary education whatever.'

By contrast, the Hopkins itself, not student fees, paid faculty salaries, and it required medical students to have not only a college degree but fluency in French and German and a background of science courses. Indeed, these requirements were so rigorous that Welch and Osler worried that the Hopkins would attract no students.

But students did come. They came flocking. Motivated and self-selected, they flocked to a school where students did not simply listen to lectures and take notes. They trooped through hospital rooms and examined patients, made diagnoses, heard the crepitant rales of a diseased lung, felt the alien and inhuman marble texture of a tumor. They performed autopsies, conducted laboratory experiments, and they explored: they explored organs with scalpels, nerves and muscles with electric currents, the invisible with microscopes.