The title of "Genius on the Edge: The Bizarre Double Life of Dr. William Stewart Halsted" suggests that Johns Hopkins' renowned first chief of surgery lived a hidden and unsavory existence in roughly the Jekyll-and-Hyde time frame. (Halsted was born in 1852, and died in 1922; Robert Louis Stevenson published his novel in 1886.)
Actually, Dr. Gerald Imber's unpredictable and unflappable biography, an intrigue-filled life story that's also a sweeping pop medical history, depicts an individual who was two different kinds of good - make that, great - doctor.
Young Halsted was a surgical virtuoso in New York City. But he became addicted to cocaine while experimenting with the drug as an anesthetic. He hoped morphine would enable him to get off cocaine. Instead, Imber writes, he "lived with a 35-year morphine habit and ... was never fully free of cocaine."
Later, a more somber and reflective Halsted helped establish Johns Hopkins Hospital and the university's school of medicine as world-class institutions, with a trio of equally brilliant doctors who tolerated his absences, bad spells and idiosyncrasies. If he didn't conquer his addiction, he transcended it. Imber writes, "Visiting colleagues who had known Halsted as one of the fastest, slickest surgeons in New York City were amazed by the transformation. In Baltimore, he had become a thinking surgeon who sacrificed speed and style for scrupulous care and anatomical integrity."
Alongside doctors William Henry Welch, Howard A. Kelly and William Osler, Halsted became one of the Hopkins "Big Four" - a group that revolutionized hospital and medical school standards and protocols, turning Baltimore into a center of medical progress. Halsted was personally responsible for innovations in many critical procedures, including hernia repair and radical mastectomy.
He still spent prolonged, solitary vacations in Europe relieving his hunger for cocaine. But in Welch, he found a loyal protector and confidant. "The pattern was established," Imber writes. "Halsted isolated and far from home, indulging his habit, confessing to Welch, and then dosing himself with morphine and resuming life as usual in Baltimore."
Nothing was conventional about "life as usual" in Baltimore. One of Halsted's most celebrated residents, Harvey Cushing, described the famous doctor's mansion at 1201 Eutaw Place as "a great, magnificent, cold stone house, full of rare old furniture, clocks, pictures and whatnot in topsy turvy condition, cold as a stone and most unlivable." Although Cushing was not a sympathetic witness, most agree that the convivial Halsted of Manhattan had become inscrutable in Baltimore.
Yet he left his mark all over Hopkins, from a seat in the medical school (the William Stewart Halsted Professorship of Surgery) to the Halsted Building in the hospital. The Department of Surgery boasts a modest William Halsted Museum, with artifacts including an example of the earliest surgical gloves.
It was Halsted's status as a medical visionary, not his mysterious bifurcated existence, that inspired the biography by Imber, a New York plastic surgeon.
For Imber, the real story "was that Halsted operated at a time when all these things that I took for granted as a surgeon 50 years later didn't exist. It was inconceivable to me that before Halsted no one had ever removed a gallstone, or that surgeons weren't routinely wearing gloves. It was hard to believe that sterility in the operating room was an issue right into the 20th century."
According to Imber, Halsted was part of the medical avant-garde inside and outside the operating room. He instituted a structured surgical residency and developed the science of experimental surgery. "Before Halsted, someone would think of an operation, try it in the operating room, and if the patient lived, do it again and if a couple of patients died, do something else. He insisted everything be done scientifically, in the dog lab, proven with animals, before it had any place in the operating room. That is a phenomenal leap from trial and error to science."
Imber first got wind of Halsted's legacy as it was discussed and dissected by other doctors.
"The stories I heard were always the funny stories," Imber says. "How Halsted would forget somebody in the wards for weeks and never show up to do the surgery. Or how, when he did do the surgery, his meticulous nature made each operation seem slow, though in reality he was as fast as most people are now. His contemporaries were comparing him to the 'slash and dash' surgeons who had been the norm before that. They would do their operations and run."