Genius on the Edge: The Bizarre Double Life of Dr. William Stewart Halsted (31 page)

“Wait until you see her. It can’t be that.”

At operation the patient was found to have a ruptured tubal pregnancy, and a belly full of blood. When Halsted was told that Finney had made the diagnosis over the phone, his first comment was, “Did Finney do that? Make a diagnosis right off over the telephone without seeing the patient?” Then he added, “Well, come to think it over, after all it isn’t as astonishing as it might appear. Of course, you and I, Pan-coast [the assistant], wouldn’t be expected to know the significance of tansey tea and cathartics, but Finney, with his knowledge of the world, he would know.”

He later added, “It is better to make no diagnosis than the correct diagnosis without a reason.”

A FEW PEOPLE WERE
fairly regular visitors at 1201 Eutaw Place. Among them were Caroline’s old friend Sally Carter, her aunts, and in later years, the wife of Halsted’s former resident, Samuel Crowe. Crowe, the son of a physician, had first encountered Halsted at the end of his first year as a medical student. He and two friends were on holiday in the North Carolina mountains in a covered wagon, pulled by two enormous Percheron horses, when one of their hired horses became immobile and seemed to freeze. At a loss for what to do, they began asking around the nearby town for a veterinarian. Crowe let it be known to the suspicious locals that he was a medical student from Johns Hopkins, which of course were the magic words. He was directed to High Hampton, some two miles away, where he would find the “doc,” who had the only barn in the area large enough to house the huge horse.

Halsted had gradually become expert in treating farm animals and pets, as well as his ailing neighbors, and was all too frequently called upon to do so. Crowe found his way to High Hampton, and to his
surprise, was welcomed by a maid in full uniform. Dazzled by the fine views, elegant plantings, and wide lawn, he waited uncomfortably for The Professor, who soon materialized from his hike in spotless white flannels, a silk shirt, patent leather pumps, and his walking stick.

Halsted had his buggy rigged and the young man led him to the ailing horse. Crowe had expected the stable man, not the doctor, to make the journey, and was even more impressed when Halsted stood in the mud for 20 minutes, quietly examining the horse. He diagnosed the problem as muscular rheumatism, and the horse was coaxed back to the big barn at High Hampton, where it spent a week wrapped from head to hoof in oilcloth and was rubbed down regularly by the professor of surgery at The Johns Hopkins School of Medicine.

Crowe was treated as an honored guest while the horse was recovering and got to know both Halsteds quite well. Halsted warmed to his guest and over the next few days spoke movingly of the beauty and demands of medicine. Young Crowe was dumbstruck and inspired by the entire experience.

The occasional resident visited the Halsted home, usually for special occasions, and few were invited more than once. There were exceptions, and in later years some spent a great deal of time at Eutaw Place and High Hampton. Few hosts were more concerned with the comfort of their guests than Halsted. But some of his closest friends and hospital associates never entered his home and rarely encountered Mrs. Halsted, if at all. William MacCallum, Halsted’s friend, collaborator, and biographer, was a frequent visitor to the private quarters but met Caroline for the first time just several months before her death.

On the rare occasions when the Halsteds entertained, Caroline ceded the entire process to her husband. It was he who scoured the vast Lexington Market for delicacies and chose the menu. He chose the china, planned the placement and the flowers, and saw to it that every wrinkle and fold was carefully ironed out of the tablecloth after it had been spread on the table. The dinners were elegantly planned
and presented multicourse affairs. Fine wines were served with every course, and Halsted would politely sip with his guests, perhaps drinking a total of a single glass of wine over the course of an evening. Otherwise, he rarely drank at all.

Despite his propensity toward solitary evenings at home, Halsted did attend some hospital functions and professional dinners, though he preferred small gatherings with his friends. After years of such sparing attendance, his presence at any gathering was dutifully noted, remembered, and reported upon, largely because these occasions were among the few social contacts many individuals had with the distant, aristocratic man who was otherwise unapproachable. Reports of these sightings were usually underscored by anecdotes of his sly sense of humor and unexpected comments.

Halsted’s passion for antique furniture, fine old Persian carpets, paintings, and all manner of decorative artifacts flourished at 1201 Eutaw Place. The first three floors of the large house were soon filled with his purchases, but the issue was less about furnishing than collecting, and the result had the effect of a disorganized storage facility. Cushing described it as “a great magnificent old stone house full of rare old furniture, clocks, pictures and what not in topsy turvy condition, cold as a stone and most unlivable.”

One of his associates in the acquisition of these antique treasures was a burly Baltimore physician named Crim. Their shared love and knowledge of antiques appeared to be the sole basis for the friendship. Dr. Crim had among his patients many of the now impoverished old Baltimore aristocracy, with whom he would barter services for antique furniture. Crim was personally unclean and medically inept, and an unlikely individual for Halsted to embrace.

Observing knee surgery on a patient he had referred to Halsted, Crim watched as the heroic preoperative preparations for sterility were carried out. The surgeons scrubbed, dipped, dipped again, and gloved. The patient had gone through overnight applications of
antiseptic solutions, was painted with antiseptic on the table, and draped with sterile white towels. When asked exactly where the symptoms had begun, Crim laid his dirty, unwashed, and ungloved hand on the carefully prepared knee and promptly contaminated the sterile field. Crim was banished from the room, and the entire preparatory procedure had to be redone.

Despite this sort of medically ignorant transgression, Crim managed to retain his relationship with Halsted. How he was perceived as a physician is another matter entirely, but socially Crim was well known and well connected. He was famous primarily for his collections and conducted an auction at which some of Halsted’s finer pieces had been purchased. Halsted was active enough in the world of antique furniture to find it worthwhile to retain an old German carpenter on his household staff to repair and maintain his acquisitions. Some of the furniture made its way to High Hampton, though the environment there was decidedly more spartan. In general, collecting was a city passion, and his dahlias, and sometimes his telescope, the country passions.

The only source of heat in the living quarters on the north side of the Eutaw Place house were the open hardwood fires, which were often inadequate compensation for the open windows. The service wing on the south side of the house was heated by a modern furnace. Among the books, and clocks, and fine furniture in the big, cold house were any number of dogs. It seemed that dachshunds and spaniels were everywhere. Halsted was fond of the dogs, but they were Mrs. Halsted’s constant companions, particularly the dachshunds.

When Halsted was in residence, a secretary, and sometimes two or three, worked alongside him in the first-floor library. Household staff scurried through the back of the house, and during the winter season Caroline Halsted, who sometimes spent entire days alone in her third-floor aerie, tended to the dogs. For exercise and excitement she often drove their large-wheeled, high-seated “dogcart” through nearby Druid Hill Park, with the dachshunds seated beside her and
the spaniels running alongside. The lightweight cart was well balanced and had the seat situated over the two large wheels. It was fast and maneuverable, and she drove aggressively. On one occasion the cart overturned, and Caroline suffered bruised ribs and a broken femur. Halsted had been away at the time and Finney cared for her at home. After cabling him to return home, Finney met Halsted’s train the following day and told him that Mrs. Halsted had suffered an accident. Sizing up the situation, he asked, “Is she dead?” with the clinical detachment that was his trademark.

By that time it was clear that her condition was stable, Finney reassured his chief, and hinted at how difficult his patient had been. Caroline had insisted on engaging an old attendant, who would tolerate being bossed around, instead of a qualified nurse. She recovered grumpily but uneventfully.

Finney had the opportunity to treat her once again, this time for acute appendicitis. He operated early, using the new “McBurney incision,”
¹
and her course was uncomplicated. As usual, Caroline refused to follow instructions. She invoked her nursing training regularly, and very soon after surgery began to complain about lying around in bed. Finney knew what was coming and anticipated her.

“Why don’t you sit up in this armchair?”

And he carried her to the chair just as Halsted entered the room.

“Finney, you get your patients up sooner after operation than I do.”

“Yes sir, some patients,” Finney admitted to The Professor, who was slyly smiling, no doubt happy to see the burden transferred to his assistant.

1 In the late 19th century, several surgeons recognized the value of early diagnosis of appendicitis and surgical removal prior to rupture. Removal after rupture was generally associated with a nearly 25 percent mortality rate, so the standard procedure was to wait for rupture and abscess, then drain the abscess and hope for the best. An early innovator was Charles McBurney, at The Roosevelt Hospital in New York City, who identified the tender point at which maximal pain from appendicitis is localized. He was also among the first to remove an acute, nonruptured appendix, and devised an incision in which the oblique muscles in the right lower quadrant of the abdomen were spread apart and not cut. This allowed access to the appendix. When the wound was closed the fibers of the two muscles, which were oriented in opposite directions above each other, reformed the abdominal wall without the weakness prevalent in muscle-splitting or muscle-cutting incisions. McBurney’s point and the McBurney incision have been in the medical lexicon for more than a century, though the diagnosis is often confirmed by scan, and the incision has become of historical significance with the advent of laparoscopic appendectomy.

CHAPTER TWENTY-FOUR
Into the 20th Century

THINGS WERE GOING ALONG
better than anyone could have predicted in the Department of Surgery at The Johns Hopkins Hospital. Halsted had done several hundred hernia repairs and dozens of operations for breast cancer, and was beginning to experiment with new techniques for surgery of the thyroid gland. The entire surgical staff was wearing sterile rubber gloves at surgery. White surgical shirts and trousers were universal, and aseptic techniques were rigidly, or almost rigidly, adhered to. Most surgeons now wore hats, but masks hadn’t yet appeared, and when Halsted really needed to get a feel of something, he would still remove his gloves. No one made much of it because he was the chief, and, more important, postsurgical infections had become increasingly rare.

Halsted had virtually banned the use of catgut sutures. Fine silk was used for internal sutures and ties around blood vessels, and wounds were closed with silver wire. Halsted found fine silk the least irritating, least disturbing material for internal use. It would become the rule. The outcome was excellent so long as the surgeon was skillful, delicate, and cognizant of the inadvisability of crushing tissue beneath the ties. In the hands of average, careless surgeons, he believed gut sutures were less problematic. So, although he insisted on the use of
fine silk sutures by his staff, he was well aware of the habits of the surgical world at large and acknowledged the existence of second-class surgeons. Wounds were no longer routinely drained to provide an exit route for infection. Sutures were not brought out through the skin, a change that prevented stitch abscesses. New types of dressings were being tried, and laboratory studies of wound healing, intestinal anastomosis, and thyroid and arterial surgery were moving forward. Joseph Bloodgood was inventing surgical pathology, though he may not have known it at the time, and he was preparing to organize and compile The Professor’s surgical experience.