Genius on the Edge: The Bizarre Double Life of Dr. William Stewart Halsted (35 page)

Cushing became consumed by questions of pituitary function, constantly mindful of the close relationship between the pituitary and the sella turcica in which it rested. Enlargement of the gland eroded or deformed the bony sella turcica and therefore was visible on X-ray. Clear cases of pituitary abnormalities began to surface, X-rays aided in the diagnosis, and Cushing began to perform surgeries. He had easy access to the pituitary under the upper lip, through the nose, and into the brain. Peering in with a miner’s headlight, he easily removed cysts and tumors of the pituitary gland, although with inconsistent outcomes. Cushing rushed to publication with his hastily assembled
The Pituitary Body and Its Disorders
, but there was far more to the master gland than he understood. Still, Cushing had opened the box for brain surgery, and opened the door to the understanding of the master gland.

Cushing’s single-minded pursuit of information brought him to study an acromegalic giant named John Turner. Cushing had cared for Turner, but when he died in Washington the family refused an autopsy. Undeterred, Cushing dispatched Crowe to the undertaking parlor with a bag of instruments, and at 3
A.M.,
unable to single-handedly remove the giant from his coffin, he operated in the burial bier, removed Turner’s pituitary, and brought it back to Hopkins.

THE TWO-STORY HUNTERIAN
Laboratory of Experimental Medicine was the scene of more triumphs than Cushing’s alone. It was there that MacCallum discovered the relationship between the parathyroid glands and calcium metabolism, and where he proved that removal of the islets of Langerhans of the pancreas caused diabetes, setting the stage for the isolation of insulin. It was also where Walter Dandy would do the monumental work in pneumo-ventriculography that resulted in a method of visualizing the interior of the brain, and making Cushing apoplectic.

Cushing was on the national stage after treating General Wood. Things were going remarkably well for him, but he was ready to move on. Osler, his father figure, had left Baltimore five years before to assume the Regius professorship at Oxford, leaving a personal void that remained unfilled. Cushing had a young family around him, but his life was his work. He was 42, ambitious, and felt continually thwarted, and he was eager to bring glory to himself and his new specialty in his own department, rather than remaining at the whim of an eccentric professor. In 1912, he left Hopkins to become chief of surgery at the new Peter Bent Brigham Hospital, and professor of surgery at Harvard.

1 Cushing had brought a blood pressure cuff and measuring device home from Europe. In addition to monitoring pressure during surgery, he pioneered placing the cuff around the scalp, below the area of incision, to control blood flow from the vascular scalp. When this proved cumbersome, he developed a technique in which he and the assistant applied pressure to their side of the proposed incision before cutting the skin and galea. This would control bleeding until clamps could be applied and blood vessels tied. After drilling holes in the skull and connecting them with the gigli saw, he lifted the bone flap and stemmed the bleeding from the skull by applying bone wax, a technique devised by Horsley, in England. Cushing was obsessed with expanding the use of his blood pressure monitoring apparatus called the Riva-Rocci cuff, and Michael Bliss wrote of an obscure footnote in which he “… decided to apply the cuff to his own neck, he and a colleague observing the results as he strangled himself to the brink of faintness and nausea.”

CHAPTER TWENTY-SIX
All Quiet on the Home Front

BY THE CLOSE OF
the 19th century, Halsted had eased into the life that he would lead for the next 22 years. Sustained by his work, enabled by a devoted, if strange, wife, isolated by a demanding addiction, and ignoring or handing off responsibilities, he showed no evidence of unhappiness with his situation. If Halsted was not oblivious to the discomfort of others caused by his behavior, he certainly gave no outward sign of acknowledgment. His enigmatic distraction was by now Hopkins legend, and those who knew him best simply shrugged their shoulders and took it in stride. In the heat of the wrestling over Cushing’s fate, Osler was asked if he had any idea what Halsted was thinking. His response was, “No, nor has anyone else.”

Halsted maintained an outward calm even as he ceded the de facto operation of the department to a succession of residents. Each year the census on Ward G, the primary surgical ward, increased. Patients didn’t enter the hospital, have surgery, and leave. This was particularly true for the charity patients. Hospital stays were protracted affairs, often lasting months. At a time when the elaborate dressing on a hernia wound remained in place for three weeks, with the patient immobile, in bed, one can only extrapolate the lengthy hospitalizations required when recovery was complicated.

Even into the early 20th century, surgery was still being performed in people’s homes. On one occasion Halsted took his traveling surgical troupe to Providence, Rhode Island, where he was “detained for 4 and 1/2 days.” The patient and his family were difficult, and Halsted, having had enough of it, departed, leaving Cushing to care for the patient. Cushing was upset by the demands of wealthy patients in general, and this one in particular, and let Halsted know about it. Halsted was effusive in his apologies, adding, “Dr. Cushing please submit your bill, I will add it to mine.” Included in his fee for services was an additional $200 for assistants, easily five times what was customary for two residents and two nurses, and exactly the figure Cushing had demanded.

Halsted did not maintain separate offices for private patients, nor did he openly promote his private practice. Fee-for-service patients were seen in their homes, their hotel rooms, or at the hospital. He demanded numerous assistants in the operating room, and when he traveled, he rarely did so alone. He charged handsomely for his services and for those of his staff. Typical fees were up to $75 per hour for time spent outside of Baltimore. His surgical fees slid readily up and down the scale, according to the patient’s ability to pay. He was often tempted to alter the bill based on the patient’s behavior but rarely did so, as the financial deal was typically struck prior to surgery. His notes on fees billed and paid offer a rare look at his world through his eyes, as well as at his cutting sense of humor.

An operation for intestinal obstruction performed in a farmhouse in Maryland was described as “Terrific operation, also highly dramatic; electric lights gave out; lamp nearly exploded, and set the house on fire; patient stopped breathing; artificial respiration; inexperienced assistants; ether gave out because etherizer had so asphyxiated the patient, he got neither air nor anesthesia; life of patient saved thus far; 5 hundred dollars by agreement, should be $5000.”

Another bill, for a complicated amputation performed in stages, was for $13,825, quite a sum—the 2009 equivalent of about $250,000.

After examining a three-year-old girl with swollen glands, he noted: “A terrible kid, consult $50 at least, one hour’s torture by child.” Sometimes he even noted when the bill was paid: “Paid within 12 hours.” Or when he was paid in the operating room: “This doesn’t happen too often.” “Very wealthy, outrageously small bill.” “Very much of a gentleman, more like a New Englander.”

Halsted’s initial salary of $2,000 was raised to $3,000 when he was appointed surgeon in chief and professor, one-third of which was paid by the university. With his salary, the funds he received from his father, and the income from his private practice, Halsted was certainly well off, but never considered himself rich. His spending habits were neither outrageous nor ostentatious, but they were free and unusual, and he did make the grand gesture now and again. When Mitchell engaged and trained a stenographer for him, Halsted then hired her as his private secretary on a one-year contract. The woman soon asked Mitchell if he could help her find a new position, as Dr. Halsted no longer needed her. Mitchell easily placed her with Henry Hurd, with whom she got on famously for years. When Mitchell finally asked Halsted why he had discharged the woman, the indignant reply was, “Mitchell, she would use perfume and I told her I objected to it, that it was distasteful to me, and what did she do but change the brand: so I gave her a year’s salary and let her go.”

His outside income afforded a level of comfort that his salary alone could not provide. In 1900, beefsteak sold for 10 cents a pound, a roast beef dinner and all the trimmings for 25 cents. With his income, Halsted was able to subsidize salaries in his laboratory; employ a full staff of household employees, including several at High Hampton; employ several private secretaries and a liveried coachman; and travel the world with impunity. He generously aided community projects in Cashiers, and even subsidized the small Episcopal church on the grounds of High Hampton, although he did not attend.

A bespoke tailor made his conservative, dark suits and country
tweeds. He favored black silk socks and highly polished, square-toed shoes, which were made for him by the half dozen pair by a Parisian bootmaker. Each pair was fashioned from a particular portion of the skins personally selected by Halsted, and upon delivery he would scrutinize them closely and discard the shoes he found beneath his standards. His gloves and hats always appeared fresh and new. English travel bags, leather goods, and brushes were perfectly cared for, and his handkerchiefs were of such fine linen that it seemed a shame to use them.

Halsted’s shirts were all of the finest cotton and linen, and made to his measurements at Charvet, the famed French shirtmaker at 28 Place Vendome, in Paris. Charvet shirts were an extravagance shared with generations of famous men, including Oscar Wilde, Gustave Eiffel, and Henri Matisse. By 1920, the cost of each bespoke shirt had risen to nearly $9, driving Medill McCormick, the United States senator from Illinois, to tell the
New York Times
how outraged he was by the manner in which Americans were being taken advantage of by the French.

In Halsted’s dressing room at Eutaw Place was a large wardrobe with many shelves piled neatly with stacks of perfectly laundered shirts. Claiming that he was unable to find anyone in this country who could adequately launder a dress shirt, he would have his shirts shipped back to Paris to be washed and ironed. When he traveled to Europe in the spring or summer, he would pack the soiled shirts and deliver them himself. Later in life, believing he had found “a little place in Baltimore where they laundered shirts sufficiently well,” he gave up the long-distance laundry.

His suits usually included a matching waistcoat, and they draped well over his top-heavy, long-armed frame. Even with his odd walk and his arms bowed at his sides, the fine lines of his suits were obvious. The cravats Halsted favored in the earlier years were replaced with conservative modern neckties, and striped shirts and bow ties were a
favored country combination, worn with either flannels or tweeds. He wore a perfectly cared-for traditional silk top hat around town until his later years, when he adopted the more modern, black derby. That, too, always appeared new and spotlessly clean.

Among the Hopkins men were any number of fashion plates, and very high on the list was William Osler. Osler was a bit flashier than Halsted in his dress, as in his demeanor. He wore brightly colored cravats, frock coats, and striped trousers and always had a rose in his lapel. The choices in his dress and the little extra touches were more lighthearted and quick-stepped than those of the somber Halsted. Finney recalled walking in the hospital corridor with Halsted, when they met Osler, who was unattended by his usual retinue. “Very soon here came Billy Thayer, hurrying to catch up with ‘The Chief.’ He too was faultlessly attired. Following him and not far behind came Barker, as I recall, also in frock coat and top hat. As each one hurried by, Dr. Halsted, after exchanging greetings, cast an envious glance out of the corner of his eye after him. Last of all came Sladen, in a great hurry. He was the epitome of sartorial elegance. This was a little too much. After Sladen had passed, Dr. Halsted stopped, turned around, and cast an admiring glance down the hall after the retreating medical men, remarked, ‘Fine dressers, these medical men, aren’t they?’”

His obsessions did not end with perfectly cut suits. The white oak and hickory logs he favored for the open fires in his rooms were equally important, and Caroline frequently scoured the suburban suppliers when the woodpile was running low. He was equally serious about his coffee, and every bean counted. Individual coffee beans were chosen to match in color and size, brewed black and thick, in the Turkish fashion, and said to have a lasting effect. Halsted’s coffee was blamed for the sleepless nights of those who had been honored with dinner invitations, and he did not trust others to prepare it.

Halsted was also an inveterate letter writer, sometimes exchanging letters with his sister Bertie in French. It was believed he had help
with this affectation, as he was not fluent in the language. But he was fluent in German, and corresponded regularly with a host of German surgeons. He wrote often to Caroline, and she to him, when she was away at High Hampton, or he on his medical travels and journeys to parts unknown. Her letters, brimming with facts of day-to-day living, also offer a window into her frustration with his character. One wonders if the veil of formality was dropped in his letters, but sadly, all that remains is a one-way correspondence. Immediately upon Caroline’s death, her sister Lucy Hampton Haskell destroyed all of Halsted’s letters to his wife, without reading them, she claimed, believing they were private and should not survive the recipient.