PageLines- halstedbannerart.jpgAt the time Dr. Halsted began experimenting with cocaine, he enjoyed a comfortable home life with his companion and roommate, Thomas Alexander McBride, a former medical school classmate. McBride, handsome and well-spoken, was considered quite the man about town. He maintained a prosperous carriage trade practice in addition to his duties as a clinical assistant in internal medicine at the College of Physicians and Surgeons. McBride and Halsted lived in a “luxuriously furnished” flat on Twenty-fifth Street between Madison Avenue and Fourth Avenue (now Park Avenue South) that served as the unofficial clubhouse for an expanding cadre of medical students and surgeons. McBridewas said to have spent “lavishly” on his roommate, but the precise contours of their domestic arrangement remains unclear. It was likely a close and loving relationship, though one that would have attracted little attention or comment in an era when there existed discrete and separate social spheres between men and women, not to mention a decided aversion to publicly discussing sexuality.

In a matter of months, cocaine completely took over Halsted’s life. First he missed only occasional lectures or perhaps an appointment with a colleague. Soon enough, he was referring patients to other surgeons to avoid the operating room. Although he made a somewhat confused appearance at the evening meeting of the New York Surgical Society on April 28, 1885, for most of that spring, William engaged in few, if any, clinical activities. His last recorded operations at Bellevue took place on March 23, an amputation of a laborer’s leg above the knee for gangrene resulting from a crush injury and an excision of a vaginal-cutaneous sinus tract in a woman. On May 5, 1885 he ceased to be a doctor and surgeon, the path to which he had devoted the last intense decade of his life. After examining a laborer suffering from a compound fracture of the tibia, a thin, haggard, and addicted Halsted abruptly exited Bellevue Hospital to nervously hibernate and abuse cocaine in his Manhattan townhouse.

Always a prolific medical correspondent with a precise literary style, the years 1885 and 1886 signaled Halsted’s most fallow period as a writer. As proof, one merely has to consult the memorial edition of the surgeon’s scientific, surgical and academic papers, a chock-filled two volumes containing more than 150 contributions. His now famous paper on cocaine that did appear in print in 1885 was all but redacted from Halsted’s leather-bound Surgical Papers. Instead, the editor lists only the paper’s title and bibliographic citation, accompanied by the terse comment that it “would require such reediting as is not deemed expedient.”

In fact, “Practical Comments on the Use and Abuse of Cocaine Suggested by its Invariably Successful Employment in More than a Thousand Minor Surgical Operations” both advanced surgical technique and informs a retrospective diagnosis of William’s condition. Many medical historians credit the article, which appeared in the September 12, 1885 issue of the New York Medical Journal, with introducing the world to local anesthetic by nerve blockade. The paper also demonstrated the ease with which cocaine could be injected into the skin to achieve the desired results, the means of diluting cocaine solutions to avoid toxicity and still numb the surgical area, and ways of prolonging the anesthetic effects by reducing the flow of blood to the operative site. Still, the paper is presented in a prose so disjointed, hyperactive,  and overwrought that it was almost certainly written under the influence of cocaine.

Neither indifferent as to which of how many possibilities may best explain, nor yet at a loss to comprehend, why surgeons have, and that so many, quite without discredit, could have exhibited scarcely any interest in what, as a local anæsthetic, had been supposed, if not declared, by most so very sure to prove, especially to them, attractive, still I do not think that this circumstance, or some sense of obligation to rescue fragmentary reputation for surgeons rather than the belief that an opportunity existed for assisting others to an appreciable extent, induced me, several months ago, to write on the subject in hand the greater part of a somewhat comprehensive paper, which poor health disinclined me to complete.

Even the most experienced consumer of the medical literature is forced to scratch his head when reading this seminal publication. The paper ends with the promise for more data to be published in a subsequent issue, but Halsted never wrote a “Part II.”

In the summer of 1885, shortly after sending his cocaine study off to the New York Medical Journal, Halsted made a return trip to Vienna in search of rest and recreation. While there, he demonstrated his cocaine-injection technique for local anesthesia to his mentor Anton Wölfler and an American dentist named Thomas. Although the dentist was thrilled by the method, Wölfler declared it to be useless.  Dr. Wölfler subsequently published an enthusiastic article on it in one of the daily newspapers, but without mentioning Halsted’s name. To the end of his life, the surgeon recalled this slight.  The one person William did not record meeting with while in Vienna was Sigmund Freud.

When William returned to New York in early January 1886, his friends noticed worrisome changes in his behavior. Once modest and self-effacing, he was now abrupt, spoke incessantly, and cared little for the responses of those he was speaking with.  Dr. George Brewer, a Baltimore urologist who visited Halsted around this time in search of a position at Roosevelt Hospital, complained that from early afternoon until long after it turned dark he could not get a word in edgewise. Brewer later remembered that Halsted was “very excited and talked constantly about everything under the sun from the transit of Venus to gonococci.” Every time the urologist tried to beat a hasty retreat out of Halsted’s house, the cocaine-fueled surgeon “would start up again.”

William probably rationalized his cocaine consumption as being in the service of scientific inquiry. But long after he concluded his experiments, he abused the drug for the same reasons  shared by most addicts: to simply feel better, to numb himself, to escape from the painful lows of depression, frustration, rejection, and a hundred and one other slings and arrows of life.

In late January 1886, a worried William Henry Welch took it upon himself to institute an ad-hoc treatment plan to arrest Halsted’s dire condition. Welch refused to accept the dogmatic pronouncements of the day dismissing alcoholics and drug addicts as hopeless, morally flawed wrecks of human beings. The pathology professor was determined to save his talented colleague from cocaine damnation.  Intervening with two other concerned friends, Drs. George Munroe and Samuel Vander Poel, Welch invited Halsted into his office and offered him a potential way out of the abyss he was facing.

Welch laid all his cards on the table. He began by revealing that he knew what was going on with respect to Halsted’s relentless cocaine abuse and that it needed to stop, posthaste. The solution Welch suggested was a rejuvenating sea voyage, then considered therapeutic for men of means suffering from a broad range of maladies. Convinced of the wisdom of this suggestion, Halsted joined Welch during February , March and April of 1886 on a schooner named the Bristol bound for the Windward Islands in the Caribbean. Recognizing that William’s previous cold turkey attempts to stop using cocaine had failed abysmally, the two physicians developed a rigorous treatment plan featuring a large supply of cocaine to be doled out by Welch while gradually cutting down William’s dosage to nothing before the trip’s end.

For much of the voyage down the Atlantic seaboard, things worked out rather well; but Halsted was still taking daily, albeit progressively smaller, doses of cocaine. By the time the bow pointed toward the Caribbean, he’d began experiencing uncomfortable feelings and emotional states of the sort that bedevil any addict trying to break free of this drug. Just as the use of cocaine brings on great feelings of euphoria and exhilaration, the cocaine-starved brain complains and rebels vociferously. With smaller and less frequent doses, William’s brain must have screamed to him, “Where is my drug? Feed me my tonic! If only I had some more cocaine, all would be well.”

It has long been observed that cocaine abusers who abruptly stop their drug of choice do not suffer the full-blown physical symptoms seen in those who suddenly quit morphine or alcohol.  Such findings formerly encouraged physicians to insist that there was no withdrawal syndrome associated with cocaine.  In more recent conceptions of addiction and withdrawal, however, experts have verified a set of nasty psychological symptoms that creep in after a cocaine abuser attempts to quit, including depression, intense fatigue, unpleasant dreams, restlessness, disturbances of appetite, and even suicidal thoughts.  This awful state of mind can last for many months after stopping and contributes to the high relapse rates among those seeking recovery.  To be sure, the effects of withdrawing from opiates and alcohol are much more intense, physical, and acute than cocaine.  Yet, as Halsted could surely have testified, cocaine maintains the ability, long after it has taken its corporal leave, to communicate with the addict’s brain, luring him back to partake once again, with the flimsy promise that all will be well—at least for a few moments.

Despite careful projections, Halsted could not satisfy his cocaine hunger.  He grew steadily more agitated as he realized that he would completely run out of the drug long before the ship changed its course to north for the voyage home.  Late one night, miles out at sea, the cocaine-obsessed Halsted lay awake, nervously rocking in his hammock while listening to the scratching and snoring of his bunkmates.  Audibly assured that they would not bear witness, he snuck out of the cabin and prowled about until he located the captain’s medicine chest.  It was a short time before this scion of privilege was reduced to breaking into the locked container for a much-needed dose.

There exists a charming, likely embellished, and difficult to verify biography of Halsted that was published in 1960.  The book was written as part of a series on famous doctors and scientists for an audience of young teenagers.  In it, we are told that at this point of the journey Drs. Welch and Halsted explored the island of Santa Lucia only to find a desperate doctor, a moribund patient, and an appendix doing its best to burst in the latter’s abdomen.  Like a fireman’s horse hearing the bell, Halsted diagnosed acute appendicitis and recommended an emergency appendectomy.  The island doctor vociferously disagreed, insisting that the patient’s problem was the result of eating a plate of poisonous roots.  William took command and insisted on beginning the operation.  But first, he administered a dose of cocaine from the ship’s store to both the patient and himself.  The patient, of course, required the drug to prevent feeling the pain of being cut open.  William, the authors claim, needed cocaine to quell his raging urges.  Halsted’s diagnosis turned out to be correct and the patient enjoyed a speedy recovery from his appendectomy.  Regardless of the veracity of this tale, let alone the improbability of operating well while under the influence, there still remained the pressing problem of the depleted cocaine supply Halsted needed so badly for the return voyage to New York.

William ran out of cocaine before the ship passed Florida and it was then that he entered the most harrowing part of his oceanic journey. Plagued by nightmares, exhaustion, irritability, outright suspicion of his fellow travelers, and, because he was clenching his muscles relentlessly, aching limbs, William felt lousy. Somehow, Dr. Welch got the cocaine-starved Halsted back to New York Harbor in one piece in late April, 1886.  But Welch was also attempted to extract a promise from Halsted before the two disembarked from their vessel and made their respective ways home.  The pathologist informed the young surgeon that he needed far more intensive treatment than afforded by a mere sea voyage: Halsted would have to be admit himself into the Butler Hospital.