Claude E. Welch

Claude E. Welch died on March 9, 1996. He was survived by his wife Phyllis; their two sons, Claude E. Welch Jr., professor emeritus of political science at University at Buffalo and John Paton Welch, a retired surgeon, of Hartford, Connecticut; and seven grandchildren.

In 1992, Welch released his autobiography detailing his life. This autobiography was more than just a reflection of his life – it was a reflection on the changes that had occurred in medicine and surgery throughout the 20th century. A review by William Longmire and H. Kim Lyerly put it succinctly: “Claude has recorded not only a sketch of Boston and the Massachusetts General Hospital and Staff, but a much broader chronicle of 20th century medicine and contemporary thought; as well as a glimpse of life during this period, with penetrating comments on current health care problems as viewed through the eyes of a most thoughtful, experience, and observant scribe”

Known as a “bold and skillful surgeon in the abdomen,” Welch performed anywhere between 15,000 and 20,000 procedures by the age of 75. He served as president in 8 of the 20 medical associations to which he belonged, wrote more than 200 articles and chapters, authored or edited six books, including his own autobiography, developed a safe technique for performing a duodenostomy, and was one of only six physicians summoned to Rome to consult about the treatment of Pope John Paul II when he was shot in 1981.

Perhaps his most famous patient however was Pope John Paul II. On May 13, 1981, the Pope was shot twice. Three days later, Welch was called to consult with the other physicians and surgeons on the Pope’s care. He was one of only six physicians summoned to Rome to consult about the treatment of the Pope. Some time after his return to Boston, he received a thank you letter from Pope John Paul II. This letter was one of his most prized possessions.

Despite his failed bid, Welch was one of the two nominees to receive the Distinguished Service Award of the AMA in 1977. This was the highest honor conferred by the organization. Indeed, Welch was one of the few surgeons who had received it at that point.

In 1975, Welch ran to be president of the AMA. Despite his campaign, he lost to Carl Hoffman – the favored candidate of the race. Hoffman not only was from a smaller, less liberal state than Massachusetts (West Virginia), but had served as secretary of the board of trustees at the AMA. During his bid, Welch pressed for “professional standards review organizations” and chaired an AMA committee that drew up “model criteria for patient care.”

During his term in office, two important issues arose. One issue was the allegations made by the Federal Trade Commission (FTC) that the ASA (and other professional organizations) were restraining trade by publishing lists of suggested charges for medical procedures. The ASA stood up for its actions and submitted the required documentation to the FTC. The FTC did not find any violations of free trade and thus declared the ASA innocent of any such charges. The second issue arose in the form of malpractice suits. This issue had been growing over the past decades, but came to the front in the 1970s. Many questions arose as a result of the growth. How were individuals who brought suits going to be fairly and equitably compensated? One option Welch helped the industry explore was a variant of no-fault insurance. This option listed problems that could occur in surgery and a list of suggested compensations should any of these problems arise. The American Bar Association refused to endorse such a method.

The same year that he was elected president of the MMS, Welch was elected to serve as a delegate from the state of Massachusetts at the American Medical Association (AMA). This was the first time he had dealt with the AMA on a national level. Prior to that, he had only been on its Residency Review Committee for Surgery. Welch served in the House as a delegate for a decade. During this time, the AMA was confronted with the problem of racism. Technically racial equality existed within the AMA, but it was in name only. In 1968, the Massachusetts delegation, of which Welch was a chairman, prepared a resolution for the Reference Committee. It called for any state association in violation of existing AMA rules (i.e. racial equality) to be expelled from the AMA. This provoked quite a debate on the floor. Welch only added fuel to the fire when he spoke after the resolution was presented. He ended his speech with the following declaration: “It is our contention that this council and House must have such power whenever any action is so fundamental that it involves guarantees extended by the Constitution of the United States.” The resolution was adopted and approved at the next meeting.

In 1965, Welch accepted the post of president of the Massachusetts Medical Society (MMS). The acceptance of this post corresponded with the rise of the relationship between medicine and politics. As president of the MMS, he witnessed the types of challenges that would erupt as a result of this new relationship. He also saw the beginnings of malpractice suits. These problems had not come front and center yet though as physicians at the time were still relatively independent.

Welch’s own involvement in the ACS did not extend beyond attending annual meetings and presenting papers until 1960. His involvement with it ran parallel to his involvement with the AMA. This presented Welch with a variety of challenges as there were strong tensions between the ACS and AMA at the time. Some of these tensions were a result of the thought that the AMA supported primary care over medical and surgical specialties. In 1973, he was elected president of the American College of Surgeons.

In addition to his work at HMS, Welch published articles in the New England Journal of Medicine. These articles included surveys of recent developments in abdominal surgery. These surveys had originally started with Dr. Allen, but Welch picked them up as Dr. Allen’s health began to deteriorate in the 1950s. These articles were just the tip of the iceberg so to speak, for in addition to these surveys, Welch contributed many articles on abdominal surgery, cancer surgery, medical ethics, and thoughts on malpractice. Welch was eventually made a member of the Committee of Publications of the Massachusetts Medical Society (MMS) in 1962. He became chairman in 1969 and served until 1980.

Welch stayed at the front lines until the war ended in 1945. His service in World War II was a significant part of his life for not only did he learn many important medical lessons, but he formed friendships that would last a lifetime. In his autobiography, he summarized the impact of the war using a quote from Colonel Washburn:

In January 1943, the 6th General Hospital was deployed to North Africa. While there, he and his colleagues discovered that many lessons learned in previous conflicts could not be applied. This was because some medical treatments used in prior conflicts were simply not effective for the different situations that World War II presented. For example:

In the spring of 1943, Welch was assigned to one of the general hospitals close to the front lines in Rome. At this hospital, there were often more than 150 surgeries a day.

On May 15, 1942, Welch joined the United States Army Medical Corps as a captain. He left behind one son (Claude E. Welch Jr. born June 12, 1939) and a pregnant wife, as well as his job at the Massachusetts General Hospital. He felt that this was a necessary sacrifice in order to serve his country in its time of need. He departed Boston with 123 other surgeons, physicians, and nurses from the Massachusetts General Hospital to Camp Blanding, Florida for training. Together they helped to constitute the 6th General Hospital.

In the early 1940s, the only acceptable way to treat a severed artery was ligation. The hope was that this would prevent gangrene – although it rarely did. After seeing the results of a failed ligation, Welch vowed to try something different. An opportunity presented itself when a man was brought in with a dislocated knee and damaged popliteal artery. Welch performed an artery graft and the leg immediately regained life.

It is funny to note, that Welch was not certified to practice surgery until 1939 – a full seven years after he graduated medical school. This is because the American Board of Surgery did not come into existence until 1937. Welch was actually only the 101st surgeon to be certified by this board. Prior to the 1930s, there had been little oversight of the medical community, but that began to change as the 20th century progressed. Indeed, the requirement for certification was only the beginning. Many more regulations would come some of which Welch would have a role in forming.

In addition to the AMA, Welch was also a part of the American College of Surgeons – one of the largest and most influential national surgical colleges in the world. Welch’s involvement with the ACS began in 1939. His decision to join at the time was due in no small part to his mentor Dr. Arthur Allen’s devotion to the organization.

After graduating from the Massachusetts General Hospital School of Nursing in 1936, Paton returned to her native Montreal and enrolled in McGill University. After obtaining her degree from McGill, she had intended to attend McGill University Medical School. But life – and Welch – had other plans. Welch and Paton were married on August 14, 1937.

In 1933, Welch met the person who would become the love of his life – Phyllis Paton. They met at the Massachusetts General Hospital where she was working as a student nurse. Although fraternization between residents and student nurses was forbidden, Paton and Welch decided to follow their hearts. Luckily their relationship resulted it only one minor reprimand for her from the understanding director of the school of nursing.

Welch graduated from HMS in the midst of the Great Depression. Times were not easy, but the class of 1932 recognized the superb education that they had received from Harvard and were determined to make the most of it.

In the early 20th century, performing a duodenostomy was considered very unsafe. Indeed, one surgeon who had attempted to perform the operation had a 100 percent death rate. Welch studied notes from the surgeon and determined that he had used “so large a drainage tube that an enormous duodenal fistula resulted through the tube and the patients died of electrolyte imbalance.” So when a patient of his in the late 1930s presented an inflamed duodenum and there was a no choice but to remove two-thirds of the stomach, Welch used a new method which he had been developing. He used a catheter to close the duodenal stump. The operation was a success. Following his success, he made an effort to find out if any similar procedures had been used by surgeons. After discovering two other surgeons who had used a similar technique, Welch reported this new method of performing a duodenostomy to the Journal of the American Medical Association (JAMA) in 1949.

Welch began medical school in 1928. Harvard Medical School was everything that it promised to be. From the very first week, he was introduced to world-famous physicians. He used the opportunity to learn from individuals who were at the top of their respective fields. It was in these first few weeks that he was introduced to a person who would become one of the most important mentors in his life, Dr. Arthur Allen.

After considering his options, Welch departed for Doane College in 1923. He believed that although Doane was small, it had many fine professors and offered a wide variety of courses. Wanting to take advantage of this, he took as many courses as possible from a wide spectrum of disciplines including astronomy and English – all while fulfilling the requirements of chemistry major. In addition to his class work, Welch also took on the responsibility of being editor of the student paper. Furthermore, he joined the glee club and participated in a number of sports. His wide participation in a variety of sports could be linked to one of his greatest ambitions at the time. His ambition was to earn an “Honor D” – a letter given to athletes to place on their sweaters for athletic accomplishment. Although Welch was not immediately successful, he was not deterred. In his last semester, he went out for Tennis where he won enough matches to reach the semifinals. This earned him his “Honor D.”

Claude Emerson Welch (March 14, 1906 – March 9, 1996) was an American surgeon who was internationally recognized, and whose career spanned forty years. For most of those forty years, Welch worked at Massachusetts General Hospital. He was involved with a variety of activities that included “patient care, teaching, clinical research, establishment of funds to maintain such activities, promotion of all aspects of medical education, and strengthening of ties between the government, the courts, the legal profession and physicians.”

Claude E. Welch was the eldest child of John and Lettie Phelan Welch. He was born on March 14, 1906, in the town of Stanton, Nebraska. From a very young age, Welch showed great intellectual promise, advancing through the first three grades in the city school in a mere three months. He attributed his rapid advancement to the excellent preschool education he received at home.