A Casualty Of Cocaine

January 30, 1994|By Scott Shane

In his later years, the eminent doctor wore a tall silk hat, ordered his suits from a London tailor and his shoes from a Paris boot maker. In the fireplace of his mansion on Eutaw Place, he burned only hickory logs cut on his summer estate in North Carolina and aged at least three years. He was a dignified and meticulous man with a long, white mustache, pince-nez and the slightly reproachful look of a Victorian gentleman.

As the first surgeon-in-chief of Johns Hopkins Hospital, Dr. William Stewart Halsted had helped transform surgery from a brutal business for amateurs to a delicate science.

A founding father of Hopkins, Halsted had developed or improved operations for breast cancer, hernia, aortal aneurysms, thyroid and gallbladder trouble. He had pioneered the use in America of silk sutures, surgical clamps and rubber gloves. He had corresponded with the greatest medical minds of Europe, operated on the rich for mind-boggling fees and trained a generation of surgeons who preached his gospel all over the country.

And he had kept his astonishing secret to himself.

Only a few of his closest associates knew that as a young surgeon experimenting with anesthesia, Halsted had become one of America's first cocaine addicts. The habit derailed and nearly destroyed his career, sending him twice to a mental hospital before he finally managed to get off cocaine -- by getting on morphine. Fewer still knew that he took time each day from the busy schedule of a Hopkins Medical School professor to shoot up with morphine, probably to the end of his life at the age of 70 in 1922.

"He fell into this not realizing the effect it could have on his life," says Dr. Daniel B. Nunn, a Florida surgeon and historian for the Halsted Society, a surgical honor society. "He was a true victim."

Today, on some of the rough streets in the shadow of Hopkins Hospital, cocaine is sold around the clock. The wonder drug of a century ago has become a scourge. Young men shot in the drug trade regularly land in the surgical intensive-care unit in the hospital building that bears Halsted's name.

Theirs is a world one presumes would be unfathomable to the stiff, wealthy patriarch who worked at Hopkins a century ago. But Dr. Nunn, who is working on a biography of Halsted, says the surgeon understood the insidious power of cocaine.

"He would be very much upset and appalled, but I'm not sure he'd be surprised," he says. "He was very much aware of what drugs could do to people."

The story of Halsted's cocaine habit, which can be pieced together from old medical journals, letters in the Hopkins archives, and the findings of a few scholars, is more than a Baltimore mystery tale or a footnote to medical history.

It is a glimpse at the very beginning of America's ruinous entanglement with the white, powdery alkaloid derived from the leaves of the South American coca plant.

The story begins in New York City, where Halsted was born in 1852, the son of a prosperous merchant. He was taught at home by a governess until the age of 10, graduated from prestigious Phillips Academy in Andover, Mass., and from Yale University, where he was a bon vivant and captain of the football team. When he went on to the College of Physicians and Surgeons in New York, which would become Columbia University's medical school, he applied himself to his studies and compiled a superb record.

After a surgical internship and two years of study in Europe, Halsted returned to New York, where he quickly established a reputation as a tireless, innovative surgeon. He operated seven days a week at six different hospitals, ran an outpatient service for the poor and still found time to offer classes for medical students -- from 9 p.m. to midnight.

Once, when his sister dangerously hemorrhaged after giving birth, he grabbed a syringe, drew his own blood and injected it into her vein, a daring move that may have saved her life. On another occasion, he performed pioneering gallbladder surgery on his own mother.

He later would describe these first five years of practice as the happiest years of his life. Friends described him as an outgoing man with a busy social life, and associates saw him as headed for a stellar career.

Then, in October 1884, Halsted saw in the Medical Record a report of a paper presented at a conference of German ophthalmologists on the anesthetic properties of cocaine. For some years, cocaine had been an ingredient in popular tonics, but its medical use was minimal. Halsted was intrigued by its promise: "Within a week or two, at most, of the arrival in this country of [Vienna ophthalmologist Carl] Koller's first paper announcing the anesthetic effect of cocaine on the conjunctiva we began active experimentation with the drug, hoping that it might prove of use in general surgery," Halsted wrote in a letter many years later. "By 'we' I mean twenty-five or thirty students . . . who registered with me as their preceptor. At the evening quizzes we began our injections into nerves."

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