Genius on the Edge: The Bizarre Double Life of Dr. William Stewart Halsted (47 page)

My Dear Miss Bessie,

I am charmed by your letter which even in its expurgated form is much too ‘lurid’ for my deserving, but not ‘fur mein Fahigkeit,’ respective ‘geraumigkeit zu verschlucken,’ which, as young ladies so well know, is the infinite capacity of old men to swallow the lurid words of a young woman.

Wonderfully distressed to hear of the ‘malade’ and the boiling oil and fearing you may succumb before Christmas I am sending the enclosed card and nervously scanning the obituary notice columns …

Faithfully Yours,
William Halsted.

Three weeks later, after receiving a gift from Elizabeth before she was meant to go to France with the Red Cross, to join Base Hospital #18, he wrote, “Verily only a trained psychiatrist could have derived from such meager data that copious tears were flowing on the corner of Eutaw Place and Dolphin Street.”

And then a telegram, sent to her at the Vanderbilt Hotel in New York, as she waited for deployment, said, “Letter follows on recovery of equilibrium sad case of love at first sight please consult alienist abroad in my behalf and advise W.S. Halsted.”

Base Hospital #18 was disbanded before her departure, and Elizabeth served the Red Cross at a base in New Jersey. When she was about to return to Baltimore, Elizabeth invited Halsted for a drive in the country. He accepted, and wrote to suggest she invite her father as chaperone.

Other plans were made and letters and notes passed, and from the content it seems likely that the ten surviving letters were merely representative of the correspondence. The true nature of the relationship remains unknown, but an undated letter speaks for itself: “Please picture me every morning at eight o’clock, unchaperoned awaiting your arrival and preparing, flinging consequences to the winds, to float southwards on and on … Ever your devoted adorer.”

The last of his letters was written some eight months before she married Harry Slack Jr., an otolaryngologist who had trained under Sam Crowe. It was sent from High Hampton on September 12, 1921, when Elizabeth had already begun seeing her future husband. The initial reference in the letter is unexplained, but the tone is obvious.

I carry it around with me everywhere—on fishing excursions, on mountain trails, on moonlight stills through “panthertown,” to Sunday school and the dahlia garden. I wonder if the Paris creations in which you are presumably soaring can be so becoming and enticingly lovely as the pink costume you wore the afternoon you so graciously entertained my friends, the Leriches from Lyon, and my adored assistant G.J.H.—if he leaves us I shall be desolated and altogether inconsolable except in the delicious and fleeting moments of Cloud–Capped. (The Randall family estate)

IN THE CONSTANT
company of illness and discomfort, Halsted began to spend more time at home. He was increasingly convinced that the pain he was experiencing in his chest and abdomen was caused by
angina pectoris, due to inadequate oxygenated blood supply to the heart muscle. The usual cause of angina is progressive occlusion of the coronary vessels by cholesterol plaques, then called arteriosclerosis. In most instances the tipping point is exercise, when the heart muscle requires more oxygen than the compromised coronary arteries can deliver. Although the pain that drove him from the operating room was never definitively diagnosed as anginal, some element of it may well have been. The electrocardiogram, universally relied upon for diagnosis, was not yet invented, and there is no evidence of Halsted being treated with nitroglycerine, which had been available for the relief of the symptoms of angina since 1879. Morphine and rest could mask the pain and relieve the symptoms in moderate cases, and one might deduce this to have been his choice of action.

In the winter of 1919, he was confined to the house for two months, with severe bronchitis. Packets of Pall Mall cigarettes were available beside him wherever Halsted worked. A cigarette burned in one of his disposable, white holders for the solitary hours of the day, as he read and wrote. There is little doubt that his heavy cigarette consumption contributed greatly to his pulmonary problems and perhaps his chest pain as well, but he did not abandon the habit. The chest and abdominal pain became something of an obsession. He was certain that each attack would be his last. And then a particularly severe attack was surprisingly followed by jaundice, and the rules changed.

Halsted consulted with Dr. Thomas Boggs, who advised him of what he already knew. He had gallbladder disease, just like his mother and other relatives before him. He very likely had a stone blocking his common duct, and would need surgery. It was not what Halsted wanted to hear, but it was preferable to angina.

HE PUT OFF THE
fateful day as long as he could. By spring, when he was well enough to travel, he went directly to High Hampton, forsaking the unaccompanied trips that had been so much a part of his routine.

By late August he once again felt the full fury of gallbladder disease, suffering painful bouts of colic from stones in the common bile duct. This time the great diagnostician needed no one to identify the source of his distress. It was his fate as he had envisioned it, and he immediately telegraphed Johns Hopkins to make preparations for his surgery. Halsted was admitted to the hospital on September 1. At the time of admission his temperature and pulse were normal, but his blood pressure was significantly elevated at 170/100, accounting for the florid complexion so often ascribed to his healthy appearance.

Finney was on vacation, and Richard Follis performed the surgery. Follis had followed Mitchell as resident, and was in private practice in Baltimore as well as on the staff at Hopkins. At operation the gallbladder, which was full of stones and gravel, was removed, and a single large stone was found obstructing the common duct.

Halsted had suggested that Follis employ his newly devised method of draining bile via the stump of the cystic duct, which had resulted in a remarkably smooth course for the patient for whom it was employed. Unfortunately, Halsted’s cystic duct was located in an anomalous and inaccessible position, behind the common duct, and Follis felt drainage would be best carried out through a tube placed in the rent in the common duct. The tube was brought out through the skin, surrounded by six rubber cigarette drains. Within 48 hours after surgery bile began pouring out through the drainage tube, taking with it essential electrolytes and digestive enzymes. On the sixth day the tube was removed, but enormous volumes of bile continued to drain from the sinus tract.

Halsted suffered. Food and drink repelled him. He lost weight rapidly, and became weak and debilitated. Fearing for his life, the surgeons treated him with 300 cubic centimeters of salt solution by rectum every six hours to maintain his body fluids. Mont Reid led the group of doctors who stood vigil at his bedside and tried to force The Professor to eat.

The sinus tract gradually dried up, the flow of bile returned to the intestine, where it belonged, and the crisis was over. With that, Halsted’s appetite returned with a vengeance. His attitude improved, and he soon began to write notes to friends and contemplate his next meal. The delight of eating, talking about eating, and savoring every delicious bite thoroughly occupied the latter days of his convalescence. Having personally experienced the ravages of the uncontrolled loss of biliary secretions, Halsted ordered his staff to institute closure of the common duct and utilize cystic duct drainage whenever possible.

He left the hospital on October 19. By January 1920, he was well enough to work, but the four-month illness had extracted its toll. The ferocious, indefinable energy of his personality was muted, his steely gaze had softened, and Halsted looked older. Prominent veins and gnarled fingers had transformed the large, powerful hands, and the slight stoop in his walk had become more pronounced. He had lost weight, and his face appeared pained even when it was not. Halsted became increasingly philosophical. He operated occasionally, worked in the lab, wrote his papers, and even managed to attend medical meetings in the spring. He spent the summer of 1920 happily in the country, returning to work in October as usual.

That December, Halsted was incapacitated with gastritis, generalized abdominal pain, and nausea. Again acting as his own physician, he diagnosed pancreatitis, secondary to obstruction of the pancreatic duct by a gallstone. This time he was correct, but happily the symptoms abated, and he resumed work. It was a remarkably productive period in which he produced two lengthy monographs,
The Operative Story of Goitre
and
Ligations of the Left Subclavian Artery in Its First Portion
. Both appeared in 1920 and were very well received, as was his paper on lymphangitis. In the lab he continued the decades-old struggle to develop a clean technique for intestinal anastomosis, coming up with several complicated and not wholly satisfactory solutions.

Halsted’s strength never fully returned. The summer of 1921 was passed pleasantly with family and friends at High Hampton, but upon returning in October he suffered a series of painful skin infections, severe gastroenteritis, and then, in November, episodic symptoms of biliary colic returned. In the weeks between attacks he managed to work, but the healthy intervals became shorter. His declining health was as evident to his colleagues as it was to Halsted, and his urge to complete his work was met by an equal desire by those he touched to pay proper homage to him. Few had had the opportunity to speak of his significance to surgery and his influence on their lives. It was not something Halsted encouraged, and his imperious demeanor had forced even those with the warmest feelings for him to keep their proper distance. His work was its own reward. Honors and accolades were not necessary for The Professor’s self-esteem, and he shunned them whenever he could.

But in April 1922, a gold medal had been struck by the National Dental Association “In recognition of his original researches and discoveries upon which the technique of local and neuroregional anesthesia in oral and dental surgery now rests.” A grand dinner to present the award was thrown in Halsted’s honor by the Maryland State Dental Association. Strawberries, lobster thermidor, breast of chicken, and Virginia ham were served. Tables were supplied with several brands of cigarettes, including Halsted’s favored Pall Mall. Among the many speakers were Welch, Finney, Barker, and Frank Goodnow, the third president of The Johns Hopkins University.
¹
Those close to Halsted threw reserve to the wind. They spoke freely of his great insight and surgical leadership, and
all he had done to alleviate suffering and advance medical science. Few had ever spoken of his accomplishments to his face, and perhaps had ever been forced to step back from years of daily interaction and assess the full impact of the odd giant in their midst.

Rudolph Matas, professor of surgery at Tulane University and the leading surgeon in New Orleans, shared many of Halsted’s professional interests, including thyroid and aneurysm surgery. He was a student of surgical history, fully understood Halsted’s role in creating modern surgery, and held The Professor in the highest esteem. They corresponded often, and Matas was a frequent visitor to Baltimore. On one such visit, Halsted operated on Matas at his home on Eutaw Place. Halsted, as usual, was exceptionally solicitous of his guest, and his concern made an indelible impression on Matas: “As I was convalescing in his home I learned to love the sound of his cautious footsteps as he approached my room late at night to assure himself of my comfort …”

It was Matas who made public his friend’s enormous contribution and clear primacy in the discovery of local and regional anesthesia. Many in both dental surgery and general surgery had no clear knowledge of the origins, and the terrible cost, of local anesthesia, and Halsted had been reticent to tell the whole story. The wounds he incurred remained open 37 years later.

To Matas, Halsted wrote, “You are indeed a sturdy friend. I wrote very little on the subject of my cocaine experiments which for a year were carried on vigorously. Then my health gave way and for more than a year I was incapacitated, and thereafter for two years worked in the Pathological Laboratory of Dr. Welch at the Johns Hopkins. Thus my misfortune has its bright side as well as its gloomy side.”

After the dinner he wrote Matas again: “My dear friend: How can I ever express my gratitude to you for this act of unparalleled kindness … Not a wink of sleep did I get during the night of Saturday—I was too exhilarated for repose. Once before in my life I was kept
awake by great happiness—this was the night I passed successfully the examination for Bellevue Hospital in 1876. Then it was in contemplation of the future, now in reflection upon the good fortune which led to our friendship.”

Halsted deserved the nation’s appreciation for a contribution that had greatly relieved suffering and transformed a profession. The public acknowledgment was that much sweeter for coming through no lobbying, chest thumping, or hinting on the part of the recipient, all of which would have been unconscionably out of character.