Genius on the Edge: The Bizarre Double Life of Dr. William Stewart Halsted (11 page)

CHAPTER EIGHT
The Very Best Men

IN SEPTEMBER 1885
, William Welch arrived in Baltimore and installed himself in two large, well-furnished rooms at 20 Cathedral Street, a fashionable address. There he was well cared for by the proprietor, Mrs. Thomas Simmons, the widow of a former Civil War major, and her daughter. In this setting Welch established a routine, which included familiarity, caring, and occasional comfortable chats without the need for intimacy. Never seeking grander accommodations and never buying a home, he lived in this modest fashion throughout his life, surrounded by his enormous personal library and close to his work.

Thirty-five years old, short and plump, with receding dark hair, a generous beard, and a benign demeanor, he brought with him an appetite for conversation as insatiable as his appetite for food. As an interesting newcomer to a stagnant society, numerous attempts were made to introduce him to the available young women in Baltimore society, but it was soon apparent that Welch would not pursue these relationships. Consumed by his work, and gracious and amusing even when demurring, he remained a much sought-after guest long after his disinterest became apparent.

THE JOHNS HOPKINS UNIVERSITY
had been functioning on the undergraduate level since 1876. Its small graduate programs within the faculty of philosophy included the professors of the sciences. Welch was the first professor appointed to the medical faculty, but the hospital did not yet exist and the medical school was still a distant dream. Welch established himself in borrowed space in the laboratories of the British physiologist H. Newell Martin, who had been appointed the first professor of biology, until the Pathological was ready for occupancy, which paved the way for several years of fruitful research by the two men.

The pathology building, referred to by a generation as the Pathological, was the first building in the hospital complex, and it was hastily completed to accommodate Welch. A small, rectangular, two-story redbrick building, it had six tall, thin windows on the long side and four on the short side, two central chimneys, and a basement. Originally meant to house only the hospital morgue, it was quickly reconfigured. Within it were the bacteriology laboratory, experimental pathology laboratories where experimental animal surgery was performed, a surgical pathology laboratory where surgical specimens were examined, and the morgue, or dead house. Bodies were brought from elsewhere for autopsy until the hospital was completed. Here, Welch oversaw the department of pathology and the first institute for experimental medicine in the country.

Welch was given autonomy in selecting his staff and students, and his uncanny ability to recognize men of great promise would serve Johns Hopkins well. His first appointment was his assistant, William T. Councilman. Locally bred and educated, Councilman was a graduate of the University of Maryland Medical School. Trained in pathology in Europe, he had already established a fine reputation in Baltimore, and his appointment did much to defuse the seething resentment within the local medical community against the new academics who were threatening to upset their system and challenge their primacy.

Welch appointed Franklin P. Mall as a fellow in pathology. Mall, then only 23, was a slight, pugnacious, and sharp-tongued man who would become an important, often difficult, and famed professor of anatomy. He had a habit of stammering when he was excited, and with his tiny frame and argumentative nature, he became the most outspoken proponent of learning by doing. This was very much the same position of Welch, whose laissez-faire attitude at the Pathological helped solidify Mall’s stance. The insensitive enforcement of this attitude would soon make Mall the most disliked of the Hopkins professors. Often refusing to lecture, and voicing his visceral dislike of anatomy books such as
Gray’s
, he would provide his students with body parts and a scalpel and leave them to their own devices.

Few would ever accuse Mall of laziness. A prodigy, he was brilliant, opinionated, and obdurate. A graduate of the University of Michigan School of Medicine, he trained with Ludwig in Leipzig, where he first met Welch. There, Mall had produced an experimental model of the intestinal blood supply composed of segments of intestine served by individual vessels. Using this model, he and Welch expanded upon his work, producing experimental occlusion of intestinal vessels in order to understand the sequence of events resulting in infarction, or tissue death, in the intestinal segment deprived of blood supply. The work added significantly to the knowledge of the phenomenon at a time when surgeons had just begun attacking intestinal problems and needed a clear understanding of the complex anatomy.

With no hospital, no medical school, and only Mall and Councilman aboard, Welch accepted 16 graduate students to study at the department of pathology. Of the 16, more than half were doing original research, making the Pathological the first institute of experimental medicine in America. Included among them would be a fully trained surgeon named William Stewart Halsted.

WITH WELCH A DAY’S
journey away, Halsted had had no monitor other than his housemate Thomas McBride, who attempted to support and counsel him. But McBride, thought to have become addicted himself, began suffering lapses in his own health.

Halsted remained unwilling or unable to reach out to his family for help. The constant preaching by his father, William Mills Halsted Jr., seemed to have driven the two apart, although the younger Halsted was still supported by his father’s largess. Then, in a turn of events worthy of a Victorian novel, Halsted, Haines and Company, the 80-year-old firm begun by William Mills Halsted Sr., suffered complete financial collapse and bankruptcy. Not only did the family fortune disappear, but William Mills Halsted Jr., the strictly moral Presbyterian, was accused of deceptive business practices and self-dealing. The
New York Times
reported on August 4, 1884, that the firm was insolvent, and on May 7, 1887, printed a virtual indictment of the W. M. Halsted Jr.:

Halsted, Haines, and Co., the old dry goods firm that failed in July, 1884, was built on a solid foundation away back in 1804. The founders established an enviable reputation and amassed fortunes. One by one they died or retired and new blood was infused into the concern. Modern methods of business and habits of living are different from the old fashioned way, and the insolvent firm seems to have floated along of late years largely on its reputation. The junior partners never bothered about the books or the general business, but left everything in the hands of the senior, who manipulated them apparently to his own satisfaction, and regardless of the creditors.

Questions were raised about the senior Halsted having secured loans using worthless stock as collateral. In the end, the creditors
suffered severely. There was apparently no legal remedy for the debt nor punishment for the perpetrators. William Mills Halsted issued preference notes in favor of his children and his brother, which were paid out of existing assets before the creditors were considered. The young surgeon benefited from a questionable “preferred loan” to the tune of $24,800, the equivalent of more than $500,000 today.

Somehow, Halsted managed to continue his routine as surgeon and teacher, and apparently was able to discharge his duties. His state of constant excitement did not go unnoticed, though few understood its nature, and no one questioned him about it.

In April 1886, it was announced that Dr. William S. Halsted was among three men being considered for the chair of surgery at P&S. The other candidates were Dr. William T. Bull, the well-respected surgeon at the Chambers Street Hospital, and Dr. Richard J. Hall, Halsted’s assistant at Roosevelt. The candidates were to write and deliver a series of papers, after which one of the three would be awarded the position. Halsted wanted the position but was unable to write the papers. By the time this became evident to him, he had already spent $1,000 on charts and pictures for his lectures. Again, he blamed failing health for his poor performance. Halsted withdrew from competition, and the job was offered to Hall. By then an addict himself, Hall declined the position and moved to Santa Barbara, California, to recover. He corresponded with Halsted over the years and often alluded to his illness, though neither ever mentioned cocaine by name.

Halsted withdrew from all of his professional responsibilities when he could no longer disguise the extent of his disability. Welch, McBride, and Halsted’s younger brother Richard, an alcoholic himself, convinced him to seek hospitalization. Though drug addiction was still relatively uncommon, alcohol abuse was not, and private mental hospitals accepted patients for the treatment of alcoholism. A few hospitals had begun treating drug addiction as well. Butler Hospital, in Providence, Rhode Island, was one of these.

Halsted arrived in Providence by train, was driven to Butler, and registered anonymously as William Stewart. Dr. Sawyer, the head of the hospital at the time, was well thought of and well connected, and took great interest in his new patient. Despite Halsted’s having registered anonymously, the staff knew his identity. Halsted had a number of visitors during his months at Butler. He was friendly with Dr. Fred C. Shattuck, an intern at the hospital who would later become a distinguished professor of medicine at Harvard, and a Dr. Folsom, who became a well-known psychiatrist. During Halsted’s hospitalization, Dr. Sawyer became seriously ill. The three physicians—Halsted, Shattuck, and Folsom—gathered around Sawyer’s bed to hear his dying words, which were an appeal to Halsted to abandon his drug addiction.
¹

HALSTED REMAINED HOSPITALIZED
for seven months. His treatment was based on encouraging a healthful lifestyle, with emphasis on diet weighted toward vegetables, outdoor exercise, meetings with alienists (as psychiatrists were then known), and a gradual reduction in his cocaine dosage. Various sedatives were employed to mitigate withdrawal symptoms, but the backbone of the treatment for cocaine addiction was substitution with morphine. This, if successful, produced addiction to a different drug with a different set of symptoms.

Apparently, the strategy was not entirely successful. Halsted bribed hospital employees to procure cocaine for him even as he was receiving morphine. One drug produced heightened sensations and a feeling of omnipotence, the other a peaceful release from the world. They created a balancing act that became central to the rest of Halsted’s life.

WELCH HAD BEEN
at Hopkins for less than six months when he returned to New York to help deal with Halsted’s deteriorating condition. The unsuccessful sailing cure and the seven months at Butler did not end the cycle of addiction. Halsted left Butler in November 1886. By then his housemate and great friend Thomas McBride had died prematurely of kidney failure. Many who knew him believed his demise was complicated by drug addiction. Halsted found himself alone, isolated from the medical community, bereft at the loss of McBride, and now addicted to both cocaine and morphine.

Recognizing that Halsted needed a friend and a controlled environment, Welch made the problem his own and invited him to Baltimore. Halsted had been among the leading surgeons in New York when his star crashed. In addition to his personally costly discovery of local anesthesia, he had begun work on an operation to cure breast cancer, campaigned for cleanliness and asepsis where there had been filth and death, and was thought by all to be the great young teacher of surgery. But he had lost control, and Welch was taking a great risk with his own future to help his friend. In December 1886, Halsted was on the train to Baltimore.

Welch counted Halsted among his few close friends, and most of the medical world in which he freely circulated as friendly acquaintances. He spent a great deal of time reading, and had an extensive library and Catholic tastes. He became the de facto medical ambassador from Johns Hopkins, and was in constant demand as a lecturer and visiting professor. Welch dined almost nightly at his club, usually in the company of Halsted and two or three nonphysician friends, and whiled away the evenings chatting by the fire in the intimate little chess room.