Amazon has a real hit with its new drama The Knick, but what many may not realize is that the shows main character, Dr. John W. Thackery played by Clive Owen is actually based on a doctor that changed the way we see and practice medicine to this day. While the show misses on some of the historical details, it is more interesting to find what they actually used and piggy back off that to learn more about the man that inspired much of Dr. Thackery’s character. Most of this story takes place between 1874 and 1922, while a little will lead up to just who the real Thackery was.

Via JAMA

Dr. William Stewart Halsted is one of the most important medical professionals of the last few centuries, yet few know anything about him. He had many accomplishments, was well respected, had a large circle of friends and students and a dark secret that you can probably already guess.

Over Halsted’s lifetime, the world saw significant changes in how medical procedures were carried out, most of which are still in practice today, as well as new and important medical procedures that had never been seen before.

Via Nerdist

Halsted was a genius in every sense of the word. He was a charismatic and hardworking individual that had a true interest in making the lives of his patients significantly better. His desire to do this was so strong that he fell deep into the constant study of medicine and eventually wrote one of the most bizarre lines ever to be found in any medical journal. You will understand how this happened shortly, but as a tease of what is to happen to this brilliant man, read one of his more memorable lines:

“Neither indifferent as to which of how many possibilities may best explain, nor yet at a loss to comprehend, why surgeons have, and that so many, quite without discredit, could have exhibited scarcely any interest in what, as a local anesthetic, had been supposed, if not declared, by most so very sure to prove, especially to them, attractive, still I do not think that this circumstance, or some sense of obligation to rescue fragmentary reputation for surgeons rather than the belief that an opportunity existed for assisting others to an appreciable extent, induced me, several months ago to write on the subject in hand that greater part of a somewhat comprehensible paper, which poor health disinclined me to complete”.

It makes no sense for good reason, and we will get to that reason very soon, but I implore you to read about this individual as he is likely a big part of the reason that your medical care is so safe and advanced. If nothing else, you will be fascinated by the road Halsted followed through his life and learn a bit more about the period in which he lived.

Not So Humble Beginnings

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On September 23rd, 1852, William Stewart Halsted was born to a wealthy family in New York City. Much of his youth is a mystery as he was not a man of any particular note until he started at Yale in 1870. He didn’t seem to be a serious student during his four years of attending Yale, backed by the fact that he never once checked out a book from the Yale library.

He was, on the other hand, a solid athlete. In 1873, the first ever football game with 11 players (Yale-Eton) had Halsted star as the captain of the Yale team in which he scored the winning goal.

From 1874 to 1877 Halsted returned to Manhattan to attend the College of Physicians and Surgeons Medical School in New York City. He had an obsession with anatomy which lead to his breakthroughs later in life and as opposed to his time at Yale, was a perfect student at this school.

Halsted planned to take the exam for internship a year early and while his fellow students were spending most of their time nose deep in their rooms studying, Halsted went to Block Island where he relaxed and spent more time trying to understand his studies. Upon his return, his fellow students were pale and beaten down while he was tan and full of life. He was awarded an internship a year ahead of schedule.

The Start Of A Historic Career

Bellevue Hospital via Ephemeral New York

From 1877 to 1878 he worked at New York Hospital, now Bellevue. There he developed a bedside chart that traced temperature, respiration, and pulse to have a consistent view of a patient’s vital signs. Here he met Dr. William Welch and quickly became close friends.

Starting in 1878 and lasting two years, Dr. Halsted traveled through Europe learning more about his art. He visited Vienna to study under Chiari in Pathology, Surgery under Billroth and Braun – which lead to more friends in their assistants Mikulcz and Woelfler, and Schneck in embryology.

He then visited Würzburg to study with Kolliker to enhance his understanding of embryology and Stoeher on histology and finally von Bergmann to learn more about surgery. He finished his travels in Hamburg and Kiel studying under Schede and Esmarch which enhanced his understanding of many of the practices of which he was interested.

For six years, known s the “New York period” from 1880 to 1886, he had the most vigorous period of his career and possibly of his life. Dr. Halsted was on the staff of the Roosevelt Hospital in which he ran the outpatient department with Richard Hull and Frank Hartley performing operations on several mornings throughout the week. He also worked at Bellevue under a specially built tent-like building where he could perform surgery using antisepsis.

As a side note, antisepsis was ignored by most in the medical community at this time. It was a new idea and one most did not trust. Dr. Halsted was one of the early adopters and it became a standard in surgery years later. During this time, he also worked at the Presbyterian as a visiting staff member and at the Chambers Street Hospital.

As if that wasn’t enough, he was part of the faculty of the College of Physicians and Surgeons with a specialty in demonstrating anatomy, he worked as the Chief of Surgery at Emigrant Hospital, and was a visiting physician at the Charity Hospital. Because he had so many commitments, his surgeries at Charity Hospital were generally performed in the night.

A Continued Success

Via Hopkins Medicine

Dr. Halsted pioneered, or was at least well known, for treating carbon monoxide poisoning, also known as Lamp-lighters disease at the time, by removing blood from a patient, shaking it to return air to the blood, the administering it back into the patient.

he had 65 students which he would run a private quiz with. Starting at around 9 at night and lasting until midnight, he would take his students on ward rounds, give lectures and anatomic or pathologic demonstrations and help the students perfect their profession. Each of his students were extremely successful and described him as a charismatic and inspiriting teacher.

In 1881, at the age of 29, Dr. Halsted’s sister gave birth to her first child, but a severe hemorrhage followed. While the doctors on hand felt that there was nothing else to be done, he arrived to perform what is widely considered the first emergency blood transfusion. He was successful in checking the hemorrhage but because of the blood loss he took blood from himself and transfused it into her. Written off as dead, his sister made a full recovery.

A year later his mother was extremely ill. When Dr. Halsted arrived he found his mother jaundiced and found that her gallbladder was tender which led to a correct diagnosis of an infected gallbladder. Working through the night with nothing more than a lamp to see, he drained puss from his mother’s gallbladder as well as seven stones. While no information is available on the outcome it appears that his mother survived.

A Significant Bump In The Road

Via BoweryBoysHistory

In 1884, two years after the surgery on his mother, Dr. Halsted learned of a study released in Heidelberg Germany which described experiments with cocaine hydroclorate as an anesthetic. Intrigued by the findings, Dr. Halsted wanted to investigate more. To make things more dramatic, Dr. Henry Noyes wrote that: “It remains, however, to investigate all of the characteristics of this substance. We may yet find that there is a shadow side as well as a brilliant side to the discovery.”

Regardless, Dr. Halsted sees the importance of the work and decides that if cocaine could block the nerves in the eyes (which it did in the original experiment) it should work throughout the body. To find out he started testing on himself, colleagues and students. The findings were astonishing as it did work as an anesthesia when injected into nerves, but the group became addicted to the cocaine and all but Dr. Halsted and Richard Hall died. Shortly thereafter, they both moved to Santa Barbara.

This was likely due to the fact that his erratic behavior and lack of reliability lost him a great deal of respect. Keep in mind that cocaine was not understood as it was today, so those that he worked with just saw a man falling off the rails. In Santa Barbara he published an article that explained his findings, which included the statement printed at the start of this article. The cocaine had taken a once brilliant man and sent him into a stupor from which his return was unsure.

The Rocky Road To Recovery

Via Wikipedia

In early 1886 Dr. Halsted attempted to cure himself of the addiction to cocaine by taking a trip on a sailboat to the Winward Islands. The intent was to bring no cocaine with him, but instead he packed half of what he felt he would need. Once he ran out, he broke into the captain’s quarters and stole cocaine from him.

By the end of 1886, he had been admitted to the Butler Hospital in Rhode Island under the name William Stewart to be treated for his addiction. The cure, of course, was morphine, which led to more addiction over time.

Upon release, he joined William Welch in Baltimore to conduct research in Welch’s experimental lab. Working with anatomist Franklin mall, the two found a new way to suture the intestinal tract. Originally, it was accepted that the sutures would be put into the thicker muscular lair, but they found that the submucosal layer worked significantly better. During a talk at Harvard Medical School, he showed his findings on fresh dog intestine in which he sutured the layer and pulled it as hard as he could, showing that they would hold.

His return to form would not last though, as he returned to Butler Hospital from March 1887 to December to try to recover from his new addiction.

 Back To Form

Via Wikipedia

By 1888, he had returned to to Johns Hopkins Hospital, which he was a founding professor, and started experimenting and seeing patients again. Over the next year he became the Surgeon-in-Chief of the hospital and married his scrub nurse, Caroline Hampton.

Over the next five years he experienced one promotion after another eventually becoming the Chairman of the Department of Surgery. It took another six years, until 1889, to see his next major accomplishments which lasted from 1889 to 1922 when he died. The next page will list his accomplishments as close to their entirety as possible.

Dr. Halsted died on September 7th, 1922. September of 1919, Halsted’s former resident performs a cholecystectomy and choledcholithotomy which relieved the pain he was suffering, but it returned in the fall of 1921.

He became jaundiced in his summer home in North Carolina, High Hapton -named after his wife, in 1922. He delayed the treatment to travel to Johns Hopkins where he requested Doctors Reid and Heuer for his surgery. Both were busy in their own careers, but made the trip. While they removed several duct stones successfully, gastrointestinal bleeding started to take Halsted’s life. The man that performed the first emergency blood transfusion could not be saved by the residents on attempts to do the same for Halsted.

But, Halsted left a legacy in his wake, more of which will be covered on the next page. Of special note was his unnatural ability to focus during surgery. One story says that he asked one of his assistants to move over a little as they had been standing on his foot for the last half hour.

A Life Of Accomplishments

Via AZ Quotes

Following are some, but not all, of the ways in which Dr. Halsted changed the world of medicine at the highest level:

He introduced the 8 year residency training program which encouraged residents to research as they perfected their craft.

He changed the idea of surgery – at his time, rapid surgery was the norm, but he slowed things down to develop the philosophy of safe surgery which is slower and more gentle. This is the common practice today.

He spent months working on a way to refine hernia repair, which he was successful in by creating a method of overlapping tissues.

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Breast cancer surgery was changed forever due to his accomplishments in which he removed the breast in a single block, including portions of the muscle under the breast and the lymph nodes, then closing the removal with skin grafting from the thigh.

He was the first surgeon to resect a periampullary cancer. As well as the first to use buried plates and screws to fix long bone fractures.

He introduced surgical gloves by working with the Goodyear Rubber Company. Six years after his suggestion, a Doctor by the name of Bloodgood suggested they were to be worn at all times.

As Dr. Halsted saw the world changing, but likely not at the pace he expected, he wrote  “It is now, as it was then, and as it may ever be, conceptions from the past blind us to facts which almost slap us in the face… how blind we are, and how blind we will ever be.”

 

 

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