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 Breast Cancer: Revisiting Accepted Wisdom in the Management of Breast Cancer - Part 1 

The early 1880s, a decade before Johns Hopkins Medical School commenced, were productive and prolific for Halsted. He published 20 scientific papers, lectured in anatomy at his alma mater, became an associate in a surgical practice at Roosevelt Hospital, and set up the outpatient clinic there. But by 1885 this had changed and Halsted's ability to deliver lectures as well as his attendance at professional meetings dramatically waned. Although a well-kept secret at the time (which wasn't confirmed conclusively until 1969, when the diary of William Osler was unlocked and disclosed), Halsted's study in Europe had launched him into a cocaine and morphine addiction that was to last the rest of his life. Halsted's dependence began in Vienna in 1884 I when ophthalmology resident Karl Roller discovered that a few drops of cocaine numbed the surface of the eye. This discovery led to the use of local anesthesia and, curiously enough in the light of history, was proposed by none other than Koller's friend, Sigmund Freud, then a 28-year-old neurologist (note 6).

Both Freud and Halsted, inspired by Koller, undertook their own investigations. In 1884, Halsted began injecting this remarkable substance into himself and his colleagues to determine its effect in blocking nerve conduction (note 7). From this time forward, Halsted struggled with a successfully clandestine yet sometimes debilitating addiction that profoundly altered his personality, yet never eclipsed his medical life. Welch, the renown Johns Hopkins pathologist and Halsted's dutiful friend, took him sailing on a 2-month voyage through the Caribbean in the winter of 1886, hoping to correct his habit. But Halsted was admitted to Butler Hospital in Providence for 7 months later that same year, and for 9 months in 1889. Halsted's addiction effectively terminated his career in New York. Again Welch rescued him by inviting him to Baltimore and securing him an appointment at Johns Hopkins.

William Osler, Welch's partner in shaping the medical school as well as its first professor of medicine, regarded as the most eminent clinician of his time, entered in his diary that 6 months after Halsted had been awarded his full position at Johns Hopkins, he saw him in a severe chill, realizing that he was still taking morphia. Having gained one another's confidence, they discussed that Halsted had never been able to reduce the amount to less than three grains daily (one grain equals about 60 mg). Osler also recorded that he did not think anyone suspected Halsted's habit--not even Welch, who assumed the addiction had been conquered. Later Osler added that in 1898 Halsted reduced his dose to 1'/: grains--nine times the standard 10 mg of morphine prescribed for severe pain today. Halsted permitted the popular deception to persist that he had been "cured" after his second hospitalization; in the public eye, he was clean. His close friends, however, noted that the socially exuberant extrovert u ho had studied in Europe had returned strangely altered.

Halsted's distinguished resident, Harvey Cushing--the progenitor of neurosurgery, the chief of surgery at Harvard, and the man for whom Cushing's Disease was named--knew Halsted only after his temperamental shift. Upon Halsted's death in 1922, Cushing eulogized his mentor (Yale Alumni Weekly. February 23, 1923), regarded by many as the most eminent surgeon of his time:

    [Halsted] was a man of unique personality, shy, something of a recluse, fastidious in his tastes and in his friendships, ... the victim of indifferent health, he nevertheless ... may be considered to have established a school of surgery comparable, in a sense, to the school of Billroth in Vienna.... [A]n aristocrat in his breeding, scholarly in his habits ... having little interest in private practice, he spent his medical life avoiding patients.... A bed-to-bed ward visit was almost an impossibility for him. If he were interested he would spend an interminable time over a single patient, ... carrying the problem to the laboratory and perhaps working on it for weeks.
(Excerpted from Alternative Therapies in Health and Medicine)
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 About The Author
Harriet Beinfield LAcHarriet Beinfield, L.Ac. and Efrem Korngold, L.Ac., O.M.D. have pioneered the practice of Chinese medicine in America for the last 28 years as educators, writers, and practitioners. They are the co-authors of the......more
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