Genius on the Edge: The Bizarre Double Life of Dr. William Stewart Halsted (2 page)

The family fortune grew, and in 1835 William Mills Halsted built a large, finely appointed home on the northwest corner of Fifth Avenue at 14th Street, soon adding three adjoining houses for his children. He was a picture of Presbyterian rectitude, constantly preaching to his children. One of his children, Thaddeus, became a physician. To another, William Mills Halsted Jr., then away at school, he wrote, “endeavor my son to qualify yourself in usefulness and responsibility.” Young William learned his lessons and succeeded his father at the helm of Halsted, Haines and Company. He was a founder of the Commonwealth Fire Insurance Company, joined the board of governors of the New York Hospital and Bloomingdale Asylum, the board of the College of the City of New York, and the board of the College of Physicians and Surgeons. William Mills Halsted Jr. married his cousin Mary Louisa Haines, and together they raised a family in New York City, summered at Irvington, 25 miles north along the Hudson River, and were pillars of the community.

Frugal and strict, William Mills Halsted Jr. adhered closely to his father’s Presbyterian ethic and demanded the same of his four children. Though he provided well for his children, he forbade them to bring friends to their home for meals. When his youngest son, Richard, disobeyed this rule, he presented Richard and his friends with a detailed bill for the food they consumed.

William Stewart Halsted was the eldest of the four children. Until the age of ten he was homeschooled by governesses, then a common practice among the affluent. Public education in New York City was inadequate, and those of means sent their older children to the numerous private institutions throughout New England, most of which had close church ties.

The Halsted family remained seemingly untouched by the Civil War raging in the South. In the summer of 1862, just a few months after the Battle of Shiloh claimed the lives of 24,000 Union and Confederate troops, William Stewart was sent off far from the fray, to a school at Monson, Massachusetts, run by a retired Congregational minister, the Reverend Mr. Tufts.

It was an unpleasant experience, and Halsted later wrote:

There were about twenty boys in the school, all much older than I. I can recall very little of the method of instruction, but I must have studied Latin for I was given the choice of learning a lesson in Latin grammar or stirring soft soap in a great cauldron on Saturday afternoon when I was kept at home for misdemeanor, usually for swimming in the river. Sunday was a nightmare: we were driven to church two miles away and spent the entire day in the churchyard—Sunday school from nine to ten or ten-thirty, church until 1 P.M. luncheon from basket, Sunday school again at 3 P.M. and church say from four to five-thirty. In the spring of 1863 I attempted to escape, walked to Palmer, four miles, took train to Springfield twenty miles; was captured at Springfield and taken back to Monson.

In July 1863, the Draft Riots, the bloodiest riots in American history, were ignited at a conscription office on 47th Street and Third Avenue when poor Irish protested a new law that allowed anyone to buy their way out of military service for $300. The violence soon took
on racial overtones, and many blacks were targeted and hanged. Over five days the mayhem claimed as many as 1,000 lives.

That fall, young Halsted, kept safe from all of this, was enrolled at Phillips Academy, a preparatory school in Andover, Massachusetts, north of Boston. The school, founded in 1778 by Samuel Phillips, is more commonly known as Andover, distinguishing it from its rival Phillips Exeter Academy, in Exeter, New Hampshire, founded three years later by another family member, Dr. John Phillips. The Phillips Academy, Andover, is rich with American history. Its great seal was designed by the silversmith Paul Revere. Two of its many distinguished graduates were telegraph inventor Samuel F. B. Morse and U.S. Supreme Court Justice Oliver Wendell Holmes. From its earliest days, Andover established a tradition of preparing its young men for enrollment at Yale. In 1868, of a senior class of 40 students, 25 went on to continue their studies in New Haven.

Even at this early stage of his life, Halsted was careful about his dress and always well turned out. A photograph from the period shows a good-looking young man in suit, waistcoat, and matching cravat—his blond hairline already rather high on his forehead, and prominent patrician nose turned up at a fairly high angle over a wide, smiling mouth and full lower lip. His ears stood smartly away from his head, a feature about which he was often teased. Later in life he defused comments by joking about his ears before others could call attention to them. Barely five feet six inches tall, Halsted was solidly built, with a surprisingly muscular upper body and a tendency to walk with his elbows out.

Not yet 17 years old at graduation in 1869, and thought too young to enter college, he was enrolled in a private day school in Manhattan and tutored privately in Latin and Greek prior to college entrance exams. Halsted was admitted “without condition” to Yale, along with numerous of his Andover classmates. At Yale, “[I] devoted myself solely to athletics,” and his grades were in no way equal to his athletic achievements. Andover boys were well prepared for the
first few semesters at Yale, and it set them off with a relaxed attitude toward college education.

Athletics remained central to his life. He joined the junior and senior class crews, was shortstop on the junior class baseball team, and in his senior year served as captain of the football team. This was the first year of modern, 11-man football in college athletics. The 160-pound Halsted also knocked his friend Sam Bushnell flat in a boxing match.

There is no record of Halsted ever having borrowed a book from the Yale library.

The class at Yale was organized into four academic divisions based on performance. Halsted spent most of his lackluster tenure in the second and third divisions, although classmates believed he could easily have been in the first had he cared. Finally convinced to apply himself to his studies, he worked hard and did well on midterm exams. He abandoned the second division and assumed what he believed to be his rightful place attending first-division classes. Not finding himself registered among the division-one students, his irate inquiry was met by an instructor informing him he had been placed in the third division. The lesson that a perception once formed is difficult to alter was one he learned well.

Notably well dressed at Yale as he had been at Andover, Halsted and a friend paraded around campus for a time in tailor-made suits of mattress ticking. Sam Bushnell believed the outrageous fashion statement was clearly a Halsted prank, but “he did not have the courage to carry out his idea alone.”

Halsted was a member of a number of college clubs including the Freshman Society, Freshman Eating Club, The Tasters, The Sophomore Society, Phi Theta Psi, the Junior Society, and Psi Epsilon. But only inclusion in the elite senior society, Skull and Bones, mattered to him. His father had been a member and had aggressively pushed his son to seek election. The society seemed so important to him that Bushnell offered to decline election if his friend was excluded, but
Halsted refused: “If you get an election, you take it; if I get an election I shall take it. I shall expect you to do the same by me.”

In the end, he was not tapped for the society. The rejection was all the more devastating since his “Bonesman” father did not take it well, saying to Bushnell, “Why didn’t you get him into Skull and Bones? You made it.”

Halsted acted in plays, “did not go in for social activities,” and did not drink. There is no mention of girls in any of Halsted’s letters or reminiscences, or in the comments of friends. He continued to attend church regularly while at school but was increasingly dismissive of the strict religious fervor of his parents. The trip to New York was fast and convenient on the New Haven Railroad, and he came home frequently during the school year. He visited with the families of college friends and made several trips to Baltimore with his friend Henry James, son of a leading local financier. Summers were spent at the family home at Irvington, in the lower Hudson Valley, and the four children remained close with their parents and one another. Several of the family members were avid gardeners, and this became a passion that William Stewart shared as well.

In a totally uncharacteristic act early in his senior year, the unscholarly Halsted purchased copies of
Gray’s Anatomy
and
Dalton’s Physiology
. He had shown no interest in science previously, but now immersed himself in the reading. He spent his free time around the laboratories and clinics at the Yale medical school, asking questions of anyone who would speak to him. As his time at Yale came to a close, young Halsted told his father that he was not interested in joining the family business but would like to study medicine. It was a decision that would change the face of modern medicine.

CHAPTER TWO
Setting the Stage

PRIOR TO 1846
, very little elective surgery was performed in either the United States or Europe. London was teeming with 2.3 million people in the most unsanitary conditions imaginable. New York City was home to 700,000 inhabitants in 1850, and more than 2 million by 1860. Disease and deformity were rampant, yet medical centers in New York and London reported no more than 200 operations a year, largely because the pain of surgery was so intolerable that the idea was rarely entertained. For centuries, little more than alcohol and opiates were available to ease the pain, and these proved inadequate for the horrors of amputation or the evacuation of a tuberculous abscess.

When catastrophic injury demanded surgery, the outcome was often as disastrous as if the injury had gone untreated. Limb amputation was the most frequently performed operation. Often the victim of an overturned wagon or a mill accident who was strong enough to withstand the pain of surgery would die from postoperative infection. During the Civil War, trained surgeons were so scarce that uneducated recruits were taught the basics of amputation and operated without supervision. Their results were often no worse than those of traditional surgeons in what passed for field hospitals. In the face of
such predictably dreadful outcomes, it is not surprising that surgeons were not well regarded by their medical colleagues.

A century earlier the teachings of the great Scottish anatomist John Hunter established some level of respect for anatomical dissection, the understanding of surgical anatomy, and well-planned operations with reproducible results. But operations were performed in only the direst of circumstances. Drugged patients were held down by several strong men and restrained from thrashing about until they ultimately fainted away, but no one could tolerate this torture for very long. Operative time was measured in minutes. The best surgeons could remove a limb in five or ten horrific minutes. Another half hour was spent attempting to stop the blood loss, which was usually enormous. Neither blood transfusions nor intravenous fluids where yet available, and patients simply went into shock and died. Bleeding was controlled with large ligatures, usually thick strings made of sheep intestine or silk, sometimes held in the surgeon’s mouth for easy access. The ligatures were hastily applied and crushed the bleeding arteries and veins, as well as the surrounding muscle. Flaps were closed crudely, and a perfect environment for infection was created.

The cause of infection was unknown, and many physicians still subscribed to the theory that an imbalance of the four humors—blood, phlegm, black bile, and yellow bile—was the root of bodily dysfunction. Doctors drained abscesses with little thought of cause or prevention. It was simply the thing to do, and it happened to work. As late as the mid-19th century, the germ theory was still unknown, and the idea of bacteria growing in the warm culture medium of devitalized human tissue hadn’t yet been suggested.

PAIN AND INFECTION
had to be conquered before surgery could advance beyond barbarism. The first of the missing links was provided two decades earlier at the Massachusetts General Hospital in
Boston. In 1845, Horace Wells attempted to demonstrate the technique of painless dental extraction using nitrous oxide gas. The level of anesthesia he used proved too light, and the patient cried out in pain. The students in the gallery at the Harvard Medical School stood, shouted “humbug,” and left the room.