Monday, September 30, 2013

Genius on the Edge, by Gerald Imber

A bit disingenuous, the title leading me to think that William Halsted was a true whackadoo who revolutionized something in modern medicine.  While the latter is true and it can be fairly argued that he was the most influential surgeon ever, I wouldn't describe his life's arc as being on the edge.  The guy had a cocaine habit, apparently, and used heroin as a way to mitigate the effects of withdrawal.  Somehow he was able to balance these addictions and maintain a productive life.  An über productive life if you will.  He introduced aseptic technique to the operating room, revolutionized hernia repairs.  Hernia repairs?  I thought "big deal."  But prior to Halstead, the failure rate was 80% and the mortality rate around 30-40%.  The alternative, of course, having no surgery, invariably led to death.  He also made great progress in the field of thyroid surgery.  His most lasting influence, however, is in the role he played establishing Johns Hopkins as the center of modern American medicine (an empiric, scientific discipline).  Modern medicine is founded on scientific methods born in the laboratories of Europe in the late 19th century.  Halsted traveled and studied there.  Under the guiding hand of William Welch, he brought these skills to Hopkins.  Under Halsted's leadership, surgeons like Cushing, Young (Urologist), Kelly (Gynecology), Dandy (most influential neurosurgeon ever?) and many others studied, practiced and took their new skills out to other institutions in the country.  American medicine is littered with surgeons, two/three generations removed from Halsted who echo his work.  Imber, to his credit, doesn't spend too much time on Halsted's private life, what little is known of it.  The drugs get their do.  An occasional mention of homosexuality, never proven.  And his marriage.  Necessary and complementary components to a rich, rounded talk of this intriguing figure.  I find interesting that Halsted was able to dedicate enormous amounts of energy and concentration to the task at hand (e.g. surgery) which, prior to his career, was a short and brutal affair.  Ether, aseptic technique and painstaking attention to detail (e.g. tying off all those little bleeders as one moved along with the procedure) led to better and better outcomes.  How could a man with a cocaine and heroin addiction perform at such a high level consistently for decades?  Did he also have Asperger's?  Imber's work is a nice complement to John Barry's The Great Influenza which chronicles the rise of modern medicine and couples it to the great flu pandemic of 1918.