The Anatomy of Deception (33 page)

“I was convinced that hygienic surgery would vastly reduce infection, and I became somewhat fanatical on the subject. Many of my colleagues grew more than a bit annoyed, being lectured to by someone no older than you are now, Dr. Carroll, but subsequent events have more than justified my behavior. Still, I was forced to move on to New York Hospital, which had a more enlightened view of scientific advance, and, I daresay, I began to build a sterling reputation as a surgeon and a researcher.” Halsted’s tone still did not waver, and there was not the slightest degree of braggadocio in his words.

“It was at New York Hospital that I met Welch. He was just my age, a brilliant pathologist, and was, at the time, teaching the first pathology course in the United States. He had converted an old morgue near the East River into a laboratory. We each saw instantly that surgery and pathology formed a symbiosis and we became both professionally inseparable and intimate friends. It is to that friendship that I owe my professional survival and quite possibly my life.

“As was customary, I left New York for two years to study in Europe. I wanted in particular to observe Billroth, who, with apologies to Gross, was certainly the finest surgeon in the world. While there, I observed the most extraordinary phenomenon, not from Billroth, but from one of his students.
Mikulicz, the Pole, had taken to employing clamps to stanch the flow of blood whilst he operated on the large bowel, thus improving his view of the affected region. I realized immediately that not only would clamping render the tissues in the open area more visible, but that it would prevent surgical shock. That, in turn, would not only save lives in and of itself, but would also allow the surgeon to proceed at a more thorough, less frenetic pace. When I returned, I employed both clamping and asepsis, and achieved astounding results.”

“You must understand, Ephraim,” interjected the Professor, as Halsted took a sip of tea, “that the innovations Dr. Halsted employed at first made him an object of ridicule. He was, after all, only twenty-eight years old. Soon, however, the results inspired many to copy his methods while arousing the enmity and jealousy of others.”

Having seen Burleigh operate, I did not need to be persuaded of that.

Halsted waited until he was certain that the Professor had finished before speaking again. “By 1884, I was at the peak of my profession. I had perfected radical mastectomy, a technique that bears my name and has saved the lives of hundreds of women. I also developed techniques for emergency transfusion and saline infusion as a treatment for shock. I was teaching anatomy to private students, was an attending physician at four hospitals, and was engaged to perform surgery for private patients who paid up to ten thousand dollars for my services.”

Ten thousand dollars? I almost asked Halsted to stop to confirm that stupendous figure, but he was continuing as if he had said “ten dollars.”

“I was also, although it is difficult to comprehend now, considered one of the leading
bon vivants
in New York, accepted and valued in the highest society. Then, Dr. Carroll, I read an article that changed my life. Karl Koller, a German ophthalmologist, had introduced a solution of cocaine, an alkaloid of
Erythroxylum coca
, to his own eye, and then pricked
it with pins but felt no pain. He had successfully anesthetized the cornea and conjunctiva. Koller, like Mikulicz, saw only the narrow applications of his finding, but I knew at once that he had discovered that cocaine could block individual nerves. It was potentially one of the most important discoveries of the century. As you know, at the time, surgeons had to choose between chloroform and ether. Ether was safe, but unreliable. Anesthetized patients had been known to get up off the operating table and walk away. Chloroform was more reliable, but extremely hazardous. Cocaine seemed to hold promise of both safety and reliability and so I felt I needed to test it at once. I recruited a like-minded colleague at Roosevelt Hospital and we injected ourselves with a solution of the drug.

“Before I continue, it is important to point out that Hall and I were correct. Nerve blocking was possible and cocaine was a correct agent to achieve the result. But, as you know, there were other results as well. I continued my experiments and within months, I had become addicted.

“I hope for the sake of your soul, Dr. Carroll, that you never have to cope with addiction. It is not, as portrayed in dime novels, a fall from Grace brought on by weak character or a plunge into sin—it is a far more insidious phenomenon that comes on gradually, soundlessly, invisibly. The poor wretch who is afflicted is the last to know and, by the time he does know, the vise has clamped shut and he is doomed.

“We all pass through adolescence, believing that we are in control of our destinies, that life is an exercise in free will. If one’s will is sufficiently strong, there are virtually no obstacles that cannot be overcome.” A wry smile passed across his face. “I know I believed so.

“At Yale, I became a superb athlete despite a lack of stature. Although I received what might best be described as mediocre grades, after I purchased a copy of
Gray’s Anatomy
in my senior year and decided to become a physician, once again, by dedicating myself to the goal, I made it so. My career
was testament to the power of will and the drive to succeed. And success fathered success. What’s more, my achievements were not simply such that they brought me personal wealth or fame—I was saving lives, many lives. If there was a formula as to how one should lead one’s life, I had found it, or so it seemed.

“Imagine then, Dr. Carroll, if you will, the shock when I realized that not only had I fallen into the grip of a hideous drug, but that I was unable, regardless of effort or will, to rid myself of it. That was a far more painful realization than finding myself in the throes of addiction itself.

“The realization did not come immediately. Quite the contrary. At first, I decided that I would overwhelm cocaine as I had overwhelmed every other obstacle. I took a leave from my practice and entered a convalescent clinic in Providence, where I remained for a year. For my first months, although it was torture to abstain, I sustained myself with the knowledge that I was asserting my will over a demon, that I was persevering through to victory. But slowly I wore down. Eventually, I was helpless to resist. I began to make arrangements with members of the staff, the very people who were charged with ensuring that the facility remained untainted, to purchase and smuggle the drug to me. It was a costly proposition, but I would have paid anything.

“Upon my departure from Providence, I was pronounced cured, my secret safe. Still, when I returned to New York, my friends and associates abandoned me. For many, the opportunity to sneer at the fallen Halsted was simply too great a temptation to resist. Except for Welch. Welch remained as intimate as before and was also the only one who at first guessed that I was still in the grip of the drug. My demeanor had been so altered, however, that it was not long before tongues began to cluck. When Welch went on to Baltimore, I was left completely alone, a pariah.

“But my salvation was at hand. Welch persuaded Gilman and Billings to take me on. My gratitude was boundless and I
was determined to justify his trust by ridding myself of my addiction once and for all.

“I decided that if I could not resist the drug, I would put myself where there were no drugs to be had. I booked passage on a ship bound for South America, and, lest I lose control completely, took with me a minimal amount of cocaine. Within two days of sailing, I had used my entire supply. I stayed in my cabin, refusing to come out, even for meals. The agony became so great that I was emitting loud moans, more animal than human. On more than one occasion, the steward knocked on my door and asked if I needed the services of a physician … quite humorous, don’t you think?

“Finally, I could endure it no longer. I burst from my cabin in the middle of the night, tore through the ship, and smashed my way into the captain’s cabin, with the aim of availing myself of whatever narcotics were in the medicine chest. I overpowered the captain and was subdued only when he raised the alarm and four sailors came to his assistance. By that time, the captain had grabbed his pistol and it was only because I was so obviously mad that I was not shot. I eventually managed to explain my situation, how I had come to be the way I was, and the captain, a decent and sympathetic man, did not have me arrested when we reached port. He even supplied me with small amounts of morphia on the return voyage to keep my situation manageable.”

“On Dr. Halsted’s request,” said the Professor, “the captain had cabled Welch in Baltimore. Welch came immediately and, as a result, the affair was not made public, not even to the Hopkins administration. I am counting on your discretion, Ephraim, to see that it remains that way.”

“I will not repeat what I have been told in confidence,” I said.

“I have no doubt of your honor,” the Professor replied. The remark stung like nettles.

“Welch took me to Baltimore,” Halsted went on, “and into
his home. He watched over me as one would tend a sick child. I told him of the success that the ship captain had substituting small quantities of morphia for cocaine, and Welch thought that an excellent idea. His hypothesis was that if cocaine addiction was the more powerful, it was vital to put an end to it by any means possible. That hypothesis proved correct. By injecting small amounts of morphia, I was able to rid myself of cocaine. It was my most blissful and productive period in five years. And, although I found that I had to slightly increase the frequency of my morphia injections over time, the effects of that drug were far less deleterious than of the other. Moreover, Welch was able to quietly spread word that Halsted was cured.

“Everything seemed to be going smoothly until six months ago, when I had occasion to come to Philadelphia to consult with a private patient. This patient, quite well-to-do, had a testicular tumor and was too embarrassed to come to Baltimore. He had set up a surgical facility at his country home and asked me to remove the growth there. His personal physician would assist and three private nurses would tend to him during his recuperation.

“More to the point, however, this man had also used morphia, but was of course unaware that we had that in common. He had been attempting to cure himself for years, although his wealth enabled him to remain a user with no one the wiser. Whilst we spoke, he told me of a new and miraculous substance, whose origins and composition were unknown, which had allowed him to break his dependency. It was only available, he said, through underworld channels and was extremely costly, but well worth it to anyone of means who found himself in a similar state.

“As you might imagine, Dr. Carroll, I was buoyed by this news, but unable to request specifics from my patient without revealing my own dependency. I immediately made inquiries in the lesser areas of the city, however—one learns by
necessity how to do such things—and was soon rewarded with the information that someone known as ‘George’ was the source of this new drug.”

“And ‘George,’ of course, was Turk,” I said.

“Of course.” Halsted was so terse in his confirmation that I felt a fool for my comment. “I arranged a rendezvous at which I purchased a small quantity of the drug. I had no idea that this mysterious ‘George’ was a doctor, just as Dr. Osler had no idea that he was a drug supplier. To my view, while obviously a more educated and polished sort than one usually encounters in such places, I assumed that he was simply a man who had been raised in wealth and descended into iniquity. I am, as you know, familiar with the breed.”

“Nonsense,” said the Professor. “You have never and will never descend into iniquity.”

Halsted ignored the comment. “Before injecting myself, I performed an analysis of the powder with Frohde’s reagent, as I am sure you have, and then checked the literature. When I came across Wright’s experiment, I knew precisely with what I was dealing. Only then did I inject the drug and, once I did, it became clear that my patient was correct. Diacetylmorphine did most definitely quell the need for the more pedestrian form of the drug.

“I decided to be clever. Not wishing to be dependent on a denizen of the underworld, I attempted to replicate Wright’s experiment. I would synthesize diacetylmorphine myself. Wright must have been lucky, though, because my attempts were not successful. As far as I can determine, acetylizing morphine renders it fat-soluble and therefore more efficacious, but my efforts produced no such result. Assuming that Turk was also not producing the drug himself, my next step was to attempt to discover where he was acquiring his supply of diacetylmorphine, but I failed here as well. I wonder, Dr. Carroll, if you have had more success?”

“Actually,” I said, feeling quite proud of myself, “I have.” I began to recount my correspondence with the Bayer
Company, but then stopped, knowing that I could have no honest reason to suspect that a German dye maker was synthesizing diacetylmorphine. But it was too late.

“The Bayer Company?” asked the Professor. “Wherever did you get hold of that?”

I was trying to think of a creditable lie, but Halsted made it unnecessary. Rather than pursue the Professor’s query, he began to tug lightly on his beard.

“Aniline dyes,” he mused. “Very interesting.”

“I don’t understand,” I said. “Why would a dye maker be involved with such a substance?”

“You should have read further, Ephraim,” said the Professor. “There has been growing awareness in Germany of a parallel between aniline dyes and synthesized medicines. As you may know, mauve, the first synthesized coal tar dye, was discovered quite by accident in 1856, while the Englishman, Perkin, was attempting to synthesize quinine. Three years ago, the most effective antipyretic we have was discovered by two German interns who used a mislabeled jar of naphthalene while experimenting on treatments of intestinal parasites. The substance, which reduced fevers, but did nothing to the parasites, turned out not to be naphthalene, but acetanilide, a commonly used aniline dye intermediate made by the Kalle Company. Kalle had no previous experience in pharmaceuticals, but immediately sought a patent, and so we now have Antifebrin. Bayer, another dye works and one of Kalle’s competitors, then also began experimenting heavily in medicines. Two years ago, they thought they had stumbled on a pain reliever, which they called phenacetin, but it was found to cause kidney failure. Diacetylmorphine is obviously one of the substances with which they are currently working.”