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.
Those at the Hopkins were hardly alone in seeking reform. The need had been recognized for decades. Leaders at a few other medical schools - especially Vaughan
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.
Those at the Hopkins were hardly alone in seeking reform. The need had been recognized for decades. Leaders at a few other medical schools - especially Vaughan
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