Sawbones: A Marital Tour of Misguided Medicine - Sawbones: The Man Behind the Knick

Episode Date: November 25, 2019

This week on the 300th (!) episode of Sawbones, meet William Halstead, the father of American surgery, the man who inspired Cinemax's The Knick and ... a great advocate for cocaine. Music: "Medicines" by The Taxpayers

Saubones is a show about medical history, and nothing the hosts say should be taken as medical advice or opinion. It's for fun. Can't you just have fun for an hour and not try to diagnose your mystery boil? We think you've earned it. Just sit back, relax, and enjoy a moment of distraction from that weird growth. You're worth it. that weird growth. You're worth it. Alright, time is about to books. One, two, one,fist guy, and welcome to Saul Bones, Emerald Tour of Fist Guy,

and medicine, I'm your co-host Justin McElroy. And I'm Sydney McElroy. Thank you. For the first time, equal, they were equal. So I got some sinus stuff going on, but it sounded equal to me So what it felt is to be back in New York and back at the King's theater. What a beautiful place We have done Several shows in New York

We once did three in one day. Yeah, that was when we kind of messed up and booked a hundred seat theater. And so we ended up having to do three shows in one day and which meant I did six shows in one day. And yeah, the quality suffered. I mean, I don't know how to say it, the quality suffered. I only did three that day, but I also was 30 weeks pregnant.

So I feel like- Okay, here we go. All right. Oh my god, balance is out. When we were trying to come up with a topic for the show, there's so many things when you dig into medical history related to New York, there are endless things you could talk about. But it gets harder when you've done as many shows as we have done here.

And so we were kind of going back and forth. What are some other things we can talk about? And Justin said, hey, why don't you talk about that show, The Nick, which is a cool, I mean, I watched the whole show. It was a really cool show, of course it was set in New York, so there's the connection. And it was about medical history, so that's all, that all makes sense, except it definitely did go off the air in 2015. Okay.

That's fine. Yes, that's accurate. That's why we brought it up, the muted response. It's just saying nobody remembers that that was on TV. John Hodgkin was in it, though, and here's the news peg. His new book, Medellin Static, is on shelves now. This week, pick it up. So that's the news hook, I guess.

Well, yeah, but no, I started digging into, after Justin said that, I was like, well, you know, maybe there's something there, because I think it was based on more than just like, there really was the Nicarbocker hospital. There was, it was based on some like actual people and stuff. So I started digging into it. And the main character on the TV show, Dr. John Thackerie,

was based on an actual human who was from New York, Dr. William Stewart-Holsted, who is known as like the father of American surgery and came from New York and has an interesting, complicated history, so you did give an interview. Tell her, spoil, man. You're the father of American surgery came from any other city, they would be losing their mind.

Yes, yes, yeah, we know. We named our college after him and the city and all our hospitals. Yeah, he's a legend here and you're like, uh, did he? Uh, weird. He's like the thousandth most interesting person from New York.

How cool. Uh, you know about Seinfeld, right, Justin? Hello. Seinfeld got more moves. He's here, Jerry. My man, thank you so much for coming. Don't crane your necks, just trust me. If you haven't ever seen the show, it's OK.

You don't need to learn about this actual historical figure. That is not necessary. But the character that was based on his life on the TV show was this like really brilliant surgeon who also had an addiction to cocaine and then later morphine and What's on what? Some roots for that. Don't applaud that. So he had some, we'll say, erratic behaviors in the operating room. And then, of course, it's all about medical history

right at the turn of the century. It was set around 1900. And everything was kind of just like, let's throw it to the wall and see what sticks, kind of attitude towards medicine. So there's lots of that. And the figure who inspired that, Dr. Hallstead, fits that pretty well.

He was a very complicated person, and he was, in many ways, a genius and did amazing things. And then there are some other more interesting parts to his history that I think makes him a perfect fit for solvones. He was born in New York, like I said, in 1852. 1852. 1852. 1852 got a bigger chair than the name of your town.

He came from a wealthy family. They had two homes. They had a home like right on Fifth Avenue, and then a big mansion upstate. And, uh, moved for the mansion upstate too. He was not a stellar student. One of his biggest frustrations is that he wasn't a stellar student, but he did go to Yale. So there says, I mentioned he came from a wealthy family. I mentioned he came from a wealthy family. I don't know if they pretended he was on crew.

But he did get into Yale. But he never was inducted into the skull and bones, and that was one of his biggest like frustrations. I mean you got some limits right? But in medical school he really started to apply himself and he did a lot better, he was making better grades. After the first two years though and back then med school was like three years typically and then after that it was just sort of like a hodgepodge of what you would do. You go to med school, you'd finish, you'd be a doctor, and then you were just expected to like, now go learn more before you practice because you don't know what you're doing,

but we're done. Uh. There's no intermediary step there. No, it's just like you're a doctor now, figure it out. So he went for two years and he was like, oh, this is tough, I need a break. So he took a summer off and like went hunting and fishing and doing, I don't know, whatever, whatever wealthy people do when they're taking a summer off from med school.

And after he was done with that, he came back and took an entrance exam to become an intern at Bellevue Hospital. And the thing is, you weren't allowed to do that unless you had finished medical school, but he did it anyway. All right. And he passed the exam, and he did so well on it that he got the internship. So he wasn't, he hadn't even finished medical school and he was already functioning as an intern

at Bellevue Hospital. And this is where, this was a really important point in his history because while he was there This was the same point in time where Lister came to the US and started giving lectures on the concept of Antisepsis of like antiseptic technique of like yeah of like let's do things cleanly and Then we won't have so many infections and that idea had had not taken hold. There were lots of surgeons who were like, psh, no.

I'm not going to watch my hands, whatever. Love being dirty. And he was, he, in this atmosphere is kind of where he, that's where his learning took place. And he was like, that sounds like a great idea. I love it, and I'm going to live by it. And it is one of the things that he was known for throughout his career.

Is it everywhere he went? He was like, listen, I don't care what the bosses say. The man's not going to stop me from washing my hands, cleaning my surgical instruments. That's the kind of rebellion I can get on board with. Trying not to sneeze in the patient. You don't always succeed, but it's nice to try. And so he did this year, and this was very important to his learning, and he did finish medical school after that in the sense that he took the exam and passed it.

And then he was among, it's noted, I read this, he was among the top 10 in his class, but to decide who was at the top of the class, I guess because everybody was so close in their scores or grades or whatever, they had a contest. Which is not how medical school works now. So they had like a quidditch cup basically. I got so excited because the one article I was reading just said that they had a contest that he won. And I was reading just said that they had a contest that he won and I was like a contest in what like what did you do? It was just an essay contest Which sounds like I know like a like a lumberjack game

So like how many patients can he slice open in one minute? So he won the whatever his essay was it was great and he won the essay contest So we got to be like top of his class. And because of that status, he went on to get a position at New York Hospital as a house officer, which was a big deal. And so he got this prestigious position because he wrote a great essay.

And while he was training this year, he developed this sounds so boring. But this was the first time anybody ever made a hospital chart. He's the guy who was like, you know what, you know what, the, patients should have like a piece of paper that has like, I don't know, their heart rate

and their temperature. He's so rudimentary with the first one, just says like, he's sick. Do not leave, give pills. And, but that, he, and this was still in his training and through that year of his training he invented the hospital chart and then he was like, my work here in the US is done. And he literally at this point he went, well, I've learned everything the United States of America has to teach me.

I'm going to Europe, which is what he did. And for two years, he just wandered all over Europe learning from every doctor or surgeon that he could. And that sounds wild. This really for the time was kind of what you were expected to do. Now obviously he had the means to go train among some of the most world-renowned surgeons and doctors of the time, which not everybody did. But that was sort of the expectation was like,

well, go out there and learn something. And he did. And he finally felt like, and this was really, you just decided, okay, I know enough, I'm done. I'm gonna go practice on my own. So in 1880, he came back to New York and said, I'm a surgeon. Trust me.

Trust me. Trust me. I know how to do this now. Trust me. Trust me. I know how to do this now. Let me work. I went to London, so I'm a surgeon, I guess. He went everywhere. And so he started working at like every hospital he could find. He was working at Roosevelt Hospital.

It would be Bellevue still. He was working at the charity hospital and the immigrant hospital. He actually he felt like he was so committed to these antiseptic techniques and he felt like he couldn't do them at Bellevue. He was like they just don't the hospital cannot do what I need in an operating room. I can't convert their operating rooms. I guess it was so dirty that he felt like I can't even clean this room. You guys have a milkshake machine in here. What is wrong with you? Why do you have a gum wall?

What were you thinking? Is that a children's play place? Like, why would you put that here? In the horror. So he had them build his own operating theater, which was basically in like a tent outside, but it was like a giant tent with a- Do you know how dirty your hospital has to be

before someone is like, I'm just gonna do it and then tent outside. That would be better for me. So, and it was like a $10,000 tent that he'd been. I mean, it was an expensive outdoor operating theater. A really nice tent, fine, okay. So, but I mean, he was really gaining a lot of, a great reputation through all of this.

Like, people, he was widely respected and his work was good and students enjoyed learning from him. He was incredibly popular among the professors. At the time, if you were a professor, you would hold what was called a quiz. And I don't mean like a quiz, like a test. I figured you would say like, we all know what a quiz is. We do all know what a quiz is.

I just want to jump on that before you give me a hard time. Back then, a quiz was like, if I had a quiz, it would be follow me around and you can watch me do things and help me do things. And I'll have lectures sometimes and classes. And it would be Sydney's quiz. Well, I'd probably go by Dr. McRoy's quiz. Dr. Sydney's quiz.

And so his quiz was the most popular. All the students wanted to learn from him, all the doctors in training. He was really hands on, and he was just, he was a very interesting lecturer. And so he built up this great reputation as a teacher and a surgeon, and he had boundless energy to do these things.

It was noted over and over again, like, this guy never sleeps. He, I mean, his lectures are so engaging and he just talks and talks and talks and then he goes and does surgery for hours and then he's up the next morning first thing and there was just, there was a lot of commentary on how to get the airship. What is the catheter? Shit. And this probably is because on October 11th, 1884, we know the date, I think it's interesting,

we know the date, he read an article in a medical journal. This is very well documented. He read an article about some recent discoveries in ophthalmology with a brand new anesthetic. And he was reading this article about how much success they'd had using this anesthetic in different procedures on the eye. And the author said it would be really interesting to see if this new anesthetic could be used elsewhere in the body, because I think it could, but that's not really my thing. So like maybe somebody else wants to try the anesthetic other places in the body, I think

it could be good for like paralyzing peripheral nerves, so like you could inject it into your arm and your arm would go numb if you hit the right nerves or your leg, that kind of thing. And I think you should, I think somebody should try it. So anyway, Halstead was like, I love this, I'm that guy, I'm gonna do this. I'm gonna do it. What do I need my hands for?

I'm just a surgeon, let's go. The medicines, the medicines, that ask you let my God before the mouth. So he got this new anesthetic, he got a team of students, and he's like, let's inject this everywhere on ourselves because they did on themselves. It was all self-experimentation to see if it works. And I mean, it was hugely successful. They were able to paralyze just, you know, this, or they were in a numb, just this finger,

just this part of your leg or whatever. And this was revolutionary like as an anesthetic for surgery. Like, this is great. We can use this and numb anything and do procedures and the patient won't feel any pain and we're so excited. And I want to read you the first sentence from the paper he published about his experiments because I think this will kind of inform what this new anesthetic was. So this was a published scientific paper.

And this is the first sentence. Neither indifference as to which of how many possibilities may best explain nor yet add a loss to comprehend why surgeons have. And that's so many, quite without discredit, could have exhibited scarcely any interest in what, as a local anesthetic, had been supposed, if not declared by most of very sure to prove,

especially to them, attractive, so I do not think that the circumstance or some sense of obligation to rescue fragmentary or revutations for surgeons rather than the belief that the opportunity existed for assisting others to an appreciable extent induced me several months ago to write on the subject and hand the greater part of a somewhat comparable paper which poor health doesn't climb me too complete.

So, so he was on Coke. Yes. Okay. The new anesthetic was cocaine. Okay, cocaine. And these doctors and students had injected themselves with cocaine for a while, and then they all became addicted to cocaine. And then they published this paper that was written on cocaine. It's was written on cocaine and written on cocaine.

And it's funny because if you read any commentary on it, they all say like, it's incomprehensible. It's all like that. The whole paper is like that. And what you can get from it is, I think cocaine works. But also, there may be some problems. I have some concerns. I don't, if you're in any field where you have to publish in journals, you know that this was submitted and published and you think, what were papers like then?

I like it. It's like, you know, I don't get it, but somebody out there will. It's not my thing, but... So, so when you look into the rest of Halstead's career, things, some strange things happen from time to time. And this was probably the turning point. At one point, he actually performed surgery. It was a groundbreaking surgery.

It was one of the first gallstone removal surgeries that he didn't remove the patient's gallbladder. He actually went in and cut a hole in it and took gallstones out to help the patient's gallbladder, he actually went in and cut a hole in it and took gallstones out to help the patient who had blockages because of those stones. And the patient was his own mother, and he did the surgery at 2am on the kitchen table in her home. Whoa! She was fine.

It worked, and she survived, and he said, I did one of the first gallbladder operations in the US, which was great, except it was definitely on your own mom on your kitchen table, man. I did it and I did it at my mom's house. Okay, this is great. I could have never done this on the incredible power of cocaine. I would have definitely second-guessed myself at some point.

Now, he did realize that this was becoming a problem. And his first instinct was to try to treat himself by taking a long sailing trip with only enough cocaine to get him through half of it. There, okay wait. He could have taken, here's what I like, if he had gone completely with that cocaine, he would have gotten two hours in and be like, actually I don't want to do this. I've changed my mind, I'm going to go back to Sher where I can find work okay. He got enough cocaine to get where I can fight work okay.

He got enough cocaine to get himself out. I love that. But then it did not go well. He ended up, they had like, there was like an emergency medical chest on the boat and he ended up rating it and finding both cocaine and morphine in it, enough to get him back to shore. OK.

That was short-sighted, I will say on his part. And the bigger problem is that then when he did seek treatment to actually go to rehab for cocaine, at the time the most popular treatment for cocaine addiction was, in fact, morphine. Lots of morphine. With the thought that maybe we'll just get you on this instead.

And so what results, which was the typical result at the time, is that you were addicted to both at the end. So. All right. And at this point in this story, this maybe why, like he's not, maybe everybody, he's not remembered in the annals of New York Hall fame, history, at this point New York was kind of done with them.

A lot of people are like, listen, we don't know what you're up to, this paper is, it's really worrying people, and you did surgery on your mom on a table. We love the clean hands thing. Yeah. So big on that. I'm gonna keep that.

I love that. But don't you have some friends in Baltimore? I heard you had some connections there. Just scooch on over to Baltimore. And why don't you hang out there? They've got this new, like, hospital school thing they're trying to set up called Johns Hopkins. They could really use some help. Go help them. And we'll just call it a day, which is what he did. And the rest of his career

he actually spent in Baltimore helping to develop all kinds of new surgeries at Johns Hopkins. And he did a lot of amazing things there. He developed brand new procedures for Inguno Hurnier Repairs. And he did the first radical mastectomy where he had to remove for breast cancer, had to remove a breast, and all the tissues around it underneath it. And it was at the time a revolutionary procedure.

So again, he's developing these amazing techniques and surgeries and teaching everybody, but he's still at the time, his documented is using cocaine and is using morphine really regularly up to the thought is, and I mean, it was different units of measurement at the time, but he was maybe using up to 200 milligrams of morphine a day. Whoa. At this point. Someone's applauding. I'm 200 milligrams of morphine a day. Whoa. At this point.

Someone's applauding. I'm assuming you're morphine sales. Oh. You got somebody from Purdue in the crowd. You're like, hey. Purdue. Come on. So anyway, and to get a sense of his personality, because if you look at this point in his history,

he really, he kind of changed a lot from this like when you hear about his life in New York, like he was, he would go out and like hang out with people and he was well known and like this kind of gregarious character. And then he became a lot more like distant and cold and orderly in his life in Baltimore. He was a very meticulous dresser. I love this point. He would wear these shirts that were made in Paris. And he would only send them back to Paris to have them laundered.

Wow. So you're saying a lot of stinky shirts for this guy. He didn't believe there was anywhere in Baltimore where they could properly launder shirts, and only Paris could do it. He would have, they rarely entertained at his home because he was so meticulous about his dinner parties and about the menu and about like all of the place settings and all this stuff that it became just overwhelming for like his wife and the staff and everybody.

And he would spend hours out in his garden with his dalleas and he was very meticulous about all these things. And if you read some of the comments, we have comments that he wrote on billing that he did like for patients like he'd go and do a surgery and then he would build them and he would write little notes like his own personal feelings about the patient or the procedure or whatever.

And there are things like very wealthy, outrageously small bill. He examined a child who had in large lymph nodes and at the bottom of the bill he wrote, a terrible kid, consult $50, at least one hours torture by child. And then things like, on other ones, he wrote, terrific operation, also highly dramatic, electric lights gave out, lamp nearly exploded and set house on fire. Patients stopped breathing, artificial respiration,

inexperienced assistance, ether gave out, because ether riser had so as fixated patient, he got neither air nor anesthesia. Life of patients saved, $500, should be $5,000. So, he's got to be a little bit more patient. And in his life in Baltimore, he also found love. And this is a very solvon's love story, I feel like.

So I've mentioned that he, that antiseptic technique was a big part of his, you know, that was his thing. And that was one of the things he went around pushing and like getting other doctors to accept and his colleagues and students. And that plays into this love story. I know that sounds weird. But but Carolyn Hampton moved to New York

to enter nursing school against her family's wishes. She started working at New York Hospital in 1888, and then she also moved to Baltimore, so it followed kind of the same path as Halston, and she moved to Baltimore, and when she was there, her personality kept bristling up against a lot of the other nurses and she actually was in danger of losing her position except Halstead kind of, I

think he'd taken a shine to her. So he kind of swooped in and said no she's going to be the chief nurse now. So she's just going to tell you all what to do. So you can't fire. And after he did that, he actually started working together a lot. She would like assist him in the OR. And because of his antiseptic procedures at the time, it required that before you would like touch the patient or touch instruments, you had to put your hands in mercuric chloride every time. And this specifically to Ms. Hampton was damaging her hands.

She was developing a terrible dermatitis because she kept having to put her hands in this stuff to follow his procedure. And he didn't want to lose her in the OR. So he went to the Good Year rubber company and asked them to make these very tight, fine, thin, fitted rubber gloves for her to wear in the OR. And this was the first time anybody ever wore rubber gloves during a surgery. And I guess it was, so one, he introduced the idea of wearing gloves in surgery this way, and two, he wooed her with these great rubber gloves, and she was so flattered, they later married. So, that's love.

I mean, you never give me rubber gloves. That's, I mean, that's not, yeah, I mean, well, that's inarguable, I guess, it's your, I mean, that's not, yeah, I mean, well, that's inarguable, I guess, did you? I mean, yeah, that's true. I mean, in our younger days, obviously. So, as Hall said, got older, he became less interested in the teaching part of his job. And he was still, like I said, he was working at Johns Hopkins, and he was supposed to be not just doing surgeries, but training and teaching.

And he more and more just wanted to spend time in his garden and spend time at home. He would take these extended summer breaks, which you don't really get from like most jobs, from like surgery jobs. You don't get to like take the summer off and be like, just take care of the patients, I'll be back at the farm. Don't worry, it's fine. But he would, he would go down to South Carolina where they had a farm for the whole summer and just not take care of his patients and let the students do it. And he, through this, he developed this idea that maybe it was a good idea to give your students

and your young doctors in training a little more independence, you know. Maybe we don't give them enough responsibility right now. They go from medical school to like an apprenticeship thing and then their doctors, but maybe there should be something in between where they have like a graduated system of responsibility where they start out and they, you know, they're told what to do a lot, but then eventually they know enough where they can just run things on their own and they're attending the doctors and charge of them can just, you know, hang at home. Take calls from there, maybe go to the farm for the entire summer.

So he wrote all this out and introduced this idea in a lecture at Johns Hopkins and said, I think we should have something that I'm calling a residency. And basically it was his way of not having to go to the hospital. And this was the structure of residency. Residency programs are based on William Holstead. Not wanting to go to work. Not wanting to go to work. I love that.

And then I'm here to announce the podcast residency program. And this really, like, in case you're not familiar with residencies today, this is very much how it works. And the whole idea was that the chief residents, the more senior residents, would teach the younger ones and would supervise the younger ones. And, you know, we really, we want to keep us as the doctor's already known.

We just want to stay out of their way, let them learn. They need some independence, they need more responsibility. And that spread all over the country. And now that is how residency programs work today, although I will say it's an attending in a residency program. Like, I don't go take the whole summer off. I don't go to a farm in South Carolina. I do go to work.

But he developed residency programs. He knows it's interesting. We've covered a lot of this guys' accomplishments. I don't go to a farm in South Carolina. I do go to work, but he developed residency programs. You know what's interesting? We've covered a lot of this guys' accomplishments. And one sentence I've yet to hear you say was, and so he stopped doing so much cooking. It is, so his closest, if you read, there are lots of different biographies you can read

if you're interested in knowing more about him. He's a character of much interest in history. That's why there was a character in a TV show based on him because he had this kind of complicated story. If you read some of those biographies, there are a lot of people who I think want to believe that he at some point stopped using cocaine or morphine or one and the other or both, but his closest friends wrote, no.

We know he never did. So as far as we know, that no. He didn't. Okay. But then he... It's a little weird note to end on, but... Well, no, because then later he got to be played by Clive Owen on a show on Cinemax.

So you're saying there's really no downside to the truck use. Okay. There you have it folks apparently. That's it. Anything negative as a result of the rampant truck you eat that you can give me. Folks we've had so much fun here tonight. Thank you so much for having us. We will be, we're going to take a quick break, come back with my brother and my brother and me. Thank you to the taxpayers for these works on the medicines as the International Program. You may be able to find in and outside some copies of the solbos book written by us illustrated by Taylor Smirl, you go buy them if you want and that's gonna do it for us for this week. Yes, Ed? That's it. So until next time, my name is Justin McRoy.

You're Sydney McRoy. And it's always don't draw a hole in your head. Alright! Maximumfun.org. Comedy and culture. Artist-Oant? Audience-supported. Comedy and Culture. Artist-owned? Audience-supported.