“Genius on the Edge”
The life of William Stewart Halstead
Jonathan McFarland
March 2015
The Knick: TV series
The Knick
In New York City in 1900, the Knickerbocker
Hospital operates with innovative surgeons,
nurses and staff who have to overcome the
limitations of the then-current medical
understanding and practice, to prevent
staggeringly high mortality rates. Dr. John
Thackery.
The Knickerbocker Hospital
John Thackeray ( Clive Owen) William Stewart Halstead
Preamble ..
“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 2am, a courageous surgeon put her on the
kitchen table and performed the first known
operation to remove gallstones.” (Harriet Hall)
The patient recovered.
The patient was the
surgeon’s own mother.
And the surgeon was
William Stewart
Halstead.
Short biography
Born september 23, 1852 in New York.
After graduating at Yale he entered Columbia University
College of Physicians and Surgeons.
Graduated in 1877.
He joined the New York Hospital as house physician.
Here he introduced the hospital chart which tracks the
patient's temperature, pulse and respiration.
Halsted then went to Europe to study under the
tutelage of several prominent surgeons and scientists.
Halsted returned to New York in 1880 and for the next
six years led an extraordinarily vigorous and energetic
life. He operated at multiple hospitals.
He was extremely popular, inspiring and charismatic
teacher.
In 1882 he performed one of the first gallbladder
operations in the United States
(a cholecystotomy performed on his mother on the
kitchen table at 2 am).
A bit of light relief…..
Another family patient
Halsted also performed one of the first blood
transfusions in the United States. He had been
called to see his sister after she had given
birth.
He found her moribund from blood loss, and in
a bold move withdrew his own blood,
transfused his blood into his sister, and then
operated on her to save her life.
Local anaesthesia
In 1884, Halsted read a report from Karl
Koller, describing the anesthetic power of
cocaine when it is instilled into the eye.
Halsted realized that cocaine might be an
excellent local anesthetic.
Having learned the scientific method when
he was in Europe, Halsted, together with his
students and fellow physicians, began to
experiment with cocaine.
The doctor addicted
They injected each other's nerves and showed
that cocaine when injected into a nerve can
produce safe and effective local anesthesia.
Halstead became addicted to cocaine.
They attempted to cure him by converting his
addiction from cocaine to morphine.
He remained dependent upon morphine for the
remainder of his life, but continued as an
innovative and pioneering surgeon
Johns Hopkins Hospital, Baltimore
1899-1900
Founding Fathers of Modern Medicine
The Four Doctors by John Singer Sargent, 1905,
From left to right William Welch, William Halstead, William Osler, Howard
Kelly
In 1886, Halsted moved to Baltimore, Maryland
to join his friend William Welch at the soon-to-
be-opened Johns Hopkins Hospital.
Halsted was the first chief of the Department of
Surgery at Johns Hopkins Hospital when it
opened in May 1889.
He was appointed surgeon-in-chief in 1890 and
became Professor of Surgery in 1892 with the
opening of Johns Hopkins University School of
Medicine
At Johns Hopkins, Halsted was credited with starting the first formal surgical residency training program in the United States.
Osler introduced the first Medical residency.
Halsted’s surgical residency program consisted of an internship (the length was left undefined and individuals advanced once Halsted believed they were ready for the next level of training).
Internship was followed by six years as an assistant resident and then two years as house surgeon.
Greatness can often be measured by what
people learned from you…
And Halstead was a fine teacher
Halsted went on to train many of the
academic surgeons of the time including
Harvey Cushing, Walter Dandy and Hugh
Hampton Young ( Founders of
neurosurgery, and urology respectively.)
Harvey Cushing
Walter Dandy
Hugh Hampton Young
He is also known for many other medical and
surgical achievements.
As one of the first proponents of Hemostasis
and investigators of wound healing.
He pioneered Halstead’s principles, modern
surgical techniques of bleeding, accurate
anatomical dissection, complete sterility, exact
approximation of tissue in wound closures
without excessive tightness
- and gentle handling of tissues.
Other achievements Halsted performed the first radical masectomy for
breast cancer in the US in 1891 ( in France it had been
performed previously)
Other achievements included the introduction of the
latex surgical glove and advances in Thyroid, biliary
tract, hernia, intestinal and arterial aneurysm surgery.
Henry Louis "HL" Mencken
an American journalist, satirist, cultural critic and scholar of
American English, wrote
“His contributions to surgery were numerous and various. He
introduced the use of local anesthetics, he was the first to
put on rubber gloves, and he devised many new and
ingenious operations….
Humanity to surgery..
But his chief service was rather more general, and hard to
describe. It was to bring in a new and better way of
regarding the patient. “
And this strongly reminds me of Osler, on the medical side,
who emphasized the importance of the patient.
From Barber to scientific
surgeonHe changed all that. He
showed that manhandled tissues, though they could not yell, could yet suffer
and die.
He studied the natural recuperative powers of the body, and showed
how they could be made to help the patient.
He stood against reckless slashing, and taught that a surgeon must walk very
warily.
Though, like most men
of his craft, he had no
religion, he yet
revived and reinforced
the ancient saying of
Ambroise Pare: “God
cured him; I assisted.
Ambroise Pare - (c. 1510 – 20 December
1590) was a French barber surgeon who
served in that role for kings Henry II,
Francis II, Charles IX and Henry III.
Docere
Above all, he was a superb
teacher, though he never formally
taught.”
DOCTOR - Middle English (in the
senses ‘learned person’ and ‘Doctor
of the Church’): via Old French from
Latin doctor ‘teacher’ (from docere
‘teach’).
Eponyms
Halstead’s law – transplanted tissue will
grow only if there is a lack of tissue in the
host.
Halstead’s sign – a medical sign for breast
cancer
halstead’s suture – a mattress suture for
wounds
Cocaine addict
The title of this short biography is
“Genius on the edge”
Because this medical genius, who
accomplished so much for science was a
drug addict for 40 years of his life.
Given morphine to help withdraw from
cocaine, and he became hooked on both.
He only worked part of the year
He would disappear for months / to
binge on cocaine.
Sometimes he would leave in the
middle of an operation complaining of
a headache.
But it is a very interesting story
Provides insight into a crucial time in
medicine, transitioning from
superstition to science.
When scientific surgery and modern medical
education were born.
Maybe the path the genius treads
is thin….
Amazing that this flawed man was able to
maintain an incredibly productive scientific
career for 4 decades with these addictions.
And today, would this be possible?
In the series Thackeray when
introducing the cocaine as a local
anaesthesia says
Thanks
Bibliography
“Genius on the Edge: the bizaare double life of Dr
Willaim Stewart Halstead, by Gerald Imber
William Stewart Halstead, A lecture by Dr Peter D.Olch –
edited by J.Scott Rankin, Annals of Surgery, 2006.
The four founding physicians, Johns Hopkins Medicine.
H.L. Mencken, "A Great American Surgeon," American
Mercury, v. 22, no. 87 (March 1931) 383. Review of
William Stewart Halsted, Surgeon, by W.G. MacCallum.
[1] Mencken on Halsted.