Halsted, William Stewart

Halsted, William Stewart

(b. New York, N.Y., 23 September 1852; d. Baltimore, Maryland, 7 September 1922)

surgery.

Halsted was the son of William Mills Halsted, Jr., and Mary Louisa Haines. His grandfather and father were successful merchants in New York City, and the family occupied a prominent position financially and philanthropically. His early education included a private school in Monson, Massachusetts, and Phillips Academy, Andover, Massachusetts, prior to his entering Yale College in 1870. Halsted was a mediocre student but an exceptional athlete who first became interested in medicine in his senior year. He entered the College of Physicians and Surgeons of New York in 1874, when it was essentially a proprietary school allied to Columbia College in name only. His preceptor was Henry Burton Sands. Halsted absorbed much of the philosophy of John Call Dalton, professor of physiology, with whom he worked as a student assistant. He graduated among the top ten members of his class in 1877 and in April 1878 completed an eighteen-month period of training in the fourth surgical division of Bellevue Hospital, under the guidance of Frank Hastings Hamilton. He then served briefly as house physician at New York Hospital.

In the fall of 1878 Halsted went to Europe for two years of further study in Austria and Germany, chiefly in the basic sciences and particularly in anatomy under Emil Zuckerkandl and Moriz Holl. He attended many clinical lectures and first became acquainted with the German method of graduate surgical education which was to have a profound effect on his future. In 1880 he returned to New York City. Shortly thereafter he joined the faculty of the College of Physicians and Surgeons as a demonstrator in anatomy. He became associated with Sands at Roosevelt Hospital, where he initiated the outpatient department, and held visiting or attending positions at four other hospitals. He also established a private practice limited to surgery and a quiz session which was academically sound.

In 1884, while experimenting with cocaine hydrochlorate as a surgical anesthetic, Halsted and several of his colleagues and students became addicted. In an attempt to overcome the addiction, he was hospitalized in Butler Hospital, Providence, Rhode Island, for six months in 1886 and for nine months in 1887. This illness ended his professional career in New York City, and he moved to Baltimore, Maryland, to work in the laboratory of William H. Welch, professor of pathology at the Johns Hopkins University, in December 1886. When he had apparently regained his health and the authorities of the Johns Hopkins Hospital (and later the Johns Hopkins Medical School) were convinced of his capabilities and reliability, he was appointed surgeon in chief to the hospital in 1890 and professor of surgery in 1892. The question of Halsted’s drug addiction and his apparent cure have been discussed for years. William Osler’s “The Inner History of the Johns Hopkins Hospital” confirms that Halsted was treated for morphine addiction as late as 1898.

In New York City before his illness Halsted was an aggressive and extraordinarily active surgeon who was rapidly rising in the ranks of the gifted surgical specialists. His career in Baltimore was that of a thoughtful, painstaking operator who returned to the laboratory to study a succession of basic problems in surgery. In a sense he left the path of Sands and Hamilton to follow a career more akin to that of his former teacher John C. Dalton.

Halsted’s important contributions included the development of neuroregional anesthesia through his cocaine experiments, a technique he used with some hesitation in future years because of his personal experience and for which he received no credit until shortly before his death; a radical operation for carcinoma of the breast, which incorporated certain modifications and improvements on the radical procedures developed by others; a radical operation for the treatment of inguinal hernia; physiologic studies of the thyroid and parathyroid glands and a technique for thyroidectomy; and the surgical treatment of vascular aneurysm. More important was the methodical manner in which he approached any surgical problem. Whether in the laboratory studying basic problems of the care and handling of wounds or at the operating table or bedside, his scholarly and painstaking approach was a model for many, although an annoyance to those surgeons who felt dexterity and rapidity were the hallmarks of greatness.

Halsted was an excellent teacher of the exceptional student and resident but devoted little time to others. Those selected few residents who trained under him for seven years or more were given complete patient responsibility, a significant alteration of the German system enthusiastically adopted by Halsted. This system of residency training is a major contribution of the Johns Hopkins Hospital to American medicine. Halsted felt that the leading surgeons in Germany, Austria, and Switzerland were the world’s finest, and he made frequent trips to their clinics. Although often considered a classic example of the salaried, full-time clinical professor, he was in fact a public supporter of the geographic full-time system (salaried position supplemented by private fees) and had a modest but lucrative private practice prior to the institution of full-time clinical chairs at Johns Hopkins in 1914.

Halsted’s meticulous nature and search for perfection in surgery were mirrored in his personal life, particularly in matters of dress and cuisine. To the majority of his colleagues he was cold and reserved, avoiding social intercourse whenever possible. To a few intimate friends he was warm and exceedingly hospitable, and displayed a rich sense of humor. He rebelled against his strict Presbyterian upbringing and was an agnostic in his adult life. In 1890 he married Caroline Hampton, a niece of Wade Hampton III of South Carolina. She was formerly the chief nurse in his operating room. They had no children. Following his marriage he retired to his estate, High Hampton, in Cashiers Valley, North Carolina, for a portion of each summer. In 1919 he underwent cholecystectomy, but in 1922 he had another attack of jaundice and pain that required an operation. He died the day after he had undergone surgery.

BIBLIOGRAPHY

I. Original Works. Halsted’s major publications appear in Surgical Papers by William Stewart Halsted, W. C. Burket, ed., 2 vols. (Baltimore, 1924; repr. 1952).

Halsted’s papers are preserved at the Welch Medical Library, Johns Hopkins University.

II. Secondary Literature. The most complete biography available is William G. MacCallum, William Stewart Halsted, Surgeon (Baltimore, 1930). An interesting view of Halsted is also found in George W. Heuer, “Dr. Halsted,” in Bulletin of the Johns Hopkins Hospital, 90, supp. (1952), 2. A detailed review of his career in New York City is found in Peter D. Olch, “William S. Halsted’s New York Period, 1874–1886,” in Bulletin of the History of Medicine, 40 (1966), 495–510. Osler’s candid comments about Halsted are found in William Osler, “The Inner History of the Johns Hopkins Hospital,” in Johns Hopkins Medical Journal, 125 (1969), 184–194. Another biographical sketch that includes biographical notes about his colleagues is Samuel J. Crowe, Halsted of Johns Hopkins: The Man and His Men (Springfield, Ill., 1957).

Peter D. Olch