| INTRODUCTION MARVIN J. STONE, MD:
Good morning. Last month Dr. John Fordtran delivered the
Alpha Omega Alpha lecture at Southwestern Medical School.
For those of you who may not know, AOA is the national
honor medical society to which top medical students are
elected in recognition of superior scholarship. Many
members of our own medical staff are members of AOA. In
addition, some of the newly elected medical students will
be joining our housestaff in July.
For a long time I've thought it interesting to observe
the subjects selected by esteemed colleagues when they
have the widest possible latitude, that is, the topic of
their choice. John chose to speak about medicine in
Dallas 100 years ago at the AOA banquet. We are fortunate
that he has agreed to give this talk again at Baylor this
morning. Now, do not think that the subject he selected
was accidental. It was arrived at after much
contemplation. Most of us know John as the chief of
medicine at Baylor for 17 years and current president of
the Baylor Research Institute. I shan't dwell on some of
his other activities, such as being acknowledged as one
of the leading investigators and educators in
gastroenterology, or being one of the 2 founding editors
of the best textbook on gastroenterology, or being
awarded virtually every prize given in the field as well
as several honorary degrees. During the past year, he was
elected to fellowship in the Royal College of Physicians
of London.
Despite these considerable accomplishments and
worldwide recognition, I submit that John Fordtran's
principal interest is medical history. Why? Not just
because of the topic chosen for his AOA lecture, which
you will hear this morning. There is in fact precedent
for my claim. Twenty-one years ago, almost to the day,
John delivered the presidential address at the annual
meeting of the American Society for Clinical
Investigation, another occasion when he could have spoken
on any topic he wished. He chose to speak on the life and
career of Samuel James Meltzer, founder and first
president of that august organization, which was
established in 1907. Ladies and gentlemen, the evidence
is overwhelming. It is a pleasure to introduce John
Fordtran, sometime gastroenterologist, but really eminent
medical historian!
JOHN S. FORDTRAN,
MD: Thank you, Marvin, for that wonderful introduction
and for your own interest in medical history and for the
effort you have made to teach the history of medicine to
our students, residents, and staff. Today, I will try to
describe what medicine was like in Dallas 100 years ago.
Actually, the time frame to be discussed is from 1890
through 1920, and I will also say a few words about the
removal of Baylor College of Medicine from Dallas to
Houston in 1943.
THE CITY OF DALLAS 100 YEARS AGO
In 1850 the population of Dallas (originally called
Peters' Colony) was about 400; by 1910 it was about
100,000. The growth was exponential (Figure 1).
Some of the things that happened along the way are noted
in the figure. In 1895, the Dallas Morning News
conducted a survey to determine why Dallas had grown so
much. The State Fair was mentioned prominently. The
certainty of Trinity navigation was high on the list;
that unfulfilled dream was one of the most important
things that built this city. Other things mentioned
included the Oriental Hotel, the railroads, the Dallas
Morning News itself, the city's location and
resources, the Commercial Club, low taxation, and
manufacturing. The major need was thought to be good
streets and sidewalks. The dirt of Dallas when it was wet
was described as closer than a brother, and it was simply
impossible to do things well when the streets were wet.
In 1890, Dallas was roughly the size of present-day
Park Cities (Figure
2). Oak Cliff existed, but it was not part
of Dallas until 1903. If you do a blowup of any part of
the map, you will see that the streets are almost
identical to those of today. The major change is that
most of the railroads have been replaced by freeways,
with the exception of Pacific Avenue, where the Texas and
Pacific Railroad has not been turned into a freeway. Figure 3 shows
some scenes from this period.
MEDICINE IN THE USA
The “regular”—or
predominant—doctors who practiced in the 19th
century were followers of Benjamin Rush. He believed that
all diseases were due to a morbid excitement induced by
capillary tension. The one remedy was depletion of the
body fluids by bloodletting to the point of
unconsciousness, and calomel (mercurous chloride) to
empty the stomach and the bowels. The resulting vascular
collapse counteracted the presumed capillary
hypertension. That's why the name “allopathic”
(“cure by opposites”) was applied to these
physicians. There were some smaller groups of
doctors—homeopaths and eclectics. They were called
“sects” because they were fewer in number.
In the 19th century physicians were generally held in
low esteem. But between 1890 and 1910 there were
impressive scientific advances. They included practical
methods to measure blood pressure and temperature,
standardized eye tests, electrocardiograms and x-rays,
chemical and bacteriological tests, diphtheria antitoxin,
vaccines for rabies and typhoid, the Wasserman test, and
Salvarsan (“606”) for syphilis (developed by
Erhlich). These scientific developments markedly advanced
the practice of medicine as well as the standing of
physicians, which reached its peak in the 1920s.
The American Medical Association (AMA) became all
powerful between 1890 and 1920. It had a Council on
Pharmacy and Chemistry, which regulated the
pharmaceutical industry. It had a section for New and
Official Remedies. The AMA also changed the focus of
advertising. Earlier, companies advertised directly to
the public. The AMA was able to stamp that out, allowing
only advertising directly to physicians. The Council on
Medical Education had the force of law, and the state
licensing boards followed what the AMA wanted. The result
was steadily rising standards.
MEDICINE IN TEXAS
A source of information about Texas medicine 100 years
ago is Dr. Pat Nixon, who carefully analyzed everything
that happened in the Texas Medical Association (TMA) from
its founding in 1853 up to 1953. In a talk at the TMA in
1890, Dr. Ramsdale of Lampassas said, “The
profession of medicine in the United States is
sick.” Among the “deforming growths upon the
fair body of medicine,” he mentioned homeopathy,
eclecticism, so-called acupuncture, and “Wilford
Hall's method of rectal irrigation.” He thought
better education of doctors was the cure. “The young
man who left the plow or the yardstick and does not know
Greek from Choctaw when he saw them in print” could
not be expected to make a good doctor. His point was that
Texas doctors were an uneducated lot, usually less
educated than the patients they were treating.
In 3 Dallas meetings of the TMA held between 1886 and
1902, some of the highlights were as follows:
- Opposition to a bill
proposing “regulation of the practice of
medicine”
- Expulsion of Dr. M. Salm of
Austin for gross plagiarism and seduction of a
young lady under grave circumstances
- Defense of animal
experimentation
- Dismissal of the teachings
of Darwin and Huxley
- Papers, including Texas
quackery, early blistering in pneumonia,
prophylaxis in smallpox, malaria, typhoid,
tuberculosis, insanity, enlarged prostate,
glaucoma, and menstrual disorders in schoolgirls
- Antiseptics
- Diphtheria antitoxin, which
had only recently been proposed in 1895
In 1886, the TMA's Special Committee on Surgery
reported on the results of 4293 operations done in Texas.
Mortality rates were as follows: trephining, 15%;
splenectomy, 100%; herniotomy, 26%; hysterectomy, 92%;
and transfusion, 75%. The committee concluded that these
were excellent results, showing that Texas doctors could
operate as well as anyone else in the country. Texas
surgeons in this survey used chloroform over ether 35:1,
in spite of the fact that ether was discovered before
chloroform. But ether had a bad smell. It was later found
out that chloroform is a myocardial depressant, and some
of the surgery-associated deaths in Texas at this time
were probably due to toxicity from chloroform.
MEDICINE IN DALLAS
According to Giles, Dallas doctors in the 1890s had
not accepted the germ theory, even though Lister had
published an article in the Lancet 20 years
earlier describing the value of antiseptic techniques in
surgery. A Dallas doctor used the example of a person who
survived a surgical procedure under contaminated
conditions as evidence that the germ theory was just a
fad. Quinine, the cupping glass, and strong emetics were
the universal cures.
Requirements for practice were meager. All a person
had to do was come to town, say he was a doctor, and
register with a health officer, and he was allowed to
practice medicine. No degree was needed.
Sanitation was poor but improving. Livestock were
forbidden on the streets, except for milk cows, which
were permitted from 8 am to 6 pm. There were many fever
scares but no recent epidemics of any significance.
Dallas had a City Hospital, which originally was on
Wood and Houston Streets and in 1875 was moved to
Columbia and South Lamar. A health officer visited
patients there once a day. Patients with life-threatening
illnesses who were about to die were in the same room or
ward with people who were likely to live through their
illness. These buildings were in terrible condition. They
stood in water when it rained. They had no bathrooms and
only a swinging light. Surgery was done right in the
middle of the ward. They were in a very bad part of town.
It was said that when a doctor visited the hospital he
carried a large bag to let it be known that he was a
doctor, and ministers going there carried an oversized
Bible.
There were also pest houses, one on Main Street and
another on Good Street. Any time a person was found with
a contagious illness, like scarlet fever, the whole
family would be forced to move into these pest houses. If
a fever or an epidemic occurred somewhere else in the
state, posses would ride out into the roads, intercept
any incoming traffic, and quarantine people suspected of
having the illness in the pest house until it was proved
they didn't have the illness or until they died. There
was absolutely no medical care in the pest houses.
Charles Rosser's description of medicine in Dallas in
the 1890s is interesting. He said the city was taking on
artificial airs. A silk top hat and a Prince Albert coat
were everyday regalia for Dallas doctors. He was
compelled to borrow money for a handsome horse and an
elegant rig because a doctor without those wouldn't be
appreciated. There was a lot of competition for the
patients who could pay for a doctor's care. The few
people who could pay wanted a doctor with a good horse
and a good rig. He also bought a saddler, a good swimming
horse that could cross creeks. His office was in a drug
store. Surgery and deliveries were done in the home.
There was no inkling that “childbirth fever”
was introduced from without and that radical
instrumentation was poisoning the patients. It was a
common practice to radically instrument women about to
undergo delivery, apparently to promote cervical
dilatation. There was no washing of hands or cleaning of
dirty fingernails prior to delivery or surgery. No rubber
gloves were used. (These weren't described until about
1910 by Halsted at Johns Hopkins, who developed rubber
gloves for a nurse who was allergic to powder used during
surgery.) Rosser hadn't heard of appendicitis at the time
he moved to Dallas, even though it had been described by
Reginald Fitts in about 1885.
PARKLAND AND ST. PAUL'S HOSPITALS
A series of health officers complained about the
terrible conditions of Dallas hospitals. One in
particular, V. P. Armstrong, finally got the attention of
the city council and other people in power, and a new
hospital was built. It was opened and inspected by the
mayor on May 16, 1894. The building was a modern one in
all appointments and furnishings. It had private
apartments, and it was built on a beautiful park. This
was the new City Hospital. The city officials, from the
mayor down, were at the opening. Dr. Armstrong was
described as being prouder than a Spanish hidalgo. He led
the way through the wards and explained the uses and
conveniences of the appliances. There was champagne and
there were many speeches. Dr. Armstrong said that he was
not a pessimist. On the contrary, he “believed the
world was growing better and that this building marked
the progress of the city and the advance of charitable
feelings.” Because the hospital was on park land, it
became known as Parkland Hospital (Figure 4).
Its first-class status did not last for long. In April
1910, the Dallas County Medical Society passed the
following resolution:
The present site is so
inaccessible that emergency care is jeopardized. The
building is without modern construction, unsanitary
and insecure against wind and fire. The dictates of
humanity command that those unfortunates . . .
required to accept charity at our hands, shall have
as safe and as scientific care as more favored
classes. . . .
The cornerstone for a new Parkland Hospital on Oak
Lawn and Maple was laid on March 18, 1913, and the
hospital was completed on February 1, 1914, with a
capacity of 100 beds. The old frame hospital was used for
isolation purposes until 1918, when it was destroyed by
fire.
St. Paul's Hospital (Figure 5)
was opened in 1897, and it is the oldest privately
supported hospital in the city. It established a school
for nursing in 1900. It offered “to care for the
sick and indigent of all classes, races, and creeds . . .
without prejudice.” It was open to all physicians,
and that was a significant departure from tradition
because the small sanitariums around Dallas at the time
were owned by individual doctors, and only the owners
could use the facilities.
CHARLES ROSSER AND MEDICAL EDUCATION
Charles Rosser (Figure
6) was born in Georgia in 1862, went west
with his family in 1865, and settled in what is now
Pittsburg, Texas. He lived near the “Big Road,”
a highly commercial road between Dallas and Jefferson. As
a boy he would hang around the road and talk to the
people passing by. After finishing his education in the
local schools, he “read medicine” with Dr.
Edwin Becton of Sulphur Springs. This was a prerequisite
for getting into the better medical schools. Rosser would
see patients with Dr. Becton and read books that he'd
been assigned. With his preceptorship certificate he was
then allowed to attend the University of Louisville
Medical Department for 2 terms. Two terms of medical
school were required to get a degree, but the second year
was a repeat of the same lectures heard the first year.
Rosser set up practice in Waxahachie. From Waxahachie,
he began to attend meetings in Dallas, and he moved here
in 1889. Rosser was an outstanding orator. He moved to
Dallas when he was 27, and he began to give talks, which
often were quoted in newspapers. One of his talks was
“the purchase of the West Indies as a sanitary
measure.” He thought that the way to eliminate
yellow fever was to buy the West Indies. I don't know
what he was going to do with it after he got it, perhaps
a quarantine. He gave talks against cultism,
chiropractors, and Christian Science. He gave a talk
about overspecialization, which he delivered entirely in
rhyme. He often wrote poetry related to medicine. These
speeches made him famous around Texas and, later,
elsewhere. He got many offers to move to other cities,
including Denver, Louisville, and Galveston, to become a
professor of medicine or surgery. But he wanted to stay
in Dallas.
He decided it would be good to have a medical school
in Dallas. He convinced the mayor, Ben E. Cabell, to put
this notice in the Dallas Morning News on August
15, 1900:
At the request of a large
number of the physicians of Dallas and Oak Cliff we
respectfully announce that a meeting of physicians
will be held in the Council Chamber of the city hall
on Thursday, August 16, at 8:30 pm, for the purpose
of taking the necessary preliminary steps to
establish a medical college in Dallas. All regular
physicians in good standing are invited to be present
and to aid in organizing a college. It is the purpose
to establish and maintain a college which will be a
credit to the profession. To this end the active
cooperation and advice of all the regular physicians
in good standing is earnestly invited.
Seven people showed up at the meeting in favor of the
medical college, but 47 showed up in staunch opposition.
Many of those opposing the college were prominent Dallas
doctors, older and more seasoned than Rosser himself at
age 28. In the heat of the argument, Rosser made the
following statement:
Medical students are bright
fellows and one who assumes to teach them will have
his measure taken. I tell you now, not as a threat
but as a matter for information, there is going to be
a medical college in Dallas. There are a number of
ambitious and qualified doctors variously located
throughout the state who, if invited to faculty
membership will come, and when you get more
competition than you know what to do with, don't
blame me.
Dr. Henry Keirn Leake, who was the recognized
premier surgeon in Dallas, had been well trained and set
the standards for surgery all over North Texas. He had
his own private hospital and he also worked at St.
Paul's. He signed a number of petitions against the
college, but I could find no explanation of why he was
against it. There have been arguments as to whether he
was against it because he thought it would be a poor
school and would turn out poorly trained doctors or
because it would generate unwanted competition.
UNIVERSITY OF DALLAS MEDICAL DEPARTMENT
The minority prevailed, and they obtained a state
charter for the University of Dallas Medical Department.
This was a university in name only; the word
“university” was apparently chosen to enhance
the image of the new school. The opening occurred on
November 19, 1900, in the former and abandoned synagogue,
Temple Emanu-el, located on Commerce Street directly
across from what is now the Adolphus Hotel.
The animosity towards the medical school was fierce.
Rosser had 3 problems: where to get students, how to get
cadavers, and where to obtain patients for clinical
teaching.
With regard to getting students, here was his dilemma.
It was not expected that many students would be attracted
to the new medical school. But what if, when the doors
were thrown open, there were no students at all? The
embarrassment and ridicule would be severe. As opening
day approached, Rosser learned by long distance that a
preceptored young man, William T. Dunn by name, living in
Greenville, was to leave for Memphis College on the next
morning's Cotton Belt. So, Rosser went to Greenville and
found Dunn in the train station before he boarded the
train to Memphis. The new medical school needed a clerk
and would exchange college tickets for Dunn's services.
When the train went north, the bird in the bush was in
the hand. The first name recorded by registrar William T.
Dunn was William T. Dunn, first matriculant to sign on
the dotted line. Rosser gave him a job as the registrar,
stole him from Memphis, and brought him back to Dallas as
his first student.
The new medical school actually got quite a few
students that first year (Figure 7).
Fort Worth had a medical school and the students got mad
at the faculty, and most of the Fort Worth graduating
class transferred to the new Dallas school. Some of the
students were “doctors” who had previously been
practicing medicine in Dallas without a diploma.
The study of anatomy was all important for a good
medical education 100 years ago, but getting cadavers for
dissection was a problem. Rosser told the following
story. Mr. M. V. Creagan was a medical student who was
working his way through school. The streets were deserted
at 11 pm. The specimen (a dead pauper), already in rigor
mortis, bent in the shape of a half-closed jackknife, sat
beside Creagan in an open buggy, fully clothed. After
they moved down Main Street and turned left on Akard, a
hat from the lifeless companion “went with the
winds,” to be overtaken by a late straggler on the
street. “Hello! You've lost your hat!” called
the straggler. The driver, Creagan, yelled back to the
straggler: “He says you can have it!” And
Creagan drove on to the rear of the synagogue college
building, where a janitor helped with the embalming.
Clinical material for teaching was also necessary for
the training of medical students. In 1903 the city
council decreed that the medical college would have
access to the charity wards and clinics of the City
Hospital. Since Oak Lawn had no street cars, the students
had to be transported to the hospital clinic once or
twice a week by a horse-drawn hack over sometimes
impassable roads. The students were also able to attend
weekly clinics at the Buckner House Annex (Children's
Hospital), located on Worth Street.
Rosser also wanted to use St. Paul's Hospital. He went
to the sister in charge and asked if he could have the
students do clinical training there. She said absolutely
not, since the St. Paul doctors were violently opposed to
the medical school.
Apparently in order to provide more convenient
clinical material for teaching purposes, Rosser opened
his own private hospital on Junius Street, 4 to 5 blocks
from St. Paul's, which was located near the corner of
Hall and Bryan streets. He named it the Good Samaritan
Hospital (Figure
8). It is uncertain how much the patients
in Good Samaritan were actually used to teach medical
students.
EDWARD H. CARY
The University of Dallas Medical Department awarded
diplomas to 15 men on May 18, 1901. The opposition of
leading doctors had not subsided, and there were major
conflicts among different factions of the faculty. Rosser
was the focal point of much of the antagonism. To
hopefully mitigate these internal and external problems,
Rosser resigned as dean and appointed Edward H. Cary as
his successor.
Cary (Figure
9) was born in 1872 and was therefore 10
years younger than Rosser. He first came to Dallas in
1890 at the age of 18 and fell in love with the city. He
said the sidewalks were crowded, there were imposing
houses, and the city had a friendliness and a breezy and
casual air that were unique. He grew a mustache and
gained confidence as a salesman. In 1901, after
graduating from medical school and obtaining training in
ophthalmology at Bellevue, he returned to Dallas to
practice medicine.
As dean of the medical school, Cary made some changes.
The synagogue burned, and he bought a new building
directly across from Old City Park. He divided the 120
students into separate classes. He pruned the senior
class. He thought most of the students weren't up to
being a good doctor, and he graduated only 4 students in
1903. He was a tough man, and he was determined to make
this a better medical school. He did a lot to accomplish
that.
DR. ADOLF LORENZ
In spite of Cary's dedication, the school probably
wouldn't have survived had it not been for Dr. Adolf
Lorenz, the “bloodless surgeon of Vienna.”
Lorenz was famous for his nonoperative method of treating
hip dislocations, clubfoot, and other orthopedic
deformities. He would forcefully break the cartilages and
then set the joint in plaster of paris for a few weeks.
It was said that after his treatment the patients could
walk and even dance. He had treated Philip Armor's son in
Chicago. Armor had given him $30,000, and this spread his
fame in the USA.
Lorenz was scheduled to visit New Orleans. Rosser and
Cary convinced him to also visit Dallas. Starting on May
20, 1903, he held 2 clinics daily, alternating between
Good Samaritan Hospital on Junius Street (Figure 10)
and the college building on Ervay Street across from Old
City Park. Doctors from all over Texas came to
watch this great man. Lorenz gave credibility to the new
medical school. He was so popular and so many patients
wanted his help that he extended his stay. There was a
big banquet the night before he was to leave, with many
speeches. The mayor gave a speech, and then Cary and
Rosser gave speeches, and each one was trying to outdo
the other. Then it was Lorenz's turn, and Lorenz made a
wonderful toast to Dallas and said how much he loved the
city, how he had been stimulated as a boy by reading
stories about Texas, and that this was his second home.
George Truett (Figure
11) was so moved by these events that he
gave his famous speech: “Is it not now time to begin
the erection of a great humanitarian hospital?” This
is how Truett got involved with the building of a new
hospital. Truett was a pastor at the First Baptist
Church. He was extremely handsome and a wonderful
speaker.
In June 1903 negotiations began in the hope of
establishing affiliation of the medical school with
Baylor University in Waco. These negotiations were
successful, and the sponsorship provided added prestige
to the school. Unfortunately, it carried no financial
support from the university. Construction on Texas
Baptist Memorial Sanitarium began in the fall of 1904 and
was completed on November 13, 1909 (Figure 12).
Rosser transferred the Good Samaritan Hospital to the
board of directors of the new sanitarium.
OTHER MEDICAL SCHOOLS IN DALLAS
The University of Dallas Medical Department was the
first but not the only medical school in Dallas in the
first part of the 1900s (Table 1).
Of note was Southwestern University Medical Department,
from 1903 to 1911. This was organized by Dr. Leake, Dr.
McReynolds, and other St. Paul physicians and was
associated with Southwestern College in Georgetown for
awhile and then later with Southern Methodist University
in Dallas. The others were not very important, but Gate
City Medical College was interesting. The dean, Dr. John
William Decker, was caught selling diplomas for $50.
Decker would, on request, predate a diploma so that it
would look like the “graduate” had had years of
experience. He was sentenced to 15 months of prison at
Fort Leavenworth.
There was one other medical school in North Texas, the
Medical Department of Fort Worth University. It began in
1894, affiliated with Texas Christian University in 1911,
and closed in 1917.
THE FLEXNER REPORT
In 1906, the AMA Council on Medical Education
inspected and graded medical schools in the USA. They
found that most medical schools were so bad that they
were afraid to publish the results. Instead, they invited
the Carnegie Foundation for the Advancement of Teaching
to conduct an independent investigation, under the
direction of Abraham Flexner. The AMA was therefore
responsible for the Flexner Report.
Flexner evaluated 4 Texas medical schools, and the
results are summarized in Table 2. Flexner's
comments on medical education in Texas in 1910 were as
follows.
There is now only one
educational institution in the state capable of
maintaining a medical school whose graduates deserve
the right to practice. . . . That institution . . .
is the medical school . . . at Galveston. The other
three schools are without resources, without ideals,
without facilities, though at Baylor the conjunction
of hospital and laboratory might be made effective if
large sums, specifically applicable to medical
education, were at hand—which is not, however,
the case. There is no indication on the face of
things that any of the three inferior schools can
live through the dry period to the opportunities of
the future. . . . The state is badly overcrowded with
just the kind of doctor that they are engaged in
producing. Should the loopholes in the present state
standard be stopped up, all three would quickly
disappear.
The consequences of the Flexner Report were many.
There was a marked improvement in medical education.
Flexner wanted to make all medical schools like Johns
Hopkins, and he turned medical education in that
direction. Teaching was taken away from private
practitioners and was given to full-time clinical
professors. There was an increase in the cost of medical
education. Only the wealthy could attend. This created a
shortage of physicians in rural areas because many of the
schools that were producing the kind of doctors who would
go to a small town were closed down. And this made an
opening for osteopathic and chiropractic practitioners to
fill in the gap.
PROGRESS AT BAYLOR MEDICAL COLLEGE FROM 1910
TO 1920
Baylor Medical College made progress in spite of
Flexner's predictions, but there were many problems. The
faculty was often in turmoil. Many doctors in the city
remained absolutely antagonistic to the school. The AMA
Council on Medical Education gave it a ranking of
“B,” meaning it was not fully accredited. In
1911 a new college building, Ramseur Hall, was built, and
in 1916 the AMA council gave Baylor class A status.
Between 1915 and 1917, Southwestern Medical College
(later Southern Methodist University Medical Department)
and the Fort Worth University Medical Department were
merged with Baylor. Baylor offered degrees to all of
their earlier graduates. Thus, in North Texas, there was
only one medical school after 1917.
Dr. Clarence Manning Grigsby, who received his medical
degree in 1883 from the College of Physicians and
Surgeons in Baltimore, was appointed associate professor
of medicine in 1911. The next year he was appointed
professor of medicine. I believe that Dr. Grigsby was the
first chief of internal medicine at Baylor Hospital. In
1928, Dr. Henry Morgan Winans became the second chief of
internal medicine. He had graduated from Johns Hopkins
University in 1919.
In 1917 a military hospital unit was organized at
Baylor and was in active service in France until 1919.
The State Dental College, which had been in Dallas since
1904, was taken over by Baylor University in 1918 and
became the Baylor University College of Dentistry. It
graduated its first class in 1919.
MINUTES OF THE DALLAS COUNTY MEDICAL SOCIETY
AND A FATEFUL DECISION BY BAYLOR
To learn more about medicine in Dallas 100 years ago,
I reviewed the minutes of the Dallas County Medical
Society. Its very first meeting was in 1876. Minutes are
available for 1876 to 1877, but they are handwritten and
I couldn't read them. Minutes from 1877 to 1909 are
missing. After 1910, legible minutes are available. The
society met monthly, first in doctors' offices and later
in hospitals. The agenda included an essay, case reports,
discussion, and routine business. Quite often, though,
these agendas would fail. The physician who was supposed
to do the report would not show up or would show up but
not do the report. Special problems, relating mainly to
illegal practitioners, division of fees, and advertising
were handled in called meetings.
A remarkable meeting occurred on Friday, May 17, 1920.
This was about the first time that a typewriter was used
to record the minutes. The purpose of the meeting was to
discuss 2 proposed changes at Baptist Memorial
Sanitarium. First, the Baptist Memorial Sanitarium was to
be renamed Baylor Hospital. Second, the hospital was to
be closed to all physicians who were not members of the
faculty of Baylor College of Medicine, apparently in
order to improve teaching. The medical society found out
about this by reading a brochure from Baylor University
in Waco. No one had told them what was going to happen.
Only about one fourth of the physicians in Dallas were
members of the Baylor faculty. So, three fourths of
Dallas physicians would no longer be eligible to use the
facilities at the newly named Baylor Hospital. The only
other hospital they had was St. Paul's.
These decisions created renewed antagonism toward the
medical school and towards Baylor Hospital. The
physicians attending this meeting of the Dallas County
Medical Society were furious. They decided it would not
be feasible for the society to have future meetings at
Baylor because nonschool members would not feel welcome.
Future meetings were to be held at Parkland Hospital.
They also voted unanimously to do everything possible to
obtain the removal of Galveston Medical School to Dallas,
in order to make Baylor College of Medicine obsolete.
Rosser tried to defend Baylor's decision and suggested
that the society should try to get some additional
medical facilities in Dallas, but he wasn't very
sympathetic to the needs of those physicians who were not
going to be able to use Baylor Hospital. In response to
the turmoil, this “closed staff” policy was
eased slightly in 1921 but, nevertheless, Dallas
physicians who were not members of the medical school
faculty essentially stopped using Baylor Hospital after
1920. It seems likely that Methodist Hospital was
built in part because of Baylor's decision to restrict
its staff. Planning for Methodist began in 1920; the
building was started in 1924 and completed in 1927 (Figure 13).
DIFFERENT NAMES FOR BAYLOR HOSPITAL
Baylor Hospital has had a lot of different names. It
was the Good Samaritan Hospital in 1901, the Texas
Baptist Memorial Sanitarium in 1904, Baylor Hospital in
1920, Baylor University Hospital in 1936, and Baylor
University Medical Center in 1959. At the same time that
the name changed to Baylor University Medical Center, the
original Texas Baptist Memorial Sanitarium building was
renamed the Minnie S. Veal Teaching and Research
Hospital.
AN UGLY SIDE OF DALLAS AND DALLAS MEDICINE
During the time period covered in this article, Dallas
was a racist city. According to Payne, the Ku Klux Klan
(KKK) had enormous influence, and its members included
chiefs of police, mayors and other city officials, and
ministers. “White supremacy” and “pure
womanhood” were 2 of its themes, and membership was
restricted to “native-born Americans.” The
Dallas KKK had a women's drum corps and a junior
auxiliary, and there was a KKK day at the State Fair. The
KKK claimed that its creed was opposed to lynching but
that it was even more strongly opposed to the things that
caused lynchings. In 1912 Allen Brooks was forced from a
courtroom by a lynch mob and hanged at Akard and Commerce
Streets. Hundreds of people are recorded in a picture
from the Dallas Public Library, watching as the hanging
occurred. The grip of the KKK subsided in the late 1920s,
but intolerable and humiliating treatment of minorities
continued for many years—made “legal” by
Jim Crow laws, which were upheld in the US Supreme Court,
as described by Curriden and Phillips.
When I was an intern in Dallas in 1956, hospital wards
were strictly segregated, as were hospital waiting rooms,
water fountains, rest rooms, and dining rooms (Figure 14).
I never spoke out against such atrocious and demeaning
policies. The worst part is, I never thought they were
wrong—and if I had, at that time I probably would
not have had the courage to object because of my need to
conform. I include these remarks because I think that
even today we need to be acutely aware about how our
senses can be dulled to unjust treatment of other people.
BAYLOR COLLEGE OF MEDICINE AFTER 1920 AND ITS
MOVE TO HOUSTON IN 1943
Walter H. Moursund, MD, replaced Cary as dean of the
medical school in 1920 (Figure 15).
By this time, the medical school was beginning to look
more modern (Figure
16). You can look hard but won't find many
women. I don't know if it was true of this medical
school, but Starr says that medical schools throughout
the country had an unspoken quota on the number of women
who could be enrolled in medicine and it was 5%. Moursund
makes it clear that, in spite of the distance between the
2 institutions, Parkland was the main teaching facility
for inpatients. Graduates from the late 1930s and early
1940s have confirmed that inpatient teaching was mainly
at Parkland but occurred also on wards for indigent
inpatients in Baylor Hospital. There was a substantial
outpatient clinic at Baylor, and the students were
actively involved in this facility. Students also made
house calls regularly (Figure 17).
After Cary resigned, he became busy with a lot of
other things. He built the Medical Arts building, and he
was president of the AMA. Not all of his accomplishments
were admirable (in my opinion), but his energy,
enthusiasm, toughness, determination, and personality
were outstanding.
In 1939, after being away from the medical school for
19 years, he formed the Southwestern Medical Foundation.
He said that the purpose of the foundation was “to
support research in medicine, to bring Dallas and Texas
to the stature enjoyed by Johns Hopkins, Cornell,
Northwestern, and Mayo Foundation.” He thought that
Baylor University College of Medicine under the present
arrangement would never get much research accomplished.
The foundation tried to raise money for an endowment for
research at the medical school, but the response to this
effort was not encouraging.
Several issues were involved in the move of Baylor
University College of Medicine from Dallas to Houston in
1943. Cary thought that Baylor was a
“sectarian” institution and that this impeded
philanthropic giving. He thought, and he was right, that
there was minimal financial support from Baylor
University in Waco. He criticized a lack of research by
the faculty.
The Southwestern Medical Foundation initially proposed
that the school be moved to the Parkland campus. An
agreement was actually signed with Waco to do just that.
But there were more serious differences related to who
was going to control the faculty, the medical school and
the university or the Southwestern Medical Foundation.
The dispute became bitter. The timing during World War II
was probably significant. Many of the physicians of the
Baylor staff were in the Second World War and were not
available to give their input. And then the closure of
the Baylor Hospital staff in 1920 was still having
repercussions, and many if not most doctors in town were
apparently happy to have the school leave Dallas. I could
find no record of anything Rosser said about the move. He
was 82 and died 2 years later.
Although several people have told me, with near
absolute authority, that wealthy men in Houston
essentially bought the school and moved it to Houston, I
can find no evidence that Houston money played any role
until after negotiations between Baylor Waco and the
Southwestern Foundation were at a complete impasse. At
that point, Baylor contacted the M. D. Anderson
Foundation, and a deal to move the medical school was
quickly made.
CLOSING THOUGHTS
I believe I learned a few things in preparing this
talk, and I will try to briefly list some of them. First,
starting in the 1890s, Dallas provided better medical
care to indigent people than did most other Texas cities
and counties, primarily because a few Dallas doctors
fought for it. Second, Dallas had great medical leaders
100 years ago. As they practiced medicine they reached
out across the state and nation to represent Dallas. They
also brought an early medical school to Dallas, they made
it good, and it graduated many excellent doctors. Figure 18 shows
some of its outstanding graduates whom I was privileged
to know. The presence of the school undoubtedly helped
the city progress during the first half of the 20th
century. Third, the rules of professionalism, ethics, and
etiquette are transient. Fourth, medical institutions and
their medical staffs should do all they can to avoid
making enemies of sister institutions and fellow
physicians. The animosities last for a long, long time.
Fifth, although there were many problems and
disagreements along the way, no one could argue with the
end result. Both Houston and Dallas have excellent
medical schools. Baylor University Medical Center has
prospered and become an outstanding teaching hospital;
both its private and its indigent patients enjoy the
enormous benefits of having medical students and
houseofficers assigned to their cases.
Acknowledgment
The author gratefully acknowledges the help of Ben
Merrick, Louise Marie Giles Baldwin, the Dallas County
Medical Society, E. R. Hayes, Larry Wilsey, and Diana
Santa Ana.
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