Thomas Eakins remained at his home on Mount Vernon Street until he died there in 1916. Although the Pre-Raphaelites he despised slipped from public acclaim, Impressionists did not. Art continued to retreat from realism and, with the rise of abstractionists like Picasso, Eakins saw his reputation wane even further. After the Lachtmann affair, Eakins devoted himself almost entirely to portraiture. He could not hide his bitterness, however, and his subjects were almost always rendered in an unflattering light, often as much older than they were. In desperation, he even attempted to incorporate some of the modernists’ techniques into his later paintings, but was nonetheless no more than a footnote in American art at his death. Susan Eakins still lives in Philadelphia, an indefatigable champion of her husband’s work. Whatever Eakins’ faults, I can only hope that one day his great talent will finally be appreciated by a nation that has spurned him.
Mary Simpson never married. The Croskey Street Settlement House thrived and became the model for similar institutions. During a speaking engagement in 1912, Mary was approached by a woman who claimed to admire her work greatly, and sought to create even more progressive enterprises for women. That woman’s name was Margaret Sanger. I corresponded with Mary from time to time, and I hoped that we would always think of each other as friends. She died peacefully of congestive heart failure four years ago, surrounded by friends and admirers. I can only hope that when it is my time, I will be so fortunate.
Haggens, despite both his style of life and his heart condition, lived for another twenty years, although Mike was shot to death in front of The Fatted Calf not six months after I left Philadelphia. Sergeant Borst was indeed promoted, eventually to captain, and he was a mainstay of the Philadelphia police department until his retirement in 1915. As far as I know, he still lives in the city. Jonas Lachtmann returned to California, where he had gotten his start, just after the turn of the century. I was more than a bit anxious when I learned that we lived in such proximity, but Lachtmann was never the same man after 1889, and he preferred to ignore me than revisit the tragedy of his daughter’s death.
I kept Abigail’s portrait of me, not as a reminder of the man I wished to be, but rather of the sins of pride and arrogance that I wished never to repeat. I dedicated my life to atoning for my role in the death of George Farnshaw although, for quite a while, despite my wife’s assurances, I felt that I never would. Then, ten years ago, at Christmas dinner, I looked around at my family, and walked into the study to read a testimonial from the grateful citizens of Seattle that I had mounted on the wall. I considered the sum of my life, went to the attic, fetched the portrait, and threw it into the fire.
My life would have been very different, I know, had I accepted the Professor’s offer and accompanied him to Johns Hopkins. I would, as Dr. Osler predicted, have achieved wealth and fame; more importantly, I would have undoubtedly contributed, as he did, to the saving of thousands of lives. But among the many decisions of my life I might wish to rescind, that is one that I have never regretted. For in turning my back on the many, I believe that I saved myself.
AUTHOR’S NOTE
TO ADDRESS THE MOST IMPORTANT point first: The Anatomy of Deception is a work of fiction. There is not a scintilla of historical evidence to suggest that William Halsted ever committed murder. Nor is there any indication that he ever performed an abortion, although, in the thousands upon thousands of surgeries he did perform, many of them private, it is not impossible that he terminated a pregnancy or two. As to his continued drug addiction, however, and thus his susceptibility to blackmail, extremely persuasive evidence does exist, and it emanated from the unlikeliest of sources.
For the last thirty years of Dr. Halsted’s life, and for almost half a century after his death in 1922, it was assumed by the public, his students, virtually all of his colleagues, and certainly his patients that he overcame his drug dependency in the 1880s by sheer force of will. The three extant Halsted biographies, none of them scholarly (the last of which, provocatively titled Cocaine, Cancer, and Courage, was published in 1960), were written by friends, colleagues, or offspring of colleagues. Each extols the man for the indomitable will required to perform such a feat of self-control.
Then, in 1969, a manuscript Dr. Osler had written but instructed be kept sealed until fifty years after his death was finally opened. In this account, called The Inner History of the Johns Hopkins Hospital, Dr. Osler revealed that Dr. Halsted had remained a drug addict. The great surgeon continued to inject morphine—regularly and in large doses—during Osler’s entire career in Baltimore. (Osler left for Great Britain in 1905, but one can reasonably assume that after two decades of addiction, Halsted did not choose to go through withdrawal in his fifties.) Thus the many operations that Dr. Halsted performed—for which he indeed was sometimes paid more than $10,000—were completed while under the influence of opiates. According to the manuscript, only Osler himself knew of Halsted’s ongoing drug use, although Michael Bliss, an Osler biographer, stated Welch possibly knew as well.
The failure to speak out about Halsted was not the only incident in which Dr. Osler turned a blind eye to the malfeasance of a fellow physician. He also remained silent after an incident in Montréal in which a patient died as a result of a colleague’s obvious blunder. Dr. Osler reassured the other doctor that no one would remember the incident in six months.
The disclosure that, whether for altruistic motives or not, Dr. Osler would keep such secrets gave me the idea for this novel. From my research, I have no doubt that William Osler personally epitomized the very peak of medical ethics and was a man of exceptionally high moral fiber. Had he paid a price, I wondered, for ignoring the immoral acts of others in pursuit of the advancement of medicine and the betterment of mankind? Would he have reported Dr. Halsted to the police if Halsted had committed a crime under the influence of drugs?
The larger question, of course, is whether science must inevitably be willing to compromise ethics in order to achieve great and beneficial change. Medicine in 1889 was a science teetering on the edge of immense advances in curing disease and alleviating suffering. I believe we as a society are in a similar position today. Dr. Osler’s dilemma could easily be our own.
From a narrative standpoint, I strove to portray the personalities of both men as they were. Osler was affable and well liked, while Halsted, after his addiction, became sarcastic and aloof. (Despite the rumors, Halsted’s face in the Sargent portrait did not fade over time.)
I thought it crucial to get the science right, and thus all of the medical tradecraft depicted in The Anatomy of Deception is as historically accurate as I could make it, from the instruments used to the order of procedures. The autopsies conducted by Osler in the first chapter come from his own notes; the manner in which he examined patients in the ward and the discussion of a physician’s four compass points also come from life.
For dramatic flow, I did take minor liberties with chronology. Rubber gloves, for example, while first fabricated in 1889, were evidently not used by a surgeon until 1890. William Osler often had tea at the home of Samuel W. Gross before Dr. Gross’ illness, and thus was introduced to Grace Linzee Gross before she became a widow.
The art side of The Anatomy of Deception is also, I hope, substantially correct. Thomas Eakins did teach in Philadelphia, where he had a nervous breakdown, and was sent out West to recover by Weir Mitchell, who was at the time considered the preeminent authority on nervous diseases. Eakins remains one of the great controversial figures in American art, and he did pose frontally nude for his own photographs. His reputation plummeted with the rise of abstract art, but he was eventually rediscovered and is now considered one of the great painters in our history. His medical paintings and their impact are as described.
Once again, for smoothness, I made some changes. Eakins, for instance, did not convert the top floor of the house on Mount Vernon Street to a studio until after his father’s death in 1899. From 1884 until that year, he worked out of a rented studio on Chestnut Str
eet.
While Reverend Squires and the Philadelphia League Against Human Vivisection are fictional, there was great resistance to autopsy in 1889, and all the machinations necessary to secure cadavers are as they were. The Blockley Dead House was as described, and the attendant was an Alsatian whom Osler nicknamed “Cadaverous Charlie,” who had indeed been caught on more than one occasion drinking from the specimen jars. There was an exhumation in which a corpse was discovered to have three livers. Although Wilberforce Burleigh is fictional, his surgical techniques are not. More surgical patients died of shock and blood loss than of illness in 1889. Cesarean section had a mortality rate of 80 percent.
The notes from Wright’s experiment and the animal tests afterward are taken from the journals, and all the details of the development of heroin are accurate. While there is no specific evidence of experiments at Bayer to acetylize morphine as early as 1889, the competition between the German chemical companies to develop drugs from industrial products was as described.
ACKNOWLEDGMENTS
I HAD A GREAT DEAL of help in completing this book, both in the research and the writing. For the former, I wish to thank Dr. H. Wayne Carver, III, chief medical examiner for the State of Connecticut, who took great pains to educate me on the intricacies of autopsy and the history of opiates and cocaine. Carol Fletterick, also of the medical examiner’s office, was consistently helpful and gracious in answering what must have been some pretty dumb questions.
Drs. Dennis Wasson and Greg Soloway both read the manuscript to ensure that I didn’t make any egregious errors in the medical sections, and Dennis imparted some wonderful anecdotes about nineteenth-century surgery. Any errors that remain are certainly mine and not theirs.
I queried any number of others. Christine Crawford-Oppenheimer at the Culinary Institute of America provided some terrific old menus and background on social mores of the period. Robert Eskind at the Philadelphia Bureau of Prisons filled me in on police procedures for the newly arrested. Beth Bensman at the Presbyterian Historical Society was an excellent resource on Philadelphia history, as was her husband, Martin Levitt, librarian at the American Philosophical Society. Toby Appel, head librarian at the Harvey Cushing/ John Hay Whitney Medical Library at Yale, unearthed some wonderful material, particularly Dr. Osler’s autopsy notes. John Rees, curator of archives and modern manuscripts at the National Library of Medicine directed me to some fascinating sources, including the Tiemann & Co.’s 1880s catalog.
On the editorial side, this book could not have been written without the indefatigable and insightful attention of my agent, Jennifer Joel. I simply have never experienced or heard of an agent who took more care with a manuscript. I am also indebted to Jenn for directing my manuscript to my editor, Kate Miciak. Kate’s vision for the book matched my own and she was patient, tireless, and thoroughly professional in nudging a sometimes reluctant author to continue to make the book better.
Finally, I want to thank my wife, Nancy, and my daughter, Emily. Each read the manuscript (in Nancy’s case, more than once) and was helpful and wise in her suggestions. But mostly I want to thank them for their tolerance, understanding, forbearance … and endurance. Living with me requires each of those traits and in some magnitude, and I am lucky to have them both.
Copyright © 2008 Lawrence Goldstone
Anchor Canada edition 2009
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Library and Archives Canada Cataloguing in Publication
Goldstone, Lawrence, 1947–
The anatomy of deception / Lawrence Goldstone.
eISBN: 978-0-385-67380-8
I. Title.
PS3557.O5317A84 2009 813’.54 C2008-906931-5
This book is a work of fiction. Names, characters, places and incidents are products of the author’s imagination or are used fictitiously. Any resemblance to actual events or locales or persons, living or dead, is entirely coincidental.
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