Genius on the Edge: The Bizarre Double Life of Dr. William Stewart Halsted (30 page)

In retrospect, much of the tardiness and the absences must have been due to the effects of the large doses of morphine. Surely some of the “poor health” that caused him to retire from surgery in mid-case was too much, or too little, morphine. On many occasions Halsted was sweaty, weak, and dizzy, which he routinely blamed on palpitations from excessive smoking. The claim was sympathetically accepted by those unaware of his history, and to some extent this might have been true, but the more likely trigger was morphine, as it had been in 1891 when Osler had observed his symptoms and learned the truth.

In April of 1891, Halsted had written the trustees requesting an extension of his summer leave to a full six months to cope with what he presumed to be malaria. The malaria letter to the trustees was one of the few concrete instances in which he plainly lied. It may be valueless parsing to harshly contrast a claim of “malaria” to “ill health” or “a racing heart,” but the malaria excuse strikes a particularly outlandish note. The malaria-causing parasite had been identified by then, and Councilman and LaFleur had made the Hopkins laboratories central to the investigation of the disease. After a tragic misdiagnosis, Osler had issued a dictum that the diagnosis of malaria was never to be presumed without the verified presence of the parasite in the red blood cells. All this was well known, and one wonders how Halsted expected to get away with his claim without a blood test. Perhaps he knew he would never be challenged. What he was doing for those six months is unknown.

He managed the decade well enough, remaining enormously productive, if not energetic in the manner of the first few years. More of his time was spent studying at home, but he would appear daily at the hospital, albeit often briefly. The experimental surgery laboratory at the Pathological again became the focus of his energies as he became increasingly involved in issues related to the thyroid gland, and the techniques of what would evolve into vascular surgery. As his operations for hernia and breast cancer became more widely adopted he could rest upon the impressive statistics being compiled by Bloodgood, but he rarely operated. It is unlikely that his colleagues among the “Big Four” registered the change, since Welch and Osler had slipped into much more comfortable routines, and Kelly was far too frenetic to notice.

THE HALSTEDS FINALLY
rented the grand house at 1201 Eutaw Place. Howard Kelly and his family lived just down the street in an enormous house at 1406, but the two couples did not socialize. In the countrified atmosphere of the Bolton Hill district, one could feel pleasantly isolated from the grit of downtown and the harbor. The short journey to the hospital across town immediately dispelled that isolation for all but the blind and anosmic. Central Baltimore was still an unsanitary backwater without municipal sewers. Bathwater and manure flowed freely across the cobbles and drainage swales. The central water system was efficient but unprotected from contamination, resulting in regular and costly outbreaks of typhoid. Osler and Welch publicly executed a campaign to correct these public health offenses, which they observed daily en route to the citadel of modern medicine and laboratory science. Amidst the dirt and debris, the old Baltimore custom of early-morning scrubbing of the stone steps in front of the homes seemed a quaint anachronism.

In the early years, Halsted made the journey to the hospital on the
hill in East Baltimore by meandering bobtail horse cart or omnibus. Later, he drove an old horse cart of his own, after acquiring driving skills as a country horseman. After a few years of driving himself he graduated to an elegant liveried carriage, which he used until the advent of electric streetcars and motorized taxis. His advancing age, and perhaps a rejection of the flashy roadsters in which the young doctors sped about town, resulted in Halsted’s general disinterest in the automobile, which his contemporaries had quickly embraced—particularly the well-compensated Kelly, who was driven around in the largest and finest of motorized steel chariots, with several spares in the carriage house attached to his home.

The large house on Eutaw Place made possible the separate living arrangements that suited them, and Halsted had room enough to establish a working office and formal library on the first floor. There he had access to medical texts and papers from his extensive personal collection, and worked with his secretaries on correspondence and Johns Hopkins business. Books and papers on his current interests were pulled and stacked in his second-floor study, where what he considered the real work took place. This arrangement freed him from interruptions but further isolated him from the hospital and his residents. If his attention was urgently required, they could reach him by telephone or send a messenger, but one rarely made the mistake of too casual an interruption.

Most evenings were spent at home. After dinner Halsted would retire to the second-floor study, exchange his suit coat for a comfortable silk dressing gown worn over his shirt and necktie, exchange his shoes for old carpet slippers, and read and write into the night. Caroline, who was a voracious reader, would retire to her sitting room on the third floor to sew and read. Her tastes in literature favored what Halsted termed “trash.” His reading was primarily the medical literature, but in later years he expanded his horizons, often seeking consultations on books from bibliophile friends before setting off for his annual holiday.

Their lives remained essentially separate until the next evening, when they would reconvene at 7
P.M.
to dine and chat until 8:30. If Halsted chose to spend the day at home they would lunch together. Mealtime conversation covered a wide spectrum, from science and medicine to farming, etymology, and evolution. Caroline often expressed appreciation for her husband’s forbearance and interest in her, and felt herself to be his intellectual inferior. “He was very patient with my ignorance but did gratify me by saying that he thought I had a scientific mind. He did not add what its limitations were but I fully appreciate how much I have lost … by not being more educated.”

In their unconventional manner, the Halsteds were devoted to each other. Caroline felt her purpose was to make life pleasant for her husband and facilitate his ability to do his work. However, some of her letters to him when she was away at High Hampton seem laced with irony, if not anger. In most cases the anger was directed at her husband’s fastidious nature:

I wanted to write you a full account of my adventures yesterday but a headache stopped me. I started at 3:30 in a drizzle. It poured a deluge and my only worry was your buggy. I knew you would rather have me stuck on the road a week than have one thread injured … I do not think your wagon is injured. I covered everything …

But there is little evidence of overt friction between them. Caroline regularly suffered migraine headaches and not infrequently took to her bed for days. She was by her own admission often feeling forlorn and depressed. In the same 1896 letter from High Hampton, she wrote, “I don’t suppose that anyone will know what a struggle it has been to me getting through this summer. I have seemed apparently well but I think that I have forced my physical recovery at the expense
of a heavy toll on my nervous system. I can’t sleep and I feel like crying most of the time.”

There were few regular guests at the house on Eutaw Place, and the legend of the reclusive nature of the couple continued to build with years of absence from the hospital social scene. Although Halsted did attend medical banquets and dinners for visiting dignitaries, he was invariably unaccompanied. On the select occasions when visiting surgeons were entertained at his home, Mrs. Halsted did not appear. Most of his socializing took place at the Maryland Club. His friends were usually in attendance, and he could count on good company. In the first years the group was made up of Welch, Halsted, Mall, and two longtime club members, Major Richard M. Venable, an attorney, and Francis H. Hambleton, an engineer. Central to the gatherings was William Welch. Osler, who had been a club member since arriving in Baltimore, was part of the unlikely group of chatterers and pranksters but rarely joined in after his marriage in 1892. More often he entertained house staff and students at his home on Franklin Street.

For a time Major Venable lived at the Maryland Club, and later he frequently hosted the group at his home. An able lawyer and Latin scholar, he was a notorious local character. The
Baltimore Sun
wrote of his membership on the City Council, “Although the Major’s constant breaking of the rules by perpetuating jokes upon his fellow councilmen interfered at times with the dignity of the branch, he assisted in accomplishing needed civic improvements.”

Dr. William Lockwood and Dr. Frank Donaldson joined the group a short time later, but Venable and Welch were the central figures who provided both the intellectual and mischievous leadership.

While climbing the stairs of the Maryland Club, Welch complained of pain and pounding in his chest. Concerned, Halsted pressed an ear to Welch’s chest and was met by a jolting protean rhythm. This, it turned out, was caused by an inflatable rubber bulb connected to another in his pocket, which Welch squeezed at irregular intervals.
Another time, Welch placed an inflatable bladder under Halsted’s plate and watched with feigned disinterest as The Professor studied the intermittently jiggling dish.

Most of their practical jokes were either sophomoric or at the expense of making others uncomfortable. Welch once invited his assistant, Simon Flexner, lately arrived from Louisville, to join him at Venable’s home for dinner. Venable’s reaction upon seeing the young man was, “I suppose you want him to stay for dinner.”

“Yes,” said Welch.

“I suppose it’s all right. I suppose there’s enough to eat.” Then Venable told the maid, “I suppose there’s going to be enough soup for one extra. If not, don’t give any to Flexner.”

He continued the routine throughout dinner, though there was quite obviously more than enough to go around. After dinner, when the stories began, the young man was temporarily relieved, only to find himself repeatedly the object of the loudest laughs.

Halsted was at ease with the group, and there was genuine fondness among its members. Most importantly, they provided an amusing and safe outlet, and the relationships were predictable and formal enough to preclude intrusion or intimacy. The interaction among the men included a good deal of intellectual teasing and scholarly one-upmanship. It is unclear whether Welch’s and Venable’s pranks annoyed Halsted as much as did Osler’s, but his own idea of humor tended more toward the sharp and sarcastic.

For all the portrayal of The Professor as out of touch and absent-minded, the detachment provided a functional cover from which he could choose the situations in which he wished to interact and ignore the others. But that did not mean he was unaware of them. He was, if anything at all, a most acute observer, and the fact that he rarely shared these keen observations was a useful tool he honed sharply over the years. He would question a new acquaintance with great interest, listen attentively to the response, and say very little. Disarming and
effective, he was able to draw people out and judge their knowledge, and value quickly. Boastfulness, inaccuracy, and dishonesty were instant disqualifiers.

Many of his casual observations were amusing commentary on the world according to William Stewart Halsted, and resound more fully when juxtaposed.

He remarked to the pediatrician Edwards Park, “At medical meetings the best looking men are the internists: the worst looking men are the dermatologists, and the surgeons come in somewhere between.”

To Edwin Baetjer, the Hopkins radiologist, with whom he was strolling down the corridor as Joe Bloodgood passed, he turned, followed Bloodgood with his eyes, and finally said, “There goes Bloodgood. He can draw more general conclusions from a single instance than anybody I ever knew.”

Bloodgood was a mediocre surgeon and an excellent surgical pathologist. He conducted his private practice of surgery elsewhere but was always in attendance at Hopkins, where he operated very occasionally. He was very well liked and often the butt of Halsted’s humor. Once, in the early days, Osler asked Halsted and Bloodgood to see a patient with what Osler called a “squint of the cock,” referring to a chordee, a condition in which the erect penis is bent.

“Doctor Bloodgood, how would you treat him?” asked Halsted.

“Oh, by massage, Doctor Halsted.”

Halsted turned to him with a smile. “Oh, Bloodgood, you don’t mean that, do you?”

FINNEY TELLS OF A
telephone call from an associate regarding a patient with acute abdominal pain, for which neither he nor Halsted could find a cause. The patient was a particularly unattractive young woman who worked as a practical nurse. Prior to coming to the hospital she had been drinking tansey tea and taking cathartics. Tansey tea was believed to stimulate menstrual flow and abortion. Finney
diagnosed a ruptured tubal pregnancy. The associate demurred, thinking about the patient’s appearance.