Sunday, February 28, 2010

William Stewart Halsted, M.D.

William Stewart Halsted, M. D.

Imber, Gerald, M. D., Genius on the Edge: The Bizarre
Double Life of Dr. William Stewart Halsted,
Kaplan Publishing, 2010 (355 pp. and end materials)

Dr. William Halsted is known as the “Father of Modern Surgery”. Many of the techniques and devices he invented are still in use. He was one of the founders of Johns Hopkins Hospital and Medical School, where he was chief of Surgery for some thirty years.

And he was also addicted to morphine and cocaine during the whole period. He continued to use those drugs until his death at the age of seventy in 1922.

A new biography by Gerald Imber, M. D., thoroughly discusses the interplay between his genius and dedication to scientific medicine with his dependence on these drugs. It places both within the context of his times. In addition to being a biography of Halsted’s professional life, it is also a good introduction to the birth of modern surgery and medical education and tells the story of the world’s introduction to cocaine.

Halsted was a fresh rising star on the New York medical scene when cocaine appeared as a new miracle drug. He began experimenting with it and developed the technique of local anesthesia, including the concept of nerve blocking. His oral injection sites are still used by dentists today.

As was usual at that time, he experimented on himself and his students. Unfortunately, his experiments were so enthusiastic that he – and several of his students as well – became addicted. Halsted’s cocaine use became so excessive that his work deteriorated to an embarrassing level.

His mentor, William H. Welch, intervened to save his protégé. He took Halstead on a sea voyage to withdraw him, but that trip ended in scandal when Halstead broke into the ship’s medical locker. The next step was to admit Halsted to Bishop’s Hospital, an institution specializing in cure of addictions.

Bishop’s used the best and most medically accepted medical cure of that time for cocaine addiction. They treated Halsted with large, regular doses of morphine. The result was that Halsted, while not totally able to abstain from cocaine, was able to limit his use to binges during vacation times for the rest of his life. However, he also developed an addiction to morphine, injecting himself two or three times daily (totaling about 130 mg. per day).

Welch had become head of the new Johns Hopkins hospital and would soon organize the Johns Hopkins medical school. At that hospital he brought together the four men who would create modern scientific medicine and medical education: Welch, Osler, Halsted, and Kelly.

He knew about Halsted’s morphine addiction (it is unclear whether he knew about the continuing cocaine use), but hired him as chief of surgery anyway. After all, about ten per cent of the medical profession at that time regularly used morphine or opium.

“Osler’s concern at that time was Halsted’s dose management, and not his ability to function. In that regard, morphine was significantly less destructive than alcohol. Halsted’s condition, and his struggle to contain it, were seen as both tragic and heroic, but not incongruent with a productive life. To Osler and Welch, Halsted was a professional equal with a chronic, but not debilitating, disease. Halsted announced his shame by working to hide all evidence of his problem.” (page 181)

Halsted arranged his life so that his drug dependency did not interfere with his professional activities. He scheduled surgery, clinical rounds, and writing during the times he was most alert and lived privately the rest of the time. During the academic year, he refrained from cocaine, but from May through September, he left the hospital. He would spend several weeks at his wife’s family farm in North Carolina, growing prize dahlias, riding horses, and serving as veterinarian to the neighbors’ animals. He would then travel to the surgical centers of Europe. During these travels he would disappear for extended periods. These times are probably when he indulged in cocaine binges, but no direct evidence has surfaced.

This discipline enabled Halsted to stay at the pinnacle of his profession for over thirty years. He was still chief of surgery at Hopkins at his death in 1922. By any measure his career was outstanding.

And what a career it was. Halsted developed the doctrine of aseptic surgery, making possible invasion of the body cavity in that age before antibiotics. Every doctor or nurse who has donned scrubs or worn rubber gloves is following the rules first laid down by Halsted. He then devised radical mastectomy for breast cancer and the repair for inguinal hernia that was used until the invention of the laparoscope. His non-crushing clamps for blood vessels still fill the instrument trays in every operating room. He painstakingly developed the anatomy and physiology of the aorta through years of research, and while the supporting technology did not allow him to repair aortal aneurisms, his work was the basis of Dr. DeBakey’s success in the 1950s. His residents became surgical professors and chiefs of service at the schools in the forefront of modern medical education. “Father of Modern Surgery” is a reputation Halsted clearly earned.

However, he was fortunate to live when he did. Although the Harrison Narcotics Tax Act of 1914 allowed people to possess opiates and doctors to prescribe them, only in 1919 did the Treasury officials adopt the thinking of the alcohol prohibitionists and begin trying to prevent personal use or possession of opiates. In 1925, three years after Halstead’s death, they forced the closure of the last opiate maintenance clinic in the U. S., and then made the status of being an addict a crime (a statute held unconstitutional in 1962). Had Halstead lived two decades later, he would have likely ended up in prison or on the streets.

Imber’s book is a fascinating and informative look at an unusual man and a critical period in the history of medicine and drug policy. And for today, it makes us take a hard, critical look at the current attempts to regulate drug use. I recommend it for everyone.


  1. Halsted's career proves that morphine addiction does not necessarily impair the ability to perform at peak levels. The medical profession has a radically different view of opiates and opiate addiction than the drug crusaders. To wit: Nowadays, people with 24/7 morphine pumps are not forbidden to practice any kind of medicine they are trained and licensed to do, including delicate brain surgery. No one with a morphine pump operating is forbidden to drive a car if their physical condition permits.

    While you are waiting for Gerald Imber's book to arrive, you can learn more about Halsted's amazing career. The irony is that many drug warriors would be rotting in their graves at early ages if it were not for Halsted's advances in medicine. They owe their lives to an addict they dedicated their lives to destroying. To say Halsted invented modern surgery is no overstatement.

    See: The Consumers Union Report on Licit and Illicit Drugs

    R Givens

  2. Just let's keep it burning!