Everyone who speaks of Dr. Halsted now makes the remark that it would be extremely difficult to give to anyone who did not know him, an adequate impression of the man. Indeed it seems impossible. His was such an elusive personality, so hidden in his habitual reserve and so hedged round with the formality of his manner, that few knew him well. Those who had his friendship often found him more companionable and, for a few, he was delighted to be on terms of complete intimacy and vivacious conversation.

In his later years he was almost bald, and wore a moustache which hung down, and a little tuft of gray hair on his lower lip. It was quite obvious that he was very short-sighted, and his ears projected to such a degree that he had finally become insensitive on the subject, and was known to have joked about it. He was not very tall, and his powerful shoulders were a little stooped. He walked with deliberate, measure tread, and his arms were held bowed out a little, which gave the impression of great muscular strength. He had not in the least a roving glance, but walked along, especially in the hospital corridors, completely inattentive to persons he met, and looked up in surprise if someone spoke to him. Then he would smile and his face relax in a curious way. At the beginning of a conversation that might ensure he was apparently completely unfamiliar with the situation, and at once was plunged in profound concentration upon the topic and the person who addressed him, oblivious of everything and everyone about him. His formality and extreme politeness hampered the other person a good deal, and the interview finally ended in the same key. With Dr. Welch or Dr. Mall, or others of his intimate circle, it was quite different - one might even detect in him a little dancing step and bright attention, eager to miss nothing of what might be said.

I, who, because of my admiration and affection for the man, write this, was privileged to know him pretty well, after many years of more remote acquaintance, partly through dining alone with him at the Maryland Club, evening after evening in the spring and autumn when Mrs. Halsted had gone to the mountains, and partly through his frequent visits to the Pathological laboratory, where he would sit and discuss his experiments. Then too there were the evenings when he and Dr. Welch and Major Venable and perhaps one or two others talked together, and I was there.

He smoked a great many cigarettes, but never, so far as I can remember, a cigar or a pipe. In his conversation, caution was always evident. He never pretended knowledge of anything - rather it always seemed that one who made any assertion, not directly supported by trustworthy evidence, was treading on thin ice in his presence, because it was so possible that he was really much better informed. This part of his habitual reserve, and he even spurred such conversation by asking questions and expressing his interest. What he knew, he knew very precisely and in great detail, and for any new thing that bore on those subjects that he made his own, he had the most eager attention. But he was not a man of very wide reading or very broad interests. He had nothing of Dr. Welch's omnivorous appetite for books on every topic, and seems to have discovered with astonishment that there was something interesting in the popular novels which Col. Garrison lent him. He was not interested in poetry nor in general literature, nor did he care for painting or sculpture, although he was not entirely indifference to picture galleries and had even picked up two or three old pictures. In the matter of antique furniture and old rugs he was expert, and, as we have said, his house was full of wonderful examples. He occasionally went to symphony concerts, but it does not appear he knew anything about music or that it made much appeal to him. He really enjoyed the theater, and, in the earlier years before his marriage, often went with Dr. Welch and had much to tell about the plays he had seen in Vienna and Paris. His conversation touched on many subjects, but he was perhaps most at ease when talking about his own world of surgery or about his various hobbies, or about people. He was extremely critical of behaviour of people, although not in the least intolerant or narrow. He merely enjoyed uncovering their motives and their foibles, and hitting them off in phrases as neat as possible. About worldly affairs, money matters, investments, the stock market and business of all sorts, he was very naive. Mr. Edwin Baetjer, his lawyer said that "the gulf which separated his higher intellectual capacities from the ability to understand or deal with the business or ordinary affairs of life, was unfathomable."

Everyone speaks of his wit and the sharp repartee with which he scored so instantaneously in an exchange of pleasantries, and it has already been pointed out that the difficulty of recalling this is almost insuperable. The examples that various people remember have lost all their savour, through separation from the pungency that his manner gave them. He was witty and sarcastic nearly always, that is, with comments that exposed the frailties and self-sufficiency of someone and left him deflated like a punctured tire. But it does not seem that he was humorous, nor that absurd exaggeration or sudden incongruity were natural fun for him.

In the strain and sudden emergencies that so often come in the course of surgical operations, he was perfectly imperturbable, and his sang-froid and real courage cannot be doubted. This extended to his every-day habit, and he was never disturbed or unduly excited in any contretemps.

In his visits to the Hunterian Laboratory, where he spent so many hours in experimental work, he frequently came over to the half of the building then devoted to experimental pathology, and spent some time in discussing his results and his plans for further steps involving his problem, or even the question of the problems themselves. One day, impressed by the number of these that crowded into his mind, he said that it would be impossible for one man to pursue them all to the end, and that it might be well to publish them as suggestions, so that others might work to solve them. His notebooks are full of these suggestions, most of which he never had time to follow out. But, really, he was not very imaginative, and his thoughts did not soar very far ahead into the unknown. Instead he had great tenacity and persisted with experiments intended to clear up the same old problem for ever so long, and even then he was generally left without a very satisfactory solution. This was perhaps because the experiments ended in gross anatomical or physiological results. The outcome of the surgical operations, as such, could be relied upon, but he had to depend upon others for the histological studies or the measurement of blood pressure, for example, above and below the bands he applied to arteries. Chemical or more exacting physical methods did not come within the range of these experiments.

There has always been dispute as to Dr. Halsted's ability as a teacher, and something has been said of this before, but few realized the extraordinary contrast between his attitude as a quiz-master in New York, and his later method in Baltimore. In his New York quiz he appears to have been a master of systematic instruction, absolutely familiar with every detail of the textbook, and rigidly insisting upon accurate knowledge from his students, for theirs was the task of passing examinations. He was regarded as a most able teacher in those days, although sometimes he would spend a great deal of time on some point that held a special interest for him, to the growing impatience of his class. In Baltimore he completely abandoned this method. He never lectured nor held a formal quiz, but in his clinics he would treat of a subject as exemplified by the patient, generally bringing out what he wished to demonstrate by leading one of the students to discuss the case, point by point. This may have seemed to the rest a rather laborious proceeding, unless that particular student chanced to b especially apt, but, as one may gather from one of these clinics reported in the Johns Hopkins Bulletin by Dr. Reid, it was a most instructive process.

He prepared himself most carefully beforehand, and consulted assiduously all the literature that bore on the condition to be brought before the class. It was indeed a most elaborate performance, and such as would prove far more inspiring to an audience of elder surgeons than to student beginners, because he grew so deeply interested in the several subjects which he preferred to show in his clinics that hi discussion tended to be over their heads.

Quite different from this, and immensely effective for those who could come into more intimate contact with him, was his example. For those who he actually trained, his consuming interest in the problem that held his attention, his enthusiasm, his thoughtfulness and inventiveness and his optimism as shown in his unflagging zeal in tracking down every bit of information that could hep to solve the riddle, his tireless energy in trying and trying again ever new experiments or repeating the old, together with his willingness to scan the literature back into the dark ages, formed a stimulus which changed their whole characters and drew them into another kind of life in which these things stood out in a new way as the real motives. Not many men can do that to a young man-it is not a question of instruction but rather of instpriation, and it is not through any plan, but merely that it is granted to that young man to see what forces are at work in his master. No other is comparable with this, or can it be imitated. It is transparently honest, else it is completely impotent, and it is inborn and cannot be cultivated. But there are few such men in the world.

When the "full time" plan was being discussed, he devoted a great deal of though to it, and even formulated his ideas in writing, although it is not clear that he ever pressed them in any debate. On the whole he regarded the plan with warm favor. For himself he thought it made little difference, financially or otherwise, so that he could consider it impartially. It seemed to reduce itself largely to the question of money, and he realized that there are men who need stimulus of moneymaking to compel them to work, but that these are not the desirable men. "We wishmen," he said, "who have learned to work for work's sake, who find it and in the search for truth, their greatest reward." "Students ape their teachers. The type of man who stimulates investigation is the best. Some of our greatest clinics yielded men of consequence or fertility." But for himself, he eagerly accepted the new conditions, and the staff was reorganized on the new basis in 1913.

The effect of this new plan, in his case, was remarkable, and evidently clearly realized by him, since he hints at it more definitely in another address. It was, not only for the active prosecution of hi experimental and other studies, but more especially for the vigorous encouragement of his assistants, in succession, to work with him, intimately associated in the effort to solve the problem. This feeling seems to be the basis of the flare-up in his activity, which became really intense about this time, although it is true that he had begun to work on the surgery of the thyroid and of blood-vessels before this. The new plan released from much routine operating, and gave him leisure, and it seems that he was one who worked to much greater advantage when he had leisure. This change was comparable in one sense with that mentioned long before, when he exchanged the strain of excessive work in New York for the leisure of Baltimore in the early days before the hospital opened. It may be objected that he always took leisure during the most active time of work in the hospital, either assigning patients to his staff for operation or leaving town for long vacations, but liberty, after all, is a matter of feeling, and not of actual moments available, and under the new plan he must have felt more completely justified in devoting himself to the development of the scientific aspects of surgery rather than to the familiar operative routine, when there were so many masters of operative surgery on his staff. At any rate the result was far more intense study of the problems that confronted him, far greater intimacy with his chosen assistants - a wonderful opportunity form them which not one he failed to grasp - and incidentally an enthusiastic return to the course in experimental surgery, which he now conducted, since Cushing had left. It seems that it was during these years that his assistants really became his disciples and ultimately his fellow workers, in a way hardly enjoyed by those who came before, and this new attitude of intense interest in the development of the men of his staff became, more and more, his preoccupation, until at the close of his life he looked back upon that long line of able surgeons as his really great contribution - greater than all he had done in his own surgical work. He was very proud of them - they worked intimately with him, and some of them wrote long papers, and sometimes, although he had contributed the ideas and often most of the drudgery of searching the literature, they failed to mentioned his interest. This may have hurt him, but he never said anything about it. Most of these men have already come to occupy prominent places in American surgery, and it is with them a matter of pride to be members of the Halsted school.

He was most conscientious about answering letters, although so frequently his replies began in a rather stereotype way - "I am mortified to find that in some way your letter has sifted down to the bottom of a pile and his remained so long unanswered." In the early days he always wrote with a quill pen, with the result shown, but later he used a fountain pen so that his writing bedamse far more legible. At best he was not a gifted letter writer; his letters are very courteous, rather excessively polite, and always a little stilted and formal, without any abandon or play of imagination. It is unfortunate that none of his letters to Mrs. Halsted are preserved. It would have been most interesting to read a letter written when he was quite off his guard. One wonders what sort of letter he wrote in answer to that long one for her which is quoted earlier in this book. Probably "H'm, that must have been interesting." His letters to his sisters and to some of his intimate friends are less guarded, and often in French, but one feels sure that he got someone to write them for him, for he never conquered French, although he was fluent enough in German.

Always, and perhaps especially in his later years, Dr. Halsted was a devotee of the dictionary, and particularly of the Century Dictionary, where he studied also the derivation of words. He was always intrigued by long and unusual words, and in one of his notebooks he has a list of uncommon expressions mistone, heuretic, comminate, pernicion and epinicion, heterophemy, nomogenist, and so forth, each Study of Goitre," " Reverdin anticipated Kocher by about one year, and appellate the train of symptoms myxdememe operatoire.'" In another place, "the dead space in the fornix of the axilla is subtended by the tightly drawn tegmen." Other words used as "deligate," "defract" and the "temerous" that so pleased Dr. Councilman, are to be found in his favorite Century Dictionary, and are perhaps only very old forms, not much used nowadays.

But his particular delight was in coining words which he afterward used confidently, indignant when, for example, the Germans failed to understand exactly what he meant by "ultraligation" in describing his operation on the thyroid. Several letters to Kocher, de Quervain and others, complain of the misinterpretation by German surgeons of this word, apparently little realizing that a foreigner might not grasp at once that it meant "ligation of the thyroid artery at the point beyond that at which the branch to the parathyroid glands is given off." Later he seems to have abandoned this technique, ligating the inferior thyroid artery near its origin, and with this change the word should disappear, since it still causes confusion.

He was very precise in all his references to articles and books in medical and surgical literature, and in his quotations, and never ventured the slightest reference without consulting the original. This is only another instance of his honesty, for so many writers, in their hast, perpetuate the errors in references to literature which have been repeated by one author after another.

Everyone who wrote to acknowledge the receipt of reprints which he had sent seems inclined to compliment him on his style. It is true that he bestowed infinite labor on the composition of his papers, and his manuscripts show as many corrections as did those of Robert Louis Stevenson. But it seems to me that the end result was still very labored and difficult to read.

Dr. Halsted was greatly impressed with the idea of the importance of an adequate library for the Johns Hopkins Medical School, and made great efforts to interest those who might assist in its development. He did not live to see even the beginning of the splendid building which is now completed, nor of the new Department of the History of Medicine with Dr. Welch as Professor, but his extensive collection of books and journals on surgery and the history of medicine have, through his will, come to enrich the library, and it is pleasant to think that his interest has been of influence in the fulfilment of this cherished plan.

He was never inclined to public appearance in any capacity, and genuinely shunned and abhorred the publicity which seems to be the breath of life to many great men nowadays. It was probably for that reason that he was not showered with honorary degrees and titles an corresponding memberships in foreign societies. He was the recipient of some of these honors, but they were comparatively few, and such as must have been conferred in real recognition of his great contributions to the science and art of surgery. For example, he was made Honorary Fellow of the Royal College of Surgeons of England in 1900, and of Edinburgh in 1905. In the same year he received the Honorary Degree of LL. D. Form Edinburgh, and a similar degree had been conferred by Yale the year before. In 1904, too, he was given by Columbia the honorary degree, Doctor of Science. He was pleased to have the LL.D. degree from Yale because if was conferred at the special request of his classmates. Dr. Gilman, then President of the Johns Hopkins University, wrote to him as follows on this occasion:

OVEREDGE, NORTH EAST HARBOR, MAINE, July 1st, 1904. My Dear Halsted,

It was delightful to see your name among the honor bearers at Commencement. Such a recognition from one's own college on such an anniversary is priceless. All your colleagues in Baltimore will join, I am sure, with your professional friends, far and wide through the country, and with your personal acquaintances in rejoicing that the honor has fallen upon one who seeks nothing for himself in the way of recognition, but devotes his rare gifts to the relief of suffering and the postponement of the inevitable. I am glad that the character and abilities which we know so well in Johns Hopkins, have once more received conspicuous honor at a distance. With kind regards to Mrs. Halsted,

I am ever sincerely yours,

DANIEL C. GILMAN

It was a matter of great pride with him to have been elected an honorary member of the German Surgical Association in 1914, and, as it seems, he took pride also in his election to the National Academy of Sciences in 1917, an honor rarely conferred upon practitioners of Medicine. He was honorary member of a few foreign medical and surgical societies and of several in this country. The American Surgical Association he served faithfully, attending their meetings regularly, even in the most remote places, reading papers and taking part in discussions.

Dr. Halsted usually left town in May and returned in October, but no one seemed to know where he went, that is it was his invariable custom to spend some part of the time at High Hampton, but whether he went abroad for a time or not was uncertain. There are notes of a trip in 1905, but no trace of one that he made in 1900 when he saw Cushing in England. He did not always visit friends when he went abroad, and in later years it was the same. Dr. Osler writes, in 1911, "I have not seen the Professor"; when over here he keeps in seclusion in a very funny way" (Cushing, vol. 2.). He was certainly in North Carolina during part of the summer of 1900, but probably spend a short time in England or France in this as in each of the other summers before going to High Hampton. He delighted in brief periods of complete seclusion, and Dr. Welch tells me that he often went to some small place in Brittany, where he could be quite alone. In Paris, he would spend weeks at the Hotel Continental, avoiding all acquaintances, and entering unobtrusively through a side door. When he went over to London, it was only to escape to some hotel in Brighton or Folkestone, where he kept to his room and read, undisturbed by any bank holiday atmosphere. Once he wrote from the Hotel Metroppole, Folkestone, to his secretary, Miss Stokes, "This is an ideal spot. En route form Bonn, I have been here a week, unable to tear myself away. Go to bed at ten punctually and sleep unusually until six. My corner room on the fifth floor has an unobstructed view of the ocean in front, and the downs on the side. At night, I can see vividly the flashlights of two lighthouses on the coast of France, 27 miles away. On a clear day one can see the French coast, and steamers and fishing boats are constantly in sight. I have a soft coal fire constantly, much to the amusement, I fancy of the servants, who do not quite approve of the combination of open windows and a fire, when the thermometer registers perhaps 60 degrees, and they are complaining that it is ot."

In 1905, he made a more extended trip visiting Schede in Hamburg, various clinics in Berlin, Terrier in Paris, etc. His notebook gives an exact account of his expenses, most of which seem to be for cabs.

It was on this trip that the wonderful picture of the "Four Doctors" was painted by Sargent, and their experience with that genius are too well told by Cushing to allow of any repetition. The individual heads were photographed separately from this picture which now hangs in the new William H. Welch Medical Library, and such was the photograph which Dr. Halsted sent when anyone succeeded in begging one from him.

It was in this year too that he visited Edinburgh and received two honorary degrees, and there he met a distinguished German surgeon and invited him to dine upon their return to London. Then he was seized with apprehension as to what the surgeon would wear, and such as his nicety in all matters of the sort, that he arranged one dinner at the Carlton and another for the same hour at Simpson's in the Strand. When they met and he found that his friend was attired in a dinner coat with a red and yellow tie and gray check trousers, they went to Simpson's.

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