Genius on the Edge: The Bizarre Double Life of Dr. William Stewart Halsted (9 page)

1 Today, when surgeons use local anesthetics such as lidocaine, a small amount of epinephrine is added, which constricts the local blood vessels, reduces blood supply, and keeps the anesthetic in the area longer. Less lidocaine can be used for a more extended period of effectiveness.

CHAPTER SEVEN
The Visionary

WHEN JOHNS HOPKINS DIED
in 1873, Baltimore was a city of 267,000, not yet fully recovered from the economic hardships of the Civil War. Divided by the tensions of Union loyalty and southern ethic, it had not fared well during the war years, and the economic strife that followed for a decade was sharply exacerbated by a financial panic that swept the nation that year. The city was an unprepossessing industrial seaport of endless row houses, each typically built with three stone entry stairs at front and a small yard behind. Squalor and poverty surrounded the port. The city had neither a cultural nor an academic center, and social and commercial opportunities were limited. Little existed to attract newcomers, and the city did not benefit from the postwar population surge seen elsewhere in the East.

Johns Hopkins had spent his lifetime in and around Baltimore, never traveling farther from home than Cape Ann, New Jersey. It was the world he knew, the city where he had amassed his wealth, and it was not surprising that the millionaire bachelor would earmark the bulk of his fortune for the civic good.

Hopkins was born in 1795, at Whitehall, his family’s 500-acre tobacco farm in Anne Arundel County, Maryland. His early life of rural southern ease was interrupted in 1807, when his abolitionist Quaker
father freed hundreds of slaves and radically changed the family’s economic circumstances. Johns’s formal education ended immediately, and the 12-year-old was sent to work in the tobacco fields alongside his siblings. There was little he enjoyed about tending tobacco, and his father arranged for him to move to Baltimore when he was 17 and work in his Uncle Gerard’s wholesale grocery store. An ill-fated, youthful romance with his cousin Elizabeth ended with Johns being denied her hand. His religious uncle considered the romance incestuous and ousted his nephew from both his home and his grocery. But Johns had learned his financial lessons well. Backed by his family, including $10,000 from Uncle Gerard, he set out on his own and had little difficulty building a thriving mercantile business. Johns was soon supplying dry goods and tobacco to the surrounding states, often bartering for whiskey, which he marketed under the name Hopkins’ Best. Trading in alcohol caused his temporary expulsion from the “Meeting,” his Quaker religious order, but this was soon resolved and he retained a long, if not close, relationship with the sect. By all accounts, Hopkins was a hard-driving businessman—so much so that his original partner, Benjamin Moore, left the successful firm saying, “I just don’t love money as much as he does.”

Hopkins bragged to a nephew that in his first year of business, “I sold $200,000 worth of goods.”

He soon enlisted three of his brothers as salesmen in the thriving business, renaming it Hopkins Brothers. He remained at the helm for 25 years, and at age 50, as his business interests expanded, he ceded the company to his siblings. He remained close to his extended family, and his home was always filled with relatives, including his old flame, cousin Elizabeth, who had, like Hopkins, honored their pledge never to marry others.

Hopkins had invested wisely and had become a very wealthy man. In addition to being a director of the Baltimore and Ohio Railroad during a period of rapid and successful expansion, he became its largest individual stockholder, with holdings exceeded only by those of
the State of Maryland and the City of Baltimore. Among several of his banking interests was the Merchant’s National Bank of Baltimore, where he held the presidency. His influence in business and civic circles was substantial and, Hopkins being in a position to come to the aid of the city he loved, Hopkins lent $500,000 to Baltimore to bridge a financial crisis brought about by the Civil War. After the war, railroads expanded the reach of economic life and were often a source of great wealth for investors and operators. But the opportunity for enrichment also fostered a highly competitive, often cutthroat environment. The fortunes of the highly leveraged railroad industry were subject to many variables, not the least of which were competition for routes, rising interest rates, and financial gossip. In this volatile environment, great fortunes were made and lost quickly.

In the fall of 1872 an equine viral epidemic, called the Great Epizootic, infected nearly 90 percent of the horses in the country. Four million horses died before the disease ran its course, leaving the country at a virtual standstill. Every industry was affected. Goods could not be produced or delivered, and financial panic engulfed the nation. Coal could not be transported from the mines to power the locomotives, and the railroads were forced to shut down. Income for the already financially extended railroads ceased; all were hit hard and many were forced into bankruptcy. Hopkins, who remained financially stable through diversified investments, was able to advance the B&O large sums of money to meet its interest obligations, thereby averting disaster for the company and solidifying his already lofty position in Baltimore business circles.

During the war, Hopkins’s sympathies lay strongly with the Union. Remaining true to the Quaker faith’s opposition to slavery, Hopkins was a “peaceful abolitionist,” and he employed all peaceful and legal means at his disposal to end the practice. He communicated with President Lincoln and openly supported Union causes. He encouraged the encampment of Federal forces in Baltimore and placed
the facilities of the B&O railroad at the disposal of the Union Army. When the war ended, feelings among Baltimore’s citizens, which were already frayed by partisanship, became hardened by economic strife. Hopkins remained successful during and after the struggle, and attempted to heal the wounds and divisions while doing what he could to help undo the wrongs done the blacks.

Unmarried, with no direct heirs, and his extended family on firm financial footing, Hopkins planned to use the bulk of his fortune “for the good of humanity.” His initial charitable bequest was $1 million for the establishment of the Johns Hopkins Colored Children Orphan Asylum. The same trustees named to oversee the orphanage would also lead the university to be built bearing his name. On April 24, 1867, he incorporated both The Johns Hopkins University and The Johns Hopkins Hospital. That year Hopkins spent $150,000 to purchase 13 acres on Loudenschlager’s Hill, the site of the Maryland Hospital for the Insane, which was to be moved elsewhere. The purchase was predicated upon the city’s closing the streets within the site so that the new hospital and medical school could be self-contained.

At his death, on Christmas Eve of 1873, the
Baltimore Sun
estimated Johns Hopkins’s wealth at $8 million, the equivalent of $160 million current value. His estate consisted of $2.25 million in Baltimore and Ohio railroad stock, $1 million in bank stock, and the remainder in real estate and commercial paper. Of this sum, $7 million had already been earmarked for the university bearing his name. It was the largest single philanthropic bequest in the history of the United States, and The Johns Hopkins University became the most richly endowed university in the country.

Hopkins’s plans were farsighted and proudly utopian but grounded in the plain words and vision of a successful businessman. The cause of higher education would benefit from the creation of the first true university in the country, offering both undergraduate and graduate courses of study, including law, medicine, and the humanities. Though
initially organized under a single board of 12 trustees, the university and medical school would be financially separate from the hospital. Half of the $7 million would go toward construction of the hospital; the other half for the university, including the medical school. Hopkins had stipulated in his will that the capital for the hospital would be invested in stocks and real estate, and the interest from these investments would fund construction, staffing, and operation, without invasion of the principal.

In an 1873 letter to the trustees, written nine months before he died, Hopkins outlined the principles of his hospital. The plan would consist of an initial building, with symmetrical additions, that would “ultimately be able to receive four hundred patients” and “compare favorably with any other institution of like character in this country or in Europe.” The hospital would treat the “indigent sick of this city and its environs without regard to sex, age or color.” The indigent would be admitted and treated without charge, and the trustees were obliged to secure the services of “surgeons and physicians of the highest character and greatest skill.” Hopkins continued, “In all your arrangements in relation to this hospital, you will bear constantly in mind that it is my wish and purpose that the institution shall ultimately form a part of the Medical School of the University for which I have made ample provision in my will.”

Despite the rich endowment, The Johns Hopkins Hospital would not open until 1889, and the medical school in 1893, 20 years after the grand plan was unveiled.

In 1874, the presidency of The Johns Hopkins University was offered to Daniel Coit Gilman, then president of the University of California. Gilman was a Yale graduate, born and educated in the East, who had spent the last three years overseeing the expansion of the University of California. He was 44 years old, a family man, and an ambitious and forward-thinking educator who compensated for his sharply receding hairline with wildly luxuriant side whiskers and mustache. Gilman
saw the mission to build a university devoted to research and scholarship as a unique opportunity, and immediately accepted the position. He assumed office the following year and would remain at the helm for more than 25 years.

The university opened its doors in 1876, and while this part of the dream had come to fruition, Gilman and the trustees wrestled with plans for the hospital. In order to build the finest facility possible, there was much to learn. They began by seeking out the leading hospital and sanitation authorities of the day. A decade beyond the Civil War, and two decades since the Crimean War, the great lessons linking sanitation and survival in hospitals were to be applied in planning the physical plant.

Among the candidates for medical and construction advisor was an army colonel, Dr. John Shaw Billings. As medical inspector of the Army of the Potomac, Billings had become expert on issues of sanitation and the prevention of epidemics. Having established his considerable reputation during the war, he was put in charge of building the Library of the Surgeon General. In seven years at the job, Billings reorganized and transformed a minor collection of 2,253 medical volumes to one with more than 25,000 books and 15,000 pamphlets, and established the index medicus to catalogue all known medical publications. Before his retirement in 1895, the Library of the Surgeon General would further expand to 116,000 volumes; it would ultimately become the National Library of Medicine, the greatest medical library in the world.

The new thinking in hospital construction would, for the first time, incorporate public health concerns into the design. To prevent the spread of disease, patients were separated from one another. Those with contagious diseases were isolated in quarantine quarters. Adequate ventilation, clean water, and sanitation were provided throughout the hospital. However, these steps were based on the erroneous theory of the presence of a miasma, or pollution of the air by some sort of putrefaction, which was believed to be responsible for everything
from cholera to the black plague. As measures to improve environmental cleanliness decreased the prevalence of disease, supporters of the theory gained strength. There was something bad in the air, and proper ventilation and adequate private space could avoid it.

The true bacterial origins for disease were not yet proven, and methods of person-to-person transmission of disease remained unclear. Though ambient air was rarely responsible for disease, and certainly not without the presence of microorganisms, cleanliness, separation of individuals, and sanitation had been shown to stem the growth of epidemic disease. Billings, believing in the theory of contaminated air, did not incorporate elevators for fear of contamination through the shafts. Others had moved on. The New York Hospital, erected in 1877, was built to a full six elevated stories, no longer adhering to the same, unproven, principles. The Billings plan consisted of a main building from which branched separate, two-story wards, or pavilions, surrounded by a number of outbuildings. Covered outdoor walkways connected the buildings and all stairways were outdoors. Patients admitted to the pavilions were carried up the external stairs. Amenities of the new hospital included central heating, hot water, fresh cold water, adequate ventilation, and electric lighting. The complex consisted of 17 buildings, including an isolation building, a pharmacy, a bathhouse, a nurses’ dormitory, the pathological, and the four primary ward buildings. The large main building from which the pavilions flowed was topped by a stately dome, which was later renamed to honor its designer. Billings’s careful renderings of the Queen Anne–style buildings were not actual architectural elevations, and the Boston firm of Cabot and Chandler was contracted to provide working drawings.

The $3.5 million willed to the hospital was made up primarily of Hopkins’s commercial real estate and his bank stocks. These proved to be stable but yielded only about $125,000 annually, hardly enough to move full steam ahead. Forbidden to augment this sum by invading the principal or borrowing to finance construction, the process,
dependent entirely on the available funds, was painfully slow. Construction was finally completed in 1889 at a total cost of $2,050,000.

It was necessary for the men chosen to lead the hospital departments to be in residence by the time the hospital opened. They would be professors at the university and the medical school, and would command all aspects of their respective departments. This was a revolutionary concept. Elsewhere, medical school faculties were made up of local practitioners not employed by the university. For the new plan to work, they would have to enlist the very best men possible. These individuals would have to share the devotion to excellence, be willing to adapt and innovate, and be substantive enough to add weight to the new endeavor. To accomplish this task, Francis King, president of the hospital board of trustees, and Daniel Coit Gilman, president of the university, turned once again to John Shaw Billings. Billings traveled widely and was very well connected in medical circles. During the early stages of hospital construction, he was busily acquainting himself with both the laboratory-centric German model and the clinically based British model. Billings thought the two systems could be joined and that the result would be superior to all others, and he set out to find professors who shared his views.