Genius on the Edge: The Bizarre Double Life of Dr. William Stewart Halsted (14 page)

Whatever the case, The Johns Hopkins Hospital was about to open without a surgeon. As impossibly shortsighted as that situation seems, the surgical world of 1889 was unrecognizable from today’s perspective and did not command the highest priority. So little surgery was being performed that there were fewer than ten physicians in the United States whose practices were restricted to surgery. The shutters condemning the world of surgery to darkness had only begun to creak open. The advent of anesthesia and antiseptic technique had made elective operations possible and survivable, but innovation and innovators still lagged behind opportunity. The appointment of Macewen, had it come to pass, might well have relegated Hopkins to an era of surgical stagnation. But, in February of 1889, in a decision with implications far beyond their imaginations, the executive committee of the hospital trustees invited William Stewart Halsted to be surgeon-in-chief to the dispensary and acting surgeon to the hospital.

Knowing what they did of Halsted’s history, the trustees were hedging their bets. His colleagues, particularly Welch and Osler, threw their support strongly behind him and very likely helped secure the position. Osler, who had recently been appointed professor of medicine but was still at work in Philadelphia, wrote university president Gilman on March 6, “Halsted is doing remarkable work in Surgery and I feel that his appointment to the University and Hospital would be quite safe.” The following October, Halsted was appointed associate professor of surgery at the university, and in March of 1890 he was made surgeon-in-chief to the hospital as well as the dispensary. It would be two more years before he was named full professor.

There was no staff, no assistants, no dedicated surgery ward, no specialized operating room, and no residents. Indeed, there was no such thing as a resident. The closest approximation was the German system, where young doctors lived in the hospital for an extended period but training was not formalized. Osler and Halsted proposed to expand on that principle for their departments. Halsted envisioned total immersion in the problems and practice of surgery until a superior level of competence and maturity was reached. The rigors of the work would demand that men be unmarried, live in the hospital, and be available for duty 24 hours a day, seven days a week. In keeping with this radical new idea, the hospital set aside a floor for residents’ living quarters. The number of years of service required to be deemed “sufficiently trained” were not specified and would vary with the resident. There would be a system of graduated responsibility, with junior assistant residents, assistant residents, and at the top of the pile, the resident.

Not every man who began the program would reach the pinnacle. Some would continue to work as assistant resident, waiting their turn while another man served as resident year after year. For others the impossibility of succession would be made plain, and they would leave. But in 1889, there was very little surgery, very few patients, and only a single resident was hired. The first man to become a resident was Fred W. Brockway. A short time later, George E. Clarke was hired for the position of assistant resident.

Brockway was a New Englander and already a competent surgeon. He, along with the newly hired assistant surgeon to the dispensary, J. M. T. Finney, would be Halsted’s assistants. They would be responsible for all patient care, perform all surgery that Halsted didn’t care to do, and assist at all the operations he did. They would be responsible for all laboratory work, such as blood and urine analyses, and for keeping daily records of the progress of the patients. As the department took shape, and later when the medical school opened,
the responsibilities greatly increased to include research and teaching, as well as overseeing junior residents.

As casual as the hiring of Finney and Brockway may have seemed, they were the cream of a limited crop. From the day the hospital opened it was understood that only the most qualified men would be hired. For the time being, that meant hiring as resident men who had already had surgical training elsewhere. The onerous task of spoon-feeding the new surgical resident would be unnecessary. Halsted’s job was to set an example for them, and that he was ready to do. Thereafter, the junior men would learn from the senior men, and the senior men would learn from Halsted. The first residents, and their successors, were young, anxious to go where surgery had never been, and willing to dedicate a decade of their youth to get there. No one had ever attempted this adventure before, nor had there ever been a structured environment in which to offer such an educational opportunity.

CHAPTER ELEVEN
Finding the Way

IN THE EARLY DAYS
of 1889, less than six months before the hospital was scheduled to open, little was in place beyond bricks and mortar. Francis King, president of the hospital board of trustees, found himself facing the enormous task of filling out the medical staff, organizing the internal organs of the organization, and selecting appropriate leaders for the many interconnecting departments who would transform the parts into a functioning entity. Realizing he needed help, the aging King called on university president Daniel Coit Gilman to assume the additional post of director of The Johns Hopkins Hospital.

Gilman was a man of enormous energy, organizational ability, and panoramic vision. He immediately exhibited his brilliant unorthodoxy by telegraphing Osler, who had only recently signed on and had not yet left Philadelphia, to meet him at the Fifth Avenue Hotel in New York on the following day.

At breakfast, Gilman announced, “Between an hotel and an hospital there is no difference, and knowing Mr. Hitchcock I thought I would first find out how the Fifth Avenue Hotel was managed.”

In a few days’ time Gilman learned the intimate details of hotel operations, and was immediately able to transfer that knowledge to hospital organization. He began with the search for department heads
and asked Osler to call on his contacts from the hospital world. For the post of matron, what would now be called the head of housekeeping, Osler recommended Miss Rachel Bonner, a Quaker he described as “shrewd, business-like, and practical, but with a large warm heart always on the alert and doing daily, numberless little acts of kindness.” Soon warmly referred to as Sister Rachel, she made the interns and residents her personal project, often dining with them, pleading their cause with the administration, and counseling them on affairs of the heart. It was generally agreed that she lived up to her advance billing as “a bond of peace.”

For a time, Sister Rachel, who was described by Finney as “a quaint little Quaker lady,” lived in a secluded apartment in the administration building. The house staff lived together on a separate floor. As the staff increased in size she was required to take up residence on an integrated floor, causing discomfort for all. The residents, who were about to lose what passed for an uninhibited lifestyle, convened an emergency meeting and arrived at a brilliant solution. For their part, they would add ruffles to their nightshirts, and Miss Bonner would wear a bell around her neck. Even the teasing of her crew of young men was part of the familial atmosphere.

The position of head of the nurses’ training school was an important one, as it included not only the training of nurses but the position of head nurse of the hospital as well. The four leading candidates appeared, and were interviewed by Billings, King, Osler, and Gilman. The first three—Miss Louisa Parsons, a severe Englishwoman who had served with Florence Nightingale in the Crimean War; Miss Annie McDowell, an Irishwoman trained in England; and Miss Caroline Hampton, a daughter of southern aristocracy who had only recently completed nurses’ training at The New York Hospital—were all well received. But the fourth candidate was the winner. Isabel Hampton (no relation to Caroline) was a Canadian who had been superintendent of nurses at Cook County Hospital in Chicago. With a beautiful face and
figure, a sweet voice, and a commanding personality, she so charmed her interviewers that when she left the room they smiled broadly at one another as Osler whistled the first two bars of “Conquering Kings their titles take, from the foes they captive make.” Little was made of her excellent practical experience and fine references.

Isabel Hampton was offered the lead position but could not begin until the following September. Miss Parsons became interim director, Miss McDowell took charge of the private ward, and Miss Caroline Hampton took charge of Halsted’s surgical ward.

Joseph Hopkins, a favorite nephew of Johns Hopkins, was put in charge of the dispensary. L. Winder Emery, a local man and former hotel manager with a tough style and good instincts, was made purveyor. Emery’s responsibilities included purchasing and catering, and the resident staff made it their business to befriend him as well as Ben and Gus, the two “colored” waiters in the doctors’ dining room.

The last of the important executive appointments was Dr. Henry M. Hurd, a psychiatrist who had been in charge of a mental hospital in Michigan and was chosen to replace Gilman as permanent director of The Johns Hopkins Hospital. He was a slightly built man in his late 40s who favored starched wing collars far too large for his thin neck. He arrived shortly after the hospital opened, was formidable-looking but well liked, and soon became known as “Hank” among the house staff. Hurd was a generally good-natured man but known to suffer headaches, digestive ailments, and foul moods. As the entire institution was new, there was a great deal of trial and error in the evolution of routines, and the house staff would often petition Hurd for changes. Always more kindly disposed to requests when he was feeling well, they learned to send a scout out to take his temperature before making their approach.

CHAPTER TWELVE
William Osler

ON MAY 3, 1889
, William Osler was two months shy of 40 years old. He arrived at his new job just three days before The Johns Hopkins Hospital was scheduled to open. By opening day everyone was aware of his presence. Word of his achievements as diagnostician and pathologist at McGill University in Montreal, and then at Pennsylvania, had preceded him. Welch believed that in Osler they had acquired “the best man to be found in the country.”

Billings had visited Osler at his apartment on Walnut Street, in Philadelphia, in the early spring of 1889 to recruit him for physician in chief. Without sitting down, Billings asked, “Will you take charge of the medical department of The Johns Hopkins Hospital?”

“Yes,” Osler replied.

“See Welch about the details: we are to open very soon. I am very busy today, good morning.”

The position would pay $5,000 a year, and offer Osler the unique opportunity to reshape medicine.

He discharged his final duties in Philadelphia, attended a round of farewell dinners, and gave his immortal address,
Aequanimitas
, a primer for young physicians on the necessity of maintaining an even keel in the face of adversity. He wanted nothing more than to be
the chief at Hopkins, and proudly arrived for the opening ceremonies stylishly dressed in a Prince Albert coat with a fresh flower in his lapel. Osler was fairly slightly built but not short. He had dark hair thinning on top and graying at the temples, wore a full mustache, and a grin from ear to ear.

An inveterate jokester, he always had a kind word or quip for student and patient alike. It was not unusual to see him walking the hospital corridors with his arm over the shoulder of his resident, sharing a confidence, enjoying a story, or discussing the elements of a case. He was as kindly and interested as Welch, but he positioned himself with the residents as a friend rather than a distant uncle. The doors to his home and office were always open, and Osler quickly became the most popular man at Johns Hopkins.

In April 1889, shortly before assuming his new post, Osler delivered a scathing address before the Medical and Chirurgical Faculty of the State of Maryland on the sorry state of medical education:

It makes one’s blood boil to think that there are sent out year after year scores of men, called doctors, who have never attended a case of labour, and are utterly ignorant of the ordinary everyday diseases which they may be called upon to treat; men who may never have seen the inside of a hospital ward and who would not know Scarpa’s space
¹
from the sole of a foot. Yet, gentlemen, this disgraceful condition which some school men have the audacity to ask you to perpetrate; to continue to entrust interests so sacred to hands so unworthy. Is it to be wondered, considering this shocking laxity, that there is a widespread distrust in the public of professional education, and that quacks, charlatans, and imposters possess the land?