Free Genius on the Edge: The Bizarre Double Life of Dr. William Stewart Halsted by Gerald Imber Md

credit Halsted’s role.
    In a formal demonstration, Halsted taught the technique of injecting the inferior alveolar (dental) nerve to a Dr. Thomas, a well-known American dentist practicing in Vienna. He spoke of the new technique to anyone who would listen and demonstrated it to whomever would watch. Before cocaine, Halsted had never sought credit for his achievements, never promoted his contributions, and never talked about himself. He was now clearly under the influence of the drug, and off balance.
    Although he was in Vienna, where the whole cocaine story had begun, Halsted did not meet with Freud. One wonders whether Freud, who was already familiar with the characteristics of cocaine abuse, would have recognized Halsted’s aberrant behavior.
    Returning home in January 1886, Halsted resumed his heavy workload. George Brewer, who worked with him in the outdoor clinic, described a conversation in which Halsted spoke constantly, excitedly, and endlessly, “about everything under the sun.” Halsted was losing control.

    WILLIAM WELCH HAD left his position at Bellevue in March 1884 to become professor of pathology at the new Johns Hopkins University in Baltimore, and part of the team chosen to build the institution from the ground up. He had spent a year in Europe immersed in the latest experimental techniques before settling in Baltimore in 1885. Alerted by McBride to the rapid deterioration of his friend, Welch immediately returned to New York to help. He hired a sailing vessel with captainand crew, and planned to take Halsted on a long sailing trip to the Windward Islands off the coast of South America. The trip was to last through February and March—long enough, he hoped, to gradually wean Halsted from his drug, watch over him, counsel him, and help him break the habit.
    It did not end well. Halsted had brought a two-week supply of cocaine aboard. Either Welch had miscalculated how much to allot or Halsted had not shared with him the increasing dosage necessary to satisfy his need, but in mid-passage Halsted ran short of cocaine. In desperation, he broke into the captain’s medicine locker. In the most dramatic retelling of the story, he was caught in the act of stealing cocaine and restrained by the crew. However, it is unlikely that a sailing ship would have any reason to carry cocaine, unless the locker was the repository for Halsted’s personal supply and some had been withheld as part of the process. It is far more plausible that the drug stolen from the captain’s locker was morphine, which would have been carried on board for emergency medical situations. In either event, Halsted’s desperation had transformed him overnight from a model of patrician rectitude to a thief.
    UPON RETURNING TO New York, Halsted continued using the drug. Welch returned to Baltimore, where he was immersed in his laboratory work and building the team for the Johns Hopkins Hospital.

1 Today, when surgeons use local anesthetics such as lidocaine, a small amount of epinephrine is added, which constricts the local blood vessels, reduces blood supply, and keeps the anesthetic in the area longer. Less lidocaine can be used for a more extended period of effectiveness.

CHAPTER SEVEN
The Visionary
    WHEN JOHNS HOPKINS DIED in 1873, Baltimore was a city of 267,000, not yet fully recovered from the economic hardships of the Civil War. Divided by the tensions of Union loyalty and southern ethic, it had not fared well during the war years, and the economic strife that followed for a decade was sharply exacerbated by a financial panic that swept the nation that year. The city was an unprepossessing industrial seaport of endless row houses, each typically built with three stone entry stairs at front and a small yard behind. Squalor and poverty surrounded the port. The city had neither a cultural nor an academic center, and social and commercial opportunities were limited. Little existed to attract newcomers, and the city did not benefit from