Genius on the Edge: The Bizarre Double Life of Dr. William Stewart Halsted (49 page)

Direct and indirect Halsted disciples became professors of surgery at Johns Hopkins, Harvard, Yale, Cornell, the University of Virginia, Columbia, the University of Cincinnati, George Washington, Stanford, the University of California, and a host of other places. Halsted-descended clinical professors, associate professors, and assistant professors are too numerous and far flung to enumerate. Virtually every academically affiliated surgeon can trace his or her teachers, and his teacher’s teachers, to William Stewart Halsted.

Far more impressive is the fact that every well-trained surgeon in the world is trained in a Halsted-type system, and all still live by the Halsted principles of surgery. Aseptic technique, gentle handling of tissue, scrupulous hemostasis, and tension-free, crush-free, and anatomically proper surgery are the rules. And they are Halsted’s rules. Although “Halsted” is not a household name, every individual in America who undergoes successful surgery owes William Stewart Halsted a nod and a deep debt of gratitude.

Scrub suits and sterile gloves began in Halsted’s operating room. His imagination, innovation, and diligence brought the first successful operations for breast cancer and hernia. He made local and spinal anesthesia a reality, and was a pioneering vascular surgeon, a pioneering endocrine surgeon, and the encouraging godfather of neurosurgery, urology, and otolaryngology. And he created the humane, scientific, experimental laboratory, where medical students learn surgery, surgeons learn new techniques, and lifesaving surgical advances are born.

Halsted was a complex and isolated man, forbidding and nurturing; rigid, proper, and secretive; compulsive and negligent; stimulating and reclusive; addicted and abstemious; oblivious and solicitous; and always concerned with advancing the science of surgery. For many it remained inconceivable that he was other than the mentor who led them into a new era. For his equals he remained a strange disciple of another calling. For the few who knew of his ability to navigate uncharted waters while the siren song rang in his ears, his journey was
nothing short of heroic. If a single person can be considered the father of modern surgery, the only contender is William Stewart Halsted.

HERBERT HOOVER, THE
31st president of the United States, wearing striped trousers and cutaway coat, silk top hat in hand, strode to the podium at Continental Memorial Hall. Sixteen hundred scientists, physicians, and government officials filled the seats. Hoover stood erect, looked out over the audience, and said, “William Henry Welch is our greatest statesman … and has contributed more than any other American in the relief of suffering and pain in our generation and for all generations to come.”

It was 1930, and the occasion was the national celebration of Welch’s 80th birthday. The hour-long festivities were carried by radio across America, and that week Welch’s portrait graced the cover of
Time
magazine. The world had changed so much since the birth of bacteriology, since he had established the country’s first pathology department at Bellevue and become a professor of pathology at The Johns Hopkins University, chief of pathology at The Johns Hopkins Hospital, founding dean at the medical school, first director of The Johns Hopkins University School of Hygiene and Public Health, and scientific director of the Rockefeller Institute for Medical Research. It was a new and healthier world, and Welch had been at its epicenter for half a century.

Humility and decency were hallmarks of Welch’s character, and one can imagine his shrinking response to the national outpouring of admiration, to say nothing of finding his face on a magazine cover. His reticence about his own accomplishments was legendary. After discovering the causative organism of gas gangrene, Welch had insisted upon referring to the microbe by the descriptive name,
Bacillus aerogenes capsulatus
, never joining the rest of the scientific world in honoring its discoverer with the name Clostridium Welchii.

It has been said that bacteriologists, not surgeons, made surgery safe. Intellectually, Welch followed Pasteur, Koch, and Lister into the operating room, teaching surgeons that aseptic surgery was safe surgery. Wound infections did not materialize spontaneously. Bacteria could be identified and avoided, and patients could be protected by simple aseptic precautions. Scrupulously clean operating rooms, sterilized instruments, proper hand decontamination, sterile gloves, and ultimately, face masks and sterile gowns made the difference between life and death. It was as simple as that.

Welch came to understand the importance of sterility in surgery; Halsted had arrived at the same conclusion on his own.

Welch took it a step further. He recognized that prevention of disease was possible on a grand scale by identifying the agents of disease, and insulating the population from them, and founded The Johns Hopkins School of Public Health. Halsted founded an equally far-reaching safe school of surgery.

Himself a follower of Koch and Cohnheim, Welch passed the baton to a new generation of students who set about changing the world. Among them was a U.S. Army doctor named Walter Reed. Reed identified mosquitoes as the vector for yellow fever, instituted mosquito control, staunched the loss of life in Central America, and made the building of the Panama Canal possible. That is the true meaning of public health, as was identifying the need, and the means, to contain tuberculosis prior to the advent of antibiotics. By the application of simple public health measures to prevent airborne transmission of the disease, annual deaths from tuberculosis dipped from the millions to the thousands in the early 20th century.

Over a span of 40 years, Welch had been the buffer and filter between Halsted and the academic world in which he functioned. In his fatherly manner, Welch had managed to defuse the fallout from his friend’s lifetime of erratic behavior and fastidiously concealed drug use, and only in his final years, a decade after Halsted’s
death, did he finally reveal that he had never been fully cured of his cocaine habit.

Welch recognized greatness, allowed for weakness, and encouraged a singular talent to flourish. William Stewart Halsted, and the birth of modern surgery, had been part of his legacy.

In his last years, indulging his interests as a bibliophile, Welch founded and directed The Johns Hopkins University Institute of the History of Medicine.

It is difficult to quantify his influence on American medicine, but the recognition he received was not misplaced. The story of Johns Hopkins pivots about Welch’s role in the critical, early stages. His influence on the transition to scientific medicine far exceeded his own specific accomplishments, and William Welch was the essential catalyst for an era of great progress in medicine.

Disorganized and perhaps overburdened, Welch had spread himself thinly, but he never relinquished the role of reliable friend and mentor to Halsted. Welch remained active through his 84th year, and died of prostate cancer at his beloved Johns Hopkins Hospital on April 30, 1934.

EPILOGUE

T
HE WEST READING ROOM on the second floor of the Welch Medical Library is a quiet spot. It is sparsely furnished beneath double-height ceilings and hung with poorly lit portraits. In a place of honor on the far end of the room a massive, dark painting dominates the wall.

The painting, measuring 10 feet 9 inches by 9 feet 1 inch, is anything but joyful. It depicts the four doctors: Halsted, Welch, Osler, and Kelly. Mary Elizabeth Garrett commissioned the picture in 1905, and somehow convinced a reluctant John Singer Sargent to take on the task. Sargent had previously painted her portrait, which hangs in the room as well. The experience had been notably unpleasant for him. During the sittings he claims to have “felt like a rabbit in the presence of a boa constrictor.”

Sargent was then the most renowned portrait painter in the world. His paintings were shown everywhere, and he was famed for his renditions of Robert Louis Stevenson, Claude Monet, Theodore Roosevelt, and the scandalous Madame X. The artist was losing interest in portrait painting and skeptical about the project. But, as usual, Mary Elizabeth Garrett prevailed.

In early June, the great men were gathered at Sargent’s Tite Street studio in the Chelsea section of London for a joint sitting. Osler had recently relocated to Oxford, Halsted was passing through London on a summer journey, and Welch and Kelly made their schedules agree.

The studio was composed of two adjoining row houses, and the workroom itself was quite large and had good northern light from double-height mullioned windows. Sargent was a burly man with a full beard, enormous appetites and interests, and very much unlike the four austere men before him. Not at all restrained, he prowled the room grumbling as he worked and tried to provoke them.

Unable to achieve a satisfactory composition, Sargent struggled with the painting for nearly a year. After an early attempt, he had thrown up his hands in frustration and left the studio. Volatile, and unwilling to compromise his art, he struggled with himself and his subjects. Upon evaluating Osler for the first time, the artist shook his huge head and muttered that he had never before been asked to paint a man with green skin. Session after session he paced, chain-smoked cigars, complained, disparaged his subjects, and freely aired his displeasure whenever the mood struck him.

Osler, proud to have recently assumed the chair at Oxford, had dressed in his red university robes. Sargent was outraged and rebuked the gentle Osler with a diatribe on the horrors of that particular British Red-Coat shade, a color he insisted caused seamstresses to go blind.

And so it went. The more difficult the creation of the picture became, the more unease permeated the group.

Sargent disliked the standoffish Halsted. Famously distant with strangers, Halsted’s intolerance and sarcasm were quick to surface, though most annoyingly, he never deviated from his soft, gentlemanly delivery. He would sit quietly, smoking his expensive Pall Mall cigarettes through his cheap white cigarette holders, and observe the process. His comments, when he made them, were withering, and not at all appreciated by the artist. Legend has it that Sargent took his revenge by painting Halsted poorly, and in colors that would soon fade. Much was made of the depiction of Halsted’s thumb as short and graceless and the blue shadow painted under his eyes, but both were accurate.

Then, as often happens at the darkest moment, inspiration struck. The artist ordered delivery of a huge Venetian globe from his Fulham Road studio. When it arrived, the globe proved too large for the doorway. Now convinced he had found his way, he ordered the door jambs chopped away and his precious prop installed behind the berobed foursome. Having won the moment, Sargent sketched the new arrangement and announced, “Gentlemen, now we have got our picture.”

Sometime later he enhanced the vertical focus of the background by adding a painting from his collection. The dark addition was a copy of
St. Martin and the Beggar
, by Jorge Manuel Theotocopouli, the son of the Spanish master El Greco, who had painted the original. A painting of a painting of a painting, but it seemed to do the trick.

The group portrait was a great success in both Britain and America. Welch and Osler were unhappy with the likeness of their friend, and it was said that the picture told more of the dynamic between them than a glance at four men in ceremonial robes would imply. Halsted said nothing, but his actions spoke for him. Notoriously camera shy, he used a photo of his bust as his official likeness for a decade. The solemn portrait of the four doctors of Johns Hopkins was greatly admired, and the fame of the painter and his subjects grew.

Finally installed where it now sits in the library, the painting darkened over the years. After a major restoration in 2001, it now appears as it was originally painted. Of the four doctors, only William Stewart Halsted appears to be posing happily, and from every angle he seems to be wearing a sly smile as he looks over the room.