GENIUSON THE

EDGE
The Bizarre Double Life of
Dr. William Stewart Halsted

GERALD IMBER, MD
This publication is designed to provide accurate and authoritative information
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© 2010 Gerald Imber, MD

Published by Kaplan Publishing, a division of Kaplan, Inc.

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10 9 8 7 6 5 4 3 2 1

Photographs reprinted with permission of the Alan Mason Chesney Archives

of The Johns Hopkins Medical Institutions.

Library of Congress Cataloging-in-Publication Data

Imber, Gerald.
Genius on the edge : the bizarre story of William Stewart Halsted, the father
of modern surgery / by Gerald Imber.
p. ; cm.
ISBN-13: 978-1-60714-627-8
ISBN-10: 1-60714-627-4
1. Halsted, William, 1852-1922. 2. Surgeons—United States—Biography. I. Title.
[DNLM: 1. Halsted, William, 1852-1922. 2. Physicians. 3. Biography.
4. General Surgery—history. 5. History, 19th Century. 6. History, 20th Century.
WZ 100 H1962I 2010]
RD27.35.H36I43 2010
617.092—dc22
[B]
2009035525

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 “Surgery would be delightful
if you did not have to operate.”
W. S. Halsted
Contents

Prologue ix

One Tumultuous Times 1

Two Setting the Stage 9
Three Physicians and Surgeons 21
Four Becoming a Surgeon 29
Five New York 37
Six Cocaine 47
Seven The Visionary 59
Eight The Very Best Men 75
Nine Baltimore 85
Ten The Hospital on the Hill 95
Eleven Finding the Way 101
Twelve William Osler 105
Thirteen The Operating Room 111
Fourteen The Radical Cure of Breast Cancer 117
Fifteen Life in Baltimore 127
Sixteen The Big Four 139
Seventeen Hernia 145
Eighteen Establishing the Routine 155
 Nineteen Country Squire 167
Twenty The First Great Medical School 183
Twenty-one Teaching without Teaching 189
Twenty-two Residents 193
Twenty-three Changes 205
Twenty-four Into the 20th Century 221
Twenty-five Harvey Cushing 229
Twenty-six All Quiet on the Home Front 247
Twenty-seven After Cushing 257
Twenty-eight New Horizons 267
Twenty-nine Addiction 277
Thirty Vascular Surgery 283
Thirty-one Scientist 287
Thirty-two A New Paradigm 297
Thirty-three A New Era 307
Thirty-four The World Changes 321
Thirty-five “My Dear Miss Bessie” 331
Thirty-six The Final Illness 341
Thirty-seven Afterward 345

Epilogue 353
Acknowledgments 357
References 359
Index 375
About the Author 389
Prologue

A PRIL 1882.
Fresh, white sheets were brought down from the linen cupboard
and laid over the kitchen table. A down pillow was placed under the
head of the jaundiced 70-year-old woman. She was febrile, nause-
ated, crippled with abdominal and back pain, and clearly in extremis.
Dr. William Stewart Halsted carefully examined his patient, working
his way to an inflamed mass on the right side of her abdomen just
beneath the rib cage. Pressing his fingers against it, he caused the
woman to jerk away and cry out.
For more than a year, she had complained of a sour taste in
her mouth, loss of appetite, and episodes of sharp pain penetrating
through to her back, symptoms that confounded the finest consul-
tants in New York City. Now, while the woman was visiting with her
daughter in Albany, the pain had become unrelenting. The onset of
high fever; rapid, shallow breathing; and the yellow cast of her eyes
made those attending her fear for her life. A telegram had been sent
summoning Dr. Halsted, who arrived by train from New York late
that same evening.
By 2 a.m. the septic patient was on the kitchen table and prepared
for surgery. What had been an elusive diagnosis was now clear: acute
cholecystitis (an infection of the gallbladder); empyema (a collection
of pus in the distended gallbladder); and gallstones, which blocked
the egress of the bile and pus. Halsted realized that nothing short
of emergency surgery could save the patient’s life.

ix
 Prologue

THE INSTRUMENTS HE brought with him were boiled and dipped

in carbolic acid. He rolled his coat sleeves above his wrists, washed
his hands with green soap, dipped them in the carbolic acid, and
approached the patient, who was now breathing ether fumes and
unaware of the impending surgery. With a scalpel in his bare hands,
he cut through the tense skin and subcutaneous fat above the hot
mass, then swiftly through rectus abdominus muscle and the perito-
neum lining the abdomen, exposing the enlarged, pus-filled gallblad-
der. Halsted incised the inflamed organ, releasing a flood of purulent
material and seven gallstones. He clamped the bleeding points with
artery forceps and tied them off with fine silk ligatures. He closed the
peritoneum and re-approximated the abdominal muscles. The skin,
and the fat beneath it, were left open and packed with cotton gauze.

RELEASING THE ACCUMULATION of pus and removing the gallstones

effectively relieved the acute problem. The patient recovered unevent-
fully and was symptom free for the remaining two years of her life.
William Stewart Halsted had successfully performed the first known
operation to remove gallstones, and in the process had brought his
mother back from the brink of death.

x
Chapter One

Tumultuous Times

W ILLIAM STEWART HALSTED WAS born in New York City on

April 23, 1852, in the decade of booming mercantile prosper-
ity and civic unrest preceding the Civil War. Immigrants seeking to
escape famine and poverty in their native lands poured into the city
at an astounding rate, often as many as 250,000 in a single year. The
new arrivals, then largely Irish, supplanted free blacks as an inex-
pensive labor source, and the slums were soon overrun. Only half the
children born in the entire country would live to the age of five. More
New Yorkers were dying from disease each year than were being born.
Two cholera epidemics in the 1830s and 1840s had claimed thousands
of lives, while earlier outbreaks of malaria and yellow fever had taken
many more. Within the filthy slums, especially the notorious Five Points
neighborhood, about which Charles Dickens said, “All that is loathsome,
drooping and decayed is here,” the death rate was three times that of the
rest of the city. Without the new immigrants, the population of the city
would have been decimated. With them, the city was almost unlivable.
Tuberculosis was rampant. It was a scourge of greater proportions
than AIDS, influenza, and polio combined, and had run unchecked for
centuries, killing hundreds of millions of people worldwide. The disease
was not limited to the lung infection, or consumption, immortalized

1
 GENIUS on the EDGE

in literature by Dumas’s Marguerite in Camille, and later Violetta in

Verdi’s La Traviata. It was a generalized condition that also produced
draining scrofulous abscesses of the lymph glands of the neck and
axilla, and bone infections necessitating amputation. Little could be
done other than drain the tumors and remove the festering parts.
Rich and poor lived in close contact, and resentment and unrest
were everywhere. Riots in the first half of the century were common
and usually reflected class and ethnic hostilities. Among these were
the deadly Astor Place Riot in 1849 and the Klein Deutschland Riot of
1857. Earlier riots had erupted between Catholic and Protestant street
gangs, and several were prompted by the city’s efforts to remove some
20,000 feral pigs from city streets.
As mid-century approached, the gentry abandoned lower Man-
hattan and moved “uptown” to the wide-open spaces of Greenwich
Village. Among them were the prosperous Halsteds.
By mid-century, 14th Street had become the epicenter of society.
Broadway was the busiest shopping corridor in the world, and 200,000
horses plied the city streets, pulling stagecoaches, buses, delivery wag-
ons, and cabs. Sanitation was nonexistent and health hazards were
overwhelming. Each horse produced more than 15 pounds of manure
daily, and there was no organized system for its disposal. Manure piles
were everywhere, seeping into street-level rooms in heavy rain, drying
in fly-infested piles in summer. Each year, 20,000 horse carcasses were
dragged from city streets to the pier on West 38th Street to be shipped
to rendering plants in Barren Island, Brooklyn, where the bones were
turned into glue. New “brownstone” homes were built with high entry
stairs to avoid the ubiquitous manure.
Human excrement was also a problem. There was no municipal
sewer system, although more affluent neighborhoods could petition
for the construction of sewers and share the cost among the residents.
Elsewhere, chamber pots were still emptied from tenement windows
into the street. Women used parasols to protect themselves and their

2
 Tumultuous Times

finery from flying excrement. The exodus uptown provided some relief,
but it wouldn’t be until after the turn of the next century that electric
buses and the automobile supplanted horses and eased the situation.
In the late 1830s, a professor of art at the University of the City
of New York named Samuel F. B. Morse designed the first operable
telegraph. Less than a decade later, private telegraph companies
turned New York into a communications hub with lines connecting
the nation. Financial institutions relished the quick transfer of infor-
mation available in Manhattan, and the industry found a permanent
home in the growing financial district around Wall Street.
By 1860, there were 30,000 miles of railroad track connecting the
country. As railroads expanded westward, a key link opened along the
route of the Erie Canal connecting the Great Lakes and the Atlantic
Ocean. Manufacturing and transportation prospered. The Croton Dis-
tributing Reservoir was built far uptown, at 42nd Street and Fifth Ave-
nue. A massive structure on a four-acre site, which is now home to the
main branch of the New York Public Library, the reservoir held 150 mil-
lion gallons of pure upstate water for the thirsty, growing city. Nearby,
the Crystal Palace, a monumental exposition hall of cast iron and glass,
was opened in the summer of 1853 to house the first World’s Fair in
America. Music and entertainment venues sprouted all over town. The
city was in thrall to Jenny Lind, the “Swedish Nightingale,” who was on
a two-year tour promoted by P. T. Barnum. Tickets to her performances
sold for as much as $650 at auction. Stephen Foster’s popular songs,
such as “Oh Susanna!” and “Camptown Races,” were perennial favorites.
Some, such as “My Old Kentucky Home, Good-night,” stirred sympathy
for the plight of America’s slaves even as most northern blacks, while
free, had achieved nothing close to equality.
The Halsted family had lived in and around New York City since
the 1657 arrival of the Englishman Timothy Halsted in Hempstead,
Long Island. By the mid-18th century the next generation of Halsteds
had moved to Elizabethtown, New Jersey, where Robert and Caleb,

3
 GENIUS on the EDGE

the first physicians in the family, were born. Robert’s son, William
Mills Halsted, did not follow his father’s calling and instead, with a
partner, R. T. Haines, founded Halsted, Haines and Company, deal-
ing in the wholesale importation and sale of dry goods. The firm
was immediately successful, and the family was soon entrenched in
the prosperous mercantile society of the city. William Mills Halsted
became an elder in the University Place Presbyterian Church, a gov-
ernor of the New York Hospital, which was then located at Broadway
and Pearl Street, and a founder of the Union Theological Seminary. He
also invested heavily in the rapid development of Chicago; the longest
thoroughfare in that city is still called Halsted Street.
The family fortune grew, and in 1835 William Mills Halsted built a
large, finely appointed home on the northwest corner of Fifth Avenue at
14th Street, soon adding three adjoining houses for his children. He was
a picture of Presbyterian rectitude, constantly preaching to his children.
One of his children, Thaddeus, became a physician. To another, William
Mills Halsted Jr., then away at school, he wrote, “endeavor my son to
qualify yourself in usefulness and responsibility.” Young William learned
his lessons and succeeded his father at the helm of Halsted, Haines
and Company. He was a founder of the Commonwealth Fire Insurance
Company, joined the board of governors of the New York Hospital and
Bloomingdale Asylum, the board of the College of the City of New York,
and the board of the College of Physicians and Surgeons. William Mills
Halsted Jr. married his cousin Mary Louisa Haines, and together they
raised a family in New York City, summered at Irvington, 25 miles north
along the Hudson River, and were pillars of the community.
Frugal and strict, William Mills Halsted Jr. adhered closely to his
father’s Presbyterian ethic and demanded the same of his four chil-
dren. Though he provided well for his children, he forbade them to
bring friends to their home for meals. When his youngest son, Richard,
disobeyed this rule, he presented Richard and his friends with a
detailed bill for the food they consumed.

4
 Tumultuous Times

William Stewart Halsted was the eldest of the four children. Until
the age of ten he was homeschooled by governesses, then a common
practice among the affluent. Public education in New York City was
inadequate, and those of means sent their older children to the numer-
ous private institutions throughout New England, most of which had
close church ties.
The Halsted family remained seemingly untouched by the Civil
War raging in the South. In the summer of 1862, just a few months
after the Battle of Shiloh claimed the lives of 24,000 Union and Con-
federate troops, William Stewart was sent off far from the fray, to a
school at Monson, Massachusetts, run by a retired Congregational
minister, the Reverend Mr. Tufts.
It was an unpleasant experience, and Halsted later wrote:

There were about twenty boys in the school, all much older
than I. I can recall very little of the method of instruction, but
I must have studied Latin for I was given the choice of learn-
ing a lesson in Latin grammar or stirring soft soap in a great
cauldron on Saturday afternoon when I was kept at home for
misdemeanor, usually for swimming in the river. Sunday was a
nightmare: we were driven to church two miles away and spent
the entire day in the churchyard — Sunday school from nine
to ten or ten-thirty, church until 1 p.m. luncheon from basket,
Sunday school again at 3 p.m. and church say from four to five-
thirty. In the spring of 1863 I attempted to escape, walked to
Palmer, four miles, took train to Springfield twenty miles; was
captured at Springfield and taken back to Monson.

In July 1863, the Draft Riots, the bloodiest riots in American his-
tory, were ignited at a conscription office on 47th Street and Third
Avenue when poor Irish protested a new law that allowed anyone to
buy their way out of military service for $300. The violence soon took

5
 GENIUS on the EDGE

on racial overtones, and many blacks were targeted and hanged. Over
five days the mayhem claimed as many as 1,000 lives.
That fall, young Halsted, kept safe from all of this, was enrolled
at Phillips Academy, a preparatory school in Andover, Massachusetts,
north of Boston. The school, founded in 1778 by Samuel Phillips, is more
commonly known as Andover, distinguishing it from its rival Phillips
Exeter Academy, in Exeter, New Hampshire, founded three years later
by another family member, Dr. John Phillips. The Phillips Academy,
Andover, is rich with American history. Its great seal was designed by
the silversmith Paul Revere. Two of its many distinguished graduates
were telegraph inventor Samuel F. B. Morse and U.S. Supreme Court
Justice Oliver Wendell Holmes. From its earliest days, Andover estab-
lished a tradition of preparing its young men for enrollment at Yale.
In 1868, of a senior class of 40 students, 25 went on to continue their
studies in New Haven.
Even at this early stage of his life, Halsted was careful about his
dress and always well turned out. A photograph from the period shows
a good-looking young man in suit, waistcoat, and matching cravat— his
blond hairline already rather high on his forehead, and prominent patri-
cian nose turned up at a fairly high angle over a wide, smiling mouth
and full lower lip. His ears stood smartly away from his head, a feature
about which he was often teased. Later in life he defused comments by
joking about his ears before others could call attention to them. Barely
five feet six inches tall, Halsted was solidly built, with a surprisingly
muscular upper body and a tendency to walk with his elbows out.
Not yet 17 years old at graduation in 1869, and thought too
young to enter college, he was enrolled in a private day school in
Manhattan and tutored privately in Latin and Greek prior to college
entrance exams. Halsted was admitted “without condition” to Yale,
along with numerous of his Andover classmates. At Yale, “[I] devoted
myself solely to athletics,” and his grades were in no way equal to
his athletic achievements. Andover boys were well prepared for the

6
 Tumultuous Times

first few semesters at Yale, and it set them off with a relaxed attitude
toward college education.
Athletics remained central to his life. He joined the junior and
senior class crews, was shortstop on the junior class baseball team, and
in his senior year served as captain of the football team. This was the
first year of modern, 11-man football in college athletics. The 160-pound
Halsted also knocked his friend Sam Bushnell flat in a boxing match.
There is no record of Halsted ever having borrowed a book from
the Yale library.
The class at Yale was organized into four academic divisions
based on performance. Halsted spent most of his lackluster tenure
in the second and third divisions, although classmates believed he
could easily have been in the first had he cared. Finally convinced
to apply himself to his studies, he worked hard and did well on mid-
term exams. He abandoned the second division and assumed what he
believed to be his rightful place attending first-division classes. Not
finding himself registered among the division-one students, his irate
inquiry was met by an instructor informing him he had been placed in
the third division. The lesson that a perception once formed is difficult
to alter was one he learned well.
Notably well dressed at Yale as he had been at Andover, Halsted
and a friend paraded around campus for a time in tailor-made suits of
mattress ticking. Sam Bushnell believed the outrageous fashion state-
ment was clearly a Halsted prank, but “he did not have the courage to
carry out his idea alone.”
Halsted was a member of a number of college clubs including the
Freshman Society, Freshman Eating Club, The Tasters, The Sopho-
more Society, Phi Theta Psi, the Junior Society, and Psi Epsilon. But
only inclusion in the elite senior society, Skull and Bones, mattered
to him. His father had been a member and had aggressively pushed
his son to seek election. The society seemed so important to him that
Bushnell offered to decline election if his friend was excluded, but

7
 GENIUS on the EDGE

Halsted refused: “If you get an election, you take it; if I get an election
I shall take it. I shall expect you to do the same by me.”
In the end, he was not tapped for the society. The rejection was all
the more devastating since his “Bonesman” father did not take it well,
saying to Bushnell, “Why didn’t you get him into Skull and Bones?
You made it.”
Halsted acted in plays, “did not go in for social activities,” and did
not drink. There is no mention of girls in any of Halsted’s letters or
reminiscences, or in the comments of friends. He continued to attend
church regularly while at school but was increasingly dismissive of
the strict religious fervor of his parents. The trip to New York was
fast and convenient on the New Haven Railroad, and he came home
frequently during the school year. He visited with the families of col-
lege friends and made several trips to Baltimore with his friend Henry
James, son of a leading local financier. Summers were spent at the
family home at Irvington, in the lower Hudson Valley, and the four
children remained close with their parents and one another. Several of
the family members were avid gardeners, and this became a passion
that William Stewart shared as well.
In a totally uncharacteristic act early in his senior year, the
unscholarly Halsted purchased copies of Gray’s Anatomy and Dalton’s
Physiology. He had shown no interest in science previously, but now
immersed himself in the reading. He spent his free time around the
laboratories and clinics at the Yale medical school, asking questions of
anyone who would speak to him. As his time at Yale came to a close,
young Halsted told his father that he was not interested in joining the
family business but would like to study medicine. It was a decision
that would change the face of modern medicine.