Eminent Addicts

Tuesday, May 6th, 2008

I was recently reading Tyler Cowen and Megan McArdle discuss the Drug War and the possible negative effects of legalizing drugs. (You see, they’re talking to a largely libertarian audience, and they’re being contrarian.)

One point I think they miss is that an increased supply of drugs may mean an increase in drug consumption, and it may even mean an increase in drug addiction, but that does not necessarily mean an increase in dysfunctional junkies.

Some eminent narcotics addicts have managed to function at an extremely high level despite their drug problems, because they have had regular access to known quantities of the drug:

The United States Supreme Court’s 1962 characterization of the drug addict as “one of the walking dead” can no doubt be illustrated many times over among addicts living under twentieth-century conditions of high opiate prices, vigorous law enforcement, repeated imprisonment, social ignominy, and periodic unavailability of opiates. The court’s major error was to attribute the effects it so vividly described to the drugs themselves rather than to the narcotics laws and to the social conditions under which addicts live today. To illustrate, let us consider the effects of opiate addiction on a few distinguished addicts who throughout their lives had adequate access to continuing supplies.

Perhaps the most remarkable case was that of Dr. William Stewart Halsted (1852-1922), one of the greatest of American surgeons. Halsted, the scion of a distinguished New York family, and captain of the Yale football team, entered the practice of medicine in New York in the 1870s and soon became one of the promising young surgeons of the city. Interested in research as well as in performing operations, he was among the first to experiment with cocaine-a stimulant drug similar to our modern amphetamines (see Part V). With a small group of associates, Halsted discovered that cocaine injected near a nerve produces local anesthesia in the area served by that nerve. This was the first local anesthetic, and its discovery was a major contribution to surgery.

Unfortunately, Halsted had also injected cocaine into himself numerous times. “Cocaine hunger fastened its dreadful hold on him,” Sir Wilder Penfield, another famed surgeon, later noted. “He tried to carry on. But a confused and unworthy period of medical practice ensued. Finally he vanished from the world he had known. Months later he returned to New York but, somehow, the brilliant and gay extrovert seemed brilliant and gay no longer.” 1

What had happened to Halsted during the period of his disappearance? A part of the secret was revealed in 1930, eight years after his death. Then Halsted’s closest friend, Dr. William Henry Welch, one of the four distinguished founders of the Johns Hopkins Medical School, stated that he (Welch) had hired a schooner and, with three trusted sailors, had slowly sailed with Halsted to the Windward Islands and back in order to keep Halsted away from cocaine.

The effort was not successful. Halsted relapsed and next went to Butler Hospital in Providence, where he spent several months. Again he relapsed, and again he went to Butler Hospital. Halsted’s biographers reported that thereafter he was cured. Through magnificent strength of will, after an epochal struggle, he had cast off his cocaine addiction and gone on to fame and fortune as one of the four distinguished founders of the Hopkins. Or so the story went.

In 1969, however, on the occasion of the eightieth anniversary of the opening of the Johns Hopkins Hospital, a “small black book closed with a lock and key of silver” 2 was opened for the first time. This book contained the “secret history” of the Hopkins written by another of its four eminent founders, Sir William Osler. Sir William revealed that Halsted had cured his cocaine habit by turning to morphine.

Thus Halsted was a morphine addict at the age of thirty-four, when Welch invited him in 1886 to join the distinguished group then laying the foundations for what was soon to become the country’s most distinguished medical school. Welch knew, of course, of Halsted’s addiction, and therefore gave him only a minor appointment at first. Halsted, however, did so brilliantly that he was soon made chief of surgery and thus joined Osler, Welch, and Billings as one of the Hopkins “Big Four.”

“When we recommended him as full surgeon,” Osler wrote in his secret history, “. . . I believed, and Welch did too, that he was no longer addicted to morphia. He had worked so well and so energetically that it did not seem possible that he could take the drug and do so much.

About six months after the full position had been given, I saw him in a severe chill [evidently a withdrawal symptom caused by Halsted's seeking to give up morphine once again] and this was the first intimation I had that he was still taking morphia. Subsequently I had many talks about it and gained his full confidence. He had never been able to reduce the amount to less than three grains [180 milligrams] daily; on this he could do his work comfortably and maintain his excellent physical vigor for he was a very muscular fellow). I do not think that anyone suspected him, not even Welch. 3

While on morphine Halsted married into a distinguished Southern family; his wife had been head nurse in the operating rooms at the Hopkins. They lived together in “complete mutual devotion” until Halsted’s death thirty-two years later.

Halsted’s skill and ingenuity as a surgeon during his years of addiction to morphine earned him national and international renown. For Lister’s concept of antisepsis— measures to kill germs in operation wounds Halsted substituted asepsis: measures to keep germs out of the wound in the first place. In this and other ways, he pioneered techniques for minimizing the damage done to delicate tissues during an operation. Precision became his surgical trademark. A British surgeon, Lord Moynihan, admiringly described the Halsted technique at the operating table as one of “frequently light, swift, sparing movements with the sharpest of knives, instead of free, heavy-handed deep cutting; of no hemorrhage or the minimum of hemorrhage instead of the severance of many vessels, each bleeding freely until clipped .” 4 For pioneering improvements such as these, Halsted became widely known as “the father of modern surgery.”

In 1898, at the age of forty-six, Osler’s secret history notes, Halsted reduced his daily morphine to a grain and a half (90 milligrams) a day. Thereafter the surviving record is silent — though Osler in 1912 expressed a hope that Halsted had “possibly” given up morphine. 5 Halsted died in 1922, at the age of seventy and at the pinnacle of his exacting profession, following a surgical operation. He remained in good health, active, esteemed, and in all probability addicted, until the end.

I first encountered the story of Dr. Halsted in Peter McWilliams‘s Ain’t Nobody’s Business if You Do.

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