William Stewart Halsted, the most influential surgeon in American medical history, is also one of the most enigmatic and tragic. His surgical innovations include the modern anesthesia record, the use of surgical gloves,and new operations for breast cancer, hernia repair, and thyroid disease.
In addition to these towering achievements, William Stewart Halsted also championed the philosophy that tissues must be handled with meticulous care during operations and large blood loss was to be avoided above all else.
Halsted also implemented the structure of the modern surgical residency in the United States by requiring medical graduates who wanted to practice surgery to spend long years of service on the hospital wards acquiring ever increasing amounts of autonomy and responsibility (a startling departure from the practices of the day).
But, despite the huge impact William Stewart Halsted had on the field of surgery and the honors and accolades bestowed on him, his life was largely one of loneliness and personal struggle.
Halsted was born in 1852 in New York into comfortable and relatively cultured circumstances. Educated at Yale and Columbia Universities, he was a lively, vivacious youth and young man with much zest for life. After finishing his education and medical training he began a private practice of surgery in New York. Although he developed a reputation for his willingness to take surgical risks and his daring research, he never developed a large surgical practice.
It was at this time that the seminal episode in his life occurred. Drawn to medical experimentation, he began studies in the field of anesthesia – cocaine anesthesia. Apparently unaware of the dangers of this powerful and interesting drug, William Stewart Â Halsted and three of his young colleagues used themselves as experimental subjects.
The consequences were, of course, disastrous. Halsted, alone of the four, was able to at least partially escape the ravages of addiction. His rescue was due to the efforts of his friend and mentor, William Welch, a staff member at the newly formed and highly ambitious Johns Hopkins Hospital. Welch saw to it that Halsted was sent to a sanitorium to break his addiction, and after an interval of supposed abstinence, he brought Halsted to Hopkins to work in his laboratory.
Halsted eventually rose to the position of professor and chief of surgery at Hopkins and was immortalized by the painter John Singer Sargent (along with Welch, William Osler and Howard Kelly) as one of Hopkins’ Four Great Physicians. Although he was instrumental in building Hopkins into the most prestigious medical institution in the world, Halsted was a damaged and changed man.
Despite constant struggle he never conquered his opiate addiction and secretly substituted morphine for cocaine until his death. Although generally admired, he was shy and aloof and shunned social and professional contact. He was not able to easily communicate his considerable surgical knowledge and he operated only infrequently.
In fact,William Stewart Halsted rarely made ward rounds and tended to get bogged down and distracted while doing so, causing great distress to the medical students forced to stand for hours while he indulged in philosophical musings.
Toward the end of his career he sought refuge almost exclusively in his animal laboratory. Married but childless, William Stewart Halsted died in 1922 and spent the last years of his life in increasing solitude on his country farm.
December 21, 2005
Disclosure: the author of this article completed a surgical fellowship interacting with the William Stewart Halsted surgical service at the Johns Hopkins Hospital