The Accidental Addict
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《新英格兰医药杂志》
All stories of addiction are tragic. Some addictions are so well concealed that, when discovered, they initially appear to be inconceivable. One of the most remarkable tales of a concealed drug addiction began more than a century ago and involves a brilliant young doctor. Talented, well educated, and socially prominent, he was a swift and decisive operator when speed was of paramount importance to surgical prowess. But by the age of 33, the physician faced both professional and literal extinction because of a losing battle against a relentless addiction to cocaine.
Yet less than a decade after reaching what recovery experts today might call his "bottom," he was appointed professor of surgery at an illustrious medical school and enjoyed international renown as one of the greatest surgeons ever to wield a scalpel. Today, his name is recognizable by even the most casual observer of American medical history: William Stewart Halsted of the Johns Hopkins Hospital. But one question has haunted many historians: Did Dr. Halsted ever vanquish his addiction, as he claimed? Sadly, as is true of so many people caught in the vortex of a disease that attacks the mind, body, and soul, he did not.
In 1884, cocaine, the alkaloid derivative of the coca plant treasured by the Incas, became all the rage among the medical cognoscenti. In July of that year, Sigmund Freud published a detailed monograph on cocaine. Although Freud's series of experiments on himself and others demonstrated many of cocaine's effects, in the monograph he glossed over a critical one that had immediate applications, the drug's properties as a local anesthetic. But one of Freud's contemporaries, an ophthalmologist named Karl Koller, did recognize this potential and that autumn announced his findings to an international congress of eye surgeons gathered in Heidelberg, Germany. Because so many surgeons around the world were engaged in the search for an anesthetic agent that was safer and simpler to use than ether, there was great excitement about the ramifications of Koller's discovery.1
In late October of 1884, Halsted, who was practicing in New York City, began his own experiments with this "wonder drug." Most important, he demonstrated how infiltrating sensory nerves and blocking major nerve trunks safely facilitated both mildly invasive and general surgical operations. Yet his description of these findings in the September 12, 1885, issue of the New York Medical Journal was so disjointed and overwrought that it could only have been written under the influence of cocaine.2 Indeed, within months after beginning his exploration of the drug and heroically enlisting himself as a human subject, Dr. Halsted had accidentally transformed himself into an addict.
By early 1886, one of his closest colleagues, an exuberant pathologist named William Henry Welch, took it upon himself to institute an ad hoc treatment plan for Halsted's deteriorating condition. First on the agenda was a sea voyage, which was then considered highly therapeutic for men of means who were suffering from a broad range of maladies. During February and March of 1886, Halsted sailed on a schooner bound for the Windward Islands. Ever the crafty addict, he had secreted a large supply of cocaine in the sincere hope of gradually cutting down his dose. Despite his calculations, Halsted could not satisfy his addictive hunger and ran out of cocaine long before the ship pointed its bow north for the voyage home. Late one night, thousands of miles out at sea, the cocaine-obsessed Halsted lay awake in his rocking hammock until his bunkmates' telltale snoring indicated slumber. Audibly assured that they would not witness his actions, Halsted sneaked out of the cabin and prowled about until he located the captain's medicine chest. It was only minutes before this scion of prestige was reduced to breaking into the locked container for a much-needed fix.
After his return to New York, Halsted remained unable to quit a habit that was clearly destroying him; he therefore admitted himself to the highly regarded Butler Psychiatric Hospital in Providence, Rhode Island. Ashamed of his addiction and afraid that public knowledge of it might adversely affect his career, he signed the hospital's register as "William Stewart."
From May to November of 1886, Halsted surrendered to the dictates of his "alienists" (i.e., psychiatrists) — seclusion, fresh air, exercise, a healthful diet, and a gradual withdrawal from cocaine. Agitation and insomnia were managed with hot wet packs and doses of alcohol, chloral hydrate, and bromides. At that time, the approach of choice for weaning an addict from cocaine was the liberal use of morphine as a substitute agent. Sadly, this drug would cause problems for Halsted in the years to come.
Around this time, Halsted's friend William Welch became a professor of pathology at the newly established Johns Hopkins Hospital in Baltimore. Armed with a hefty endowment, Welch was charged with gathering the talent to launch one of the greatest experiments in modern medicine. Shortly after Halsted's discharge from Butler, Welch urged the troubled surgeon to quit New York and his cocaine-abusing cronies and move to Baltimore to live in Welch's home and work in his laboratory. Welch kept a watchful eye on Halsted, remaining far more attentive than mere friendship or an employer's supervision demanded. One of Welch's principal tasks involved monitoring the surgeon's cash flow to ensure that Halsted did not have enough money to satisfy his cocaine cravings.3
During the next few years, Halsted labored in the laboratory, patiently creating new surgical procedures and testing them on dogs. However, in late 1887 he readmitted himself to Butler Hospital for an extended period. By early 1889, he had convinced his colleagues that he was no longer a slave to either cocaine or morphine and could be trusted to care for patients — a claim he firmly maintained for the rest of his life. In February 1889, he was named surgeon-in-chief at the Johns Hopkins dispensary and acting surgeon at the hospital. In 1892, he was appointed the first professor of surgery at Hopkins.
William Stewart Halsted Performing Surgery at Johns Hopkins Hospital, 1904.
Halsted is second from the left, bending over the patient.
Courtesy of the Alan Mason Chesney Medical Archives of the Johns Hopkins Medical Institutions.
His New York days and his old reputation behind him, Halsted was now revered as a careful, deliberate, and painstakingly slow surgeon. Indeed, many surgeons referred to Halsted's newly adopted technique as the "School of Safety." Others have speculated, however, that this level of patience may have been augmented by the powers of concentration then associated with using cocaine. Nevertheless, it was in Baltimore that Halsted developed several highly regarded surgical procedures, including the use of rubber gloves to advance sterile technique, and launched a rigorous training program for junior surgeons that continues in some fashion to the present.
According to most firsthand accounts of his days at Johns Hopkins, Halsted was moody, elusive, sarcastic, and prone to dropping out in the middle of an operation and leaving his talented resident assistants to complete the procedure that was under way. The excuses he gave were anginal pain or, more troubling, hands that were simply too shaky to operate — a symptom that Halsted blamed on his legendary overconsumption of cigarettes but that could also have been caused by the recent ingestion of cocaine or withdrawal from morphine.
In fact, many of Halsted's colleagues thought something was amiss and worried that his addiction remained active. Most famously, Dr. William Osler recalled in 1890 that he had seen the surgeon having severe chills. Suspecting that Halsted was still addicted to morphine and was going through withdrawal, Osler gained the surgeon's trust and confidence. In a secret diary that Osler kept sometime between 1902 and 1905, which was not unsealed until 1969, the great physician wrote, "[Halsted] has never been able to reduce the amount to less than three grains [of morphine] daily, on this he could do his work comfortably and maintain his excellent physical vigor. . . . I do not think that anyone suspected him — not even Welch."4
Although Halsted's nieces and his longtime secretary said that they never saw any evidence of drug addiction, another close observer, his former chief resident George Heuer, speculated that "the real truth of the matter is that he never conquered" his cocaine addiction.5 Definitive answers to questions such as "how much," "what," and "when" will probably never be found. But in addition to Halsted's erratic behavior in the operating room, circumstantial evidence — ranging from his frequent absences from the hospital when his whereabouts were unknown to his avoidance of close colleagues when he walked the wards (perhaps because he was under the influence and did not wish to be scrutinized by those who might recognize this), his going home daily at 4:30 p.m. and locking himself in his study for 90 minutes before dinner, his curious habit of sending his soiled linen to an exclusive laundry in Paris (which may or may not have sent back more than clean shirts), and, most troubling, his easy access to morphine and to the cocaine that was used in his operating room throughout this period — suggests that he continued to abuse morphine and, I suspect, cocaine to the end of his life.5
Halsted's affliction was no less real than others' addictions simply because it occurred "accidentally" in the name of advancing science. No one becomes an addict on purpose. Unfortunately, society's view of drug addiction has remained largely unchanged since Halsted's time; the disease, which today has reached epidemic proportions, is still too often met with secrecy, denial, and shame.
Source Information
Dr. Markel is director of the Center for the History of Medicine and a professor of pediatrics and communicable diseases at the University of Michigan Medical School, Ann Arbor.
References
Freud S. Uber coca. In: Byck R, ed. Cocaine papers. New York: Stonehill, 1974:48-73, 107-9, 263-319.
Halsted WS. Practical comments on the use and abuse of cocaine. N Y Med J 1885;42:294-5.
Olch PD. William S. Halsted and local anesthesia: contributions and complications. Anesthesiology 1975;42:479-486.
Osler W, Bates DG, Bensley EH. The inner history of the Johns Hopkins Hospital. Johns Hopkins Med J 1969;125:184-194.
Heuer GW. Dr. Halsted. Bull Johns Hopkins Hosp 1952;90:Suppl 2:1-105.(Howard Markel, M.D., Ph.D)
Yet less than a decade after reaching what recovery experts today might call his "bottom," he was appointed professor of surgery at an illustrious medical school and enjoyed international renown as one of the greatest surgeons ever to wield a scalpel. Today, his name is recognizable by even the most casual observer of American medical history: William Stewart Halsted of the Johns Hopkins Hospital. But one question has haunted many historians: Did Dr. Halsted ever vanquish his addiction, as he claimed? Sadly, as is true of so many people caught in the vortex of a disease that attacks the mind, body, and soul, he did not.
In 1884, cocaine, the alkaloid derivative of the coca plant treasured by the Incas, became all the rage among the medical cognoscenti. In July of that year, Sigmund Freud published a detailed monograph on cocaine. Although Freud's series of experiments on himself and others demonstrated many of cocaine's effects, in the monograph he glossed over a critical one that had immediate applications, the drug's properties as a local anesthetic. But one of Freud's contemporaries, an ophthalmologist named Karl Koller, did recognize this potential and that autumn announced his findings to an international congress of eye surgeons gathered in Heidelberg, Germany. Because so many surgeons around the world were engaged in the search for an anesthetic agent that was safer and simpler to use than ether, there was great excitement about the ramifications of Koller's discovery.1
In late October of 1884, Halsted, who was practicing in New York City, began his own experiments with this "wonder drug." Most important, he demonstrated how infiltrating sensory nerves and blocking major nerve trunks safely facilitated both mildly invasive and general surgical operations. Yet his description of these findings in the September 12, 1885, issue of the New York Medical Journal was so disjointed and overwrought that it could only have been written under the influence of cocaine.2 Indeed, within months after beginning his exploration of the drug and heroically enlisting himself as a human subject, Dr. Halsted had accidentally transformed himself into an addict.
By early 1886, one of his closest colleagues, an exuberant pathologist named William Henry Welch, took it upon himself to institute an ad hoc treatment plan for Halsted's deteriorating condition. First on the agenda was a sea voyage, which was then considered highly therapeutic for men of means who were suffering from a broad range of maladies. During February and March of 1886, Halsted sailed on a schooner bound for the Windward Islands. Ever the crafty addict, he had secreted a large supply of cocaine in the sincere hope of gradually cutting down his dose. Despite his calculations, Halsted could not satisfy his addictive hunger and ran out of cocaine long before the ship pointed its bow north for the voyage home. Late one night, thousands of miles out at sea, the cocaine-obsessed Halsted lay awake in his rocking hammock until his bunkmates' telltale snoring indicated slumber. Audibly assured that they would not witness his actions, Halsted sneaked out of the cabin and prowled about until he located the captain's medicine chest. It was only minutes before this scion of prestige was reduced to breaking into the locked container for a much-needed fix.
After his return to New York, Halsted remained unable to quit a habit that was clearly destroying him; he therefore admitted himself to the highly regarded Butler Psychiatric Hospital in Providence, Rhode Island. Ashamed of his addiction and afraid that public knowledge of it might adversely affect his career, he signed the hospital's register as "William Stewart."
From May to November of 1886, Halsted surrendered to the dictates of his "alienists" (i.e., psychiatrists) — seclusion, fresh air, exercise, a healthful diet, and a gradual withdrawal from cocaine. Agitation and insomnia were managed with hot wet packs and doses of alcohol, chloral hydrate, and bromides. At that time, the approach of choice for weaning an addict from cocaine was the liberal use of morphine as a substitute agent. Sadly, this drug would cause problems for Halsted in the years to come.
Around this time, Halsted's friend William Welch became a professor of pathology at the newly established Johns Hopkins Hospital in Baltimore. Armed with a hefty endowment, Welch was charged with gathering the talent to launch one of the greatest experiments in modern medicine. Shortly after Halsted's discharge from Butler, Welch urged the troubled surgeon to quit New York and his cocaine-abusing cronies and move to Baltimore to live in Welch's home and work in his laboratory. Welch kept a watchful eye on Halsted, remaining far more attentive than mere friendship or an employer's supervision demanded. One of Welch's principal tasks involved monitoring the surgeon's cash flow to ensure that Halsted did not have enough money to satisfy his cocaine cravings.3
During the next few years, Halsted labored in the laboratory, patiently creating new surgical procedures and testing them on dogs. However, in late 1887 he readmitted himself to Butler Hospital for an extended period. By early 1889, he had convinced his colleagues that he was no longer a slave to either cocaine or morphine and could be trusted to care for patients — a claim he firmly maintained for the rest of his life. In February 1889, he was named surgeon-in-chief at the Johns Hopkins dispensary and acting surgeon at the hospital. In 1892, he was appointed the first professor of surgery at Hopkins.
William Stewart Halsted Performing Surgery at Johns Hopkins Hospital, 1904.
Halsted is second from the left, bending over the patient.
Courtesy of the Alan Mason Chesney Medical Archives of the Johns Hopkins Medical Institutions.
His New York days and his old reputation behind him, Halsted was now revered as a careful, deliberate, and painstakingly slow surgeon. Indeed, many surgeons referred to Halsted's newly adopted technique as the "School of Safety." Others have speculated, however, that this level of patience may have been augmented by the powers of concentration then associated with using cocaine. Nevertheless, it was in Baltimore that Halsted developed several highly regarded surgical procedures, including the use of rubber gloves to advance sterile technique, and launched a rigorous training program for junior surgeons that continues in some fashion to the present.
According to most firsthand accounts of his days at Johns Hopkins, Halsted was moody, elusive, sarcastic, and prone to dropping out in the middle of an operation and leaving his talented resident assistants to complete the procedure that was under way. The excuses he gave were anginal pain or, more troubling, hands that were simply too shaky to operate — a symptom that Halsted blamed on his legendary overconsumption of cigarettes but that could also have been caused by the recent ingestion of cocaine or withdrawal from morphine.
In fact, many of Halsted's colleagues thought something was amiss and worried that his addiction remained active. Most famously, Dr. William Osler recalled in 1890 that he had seen the surgeon having severe chills. Suspecting that Halsted was still addicted to morphine and was going through withdrawal, Osler gained the surgeon's trust and confidence. In a secret diary that Osler kept sometime between 1902 and 1905, which was not unsealed until 1969, the great physician wrote, "[Halsted] has never been able to reduce the amount to less than three grains [of morphine] daily, on this he could do his work comfortably and maintain his excellent physical vigor. . . . I do not think that anyone suspected him — not even Welch."4
Although Halsted's nieces and his longtime secretary said that they never saw any evidence of drug addiction, another close observer, his former chief resident George Heuer, speculated that "the real truth of the matter is that he never conquered" his cocaine addiction.5 Definitive answers to questions such as "how much," "what," and "when" will probably never be found. But in addition to Halsted's erratic behavior in the operating room, circumstantial evidence — ranging from his frequent absences from the hospital when his whereabouts were unknown to his avoidance of close colleagues when he walked the wards (perhaps because he was under the influence and did not wish to be scrutinized by those who might recognize this), his going home daily at 4:30 p.m. and locking himself in his study for 90 minutes before dinner, his curious habit of sending his soiled linen to an exclusive laundry in Paris (which may or may not have sent back more than clean shirts), and, most troubling, his easy access to morphine and to the cocaine that was used in his operating room throughout this period — suggests that he continued to abuse morphine and, I suspect, cocaine to the end of his life.5
Halsted's affliction was no less real than others' addictions simply because it occurred "accidentally" in the name of advancing science. No one becomes an addict on purpose. Unfortunately, society's view of drug addiction has remained largely unchanged since Halsted's time; the disease, which today has reached epidemic proportions, is still too often met with secrecy, denial, and shame.
Source Information
Dr. Markel is director of the Center for the History of Medicine and a professor of pediatrics and communicable diseases at the University of Michigan Medical School, Ann Arbor.
References
Freud S. Uber coca. In: Byck R, ed. Cocaine papers. New York: Stonehill, 1974:48-73, 107-9, 263-319.
Halsted WS. Practical comments on the use and abuse of cocaine. N Y Med J 1885;42:294-5.
Olch PD. William S. Halsted and local anesthesia: contributions and complications. Anesthesiology 1975;42:479-486.
Osler W, Bates DG, Bensley EH. The inner history of the Johns Hopkins Hospital. Johns Hopkins Med J 1969;125:184-194.
Heuer GW. Dr. Halsted. Bull Johns Hopkins Hosp 1952;90:Suppl 2:1-105.(Howard Markel, M.D., Ph.D)