Genius on the Edge: The Bizarre Double Life of Dr. William Stewart Halsted (27 page)

Sentiment in the boardroom was generally against coeducation. Welch agreed, defending his position by saying he would be embarrassed discussing certain subjects in front of women. He later came about a full 180 degrees and was a proud spokesperson for equality for women. Osler came over early and even contributed to the fund drive, but he was far from convinced. Hurd came around, and Kelly was supportive. Halsted was silent.

By the fall, the Women’s Fund had raised $100,000. Of this amount, $48,787.50 came from Mary Elizabeth Garrett, the daughter of a former head of the B&O. The funds would be made available to the university if they agreed to coeducation. Now the pressure was on. Rumors were flying that the doctors were unhappy about the prospect of coeducation and were thinking of defecting. Generous offers were being made. Harvard tried to entice Osler and Welch with plans for a new, higher-quality four-year school, including grades for students. Both demurred, but Welch lost his second in command,
William Councilman, who accepted the chair at Harvard in lieu of his mentor. McGill in Montreal tried to repatriate native son William Osler with what was reported to be a king’s ransom. He resisted this as well, but a feeling of unrest had replaced the heady atmosphere of the prior years. Something needed to happen, and that something was to make good the unfulfilled promise of a medical school.

Gilman was against accepting the $100,000 and opening the medical school to coeducation. Welch equivocated, but Hurd, Osler, and Kelly strongly urged Gilman to accept. Welch wrote to Mall, who was now in Chicago: “Pres. Gilman and some of the trustees really do not want (sub rosa) the women to succeed, for they do not like the idea of co-sexual medical education. I do not myself hanker after it, but do not see how they can refuse such a large sum of money.”

Finally, Gilman reached what he believed was a face-saving compromise. The university would accept the money and allow equal access to women, but the medical school would not commence operation until the full $500,000 necessary to operate had been raised. The women continued their work, and in December 1892, Mary Elizabeth Garrett personally contributed another $306,977, bringing the grand total to $500,000. But she was not about to hand over the money and leave. With her position solidified, Mary Garrett became the conscience of The Johns Hopkins School of Medicine.

She now insisted that all students must have earned a bachelor’s degree, as other graduate schools at Johns Hopkins already required. To this she added a working knowledge of French and German, and the premedical requirements of biology, chemistry, and physics. The medical degree would require a four-year course of study. These demands had not materialized from thin air, nor had they been invented by Miss Garrett. They were largely the requirements that had been spelled out by Welch at the behest of Billings and the trustees, in the earliest stages of planning. They were not appreciably different from still earlier suggestions made by Billings to Gilman in 1878. On
both occasions Gilman praised their high-mindedness but dismissed the requirements as unrealistic. Pointing to the lax requirements at even the finest medical schools, and the additional year required when others programs were only three years, he doubted they would attract enough students to fill a class.

The trustees were totally undone. Fathers applied pressure to daughters, meetings were held in small groups, and everyone outside the women’s committee tried to convince Mary Garrett to soften her terms. Instead of softening them, she added a few more. The most important was that women would not be admitted as separate but equal with men, but on the same terms, guaranteeing the “same” medical education to women. Garrett also stipulated that no more than $50,000 of her gift be used for the Women’s Fund Memorial Building. Negotiations had become so acrimonious that Garrett named a committee of six women who would operate in perpetuity to ensure that if the terms of her gift were violated, the funds would be returned to her estate. As it turned out, she had reason to retain the lever of financial power. As the new anatomy building neared completion, relieving pressure on the already expanded Pathological, Garrett insisted the Women’s Fund name be inscribed on the outside. Gilman wanted an inscribed tablet inside the building, and Welch, as the first dean of the school, stepped in to remind Gilman that this was not a fight they would win.

Now the great experiment could begin in earnest. Welch, as dean, set about recruiting both the most accomplished men to teach the preclinical sciences and members of the first class of medical students at The Johns Hopkins School of Medicine.

Gilman convinced William H. Howell, a distinguished physiologist, to leave his post at Harvard and return to Hopkins. Howell would be replacing his old professor H. Newell Martin in the post. Martin had become an increasingly debilitated alcoholic and had been convinced to resign. Next on the list was Franklin P. Mall, the anatomist. Mall had left Hopkins for Clark University, and then moved to the University of
Chicago as professor of anatomy. There he spearheaded plans for integrated departments of basic science and experimental research into disease. Halsted was confident that Mall would return to the fold no matter how rich the carrot at the end of the other stick. Mall had been talking about building a $4 million anatomy institute at Chicago, while the income available to him from the Women’s Fund was barely $20,000 a year. Still, Mall telegraphed, “Shall cast my lot with Johns Hopkins,” and they were off to the races. The next recruit was John J. Abel, a pharmacologist and chemist then at the University of Michigan. All would soon distinguish themselves and Johns Hopkins.

In the fall of 1893, 18 students registered for the first-year class at The Johns Hopkins School of Medicine. The 15 men and three women were about to participate in a very trying experiment. There was no formalized curriculum in place, and the clinical and laboratory faculty greatly outnumbered the student body. Lectures were largely replaced by laboratory work; experiments were devised and carried out to reach conclusions students would otherwise be taught. Scientific papers in the original languages were required reading instead of textbook distillations. Students found themselves with free time, and very little direction. Mall welcomed the first-year students to the anatomy lab, and after a long wait for dissecting material, presented them with a cadaver and a scalpel, and left. He provided no text, lectures, or instructions. The students were being treated as scholars, and they didn’t seem to like it.

Welch later wrote, “As it turned out, the embarrassments and difficulties we feared in the novel venture of co-education in medicine never materialized.”

Osler, on considering the high standards for admission to the new medical school, commented, “Welch, we are lucky to get in as professors, for I am sure that neither you nor I could get in as students.”

CHAPTER TWENTY-ONE
Teaching without Teaching

THE SECOND-YEAR CLASS WAS
40 strong, including eight women. What they shared with the inaugural class was dissatisfaction with the instruction they were receiving, or weren’t receiving. From the first day there was a running battle with Mall, who not only had not procured cadavers for dissection, but didn’t know how to properly embalm and store them when supply became plentiful. What sharp contrast this was from the P&S anatomy instructor, William S. Halsted, who was ever present in the dissecting room and provided excellent examples of proper dissections for the students to study. Mall offered no instruction. He expected medical students had no need for spoon-feeding of so basic a subject; that’s what books were for. Nor did he bother with formal lectures. He was, however, available to the few who were interested in experimental projects. The medical students didn’t simply dislike Mall, they detested him. He, in turn, wasn’t going to be bothered with students unwilling to educate themselves. When a student complained about having nothing to do, Mall handed him a broom. He simply refused to teach “shoemaker anatomy for the pill doctors.” He did pay enough attention to one of the female first-year students to marry her. However, marriage disqualified students, and the new Mrs. Mall dropped out.

The students complained to the dean. Welch tried to mediate, but the students soon found that he, too, was among the missing when it came to teaching. Simon Flexner, who had come to him as a graduate student in 1890, was his assistant when the medical school opened. Welch had regularly scheduled lectures for the class, which he rarely attended, sending Flexner, who was a fine researcher but a less than dynamic speaker, in his stead. Welch and Mall shared the philosophy that American medical students were taught too much, and not allowed to learn. The students thought they were simply lazy. Their colleagues, particularly Osler, believed both Mall and Welch were lazy and derelict in their duties to the medical students.

John J. Abel, the third laboratory scientist whose fame was meant to attract the best student population, was another teaching dud. Having spent seven years in Europe after earning his PhD at Michigan, he returned home with an MD degree but very little desire to practice medicine. In the laboratory he was among the first to isolate epinephrine, did important research on insulin, and was respected as a biochemist and physiologist. But as well-meaning as he was, Abel was a boring lecturer, not at all interested in teaching, and impossibly inept at laboratory demonstrations.

The biggest problem, however, was Halsted. In the fall of 1895, the students were beginning their exposure to clinical subjects. As the moment marking the transition from student of basic science to fledgling physician, it was much anticipated and meant a great deal to the already disgruntled students. Halsted had been scheduled to lecture on wound healing the previous spring, but the course never materialized. The Professor was nowhere to be found; having left Baltimore for the mountains of North Carolina and parts unknown, he began the extended absences that became the hallmark of his erratic behavior. Not only had he not planned the formal lecture series and the introduction to surgery, which sorely disappointed the now third-year students, but he was frequently absent from the hospital as well. Hospital
superintendent Henry Hurd repeatedly confronted him, and Halsted repeatedly assured him of his future compliance. Finally, exasperated, Hurd reported the problem to the board of trustees, who declared that attendance regulations must be “rigidly observed.”

Morphine and, possibly, cocaine were at least indirectly responsible for these episodes of erratic behavior and absences. At the time, Halsted’s daily dose was three grains of morphine, enormous by any standard and, naturally, difficult to manage. He was a changed man in so many ways that it didn’t take a great leap of imagination to assume drug implications. His slower, more intense pace may have been in some respects an intellectual epiphany brought about by the tranquilizing effect of morphine. Since only Osler and Welch were aware of his drug use, students, colleagues, and the trustees had to judge the man by his actions. And his actions were very confusing.

The work being produced by Halsted was a resplendent feather in the Hopkins cap, and the staff and trustees were justifiably proud of the international fame that followed it. In 1890, he had reported on his new hernia operation, and in 1892, he published the results of 82 cases. Hernia surgery was now an elective reality. In 1894, Halsted reported on 50 cases of his radical operation for breast cancer, again devising an operation considered the gold standard by the American Surgical Association, an honor whose rewards would accrue to The Johns Hopkins Hospital. The trustees of the hospital were in an uncomfortable position. They were facing a problem they would rather ignore, and they never took action.

Absenteeism was not the only issue. Halsted had no relationship with the medical students and made no effort to develop one. Not only did he often skip his weekly lectures, but the subjects upon which he lectured were so far over the heads of the students that they felt excluded. The same applied to his clinic and ward rounds. The students were required to attend, but it was as though they were invisible. Questions, when The Professor asked them, were often unrelated
to the patient in front of them, or were aimed at the senior resident who was expected to be in command of the literature. Often, Halsted would discover a symptom or curious finding, quietly contemplate it, examine the patient with no time constraints, and with no explanation, move on. Worst of all, his radar would sound at the slightest blip of untruth or lack of knowledge. The medical students tried to hold their tongues and duck questions. But somehow The Professor found the ones with great holes in their knowledge and exposed them publicly, which did not add to his popularity. Finney said, “To the good student, he was a great stimulus, to the poor one, a constant terror.”

Formal ward rounds were interminable. The students commonly referred to them as “shifting dullness,” a parody on the flat percussive note caused by a collection of fluid in the abdomen that had shifted with the patient’s position.