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When Myths are Rewritten


Book cover: Genius on the Edge

Most of us recall the ardour of our residency training, and the long hours we logged over many consecutive years to learn our trade. Back then, I fully believed that the importance of such an apprenticeship was written on stone tablets, and handed down to us from enlightened mentors, all of whom shared a certain genealogy with the "grandfather" of modern day surgery, Dr William Stewart Halsted. I was led to believe that the manner in which we trained as residents was the result of careful study and analysis over many years by Dr. Halsted. The Halstedian model of residency training was sacrosanct.

Gerald Imber
Gerald Imber

In the book Genius on the Edge: The Bizarre Double Life of Dr William Steward Halsted by Dr. Gerald Imber, the mythology surrounding Halsted is dismantled and rewritten. Through his primary research into one of America’s most enigmatic early surgeons, Dr Imber casts new light on the personality and habits of this fascinating man. Halsted worked at Johns Hopkins medical school in Maryland, and was one of the luminous "Big Four Doctors", famous for their contributions to their respective fields of study, who included Drs William Osler, William H Welch, first dean of Johns Hopkins Medical School, and Howard Atwood Kelly, the highly skilled Professor of gynecology.

It was Halsted who recognized the importance a system to transform a journeyman surgeon into a scholar. The process established by Halsted required an exacting knowledge of surgical pathology, teaching one’s juniors, incremental acquisition of surgical responsibility, and independent laboratory studies. In the end, Halsted trained 17 residents, all of whom became surgeon educators and highly competent surgeons. Halsted himself wrote highly insightful works on hernia repair and radical mastectomy for breast cancer, which became the gospel for generations of surgeons.

However, there was a dark side to Halsted’s personality and behavior which Imber brings to light in Genius on the Edge. Halsted was hopelessly addicted to morphine and cocaine, an addiction which dated back to 1884 when he began to experiment with topical and injectable cocaine to induce local anesthesia. His career became marked by significant absenteeism as he left his practice for weeks and months at a time. He lost interest in instructing medical students. He began doing fewer surgical procedures, and often handed them off to his assistants while part way through. Sadly, his addiction haunted him throughout his entire career. He was unable to break the habit, and Johns Hopkins medical school had great difficulty keeping the knowledge of his addiction quiet.

In the words of Imber: "Halsted was a complex and isolated man, forbidding and nurturing; rigid, proper, and secretive; compulsive and negligent; stimulating and reclusive; addicted and abstemious; oblivious and solicitous; and always concerned about the science of surgery". It is interesting to speculate how much of modern day surgical training stems from the mind of a man who, while under the influence of addiction, considered himself invincible and indefatigable. Were Halsted not addicted to narcotics, one wonders what his recommendations would have been regarding residency training in surgery. In my view, Genius on the Edge is mandatory reading for all surgical residents.

We are indeed fortunate that Dr Gerald Imber has agreed to deliver the Frank Kergin Lecture on February 1st, 2013, at Women’s College hospital from 7:30 - 8:30 am. He has already agreed to tell us more about the enigmatic Halsted, and the factors that influenced his early decisions to create surgical residency training programs the way he did. I look forward to seeing all of you there for that lecture.

James T Rutka,
RS McLaughlin Chair, Dept Surgery

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