Customer Reviews

Genius on the Edge: The Bizarre Double Life of Dr. William Stewart Halsted

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Dr. Gerald Imber will change your views of what it means to be a doctor and a patient, to be sick and to be well. While tracing the convoluted evolution of modern surgery, Imber also chronicles the prodigious, twisted career of the greatest surgeon in American history. As he modernized medicine - introducing such life-sparing novelties as anesthesia, scrubsuits, handwashing, sterlized instruments, even while the medical establishment strenuously resisted his innovations -- Halsted himself descended into a dark, secretive abyss of cocaine abuse and closeted homosexuality. Yet Halsted's techniques and his teaching were so unimpeachably sound, they remain the model for practicing and teaching surgery today. Halsted's story is written with such clarity, it will appeal universally - along the way, Imber's tale encompasses, among other matters, 19th-century American and European history, and some commendably high and lamentably low examples of the human condition. It is a wonder Halsted never had a biography before; we should be very grateful that Dr. Gerald Imber took on this daunting task. His impressive scholarship never gets in the way of good story telling. The charm, humor, and authority of the author's voice shines warmly throughout the sprawling narrative.

"Genius on the Edge" is an interesting book describing the medical developments (especially in surgery) during the period of about 1846 to 1922. The first third of the book mainly focused on what surgery was like before this period, on the developments that occurred from 1846 to 1889, and how they affected Halsted's medical training and prompted his surgical innovations. The rest of the book was more a series of short biographies of men who worked with Halsted and the developments they (and he) brought to the practice of surgery from 1889-1922. It also covered Halsted's marriage and how he lived.

The author didn't assume that the reader was familiar with medical terms and so concisely worked that information in as was needed to understand the innovations. He did an excellent job of making the topic fascinating and easy to understand. I found the book a quick read despite the amount of information packed into it. I also liked how the author wove the general technological changes and social setting into the story so we could see how society effected the advances and how Halsted and the others influenced society in turn. While the book mostly focused on American surgery (especially that done at Johns Hopkins Hospital and Johns Hopkins School of Medicine), the author also brought up related advances over in Europe.

There were only a couple of brief descriptions of actual surgery, so most of the book probably wouldn't bother those who get queasy by descriptions of operations.

Some of the topics covered were: the introduction of general anesthetics, heat sterilization, and antiseptics to make surgery safer. How medical training had been done and how it changed (both in medical school and post-graduate) under the influence of Halsted and his friends at Johns Hopkins. The creation of out-patient clinics, the beginnings of bacteriology and the germ theory, the change from quick and brutal surgery to gentle, careful handing during surgery, the introduction of surgical gloves, of using cocaine as a local anesthetic, emergency blood transfusion, surgery of the brain, and much more.

Overall, I'd highly recommend this well-written and interesting book to those interested in how medicine (especially surgery) has developed into what we take for granted today.

I received this book as a review copy from the publisher.

Reviewed by Debbie of Different Time, Different Place book reviews
(differenttimedifferentplace. blogspot. com)

By far the best biography I have read. I did not have to skip over any boring parts or risk falling asleep. It was strange to realize that not only did people not always use sterile practices but that within the last 100 years people did not use sterile practices. Dr Halsted snd his peers were the creators of modern medicine as we still know it, and their story is a fascinating one.

A life of Halstead has been a major need in the history of medicine for ages - Imber provides one that is both accessible to the lay reader as well as technically detailed enough to satisfy those with med/surgical trainining. Although he leans on sources for the history of Johns Hopkins and its founding (especially Bliss, Fleming, and Flexner)that will be familiar to those with an interest in the Four Doctors he wisely steers clear of MacCallum's early hagiography, not averting his gaze from Halstead's addiction and the question of how he still performed and founded modern surgery.

That said, I agree he could have used a more rigorous editor; the latter half does ramble a bit, and the repeated use of 'disinterested' as a synonym for 'uninterested' (instead of its true meaning: 'impartial') does grate. Overall, though a fascinating guide that gets closer to what made Halstead tick.

... and if I was the Program Director, I would mail this book to all my incoming residents and make it a mandatory read before they start as surgical interns.

This is one of my top 3 books and I highly recommend it to anyone who wants a great perspective on the medical happenings around the turn of the 19th century. It's fascinating to realize how the changes that took place and led to modern surgery hinged on a single person, Dr. Halsted (incorporating work of many over decades, of course).

Some reviewers complained about the style, including some medical lingo, however other than 2 or 3 expressions that went unexplained, everything makes good sense even for the non-healthcare related reader. It's really hard to put this book down.

If you want to get a feel for what it was like to live in the late 1800s, what the health care was before and after Johns Hopkins as well as the intricate minds of those visionary men that revolutionized the medical/surgical practice and education, this is the book to read, hands down.

On a personal note, I greatly enjoyed reading on a few golden nuggets on Dr. George Heuer and Dr. Mont Reid, especially because they went on the become the founding Chairmen of the Department of Surgery at the University of Cincinnati, where I proudly practice.

Genius on the Edge by Dr. Gerald Imber MD
Kaplan Publishing

Title of the Review: Genius Recognized

Reviewed by: Dr. Joseph S. Maresca CPA, CISA

The author, Dr. Gerald Imber, MD does an excellent job of
documenting the life and times of Dr. William S. Halsted MD.
Dr. William Stewart Halsted was educated in New York initially.
He attended Yale and the College of Physicians and Surgeons
at 23rd St. and 4th Av. in NYC.

Scholastically, he graduated in the top 10 of his class
and won $100 in an essay contest for the description of
the arteries of the neck. He worked at
New York Hospital and read extensive surgical
scholarship written in Europe. He held positions at
Blackwell's Island and Emigrant Hospital, although the
workload was staggering .

At an early age, he began to understand the intricacies
of blood group incompatibility. He found that intestinal
anastomosis using fine silk sutures incorporating the submucosal
layer withstood the pressures of normal bodily functions.
He demonstrated this aspect graphically.

By 1889, rubber sterile gloves were introduced to protect
the skin from irritation. Halsted perfected radical surgery
with extensive fine suturing for breast cancer.
He reconstructed hernia defects in the groin by using muscle
and tough fascial sheath of the oblique muscles of the lower
abdomen to reconstruct the inguinal canal floor. Halsted sutured
the muscles and fascia to Poupart's ligament, an anatomical
inguinal ligament that traverses the iliac bone of the pubis.
Strong silk sutures were used to tighten the internal abdominal
ring as well. These suturing techniques could have important
application for the repair of dropped bladders, major surgical
intestinal resections, downsizing mega-intestines (over 27 feet )
and complications from radical hysterectomies.
He perfected hernia repair and found that silver (Ag) had
antiseptic qualities as well.

On April 4, 1892, Halsted was made a Professor of Surgery,
although he had no formal institution to practice the art
at the time. By 1900, he perfected two gold standard operations,
placed surgeons' hands in sterile gloves and commenced a
training system for 3 generations of the most influential
surgeons in the USA.

Today, some of Dr. Halsted's techniques could be enshrined
in modern artificial intelligence and "Advice-Giving" systems
and processes on knowledge databases.

Cushing was the most impressive of a group of 17 Halsted
residents. He was the first to use anesthesia in hernia
repair, the first to operate on the pituitary gland ;and,
the first to routinely open the skull to
decompress the brain and develop neurological surgical
prototypes.

Halsted performed the first successful excision of an
aneurysm of a major blood vessel. He passed on from
lobar pneumonia on 9-7- 1922.
The work is a classic covering the slow but steady
evolution of basic surgery in the late 19th century and early
20th century. The presentation would make excellent
reading for a wide constituency of journalists, historians,
physicians and academicians everywhere .

Dr. Joseph S. Maresca CPA, CISA

Like most people, I never gave any thought whatsoever to how our modern surgeries evolved, and took for granted that Westernized modern surgeries require a sterile field, sterile rooms and sterile gloves. This book, "Genius on the Edge; the Bizarre Double Life of Dr. William Stewart Halsted", grabbed me by my collar at the bookstore, and after reading the first two pages, "the Prologue," I was hooked. I bought this book, not hearing anything about it, or even the legendary genius, Dr. Halsted. I read the whole thing in two days.

"Surgery would be delightful if you did not have to operate," was the opening statement of this fine book, given many years ago - by the brilliant Dr. Halsted. Back in the day, when surgery was just being figured out, most `surgeons' were mere "butchers" by today's standards, or "meat carvers" - whose surgical prowess and technique was judged on how fast they could do the deed. Surgery was excruciatingly painful and left physical and emotional scars that never healed. Many surgeons of that era were very hard on the body parts they operated on; and a patient of that era was fortunate if their surgeon knew how to use a bar of soap & water prior to operating. A huge percentage of early patients did poorly post-op, so consequently, surgery was the last resort any person chose. Most persons died of the resulting infection than the original malady, and Dr. Halsted was painfully aware of this and set out to correct it.

The true story of this book was really never fully explored. A lot was said in regards to Dr. Halsted's self-experimentation with Cocaine, and how he carefully calibrated small doses as he experimented with Coke for dental procedures. Dr Halsted was extremely careful; he invited and involved multiple medical students who were made to take small doses of Cocaine; all in the name of Medical Research, but a not legal or ethical practice. They reported feeling no pain when taking Cocaine, and also reported having felt an enjoyable sense of exhilaration after taking the Coke. Cocaine dosaging was either inhaled or injected, and was used in social circumstances as well. Gradually, the good doctor and his students became addicted. One by one, the students began to behave erratically and eventually dropped out of medical school and dropped out of sight. Dr. Halsted hung in because he was a professor and chief surgeon, but he himself became lost in the netherworld of Coke addiction - and temporarily lost the ability to write papers coherently. He required long vacations for the rest of his illustrious career. He would manage to focus intensely on his work 6 months out of a year, but then he would drop out for 6 months at a time, where he could indulge his secret chemical habit. He tried hard to quit Cocaine and mistakenly took Morphine to "cure" himself - thus only winding up becoming dually addicted to both substances. This dual addiction would destroy most strong men, but it did not destroy Dr. Halsted...somehow, he was able to compartmentalize his addictions versus his life-works / but how he did this remains unknown. This book glosses over how Dr. Halsted was able to maintain such a rigorous and relentless work schedule while remaining hooked. This juicy tidbit remains a mystery is how the good doctor managed to maintain his coke addiction and simultaneously build and develop massive innovations in surgery at Johns Hopkins Hospital. I still don't know how Dr. Halsted managed this...one can only wonder and think.

Halsted was strongly influenced by other medical giants in his medical world: Luis Pasteur, Robert Koch and Joseph Lister. As Halsted became a surgeon at New York Hospital, and ultimately Johns Hopkins - where he spent as much time as he possibly could observing surgeries in that hallowed house of pain. In 1881 he performed the first emergency blood transfusion by withdrawing a large amount of blood from his own arm and injecting it into his sister's arm, in order to save her life immediately post-partum. Thus the ABO blood groups were later identified by Karl Landsteiner but not until 1900.

What I love about this book is that a lot of discussions are included regarding many medical discoveries, and the reader gets the back story on how certain innovations came about.

This book was written strong enough to reach across the aisle and compell me to reach back to read it. I found it to be fascinating and intriguing. I am a registered nurse, so perhaps this is why I devoured this book and relished every bite. I encourage all scientifically minded persons to buy this book and read it and save it forever so you can re-read it and refer to it's historic significance.

Dr. Gerald Imber is the author who created this book and I wish to thank the good doctor for doing all his exhaustive research on the matter of Dr. William Stewart Halsted and his peers. This is an excellent book, receiving 5 out of 5 stars. * * * * *

At UCLA Medical School I first learned about William Halsted. Little did I know how much Halsted had influenced UCLA's Department of Surgery, which was first chaired by a descendant of Halsted's surgical program at Johns Hopkins. Author Gerald Imber does a superb job of portraying Halsted as a person with profound weaknesses as well as scintillating brilliance. His impact on surgical training methods, surgical technique, and research are experienced by every surgeon and in every top operating room in the US. Not just for doctors, Genius on the Edge is written for everyone with any interest in how health care has advanced from leeches and bleeding. I loved this book; it has reverberated in my head for days.

Especially for those in the medical profession, this book provides an actual doorway into modern medicine with detailed information of the surgical and medical pioneers and innovators that developed procedures and policies that started professional medicine at Johns Hopkins. Thoroughly enjoyable reading about the lives of those that we had only heard refereed to as Lister, Halstead, etc.

I enjoyed this book.As a surgeon with a special interest in Halsted I thought another
biography of HALSTED was past due.The prologue describes the emergency surgery by
HALSTED on his mother in april of 1882 where he removed her gallstones [cholecystostomy].The author states that Halsted had successfully performed the
first known operation to remove gallstones.. Dr. John Bobbs of Indiana
did this in 1867 with success and reported it.He is generally given credit for this
by historians. nine yrs later he performed another successful cholecystostomy. Johann
Thudicum described this procedure to the MEdical Society of London on Oct 17, 1859.
J.L. Petit performed a successful cholecystostomy in 1743.J Marion Sims,the N.Y.
surgeon did this same emergency operation on an American woman in Paris in 1878 and
reported it in the British Med. J. that same year.