Sargent, John Singer (American, 1856-1925)

The Four Doctors

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One of the greatest contributors to modern medicine was Quaker bachelor and businessman Johns Hopkins, who left his fortune to the endowment of a hospital and medical school. The Johns Hopkins Hospital opened in 1889; the medical school was scheduled to open at the same time. However, the railroad stock Hopkins had intended to use for operating expenses had lost all its value. The project was revived when four of the original trustees’ daughters—Martha Carey Thomas, Mary Elizabeth Garrett, Elizabeth King, and Mary Gwinn—presented the men with a proposal. The ladies agreed to raise the $500,000 needed to open the school and construct a building, but only if qualified women were admitted. After lengthy debate, it was agreed. By 1892 the funds had been collected, and the ladies insisted on new requirements for admission to the school: proof of an undergraduate degree; proficiency in French, German, and Latin; and strong background in physics, chemistry, and biology. Although the men thought this might be impossible, they agreed. The Johns Hopkins Medical School provided the first laboratories for students and required clinical rotations in addition to lectures and demonstrations. Science-based training for college graduates replaced apprenticeships for men who could pay for them. Faculty were expected to excel in teaching, clinical work, and research. The modern medical school had arrived. This portrait was painted by John Singer Sargent, one of the most popular portrait painters of the time in both the US and Europe, in his studio in London. They are now known as the Big Four and are, from left to right: William Henry Welch (1850-1934): pathologist; first dean of the School of Medicine and founder of the first school of public health in the country—Johns Hopkins School of Hygiene and Public Health; established the first graduate training program in medicine; nicknamed in his lifetime “the Dean of American Medicine.” William Stewart Halsted (1852-1922): surgeon who propounded aseptic technique during procedures; started the practice of wearing gloves during operations; adopted and preached anesthetics; revolutionized surgery by emphasizing skill and technique over brute strength; introduced new operations, including radical mastectomy, and new ways of doing intestinal and stomach surgery, removing gallstones, and hernia repair; strict with students, perhaps to hide his severe shyness. Halsted’s life was tragically compromised by a dual addiction, which started with cocaine during experimentation of its potential use as a local anesthetic and then included morphine as well, which he used to treat his cocaine dependency. Nonetheless, Halsted is a towering figure in the history of surgery, training the following generation of surgeons. William Osler (Canadian, 1849-1919): internist; created first residency program and was first to include bedside clinical training along with lectures; considered America’s premier physician and was known for his skill at clinical instruction (e.g. famous for using alliteration to help students remember things); advocate of nursing, hygiene, and prevention; quote: “a physician who treats himself has a fool for a patient.” Howard Kelly (1858-1943): gynecologist and surgeon; credited with establishing it as a true specialty; invented numerous devices, such as the urinary cystoscope; one of the first to try radium for cancer treatment, and founded the private Kelly Clinic in Baltimore, which was a leader in radiation therapy; introduced use of absorbable sutures to Hopkins; a colleague once said, “put a knife in his hand, and he is at once master of the situation, and if surgery can help the patient, the patient will be helped.” Notes by Dr. Linda Pessar and Mariann Smith
Art of Medicine
History of Medicine
Medical Students
Johns Hopkins Medical Institutions, Baltimore