Genius on the Edge: The Bizarre Double Life of Dr. William Stewart Halsted (48 page)

For the first time in his life, Halsted felt unabashed joy at being celebrated, but he had not exorcised the demon, and time was running out.

1 Goodnow tried to recruit Nobel Prize winner Albert Einstein to teach at Hopkins in 1927. The offer of $10,000 for the academic year was gratefully declined by Einstein, who said the sum was more money than he was worth. Einstein claimed difficulties in traveling to America and health concerns, neither of which stopped him from moving to Princeton to escape the Nazis. The sum of $10,000 was also the salary for “full-time” medical professors at Hopkins in 1913.

CHAPTER THIRTY-SIX
The Final Illness

HALSTED DID NOT LEAVE
for High Hampton that year until mid-June. Attacks were now coming daily, and he was loath to leave Baltimore. When the frequency abated he chanced to make the trip, and for some weeks he felt better. On August 3, he responded to Welch’s request for biographical material. His excuse for not having written sooner was “a furuncle on my firmament.” On August 9, pain and jaundice returned. This time the diagnosis was not at all in doubt. For the next ten days he suffered severe chills, fever, nausea, and vomiting, and finally he telegraphed that he was returning to Baltimore. As luck would have it, Finney was once again out of town. Halsted requested that two of his favorite former residents, George Heuer and Mont Reid, rush to Baltimore for his surgery. Both men had been in Cincinnati, where Heuer had recently become professor of surgery.

On August 23, after a long, hot, and very uncomfortable trip, the Halsteds arrived at The Johns Hopkins Hospital. Halsted was yellow-green in color, dehydrated from vomiting and not eating, and clearly very ill. Rienhoff and Carter were the residents in charge of the ward when he arrived, and Reid immediately had them begin rehydrating
their patient with large volumes of salt solution injected under the skin. After 12 hours of this therapy, his rapid pulse rate decreased and his kidneys began to function.

Caroline Halsted understood the gravity of the situation and spent much of each day at her husband’s bedside. During her moments at home she dispatched a steady stream of status reports in the form of short letters dictated to one of Halsted’s secretaries.

On August 25, George Heuer, assisted by Reid and Rienhoff, operated on his mentor. This time a single stone was found and removed from the common bile duct. Drainage was carried out through a tube in the stump of the cystic duct, by the method Halsted described. The incision in the common duct was carefully sutured closed, and two drains were placed alongside the tube from the cystic duct. By all obvious measures the operation was a success. Halsted’s pulse and temperature returned to normal, and on August 26, he sent a message to Welch, in Atlantic City, that his condition was “very satisfactory.”

Reid and Heuer nursed The Professor night and day. On August 29, Halsted passed a very uncomfortable night and was unable to hold down food. On August 30, which was the fourth postoperative day, he was able to eat oatmeal, cantaloupe, and tea, and retain all he had eaten. His condition remained weak but stable. Then, on September 3, he suddenly vomited a large quantity of blood and began to pass black, bloody-tarry stools. He was bleeding into his digestive tract. The bleeding continued over the following days, and blood transfusions were obtained from several donors, including Mont Reid. When the frustrated Rienhoff could find no more veins for the transfusions, Halsted, moribund but unchanged, calmly asked if he had ever considered putting the needle into the brachial artery. The idea was a brilliant revelation to the young Rienhoff, but The Professor had performed the same arterial puncture for lamp gas poisoning more than 40 years before.

On September 5, Caroline telegraphed precisely the same short, formal message to Halsted’s sisters Bertha and Minnie, his brother Richard, and his nephew W. Halsted Van der Poel:

Doctors consider Dr. Halsted’s condition very critical. Caroline Halsted

Over the next four days, Halsted weakened further. He became feverish and developed lobar pneumonia, and an already critical course rapidly accelerated downhill. On September 7, 1922, on his surgical ward at The Johns Hopkins Hospital, William Stewart Halsted died.

CHAPTER THIRTY-SEVEN
Afterward

WITH A FULL RESERVE
of scientific detachment, Mont Reid and William Rienhoff attended the autopsy on the body of William S. Halsted, in the dead house of The Johns Hopkins Hospital. Examination of the internal organs revealed a well-healed incision in the common bile duct. The entire small intestine, from pylorus to ileocecal valve, was cherry red with blood under the mucosa. There was no evidence of abdominal infection. A pint of turbid fluid was found in the chest cavity and pleurisy surrounded the right upper lobe of the lungs, which had been consolidated by pneumonia. There was severe arteriosclerosis, especially in the coronary arteries.

Halsted had brought with him, on his final admission to the hospital, a daily record of the dilute morphine solution he had been taking for pain during the months of July and August. The amounts charted were unusually small, typically no more than ten milligrams in 24 hours—a remarkable, and unlikely, dose for a man who had been using almost ten times that for more than 35 years. Halsted brought this dilute morphine solution to the hospital and it was administered by injection as he needed it. One suspects that either the “dilute” solution was not all that dilute or, as some postulated, he had finally broken the chokehold of his addiction. Had
this been true, it would have been a properly dramatic conclusion to a battle of epic proportions.

Nothing was written to clarify the situation by the only two knowledgeable survivors, William Welch and Caroline Halsted, but Welch, on his deathbed, said in reference to cocaine:

Although it has been widely reported that Halsted conquered his addiction, this is not entirely true. As long as he lived he would occasionally have a relapse and go back to the drug. He would always go out of town for this and when he returned he would come to me, very contrite and apologetic, to confess. He had an idea that I could tell what he had done. I couldn’t, but I let him go on thinking so because I felt it was good for him to have somebody to talk it over with.

A FUNERAL SERVICE was held in the library at Eutaw Place on Saturday, September 9. Ranks of chairs were provided for the guests in the book-lined room. Everywhere, small tags of blue paper stood from the volumes like flags of tribute to the man who spent so much of his life among them. The Reverend Samuel Bushnell officiated. Among the four readings was a poem by W. K. Wallace, another member of the Yale class of ’74.

William Stewart Halsted’s body was cremated at the Loudon Park Cemetery in Baltimore, and his ashes were transported to the Greenwood Cemetery in Brooklyn. On September 17, they were interred in the large family plot overlooking New York Harbor. Caroline Halsted was exhausted from the month-long ordeal, and did not accompany her husband’s remains on his final trip. She was not at all close with the Halsted siblings and did not wish to spend this sad time with them. Richard Halsted, Bertha Halsted Terry, Minnie Halsted Van der Poel, and their families attended the small ceremony. One of Bertha
Terry’s sons-in-law was a clergyman, and he said a brief prayer, following which they adjourned to her apartment on Park Avenue. Only William Welch attended both services.

Caroline Halsted stayed in constant contact with Welch. On October 11, she wrote, “Dr. Halsted once said of them [his sisters], ‘they have not the least grasp of what the word science means.’ I was not going to interfere in any way with what they wanted. You know how people feel about their brother’s wife.” She was grateful for the help Welch had given her, and went on to tell him of Halsted’s feelings for him:

I sometimes wonder if you have any idea of the great love and admiration that Dr. Halsted had for you. He never mentioned you without praise. Most of us meet with adverse criticism from those who love us best but I never heard him say anything but what a true friend you have always been to him and how much you and all your work meant to the Johns Hopkins. He often said ‘Welch is the Johns Hopkins. Without him it would be nothing. He has been the best friend to me that any man could ever be.’

Welch suggested a simple inscription for the flat, granite grave marker:

William Stewart Halsted, M.D.
September 23, 1852–September 7, 1922
Professor of Surgery in the Johns Hopkins University

Caroline Halsted was overwhelmed by the death of her husband, and frightened for her future. Despite a groundswell of support from her family, her few friends, and the senior hospital community, she was rudderless and depressed. Unable to fully comprehend her finances, Caroline busied herself preparing to sublet the house at 1201 Eutaw Place. On November 20, Sam Crowe called Dr. Boggs and asked him
to look in on her. She had been complaining of a headache and fever, and Boggs’s examination revealed a rapid, irregular pulse as well. He suggested hospitalization. Caroline refused. The following day her condition worsened, and against her wishes, Crowe took her by ambulance to The Johns Hopkins Hospital. There she was diagnosed with left upper lobe pneumonia. At noon on November 27, Caroline Halsted died, barely two months after her husband.

WILLIAM HALSTED’S DEATH
was mourned throughout the surgical world. The Baltimore community felt the loss acutely at all levels of society. He was memorialized in a laudatory tribute in the
Baltimore Sun
, in which H. L. Mencken recognized his contributions and contradictions, his icy countenance and his humanity, what he had done to modernize surgery and how he stood out among the great men of Hopkins.

The American public was generally unaware of William Stewart Halsted. He was not as famous as Osler, Welch, or Cushing, nor as prolific as Kelly. He didn’t make speeches or befriend the powerful, and the fruit of his seminal work would not fully ripen for at least a generation. At the outset of Halsted’s career, fewer than a dozen doctors restricted their practices to the unsustainable, barbaric, and off-putting practice of surgery. Over his 33 years at the helm of surgery at Johns Hopkins, Halsted not only invented an entire surgical philosophy, he instituted a system to inculcate in surgeons this philosophy, which spawned several generations of the finest teachers of surgery in the world.

His goal was to train “not only surgeons but surgeons of the highest type, men who will stimulate the first youth of our country to devote their energies and their lives to raising the standards of surgical science.” In this, his success is everywhere to be seen. Of Halsted’s 17 residents, 12 became professors of surgery, associate professors, assistant professors, or surgeons in chief. Forty-six of his 55 assistant residents held academic titles, and the residents of his residents came to lead major surgical faculties throughout the country.