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technique, use of the animal lab, and Billroth’s concept of surgical training left their mark on young Halsted. They would all resurface at Johns Hopkins a decade later.
    IN THE SPRING of 1879 Halsted left Vienna to study embryology in Wurzburg, and then went on to Liverpool, where he would join his parents and siblings and travel with them for the summer. Halsted looked forward to the reunion and the respite from constant study. With his father’s permission, he invited Samuel Van der Poel to join the family traveling party. The trip was a great success, and by summer’s end Van der Poel had become engaged to marry the youngest Halsted daughter, Minnie.
    Returning to Vienna in the fall, Halsted continued his studies with Richard von Volkmann, another proponent of aseptic surgery and a pioneer of joint and extremity surgery; Johannes Friedrich von Esmarch, a German military surgeon who instituted training in first aid for civilian and military personnel, and introduced the use of the first-aid bandage on the battlefield and a surgical tourniquet that allowed a bloodless field for extremity surgery; and Karl Thiersch, who is credited with having invented skin grafting. All three surgeons are still known for work they did more than 100 years ago. On his two-year learning tour, Halsted had yet again managed to find himself in very accomplished company.
    He took up residence with two other men in a boardinghouse, where they took their meals. The arrangement forced them to speak German all day. Although he never mentions women in his journals and letters home, he referred to his Vienna housemate, George Dixon, as a very attractive man who became involved with numerous women and whose charm opened many doors for the trio.
    Another American friend who had joined him in Leipzig soon fell ill with typhoid. One day Halsted was called to see him by the attending nurse, who anxiously reported the patient’s pulse had risen to 200. Halsted was stymied. His friend looked well enough, and his pulse was quite normal. Apparently, the nurse, who didn’t have a watch, held his wrist to count pulse beats while the patient was instructed to count out loud to 60, to determine the number of pulse beats in a minute. His German was halting and he counted very slowly. Halsted later commented, “This was beyond his powers and I have never understood why the nurse stopped counting at two hundred.”
    The final stop on the tour was to study with Karl Thiersch, who introduced the split-thickness skin graft in 1874. Halsted found most of Thiersch’s operations “minor,” and knowing that his friend Frank Hamilton of Bellevue had been performing skin grafts for years, he was unimpressed.
    In early September 1880, Halsted sailed for New York, ready to begin his career.

1 Some evidence exists that the Halsted charts were abandoned shortly after his tenure, though they do show up later, both at the New York Hospital and at Johns Hopkins. Others believe that the now ubiquitous bedside chart is the direct result of Halsted’s innovation.

CHAPTER FIVE
New York
    THAT SEPTEMBER, HALSTED WAS 28 years old and in physically fine shape, though his muscular upper body was perhaps a bit broader from two years of heavy dining and little or no exercise. His fine, light hair, now thin to the point of baldness on top, was cut short at the sides, further accentuating his prominent ears. No longer clean-shaven, he sported a close-cropped beard and was, as always, immaculately groomed. He was charged with energy and ideas, and couldn’t wait to get to work.
    Not fully accepting the need for the carbolizer, or the idea that the danger of germs was in the ambient air, Halsted and a colleague worked hard to modify Lister’s technique and institute the scrubbing and chemical decontamination of hands and tools before operating.
    He renewed contact with his medical school preceptor, Henry Sands, who invited him to join his practice at Roosevelt Hospital. Sands was an