Tuesday, March 30, 2010

Genius on the Edge by Dr. Gerald Imber

book cover

Genius on the Edge
by Dr. Gerald Imber

Hardback: 412 pages
Publisher: Kaplan Publishing
First Released: 2010

Source: Review copy provided by the publisher.

Book Description (from publisher's website):
A major new biography of the doctor who invented modern surgery. Brilliant, driven, but haunted by demons, William Stewart Halsted took surgery from a horrific, dangerous practice to what we now know as a lifesaving art.

Halsted was born to wealth and privilege in New York City in the mid-1800s. He attended the finest schools, but he was a mediocre student. His academic interests blossomed at medical school and he quickly became a celebrated surgeon. Experimenting with cocaine as a local anesthetic, he became addicted. He was hospitalized and treated with morphine to control his craving for cocaine. For the remaining 40 years of his life he was addicted to both drugs.

Halsted resurrected his career at Johns Hopkins, where he became the first chief of surgery. Among his accomplishments, he introduced the residency training system, the use of sterile gloves, the first successful hernia repair, radical mastectomy, fine silk sutures, and anatomically correct surgical technique. Halsted is without doubt the father of modern surgery, and his eccentric behavior, unusual lifestyle, and counterintuitive productivity in the face of lifelong addiction make his story unusually compelling.

Gerald Imber, a renowned surgeon himself, evokes Halsted’s extraordinary life and achievements and places them squarely in the historical and social context of the late 19th century. The result is an illuminating biography of a complex and troubled man, whose genius we continue to benefit from today.

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.

If you've read this book, what do you think about it? I'd be honored if you wrote your own opinion of the book in the comments.

Excerpt from Chapter One
WILLIAM STEWART HALSTED WAS born in New York City on April 23, 1852, in the decade of booming mercantile prosperity and civic unrest preceding the Civil War. Immigrants seeking to escape famine and poverty in their native lands poured into the city at an astounding rate, often as many as 250,000 in a single year. The new arrivals, then largely Irish, supplanted free blacks as an inexpensive labor source, and the slums were soon overrun. Only half the children born in the entire country would live to the age of five. More New Yorkers were dying from disease each year than were being born. Two cholera epidemics in the 1830s and 1840s had claimed thousands of lives, while earlier outbreaks of malaria and yellow fever had taken many more. Within the filthy slums, especially the notorious Five Points neighborhood, about which Charles Dickens said, "All that is loathsome, drooping and decayed is here:' the death rate was three times that of the rest of the city. Without the new immigrants, the population of the city would have been decimated. With them, the city was almost unlivable.

Tuberculosis was rampant. It was a scourge of greater proportions than AIDS, influenza, and polio combined, and had run unchecked for centuries, killing hundreds of millions of people worldwide. The disease was not limited to the lung infection, or consumption, immortalized in literature by Dumas's Marguerite in Camille, and later Violetta in Verdi's La Traviata. It was a generalized condition that also produced draining scrofulous abscesses of the lymph glands of the neck and axilla, and bone infections necessitating amputation. Little could be done other than drain the tumors and remove the festering parts.

Rich and poor lived in close contact, and resentment and unrest were everywhere. Riots in the first half of the century were common and usually reflected class and ethnic hostilities. Among these were the deadly Astor Place Riot in 1849 and the Klein Deutschland Riot of 1857. Earlier riots had erupted between Catholic and Protestant street gangs, and several were prompted by the city's efforts to remove some 20,000 feral pigs from city streets.

As mid-century approached, the gentry abandoned lower Manhattan and moved "uptown" to the wide-open spaces of Greenwich Village. Among them were the prosperous Halsteds.

By mid-century, 14th Street had become the epicenter of society. Broadway was the busiest shopping corridor in the world, and 200,000 horses plied the city streets, pulling stagecoaches, buses, delivery wagons, and cabs. Sanitation was nonexistent and health hazards were overwhelming. Each horse produced more than 15 pounds of manure daily, and there was no organized system for its disposal. Manure piles were everywhere, seeping into street-level rooms in heavy rain, drying in fly-infested piles in summer. Each year, 20,000 horse carcasses were dragged from city streets to the pier on West 38th Street to be shipped to rendering plants in Barren Island, Brooklyn, where the bones were turned into glue. New "brownstone" homes were built with high entry stairs to avoid the ubiquitous manure.

Human excrement was also a problem. There was no municipal sewer system, although more affluent neighborhoods could petition for the construction of sewers and share the cost among the residents. Elsewhere, chamber pots were still emptied from tenement windows into the street. Women used parasols to protect themselves and their finery from flying excrement. The exodus uptown provided some relief, but it wouldn't be until after the turn of the next century that electric buses and the automobile supplanted horses and eased the situation.

No comments: