Read Genius on the Edge: The Bizarre Double Life of Dr. William Stewart Halsted Online

Authors: Gerald Imber Md

Tags: #Biography & Autobiography, #Medical, #Surgery, #General

Genius on the Edge: The Bizarre Double Life of Dr. William Stewart Halsted (32 page)

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In 1897, the first medical school class was preparing to graduate, and applications for future places were outstripping availability. When one of the three female students in the first class had married Franklin Mall, the scourge of the medical student, and dropped out, Osler quipped that at that rate there would be no women remaining to graduate. Otherwise, resistance to coeducation had dissipated, and varying numbers of women entered succeeding classes. However, an undercurrent of displeasure with women in medicine persisted. Most thought women did not have the physical ability to tolerate the grind. There were comments about the loss of femininity and sexuality necessary for them to succeed, and even Osler was said to have commented on the three classes of humanity: men, women, and women physicians.

The chiefs were pleased to have their first homegrown class of young doctors from which to choose their interns and residents, and things were finally going along according to the original plan. The same professors of clinical medicine had been responsible for teaching the rudiments of scientific medicine to the students. And students who had shown an aptitude for independent thought and research were being rewarded with positions under their mentors.

The dog surgery course finally got off the ground late in 1895, and it was a resounding success. Halsted had made good on his promise. He had structured an experience that accurately mimicked human
surgery, and the students were not only consumed by the opportunity, but aware of being part of an important transition in medical education. The vision and the syllabus were his, and he taught the course whenever he could, and then whenever he felt like it, and then not at all.

Perhaps the greatest disappointment for the third-year students was the absence of surgical teaching beyond the dog lab. Lectures were frequently canceled, and when they took place, were too esoteric to be worthwhile. Halsted still didn’t get it. His interests were in unsolved surgical problems, in difficult diagnosis, and the correlation between disease and surgical pathology, all far beyond the scope of undergraduate surgery. The students were interested in learning the day-to-day clinical practice of surgery. The residents understood this and attempted to fill in the gaps.

Friday surgical clinics were a great success. These took place in the amphitheater. Halsted held the floor; patients were presented and discussed. The medical students in the rows of benches did their best to keep out of sight. After Halsted’s presentation, he asked questions on a wide range of topics. In a discussion that wandered to the muscles of the neck, William Rienhoff recalled The Professor asking the students gathered around him, “What made the larynx go up and down when one swallowed?”

After a significant silence, Halsted answered his own question. “The inferior constrictor of the pharynx,” a muscle located in the back of the throat.

Rienhoff didn’t accept the answer. The next day he went to the anatomy building and dissected a human neck. His dissection demonstrated that the muscle responsible for laryngeal movement was, in fact, the stylohyoid. With trepidation, Rienhoff reported his findings. It was this sort of curiosity that Halsted sought, and Rienhoff remained a favorite thereafter, ultimately earning the position of resident.

Despite the disorganization and disappointments, the popularity of the school grew. The Johns Hopkins School of Medicine stood alone
in the country, and was being recognized for the phenomenon that it was. By 1896, the entering class was more than 40-strong. Women were filling more of the places, and the quality of the female students was generally excellent. Even skeptics like Welch were speaking out for coeducation.

Not all the bright, young students fit the mold, or were able to thrive within the system. Gertrude Stein entered with the class of 1901. Having studied experimental psychology with William James at Radcliffe, Stein returned to her family in Baltimore and enrolled at The Johns Hopkins School of Medicine. From the start, she was anything but popular with fellow students. The butt of pranks and unflattering sobriquets, she was thought generally unpleasant in manner and mannish in appearance—two accurately portrayed traits, which she incorporated into her persona.

Stein developed close relationships with feminist voices in the community, including Dr. Claribel Cone and her sister, Etta, who were wealthy art collectors. Claribel was doing postgraduate work at the medical school, and she and Stein built an enduring friendship. Stein openly espoused her lesbian philosophy and lived outside the mainstream of student life. She did well through the two preclinical years and idolized professors the other students despised, particularly Mall and Halsted.

In the clinical years Stein failed miserably, and by consensus she was denied her degree. For a period she remained at Hopkins studying neu-roanatomy with Mall, but that, too, ended in failure. With no aptitude for medicine, Gertrude Stein moved to Paris and gained fame as a writer. Stein coined the term “The Lost Generation,” for the young, intellectual expatriates struggling to find themselves in postwar Paris, including her friends Ernest Hemingway, F. Scott Fitzgerald, and Sherwood Anderson. She befriended Picasso and Matisse; claimed that Cézanne’s painting
Madame Cézanne
, beneath which she sat while writing
Three Lives
, was the inspiration for her book, and went on to amass a brilliant collection
of Impressionist art. For that collection alone, she will always be remembered. Stein’s influence on the literature of the day was significant, if debated. Much of her writing was obtuse, and though few believed her work to be as great as did she, much of it has survived.

AS THE CENTURY
drew to a close, The Johns Hopkins Hospital was filling its beds and changing the way medicine was practiced. Everyone was working well, no one was working excessively hard, and each of the Big Four was rapidly becoming a caricature of himself. Welch was wearing too many hats and spending too little time in each. His lectures were mostly given by assistants, who were not nearly so dynamic and embracing as speakers. The joke was that his courses were “too much Flexner and not enough Welch.” His laboratory work and scientific paper production had dwindled to near nothing. He spent some time as dean of the medical school, some time as pathologist in chief, and lots of time at the dining table.

Halsted was fond of writing letters, but he was notoriously slow in responding to his mail. Knowing this, he often began the return letter with a disclaimer and apology for the piece having slipped to the bottom of the stack. Welch, on the other hand, was completely hopeless. In 1896, he had founded the
Journal of Experimental Medicine
, which he also edited. Prominent scientists gladly contributed their work, only to lose touch with their manuscripts and hear nothing from Welch. Requests for return of the manuscripts went unheeded, and Henry Hurd was asked to intervene. Hurd began to periodically slip into Welch’s study when he was away for his weekends, rummage through the stacks of unopened manuscripts, and return them to their worried authors.

Welch’s library was furnished with eight chairs and a desk, all piled high with unopened mail. The disorder was staggering, but Welch, it seemed, had a system: “On that armchair there I have the letters that have come during the past week; I hope to read these in the
near future. On that chair I have the letters that have come within the last month. On the other chairs are letters and magazines anywhere from six months to a year old which I hope to get to sometime.”

He had reserved one small corner of his desk for writing. The bulk of the surface was reserved for storage. When the desk became too littered he would spread a newspaper over the letters and papers, and start again. Hugh Young recalled seeing four such layers on the desk. Young offered a Dictaphone and stenographer to help restore order. When the first cylinder was returned for transcription, the only message on it was a salutation, followed by, “Young, I can’t use this machine. Send your boy around to get it.”

WILLIAM OSLER REVELED
in the success of
The Principles and Practice
. He drew the finest residents around him and was absolutely beloved by the medical students, who endured the first grueling years of basic sciences awaiting their exposure to the great man. Osler could regularly be seen walking the halls with an arm on the shoulder of a student or intern. He was the only senior faculty member who regularly socialized with the students, even inviting groups of them to his home on Saturday evenings for dinner or dessert. He was on close terms with the residents, not only those in his department, and beloved by all. And he was a congenital jokester. His pranks were generally enjoyed, other than by Halsted. He continued to compose verse, often on hospital issues, and was, in the eyes of all, particularly his juniors, the beating heart of the institution.

Kelly was operating constantly. Hunter Robb, who had been Kelly’s assistant, and preceded Bloodgood as the first man to wear surgical gloves for surgery, had become resident. “Bull” Williams, who led obstetrics, was a difficult and biased man. He was intensely disliked by the female medical students, who found his offhand, sexist remarks offensive. Kelly was too busy to take up the cause, but it was his nature to defend honor and decency, even when he wasn’t asked to do so.

Kelly’s fees were extremely high, and his popularity enormous. He had already written the two-volume text
Operative Gynecology
and was thought to be the best surgeon in the country.

Halsted’s fame was nearly equal to that of his peers, about which he was honestly unimpressed, and the surgical service was busy. His private practice had grown with his fame, but he was operating less and relying more on his assistants. Fewer private patients were treated in their homes, and increasingly the resident performed the surgery when the patient was hospitalized.

The charity wards provided the overwhelming percentage of surgical patients. Initially, the wards were racially integrated, in the spirit of the founder. The board of trustees—founder Johns Hopkins’s fellow Quakers—generally favored integration, and Francis King, the president of the board, personally saw to it that the hospital opened with racially integrated wards. In short order, protests and unrest festered among staff members and the patient population, both black and white. The experiment in integration was abandoned shortly after it was begun, and segregated wards were created.

All charity patients were treated by Halsted with the same gentlemanly intensity and detachment as were his private patients, but gradually, this aspect of his life became less central. There always seemed to be something that demanded his attention—a project in the lab, a paper he was working on, a problem at home, or simply his feeling out of sorts. As Halsted withdrew from the operating room, the burden fell increasingly on Finney, Bloodgood, and Mitchell. The occasions upon which he verbalized his thanks to those picking up the slack were few. It had become an unspoken part of the job.

THE ENORMITY OF
the success of the Hopkins experiment could only have been the result of the unique celestial alignment that brought together Welch, Osler, Halsted, and Kelly. Other institutions were
working to move medicine forward, and many began to adopt elements of the Hopkins style. Laboratories were integrated into the great hospitals, aseptic surgery was slowly accepted, and postgraduate training became available. The better medical schools instituted more stringent admission requirements and some moved to a four-year curriculum, but abandoning the old ways was a slow process. Hopkins soon stood alone far ahead of the pack, and it would take the organized outrage of the Carnegie Commission to fully turn the page. By the time that would come to pass in 1910, there was Johns Hopkins, and there was everyplace else.

But a big shake-up was headed for the Department of Surgery. It came in the form of an assistant resident, the son of a wealthy Cleveland doctor, by way of Harvard and the Massachusetts General Hospital, and in the person of Harvey Cushing. A slight, dark-haired young man, Cushing was aristocratically handsome, with a beaklike nose and strong jaw, and was as tightly wound a “type A” overachiever as one could imagine. With boundless energy, enormous technical skill, scientific curiosity, and great intelligence, all packaged together with soaring ambition and no small amount of hubris, he moved into the world of Johns Hopkins. Not surprisingly, Cushing would be the first of the Halsted residents to stamp his own mark on the surgical world.

BOOK: Genius on the Edge: The Bizarre Double Life of Dr. William Stewart Halsted
4.41Mb size Format: txt, pdf, ePub
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