H. L. Mencken and the four doctors: Osler, Halsted, Welch, and Kelly

Halsted stood clearly at the head of the list, with Osler a good distance below him. Probably on a level with Osler stood Kelly; then there was another drop to Welch. —H. L. Mencken (1)

Henry Louis Mencken, “the sage of Baltimore,” lived his entire life, 1880 to 1956, in Baltimore, Maryland (Figure 1). During this period, The Johns Hopkins Hospital and Medical School was established under the medical leadership of “the Big Four”: Sir William Osler in medicine, William Stewart Halsted in surgery, William Henry Welch in pathology, and Howard Atwood Kelly in obstetrics and gynecology—captured together in the famous painting by John Singer Sargent entitled “The Four Doctors” (Figure 2). Mencken resided in Baltimore during the entire period that each of these professors worked at Hopkins. He knew Kelly and Welch well, Osler only briefly, and Halsted he never met. Of all four physicians, however, Mencken formed a solid opinion.

Figure 1.

H. L. Mencken. Published by permission of the Enoch Pratt Free Library, Baltimore, in accordance with the terms of Mr. Mencken's will.

Figure 2.

Portrait of “the big four” at Hopkins: Drs. Welch, Osler, Halsted, and Kelly. Mencken called it the “historic Sargent caricature.” John Singer Sargent called it “The Four Doctors.” Reprinted with permission of the Alan Mason Chesney Medical Archives of The Johns Hopkins Medical Institutions.

Why should Mencken's opinion of these four professors interest us? Perhaps because Mencken was the most influential journalist of his day; he made a lasting impression on American life and letters. In the Roaring Twenties, Mencken was America's leading intellectual. Walter Lippmann called Mencken in 1926 “the most powerful personal influence on this whole generation of educated people” (2). The New York Times considered him the most powerful private citizen in America. In terms of the sheer volume of his writings, he compares to the late William F. Buckley Jr.

Briefly, Mencken began as a newspaperman at the age of 19 in 1899. By 25, he was editor in chief of the Baltimore Morning Herald. He soon switched to the Baltimore Sun, where he remained as a journalist and editorial writer for more than 4 decades (1906–1948). He was author of 83 books and pamphlets between 1905 and 1961 as well as hundreds of articles (3). More books by him continue to be published posthumously. Thirty books were written about him between 1920 and 1961, and many more since.

Mencken is perhaps best known for his treatise The American Language (4), his six volumes of essays called Prejudices (5), and a wonderful trilogy of memoirs entitled Happy Days (6), Newspaper Days (7), and Heathen Days (8). He also wrote the first books by an American on George Bernard Shaw (9) and Frederick Nietzsche (10).

Mencken typically read 10 books a week. He respected “competence” in any form, and he had a simple moral code: “Keep your engagements.” He admired Aristotle, Nietzsche, and Thomas Henry Huxley, among others. “To me,” he wrote late in life, “the scientific point of view is completely satisfying, and it has been so as long as I can remember. Not once in this life have I ever been inclined to seek a rock and refuge elsewhere” (11). Mencken was a genuine skeptic in the tradition of Voltaire. This philosophical intransigence is pertinent to his relations with the Big Four. Mencken wrote:

Converting me to anything is probably a psychological impossibility. At all events, it has never been achieved by anyone, though I have been exposed more than once to the missionary technic of very talented virtuosi. I can't recall changing my mind about any capital matter. My general body of fundamental ideas is the same today as it was in the days when I first began to ponder (11).

What Mencken thought about Huxley is instructive; it shows he was quite capable of admiration and praise:

Huxley, I believe, was the greatest Englishman of the Nineteenth Century, perhaps the greatest Englishman of all time.… There have been far greater scientists, even in England, but there has never been a scientist who was a greater man. He found science a pretty intellectual plaything, with overtones of the scandalous; and he left it the chief serious concern of civilized man (12).

What did Mencken know about medicine and physicians? Biographer Carl Bode noted that Mencken's Baltimore friends were, for the most part, “newspapermen, musicians, and doctors” (13). George Jean Nathan wrote about Mencken in 1917: “He has a wide acquaintance among medical men and knows a good deal about modern medical problems.” Alfred A. Knopf, the dean of American publishers and lifelong friend of Mencken, later wrote: “In Baltimore, he cultivated all his life the wise medical men at Johns Hopkins, and he spent a fantastic amount of his time getting friends to and from doctors' waiting rooms and hospitals, comforting them and keeping them company there” (14).

Mencken's writings contain many references to medicine that prove to be accurate and correct, without exception. Charles A. Fecher, another biographer, wrote that the ideas of Mencken

exhibit an internal consistency and lack of contradiction that must be without parallel in literature. They exhibit, too, an absolute clarity; there will never be any need for an English professor or a candidate for the Ph.D. to busy himself with a tortured analysis of what Mencken meant. What he meant is exactly what he said, and it leaves no room for doubt (15).

Fecher further observed that Mencken “devoted his entire life, and most of his fantastic energies, to exposing ideas he believed to be wrong and men who he was convinced were frauds.” For this very reason, Kelly and Welch attracted the most attention from Mencken; Halsted and Osler attracted the least attention, but perhaps the most respect.

HOWARD ATWOOD KELLY (1858–1943)

In his relationship with H. L. Mencken, Howard Atwood Kelly was “the kind of friend who relieved him of the need for enemies” (13) (Figure 3). Kelly was the only Christian fundamentalist of the Big Four. Some 30 years older than Mencken, Kelly tried “unctuously and persistently” to win him to Christ. Kelly told Mencken that he prayed for him almost daily and regularly sent Mencken books and articles on Christianity. Mencken called Kelly “the most implacable Christian I ever knew, at least among educated men.”

Figure 3.

Dr. Kelly (a) with a snake and (b) operating (second from left). Mencken wrote of Kelly in 1921, “As a theologian—ach, du heiliger! But put a knife into his hands, and he is once master of the situation.” Reprinted with permission of the Alan Mason Chesney Medical Archives of The Johns Hopkins Medical Institutions.

Kelly also supported nearly every social cause, including Prohibition, that Mencken warred against. During the Prohibition years, for example, Mencken “boasted that he could find beer within ten minutes of his arrival in any town.” Their paths first converged, according to Bode, in October 1912 (Kelly was 54 and Mencken 32), when Kelly struck the wrong chord with Mencken:

On the 17th he sent Mencken an invitation to a dinner to be given some medical students in order to interest them in purity. He continued in the same way. On the 31st he said he was sending him a book about the world's present troubles, including prostitution. In the middle of the next month he wrote Mencken, inviting him to meet, of all persons, Anthony Comstock. He assured Mencken that Comstock was the foremost protagonist of pure literature in America if not the entire world. The month after that he invited Mencken to meet John Sumner and hear him speak; he told Mencken that for the Sumner meeting he had taken a box and wanted Mencken to have it. He went on to tell Mencken how much Christ had meant to him and ended by asking Mencken if he had ever prayerfully and carefully looked into the New Testament.…

Howard Kelly's pomposities annoyed Mencken nearly as much as his piety. He would invite Mencken to dinner, for instance, and assure him that the meal would be simple and that Mencken could come in his ordinary day clothes. Or he would apologize for not having invited Mencken because the Kellys did not have a servant to wait on the table.…

Howard Kelly's language was, moreover, so splendidly appropriate to his attitude that Mencken could only wince. Kelly would write, for instance, that a reporter they both know had now “gone home into the glory.” His note for Christmas 1914 says about his pious card, “May the splendid spirit of service it breathes be a common bond between you and me” (13).

In his memoir 35 Years in Newspaper Work, which was published posthumously, Mencken recalled the beginning of the relationship with Kelly:

When I began to maul such things in the Free Lance he came down to the office, remonstrated earnestly, and told me that he proposed to pray for me, and hoped to bring me up to grace. I bade him do his damndest, but predicted that he would never fetch me. Thereafter, for many years, he called on me regularly and bombarded me in the intervals with pious letters (16).

Writing under a pseudonym in an article called “Mirrors of Maryland,” Mencken wrote in 1921: “Mention the Johns Hopkins Medical School anywhere in the United States and instantly someone will ask you about Howard Kelly. He seems to be heard everywhere; he is the best known of all Baltimoreans, not even excepting the late Joe Gans [boxer]” (16). Kelly's biographer, Audrey W. Davis, observed that his religious views were “so contrary … to the prevailing mores of the men in the Hospital that he was accepted by them because of his great talents, little real effort being made to understand the man himself” (17). Mencken also recognized that many of the Hopkins staff were disconcerted by Kelly's ardent religious views, while lauding his surgical skill:

As a matter of fact, they probably exaggerate his professional cunning in their laudable efforts to distract attention from his theological dissipations. As they describe his method of work, he appears to function at such dizzy speed that it becomes fabulous. Before cock-crow in the morning he has got out of bed, held a song and praise service, read two or three chapters in his Greek Old Testament, sung a couple of hymns, cut off six or eight legs, pulled out a pint of tonsils and eyeballs, relieved a dozen patients of their appendices, filled the gall-stone keg in the corner, pronounced the benediction, washed up, filled his pockets with tracts, got into a high-speed automobile with the Rev. W. W. Davis, and started off at 50 miles an hour to raid a gambling house and close the red light district at Emory Grove, Maryland (18).

After a medical banquet Kelly and Mencken attended together in Washington in May 1922, they sat beside one another on the train back to Baltimore. About the experience, Mencken later wrote to a friend, “Three separate times I was on the point of jumping out of the train window” (19).

In his coverage of the Scopes trial in Dayton, Tennessee, which involved a teacher accused of teaching the theory of evolution, Mencken launched into Kelly in his Baltimore Sun column:

Try to picture a town made up of wholly Dr. Crabbes and Dr. Kellys, and you will have a reasonably accurate image of it. Its people are simply unable to imagine a man who rejects the literal authority of the Bible.…

Dr. Kelly should come down here and make his dreams real. He will find a people who not only accept the Bible as an infallible handbook of history, geology, biology, and celestial physics, but who also practice its moral precepts—at all events, up to the limits of human capacity. It would be hard to imagine a more moral town than Dayton.…

I propose that Dr. Kelly be sent here for sixty days, preferably in the heat of summer. He will return to Baltimore yelling for a carboy of Pilsner and eager to master the saxophone. His soul perhaps will be lost, but he will be a merry and happy man (20).

Mencken reviewed two of Kelly's books: Walter Reed and Yellow Fever (1907) and A Scientific Man and the Bible (1925). Concerning the latter book, Mencken wrote of Kelly in the American Mercury in 1926:

In brief, a medical man of the first caliber: when he speaks of himself as a scientist, as he does very often in his book, he has every right to use the word. His life has been devoted to exact observation, and that observation has been made so competently and interpreted so logically that the result has been a series of immensely valuable improvements in the healing art and craft. And yet—and yet—But how am I to make you believe that such a man has actually written such a volume as this one? How am I to convince you that one of the men who laid the foundations of the Johns Hopkins Medical School—the daily associate and peer of Osler, Welch, and Halsted—is here on exhibition as a Fundamentalist of the most extreme wing, compared to whom Judge Raulston, of Dayton, Tennessee, seems almost an atheist?

Yet it is so—and I go, for the depressing proof, behind the book and to the man himself. I have known Dr. Kelly for twenty years, and at different times have seen a great deal of him. Hours on end I have discussed his theological ideas with him, and heard his reasons for cherishing them.

They seem to me now, as they seemed when I first heard them, to be completely insane—yet Kelly himself is surely not insane. Nor is there the remotest suspicion of insincerity about him. It would be of vast benefit to him professionally to throw over his great cargo of supernatural rubbish, and trim his course as his colleagues trim theirs.…

In his book Dr. Kelly offers powerful argument for his amazing credo, but I can only report that, in cold type as vivo voce, he leaves me full of what the lawyers call reasonable doubt. His logic has a curious habit of going half way to a plausible conclusion, and then blowing up completely. For example, he starts off, in one place, by showing how the early criticism of the Gospel of John has broken down—and then proceeds gaily to the assumption that proving an error in criticism is identical with proving the complete authenticity of the thing criticized.…

Early in manhood he had to give up his medical studies on account of ill-health and went west to recuperate. In Colorado, during a blizzard, he was beset with snow blindness, and had to take to his bed. Suddenly there came to him “an overwhelming sense of a great light in the room.” How would an ordinary medical student interpret that bright light? How would any ordinary ice-wagon driver, or chiropractor, or Methodist bishop, or even a catfish interpret it? Obviously, he would refer it to the violent conjunctivitis from which he was suffering—in other words, to a purely physical sense. But not Kelly. After forty-four years of active medical practice he still believes that the glare was due to the presence of God! This divine visitation he speaks of simply as the “chief event” of his life. It surely was—if it was real (21).

Kelly edited a newspaper, The Christian Citizen, which circulated throughout Maryland and served as an outlet for his ideas. For example, Kelly fought for legislation to keep places of amusement closed on Sunday. Mencken, who influenced public opinion chiefly through his columns in the Baltimore Sun, wrote of Kelly in 1927:

He happens to be a man I have long known, and in every respect save the theological, greatly respected. But in that theological aspect, it seems to me, he is so plainly a menace to the peace and dignity of this town that what he believes should be made known to everyone, that the people may be alerted to his aberrations and keep a curb upon his public influence. If he had his way, it must be obvious, life here would be almost impossible to civilized men. He is against practically everything that such men esteem (22).

Mencken's posthumously published newspaper memoir gives a description of Kelly's medical practice:

He ran a private hospital in Eutaw place, and was notorious for his extravagant fees. He invented the system of charging a husband a month's income for an operation on his wife. If the husband protested, he would say, “Well, then, tell me how much your wife's life is worth to you, and I'll take it.” His hospital was expensive otherwise; and in consequence, nine tenths of his patients were the wives of wealthy men. It was reported that he not infrequently demanded and got a fee of $10,000 (16).

Mencken appears to have helped extricate Kelly from a potentially damaging situation, without Kelly's knowledge. The following appears in the same memoir:

When the bawdy-houses in one of the red-light districts were closed I made a hypocritical uproar about the probable starvation of the girls who were turned into the street, and Kelly set up a refuge for them in an old house near his hospital, with one of the late madams in charge. The girls, of course, soon let their clients know where they were, and in a little while the place was operating as a bawdy-house of a new and improved model, for there was no rent to pay. The grand jury, informed of this by the cops, proposed to indict Kelly for maintaining a house of ill-fame. It was a grand joke, but I was in fear that if he were indicted, a ribald petit jury might convict him, and I knew that in any case, the scandal would do him grave damage professionally and cost him a great deal of money, so I argued the grand jurymen into finding no bill. The cops then told Kelly and he was so upset that he rushed off to his camp in Canada and remained away from Baltimore for months. He never learned of the part I played in the affair (16).

Despite their philosophical disagreements, however, Kelly and Mencken met occasionally for tea and maintained a certain respect for one another. Unable to attend a testimonial dinner in honor of Kelly on his 75th birthday, Mencken sent a letter of regret:

This will be a deprivation, indeed, for I have known and esteemed Doctor Kelly for many years. More than once we have been on opposite sides of some public matter, but every contact with him, whatever the issue, has only increased my admiration for his immense energy, his unbreakable resolution, and his complete honesty. Baltimore owes him a lot, and I am glad to see that the debt is not forgotten. Above all, it is pleasant to note that, at seventy-five, he is in full vigor, and still fertile in his amiable deviltries (23).

Mencken began a diary in 1930 at age 50, and a few references to Kelly appear. For example, at the funeral of Max Broedel, the famous medical illustrator, Mencken observed on October 19, 1941, that “old Dr. Howard A. Kelly sat with his family, squired by Dr. Thomas S. Cullen. He looked shrunken and pathetic, and it was obvious that his 83 years were closing in on him” (1).

Broedel and Mencken were both agnostics. Because of the anticipated size of the funeral crowd, Mrs. Broedel agreed to hold the service at a cathedral. Mencken noted that “it seemed almost comic for so sturdy an agnostic to be buried from a Christian church, but there seemed no other way out.” Mrs. Cullen Thomas promptly wrote to Mencken from the Eastern Shore of Maryland, with a reference to Kelly:

It may be poor taste of me to express myself thus, but the funeral arrangements for him seem perfectly horrible. However, if they assuaged anyone's grief, I suppose Max wouldn't care. Perhaps he would have, with one of his short laughs, likened himself to Lenin. About the pro-Cathedral “incident” he might add: “Dr. Kelly got the better of me after all” (1).

A final reference to Kelly appears in Mencken's diary on December 27, 1942. Mencken had written elsewhere that “Kelly had a large family of children, all of whom turned out badly. In fact, he was still supporting them at the age of 80” (16). The diary passage, which also mentions Kelly's children, is as follows:

The day after Christmas I went to the annual luncheon at the Maryland Club, and found it almost unbearably dull. There was none of the traditional singing and yowling. The gayest persons present were two of the sons of Dr. Howard A. Kelly. They got up a crap game after lunch and played furiously, though their father and mother are both in hospital and may die very soon.

Mencken's last reference to Kelly is in his book, Minority Report: The Notebooks of H. L. Mencken, which appeared in 1956, some 13 years after Kelly's death. It is a note on the relation of science and religion:

There is no possibility whatsoever of reconciling science and theology, at least in Christendom. Either Jesus arose from the dead or He didn't. If He did, then Christianity becomes plausible; if He did not, then it is sheer nonsense. I defy any genuine scientist to say that he believes in the Resurrection, or indeed any other cardinal dogma of the Christian system. They are all grounded upon statements of fact that are intrinsically incredible. Those so-called scientists who profess to accept them are not scientists at all—for example, the late Howard A. Kelly. Kelly was simply an extraordinarily skillful and successful virtuoso of technic, comparable to a champion golfer or a buck-and-wing dancer. He made a few more or less useful contributions to surgical mechanics, but so far as I know he has made none whatever to the science of medicine. Nicholas W. Alter, who used to be his pathologist, once told me that he was a complete dud at the microscope. Alter swore, in fact, that Kelly couldn't distinguish between a section of sarcoma and a slice of beefsteak (11).

WILLIAM HENRY WELCH (1850–1934)

H. L. Mencken and William Henry Welch (Figure 4) first met after World War I (1914–1918). Though never intimate friends, they crossed paths occasionally in Baltimore and had some similarities. Both came from well-to-do families, both were bachelors for the greater part of their lives, both liked good food and drink, both regularly smoked cigars, and both devoted overwhelming energy to their professions. Nevertheless, Mencken had little admiration for Welch. In his newspaper memoir, Mencken wrote:

Figure 4.

Dr. Welch (right) with President Hoover. Reprinted with permission of the Alan Mason Chesney Medical Archives of The Johns Hopkins Medical Institutions.

Welch I knew quite well in his later years. He was a medical politician and a money-raiser rather than a scientist. He brought in more money to the Hopkins than all its other collectors put together, but he did very little original work after the age of thirty. In his last two decades he was hardly more than a museum piece (16).

Mencken seemed to have lost respect for Welch during World War I (Figure 5), because Welch, like Kelly, came out strongly patriotic, which went against Mencken's Germanic sympathies. Mencken was of German descent and deeply resented the anti-German rhetoric of the times. Mencken wrote the following to his friend Fielding Garrison, the medical historian, a year after the war, before he had met Welch:

Figure 5.

Dr. Welch in uniform during World War I at Arles. Reprinted with permission of the Alan Mason Chesney Medical Archives of The Johns Hopkins Medical Institutions.

The case of Dr. Welch puzzles me. Unluckily, I don't know him; he and Dr. Halsted are about the only Johns Hopkins men I have never met. I can easily imagine him being against the Germans in the war, if only as a matter of race loyalty, but what I can't understand is (a) his open alliance with the most extravagant and ignorant sort of German-baiters and spy-hunters, and (b) his almost childish assent to the Wilson buncombe. It seems to me that (b) is obviously a proof of intellectual napping, and that (a) comes unpleasantly close to compromising his common decency. One does not ask an intellectual in time of war to stand against his country, one expects him to stand with his country—but like a gentleman.… The course of Dr. Welch frankly gave me the shock of my life. Consider the sharp contrast offered by the course of other men, notably Halsted and Barker. Neither owed one-tenth as much to Germany as Welch owed, and yet both carefully avoided the slightest hysteria, and not a word came out of them from first to last that any reasonable opponent could object to today (19).

In Mencken's diary are several references to Welch. This first is on November 21, 1931, and it suggests that Welch may have had antipathy toward Mencken. Mentioned in this entry is Raymond Pearl (1879–1940), who was professor of biology at The Johns Hopkins School of Medicine. The entire entry for the day reads:

Pearl tells me that he was at a party the other night at which Dr. William H. Welch was also present. Welch entertained a miscellaneous company with the news that the American Mercury [edited by Mencken] was in serious difficulties and for sale. He said he had been told by W. W. Norton, the publisher of scientific books. This is my reward for many favors done Norton, especially when he first set up business. Pearl says that Welch evidently took delight in the news. By that I am not surprised. Welch is a very shifty old fellow. He grossly deceived Pearl at the time of the Harvard episode. And during the war, though he owed his start to the Germans, he joined the professional patriots in denouncing them. I warned Pearl against him long ago (1).

The personal health of Welch seemed to interest Mencken. In another diary entry on November 3, 1932, Mencken describes an experience at a luncheon given by the Germania Club at the Southern Hotel in Baltimore in honor of Henry Sigerist (1891–1957), who succeeded Welch as director of the Institute of the History of Medicine:

I sat beside Dr. William H. Welch, who now eighty-two or three, and begins to look it. The old man is a walking refutation of the doctrines of some of his colleagues. He has been a hearty eater and drinker all his life, and has been overweight for many years. Yet he continues in reasonably good health in his eighties. Theoretically, a man of his round belly and thick neck should have died in the forties.

Welch is full of interesting anecdotes about his early days in Germany. He told me that when he notified Carl Ludwig at Leipzig that he proposed to proceed to Berlin and enter Rudolf Virchow's laboratory, Ludwig denounced Virchow bitterly. Welch protested that Virchow certainly deserved some respect, for he was the founder of cellular pathology. Ludwig answered: “Well, what of it? Wasn't the cellular pathology obvious? Once it had been discovered that the normal body was made up of cells, it certainly followed inevitably that diseased tissue was of the same composition.” Ludwig was so hot against Virchow that he persuaded Welch to go to Cohnheim instead. This change of plans undoubtedly had a considerable effect upon the course of Welch's life and, by corollary, upon the history of pathology in America (1).

On May 22, 1934, Mencken made another fascinating entry in his diary, involving Welch primarily but touching upon all of the Big Four. One takes from this entry that Mencken had the least respect for Welch of the Big Four. Information from Raymond Pearl, the professor of biology, once again leads off the entry:

Raymond Pearl tells me that he hears from W. G. MacCallum, head of the department of pathology at the Johns Hopkins, that the records of the hospital show only two autopsies by William H. Welch during his whole career there. This news is surely not surprising. Welch was one of the laziest men ever heard of, and even in his earliest days at the Hopkins he spent most of his time trying to dodge work. After his appointment he was sent abroad by Daniel Gilman to pick up the latest ideas in Germany. He overstayed his leave by at least six months, and even after he got home he did very little work. His so-called scientific achievements were of the most meager. He discovered two bacilli, but in those days any one with a microscope could discover one at will. He was not even a good pedagogue: he was simply a medical politician.

His great fame in the world was probably due mainly to his extraordinary talent for getting publicity. He always managed to make himself the center of situations, and he greatly enjoyed the adulation which bathed him in his later years. At one of the last lunch parties he attended I happened to sit beside him. The usual extravagant compliments were hurled at him, and I asked him politely if they did not bore him. He confessed frankly that he liked them. In those later years he went out to dinner almost every night, and usually managed to attend a lunch party by day and at least one medical meeting.

It was generally believed at the Hopkins that Welch, who was a bachelor, was worth at least a million, and that all of his money would be left to the medical school. He actually left three-fourths of it to his niece and two nephews, all of whom were already rich. The fourth share he left, not to the medical school in general, but to the Welch Memorial Library and the School of Hygiene, the first of which was his monument and second of which was his pet. He left a few bequests of $100 each to the poor old girls who slaved for him in the Welch Memorial Library. How much of his estate amounts to I don't know, but it is probably less valuable than rumor made it.

Welch was one of the most selfish men I ever heard of. From end to end of his life his operations were planned with a view to his own advantage. He was not above walking out on friends in difficulty, as he did notably in the case of Raymond Pearl. I think that most competent men would say that he was the least talented of the four original medical school professors. Halsted stood clearly at the head of the list, with Osler a good distance below him. Probably on a level with Osler stood Kelly; and then there was another drop to Welch.

His family connections and his social talents gave him access to men of money, and he worked them for a fare-you-well. His great influence at the Hopkins was due mainly to this fact. He brought in more money than all of the other members of the faculty put together, with the Board of Trustees added—in fact, he brought in at least five times as much. He always took good care to see that this money increased the celebrity of William H. Welch.

His doings during the war were of an almost shameful character. He owed everything that he knew to Germany, but when the United States went into the war he began making speeches denying that the Germans had ever made any serious contribution to medicine. Is seems incredible that a man in his position should have said anything so absurd, but Dr. Chr. Deetjen told me the other day that he had heard it with his own ears. He broke out into a uniform during the war, and was always on hand when publicity was on tap (1).

Mencken's last written impressions of Welch were recorded in an article entitled “Moral Tale,” which appeared in the Baltimore Sun in 1935 (24), a year after Welch's death. He describes Welch as “a sort of walking reduction ad absurdum of some of the most confident theories of his fellow resurrection-men.” He notes that the famous pathologist lived 84 years “with a distaste for exercise, a habit of sitting up until all hours of the night and an enlightened appreciation of each and every variety of sound food and drink.” Mencken describes an encounter with Welch:

A year or so before his death I happened to sit beside him one day at lunch. The main dish was country ham and greens, and of it he ate a large portion, washing it down with several mugs of beer. There followed lemon meringue pie. He ate an arc of at least 75 degrees of it, and eased it into his system with a cup of coffee. Then he lighted a six-inch panatela and smoked it to the butt. And then he ambled off to attend a medical meeting and to prepare for dinner. The night before, so I gathered from his talk, he had been to a banquet, and sat until 11:30 listening to bad speeches and breathing tobacco smoke. The wines had been good enough for him to remember them and mention them. Returning to his bachelor quarters, he had read until 1 o'clock and then turned in. The morning before our meeting he had devoted to meditation in an easy chair, cigar in hand. At the lunch itself, I forgot to mention, he made a speech, beginning in English and finishing in German.

What are we to gather, brethren, from Dr. Welch's chart? Simply that pathology is still far from an exact science, especially in the department of forecasting. In the presence of what are assumed to be causes the expected effects do not always necessarily follow. Here was a man who stood in the front rank of the medical profession, and yet his whole life was a refutation of some of its most confident generalizations. He lived to be pallbearer to scores of colleagues who made 36 holes of golf a week a religious rite, and to scores more who went on strict diets at 30 and stuck to them heroically until they died at 50 or 60 (24).

WILLIAM STEWART HALSTEAD (1852–1922)

Though their lives overlapped for 25 years in Baltimore, H. L. Mencken never met William Stewart Halsted (Figure 6). Mencken had a large number of friends and Halsted relatively few. Neither man had children. They shared an admiration for Germany and were both agnostics in adult life. Like Mencken, Halsted was a skeptic.

Figure 6.

Dr. Halsted (a) in the operating room and (b) in his later years. Reprinted with permission of the Alan Mason Chesney Medical Archives of The Johns Hopkins Medical Institutions.

Their relatively similar worldview is evident in Halsted's private papers. In 1918, Halsted received from Professor Adolf Meyer the 13-volume set of the The Golden Bough (3rd edition) by Sir James George Frazer. In his letter expressing gratitude to Meyer, Halsted described the treatise as “such a stupendous and bloodcurdling work.” In a style not unlike Mencken's, Halsted went on to write:

What a fearful thing is ignorance. Its disciples, from the Khonds to Cotton Mather, Jonathan Edwards, and modern clergyman, all seem to have the same genes. Walking encyclopedias may still live in the dark ages. By the time I have absorbed the 13 volumes, I shall probably release my pew in the church, and break loose from the pious bloodthirsty cruel soul-savers (25).

Mencken admired Halsted's measured response to World War I. Mencken wrote in his diary on February 5, 1942, of their mutual friend, Max Broedel, who was also of German descent: “He got a lot of consolation in those days from Dr. William Stewart Halsted, who was too civilized a man to have any faith in the war to save democracy” (1). In their Saturday Night Club (Figure 7) (26), Max Broedel, who knew all the Big Four, played four-handed piano with Mencken, beside one another, through both world wars.

Figure 7.

H. L. Mencken (far right) beside Max Broedel at the piano with members of the Saturday Night Club. Reprinted from Crosby RW, Cody J. Max Broedel. The Man Who Put Art into Medicine. New York: Springer-Verlag, 1991.

Mencken makes a single reference to Halsted in his 1926 book, Notes on Democracy, in a discussion of politicians: “The distinction that goes with mere office runs far ahead of the distinction that goes with actual achievement. A Harding is regarded as genuinely superior to a Halsted, no doubt because his doings are better understood” (27).

In Mencken's diary is another entry concerning Halsted on January 14, 1934, in which Mencken relates a conversation he had with Dr. Joseph C. Bloodgood (1867–1935), a surgeon at The Johns Hopkins Hospital and internationally known for his cancer research:

Dr. Joseph C. Bloodgood told me today that Dr. William S. Halsted, the celebrated Johns Hopkins surgeon, suffered greatly from tachycardia, due to excessive smoking. Bloodgood says that when he was resident surgeon at the Johns Hopkins Hospital he had to do a great deal of Halsted's work. Halsted would begin an operation and then have to abandon it because of the thumping of his heart. Said Bloodgood: “This gave me an extraordinary amount of experience, and did me a lot of good. So long as Halsted smoked, whoever was surgical resident at the Johns Hopkins had his hands full. When he stopped smoking he began to do all of his own work. The residents then got less experience, and hence amounted to less when they left.”

Bloodgood told me that he visited Halsted's home very often, but that Mrs. Halsted was never present at meals. She was a curiously anti-social woman, and seldom saw any one. However, Bloodgood believes that she had a powerful effect upon Halsted's career. Many of Halsted's improvements in technique, in fact, were due to her suggestions—for she had been chief surgical nurse at the Johns Hopkins before their marriage, and was a very intelligent woman (1).

In his newspaper memoir, Mencken weighed in on each of the Big Four, with these particular comments on Halsted:

Halsted was the least known to the public, but he was the greatest man, and by far. His innovations in surgery were revolutionary. In his early days he became a cocaine addict, and the legend was that he had himself cured by shipping on a sailing vessel bound ‘round the Horn. But in all probability, he pursued the habit more or less to the end of his days. Greatly to my regret, I never met him, though my friend Max Broedel, professor of art as applied to anatomy at the Johns Hopkins, often offered to take me to see him (16).

The late Peter D. Olch, MD, a scholar on Halsted, gave a lecture on the Hopkins surgeon at Duke University in 1979. He closed the lecture, which was later published, with the following brief sketch of Halsted, authored by none other than Mencken:

He was one of the first surgeons to employ courtesy in surgery, to show any consideration for the insides of a man he was operating on. The old method was to slit a man from the chin down, take out his bowels, and spread them on a towel while you sorted them out. Halsted held that if you touched an intestine with your finger you injured it and the patient suffered the effects of the injury. That was a new doctrine when he began. Halsted introduced rubber gloves. He invented the technique of shutting off the area of operation, blocking it with shots of cocaine in the surrounding nerves so there would be less general shock. He was so gentle and a little inhuman. He had to be because he was so sensitive.

He married a Johns Hopkins nurse, the Confederate General Wade Hampton's daughter [actually it was his niece]. They lived a strange, sequestered life in a great big house where each had his own quarters and neither saw anybody. Halsted had an odd detached way always, even when he was operating. He would start an operation, go on for a bit, and then seem to get tired and say to his assistant, “You see what I want to do, you finish it,” and walk away. But Max Broedel, who worked with them all, always said Halsted was the pick of the Big Four. He knew “things” (25).

SIR WILLIAM OSLER (1849–1919)

Sir William Osler, the first professor of medicine at Hopkins, was in Baltimore about 15 years, while H. L. Mencken was relatively young. In a later memoir, Mencken wrote: “Osler I saw often in my reportorial days. He was a charming fellow, but was always more the popular physician than the scientist” (16). In 1905 at age 56, Osler left Baltimore for Oxford (Figure 8). The same year at age 25, Mencken published his first prose book, The Plays of George Bernard Shaw, and became editor in chief of the Baltimore Morning Herald.

Figure 8.

Sir William Osler in 1912 at age 63, “a snapshot taken in the Hopkins garden” during his last visit to America. Osler moved from Baltimore to Oxford in 1905, at which time Mencken was the new editor in chief of the Baltimore Morning Herald, at the young age of 25. Reprinted with permission of the Alan Mason Chesney Medical Archives of The Johns Hopkins Medical Institutions.

Mencken first mentions Osler in his book The Philosophy of Friedrich Nietzsche, the first book on Nietzsche by an American, which appeared in 1908. In a chapter on “Truth,” Mencken writes:

The fact that the great majority of human beings are utterly incapable of original thought, and so must, perforce, borrow their ideas or submit tamely to some authority, explains Nietzsche's violent loathing and contempt for the masses. The average, self-satisfied, conservative, orthodox, law-abiding citizen appeared to him to be a being but little raised above the cattle in the barn-yard.… “Truth,” said Dr. Osler a while ago, “scarcely ever carries the struggle for acceptance at its first appearance.” The masses are always a century or two behind (10).

In a section entitled “The Attitude at Death,” Mencken continues:

Nietzsche rejects entirely that pious belief in signs and portents which sees a significance in death-bed confessions and “dying words.” The average man, he says, dies pretty much as he has lived, and in this Dr. Osler and other unusually competent and accurate observers agree with him. When the dying man exhibits unusual emotions or expresses ideas out of tune with his known creed, the explanation is to be found in the fact that, toward the time of death the mind commonly gives way and customary processes of thought are disordered (10).

Mencken was surely familiar with Osler's writings. In the same book on Nietzsche in a discussion of Thomas Henry Huxley, Mencken refers to Osler's paper on “Science and Mortality,” which was published 4 years earlier in 1904:

To the end of his days Huxley believed that, to the average human being, even of the higher class, some sort of faith would always be necessary. “My work in the London hospitals,” he said, “taught me that the preacher often does as much good as the doctor.” It would be interesting to show how this notion has been abandoned in recent years. The trained nurse, who was unknown in Huxley's hospital days, now takes the place of the confessor, and as Dr. Osler has shown us in “Science and Immortality,” men die just as comfortably as before (10).

In 1909, 4 years after Osler left Baltimore, Mencken devotes a full, though brief, article to “Dr. William Osler” in the October issue of American Magazine. Under a section called “Interesting People,” the article on Osler is only 6 paragraphs, which are reprinted here:

A handicap of crushing weight rests upon the ambitious young gentlemen who swarm in clinic-studded Baltimore. It is their evil fate to be measured with a colossus. Say of one of them that he used to sit under Osler at the John Hopkins, and you are giving him high praise. Say of him, going further, that he promises, some day, to be worthy of his master, and you are at the limit of lawful eulogy.

Dr. Osler, of course, was not snatched up to Mount Olympus the moment of his arrival. Like the new Johns Hopkins Medical School, which he came to nurse and glorify, he was received, at the start, with something not unlike polite suspicion. Saving only Dr. William H. Welch—that father of genius—no one quite appreciated his true stature.

But before long, interesting news began to filter from the Hopkins. Dr. Osler was solving problems that the textbooks put down as insoluble; he was ridding the art of medicine of cobwebs and barnacles; he was sending our parties of enthusiastic young men to explore the medical Farthest North and Darkest Africa. He observed things that no one else noticed, and he drew conclusions that violated the league rules. One day the newspapers became aware of him, and the next day the public. By and by, the doctors followed.

During the last few years of his residence in Baltimore, Dr. Osler might have used Druid Hill Park as a waiting-room. People came from all over the country to consult him, accompanied by their attendant physicians, surgeons, spiritual advisors, and nurses; and no Baltimorean of position felt it decent to surrender his appendix without first seeking the advice of the great diagnostician.

In the end the doctors themselves drove him out of Baltimore. By the rules of the healing art, be it known, a physician is forbidden to accept a fee from a fellow practitioner. Under this rule, the sick doctors of America paid gloriously but embarrassing tribute to Osler. They were welcome, and it was a pleasure and a privilege to see them—but there were classes to teach, books to read and write, clinics to look after, problems to ponder. The day brought a hundred hours' work, and but twenty-four hours of time.

Unexpectedly a message came from the King of England, offering Dr. Osler a royal appointment, with leisure unlimited, at Oxford.… Baltimore is mourning yet (28).

Mencken had definite opinions on the motivations of physicians, artists, and scientists. In an article in the Baltimore Evening Sun, called “On Getting a Living,” Mencken discusses “the medical man” with a reference to Osler:

True enough, a medical man who is intensely interested in his work, without regard to its material rewards—such a medical man often makes a great deal of money. If he has genuine ability, indeed, he almost invariably does so. But it is extremely difficult to put the cart before the horse. That is to say, it is extremely difficult to practice medicine primarily as a business, and at the same time keep up its dignity as an art and science. The man who does so is on the wrong track. He is heading toward the chiropractors, not toward the Oslers (29).

A year later in 1925, another reference to Osler appears. Among the several editorials for the Baltimore Sun which Mencken wrote while attending the Scopes trial in Dayton, Tennessee, is a reference about the judge in the case: “I met members of the State judiciary who were as heartily ashamed of the bucolic ass, Raulston, as an Osler would be of a chiropractor” (30).

In the August 1925 issue of The American Mercury (31), Mencken published a book review under the simple title, “Osler,” concerning Cushing's biography, The Life of Sir William Osler. Mencken begins:

… no other American medical man has ever left so brilliant and durable an impression upon the craft in this country, or upon the general imagination. During his sixteen years at the Johns Hopkins he was not only the first of American physicians; he was in a category all his own, and quite beyond the reach of rivalry.… All he asked of life, at fifty six, was peace. He got it for a few years, but then came a rising tide of new duties, and then the great shock of the war, and then a family calamity of the first magnitude—the death of his only son in battle. When Osler took to his bed in 1919, he was broken by the struggle. There were hopes for his recovery, but not in his own heart. He turned his face to the wall (31).

About the book itself, Mencken wrote that Cushing “attempts no critical evaluation of the man, but contents himself with gathering and organizing the materials for it.” Mencken called the book “a collection of souvenirs of Osler the man.”

Mencken notes in the review the powerful impact that Osler's textbook of medicine had upon John D. Rockefeller. Mencken, self-avowed skeptic, wrote that “it was the skepticism in the first edition of his Principles and Practice—the frank confession, over and over again, that for this or that disease there was no remedy—that led him into what was perhaps his greatest service to medicine.” According to Mencken, “The depressing news was reduced to words of one syllable for old John D. and the net result was the founding of the Rockefeller Institute” (31).

Mencken seemed to come to terms with Osler in the final paragraph of his review, in which he makes the point again that Osler's greatest contribution was his textbook:

Much has been written of his purely literary writings—the essays with which he beguiled the fugitive and elusive leisure of a pack-horse professional life. He was a great lover of old books, and he liked to write about them. He wrote gracefully and charmingly, but I doubt if his compositions will be long remembered. Even today, indeed they are not much read. A considerable pedantry is in them; they smell of the lamp. The essential man is in his medical writings. His Principles and Practice remains his masterpiece. To find its match you must go to Huxley's Crayfish. Into it he poured the vast knowledge of one of the most adept and penetrating diagnosticians ever heard of, and into it he put, too, all his fascination as a man. It is profound, and yet it is romantic. Even medical students read it with pleasure (31).

In a final reference to Osler, this time in a diary entry on November 13, 1944, Mencken conveys this anecdote:

I went to the Johns Hopkins (Homewood) on November 10 to address the Stuart and Tudor Club, founded by Dr. William Osler, who left his collection of books by his will, and enough money to keep it going. It consists, in theory, of persons interested in English literature in the Golden Age, but it also includes a miscellany of Anglomaniacs. I had been invited to harangue it often in the past, but always put it off. Some time ago I decided to take a look.… This Stuart and Tudor Club is supposed to include the intellectual elite of the Johns Hopkins academic department, and poor Osler hoped that his legacy would make it a center of the enlightenment. I can see nothing in it save a gang of third-rate pedagogues.… I was told at the meeting that I have been elected an honorary member of the club, but have heard nothing of this since. I sincerely hope that the news was false (1).

It should be mentioned that Mencken and Osler shared several personal characteristics and beliefs. Both men mastered their respective fields—journalism and medicine. Both men were cultivated citizens of the world. Both were avid readers and prolific writers. Both had a wide circle of friends, locally and nationally. Both believed in punctuality in appointments and imperturbability in life. Each man had a famous sense of humor. And both believed in a philosophy of work as the path to contentment (Figure 9). Osler called it “the master-word” (32); Mencken called it “the only solution.”

Figure 9.

Osler and Mencken at work in Baltimore. (a) William Osler writing his textbook, The Principles and Practice of Medicine, circa September 1891, age 42. Reprinted with permission of the Alan Mason Chesney Medical Archives of The Johns Hopkins Medical Institutions. (b) H. L. Mencken pounding out copy at his typewriter at the Baltimore Sun office in 1913, age 33. Photo by Alfred A. Knopf, published by permission of the Enoch Pratt Free Library, Baltimore, in accordance with the terms of Mr. Mencken's will.

CONCLUSION

H. L. Mencken recorded astute observations of each of the Big Four professors of the Johns Hopkins Hospital in various publications during his lifetime and posthumously over the period of a century. Kelly he lambasted for his Christian fundamentalism, though he respected his surgical skill. Welch he called a “medical politician” and held in low regard, particularly for his anti-German stance in World War I. Halsted he never met but admired greatly, not only for his surgical accomplishments, but also for his agnosticism and for his neutral stance in World War I. Osler he knew only briefly and seemed to admire increasingly after his departure from Baltimore, not so much for his humanistic writings, but rather for the science and skepticism in his single-authored medical textbook of 1892.

ACKNOWLEDGMENTS

Permission to use the Mencken quotes was provided both by the Enoch Pratt Free Library, Baltimore, in accordance with the terms of Mr. Mencken's will, and by Alfred A. Knopf, Inc.