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Daniel Hale Williams: Innovative Surgeon, Educator, and Hospital Administrator
MEDICAL HISTORY
Daniel Hale Williams: Innovative Surgeon, Educator, and Hospital Administrator William K. Beatty, M.S.·
Dr. Williams' patient at Provident Hospital in Chicago was a 25-year-old black expressman, James Cornish, who had been stabbed in the chest. No cause is cited for the argument, but the evening of July 9, 1893 was in the midst of a heatwave and the weather in Chicago can do strange things to a man's temper. Cornish was examined immediately by Dr. Williams, the founder and moving spirit of Provident Hospital. The injury appeared to be superficial, and Williams thought no more about it until Cornish developed severe pain near his heart and started into shock. Something had to be done, and Williams was sufficiently experienced and well-read to be aware of the possibilities. Most surgeons were firm in the belief that the area of the heart was out of bounds for any responsible surgeon. This belief had been stated as gospel by such authorities as Theodor Billroth and Nicholas Senne Billroth had made several strong statements almost anathematizing any surgeon who entered this field, and these comments were frequently cited both in and out of context. Textbooks and articles were almost unanimous in their stand on this, and yet persistent doubts kept forcing their way into Dr. Williams' mind. If he did nothing, and relied solely on rest and opiates, young Cornish would probably die. Williams made up his mind and decided to open Cornish's chest and take a look. Williams not only believed in keeping himself up to date on medical and surgical practice, but he was also convinced of the necessity of continuing education for all physicians. Accordingly, while the patient and the operating quarters were being prepared, Williams notified some of his colleagues, and
When Dr. Daniel Hale Williams, a black surgeon, reported his successful suturing of the pericardium early in 1897 he stated: "The Index Catalogue and Medicus of the National Medical Library, surgeon-general's office, Washington, D.C., do not give a single title descriptive of suture of the pericardium or heart in the human subject. This being the fact, this case is the 6rst successful or unsuccessful case of suture of the pericardium that has ever been recorded."! Dr. Williams also examined the specimens of pericardial and heart wounds in the Army Medical Museum and found none that had any history of operation. These steps were typical of Dr. Williams' thoroughness throughout his 4O-year career. As it turned out Dr. Williams had been preceded both in deed and publication, although these facts in no way lessen the courage and pioneering of this surgeon who was 37 at the time he performed his pericardiorrhaphy on July 10, 1893. Dr. Henry C. Dalton of St. Louis had sutured a two-inch wound in the pericardium of Eugene L., a young man of 22, on September 6, 1891. Dr. Dalton reported this case four years later and made several interesting comments. Since the patient "seemed to be dying" several times during the operation he was given hypodermic injections of whiskey and strychnine. ~ The patient made an uninterrupted recovery after his rather harrowing experience. Dr. Dalton wrote, "I had no precedent to guide me, no authority to uphold me . . . However, I thought then, and still think, that my patient had a better chance for recovery after the wound was closed.T' -Librarian and Professor of Medical Bibliography, Northwestern University Medical School, Chicago.
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six of them showed up for this event. Provident Hospital had been founded just two years before, and it was still in a remodelled house, its original building. The operating room was a small converted bedroom, and the scene can be imagined with seven physicians and several nurses crowded into this room around the patient; the heat must have been stifling. Dr. Williams reported the operation in the following words : The original wound was lengthened to the right as far as the middle of the sternum. A second incision was made from the centre of the first and carried over the middle of the cartilage and fifth rib , about six inches in length. The sternum, cartilage, and about one inch of the fifth rib were exposed. The cartilage of the fifth rib was separated at its junction with the sternum and at a point two and one-half inches from the sternum and one-fourth of an inch from its attachment to the rib . The inferior attachments of the incised piece were separated, leaving the supe rior ones in place. The incised piece was reflected upward, making an opening about two inches long and one and one-half inches wide, bringing the internal mammary vessels into view . These vessels we re ligated above and below with small catgut. This large opening permitted easy ligation and manipulation. To secure additional room an incision was made in the fifth intercostal space. The heart and lung being depressed backward, a small punctured wound of the heart, about one-tenth of an inch in length and about one-half of an inch to the right of the right coronary artery, between two of its lateral branches, was seen . The wound in the pericardium was about one and a quarter inches in length. There was no hemorrhage from the heart or pericardium. The edges of the percardium were held by long smooth forceps, and a continuous suture of fine catgut was made. Before the pericardial wound was closed it was irrigated with normal salt solution. The temperature was 100· F. Catgut was used in closing the intercostal and subca rtilaginous wounds and silkworm gut in the cartilages and skin . A few silkworm-gut sutures were left long in the external wound, so as to permit easy removal , in case it should be necessary, on account of infection or hemorrhage. A dry dressing was applied.s
Cornish (Fig 1) suffered a few postoperative complications. Paroxysms of coughing and hiecoughing on the second day were threatening, and the accumulation of fluid in the pleural cavity eventually forced an operation on August 2 when 80 ounces were removed. Infection of the pleural cavity had been prevented by causing the fluid to flow under several layers of sterile gauze which were kept wet by a stream of water. This kept the pressure in the cavity sufficiently high to prevent any inrush of infecting agents . After the operation Dr. Williams was puzzled by his failure to realize the depth of the stab wound. He experimented with several cadavers and demonstrated that this type of wound in that area always seals itself off by the elasticity of the cartilage. Dr. Williams ' dramatic operation soon became public knowledge through newspaper" and word-of-
FIGURE
1. James Cornish after the operation.
mouth reporting. Cornish left Provident on August 30, and he was known to be in good shape 20 years after the operation. Williams accomplished several important things with his suturing of Cornish's pericardium. He proved that the thoracic cavity was suitable territory for surgical intervention, and his practical example knocked some of the force out of the dogmatic assertions made by several leading surgeons. Surgical intervention in and around the heart faced both psychologic and technical barriers in the second half of the 19th century. However, this area was bound to come under the surgeon's scalpel eventually. In October, 1872, George Callender, an English surgeon at St. Bartholomew's, had extracted a two-inch needle that had stuck in the heart of a 31year-old man during a bar-room brawl. The patient made an uneventful recovery, but whether he continued to carry a needle in his lapel is not known. 6 Ten years later a surgeon in Danzig, Block, did some experimental suturing on the hearts of several rabbits. He was so successful .that he attempted to remove some tuberculous tissue from the lungs of a young woman relative. The woman unfortunately died on the operating table. When the postmortem showed no evidence of tuberculosis, Dr. Block became so upset that he committed suicide. CHEST, VOL. 60, NO.2, AUGUST 1971
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DANIEL HALE WILLIAMS In September, 1895, Axel Cappelen of Kristiania (now Oslo) repaired a I-inch wound in the left ventricle of a patient who died two days later. Guido Farina of Rome sewed up a 7-mm wound in the right ventricle of a patient in March, 1896, but that patient also died, eight days after the operation. Success on the heart itself was finally achieved by Ludwig Rehn of Frankfurt am Main, in September of 1896. He sewed up a 1.5 em wound in the right ventricle of a patient who was still alive ten years later. Rehn followed up on this milestone and could in 1907 report a 40 percent success rate on 124 patients. 7 The first surgeon in this country to perform a successful suturing of the heart was Luther Hill of Montgomery, Alabama.f Dr. Hill, with the assistanee of six colleagues (including his brother), sewed up a wound in the heart of a 13-year-old boy. This operation, September 14, 1902, took place on a table in the family's cabin. One of Luther's children, Lister, later achieved fame as a United States Senator. Interestingly enough, five years earlier Dr. Hill had, at an operation in his home, successfully removed a 2" inch needle accidentally driven into the heart of an eight-year-old girl. 9 A "filler" at the end of the article reporting this case noted that the Vermont legislature had just passed a bill prohibiting the sale of cigarettes in that state. Daniel Williams was involved in several other surgical operations of considerable interest in addition to his repair of the stab wound in Jim Cornish's pericardium. At the end of July, 1902, Williams performed one of the earliest successful sutures of the spleen in this country. The first, duly referred to by Williams in his paper, was reported by Tiffany of Baltimore in 1894. Williams' patient, a 27-yearold man, had been stabbed through the eighth interspace. Upon operation Williams was confronted with a profusely bleeding spleen : My first attempt at suture ended in complete failure by tearing out as I endeavored to draw the suture down. I therefore changed my method by selecting a full, curved, round Mayo needle threaded with No. 2 catgut. This I introduced one-half inch from the margin of the wound edges, and without the least force allowed the needle to follow its full curve, emerging from the opposite side of the wound the same distance as it entered, and making a triple loop without a reenforcing knot. Hot gauze compresses were held on each loop as the edges were approximated, with the idea of causing the catgut to swell and engage opposing fibres, so as to make 'a finn line . Every suture put in in this manner held firmly. After watching it for twenty minutes, I returned the spleen to the abdomen, and surrounded it with omentum, a very important part of the detail, on account of its well-known property of protection. The patient made a rapid and perma-
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nent recovery. He left the hospital in three weeks.l 0
Following this account Dr. Williams gave a brief description of the work by Lamarchia, Madelung, Berger, and Senn. Once again, his detailed knowledge of the medical literature was evident in support of his innovative surgery. In this same paper Dr. Williams reported two more successful cases of surgical treatment of wounds in the thorax . When Dr . Williams was at Freedmen's Hospital in Washington (1894-1898) he had many opportunities to see both black and white women with ovarian cysts. Most gynecologists had held that black women did not have ovarian cysts, and Williams, in the paper- ! reporting his own experiences which effectively refuted this belief, quoted Thomas Brown at Johns Hopkins, "One frequently hears surgeons say: 'The tumor before us presents all the features of an ovarian cyst, but inasmuch as the patient is a negress, it is certainly not so, but a tumor of different origin (cystic myoma, etc), as multilocular cysts are unknown in the negress.''' After a thorough reporting of the earlier literature, which included work by Rudolph Matas and Howard Kelly, Williams pointed out that in his 357 operations on women of both races the number of fibrous tumors in each was almost equal. A slight gleam of humor runs through this paper since Williams was able to see both the ridiculous and scientific sides of the situation. Perhaps Williams' interest in continuing education was in part caused by his own difficulties in obtaining both his early schooling and his medical education. Daniel Hale Williams was born on January 18, 1856, at Holidaysburg, a small town in south central Pennsylvania.t s His parents, Daniel Williams, [r., (Fig 2) and Sarah Price Williams, (Fig 3) were black with admixtures of Shawnee and Delaware Indian and several white strains,
FIGURE 2 (left). Daniel Will iams, Ir., father of Daniel Hale Williams, (by permission of Pitman Publishing Co.). FIGURE 3 (right) . Sarah Price Williams, mother of Daniel Hale Will iams, (by permission of Pitman Publishing Co.) .
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primarily German and Celtic. Both parents showed the black and Indian strains more evidently than did young Dan, who was pale and red-haired, and this closeness to the whites was later used by several antagonistic black physicians and lay people who vigorously opposed some of Dan's medical and social activities. Dan's father and mother were from free families and his father was fairly well off. Unfortunately the father died when Dan was 11, and his life became much less secure and pleasant. Dan's mother apprenticed him to a shoemaker in Baltimore, and took two of Dan's six brothers and sisters out to live with relatives in Rockford, Illinois. Dan's life for the next few years was one uprooting after another. At 17 Dan and a sister, Sally, settled in Janesville, Wisconsin. Dan got a job at Harry Anderson's Tonsorial Parlor and Bathing Rooms and Sally worked at a hair stylist's. Anderson was so favorably impressed by Dan that he took both children into his house. Sally married shortly after this and moved away. Harry Anderson was able to help Dan through high school using him. on the guitar and as a tenor in Anderson's string band. Anderson kept up his financial aid when Dan went on to medical school. After graduating from the Classical Academy in Janesville in 1877 Dan tried his hand at law. He was eventually drawn to the town's most prominent doctor, Henry Palmer. Palmer recognized Dan's insatiable curiosity and personal drive and took him on as an apprentice in 1878. Dr. Palmer had received an education and experience above the average of his time, and he was able to impart to . young Dan both a practical and a philosophic knowledge which included an awareness of social· trends. In the fall of 1880 Williams and two other apprentices were ready to enter medical school. Chicago was the most likely place; Rush Medical College and Chicago Medical College (affiliated with Northwestern University) were the two top schools. Rush required two five-month terms, Chicago required three six-month terms. The. three apprentices were all accepted at the Chicago Medical College. Thanks to the irregular but vital help of Harry Anderson and the assistance of Mrs. John Jones, the wealthy widow of a black physician, Williams made his way through medical school. His three years were dogged with illness, financial problems, and hard work but he was one of the three dozen members of the graduating class in March, 1883. The first problem that. Dr. Williams had to face after graduation was the straightforward question,
WILLIAM K. BEATTY where could a black physician practice? The second was broader. When Dr. Williams opened his office in Chicago at the comer of 31st Street and Michigan Avenue there were three black physicians already in practice in the city. Chicago was not divided into black and white areas, but problems arose concerning hospital appointments, the availability of black assistants, and the psychologic comfort of black patients. Although Williams drew his patients from both black and white communities he was well aware of these problems. The Rev. Louis Reynolds, pastor of St. Stephen's African Methodist Episcopal Church on the west side of Chicago, provided the spark that turned Dr. Williams' thoughts into action. On a December evening in 1890 he asked Dr. Williams over for some advice about his sister, Emma, who wanted to become a nurse. Emma had applied for admission to the local training schools but had been turned down by them because of her color. This situation moved Williams into responding not only to Emma's problem but to others as well. He decided to establish an interracial hospital to provide for the patients who were not receiving adequate care elsewhere and to give staff privileges and experience to young black physicians. The training school to take care of Emma (and many others) would be attached to the hospital. When that decision was made all that Williams had left to do was to provide land, a building, staff, equipment, and continuing financial support. Individuals and groups, both black and white, were soon stirred into action by means of private prodding and public meetings. The key to the success of the program, besides just plain hard work, was the setting up of the Provident Hospital Association to which all donors automatically belonged (whether they gave money or other gifts, eg, clothes wringers, lace for the nurses caps). Dr. Williams was tireless in· his efforts and gave innumerable formal speeches and informal talks, as well as making effective personal calls on P. D. Armour, H. H. Kohlsaat, and other wealthy Chicagoans. Sufficient funds were finally collected to make possible the purchase of a three-story brick building at Dearborn and 29th Street. This was fitted out with 12 beds. The articles of incorporation were signed for both the Provident Hospital and the Training School Association on January 23, 1891. The top signature line on the document was symbolically left blank because Dr. Williams was called away during the ceremony to take care of a ·patient. Provident Hospital opened for service on May 4, 1891. This child of Dr. Williams' social conscience CHEST, VOL. 60, NO.2, AUGUST 1971
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and personal effort was to occupy a large proportion of his life for the next 20 years. Both the staff and the patients included blacks and whites, and Dr. Williams also drew on the support of Frank Billings, Christian Fenger, and other well-known men as consultants. The question of staff appointments, however, caused some problems since there were few black physicians who could meet the high standards set by Dr. Williams. He appointed Charles Bentley as the oral surgeon and Allen A. Wesley as the gynecologist. Austin M. Curtis was given the one internship. Trouble arose in the person of George C. Hall who aggressively sought an appointment despite his lack of qualifications in terms of Dr. Williams' requirements. A compromise was reached, but Hall never forgave Williams and was a thorn in both his private and professional lives for many years. The Training School opened up an exciting new possibility for young women in the area, and 175 applicants applied for "the first class. Dr. Williams selected seven of these, and then put them through an 18 month course that not only taught them nursing but also a good deal about psychology and life. With the Hospital, Training School, and a rapidly expanding practice Williams had his hands full, but his desire to keep up with advancing medical science caused him to enroll in one of the early courses in bacteriology given at the Chicago Medical College. The general depression of 1893 had its effect on Provident, and- the Hospital and School were almost driven to the wall. However, as a result of redoubled efforts by Williams and others, George Webster and some of the other individual donors made substantial increases in their support. Some moraleboosting was involved too, and when Frederick Douglass gave a well-publicized lecture at the World's Fair and donated the proceeds to Provident in person no harm was done to either the Hospital's finances or to its public image. Provident soon became busy and filled to capacity, and the need for new quarters was pressing. Kohlsaat gave some land on the comer of Dearborn and 36th, a location now served by the modem cable cars instead of the old fashioned horse cars. Armour paid for the new building, and a new 65bed hospital was in operation by the end of 1896. This location eventually included an outpatient clinic that handled 6,000 patients a year, and a nurses' home. The latter. building was erected on land donated by George Pullman, Marshall Field, and Otto Young. Toward the end of his life Dr. Williams initiated CHEST, VOL. 60, NO.2, AUGUST 1971
179 a campaign for a new building, and a 167-bed, seven-story structure, with four-story clinic, was finally completed in 1936, five years after his death. Although Williams' mental and professional horizons were not narrow he might have been content to remain at Provident for the rest of his life if a new challenge had not been dropped into his lap. Judge Walter Q. Gresham had been a friend of Williams for many years. When the second Cleveland administration took office in 1893 the aging Gresham agreed reluctantly to serve as Secretary of State. In a reverse twist of Gresham's Law (bad money drives out good) he urged Williams to apply for the position of Surgeon-in-Chief at Freedmen's Hospital in Washington. Freedmen's was a product of the Civil War and had begun its institutional life as a combined asylum and hospital for the blacks who had poured into the capitol seeking refuge from the war and its ramifications. 1 :-l Freedmen's had a unique position as the oldest institution in the country with the major objective of providing patient care and professional training for blacks. With this institutional standing, and its location at the "center" of the country, the opportunities were evident to the 37year-old Williams. Daniel Williams devoted much thought to the judge's arguments, and finally agreed to become a candidate. Problems arose immediately. The incumbent, Dr. Charles B. Purvis, was not only the first black to hold this position but he had been in it since 1881 and was well-entrenched. Purvis pulled all the strings that were available, both aboveboard and underhand. The situation was complicated further when Dr. Williams accidentally shot himself in the foot while on a quail hunt. An infection set in and made it impossible for Williams to go to Washington immediately after his appointment in February, 1894. The infection worsened and an amputation became imminent. Christian Fenger was called in, was able to save the foot, and make it possible for Williams to visit Washington briefly in May. Unfortunately, further complications developed and Dr. Williams did not finally take over his new post until the middle of September. During the seven months since Williams' appointment George Hall and some of his friends, as well as Charles Purvis, Williams' predecessor, had been busily at work. Seeds were planted in political circles for later flowering, newspapers were used as vehicles for lies and half-truths, and the support of leaders in the black communities was sought. Williams' weathered these storms for a while, but their
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cumulative effect eventually drove him back to Chicago after four hectic but productive years in Washington. What did Dr. Williams find when he arrived at Freedmen's? Physically, the buildings were in mediocre to poor condition, and were certainly not designed for use as a hospital. The 'separate structures were scattered over the site, and the moving of patients, even in the best of weather, was neither logical nor therapeutic. Administratively, the situation might have been described as rather loosely structured chaos. Several federal and local agencies, as well as the Howard University Medical School, were either struggling for control or else were reluctantly accepting it by default. Dr. Williams as Surgeon-in-Chief could control neither the admission nor the discharge of patients. The professional staff, which was minimal, was both poorly trained and insufficiently motivated. The nursing staff consisted primarily of "mammies" who stood in the center of the wards periodically and shouted, "All you 'leven o'cloekers, take your medicine." They and the attendants were mostly illiterate, often drunk, and seldom as interested in their human patients as in their monetary pittance. The death rate under Purvis had been 10 percent in good years. Dr. Williams went to work energetically but had to channel his efforts carefully because of the explosive political and social conditions. He first reorganized the staff and made it interracial. Then he created an advisory board of outstanding physicians for both their professional and political help. The next step was to establish a training school similar to the one that had been so successful at Provident. Purvis, from his position on the Howard faculty, kept up his sniping, in part through a "training school" for nurses that he had started just before he had been dismissed from Freedmen's. This program met for two evenings a week and was not overly effective. The two schools were kept running side by side for several months until Williams was finally able to close the evening version down for good. Williams had over 500 applicants to choose from for his first class, selected 59 probationers, and allowed 46 of those to embark upon the full IS-month. program. Since postgraduate training was a great need for black physicians Dr. Williams began an internship program with four men in the first group. Freedmen's became an important source from which black physicians went out to various parts of the country to improve the quality of care for both black and white patients.
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Little could be done about the physical plant, but Williams was able to improve the operating areas and eventually to provide a covered way to them from the wards. He had thelarge area on which the buildings were located kept clean and brightened up with flowers. What was really needed was a single building that was both new and functional. Most of the Howard Medical School faculty was slowly won over by Williams' capable professional work and by his persistent efforts for improvement. The local medical society was another matter, and the only solution that would provide the black physicians with the vital stimulus of professional meetings turned out to be the founding of an interracial society. This was done by three white and five black physicians and the Medico-Chirurgical Society of the District of Columbia was established in January, 1895. This took care of the local scene, but nationally black physicians still could not join a country-wide medical association. After much preliminary effort the National Medical Association was founded in Atlanta in December, 1895. Dr. Williams was offered the presidency and declined although he did accept the vice-presidency. The Republican victory in 1896 had as one of its ripples the almost certain removal of Dr. Williams. This more or less normal political condition was complicated by the Secretary of the Interior, Cornelius Bliss, who announced a civil service exam for Williams' post on the basis that he had already resigned, and by Senator James McMillan, Republican from Michigan and chairman of a joint committee to investigate charitable and reformatory institutions in the District of Columbia, who announced that his committee was going to investigate Freedmen's. As a final straw Dr. William Warfield, one of the early interns at Freedmen's and later Williams' first assistant surgeon, went to the hospital's Board of Visitors and formally charged Dr. Williams with the theft of hospital materials. The civil service exam was held early in 1897 with the following results: Dr. Charles I. West, Washington, 91:50; Dr. Austin M. Curtis, Chicago, 79:10; and Dr. James A. Wormley, Newark, 76:05, Curtis, the man with the second highest score, was selected when Williams resigned in February, 1898. Mrs. Curtis had supposedly been quite helpful to Mark Hanna when he was chairman of the Republican National Committee. Dr. Curtis was Chief until 1901, and then William Warfield finally achieved his goal and served for 35 years. Senator McMillan's investigation dragged on for some time, and considerable political mileage was made by both sides. Williams received substantial CHEST, VOL. 60, NO.2, AUGUST 1971
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FIGURE 4. Alice Johnson, about 1890, (by permission of Pitman Publishing Co. ).
help from the Rev. Jeremiah Rankin, President of Howard University, who gave some forthright testimony. Rankin had earlier shown his confidence in Dr. Williams by drawing on him as a physician for the Rankin family. The Committee finally made a report in June, 1898, which emphasized the problems between Howard and Freedmen's and assailed Dr. Williams for his lack of administrative ability. Warfield's charges of theft led to several dramatic scenes and apparently were deeply felt by Williams . The Board of Visitors held hearings on these charges in July, 1898, and Warfield had a field day . He accused his previous chief not only of stealing instruments and books but also of suggesting the sale for personal gain of unclaimed bodies of hospital patients. The Board eventually exonerated Williams, but the affair was a trying and disillusioning experience. One positive result of Williams' four years in Washington was his marriage with Alice Johnson (Fig 4) on April 2, 1898. The Rev. Jeremiah Rankin officiated at the Johnson home. Daniel (Fig 5) and Alice had met shortly after his arrival in Washington, and he had operated on Alice's mother in May, 1.897. After the wedding the Williams moved to Chicago and Dr. Williams settled back into his old office at 31st Street and Michigan Avenue. What should have been a pleasant and reasonably relaxed professional and social life was, however, turned into a turmoil by both Dr. George Hall and his aggressive wife, Theodocia, and by controversies centering around Booker T. Washington. CHEST, VOL. 60, NO.2, AUGUST 1971
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George Hall finally achieved his goal in 1912 when Williams resigned from the staff at Provident. Williams had been an attending surgeon at Cook County Hospital for a number of years, and when he was appointed an associate attending surgeon at St. Luke's early in 1912 Hall used this as an indication of "disloyalty" to Provident. During his second stay in Chicago Williams made many visits to Meharry and other schools and hospitals in the South to do clinical and educational work. These events were among the most satisfying in his career, and they had an incalculable effect on the improvement of medical education and care for black physicians and patients. While most of his publications dealt with surgical procedures and reports, one of the more thoughtprovoking papers Dr. Williams gave dealt with a subject of interest to both the medical and legal professions, the malingerer. 14 In this talk, presented at a meeting of the Surgical Association of the Chicago & North Western Railway held at Rochester, Minnesota, late in 1915, Williams drew attention to the various pressures felt in a malingering situation and stressed the social and ethical problems involved. The effects of a long and active life were beginning to tire Daniel Williams and, after some searching, he found a pleasant spot near Idlewild in Lake County, Michigan. His home, Oakmere, was in an area wooded with pine and oak and with a fine view over the lake. His wife, Alice, succumbed to Parkinson's disease four years after they moved to
FIGURE 5. Daniel Hale Williams, while Surgeon-in-Chief, Freedmen's Hospital, 1894-1898, (by permission of Pitman Publishing Co. ).
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Michigan. Dr. Williams continued his practice until diabetes and a stroke forced him to spend most of his time sitting on his porch, looking outwardly over the beautiful landscape and inwardly over his many and varied memories. The last five years of his life were a sad period of mental and physical deterioration, but death finally released him on August 4, 1931.
Dr. Williams received both direct and indirect honors during his lifetime. One of the major public recognitions of his work and standing came when he was chosen in 1913 as a charter member of the American College of Surgeons, the only black so honored. His life, however, had more than its share of tragedy and disillusionment, and it could, in one sense, be symbolized by his long-time enemy, George Hall, who once vowed heatedly, "Curse him! I'll punish him worse than God ever will. 111 see he's forgotten before he's dead." 1 :s REFERENCES
2
3 4 5
Williams DH: Stab wound of the heart and pericardiumsuture of the pericardium-recovery-patient alive three years afterward. Med Rec 51 :439, 1897 Dalton HC: Report of a case of stab-wound of the pericardium, terminating in recovery after resection of a rib and suture of the pericardium. Ann Surg 21: 148, 1895 Dalton, Ref. 2, p 151 Williams, Ref. 1, pp 437-438 The Daily Inter Ocean, 1893, July 22, col 3 p 8 .
6 Richardson RG: The Surgeon's Heart; a History of Cardiac Surgery. London, Heinemann, 1969, pp 25-32 (Richardson also provides useful information on Block, Cappelen, and Rehn) 7 Johnson SL: The History of Cardiac Surgery, 1896-1955. Baltimore, Johns Hopkins, 1970, p 6 (Johnson has good material on Rehn and Hill). 8 Hill LL: A report of a case of successful suturing of the heart, and table of 37 other cases of suturing by different operators with various terminations, and the conclusions drawn. Med Rec 62:846-848, 1902 9 Hill LL: Wounds of the heart with a report of 17 cases of heart suture. Med Rec 58:921-924, 1900 10 Williams DH: Penetrating wounds of the chest, perforating the diaphragm, and involving the abdominal viscera; case of successful spleen suture for traumatic haemorrhage. Ann Surg 40:682-683, 1904 11 Williams DH: Ovarian cysts in colored women, with notes on the relative frequency of fibromata in both races. Chicago Med Rec 20:47-57, 1901 (The discussion of this paper by Dr. A. ]. Ochsner is summarized on pp 100101) 12 Buckler, H: Daniel Hale Williams: Negro Surgeon. (2nd ed) New York, Pibnan, 1968 (Much of the personal information about Williams comes from this well-written biography) . 13 Cobb WM: A short history of Freedman's hospital. J Nat Med Assoc 54:271-287, 1962 14 Williams DH: The malingerer. Railway Surg J 22:443446, 1915-1916 (Discussion of this paper is on pp 446448) 15 Buckler, Ref. 12, p 269 Reprint requests: Mr. Beatty, Northwestern University Medical School Library, 745 North Fairbanks Court, Chicago 60611
Adversities Encountered in Music Appreciation The Russian composers, and Tschaikovsky (18401893) chief among them, were the discoverers of a musical universe, the novelty of which may nowadays elude us. Tschaikovsky was a solitary, whose music is shot through with a dark passion which it is hard not to relate to his private struggles. He was greatly attracted to the lithe, sensuous music of Bizet and the polished grace of Saint-Saens, though it is evident that the spirit of those composers was boldly transformed in his own more deeply colored music. He was also blessed with the gift for the most generous fonn of melody, a gift which his detractors frequently refuse him on the ground that he was a gushing sentimentalist, an exhibitionist with no ideal of restraint. It is here that Tschaikovsky can easily be misjudged. There is a big heart in his music, but he
was not gross or insensitive. Mozart, another of his few
links with the West, was his ideal-as also seemingly unMozartian composers, among them Gounod and Richard Strauss. And, in fact, there is many a passage in Tschaikovsky which is exquisitely Mozartian in detail and subtlety. Nevertheless, Bernard Shaw in his days as music critic wrote that "Tsehaikovsky had a thoroughly Byronic power of being tragic, momentous, romantic about nothing at all . . . like Childe Harold, who was more tragic when there was nothing whatever the matter with him than ordinary Englishman when he is going to be executed." Sargeant, M and Cooper, M (editors): The Outline of Music. New York, Arco, 1963
CHEST, VOL. 60, NO.2, AUGUST 1971
Daniel Hale Williams: Innovative Surgeon, Educator, and Hospital Administrator William K. Beatty, M.S.·
Dr. Williams' patient at Provident Hospital in Chicago was a 25-year-old black expressman, James Cornish, who had been stabbed in the chest. No cause is cited for the argument, but the evening of July 9, 1893 was in the midst of a heatwave and the weather in Chicago can do strange things to a man's temper. Cornish was examined immediately by Dr. Williams, the founder and moving spirit of Provident Hospital. The injury appeared to be superficial, and Williams thought no more about it until Cornish developed severe pain near his heart and started into shock. Something had to be done, and Williams was sufficiently experienced and well-read to be aware of the possibilities. Most surgeons were firm in the belief that the area of the heart was out of bounds for any responsible surgeon. This belief had been stated as gospel by such authorities as Theodor Billroth and Nicholas Senne Billroth had made several strong statements almost anathematizing any surgeon who entered this field, and these comments were frequently cited both in and out of context. Textbooks and articles were almost unanimous in their stand on this, and yet persistent doubts kept forcing their way into Dr. Williams' mind. If he did nothing, and relied solely on rest and opiates, young Cornish would probably die. Williams made up his mind and decided to open Cornish's chest and take a look. Williams not only believed in keeping himself up to date on medical and surgical practice, but he was also convinced of the necessity of continuing education for all physicians. Accordingly, while the patient and the operating quarters were being prepared, Williams notified some of his colleagues, and
When Dr. Daniel Hale Williams, a black surgeon, reported his successful suturing of the pericardium early in 1897 he stated: "The Index Catalogue and Medicus of the National Medical Library, surgeon-general's office, Washington, D.C., do not give a single title descriptive of suture of the pericardium or heart in the human subject. This being the fact, this case is the 6rst successful or unsuccessful case of suture of the pericardium that has ever been recorded."! Dr. Williams also examined the specimens of pericardial and heart wounds in the Army Medical Museum and found none that had any history of operation. These steps were typical of Dr. Williams' thoroughness throughout his 4O-year career. As it turned out Dr. Williams had been preceded both in deed and publication, although these facts in no way lessen the courage and pioneering of this surgeon who was 37 at the time he performed his pericardiorrhaphy on July 10, 1893. Dr. Henry C. Dalton of St. Louis had sutured a two-inch wound in the pericardium of Eugene L., a young man of 22, on September 6, 1891. Dr. Dalton reported this case four years later and made several interesting comments. Since the patient "seemed to be dying" several times during the operation he was given hypodermic injections of whiskey and strychnine. ~ The patient made an uninterrupted recovery after his rather harrowing experience. Dr. Dalton wrote, "I had no precedent to guide me, no authority to uphold me . . . However, I thought then, and still think, that my patient had a better chance for recovery after the wound was closed.T' -Librarian and Professor of Medical Bibliography, Northwestern University Medical School, Chicago.
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six of them showed up for this event. Provident Hospital had been founded just two years before, and it was still in a remodelled house, its original building. The operating room was a small converted bedroom, and the scene can be imagined with seven physicians and several nurses crowded into this room around the patient; the heat must have been stifling. Dr. Williams reported the operation in the following words : The original wound was lengthened to the right as far as the middle of the sternum. A second incision was made from the centre of the first and carried over the middle of the cartilage and fifth rib , about six inches in length. The sternum, cartilage, and about one inch of the fifth rib were exposed. The cartilage of the fifth rib was separated at its junction with the sternum and at a point two and one-half inches from the sternum and one-fourth of an inch from its attachment to the rib . The inferior attachments of the incised piece were separated, leaving the supe rior ones in place. The incised piece was reflected upward, making an opening about two inches long and one and one-half inches wide, bringing the internal mammary vessels into view . These vessels we re ligated above and below with small catgut. This large opening permitted easy ligation and manipulation. To secure additional room an incision was made in the fifth intercostal space. The heart and lung being depressed backward, a small punctured wound of the heart, about one-tenth of an inch in length and about one-half of an inch to the right of the right coronary artery, between two of its lateral branches, was seen . The wound in the pericardium was about one and a quarter inches in length. There was no hemorrhage from the heart or pericardium. The edges of the percardium were held by long smooth forceps, and a continuous suture of fine catgut was made. Before the pericardial wound was closed it was irrigated with normal salt solution. The temperature was 100· F. Catgut was used in closing the intercostal and subca rtilaginous wounds and silkworm gut in the cartilages and skin . A few silkworm-gut sutures were left long in the external wound, so as to permit easy removal , in case it should be necessary, on account of infection or hemorrhage. A dry dressing was applied.s
Cornish (Fig 1) suffered a few postoperative complications. Paroxysms of coughing and hiecoughing on the second day were threatening, and the accumulation of fluid in the pleural cavity eventually forced an operation on August 2 when 80 ounces were removed. Infection of the pleural cavity had been prevented by causing the fluid to flow under several layers of sterile gauze which were kept wet by a stream of water. This kept the pressure in the cavity sufficiently high to prevent any inrush of infecting agents . After the operation Dr. Williams was puzzled by his failure to realize the depth of the stab wound. He experimented with several cadavers and demonstrated that this type of wound in that area always seals itself off by the elasticity of the cartilage. Dr. Williams ' dramatic operation soon became public knowledge through newspaper" and word-of-
FIGURE
1. James Cornish after the operation.
mouth reporting. Cornish left Provident on August 30, and he was known to be in good shape 20 years after the operation. Williams accomplished several important things with his suturing of Cornish's pericardium. He proved that the thoracic cavity was suitable territory for surgical intervention, and his practical example knocked some of the force out of the dogmatic assertions made by several leading surgeons. Surgical intervention in and around the heart faced both psychologic and technical barriers in the second half of the 19th century. However, this area was bound to come under the surgeon's scalpel eventually. In October, 1872, George Callender, an English surgeon at St. Bartholomew's, had extracted a two-inch needle that had stuck in the heart of a 31year-old man during a bar-room brawl. The patient made an uneventful recovery, but whether he continued to carry a needle in his lapel is not known. 6 Ten years later a surgeon in Danzig, Block, did some experimental suturing on the hearts of several rabbits. He was so successful .that he attempted to remove some tuberculous tissue from the lungs of a young woman relative. The woman unfortunately died on the operating table. When the postmortem showed no evidence of tuberculosis, Dr. Block became so upset that he committed suicide. CHEST, VOL. 60, NO.2, AUGUST 1971
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DANIEL HALE WILLIAMS In September, 1895, Axel Cappelen of Kristiania (now Oslo) repaired a I-inch wound in the left ventricle of a patient who died two days later. Guido Farina of Rome sewed up a 7-mm wound in the right ventricle of a patient in March, 1896, but that patient also died, eight days after the operation. Success on the heart itself was finally achieved by Ludwig Rehn of Frankfurt am Main, in September of 1896. He sewed up a 1.5 em wound in the right ventricle of a patient who was still alive ten years later. Rehn followed up on this milestone and could in 1907 report a 40 percent success rate on 124 patients. 7 The first surgeon in this country to perform a successful suturing of the heart was Luther Hill of Montgomery, Alabama.f Dr. Hill, with the assistanee of six colleagues (including his brother), sewed up a wound in the heart of a 13-year-old boy. This operation, September 14, 1902, took place on a table in the family's cabin. One of Luther's children, Lister, later achieved fame as a United States Senator. Interestingly enough, five years earlier Dr. Hill had, at an operation in his home, successfully removed a 2" inch needle accidentally driven into the heart of an eight-year-old girl. 9 A "filler" at the end of the article reporting this case noted that the Vermont legislature had just passed a bill prohibiting the sale of cigarettes in that state. Daniel Williams was involved in several other surgical operations of considerable interest in addition to his repair of the stab wound in Jim Cornish's pericardium. At the end of July, 1902, Williams performed one of the earliest successful sutures of the spleen in this country. The first, duly referred to by Williams in his paper, was reported by Tiffany of Baltimore in 1894. Williams' patient, a 27-yearold man, had been stabbed through the eighth interspace. Upon operation Williams was confronted with a profusely bleeding spleen : My first attempt at suture ended in complete failure by tearing out as I endeavored to draw the suture down. I therefore changed my method by selecting a full, curved, round Mayo needle threaded with No. 2 catgut. This I introduced one-half inch from the margin of the wound edges, and without the least force allowed the needle to follow its full curve, emerging from the opposite side of the wound the same distance as it entered, and making a triple loop without a reenforcing knot. Hot gauze compresses were held on each loop as the edges were approximated, with the idea of causing the catgut to swell and engage opposing fibres, so as to make 'a finn line . Every suture put in in this manner held firmly. After watching it for twenty minutes, I returned the spleen to the abdomen, and surrounded it with omentum, a very important part of the detail, on account of its well-known property of protection. The patient made a rapid and perma-
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nent recovery. He left the hospital in three weeks.l 0
Following this account Dr. Williams gave a brief description of the work by Lamarchia, Madelung, Berger, and Senn. Once again, his detailed knowledge of the medical literature was evident in support of his innovative surgery. In this same paper Dr. Williams reported two more successful cases of surgical treatment of wounds in the thorax . When Dr . Williams was at Freedmen's Hospital in Washington (1894-1898) he had many opportunities to see both black and white women with ovarian cysts. Most gynecologists had held that black women did not have ovarian cysts, and Williams, in the paper- ! reporting his own experiences which effectively refuted this belief, quoted Thomas Brown at Johns Hopkins, "One frequently hears surgeons say: 'The tumor before us presents all the features of an ovarian cyst, but inasmuch as the patient is a negress, it is certainly not so, but a tumor of different origin (cystic myoma, etc), as multilocular cysts are unknown in the negress.''' After a thorough reporting of the earlier literature, which included work by Rudolph Matas and Howard Kelly, Williams pointed out that in his 357 operations on women of both races the number of fibrous tumors in each was almost equal. A slight gleam of humor runs through this paper since Williams was able to see both the ridiculous and scientific sides of the situation. Perhaps Williams' interest in continuing education was in part caused by his own difficulties in obtaining both his early schooling and his medical education. Daniel Hale Williams was born on January 18, 1856, at Holidaysburg, a small town in south central Pennsylvania.t s His parents, Daniel Williams, [r., (Fig 2) and Sarah Price Williams, (Fig 3) were black with admixtures of Shawnee and Delaware Indian and several white strains,
FIGURE 2 (left). Daniel Will iams, Ir., father of Daniel Hale Williams, (by permission of Pitman Publishing Co.). FIGURE 3 (right) . Sarah Price Williams, mother of Daniel Hale Will iams, (by permission of Pitman Publishing Co.) .
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primarily German and Celtic. Both parents showed the black and Indian strains more evidently than did young Dan, who was pale and red-haired, and this closeness to the whites was later used by several antagonistic black physicians and lay people who vigorously opposed some of Dan's medical and social activities. Dan's father and mother were from free families and his father was fairly well off. Unfortunately the father died when Dan was 11, and his life became much less secure and pleasant. Dan's mother apprenticed him to a shoemaker in Baltimore, and took two of Dan's six brothers and sisters out to live with relatives in Rockford, Illinois. Dan's life for the next few years was one uprooting after another. At 17 Dan and a sister, Sally, settled in Janesville, Wisconsin. Dan got a job at Harry Anderson's Tonsorial Parlor and Bathing Rooms and Sally worked at a hair stylist's. Anderson was so favorably impressed by Dan that he took both children into his house. Sally married shortly after this and moved away. Harry Anderson was able to help Dan through high school using him. on the guitar and as a tenor in Anderson's string band. Anderson kept up his financial aid when Dan went on to medical school. After graduating from the Classical Academy in Janesville in 1877 Dan tried his hand at law. He was eventually drawn to the town's most prominent doctor, Henry Palmer. Palmer recognized Dan's insatiable curiosity and personal drive and took him on as an apprentice in 1878. Dr. Palmer had received an education and experience above the average of his time, and he was able to impart to . young Dan both a practical and a philosophic knowledge which included an awareness of social· trends. In the fall of 1880 Williams and two other apprentices were ready to enter medical school. Chicago was the most likely place; Rush Medical College and Chicago Medical College (affiliated with Northwestern University) were the two top schools. Rush required two five-month terms, Chicago required three six-month terms. The. three apprentices were all accepted at the Chicago Medical College. Thanks to the irregular but vital help of Harry Anderson and the assistance of Mrs. John Jones, the wealthy widow of a black physician, Williams made his way through medical school. His three years were dogged with illness, financial problems, and hard work but he was one of the three dozen members of the graduating class in March, 1883. The first problem that. Dr. Williams had to face after graduation was the straightforward question,
WILLIAM K. BEATTY where could a black physician practice? The second was broader. When Dr. Williams opened his office in Chicago at the comer of 31st Street and Michigan Avenue there were three black physicians already in practice in the city. Chicago was not divided into black and white areas, but problems arose concerning hospital appointments, the availability of black assistants, and the psychologic comfort of black patients. Although Williams drew his patients from both black and white communities he was well aware of these problems. The Rev. Louis Reynolds, pastor of St. Stephen's African Methodist Episcopal Church on the west side of Chicago, provided the spark that turned Dr. Williams' thoughts into action. On a December evening in 1890 he asked Dr. Williams over for some advice about his sister, Emma, who wanted to become a nurse. Emma had applied for admission to the local training schools but had been turned down by them because of her color. This situation moved Williams into responding not only to Emma's problem but to others as well. He decided to establish an interracial hospital to provide for the patients who were not receiving adequate care elsewhere and to give staff privileges and experience to young black physicians. The training school to take care of Emma (and many others) would be attached to the hospital. When that decision was made all that Williams had left to do was to provide land, a building, staff, equipment, and continuing financial support. Individuals and groups, both black and white, were soon stirred into action by means of private prodding and public meetings. The key to the success of the program, besides just plain hard work, was the setting up of the Provident Hospital Association to which all donors automatically belonged (whether they gave money or other gifts, eg, clothes wringers, lace for the nurses caps). Dr. Williams was tireless in· his efforts and gave innumerable formal speeches and informal talks, as well as making effective personal calls on P. D. Armour, H. H. Kohlsaat, and other wealthy Chicagoans. Sufficient funds were finally collected to make possible the purchase of a three-story brick building at Dearborn and 29th Street. This was fitted out with 12 beds. The articles of incorporation were signed for both the Provident Hospital and the Training School Association on January 23, 1891. The top signature line on the document was symbolically left blank because Dr. Williams was called away during the ceremony to take care of a ·patient. Provident Hospital opened for service on May 4, 1891. This child of Dr. Williams' social conscience CHEST, VOL. 60, NO.2, AUGUST 1971
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and personal effort was to occupy a large proportion of his life for the next 20 years. Both the staff and the patients included blacks and whites, and Dr. Williams also drew on the support of Frank Billings, Christian Fenger, and other well-known men as consultants. The question of staff appointments, however, caused some problems since there were few black physicians who could meet the high standards set by Dr. Williams. He appointed Charles Bentley as the oral surgeon and Allen A. Wesley as the gynecologist. Austin M. Curtis was given the one internship. Trouble arose in the person of George C. Hall who aggressively sought an appointment despite his lack of qualifications in terms of Dr. Williams' requirements. A compromise was reached, but Hall never forgave Williams and was a thorn in both his private and professional lives for many years. The Training School opened up an exciting new possibility for young women in the area, and 175 applicants applied for "the first class. Dr. Williams selected seven of these, and then put them through an 18 month course that not only taught them nursing but also a good deal about psychology and life. With the Hospital, Training School, and a rapidly expanding practice Williams had his hands full, but his desire to keep up with advancing medical science caused him to enroll in one of the early courses in bacteriology given at the Chicago Medical College. The general depression of 1893 had its effect on Provident, and- the Hospital and School were almost driven to the wall. However, as a result of redoubled efforts by Williams and others, George Webster and some of the other individual donors made substantial increases in their support. Some moraleboosting was involved too, and when Frederick Douglass gave a well-publicized lecture at the World's Fair and donated the proceeds to Provident in person no harm was done to either the Hospital's finances or to its public image. Provident soon became busy and filled to capacity, and the need for new quarters was pressing. Kohlsaat gave some land on the comer of Dearborn and 36th, a location now served by the modem cable cars instead of the old fashioned horse cars. Armour paid for the new building, and a new 65bed hospital was in operation by the end of 1896. This location eventually included an outpatient clinic that handled 6,000 patients a year, and a nurses' home. The latter. building was erected on land donated by George Pullman, Marshall Field, and Otto Young. Toward the end of his life Dr. Williams initiated CHEST, VOL. 60, NO.2, AUGUST 1971
179 a campaign for a new building, and a 167-bed, seven-story structure, with four-story clinic, was finally completed in 1936, five years after his death. Although Williams' mental and professional horizons were not narrow he might have been content to remain at Provident for the rest of his life if a new challenge had not been dropped into his lap. Judge Walter Q. Gresham had been a friend of Williams for many years. When the second Cleveland administration took office in 1893 the aging Gresham agreed reluctantly to serve as Secretary of State. In a reverse twist of Gresham's Law (bad money drives out good) he urged Williams to apply for the position of Surgeon-in-Chief at Freedmen's Hospital in Washington. Freedmen's was a product of the Civil War and had begun its institutional life as a combined asylum and hospital for the blacks who had poured into the capitol seeking refuge from the war and its ramifications. 1 :-l Freedmen's had a unique position as the oldest institution in the country with the major objective of providing patient care and professional training for blacks. With this institutional standing, and its location at the "center" of the country, the opportunities were evident to the 37year-old Williams. Daniel Williams devoted much thought to the judge's arguments, and finally agreed to become a candidate. Problems arose immediately. The incumbent, Dr. Charles B. Purvis, was not only the first black to hold this position but he had been in it since 1881 and was well-entrenched. Purvis pulled all the strings that were available, both aboveboard and underhand. The situation was complicated further when Dr. Williams accidentally shot himself in the foot while on a quail hunt. An infection set in and made it impossible for Williams to go to Washington immediately after his appointment in February, 1894. The infection worsened and an amputation became imminent. Christian Fenger was called in, was able to save the foot, and make it possible for Williams to visit Washington briefly in May. Unfortunately, further complications developed and Dr. Williams did not finally take over his new post until the middle of September. During the seven months since Williams' appointment George Hall and some of his friends, as well as Charles Purvis, Williams' predecessor, had been busily at work. Seeds were planted in political circles for later flowering, newspapers were used as vehicles for lies and half-truths, and the support of leaders in the black communities was sought. Williams' weathered these storms for a while, but their
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cumulative effect eventually drove him back to Chicago after four hectic but productive years in Washington. What did Dr. Williams find when he arrived at Freedmen's? Physically, the buildings were in mediocre to poor condition, and were certainly not designed for use as a hospital. The 'separate structures were scattered over the site, and the moving of patients, even in the best of weather, was neither logical nor therapeutic. Administratively, the situation might have been described as rather loosely structured chaos. Several federal and local agencies, as well as the Howard University Medical School, were either struggling for control or else were reluctantly accepting it by default. Dr. Williams as Surgeon-in-Chief could control neither the admission nor the discharge of patients. The professional staff, which was minimal, was both poorly trained and insufficiently motivated. The nursing staff consisted primarily of "mammies" who stood in the center of the wards periodically and shouted, "All you 'leven o'cloekers, take your medicine." They and the attendants were mostly illiterate, often drunk, and seldom as interested in their human patients as in their monetary pittance. The death rate under Purvis had been 10 percent in good years. Dr. Williams went to work energetically but had to channel his efforts carefully because of the explosive political and social conditions. He first reorganized the staff and made it interracial. Then he created an advisory board of outstanding physicians for both their professional and political help. The next step was to establish a training school similar to the one that had been so successful at Provident. Purvis, from his position on the Howard faculty, kept up his sniping, in part through a "training school" for nurses that he had started just before he had been dismissed from Freedmen's. This program met for two evenings a week and was not overly effective. The two schools were kept running side by side for several months until Williams was finally able to close the evening version down for good. Williams had over 500 applicants to choose from for his first class, selected 59 probationers, and allowed 46 of those to embark upon the full IS-month. program. Since postgraduate training was a great need for black physicians Dr. Williams began an internship program with four men in the first group. Freedmen's became an important source from which black physicians went out to various parts of the country to improve the quality of care for both black and white patients.
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Little could be done about the physical plant, but Williams was able to improve the operating areas and eventually to provide a covered way to them from the wards. He had thelarge area on which the buildings were located kept clean and brightened up with flowers. What was really needed was a single building that was both new and functional. Most of the Howard Medical School faculty was slowly won over by Williams' capable professional work and by his persistent efforts for improvement. The local medical society was another matter, and the only solution that would provide the black physicians with the vital stimulus of professional meetings turned out to be the founding of an interracial society. This was done by three white and five black physicians and the Medico-Chirurgical Society of the District of Columbia was established in January, 1895. This took care of the local scene, but nationally black physicians still could not join a country-wide medical association. After much preliminary effort the National Medical Association was founded in Atlanta in December, 1895. Dr. Williams was offered the presidency and declined although he did accept the vice-presidency. The Republican victory in 1896 had as one of its ripples the almost certain removal of Dr. Williams. This more or less normal political condition was complicated by the Secretary of the Interior, Cornelius Bliss, who announced a civil service exam for Williams' post on the basis that he had already resigned, and by Senator James McMillan, Republican from Michigan and chairman of a joint committee to investigate charitable and reformatory institutions in the District of Columbia, who announced that his committee was going to investigate Freedmen's. As a final straw Dr. William Warfield, one of the early interns at Freedmen's and later Williams' first assistant surgeon, went to the hospital's Board of Visitors and formally charged Dr. Williams with the theft of hospital materials. The civil service exam was held early in 1897 with the following results: Dr. Charles I. West, Washington, 91:50; Dr. Austin M. Curtis, Chicago, 79:10; and Dr. James A. Wormley, Newark, 76:05, Curtis, the man with the second highest score, was selected when Williams resigned in February, 1898. Mrs. Curtis had supposedly been quite helpful to Mark Hanna when he was chairman of the Republican National Committee. Dr. Curtis was Chief until 1901, and then William Warfield finally achieved his goal and served for 35 years. Senator McMillan's investigation dragged on for some time, and considerable political mileage was made by both sides. Williams received substantial CHEST, VOL. 60, NO.2, AUGUST 1971
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FIGURE 4. Alice Johnson, about 1890, (by permission of Pitman Publishing Co. ).
help from the Rev. Jeremiah Rankin, President of Howard University, who gave some forthright testimony. Rankin had earlier shown his confidence in Dr. Williams by drawing on him as a physician for the Rankin family. The Committee finally made a report in June, 1898, which emphasized the problems between Howard and Freedmen's and assailed Dr. Williams for his lack of administrative ability. Warfield's charges of theft led to several dramatic scenes and apparently were deeply felt by Williams . The Board of Visitors held hearings on these charges in July, 1898, and Warfield had a field day . He accused his previous chief not only of stealing instruments and books but also of suggesting the sale for personal gain of unclaimed bodies of hospital patients. The Board eventually exonerated Williams, but the affair was a trying and disillusioning experience. One positive result of Williams' four years in Washington was his marriage with Alice Johnson (Fig 4) on April 2, 1898. The Rev. Jeremiah Rankin officiated at the Johnson home. Daniel (Fig 5) and Alice had met shortly after his arrival in Washington, and he had operated on Alice's mother in May, 1.897. After the wedding the Williams moved to Chicago and Dr. Williams settled back into his old office at 31st Street and Michigan Avenue. What should have been a pleasant and reasonably relaxed professional and social life was, however, turned into a turmoil by both Dr. George Hall and his aggressive wife, Theodocia, and by controversies centering around Booker T. Washington. CHEST, VOL. 60, NO.2, AUGUST 1971
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George Hall finally achieved his goal in 1912 when Williams resigned from the staff at Provident. Williams had been an attending surgeon at Cook County Hospital for a number of years, and when he was appointed an associate attending surgeon at St. Luke's early in 1912 Hall used this as an indication of "disloyalty" to Provident. During his second stay in Chicago Williams made many visits to Meharry and other schools and hospitals in the South to do clinical and educational work. These events were among the most satisfying in his career, and they had an incalculable effect on the improvement of medical education and care for black physicians and patients. While most of his publications dealt with surgical procedures and reports, one of the more thoughtprovoking papers Dr. Williams gave dealt with a subject of interest to both the medical and legal professions, the malingerer. 14 In this talk, presented at a meeting of the Surgical Association of the Chicago & North Western Railway held at Rochester, Minnesota, late in 1915, Williams drew attention to the various pressures felt in a malingering situation and stressed the social and ethical problems involved. The effects of a long and active life were beginning to tire Daniel Williams and, after some searching, he found a pleasant spot near Idlewild in Lake County, Michigan. His home, Oakmere, was in an area wooded with pine and oak and with a fine view over the lake. His wife, Alice, succumbed to Parkinson's disease four years after they moved to
FIGURE 5. Daniel Hale Williams, while Surgeon-in-Chief, Freedmen's Hospital, 1894-1898, (by permission of Pitman Publishing Co. ).
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Michigan. Dr. Williams continued his practice until diabetes and a stroke forced him to spend most of his time sitting on his porch, looking outwardly over the beautiful landscape and inwardly over his many and varied memories. The last five years of his life were a sad period of mental and physical deterioration, but death finally released him on August 4, 1931.
Dr. Williams received both direct and indirect honors during his lifetime. One of the major public recognitions of his work and standing came when he was chosen in 1913 as a charter member of the American College of Surgeons, the only black so honored. His life, however, had more than its share of tragedy and disillusionment, and it could, in one sense, be symbolized by his long-time enemy, George Hall, who once vowed heatedly, "Curse him! I'll punish him worse than God ever will. 111 see he's forgotten before he's dead." 1 :s REFERENCES
2
3 4 5
Williams DH: Stab wound of the heart and pericardiumsuture of the pericardium-recovery-patient alive three years afterward. Med Rec 51 :439, 1897 Dalton HC: Report of a case of stab-wound of the pericardium, terminating in recovery after resection of a rib and suture of the pericardium. Ann Surg 21: 148, 1895 Dalton, Ref. 2, p 151 Williams, Ref. 1, pp 437-438 The Daily Inter Ocean, 1893, July 22, col 3 p 8 .
6 Richardson RG: The Surgeon's Heart; a History of Cardiac Surgery. London, Heinemann, 1969, pp 25-32 (Richardson also provides useful information on Block, Cappelen, and Rehn) 7 Johnson SL: The History of Cardiac Surgery, 1896-1955. Baltimore, Johns Hopkins, 1970, p 6 (Johnson has good material on Rehn and Hill). 8 Hill LL: A report of a case of successful suturing of the heart, and table of 37 other cases of suturing by different operators with various terminations, and the conclusions drawn. Med Rec 62:846-848, 1902 9 Hill LL: Wounds of the heart with a report of 17 cases of heart suture. Med Rec 58:921-924, 1900 10 Williams DH: Penetrating wounds of the chest, perforating the diaphragm, and involving the abdominal viscera; case of successful spleen suture for traumatic haemorrhage. Ann Surg 40:682-683, 1904 11 Williams DH: Ovarian cysts in colored women, with notes on the relative frequency of fibromata in both races. Chicago Med Rec 20:47-57, 1901 (The discussion of this paper by Dr. A. ]. Ochsner is summarized on pp 100101) 12 Buckler, H: Daniel Hale Williams: Negro Surgeon. (2nd ed) New York, Pibnan, 1968 (Much of the personal information about Williams comes from this well-written biography) . 13 Cobb WM: A short history of Freedman's hospital. J Nat Med Assoc 54:271-287, 1962 14 Williams DH: The malingerer. Railway Surg J 22:443446, 1915-1916 (Discussion of this paper is on pp 446448) 15 Buckler, Ref. 12, p 269 Reprint requests: Mr. Beatty, Northwestern University Medical School Library, 745 North Fairbanks Court, Chicago 60611
Adversities Encountered in Music Appreciation The Russian composers, and Tschaikovsky (18401893) chief among them, were the discoverers of a musical universe, the novelty of which may nowadays elude us. Tschaikovsky was a solitary, whose music is shot through with a dark passion which it is hard not to relate to his private struggles. He was greatly attracted to the lithe, sensuous music of Bizet and the polished grace of Saint-Saens, though it is evident that the spirit of those composers was boldly transformed in his own more deeply colored music. He was also blessed with the gift for the most generous fonn of melody, a gift which his detractors frequently refuse him on the ground that he was a gushing sentimentalist, an exhibitionist with no ideal of restraint. It is here that Tschaikovsky can easily be misjudged. There is a big heart in his music, but he
was not gross or insensitive. Mozart, another of his few
links with the West, was his ideal-as also seemingly unMozartian composers, among them Gounod and Richard Strauss. And, in fact, there is many a passage in Tschaikovsky which is exquisitely Mozartian in detail and subtlety. Nevertheless, Bernard Shaw in his days as music critic wrote that "Tsehaikovsky had a thoroughly Byronic power of being tragic, momentous, romantic about nothing at all . . . like Childe Harold, who was more tragic when there was nothing whatever the matter with him than ordinary Englishman when he is going to be executed." Sargeant, M and Cooper, M (editors): The Outline of Music. New York, Arco, 1963
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