Gerald Imber - Genius on the Edge: The Bizarre Double Life of Dr. William Stewart Halsted

GENIUS
ON THE
EDGE

The Bizarre Double Life of
Dr. William Stewart Halsted

GERALD IMBER, MD

PUBLISHING
New York

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2010 Gerald Imber, MD

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e-ISBN: 978-1-60714-880-7

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Surgery would be delightful
if you did not have to operate.
W. S. HALSTED

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, nauseated, 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 consultants 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 patients life.

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 peritoneum lining the abdomen, exposing the enlarged, pus-filled gallbladder. 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 uneventfully 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.

W ILLIAM STEWART HALSTED WAS born in New York City on April 23, 1852, in the decade of booming mercantile prosperity 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 inexpensive 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 in literature by Dumass Marguerite in Camille, and later Violetta in Verdis 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 citys efforts to remove some 20,000 feral pigs from city streets.

As mid-century approached, the gentry abandoned lower Manhattan 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 wagons, 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.