Genius on the Edge: The Bizarre Double Life of Dr. William Stewart Halsted Read Online Free PDF Page B

quite convinced of the usefulness of Lister’s new ideas, Hamilton examined patients and operated bare-handed, without washing or decontaminating his hands after his horseback ride to work.
    Bellevue was a very busy place, and interns worked a grueling seven-day week. They were a small, close-knit group, helping one another, spelling one another to attend surgery, and spending what little free time they had talking surgery. Looking old beyond their years, they were generally men from affluent families and arrived at work dressed no differently than bankers. Halsted favored wing collars, waistcoats, and wide cravats. Most smoked, and those who did smoked freely at work. This was particularly true during anatomical dissections in the dead house, or morgue, where, before refrigeration, smoking provided a defense against the noxious odors of decomposing flesh. The only area off-limits for smoking was the operating theater, but this was only because of the explosive nature of gaseous ether.
    During Halsted’s seven-month internship, there were only 95 patients admitted to the fourth surgical division. Of these, 50 had simple fractures and dislocations. Few elective operations were attempted, for even clean surgical incisions were likely to become infected and result in death. Already contaminated wounds such as compound fractures were doomed to infection and amputation. The fear of infection loomed everywhere, and abdominal surgery remained so risky that even appendectomies had not yet been performed. The diagnosis of perityphlitis, as appendicitis was then called, was made clinically, but nothing could be done other than confirming it at autopsy. Under the best of circumstances an abscess developed around the infected appendix, which could be successfully drained. In some cases the natural body defenses and the large fatty apron in the abdomen called the omentum helped wall off the infection. These defenses, combined with prompt drainage, managed to control the infection and might allow the patient to survive. Often, when the appendix burst and overwhelming peritonitis developed, the less lucky patient died, as expected.
    At the completion of his premature internship in May 1877, Halsted returned to finish his final year of medical school and prepare for examinations. He finished in the top ten students of the class,was graduated with honors, and qualified for the honors essay contest. Halsted spent the entire three hours on a single question: the description of the arteries of the neck. It was as if the young anatomist had written his own question. In a final coup for the student who had shown no academic aptitude before finding medicine, he won the contest and the $100 prize.

CHAPTER FOUR
Becoming a Surgeon
    TO GAIN FURTHER EXPERIENCE , Halsted took a newly created position as house physician at New York Hospital. It was not a surgical post, but at least he would be able to learn more of the ins and outs of a doctor’s work in a hospital setting.
    New York Hospital, chartered by King George III in 1771, was the second oldest hospital in the nation. From inception it was an important local institution, and its governors were the leaders of the New York business and social worlds. Halsted’s father and grandfather were members of the board of governors and significant financial supporters of the hospital. An uncle, Thaddeus Halsted, had been an attending surgeon at the hospital as well, so the Halsted name was anything but unknown when the young physician sought employment. Halsted always claimed to have taken a competitive exam to win the position, but New York Hospital records make no mention of an examination ever being offered. The medical wards of the new hospital building were about to open, and based on a glowing recommendation from Dr. Henry Sands, the board of governors ordered “Dr. William S. Halsted, late house physician at Bellevue hospital,” appointed without delay.
    In March 1877, the new hospital opened. A