Genius on the Edge: The Bizarre Double Life of Dr. William Stewart Halsted (36 page)

Through the late 19th century Halsted wrote with duck quill pen and ink. Lewis Waterman perfected and patented the design for the fountain pen in 1884, and when Halsted fell in love with the writing gadget, he fell hard. For years he bought large quantities of fountain pens, far more than he would ever have any use for, and stored them in his desk.

His care and preoccupation with material objects and style should not be confused with venality, for Halsted was anything but venal. It was more about an obsession with excellence. He rarely mentioned money and never mentioned the cost of his extravagances. Of course, one can be happily oblivious to finances when money is simply there.

So it was for a good part of his life: not quite wealthy, but never wanting, and never caring. If there was enough to do whatever one wished in the manner one wished to do it, what was the problem? Halsted was not only unconcerned with finances, he was believed by those close to him to be shockingly inept in business matters. The lack of interest might well have been a simple matter of choice in the absence of necessity. Edwin Baetjer, Halsted’s lawyer, commented, “The gulf which separated his higher intellectual capacities from the ability to understand or deal with the business or ordinary affairs of life, was unfathomable.”

In a 1914 letter to the wife of surgeon Herbert Evans, Caroline Halsted wrote:

When I was married, Dr. Halsted had $3,000 a year and some debts. After he began to practice it seemed that money came so easily that I could not understand why he should do almost everything but positively decline cases so as to devote more time to the hospital. He became more devoted to his work and finally took up spending a good part of his salary on the hospital. The trustees did not enough for the salaries of certain employees considered necessary and to keep them Dr. H added enough to induce them to stay. One year I know his whole salary went back to the hospital. The young men grew up, got married and soon had motors [automobiles]. I candidly say that I did at times feel sour when I was waiting on a corner for a car to see the young people passing in their autos. We decided that we did not care for a family which of course saved considerable. We entertain very little for Dr. Halsted likes to have his evenings undisturbed for work.

I am gradually making the place [High Hampton] more self supporting. As I am there six months or more every year and my needs are small. I buy coffee and flour and pay for my cooking and washing and house work the enormous sum of $3.75 a week. My clothes are home made and cost little. So in the end I am glad the decision was for science and not money.

By this time private practice had been abolished among the chiefs of service at Hopkins. They were meant to be working full time for a fixed salary. For Halsted, it represented far less of a change in his routine than it did for others, as he was not operating frequently, saw few private patients, and was spending most of his time on his research and writing.

Caroline also referred to her loneliness as “one who paddled their own canoe … For I go off alone, stay on the farm and travel home alone. I might go on to say that I live alone on the third floor. All the rest of the house is given up to stenographers and books.”

There appeared to be no substantive changes in the nature of the relationship between the Halsteds as the years passed. The decision not to have children was made early in the marriage. After frequently hosting young nieces and nephews at High Hampton, they congratulated each other on having made a proper choice. The unconventional match seemed to thrive under living conditions characterized by separation and isolation.

The arrangement apparently suited them. Both husband and wife had entered into the contract with unusual expectations. Halsted surprised himself with his interest in Caroline. For her part, she made plain the appreciable changes that marriage would make in her life circumstances. If Caroline appeared mannish and unattractive in dark clothes and work shoes, it was a package that did not seem to disturb her new husband. Of his feelings, little can be said other than that he took delight in her southern manner and ancestry, breeding having been a favorite theme over the years. Caroline worked happily at providing an undemanding environment in which her husband could follow his intellectual star, and only after some years of marriage were there signs of discontent or feelings of neglect. Still, Caroline Halsted voluntarily spent six months of each year away from her husband.

Whether it was a marriage with infrequent sex, or any sex at all, is a matter for conjecture. Halsted’s sexuality is a muddy pond. There are no stories of adolescent infatuation; there is no known previous involvement with women, and no evidence of the desire for any sort of relationship until nearly age 40. Nor is there any evidence of homosexual relationships. His Yale friend and roommate, the Reverend Bushnell, commented, “While he liked girls he did not go in
for social things.” Cushing believed both Halsted and Welch to be homosexual, and hinted at a relationship between them, but there is no evidence beyond innuendo. Sexual inversion, the operative term for homosexuality at the time, would not have been tolerated at Johns Hopkins during the Halsted era. And just as his drug addiction, at the time a far less damning trait, was hidden, one would not expect Halsted to openly admit homosexuality, or perhaps even admit his unrealized desires to himself. His close relationship with Mall, and the letter in which he predicted Mall’s surprise that he was engaged to marry a woman, can be read as misanthropic humor, which is likely given the waspish jibing that passed between them.

CHAPTER TWENTY-SEVEN
After Cushing

AS A RULE, HALSTED
made infrequent appearances on the ward; hence, the level of organization of the service varied with the energy and ability of the resident surgeon. All the residents were competent; some were great, but that greatness was measured in different ways. To be chosen as resident was a singular honor, and the competition for the post was intense. Halsted often passed over senior men to appoint a particularly talented junior, as he had with Cushing.

Halsted picked interns from among the students he knew, and since he spent a great deal of his time in the laboratory, that was a good place to catch The Professor’s eye. The favored students were those who asked insightful questions at the bedside or in the formal clinic.

Whenever possible, his choices for resident were made from among those who had shown an aptitude for the laboratory. Surgical stars did not shine as brightly in the eyes of The Professor as did inquiring minds, and he was not at all reticent about deciding what career path a man was suited to follow. Some trainees were made to detour from general surgery while waiting to become resident, and establish themselves in the evolving world of surgical specialties. Others had decided on their future only to have The Professor abruptly change their plan. This was sometimes done by fiat and at
other times accomplished by gentle suggestion, which implied a fall from grace if disregarded.

Some, like William F. Rienhoff, Halsted’s last resident, had an easier time predicting their future. Halsted had learned from Mac-Callum that Rienhoff, as a medical student, was interested in working in the experimental surgery laboratory. Rienhoff recalled:

He had every intention of keeping me on later if I worked hard and carefully and of having me follow into the residency. It interested me very much that he had planned things so very far ahead. I was convinced that if I attended to my business, my chances of being trained into the residency were good. He relieved my mind of any apprehension about getting on and put me in a position where I could spend all my time in working and need not worry about the next year. I know that he had similar conversations with two others of his residents. It is true, of course, that the men he did not care to keep on, had no interview with him on the subject as he would not permit it. He made up his mind in these three instances at the very beginning of our hospital careers and from then on, these men were given advantages in assisting and time to work in the laboratory that other men did not receive.

Choices were made by a committee of one, and although instances abound of men assuming new positions without his knowledge, Halsted’s tacit approval of the individual had already been demonstrated. Distracted and unorthodox as Halsted was, his choices for resident were unfailingly excellent.

The operating room diminished as the primary focus of his interest as he moved on to another phase of his career, and Halsted summed up the state of affairs in his own words: “Surgery would be delightful if you did not have to operate.”

NOW, 20 YEARS AFTER
founding the department of surgery at The Johns Hopkins Hospital, Halsted changed yet again. He had become intensely interested in the thyroid gland and was experimenting with vascular surgery, while performing clinical surgery only once or twice a week. The combination of his reduced surgical burden and the departure of Harvey Cushing for Boston drove him to reenter the world of teaching. He resumed leading the course in experimental surgery, and he was present more regularly at the Friday teaching clinic. His interaction with the residents increased as his dependence on a single man abated, but mostly, his mind was on his research.

The resident following Cushing was James Farnandis Mitchell. Mitchell was a superb general surgeon, but he was not Cushing. There was a gap to fill, and with Cushing gone, it was the time for others to shine.

HUGH HAMPTON YOUNG
was the Virginia-born son of a Confederate general. His grandmother was a cousin of Wade Hampton II, Caroline Hampton Halsted’s grandfather. Young was an unusually bright student, and in a single four-year period at the University of Virginia he earned bachelor’s, master’s, and medical degrees. After medical school, Young moved to Baltimore and found work under Osler as a graduate student in the dispensary. Somewhere along the way he developed an overriding interest in bacteriology, and always carried around a pocket full of culture tubes. It was not unusual to see Hugh Young poking around the hospital and culturing everything in sight. On one occasion he cultured a patient’s lower lid abscess and identified the first case of anthrax seen at the hospital.

In 1895, he decided to seek training in surgery and wrote Halsted to apply for internship. When he next met Halsted, Young introduced himself.

“I wrote you applying for a position on the surgical staff.”

Halsted nodded stiffly. “Oh, yes, Young, I got your letter, but there isn’t any place for you.” Halsted had nothing more to say.

Disappointed, Young found summer work in bacteriology. In September, a surgery intern at Hopkins telephoned to ask him to be his substitute during his vacation. The intern returned from vacation, but in October two intern places opened. Young and two others, a total of three, hoped to secure the two spots. All three continued to work under Finney’s supervision. When Halsted returned from his summer holiday he said nothing about filling the positions. Young decided to simply stay on until they kicked him out, and the others followed suit. After a few weeks one of the three became ill with typhoid fever and withdrew to convalesce, and the problem solved itself. Halsted was unaware of the issue and expressed no surprise whatsoever at seeing Young on his staff, accepting him as though the hiring had been his idea.