Genius on the Edge: The Bizarre Double Life of Dr. William Stewart Halsted.  By Gerald Imber, M.D. New York, Kaplan, 2010. Pages: 412. Price: $25.95.

To tell the story of Coleridge without the opium is to tell the story of Hamlet without mentioning the Ghost.

—Sir Leslie Stephen

It is well known that William Stewart Halsted (1852–1922) suffered addiction to cocaine. This biography emphasizes that the tragedy occurred early in his career during seminal work for nerve blocking in clinical surgery and dentistry. Carrying that awful burden for the rest of his life, the driven Halsted did much to create the modern university hospital and its operating rooms and residencies. Imber relates the saga beautifully. A nice sense is conveyed of the New York City, New York, and Baltimore, Maryland, environments during these exciting times. Although Halsted is remembered as a surgeon, anesthesia and surgery were not fenced apart in his day.

In the Prologue, a 30-yr-old Halstead performs “the first known operation to remove gallstones.” The patient on the kitchen table was his mother. A year before, he had performed “the first emergency blood transfusion,” pumping his own blood into his “ghastly white, quite pulseless and almost unconscious” sister. A titan stands before the reader.

In 1884, Karl Koller (1857–1944) announced that topical cocaine facilitated eye surgery. The same year, Halsted began blocking nerves with injected drug. Alas, the young titan was laid low in less than 12 months. The reader feels the incredible pain while reading Halsted's disjointed paper of 1885.

As much as possible, Imber lets Halsted do the talking. We read, “Neither indifferent as to which of how many possibilities may best explain, nor yet at a loss to comprehend, why surgeons have, and that so many, quite without discredit, could have exhibited scarcely any interest in what, as a local anesthetic, had been supposed, …,” and so goeth Halsted.

It is sad indeed to learn that Halsted never shook off the demon. It is hard to interrupt reading the story of a tortured but brilliant mind and indomitable will that regained its dignity and revolutionized surgical training and surgery.

Imber's account of the Halsted recovery from disgrace is fascinating. The reader can sense how Halsted inspired great loyalty and confidence in his potential. Banished to the “dog lab,” Halsted created what was arguably the most humane and well-run experimental surgery laboratory in the world.

Gerald Imber is a plastic surgeon writing for a general audience. He provides a vivid sense of many “larger-than-life personalities,” including those of William Welch, William Osler, Howard Kelly, Harvey Cushing, and Walter Dandy. His powers of description are compelling, and his carefully chosen words seem to let the monumental events speak for themselves. The book is a must-read for residents. The residency of the 21st century is evolving from that of the 20th, but it will be a long time before Halsted's imprint is no longer palpable.

Theodore A. Alston, M.D., Ph.D.

Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts.