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| The John Hopkins Hospital |
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| John Hopkins |
Johns Hopkins born in 1795, an entrepreneur
and philanthropist was one of the richest Americans of his time. In 1889 Johns
Hopkins donated this huge hospital and the university to Baltimore and it was
to be called The Johns Hopkins Hospital “the greatest gift to mankind”. Dr.
Welch was a trustee. Welch had already established himself as a great
pathologist. He was a friend of Dr. John. S. Billings who had been librarian of
the Surgeon General’s Office and was now chairman of the board of trustees of
the Johns Hopkins Hospital.
Welch had suggested to Billings that William
Halsted was the right man for the chair of surgery in spite of his recent
addiction to Cocaine which he had got over. He was appointed to this
prestigious position. Besides Welch there were on the team William Osler now
called the father of modern medicine and Kelly a man who had blazed a trail in
gynecology. So it was Osler, Welch, Kelly and Halsted who formed the nucleus of
this great team, an institution that would break all barriers in medical
science. No more did people talk only of Berlin and Vienna but they spoke in
the same breath of The Johns Hopkins and the Mayo clinic. American medicine had
come into its own.
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| William Halsted |
What was William Halsted’s background before
he joined the Johns Hopkins in 1889. He ardently believed in the work of
Pasteur, Koch and Semmelweis, and Lister’s application of the antiseptic theory
and applied it to his work in New York where he had already established himself
as a surgeon of repute. In 1882 he was the first surgeon to do a
cholecystectomy and that too on his mother. Halsted was also the first to give his
own blood to his sister who was dying of postpartum hemorrhage, and this was
before Landsteiner had discovered the blood groups. His sister lived, they must
have been of the same group or Halsted must have been group ‘O’. He was also
the first to device an ingenious method of treating carbon monoxide poisoning.
He drew blood from the patient in a citrate solution in an open container and
then shook the flask to oxygenate it and injected it back into the patient. His
patients lived.
Then tragedy struck Halsted. He had heard of
Karl Koller an ophthalmologist’s work on Cocaine- he was removing cataracts
painlessly under a local drop of Cocaine in the eye. This was actually
suggested to Koller by a paper published by his friend Sigmund Freud, Halsted
always the scientist and experimenter began to experiment on himself and some
of his pupils. He performed major surgery by using Cocaine as nerve blocks. He
also found that he under Cocaine had developed tremendous energy and capacity
for work without any fatigue. Then one tragic day as he picked up his knife to
operate he found that his hand was shacking. He was shocked, looked around
amazed, handed the knife to his assistant and had to be helped out of the
theater. That night was the darkest night in William Halsted’s life this great
surgeon with a remarkable future had become a physical and mental wreck. Welch
who was following Halsted’s career closely and believed that the man had a
great future came to his rescue. He institutionalized him, opium was used in small
doses to get him off cocaine. But unfortunately he got hooked on to opium so it
was from the frying pan into the fire. It took a long time to get this man back
to work.
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| Portrait of 'the big four' at Hopkins - Drs. Welsh, Osler, Halsted and Kelly from the medical archives of the John Hopkins Medical Institute. |
It was then that he took on the chair of
surgery at The Johns Hopkins and accepted Billing’s offer prompted by Welch.
This he did with great hesitation for he was not sure of himself. Prior to this
he had spent a lot of time while recuperating in Welch’s laboratory where he
had ample opportunity to study both anatomy and pathology in the cadaver. Cocaine had changed his personality
and this fast, bold and rather traumatic surgeon became slow and meticulous. He
devised new and systematic operations- one of the examples was his work on
Cancer of the Breast. Kelly said of him, half in joke, that William Halsted is
the only surgeon whose upper incision healed before he has come to the lower
part. From Halsted’s cocaine addiction came the three principles of good
surgery, reverence for tissue, elimination of dead space, and complete hemostasis.
Halsted fell in love with his theater sister
Caroline Hampton and married her. Caroline was a remarkable woman and supported
Halsted in his work, she developed an allergy to carbolic and Halsted had the
Leyland rubber company make surgical gloves for her, which later became part of
the ritual for the exercise of aseptic surgery and every surgeon began to wear
sterile rubber gloves. At about this time Johns Hopkins decided to appoint an
Urologist under Halsted. By now The Johns Hopkins had become a famed center and
hoary professors of surgery applied for the post from all over Europe and
America. Osler, Welch, Kelly and Halsted were on the selection committee.
During the interview Halsted kept falling asleep and the others would wake him
up saying “William this is going to be your decision. Wake up and listen” and
Halsted would say “I am listening, I am listening”. At the end of the three
days they asked him, “William who is your choice?” Back came the answer like a
bolt from the blue. “why who else but young Hugh” the pun was on the word
young. The others almost jumped out of their seats and they asked “what does
Hugh Young know about uro surgery?” Nothing replied Halsted but what do those
old fogies that we have heard know about the subject? “This man has a clean
incisive virgin mind you appoint him and you take my word he will blaze a trail
and one day Johns Hopkins will be proud of him”... They appointed him, Halsted
was right, you open any chapter on genito urinary surgery and Hugh Young has
made a contribution. Today he is remembered for his radical perineal
prostatectomy for cancer of the prostate.
Halsted was not only a great surgeon but he
was a great teacher of surgery. He collected in his unit at one time men like
Harvey Cushing who pioneered neuro surgery, Bloodgood, who made monumental
contribution to breast pathology, Foley of Foleys catheter fame, Finney, who
did the first pyloroplasty and revolutionized gastric surgery, Mitchell who
devised his clips and Hugh Young who pioneered uro surgery and above them all
was Osler the father of modern medicine, Welch a great pathologist and Kelly
who was a master of gynecological surgery.
In 1918 Halstead recognized that he had like
his mother gall stones and that he would require a surgery of which he was a
pioneer. One of his assistant Dr. Foley operated on him. The recovery was slow
and he was never the same man again. He said to Caroline one day “I can still
think, I can read & write and talk. When I can’t do any of these things, it
will be time to quit.” Papers on the thyroid, on arteries, aneurysms and cancer
poured from his pen. He spoke occasionally at meetings.
On an August morning he quietly told Caroline
to phone up the hospital in Baltimore and have a surgeon ready to operate “It
is my old enemy again Caroline. Dr. Reid was to operate. “Be sure that the
drainage is done through the cystic duct, this might be my last experiment”.
There was a faint smile on his face as he went under. A large stone was removed
from the common bile duct. In early September Halsted developed Pneumonia. His
old friend and mentor Sir William Osler had called Pneumonia “the old man’s
friend”. On September the 7th William
Halstead died. A postmortem was conducted according to his request. The cause
of death was pneumonia, pleurisy and advanced atherosclerosis. There was no
peritonitis, the drainage through the cystic duct had been perfect. William
Halstead’s “last experiment” as he called it was a success.
The next day the Baltimore Sun carried an
editorial the rest of the page was left blank and this is what it
said:-“Because Dr. William S. Halsted
lived, the world is a better, a safer, a happier place in which to be. In his
death, not only Baltimore, but civilization everywhere has sustained a heavy
loss. He was one of the few men who really did count. Quiet, simple,
un-ostentatious except in the medical world, where he towered, a great and
dominating figure, the full scope of his genius and the tremendous extent and
value of his service to mankind were neither generally known nor generally
appreciated. To the Johns Hopkins hospital, the institution to whose reputation
and up building he had so enormously contributed, his death is a staggering
blow. Along with Osler and Welch he laid the foundation upon which Hopkins so solidly rests today.
I am posting some pictures of these great men
all from the Johns Hopkins and all at the same time. I have always been
fascinated by this story and would like to share it with you.
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