Genius on the Edge: The Bizarre Double Life of Dr. William Stewart Halsted (6 page)

In early September 1880, Halsted sailed for New York, ready to begin his career.

1 Some evidence exists that the Halsted charts were abandoned shortly after his tenure, though they do show up later, both at the New York Hospital and at Johns Hopkins. Others believe that the now ubiquitous bedside chart is the direct result of Halsted’s innovation.

CHAPTER FIVE
New York

THAT SEPTEMBER, HALSTED WAS
28 years old and in physically fine shape, though his muscular upper body was perhaps a bit broader from two years of heavy dining and little or no exercise. His fine, light hair, now thin to the point of baldness on top, was cut short at the sides, further accentuating his prominent ears. No longer clean-shaven, he sported a close-cropped beard and was, as always, immaculately groomed. He was charged with energy and ideas, and couldn’t wait to get to work.

Not fully accepting the need for the carbolizer, or the idea that the danger of germs was in the ambient air, Halsted and a colleague worked hard to modify Lister’s technique and institute the scrubbing and chemical decontamination of hands and tools before operating.

He renewed contact with his medical school preceptor, Henry Sands, who invited him to join his practice at Roosevelt Hospital. Sands was an important man in New York. He covered a busy surgical service at Roosevelt, had a large private practice, and was professor of private practice and anatomy at P&S. Having the tireless Halsted to share the load would be a great help.

Sands encouraged Halsted to operate on any cases that interested him and allowed him to purchase new equipment for the surgical
service. The surprised staff had no idea what to do with the large number of fine artery forceps that soon arrived from Germany. The purchase had come about as a direct result of observing Billroth carefully clamping and tying blood vessels to prevent hemorrhage. This procedure amazed Halsted, as it seemed so logical and proper. Few American surgeons bothered with the time-consuming technique, but it soon became a religion to Halsted.

Although he spent long hours operating and assisting, it became apparent that Roosevelt needed a clinic to care for nonoperative cases, minor surgical cases not requiring hospitalization, and follow-up patients. Halsted suggested the idea to Sands, who helped convince the trustees of its potential usefulness. He was given rooms in the hospital basement, buried deep among the gas and water pipes. Early each morning, Sundays included, Halsted hailed a horse-drawn cab at 25th Street, where he had set up house with his friend Thomas McBride, and made the two-mile trip to 59th Street and Ninth Avenue. His outpatient clinic was an immediate success. Soon the hospital devoted an entire floor of a new building to it. Roosevelt Hospital’s reputation was growing, and the physical plant was growing with it. Plans went forward to add two floors of opulent private rooms for wealthy patients above a new outpatient building. These rooms and suites would cost $25 to $75 per night, depending on size and furnishing, and they would help defray the cost of the primary mission of the hospital, which was the 180-bed charity ward.

Halsted worked in the hospital laboratory as well as in the clinic and operating room. There he devised a successful irrigation treatment for gonorrhea, washing out the infected urethra with dilute disinfecting solution, counting the reduced numbers of gonococcus organisms, and establishing a successful therapy for a ubiquitous disease. Half a century before the advent of antibiotics, any relief at all was welcome. The work did much to raise Halsted’s stock at Roosevelt, but his procedure was not generally adopted by the medical
community, where it was thought excessively time-consuming, a judgment that would be applied to much of Halsted’s future work.

Sands thought enough of the 28-year-old to invite him to share his teaching responsibilities as well. He had neither the time nor inclination to prepare dissections for his lectures at P&S, so this fell to Halsted, who took great pleasure in the work. Throughout the school year he spent long hours strutting through the dissecting room among the partially dismembered bodies; in shirtsleeves, pince-nez glasses, and high hat, he inspired students with his knowledge and enthusiasm as he demonstrated the intricacies of human anatomy.

He took a position as visiting physician at the city hospital on Blackwell’s Island (now Roosevelt Island) and at Emigrant Hospital on Ward’s Island, both located in New York’s East River. Most of his duties at these hospitals were carried out at night, since, as he later wrote, “few hours by day were unoccupied.”

Halsted held these charity hospitals in high regard and was full of praise for the staff physicians. Allen M. Thomas, the obstetrician at Emigrant Hospital, was said to have reduced maternal mortality at childbirth from 25 percent to ½ of 1 percent. Most maternal fatalities were due to puerperal fever, a virulent infection spread by physicians with unclean hands performing bare-handed vaginal examinations and deliveries. It was not a new problem. In Vienna in 1847, Ignaz Semmelweis had noted that the maternal mortality rate at the Wiener Allegemeines Krankenhaus (Vienna General Hospital) was much higher in the wards where doctors coming from morgue dissections and surgery performed bare-handed exams and deliveries than they were on the ward where deliveries were done by midwives, who had no such duties. This was before Lister and Pasteur and germ theory, yet Semmelweis believed some sort of invisible infective particles were being transferred to the susceptible mother. He found that by having those on his service wash their hands with a chlorine solution, maternal mortality rates plummeted from 18.2 percent to 1.2 percent. Sadly,
Semmelweis’s work was largely ignored until after his death in 1865. Prior to Thomas’s precautions, the statistics at the Emigrant Hospital had been significantly worse than those in Vienna, and the eradication of puerperal fever in America similarly parallels the grudging acceptance of antiseptic techniques.

DURING THIS PERIOD
Halsted shared a house with his friend Thomas McBride on 25th Street between Madison and Fourth avenues at fashionable Madison Square, just a short walk from his parents’ home at 14th Street and Fifth Avenue. It was also conveniently located around the corner from the University Club, where he spent time with friends, frequently dined, and sometimes bowled ten-pins. The house was large, stylish, lavishly appointed for entertaining, and included medical offices for the wealthy young men. Together, they gave small dinner parties several times a week and entertained bright young professional men like themselves. There was always food and drink enough for unexpected guests, and visits were encouraged. Halsted’s closest friend, William Welch—a pathologist at Bellevue, faculty member at Bellevue Medical College, and the man who had begun the nation’s first pathology laboratory—was a frequent visitor.

Halsted was always central to the fun. Vivacious and amusing, he was unfailingly thoughtful and extremely well-mannered. He might have an occasional glass of wine, but he was anything but a drinker. His only vice, it would seem, was the endless stream of carefully rolled cigarettes he smoked in inexpensive white holders. These were purchased by the hundreds and disposed of the instant a sign of tarnish or wear appeared. The details of running the house were largely his concern, and everything was properly arranged for entertaining, even on those Sunday afternoons when the furniture was repositioned to accommodate an audience for concerts given by male singing quartets.

Madison Square was central to the changing city. New elevated railroad lines were running on Second and Third avenues, the latter even operating trains through the night. Electric lights were installed along Broadway from 14th Street to Madison Square, with the final light in the center of the small park. The area was a showplace for Thomas Edison, who purchased a four-story house on Fifth Avenue and 14th Street, a few doors from Halsted’s parents. Edison outfitted the house with 100 electric bulbs, and kept it lit night and day to give the public a taste of the future. The first telephones became operational that year and boasted 252 early subscribers. Soon, new telephone companies cropped up to meet the booming demand.

HALSTED’S WORKDAY WAS
staggering: early morning at the Roosevelt Hospital outpatient clinic, daily surgeries, patient care at several hospitals, instructing and dissecting in the anatomy lab, and frequent trips to the charity hospitals to consult and operate. Several of the hospitals he attended were within walking distance of Madison Square; others, particularly the charity hospitals, required time-consuming transportation. In addition to these responsibilities, he and several colleagues organized a quiz for P&S medical students. Students entering the quiz were required to have bachelor’s degrees, making the standards for entry higher than those of the medical school. Determined to encourage real learning in addition to the rote memorization and regurgitation they had endured, Halsted and his colleagues began assembling a faculty interested in expanding the students’ knowledge. Many of the quizmasters were P&S instructors, but they were chosen carefully and were primarily younger faculty members. Outside faculty was sought as well. The star among them all was William Welch.

Just two years older than Halsted, Welch had already earned a significant reputation. At the quiz he not only lectured the students on histology and pathology, but also allowed them access to his laboratory
and freedom to observe his processes in action. Most important, he provided a wealth of autopsy material—cadavers—for study.

Some 25 or 30 medical students, and at one point up to 65, met several evenings a week. The locale was usually Halsted’s office in his 25th Street residence, with side trips to Welch’s pathology laboratory. As was standard, the fee for the course of study was $100 a person. The fee always struck Halsted as excessive, but they accepted the money.

Teaching anatomy and surgery, Halsted was a walking, talking
Gray’s Anatomy
textbook. His knowledge was so encyclopedic that students made a game of trying to catch him in mistakes, but his command of the anatomy and near-photographic recall of
Gray’s
always seemed to carry the day. On one occasion when he challenged a student’s answer, they went to
Gray’s
, where the student was surprisingly upheld.

“Wait a minute, I’m sure
Gray
gave it my way in the edition I studied,” Halsted said. Out came the older edition of
Gray’s
, which was exactly as Halsted had remembered.

He was idolized by the students and, in turn, was dedicated to seeing them succeed. Graduates of Halsted’s quiz invariably did well in their exams and often occupied the first ten places in the medical school graduating class, a feat that brought him considerable joy and the quiz great popularity.

Halsted quickly earned a reputation as a bright and aggressive surgeon, and his practice prospered. He analyzed situations differently from those around him, acted quickly, and often followed an unorthodox course of action. In 1881, he made medical history by performing the first emergency blood transfusion, under extraordinary circumstances. He was in Albany visiting his youngest sister, Minnie, just as she was giving birth to her first child. Her husband, Sam Van der Poel, came happily downstairs from the bedroom to greet his old friend and announce the birth of a healthy baby boy. Normally following delivery, the stretched and torn muscles of the uterus contract, and bleeding ceases. Minnie continued to hemorrhage. Twenty minutes
later, Halsted was called to his sister’s bedside in consultation. Van der Poel, Halsted, and the attending physician tried controlling the hemorrhage with ice-water douches, pressure, and packing. Finding Minnie “ghastly white, quite pulseless and almost unconscious,” Halsted drew blood with a syringe from his own veins and injected it directly into his sister’s vein, possibly saving her life.