Genius on the Edge: The Bizarre Double Life of Dr. William Stewart Halsted (46 page)

Franklin P. Mall died at The Johns Hopkins Hospital on November 17, 1917. He was 55 years old. Halsted blamed himself for the loss of his friend, but in truth, events were stacked against the anatomist, and his death was hastened by what was thought to be the newest in scientific treatments.

Carrel’s casual approval of the intraperitoneal use of the caustic agent had been wrong. Others had similar experiences with Dakin’s eroding the pleural lining of the lungs and causing fistulae, and it had become clear that the full ramifications of its use were yet to be
known. Those who bore witness to the acceleration of Mall’s free fall held Carrel in very low esteem. Halsted was never heard to blame the French/American surgeon. In conversations with others touching on Mall’s death, Halsted limited himself to how much he missed his friend. He never openly disparaged Carrel, and though he never mentioned the incident, he wrote in the
Journal of the American Medical Association
, “I would warn against the use of Dakin’s solution in so fresh a sinus lined with intestine.”

Halsted returned to work, but an important link connecting him with Johns Hopkins had been lost. He wrote Councilman, at Harvard, “I shall never cease to mourn the death of the incomparable Mall.” Only Welch and Councilman remained from the original group at the Pathological, and Halsted’s correspondence with the latter became more poignant, but always slyly amusing. In one letter, he wrote, “I confess to having been not a little apprehensive lest the heat and insects of the equator might give a twist to your peerless disposition. [Councilman had planned a trip to the Amazon.] You say that inasmuch as a trained nurse is to be in the party you are not looking for trouble. Evidently you are not a clinician.”

As he grew older, Halsted had become an even more prolific letter writer, and increasingly employed uncommon words. When he wrote, his favored
Century Dictionary
was always open on his desk. His medical prose was dense and the ten-dollar words made it even less enjoyable to read. Councilman wrote, “I find words which to me are new but which I suppose are commonplace in your conversation with the intellectual giants around you. For instance, ‘temerous’ which is fine, but I think you are the only one who has ever used it.”

Tegmen, deligate
, and
defract
found their way into his scientific papers. Halsted kept a notebook of unusual words and phrases and their derivations. After he created new medical terms to describe a procedure, he feigned horror that others were unfamiliar with them. He responded to German surgeons questioning the meaning of the
term
ultraligation
, used in his paper on thyroid surgery, “Ligation of the thyroid artery at a point beyond that at which the branch to the parathyroid glands is given off.” Who knew?

Some may have found this an annoying affectation, or perhaps deliberate obfuscation. Councilman certainly found it amusing. It was not a late folly, for Halsted’s interest in etymology was long-standing. He and Caroline often discussed the derivation of words over dinner. And some of the pranks the “old gang” at the Maryland Club played on one another were word games, occasionally even based on classical Latin.

Obsessed with words, Halsted worked and reworked his scientific papers until they conveyed precisely what he wished his message to be, and encouraged the use of what he believed to be the single most critical word for scientific discourse: “If you put ‘perhaps’ before a statement and the statement turns out to be true, you will get credit for making it; if it turns out to be false you will not be blamed.”

As Halsted considered his own mortality, he remained convinced that he would perish at 70, of gallbladder disease. With so much yet to be done, he focused his energies once again on the unsolved problems of intestinal anastomosis, aneurysm, exophthalmic goiter, and the swelling, or lymphedema, of the arm after radical breast surgery, which he called elephantiasis chirugica. He compared it to other forms of massive swelling of the extremity, which he believed to be caused by infection; after radical breast surgery, he believed the “dead space” created in the axilla filled with fluid and provided a perfect environment for infection to thrive. The operation was modified to eliminate the dead space and the medium for bacterial growth. This was largely successful, though even in the antibiotic era lymphedema was not totally eliminated.

In 1914, Halsted published his 650 cases of exophthalmic goiter. The bloody operation was always a test for the surgeon, and one he continued to perform. As his experience increased, he set about the daunting task of compiling the definitive monograph on the subject.

In 1915, he devised a method for draining the common bile duct through the stump of the cystic duct. The technique allowed closure of the common bile duct, and prevented the debilitating weakness caused by constant loss of bile. The first application of his innovation took place in March 1917. It was successful in every way, and the patient had a quick and uneventful recovery. Halsted was impressed, and advised, but did not insist upon, its adoption by his staff, which would come to have personal implications.

IN APRIL OF 1917,
America declared war on Germany and joined the campaign which had been raging in Western Europe for nearly three years. The first troops of the American Expeditionary Force had shipped out for France in June 1917. By the following July there were more than a million American soldiers in Europe, and by November, the last month of hostilities, the number had doubled to two million men.

The rapid deployment of large numbers of troops into the escalating fight required massive medical and surgical support. To meet the need, many of the leading American hospitals mobilized their staffs and manned A.E.F. base hospitals as dedicated units. Base Hospital #18 was the Johns Hopkins Unit. With American casualties amounting to more than 300,000 dead and wounded, there was a great deal to do. Doctors and nurses around the country put their careers on hold to accept military commissions. The mobilization of the Hopkins unit, while generally applauded, and necessary, greatly reduced the manpower remaining at the hospital. Thirty-two Johns Hopkins medical students volunteered as well. Thirty of them had completed three years of medical school, and would earn their MD degrees for their service. The other two students had completed only two years, one of whom was the eldest son of J. M. T. Finney.

Volunteer Baltimore women made dressings, gowns, sheets, pillowcases, and towels, and local businessmen contributed $30,000
to equip the unit. In October, Base Hospital #18 took over a 1,000-bed hospital from the French. The surgical unit distinguished itself mightily by working night and day through those horrible final two months of the war.

Halsted was 65. Too old and infirm to serve overseas, he picked up the pace of his work at home, resuming a more arduous teaching and surgical schedule. He corresponded with many of the Hopkins men in the service, particularly his trusted assistant George Heuer, often letting him know how much he was missed and needed. In a letter dated April 29, 1918, he added the sentiment many of those stateside shared: “I fancy that by the time you return to America operative surgery will have no more thrills for you.”

Heuer commanded the surgical unit of Base Hospital #18, and Baer was an orthopedic consultant to the A.E.F. Both men distinguished themselves at war and returned with experience that translated well to civilian service. Heuer, whose primary interest had been neurosurgery, became a leading expert in the treatment of penetrating chest wounds and trauma.

HUGH HAMPTON YOUNG,
mustered as a colonel, was tapped by General John Pershing to command the urological unit of the A.E.F. and became intimately involved in public health measures. Before the advent of antibiotics, venereal diseases spread rampantly and plagued the armies. Young’s knowledge, his particular interest in bacteriology, and his intense level of organization contributed greatly to the control and treatment of these diseases.

Baer, who founded the orthopedic department at Hopkins, rediscovered an efficient old treatment for cleaning chronic open wounds: maggots. Having examined two starving, wounded soldiers, Baer was thoroughly disgusted to see their week-old wounds crawling with maggots. Sweeping the worms away, he found the wound lined with clean granulation tissue, and healing. The method for cleaning wounds
followed him home, but other more aesthetically acceptable methods of treatment, such as the Carrel-Dakin’s irrigation, won the day.

Finney had assumed a position of great importance as a colonel and chief surgical consultant to the A.E.F. He had known President Woodrow Wilson for years, both as his doctor and as a member of the board of trustees of Princeton. General Pershing was aware of the connection and sent Finney from his assignment in France to Washington, D.C., to convince the president to choose the proper man as surgeon general at a critical moment for the army. Wilson heeded his doctor’s advice, and Finney’s stock with Pershing rose sharply.

Late in the horrible war, Finney shared a lunch and reminiscences with an old Hopkins friend, John McCrae, who died in a battlefield hospital shortly thereafter. McCrae was best known for his haunting poem,

In Flanders fields the poppies blow

Between the crosses, row on row
,

That mark our place; and in the sky

The larks, still bravely singing, fly

Scarce heard amid the guns below
.

We are the dead. Short days ago

We lived, felt dawn, saw sunset glow
,

Loved and were loved, and now we lie

In Flanders fields
.

Take up our quarrel with the foe:

To your firm failing hands we throw

The torch; be yours to hold it high
.

If ye break faith with us who die

We shall not sleep, though poppies grow

In Flanders fields
.

CHAPTER THIRTY-FIVE
“My Dear Miss Bessie”

IN NOVEMBER 1918,
the war was winding down. Halsted, at 66 years old, was tired. He had endured two busy and uncomfortable years at a stage of his life when he should have been more at his ease. European travel had been impossible since the outbreak of hostilities in 1914. Though he and Caroline fully supported the war effort, he still had many close friends in the German scientific community. Contact was difficult, but he did what he could to soften the economic hardships inflicted on them toward the end of the war. Coping with the manpower shortage at the hospital was trying, but the Hopkins unit was doing its duty and was a source of pride to those remaining behind. Heuer, who had been carrying so much of the surgical and teaching burden of the department, would not return until the spring, but at least the end was in sight.

As weighty events were unfolding overseas, the enigmatic Halsted was beginning a relationship with Elizabeth Randall, a woman 40 years his junior. Well accustomed to hiding private matters, Halsted kept no diary, sought no confidants, and quietly carried out a relationship that had all the earmarks of youthful romance. Whether the relationship was consummated, or if such was even contemplated, is unknown. The story, patched together from a series of letters
Halsted wrote to the young woman, reveals a gentle, touching, and often humorous flirtation.

Elizabeth started the exchange, which spans a period of three years. The flirtatious letters speak only Halsted’s words. Elizabeth’s letters to him have not been found, but from his responses one can easily infer a mutual infatuation first communicated by her. Halsted and Elizabeth Randall seem to have known each other through Baltimore social circles. In his initial letter, in response to the first from her, he wrote: