Mar 09 2010
One (dark and stormy?) night in 1882, a critically ill 70 year old woman was at the verge of death at her daughter’s home, suffering from fever, crippling pain, nausea, and an inflamed abdominal mass. At 2 AM, a courageous surgeon put her on the kitchen table and performed the first known operation to remove gallstones. The patient recovered uneventfully. The patient was the surgeon’s own mother.
This compelling story is the beginning of an excellent new biography of William Halsted, the father of modern surgery, Genius on the Edge: The Bizarre Double Life of Dr. William Stewart Halsted, by Gerald Imber, MD.
When Halsted went to medical school, surgeons still operated in street clothes, with bare hands, and major surgical procedures carried a mortality rate of nearly 50 percent. Suppuration of wounds was called laudable pus. Lister had recently introduced carbolic acid dips and sprays (that were irritating and toxic), but hand washing was discouraged because it was thought to force germs into skin crevices.
Halsted was responsible for the first use of sterile gloves in the operating room, although his initial reason for introducing them was to relieve the skin irritation of the scrub nurse who later became his wife. He collected statistics to prove that gloves reduced the infection rate, although he wasn’t always consistent: he once removed his gloves to better palpate a lesion and the patient got infected and died. In addition to the first gallstone removal, he developed the radical mastectomy (radically improving the survival of breast cancer patients), the first successful hernia repair and aneurysm repair, and many techniques that improved the outcomes of surgery. He established an animal lab to teach surgery to students and to try out new procedures. He kept refining his knowledge of anatomy, used meticulous surgical technique and fine silk sutures to minimize tissue damage (thereby reducing the chance of infection), insisted on hand washing and sterile technique, and kept careful records of outcomes to determine which procedures were best.
With his equally renowned colleagues internist William Osler, pathologist William Welch, and gynecologist Howard Kelly, he helped revolutionize the training of doctors by creating the first modern medical school at Johns Hopkins. Previously, medical schools were little more than for-profit trade schools. There was no laboratory or clinical work and students often did not see patients at all. The course lasted 3 years and had no entry requirements. At Johns Hopkins, an undergraduate degree was required for admission, the program lasted 4 years, there was extensive training in science, bedside teaching rounds were instituted, and there was a hierarchy of post-graduate training with interns and residents.
They even admitted women on the same basis as men. I thought it was hilarious how that came about. After building the hospital they had run out of money and were desperately seeking an endowment to establish a medical school. A committee of women offered to raise the money if the board would agree to admit women students. The board didn’t want to admit women, but they thought it would be safe to agree because they were confident the women would never be able to raise the necessary amount. The women promptly raised more than enough and forced the board to honor its promise! Incidentally, Gertrude Stein was an early medical student there, but instead of sticking around to graduate she went to Paris to write poetry and become famous.
The students Halsted trained (including Harvey Cushing, the father of neurosurgery) developed into a new generation of leaders and teachers: science-based surgeons who were responsible for many of the subsequent advances in surgery. They went on to teach another generation, and many of today’s most prominent surgeons and researchers can trace the line of their teachers’ teachers directly back to Halsted.
Yet this man who accomplished so much for science was a drug addict for 40 years. He was given morphine to help him withdraw from cocaine and ended up hooked on both drugs for the rest of his life. He only worked part of each year. He would disappear for months at a time, apparently to binge on cocaine in privacy. He was sometimes observed by colleagues to be suffering drug effects or withdrawal symptoms. Sometimes he would leave in the middle of an operation, saying he had a headache, leaving his residents to finish the procedure.
He was an odd duck in many ways. He was abrasive, abrupt, inconsiderate, forgetful, and apparently unfeeling: his personality quirks constantly antagonized his students and colleagues. His marriage was apparently sexless and his wife was also addicted to morphine.
His story is interesting in more ways than one. It provides insight into a crucial time in history when medicine was transitioning from superstition to science, when scientific surgery and modern medical education were being born. It is also fascinating to realize that this flawed man was able to maintain an incredibly productive scientific career for 4 decades despite his addictions. I can’t help but wonder what would happen to such a man today.
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