Genius on the Edge: The Bizarre Double Life of Dr. William Stewart Halsted (37 page)

The next year Young worked on Ward E, where the urology patients were assigned. One of the patients he was caring for was incapacitated by the need to urinate every 15 minutes, and no one knew how to deal with his problem. Young’s examination revealed the man’s bladder had shrunk to the capacity of a tablespoon. It seemed reasonable to believe that he could dilate the bladder by forcing fluid into it. Young rigged a 15-foot-high pole with a fountain syringe on top. He fixed the tube against the tip of the man’s penis and forced fluid up the urethra and into the bladder—first a tablespoonful, then as the bladder dilated, an ounce, and then two. Gradually, the man’s bladder capacity increased to normal, and the frequent urge to urinate disappeared.

The procedure was used thereafter whenever a similar problem presented itself, but always with the overriding fear that fluids forced into the bladder might back up into the ureters and the kidneys, risking serious infection. Young studied the question by pumping tinted fluid through the urethra into the bladder of fresh cadaver. When the
bladder was blown up like a balloon with a full quart of tinted liquid, Welch and the other observers backed off, expecting the dam to burst. But it didn’t. Young cut into the ureters and found no backflow of the colored fluid. The fluid remained sequestered in the bladder. The experiments were presented to much acclaim at the Johns Hopkins Medical Society. Halsted said nothing, and Young continued on as an assistant resident.

The following October, Young turned a corner in a hospital corridor and ran head on into Halsted, nearly bowling him over. Catching The Professor before he hit the floor, Young began to apologize profusely.

“Don’t apologize, Young, I was looking for you to tell you we want you to take charge of the Department of Genito-Urinary Surgery.”

Young demurred, but didn’t have the courage to outright refuse. He had finished his time on the G-U ward and was looking forward to general surgery, and besides, he didn’t know anything about the subject.

“Welch and I said you didn’t know anything about it, but we believe you can learn.”

Young yielded to The Professor’s pressure, and he did manage to learn quite well.

One of the new methods for studying the internal “plumbing” of the genitourinary system was the cystoscope. The device was basically a thin tube inserted into the urethra through the penis, which had been numbed with cocaine. The surgeon would look around the bladder through the long, thin metal device with illumination provided by a tiny lightbulb. This illumination was an advance over the pre-Edison models, which were lit by a glowing platinum loop, which would burn the bladder if not properly cooled with ice water. Young further improved the instrument by adding a prism at the tip, which afforded more panoramic visualization.

Then, as now, prostate cancer was the plague of men of late middle-age. Young recognized its nature as a slow-growing tumor and saw the value of catching it early. Just as he had previously run around
culturing everything, he now began doing rectal examinations on all his male patients, ushering in the era of early diagnosis of prostate cancer and greatly increasing the chance of cure with surgery. He improved on the bloody suprapubic prostatectomy and introduced a new method called the perineal prostatectomy, performed through an incision beneath the scrotum and above the anus. He popularized the new operation and gained fame for performing 125 perineal prostatectomies without a fatality. This arcane record led a New York urologist to quip, “The prostate makes most men old, but it made Hugh Young.”

In addition to being a world-class tinkerer, Young was a very good surgeon. He was bold and confident, and a fine leader and teacher, but when Halsted hovered behind him in the operating room, it all disappeared. He was known to break out in a sweat and fumble in Halsted’s presence, and afterward throw his sweat-soaked scrubs on the dressing room floor, kick them across the room, and curse himself, asking, “Why can’t I get over this feeling of inferiority when The Professor is around?”

Few men other than Finney, Cushing, and Richard Follis appeared fully comfortable in his presence, and even then, their apparent comfort might not have been what it seemed. Halsted was well aware of the unsettling effect he had. He rarely did more than quietly ask the surgeons what they were up to. He never commented, never corrected, and rarely brought the subject up later. Only the most grievous error brought unsolicited comment, and the worst punishment of all, banishment from the operating room. For the senior staff, nothing was missed by Halsted, and they knew it. But occasionally, a nod or a sly smile gave him away. If he enjoyed the discomfort he caused, and he probably did, Halsted was nothing but helpful and supportive when the operator was truly in trouble. Even with staff members whose technique disappointed him, The Professor castigated himself for not becoming aware of their shortcomings earlier, but did not confront them or try to change what had already become ingrained.

TAKING THE LEAD
from Halsted, who believed that many of the answers to surgical mysteries were found in the study of laboratory specimens, Young performed microscopic examinations on all prostate samples he removed. As the first surgeon to do so, he greatly expanded the understanding of the disease. In older men, benign enlargement of the prostate is responsible for difficulties in passing urine. The usual cause is enlargement of the central bar of the prostate, which compresses the urethra, blocking urine flow. Young modified a cystoscope through which was passed another instrument with a biting tip. Several bites with its jaws removed enough of the obstruction to allow normal urination. This relatively minor procedure replaced an extensive, invasive, and very bloody one, in which an incision was made over the pubic bone and into the bladder, and a section of the prostate excised.

This simple advance quickly changed the lives of many thousands of men. Among the earliest patients to benefit from the new procedure was James Buchanan Brady. The legendary “Diamond Jim” underwent the operation and had a rough postoperative course, but he could urinate. Brady became a great patron of Young’s and endowed the first urological institute in the country, which bears his name at The Johns Hopkins Hospital.

Under normal circumstances, urine is a sterile fluid. The complex urinary tract begins with the kidneys, where urine is manufactured. The ureters carry the urine from the kidneys to the bladder, and from the bladder it reaches the exterior via the urethra. The entire system should be sterile, but it is subject to retrograde infection from the outside. Once seeded, these infections are difficult to eradicate. Fifty years before the antibiotic era, Young was searching for an antiseptic solution to maintain sterility and treat infections of the bladder and urethra. In 1919, after years of experimenting with numerous chemicals in the labs at the Brady Urological Institute, Young and his staff settled upon a relatively nontoxic compound of mercury, which they named Mercurochrome. The new, red-brown antiseptic became instantly
popular and was soon used universally to treat scrapes and cuts. Children knew it as “monkey blood” because of its color, and for decades no household was without it. Young was convinced of its miraculous powers and used it in virtually all his procedures, believing it could cure everything from septicemia to bladder and kidney infections.

As a victim of chronic bronchitis, Young coerced his colleague Sam Crowe into injecting Mercurochrome between his vocal cords and into his trachea and bronchi. Crowe performed the procedure quickly and expertly, and remembers, “An immediate series of explosive coughs sprayed me, the ceiling, and the surrounding walls with the bright red drug.”

But the mess wasn’t the worst of it. Apparently, enough Mercurochrome was absorbed for Young to develop signs of kidney failure, which only slowly resolved. This extremely dangerous episode didn’t stop his experimentation with the drug, and some time later he managed to have his resident administer an intravenous injection of Mercurochrome to prevent an abscessed tooth from requiring extraction. There is no record of how this ill-conceived adventure turned out.

Mercurochrome is still a popular antiseptic everywhere but in the United States. Because of the alleged potential for mercury toxicity, and its unproven effectiveness, the FDA has banned interstate commerce in Mercurochrome, and the substance has disappeared.

Young’s residents went on to found urology departments at universities around the country, among them Harvard, Yale, Cornell, and the University of Pennsylvania. Advances came quickly, and based on his experience with the Journal Club at Hopkins, Young recognized the need for the exchange of information. He founded the
Journal of Urology
, a project he personally funded for years. A man of wide-ranging mechanical inspirations, his creations varied from Mercurochrome to a mechanical soap dispenser to seaplane landing gear.

Hugh Hampton Young never achieved his goal of resident in surgery. Instead he became the father of urology.

JUST AS HALSTED
identified the moment and the man for urology, he seized upon Frederick Henry Baetjer to be the first official actinographer
¹
at The Johns Hopkins Hospital. After an internship in medicine under Osler, Baetjer was appointed assistant resident in surgery. He had worked on the hand-cranked X-ray machine with Cushing since medical school, and when Cushing finished his residency the work seemed to fall to Baetjer. He signed on to the job full time in 1902 for the lofty salary of $900 a year, for which he developed the specialty of radiology, lost most of his fingers and an eye, and developed lymphatic cancer.

Baetjer was a rotund and happy individual with enormous scientific curiosity. Carefully following his findings on the roentgenograms into the operating room, he was able to dramatically demonstrate the diagnostic possibilities of the new technique. Just as Cushing had done at the beginning, Baetjer focused the X-ray beam on his hands and often held the patient in place while exposing the plate. At the time, the long-term effects of radiation were unknown. As late as the 1940s, fluoroscope machines in shoe stores produced a moving X-ray image to demonstrate the fit of the bones of the feet in the new shoes. The miraculous toy delighted children until the dangers of radiation became known. Baetjer learned the lesson earlier.

The field was still in its infancy. There were no protective lead aprons and gloves, and the radiologist was not separated from his subject by an impermeable shield. X-ray tissue damage is cumulative and takes years to express itself. Among the first signs of trouble are thinning of the skin as a fibrosis of the blood vessels sets in. Once set
in motion the process cannot be reversed, and yesterday’s exposure continues to manifest itself today.

On June 3, 1908, the
New York Times
said:

Dr. Frederick Baetjer, widely known as an authority on roentgen rays, today underwent a surgical operation for the removal of his right eye. His friends thought that the trouble might have been aggravated by his continuous experiments with the rays, but the oculists say it was the result of an accident during his college days.

Some time ago Dr. Baetjer was attacked with a particular partial shriveling of the arm and hand from which he recovered. It was attributed to the effect of the X-rays.

Dr. Baetjer is a member of the Johns Hopkins Hospital staff.

The
Times
story was probably incorrect, and later accounts believe the cause of the lost eye was radiation. Baetjer underwent more than 100 operations and ultimately lost part, or all, of eight fingers, but his spirit was never broken. The lifelong bachelor was much loved and a great favorite of everyone at Hopkins. His relationship with Halsted was always good, and The Professor both appreciated him and enjoyed making jokes at his expense. Typically, when Baetjer was demonstrating a finding, he held up an X-ray film and started his talk with, “This is an image of the skull.”

To which Halsted responded, “Really, Baetjer, I had that thought myself.”

After learning the price of exposure, Baetjer abandoned the mechanical side of radiology and concentrated on reading films and clinical correlation.