Reviewed by Michael Bliss
Imber goes a bit further than I did in suggesting convincingly that Halsted’s long periods of solitary travel probably involved heavy use of both morphine and cocaine, but he also sets morphine addiction nicely in the context of a time when the drug was very readily available and its use deemed less reprehensible than, say alcoholism. When Imber further argues that Halsted’s addiction involved “belies the conventional wisdom concerning long-term drug use” because “there was little or no collateral damage” (p. 282) he seems to beg major questions hinging on counter-factual assumptions about Halsted’s life if he had been drug-free. We can never know, but in my view the evidence suggests that addiction severely limited Halsted’s productivity and his ability to mentor young surgeons. It also on several occasions came close to getting him fired by the trustees of Johns Hopkins.
Thanks to Imber we do know more about William Stewart Halsted’s contributions to surgery. Drawing on his own professional background, Imber provides good and well-contextualized discussions of Halsted’s innovations both generally (rigid antisepsis and haemostasis, profound respect for tissue, obsession with surgical caution and perfectionism), and with particular reference to his radical mastectomy, his approach to inguinal hernia, his thyroid work, and his truly pioneering interest in vascular surgery. While there is nothing in Imber’s book that would cause me to change my portrait of Halsted’s greatest “student”, Harvery Cushing, who was the founder of effective neurosurgery, I do gain from Imber a better understanding of the breadth of Halsted’s influence, which extends far beyond Cushing’s development of the frontier of neurological surgery. Halsted was also an important if less direct influence in the conquest of the next great surgical frontier, the heart. Perhaps too Harvey Cushing might have been a bit more generous in acknowledging Halsted’s genius.
Imber has written a good, workmanlike, well-paced biography of a great figure in the history of surgery. It deserves a wide readership. But the book tantalizes us. We want to know much more. More, perhaps, than we may ever know about Halsted, William Welch, and the founding of Johns Hopkins. I hope I’m wrong about this, and that future biographers find better sources.