“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.