Major's Undertakings

Tuesday, September 1, 1914

With an “inquiring mind and exceptionally wide interests,” he was a “scholar in the best sense of [the] term.”



Once dubbed the “Kansas sage of medicine,” this physician, educator, author, historian, military veteran, ardent bibliophile, amateur musician, and master of six languages “fit the classical description of the Renaissance man.”



To his friends, he was a “paradigm of grace.” To students at the KU School of Medicine, he was a “born teacher.” And to his professional colleagues, he was known simply, but affectionately, as “the Chief.”



His name was Dr. Ralph H. Major. And on September 1, 1914 – just days following his 30th birthday – this Kansas City-area native and alumnus of Johns Hopkins University was appointed professor of pathology, as well as department chairman, at the University of Kansas School of Medicine. What followed was a nearly unbroken 56-year affiliation with KU, the positive effects of which are still being felt to this day.



Whether one points to his pioneering work in treating diabetes, his contributions to the School’s renowned history of medicine library, or to the generations of physicians who benefited from his tutelage, in both practice and presence, Major helped build a first-class institution out of what originally were decidedly second-class materials.



Indeed, the KU School of Medicine that Major joined was both understaffed and under-funded – initially, he would even be forced to do his own janitorial work. The School’s lone praiseworthy attribute, as Major put it, was “the ability and determination of some of the faculty.” Too modest to ascribe these qualities to himself, his subsequent career and lifetime of service suggests that, perhaps, he possessed them most of all.



Born August 24, 1884, in Liberty, Missouri, Ralph Hermon Major was the only child of John and Virginia Major to survive infancy. Early on, he displayed a precociousness that would forecast his future as a well-rounded, accomplished man of learning.



Childhood proficiency on the violin and piano preceded an adolescent aptitude for linguistics. By the time he completed his undergraduate education at William Jewell College at age 17 – then the youngest AB degree holder in the school’s history – Major had a strong command not only of German, Spanish and French, but of Latin and Greek as well.



These scholarly pursuits were encouraged by his prosperous bank president father, a man to whom, Major once wrote, he “owed many things, among them an interest in the thoughts and languages of others.”



With fatherly financial assistance, after graduation Major embarked on a Grand Tour of European capitals and cultural meccas. Planned as a one-year excursion, this trip ultimately would extend into a nearly three-year odyssey of education, personal growth and experience, taking Major to Paris and Rome, Athens and Moscow, Corinth, Florence, Constantinople and many other exotic locales.



It was in the prewar Germany of Kaiser Wilhelm II, though, that Major spent most of his time, taking classes, perfecting his German language skills and becoming immersed in the vibrant fraternity life. Taking classes at various times in the universities of Halle, Heidelberg, Munich and especially Leipzig, he found his heartiest comradeship at the latter, joining a uniformed students’ society called Burschenschaft Alemannia and participating in the group’s favorite pastimes: singing, drinking beer, and dueling with swords (though not necessarily in that order).



Early twentieth-century Germany was a world leader in scientific research and advancement, particularly in the field of medicine. This immersion in German higher education would prove of immense value to Major.



In 1906, when the now 22-year-old was back in Missouri, he decided to become a physician. Possessing only a liberal arts degree, were it not for Major’s fluency in German – then the foremost language of science – his application to America’s top medical school, Baltimore’s Johns Hopkins University, may well have been rejected.



But Major was accepted, and upon completing the school’s rigorous four-year program, he earned an MD in 1910, after which he stayed on at Hopkins to serve a two-year hospital residency. But Europe soon again beckoned, persuading the young doctor to spend much of 1912-13 learning from and working with some of the most distinguished researchers and clinicians in both Vienna and Munich.



While overseas, Major determined that his future lay in internal medicine. However, he received his first formal job offer in pathology – an instructorship at Stanford University. This actually worked out rather well, though. Educated as he was in the tradition of Sir William Osler – the Canadian physician and celebrated Johns Hopkins professor, often hailed as the “Father of Modern Medicine” – Major accepted the post, given that initial experience in pathology was highly recommended for aspiring internists.



As it turned out, Major’s stint in California lasted but one academic year. At the end of the spring 1914 semester, he received, as he later put it, a real “stunner” of a letter. Drafted by Dr. Mervin T. Sudler, associate dean and effective head of the University of Kansas School of Medicine, the missive contained a most unlikely invitation.



Come to KU, Sudler implored, and not only be promoted instantly from instructor to full professor of pathology, but also chair the entire department. (It is unclear just how, or if, Sudler and Major knew each other prior to this correspondence, although considering the latter’s Clay County ties and the fact that they were both “Hopkins men,” it seems unlikely that the two were perfect strangers.)



While one hesitates to insinuate that Dr. Major (not yet 30 years old) was unqualified for the job Sudler was dangling before him, the offer makes sense in the context of times. In 1914, the KU School of Medicine was also relatively young, having only become a full-fledged, four-year institution a mere nine years earlier.



Far from ideally arranged, the School was, in fact, awkwardly divided between two campuses.



The Scientific Department, which provided background instruction in subjects such as anatomy, biochemistry and physiology, was located in Lawrence on the main campus of the University of Kansas.



The Clinical Department, based some 40 miles away in Rosedale (now part of present-day Kansas City, Kansas) offered students more specialized training in surgery, obstetrics, ophthalmology and the like, as well as hands-on, bedside experience in diagnosing illnesses and prescribing treatments.



In addition to ordinary growing pains, the School was still reeling from the drubbing it had taken in Abraham Flexner’s 1910 critical survey of North American medical colleges. In its wake, according to KU historian Clifford Griffin, administrators were having no luck recruiting any “nationally distinguished physicians.”



As Griffin put it, those who refused complained that “the $2,500 full professor’s salary was too low, the hospital and teaching facilities ridiculous, the provisions for individual research exceptionally poor, and the medical library unsatisfactory.”



Indeed, as one insider noted, the only things not in short supply at the University of Kansas Medical School during this period were “ill will” and “unsought advice.” A typical response explaining the refusal to accept a position at KU came from Dr. J.H. Hewitt of Chicago. “It would be suicidal, almost, for me to give up what I have here, which is secure and certain … for something that is small to begin with and appears rather problematic and to a degree uncertain for the future.”



In making such a princely offer to Major, Dean Sudler was certainly hoping that one man’s suicidal plunge would be another’s leap of faith. He was not to be disappointed. In spite of the sheer incredulity expressed by many of Major’s Stanford colleagues, who thought him “crazy to [even] think of leaving San Francisco for Kansas City,” it was an offer, an opportunity, and an astonishing promotion that he could hardly refuse.



And so, on September 1, 1914, Major accepted the pathology professorship and departmental chair in the KU School of Medicine without, incidentally, ever having visited its facilities – and a good thing, too.



Writing decades hence, he remembered feeling that “the Medical School was taking a big chance, [but], as I later learned from Dr. Sudler, they felt I was [the one] taking the big chance. In fact, Dr. Sudler said that he was afraid I would wish to investigate the pathology department before I accepted, and, if I did, he knew I would decline.”



Sure enough, upon surveying his new domain – located in the unnamed laboratory and research building adjacent to Rosedale’s Bell Memorial Hospital on “Goat Hill” – Major agreed that “it was really depressing.” He discovered dirty shelves, dirty walls and dirty windows, “broken test tubes, dried-up specimens, empty cardboard boxes, waste paper” and “rubbish which had accumulated on the floor in heaps.”



There was actually a janitor on staff, but he had a rather serious heart condition that, apparently, made the climb to the second-floor pathology department seem more like a trek up Everest. Thus, out of pity, management had long since stopped asking him to clean anything above the ground floor.



Conveniently for Major (perhaps the first Johns Hopkins MD whose professional duties included janitorial work), his initial crop of 14 medical students would not arrive until the beginning of the 1915 spring semester. As such, he and his student assistant – who, together, embodied the entire pathology department – had time both to prepare and repair.



“We washed and scrubbed floors, walls and windows,” Major recalled, “burned countless paper boxes and scrap paper, carried baskets of broken bottles, test tubes and trash to nearby dumps,” until, “after much physical exertion, we no longer had to apologize for our dirty department.”



Yet if Major was going to conduct a proper course in pathology – which involves understanding the nature of diseases and, especially, the structural and functional changes produced by them – an additional sort of exertion would be required. He would personally, almost from scratch, have to build up the department’s catalogue of surgical specimens and diseased-tissue slides, something his predecessor had woefully neglected.



To accomplish this necessary task, Major made it well known that he would perform any autopsy, any time; and from these (along with operative samples from the still-living) he slowly created an extensive collection of “visual aides,” demonstrating the bodily and cellular effects of nearly every conceivable disease.



As Major put it, his inaugural semester of teaching went off “without any noteworthy catastrophes.” There were, of course, the usual throbbing headaches, caused mainly by a meager budget; inadequate facilities; legislative indifference (if not outright hostility); and the unending grief the School got from the Kansas medical community – for being too close to Missouri and having too many non-Kansans, like Major, on staff.



Added to this was an ongoing debate about whether to move the Clinical Department off Goat Hill in Rosedale and, instead, locate the entire School on Mount Oread, or maybe in Topeka, or even Wichita. Fortunately, though, Major could associate 1915 with something thoroughly pleasant – his marriage to Margaret Norman Jackson, with whom he would later have three children.



As if the Medical School needed any additional problems, American entry into World War I caused a fairly serious diminution in both faculty and students. Among those entering military service was Ralph Major, commissioned in 1918 as a captain and assigned to the Yale Laboratory School in New Haven, Connecticut, which the War Department had taken over for the care of wounded soldiers.



During his roughly year-long stay, Major developed a strong friendship with the school’s director, a fellow captain (and another Hopkins man) by the name of Dr. Harry R. Wahl. Like Major, Wahl was a pathologist; but whereas Wahl had committed to this particular field, Major still considered himself an internist trapped in an pathologist’s body.



“I had always regarded my pathological work as an excursion rather than as a permanent career,” Major later wrote. “I had always wished to return to internal medicine.” Therefore, upon release from the Army, he informed Dean Sudler that he had been offered, and planned to take, an internal medicine post at Detroit’s Henry Ford Hospital. He then immediately suggested Dr. Wahl as his replacement, remarking that his friend was “an excellent teacher and had organized an outstanding school [in New Haven].”



Sudler agreed to make the overture and, to both men’s immense satisfaction, Wahl enthusiastically accepted, declaring (to both men’s apparent amazement) that KU was actually better equipped than the Cleveland hospital where he had been working since war’s end. The succession thus assured, in 1919 Major and his wife moved to Michigan. As it happened, their time away from KU would be brief.



“While I was in Detroit,” Major noted in his 1968 Account of the University of Kansas School of Medicine, “the long-awaited Messiah, for whom the Medical School had prayed so long, appeared in the person of [Kansas] Governor Henry J. Allen.” Indeed, over the next several years, under the governor’s leadership – and with some comparatively enormous appropriations from the state legislature – the institution would enter what Major dubbed its “renaissance.”



Lured back to the University in 1921, Major returned just in time to participate in the gradual upbuilding of the Medical School’s new and consolidating campus located at 39th and Rainbow Boulevard in what is now Kansas City, Kansas. With the offer of both a professorship in internal medicine and the departmental chair on the table, it was not a particularly hard sell.



Although he had enjoyed his time in Detroit, “my roots were in the Middle West,” Major would explain. “My family lived near Kansas City; many of my old friends lived there, and in addition, I wanted to be back with my old colleagues who had fought such a long and, at times, apparently hopeless fight in Rosedale.”



Major had but two conditions before he accepted the job. First, he insisted the School's Internal Medicine Department have its own laboratory in Rosedale. Second, he wanted his colleague from Henry Ford Hospital, Dr. Russell Haden (yet another Johns Hopkins alumnus), to be brought in and put in charge of this lab. Both stipulations were met, and as a result, the KU School of Medicine ended up having five Hopkins men on its faculty – Sudler, Wahl, Major, Haden, and Dr. Thomas G. Orr.



(Orr, incidentally, was also a close friend of Major’s who had secured his position, back in 1914, by similar means. At Major’s urging, Orr was offered a bacteriology professorship and began his four-decade tenure at the Medical School the following year, eventually rising to professor and, for 25 years, department chairman of surgery before his death in 1955.)



With so much talent present, it was perhaps inevitable that great work would be done, and no great surprise that Ralph Major would be at the forefront. In 1922, he heard that two University of Toronto researchers – Dr. Frederick G. Banting and assistant Charles H. Best – had discovered and isolated insulin, the “long-sought internal secretion of the pancreas which would control diabetes.”



Knowing all too well that the disease was a merciless ravager, the diagnosis of which was little different than a death sentence, Major managed to secure a small supply of insulin for KU and performed the first clinical trials in the Kansas City area. The results were both immediate and astounding.



On January 13, 1923, Major injected insulin into a terminally comatose diabetic patient, and not only was he revived, but within four days had his blood sugar returned to normal levels. A month later, a second patient was treated following the same procedure, and he too regained consciousness and was restored to health. As Major described it, “The news spread like wildfire, and soon we had more patients that we could possibly admit.”



Fortunately, the Eli Lilly Company of Indianapolis, Indiana – with which Banting and Best had partnered to produce insulin and conduct clinical trials – began mass-producing the new wonder drug. This ensuing availability, coupled with other successful trials and perfected techniques reported in the nation’s leading medical journals, eventually redounded to the physical salvation of untold millions.



And for this, the KU School of Medicine deserves some measure of credit. In fact, as Major noted in his 1968 Account, “When the first report on insulin was printed in the Journal of the American Medical Association for June 2, 1923, one of the three articles was from the University of Kansas.” Characteristically, the self-effacing physician neglected to mention that the author of the KU paper, titled “The Treatment of Diabetes Mellitus with Insulin,” was none other than Ralph H. Major, MD, himself.



Although this treatise on insulin remains perhaps Major’s most notable article-length work, in the decades that followed, he would contribute more than 200 other pieces on everything from arterial hypertension, typhoid fever and pneumonia to “How Hippocrates Made His Diagnoses” and “Landmarks in the History of Lead Poisoning.”



By 1924, Major had distinguished himself not only as an author and researcher, but as a physician and teacher as well – and, indeed, that year he had the chance to add Medical School dean to his increasingly impressive résumé.



This opportunity came about amid the chaotic and politically rancorous chain of events that resulted in the resignation of Dean Sudler, who had run afoul of Kansas Governor Jonathan Davis and his handpicked Board of Administration (a body whose jurisdiction included the entire state university system and numerous other state-operated entities). To fill the void, according to Major, Davis said he “had received some very favorable reports regarding me and asked if I would accept an appointment as dean.”



Admittedly, Major was predisposed to decline the job – he claimed to have seen “too much of the trials and tribulations of a dean” to relish even the thought of taking it. Moreover, he was most reluctant to give up his professorial work, as well as his private medical practice that provided additional income.



Even so, Major nonetheless confessed a “deep sense of obligation to the School” and informed the governor he would accept the offer under certain conditions. When asked what the first of those would be, he replied, “that Dr. Sudler should be reinstated as professor of surgery.” This time, however, Major had apparently asked too much. According to his account, Davis considered this demand “absolutely impossible,” and as such, “This ended the interview.”



Major’s elimination from consideration left the door open for his friend and colleague Dr. Harry Wahl, who was appointed acting dean until a permanent one could be found. As it turned out, though, this “temporary” incumbency lasted until 1927, at which point Wahl himself became permanent dean, a position he held for the next 21 years.



It was probably for the best. Major himself thought he possessed neither the “training [nor] the temperament” necessary to succeed as dean, and accordingly cheered his better-tempered friend’s assumption of the often thankless task. Having slipped the administrative noose and with the School now in Wahl’s hands, Major was free to pursue endeavors more to his liking.



Beginning in the 1930s, Major began authoring popularly accessible books on diverse medical subjects, churning them out at a breakneck pace, each one seemingly more successful than the last – all the while teaching and maintaining his own private practice.



His first venture, The Doctor Explains, published in 1931, was geared toward patients and sought to give them a better understanding of how practitioners treat various illnesses. To this end, as one reviewer wrote, “He told the stories of great medical discoveries, recounted the development of some of medicine’s basic diagnostic instruments and techniques [and] interpreted in simple terms the physiology and chemistry of the more common disorders.” The goal was to ease fears and sweep aside much of the mystery that often shrouds the medical profession.



A year later, Major came out with Classic Descriptions of Disease, a remarkable and beautifully illustrated work of nearly 700 pages that only someone like Major – with his command of numerous languages – could write. In Classic Descriptions of Disease, Major translated and compiled original eyewitness reports of diseases and scourges such as plague, smallpox, and syphilis as they had been observed by physicians and litterateurs reaching all the way back to antiquity.



In 1936, Major followed up with Disease and Destiny, in which he explained the effects contagious diseases have had on civilizations, world events and eminent historical figures. By far his most commercially successful volume, however, was Physical Diagnosis, a medical textbook published in 1937 that would become an international standard, go into nine editions in six languages (including one pirated Chinese version he took great pride in displaying) and eventually sell well over 100,000 copies.



Aside from Physical Diagnosis, most of Major’s works contained a heavy component of medical history. It was a subject very near to his bibliophilic heart and an interest he shared, incidentally, with his close friend and KU Medical School colleague, Dr. Logan Clendening.



In Faiths That Healed (1940), Major “examined history in terms of disease and religious faith.” In Fatal Partners: War and Pestilence (1941), he “traced the relationship of war, disease and medicine throughout history.”



And following Clendening’s death in 1945, Major assumed the mantle of KU’s resident expert on medical history. He also became principal contributor and steward to the University’s nationally renowned Clendening history of medicine collection, the core of which encompassed his late friend’s 10,000-volume personal library.



Indeed, if there was one field that possibly fascinated him more than internal medicine, it may well have been the historically based study of his profession. By 1950, Major had held his medical professorship and been chair of the Internal Medicine Department – in which he was widely and fondly known as “the Chief” – for 29 consecutive years.



And always game for new challenges, at a still robust 66, he decided to relinquish his duties at Internal Medicine and accept the chairmanship of the Department of the History of Medicine, a position he held until 1954.



That year, though it marked his last as a full-time professor in the School of Medicine, was nonetheless a momentous one. It witnessed the publication of his medical history magnum opus, an acclaimed two-volume, 1,155-page tome titled A History of Medicine, as well as a number of prestigious parting honors bestowed upon him by a grateful University.



On November 16, 1954, the medical department held its first annual Ralph H. Major Lectureship. That day, too, KU also presented Major with the Gold-Headed Cane, reflecting a British tradition that had so honored master physicians as far back as the 1690s.



During the next 16 years, Major enjoyed what one friend termed a “misnamed retirement.” In 1955, he embarked on a world cruise with his wife, although they spent much of their time in the Philippines, where the doctor had accepted a one-semester professorship at the University of Manila.



Upon returning, he was given emeritus status in the KU School of Medicine and devoted considerable time to cataloguing new and existing acquisitions – many of which were his own gifts – for the Clendening Medical Library.



Still active, creative and remarkably productive even into his mid-80s, Major would author three more books in rapid succession, bringing his career total to 10.



In 1967, his Memories of a Vanished Era appeared, chronicling his Grand Tour adventures as a young man in pre-World War I Europe. One year later, two more works were completed: his warmly anecdotal Account of the University of Kansas School of Medicine and another memoir, this one titled Old Ties and New, covering his later-in-life travels throughout Europe and the Far East. Unfortunately, his wife Margaret, partner of 50 years, would not live to read these. She passed away in 1965.



Two years later, Major married longtime family friend Wanda Egbert Graham. She provided him much needed comfort as his own health worsened until, finally, on October 15, 1970 (at age 86) he, too, passed away. The cause of death was a basilar artery thrombosis, or rather – as this learned man with the layman’s touch might have preferred to call it – a stroke.



Seeking to honor posthumously and memorialize permanently this man who had given virtually his entire professional life to the University of Kansas, on May 21, 1976, the School of Medicine formally dedicated its new $5.5 million science building, calling it Orr-Major Hall. His co-namesake was fellow Hopkins alum and longtime surgery department head Dr. Thomas G. Orr. Friends and colleagues in life, the two were now joined in memory as well.



During his 50-plus years of service to KU, Major’s many accomplishments contributed greatly to the School of Medicine’s maturation into one of the nation’s preeminent regional medical institutions. Whereas it counted a mere 66 faculty and 105 students upon his arrival back in 1914, by the time his formal affiliation ended, there were 370 faculty and 453 aspiring physicians enrolled.



The pathology department, which he had initially chaired, experienced a similarly remarkable expansion, going from a single professor and part-time assistant to a teaching staff of more than 30. And as to its annual departmental budget, by the 1960s it far surpassed the amount that had funded the entire Medical School of the pre-World War I era.



One can also point to the dramatically expanded physical plant, the complete consolidation of the School in Kansas City, the graduation of more than 2,500 doctors, and the establishment of an Alpha Omega Alpha honor society chapter (considered the Phi Beta Kappa of medicine and an indication that a school’s instruction is of superior quality). And while none of these achievements can be individually and solely credited to Dr. Ralph Major, it is perhaps difficult to imagine them occurring without him.



Yet as Dr. Robert P. Hudson – one of Major’s successors as chairman of the History of Medicine Department – once remarked, his colleague’s contributions could never be truly or adequately honored, nor could they be enumerated on a page.



“A man who devotes more than a half century of gifted life to a single school of medicine,” Hudson wrote, “has an impact that can never be measured in terms any more precise than immense or profound.”



John H. McCool

Department of History

University of Kansas

 

[Source Notes: Ralph H. Major, MD, An Account of the University of Kansas School of Medicine (University of Kansas Medical Alumni Association, 1968), passim; Ralph H. Major, MD, “The Treatment of Diabetes Mellitus with Insulin,” Journal of the American Medical Association 80:22 (June 2, 1923), pp. 1597-1600; Lawrence H. Larsen and Nancy J. Hulston, The University of Kansas Medical Center: A Pictorial History, (University Press of Kansas, 1992), passim; Robert P. Hudson, MD, “Ralph H. Major: 1884-1970,” Bulletin of the History of Medicine 45:3 (May-June 1971), pp. 283-286; “Millennial Traveler,” MD (February 1972), pp. 172-175; William S. Middleton, “Intellectual Crossroads – An Appreciation of Ralph H. Major,” Perspectives in Biology and Medicine 14:4 (Summer 1971), pp. 651-658; Medical Center Bulletin (June 1964), pp. 5-6; Medical Center Bulletin (April 1968), p. 9; Medical Center Bulletin (April 1970), p. 15; Medical Center Bulletin (December 1970), pp. 1-2; Kansas City Star (November 22, 1970); “Contemporaries,” Modern Medicine (November 27, 1961), pp. 59-60; Glen R. Shepherd, MD, to John Stewart Smith (March 17, 1955); Clifford S. Griffin, The University of Kansas: A History (University Press of Kansas, 1974), pp. 264-273.]