Genius on the Edge: The Bizarre Double Life of Dr. William Stewart Halsted (13 page)

Before this, surgical advances were the fruit of a surgeon’s following his idea to the operating room. Sometimes, the inspiration appeared subjectively correct and found its way into other operating rooms. If it was incorrect, the outcome could prove fatal for the patient on whom the experiment was carried out. What was necessary was a method of developing objective evidence of efficacy without a cost in human life. Halsted had replaced trial and error with investigative method.

His technique, his laboratory protocol, and his new career were off to an admirable start. But things were not all they seemed to be.

IN THE THREE YEARS
following his arrival in Baltimore in December 1886, Halsted lived a thoroughly different life than he had in New York. Far from the elegant surroundings of his fine home off Madison Square Park, his private space was restricted to a room in
Mrs. Simmons’s house at 506 Cathedral Street. He did no entertaining at home, took his lunch with his laboratory mates at the tavern across the street from the Pathological, did no exercise or sports, and most unusual of all performed no surgery on humans. His laboratory was his clinic and the dogs were his patients. Halsted saw the replication of proper operating room conditions as both a sign of respect for the animals and a means of eliminating as many variables from the equation as possible.

But the overriding reason for his isolation in a laboratory was that Halsted was a surgical pariah. He had wrecked his career in New York and was at Hopkins on trial and under scrutiny. Though the issue of his addiction was not commonly known or openly discussed, it weighed heavily on Welch. He had shared his knowledge with Gilman, the trustees, and very likely Billings, who was intimately involved in staffing the new medical center. Billings was also well connected in New York medical circles, where the cocaine stories were well known. To the few with whom he discussed it, Halsted declared himself cured of his addiction. This, sadly, was fabricated of whole cloth. Not only was it likely he had continued using cocaine, but he had become increasingly dependent on morphine since “taking the cure” at Butler.

Halsted did well at hiding his addiction from experienced professionals, including several aware of his history. Welch was apparently unaware of any recurring difficulties, and although Halsted seemed distracted and introverted, he was able to function at an extremely high level. He was good company when he appeared for lunch, and he was in great spirits in the evening for dinner and socializing. To combat the flagging energy and irritability he experienced in the afternoon, he chose late afternoon for part of his morphine dose. Restored, he was able to function well for the remainder of the day and into the evening.

For the first six months in Baltimore it all went according to plan. He worked hard, produced significant work, and gave no hint of
losing control. But addicted to two powerful drugs, he was performing a precarious dance. Shortly after delivering his paper at Harvard, he voluntarily returned to Butler Hospital.

Again he registered under an assumed name, but this time he didn’t bring cocaine, or money to bribe hospital employees to procure it for him. Records of this hospitalization went missing, and virtually nothing is known about the episode other than the sparse reports he made in letters to Welch. He also corresponded with Mall but begged off writing extensive letters, claiming weakness. There is no evidence that he ever told Mall the whole truth.

Halsted remained hospitalized for nine months and returned to Baltimore in December 1887. To those who knew the nature of his indisposition, including Welch, Halsted declared himself completely “cured.” But Welch was protective of his friend and toyed with the truth. Halsted continued his clandestine life. Whether he believed he had control of the situation is unknown. He guarded the truth carefully and continued to successfully juggle two seemingly conflicting aspects of his life.

He behaved normally, made few excuses, lied when pressed, and went on with his life. In the early winter, he returned to his lodging on Cathedral Street and resumed full-time work at the Pathological. His biographers, who were either students or acolytes, trumpeted Halsted’s heroic determination and willpower in conquering his demons. No one knew the whole truth but William S. Halsted, and he was keeping his own counsel.

When Halsted returned to the Pathological, the closely held secret was protected. There was no talk of drug addiction, nor was there ignorance of his important discovery of cocaine as a local anesthetic. The world that had taken note of his achievement was largely unaware of the suffering and loss of life associated with it. Halsted shied away from discussing any aspect of the cocaine episode, but when the need arose, his colleagues sought his expertise.

When Councilman suffered great pain from an infected inferior molar, he walked across the hall of the Pathological and sought help from Halsted. An injection of cocaine brought “complete relief, followed by a painless extraction.” Over several years, the use of cocaine as a local anesthetic had become thoroughly integrated into surgical practice and was no longer automatically associated with Halsted. He was happy to be distanced from a subject he did not wish to discuss, and he did not seek credit for his discovery. Having paid dearly, he had lost all enthusiasm for the use of cocaine anesthesia.

Life returned to normal on Cathedral Street, and Halsted resumed his role as if there had been no interruption. He participated in the scientific chatter at lunch with colleagues from the Pathological and dined, as usual, among friends at the Maryland Club. The club, located in a fine old mansion at Franklin and Cathedral streets, had seen better days. Welch was a constant presence, and under his sponsorship Halsted became an active member. The run-down, rat-infested building was steeped in local history, and its proximity appealed to the ease of the two bachelors living down the street. Neither man was involved in a relationship with a woman, nor did they profess any interest. They saw a great deal of each other, as well as a number of Baltimore and Hopkins friends. Days were filled with the excitement of discovery, evenings with intelligent talk and easy banter in convivial settings.

Back on the second floor of the Pathological, Halsted turned his attention to the thyroid gland, a complicated endocrine organ in the neck whose unexplained functions appeared responsible for dramatic physical manifestations. So little was known of endocrine function at the time that every new finding made unscrambling the mystery more difficult. The very nature of endocrine glands was not yet understood, and 30 years of study began, which would lead to Halsted’s publication of the definitive tome on the subject.

Things at the Pathological were braced for change. The days of a few good comrades sharing their love of pure research with similarly
inclined graduate students were winding down, and the Pathological was about to be integrated into a larger whole. There was still no medical school, but the hospital was finally set to open in May 1889. A full team would need to be assembled. The task fell to Welch and Billings, and they were scrambling to put together the finest medical staff in the country. The previous fall, William Osler had been lured away from Philadelphia to become physician-in-chief, but as yet no one had been chosen as surgeon. In fact, there was only one surgeon associated with Johns Hopkins, and it was barely a year and a half since he had been hospitalized for drug abuse.

CHAPTER TEN
The Hospital on the Hill

J. M. T. FINNEY WAS
a short, solid, round-faced New Englander with jet-black hair and a thick mustache, and had arrived from Boston just before the opening ceremonies for The Johns Hopkins Hospital. It was May 7, and this was his second visit to the new hospital in just a few weeks. Baltimore was in the middle of an unusually cool and rainy spring, but that Tuesday the city awakened to a perfect morning. In the bright sunshine the hospital looked decidedly different. Plantings were in bloom on the grounds, and the harsh red brick of the sprawling, ungainly structure was softened and relieved by copious bunting and colorful flags that continued into the grand rotunda. Garlands of similax hung from the chandeliers, great bowers of carefully arranged cut flowers were everywhere inside, and a crowd of elegantly dressed men and women enhanced the festive atmosphere. A marble bust of Johns Hopkins watched over it all from a corner of the rotunda. He, too, was festively draped in similax. The rows of seating erected for the occasion were still sparsely filled, save for the third tier, where a 25-piece band practiced the musical numbers they would be playing between speakers.

Previously, Finney had come armed with letters of recommendation from his seniors at the Massachusetts General Hospital, where
he was house surgeon. Seeking out Dr. Halsted, he had been eager to present his credentials in hope of becoming part of the new world of scientific surgery. As luck would have it, Halsted had not yet returned from a European trip. Looking for someone in charge, Finney was sent to see Welch, who was working at home. Never having met the famous pathologist, he screwed up his courage and called on him at Cathedral Street. Welch, in typical fashion, welcomed the young man, hustled him into one of the old-fashioned bob-tailed Monument Street horse cars, and rode with him back to the hospital. Throughout the ride Welch asked about Finney’s experience, interests, and aspirations in such a pleasant and offhand manner that only later did Finney realize he was being interviewed. Bidding him farewell and promising to relay the information to Halsted, Welch deposited Finney at the hospital with Franklin Mall, who provided the full tour.

Finney returned to Boston even more enthusiastic about Johns Hopkins than before. A week before opening day a letter arrived from Halsted with an invitation for a personal visit, and to witness the formal opening ceremonies for the hospital.

Six hundred attendees were expected for the long program, which would include remarks by Francis King, president of the hospital’s board of trustees; Daniel Coit Gilman, president of the university; and John Shaw Billings, the man who conceived the structure. Mingling with the assembled dignitaries, Finney once again anxiously sought out Dr. Halsted. The hospital would not be receiving patients until the following day, and visitors had free run of the huge, open wards, each nearly 100 feet long and dramatically sheltering 28 empty beds under ceilings 27 feet high. Unable to locate Halsted in the throng, he spied Welch, who once again welcomed him and accompanied him through the hospital corridors. The portly pathologist chatted up the young man and put Finney at ease until Halsted surfaced among the crowd. Hastily introduced before the ceremony began, the nearsighted Halsted peered disarmingly over
his pince-nez glasses at Finney for what seemed to him an eternity, before he finally spoke.

“Big crowd, isn’t it?”

“Yes, sir.”

“Nice day, isn’t it?”

“Yes, sir.”

Halsted looked away in silence, then after a few seconds turned back to Finney.

“I’ll have to ask you to excuse me, as I have an appointment in the laboratory in a few minutes. What time can you report for duty?”

Finney had no idea how to respond.

“I beg your pardon, sir.”

“I want you to come down here and work in the surgical dispensary. When can you begin work?”

“I’m not yet through at the Massachusetts General Hospital, not until July first, but I suppose they will let me off a bit earlier.”

“Oh, I fancy they’ll let you off all right. You come down just as soon as you can. I shall expect you. Good morning.”

Pleased, and confused, Finney had just been hired in some capacity, to do he knew not what. No questions were asked in the three-minute interview, and Dr. J. M. T. Finney had begun a 33-year association with Dr. William Stewart Halsted in which he never received a single word of orders or instruction, and only once in 33 years, a compliment.

HALSTED HAD BEGUN
seeing patients and operating at local hospitals during the winter of 1889. He was the only surgeon associated with Johns Hopkins at the time, and although his status was clouded by the knowledge of his drug history, he was doing remarkable investigative work. Since the hospital was to be up and running by early May, they needed to appoint a surgeon. President Gilman, Billings, and Osler had been charged by the trustees to seek a proper chief of
surgery. They finally settled on Sir William Macewen, successor to the great John Lister in Glasgow, but the deal unraveled when Macewen insisted on including his entire nursing staff in the bargain. Whether the trustees reacted to his haughty attitude or if the wholesale importation of staff already set in their ways was felt to be at cross-purposes with the philosophy of the new institution, is not clear.