GENIUS ON THE EDGE

Ostensibly a biography of William Stewart Halsted (1852–1922), but the main story is the transformation of medical education in America.

Imber (Clinical Surgery/Weill-Cornell School of Medicine) tries valiantly to revivify the elusive Halsted. He was aristocratic and urbane, meticulous in his dress—he sent his shirts to Paris for laundering—and could be cold and imperious. He also had a strange, possibly sexless, marriage, but just what made him tick remains a mystery. Medical education in 19th-century America was haphazard at best, and surgery was often brutal and risky. After attending Columbia University College of Physicians and Surgeons in New York City and interning at Bellevue, like other young men of means, Halsted completed his medical education in Europe. His career as a surgeon was off to a brilliant start in New York in the 1880s, but his experiments with cocaine as a local anesthetic led to his addiction to it and later to morphine. Fortunately, his friend William Welch offered him a new start at Johns Hopkins Hospital, and in 1886, Halsted left New York for Baltimore. Although his presence at the school was interrupted by months of absence every year due to his drug dependency, he made numerous innovations in surgical technique. However, it was his contributions to the training of surgeons and his development of scientific, safe and anatomically proper surgery that cemented his reputation. He set exceptionally high standards for his residents at Hopkins, and Imber profiles a few, including the distinguished Harvey Cushing. Many of Halsted's students eventually became professors and chiefs of surgery, and in turn their residents became heads of major surgical facilities across the United States. In the author's view, anyone in America who undergoes a successful surgery owes a debt of gratitude to Halsted.

Halsted remains out of focus, but the significance of Johns Hopkins in modernizing the education of doctors is clear.