Sunday, February 21, 2010
Genius On The Edge is a Great Read
I am one who loves medical history and Genius On The Edge - the bizarre double life of Dr. William Stewart Halsted, was a captivating read. For those who don't know, Dr. Halsted is known as the "Father of Surgery" and practiced medicine after the civil war. Written by author physician, Dr. Gerald Imber, the medical facts are sound and the story is fascinating for any reader.
We learn that in 1850 there was no anesthesia, no knowledge of germs, no IVs or blood transfusions and no more than 200 surgeries a year were performed because the outcomes were usually disastrous. The patient who needed emergency surgery died of overwhelming infection, gangrene or shock from blood loss.
Dr. William Halsted, like all physicians of that time, was born into wealth and privilege. He began his training in 1875, ten years after Louis Pasteur showed sour milk was caused by a bacteria and when Robert Koch was able to cultivate the anthrax bacillus. At a time when surgeons were not washing their hands and were operating in dirty clothes, the concept of antisepsis was a critical advance that Dr. Halsted seized for his own training. Medical Schools were for-profit trade schools and no laboratory or clinical work was required but like many wealthy young physicians, he traveled to Europe to study the newest techniques.
In early 1884 Sigmund Freud began experiments with an exciting new drug called cocaine. William Halsted saw its possibilities as an anesthetic and began injecting it into himself and patients. It was a successful anesthetic but he became powerfully addicted. He turned to morphine (the other widely available drug of the time) and ended up with a dual addiction that he hid and struggled with until he died in 1922.
In telling the amazing story of Dr. William Halsted, the author takes the reader through the beginning of modern medicine. It is the story of Johns Hopkins University and Medical Center and the story of the great names of medicine...Dr. Osler, Dr. Cushing, Dr. Welch and Dr. Kelly. We see how the specialties of gynecology, pathology, medicine and neurosurgery were born. These early physicians were men of great curiosity and innovation but they were also aristocrats that lived a life of privilege.
Dr William Halsted took a 5 month vacation every year and when he was working he actually avoided surgery unless it was an "interesting case" that he could learn from. He much preferred the lab where he could work privately on experiments and technique. Despite being arrogant, aloof and detached, patients flocked to his hospital because he performed successful surgery for hernia, mastectomy, thyroid and aneurysms at a time when they were not being attempted. His infection rates were close to zero before antibiotics due to his meticulous habits and rules in the OR. The surgeons that trained under him also adopted these habits and went on to spread the "Halsted Surgery Method" across the country.
I couldn't put Genius On the Edge down. Here was a man who transformed medicine but was so personally flawed with addiction and a bizarre marriage. (I believe he may have been homosexual). He was so meticulous, he sent his linen shirts to Europe to be laundered and always wore a top hat. He often forgot the patients on the wards that were waiting weeks for surgery. He actually didn't like patients very much, nor did the other professors, with the exception of Dr. William Osler, who spent most of his time with patients and teaching residents.
So much of medical training as we know it today, stemmed from the "modern" medical school that was developed at Johns Hopkins. The controversy between faculty being on salary versus having to "earn" their income from patient care and research carries over even until today. I was also interested that the salary of $10,000/year paid to the professors is equivalent to about $300K today. In addition they saw private patients and seemed to have a great deal of leisure time to smoke cigarettes, join special men's clubs and travel to Europe.
Genius on the Edge is a portrait of a brilliant, drug addicted surgeon who transformed medicine and ushered in the 20th century. The descriptions of hospitals, training, surgical technique and bizarre beliefs makes this a fascinating true story.
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