11 Only a decade later: For example, in 1909, Freud was invited to give five major lectures on psychoanalysis at Clark University, in Worcester, Massachusetts, by the great American psychologist G. Stanley Hall. Freud also traveled to Boston, where he met with Harvard professors William James, James Jackson Putnam, and many other luminaries; to New York City, where he explored Chinatown and the Jewish ghetto; and through Albany to Buffalo to see Niagara Falls. Unfortunately, Freud did not venture south to Baltimore and the Johns Hopkins Hospital, where Halsted was still practicing. These lectures appear in Saul Rosenzweig, The Historic Expedition to America (1909): Freud, Jung, and Hall the King-Maker (St. Louis: Rana House, 1994); see also J. Harris, “The Clark University Vicennial Conference on Psychology and Pedagogy,” Archives of General Psychiatry 67, no. 3 (2010): 218–19. In 1909 and 1910, Freud published second editions of Studies in Hysteria, The Interpretation of Dreams, and Three Essays on Sexuality; George Makari, Revolution in Mind: The Creation of Psychoanalysis (New York: Harper Perennial, 2008), pp. 234–35.
12 “You have not only noticed”: The italics are Freud’s and appear in his letter. Freud to Ferenczi, October 6, 1910. Quoted in Ernest Jones, The Life and Work of Sigmund Freud, vol. 2, 1901–1919 (New York: Basic Books, 1955), pp. 83–84. “Cathexis” is a Freudian term referring to the investment of emotional significance in an object, activity, or notion.
13 “You probably imagine”: Unpublished letter, Freud to Ferenczi, October 17, 1910, quoted in Complete Letters, p. 4.
14 “I have now overcome”: Unpublished letter, Freud to Ferenczi, December 16, 1910, quoted in Complete Letters, p. 4.
15 “any particular predilection”: Sigmund Freud, An Autobiographical Study, trans. James Strachey (New York: W. W. Norton, rpt. ed., 1989), p. 6.
16 “We are doctors”: J. Turner, “The Otto Gross—Frieda Weekley Correspondence,” The D. H. Lawrence Review 22, no. 2 (1990): 137–227; quote is from p. 143. See also Makari, Revolution in Mind, p. 226. This comment, made in 1908, was in response to Dr. Otto Gross’s grandiose compliment that Freud was a scientific revolutionary who broke the mythologies of past attempts to understand human psychology.
17 “That you surmised”: Freud to Ferenczi, October 6, 1910; quoted in Jones, Life, vol. 2, pp. 83–84. This is the same letter where Freud makes his veiled confession about a possible homosexual relationship with Fliess.
18 Writing to Jung: Freud to Carl Jung, June 21, 1908, in W. McGuire, ed., The Freud/Jung Letters: The Correspondence Between Sigmund Freud and C. G. Jung (London: Hogarth Press and Routledge and Kegan Paul, 1974), pp. 157–60; quote is from p. 158. Freud eventually dismissed Gross from the psychoanalytic movement because of his addictions, a series of sexual scandals, his unorthodox medical practices, and a desire to convert psychoanalysis into a philosophy of revolution. Starving and living on the streets of Berlin, Gross died of pneumonia in 1920.
19 Only a few months earlier: Freud to Ferenczi, June 1, 1916, and February 13, 1916, in Jones, Life, vol. 2, p. 189.
20 More often than not: Jones, Life, vol. 2, pp. 381–86.
21 Dr. Schur administered: Both Jones’s and Gay’s biographies poignantly document Sigmund Freud’s valiant last years as he slowly succumbed to the ravages of oral cancer. Ernest Jones insists that during Freud’s fatal battle with cancer he avoided all painkillers save aspirin. Jones delicately states that at the very end, Freud was given “adequate sedation” for his severe cancer pain, but he avoids concluding that the situation was more akin to an assisted suicide; Ernest Jones, The Life and Work of Sigmund Freud, vol. 3, 1919–1939 (New York: Basic Books, 1957), pp. 218–48. Peter Gay, on the other hand, documents rather conclusively that while Sigmund probably was not using opiate painkillers during his long bout with cancer, he did receive morphine to end his life in September 1939; Gay, Freud, pp. 649–51, 739–40. Gay bases his conclusions on a review of Max Schur’s unpublished manuscript “The Medical Case History of Sigmund Freud,” which is dated February 27, 1954; Max Schur Papers, Library of Congress, Washington, D.C. See also Max Schur, Freud: Living and Dying (New York: International Universities Press, 1972); and S. Aziz, “Sigmund Freud: Psychoanalysis, Cigars, and Oral Cancer,” Journal of Oral and Maxillofacial Surgery 58, no. 3 (2000): 320–23.
22 In a book entitled Freud and Cocaine: E. M. Thornton, Freud and Cocaine: The Freudian Fallacy (London: Blond and Briggs, 1983), pp. 1–10.
23 In recent years: For other accounts on the relationship between Freud’s cocaine abuse from 1884 to 1896 and his thoughts and theories, see Frederick C. Crews, ed., Unauthorized Freud: Doubters Confront a Legend (New York: Viking, 1998); Frederick C. Crews, The Memory Wars: Freud’s Legacy in Dispute (New York: New York Review Books, 1995); Frederick C. Crews, Follies of the Wise: Dissenting Essays (New York: Counterpoint, 2007); J. Lilly, “From Here to Alterity and Beyond,” in Mavericks of the Mind: Conversations for the New Millennium, ed. D. J. Brown and R. M. Novick (Freedom, Calif.: Crossing Press, 1993), pp. 203–25; Robert C. Fuller, “Biographical Origins of Psychological Ideas: Freud’s Cocaine Studies,” Journal of Humanistic Psychology 32 (1992): 67–86; R. Karmel, “Freud’s Cocaine Papers (1884–1887): A Commentary,” Canadian Journal of Psychoanalysis 11 (2003): 161–69; J. Scheidt, “Sigmund Freud und Cocaine,” Psyche 27, no. 5 (1973): 385–430; R. Dadoun, “Un ‘Sublime Amour’ de Sherlock Holmes et de Sigmund Freud,” Littérature 49 (1983): 69–76; and Stanley E. Hyman, “Freud and Boas: Secular Rabbis? Vienna Gaon, Tsaddik of Morningside Heights” (a book review of Ernest Jones’s Life and Work of Sigmund Freud, vol. 1, and M. J. Herskovits’s biography Franz Boas), Commentary 17, no. 3 (1954): 264–67. Preceding all these works by several decades is the superb essay by Siegfried Bernfeld, “Freud’s Studies on Cocaine, 1884–1887,” Journal of the American Psychoanalytic Association 1 (1953): 581–613. Bernfeld also notes the “guilty” dreams Freud had about Fleischl-Marxow during this period.
24 Most intriguing is a theory: Peter Swales, “Freud, Cocaine and Sexual Chemistry: The Role of Cocaine in Freud’s Conception of the Libido,” in Sigmund Freud: Critical Assessments, ed. Laurence Spurling, vol. 1 (London: Routledge, 1989), pp. 273–301; quote is from p. 274. Freud defined the libido—or sexual drive—as an instinctual energy that constitutes the “id,” or unconscious portion of one’s psyche. He posits that one’s libido often is in conflict with the behaviors acceptable to a given society (which is represented in the psyche as the “superego”) and that such conflicts can lead to significant tension and disturbances, which require a variety of ego defenses to counterbalance the tensions. If too excessive, the ego defenses can lead to a neurosis. Indeed, one of the goals of psychoanalysis was to allow the libidinal drives to enter one’s conscious thought and, thus, allow the patient to confront them directly and limit the need to rely on ego defenses. Swales also asserts that Freud’s experience with cocaine is the source of his early views about somatic sexual neuroses. As Swales notes, at several points in Freud’s writings on neuroses, particularly his 1905 essay on sexuality and the etiology of neuroses (A Case of Hysteria, Three Essays on Sexuality, and Other Works, in Standard Edition of the Complete Psychological Works of Sigmund Freud, vol. 7, p. 279), Freud likens a neurosis to the use of a chemical substance, such as “the use of certain alkaloids” (i.e., cocaine), which is damaging when taken to excess or during withdrawal. At other points, Freud describes a “toxicological theory” of neuroses. It is also important, however, to consider the late-nineteenth-century concept of autointoxication—an excess of toxic chemicals resulting from either constipation or lack of sexual activity. Such endogenous toxins represent a different entity than an exogenous “toxin” such as cocaine. Nevertheless, this observation is fascinating in suggesting how Freud may have used his cocaine experiences to elaborate and explain some of his concepts.
25 For all the reasons enumerated: Peter Gay, “Freud: A Brief Life,” in Sigmund Freud, The Ego and the Id, trans. Joan Riviere, part of the Standard Edition of the Comp
lete Psychological Works of Sigmund Freud (New York: W. W. Norton, 1989), p. xviii.
26 The clinical odds: D. D. Simpson, G. W. Joe, and K. M. Broome, “A National 5-Year Follow-up of Treatment Outcomes for Cocaine Dependence,” Archives of General Psychiatry 59 (2002): 538–44. There may be a genetic explanation for cocaine addiction. Recently scientists have demonstrated that cocaine use can actually alter the gene expression, causing changes in neuronal morphology and behavior; see I. Maze, H. E. Covington, D. M. Dietz, Q. LaPlant, W. Renthal, S. J. Russo, M. Mechanic, E. Mouzon, R. L. Neve, S. J. Haggarty, Y. Ren, S. C. Sampath, Y. L. Hurd, P. Greengard, A. Tarakhovsky, A. Schaefer, and E. J. Nestler, “Essential Role of the Histone Methyltransferase G9a in Cocaine-Induced Plasticity,” Science 327 (2010): 213–16.
Chapter 12. Dr. Halsted in Limbo
1 In 1905 Mary Elizabeth Garrett: In late 1892, Mary Elizabeth Garrett, whose father once ran the Baltimore and Ohio Railroad Company, made a major gift of over $300,000 (or almost $7.5 million in 2010 dollars) that allowed the Johns Hopkins Medical School to open its doors in 1893, provided women medical students were admitted. In tribute to her work, the Hopkins trustees commissioned Sargent to paint her portrait and provided half of the fee, with Garrett paying the rest; in return, she donated the funds to pay for the group portrait. Both paintings hang in the Welch Medical Library in Baltimore. The Four Doctors was formally unveiled in 1907. Although the son of a Philadelphia eye surgeon, Sargent had lived in Europe since boyhood. One of the premier portraitists of his day, the artist made his home in London and found his muse in the persons of the rich and famous. He charged $5,000 or more a portrait ($125,000 in 2010 dollars), and the majority of his customers hailed from the gentry of Great Britain and the Continent. A smaller number of well-heeled Americans anxious to be so sumptuously captured for the ages happily crossed “the pond” at their own expense to sit patiently in Sargent’s studio. See A. M. Harvey, G. H. Brieger, S. L. Abrams, J. M. Fishbein and V. A. McKusick, A Model of Its Kind, vol. 2, A Pictorial History of Medicine at Johns Hopkins (Baltimore: Johns Hopkins University Press, 1989), pp. 68–69; Nancy McCall, ed., The Portrait Collection of Johns Hopkins Medicine: A Catalog of Paintings and Photographs at the Johns Hopkins University School of Medicine and the Johns Hopkins Hospital (Baltimore: The Johns Hopkins University School of Medicine, 1993); Stanley Olsen, John Singer Sargent: His Portrait (New York: St. Martin’s Press/Griffin, 2001); and Elaine Kilmurray and Richard Ormond, John Singer Sargent (Princeton, N.J.: Princeton University Press, 1998). To convert 1905 dollars into 2010 values, I used a formula based on the consumer price index from the economic history–focused website Measuring Worth, www.measuringworth.com/index.html (accessed February 25, 2010). I am indebted to Nancy McCall, chief archivist of the Alan Mason Chesney Archives at the Johns Hopkins Medical Institutions, for sharing her knowledge and research on this great painting.
2 There they reunited: Harvey Cushing, The Life of Sir William Osler, vol. 2 (Oxford: Oxford University Press, 1925); and Michael Bliss, William Osler: A Life in Medicine (New York: Oxford University Press, 1999).
3 Sargent was said to have pulled: Royal Cortissoz, The Johns Hopkins University Circular, February 1907; quoted in “The Four Doctors,” Johns Hopkins Alumni Magazine 2 (1913–14): 23–26.
4 Legend has it: D. Geraint James, “John Singer Sargent and ‘The Four Doctors,’ ” Journal of Medical Biography 15, Supp. 1 (2007): 5; and Stefan C. Schatzki, “The Four Doctors,” American Journal of Radiology 169 (1997): 504. The entire painting underwent restoration in 2001.
5 After the war: R. B. Wallace, “Historical Perspectives of the American Association for Thoracic Surgery: George J. Heuer, M.D. (1882–1950),” Journal of Thoracic and Cardiovascular Surgery 130, no. 4 (2005): 1194–95. Heuer had a close filial relationship with Halsted and even dined with the surgeon in his home. He recalls, in his biography, charming stories of Halsted’s consideration for him as a guest, to the extent of running out to the market to make sure Heuer had a fresh grapefruit for breakfast and how jovial and pleasant Halsted could be among the company of one or two close friends at the dining table and in his study.
6 “In the pages of this narrative”: William H. Welch, “Introduction,” in William G. MacCallum, William Stewart Halsted, Surgeon (Baltimore: Johns Hopkins University Press, 1930), pp. v–xiii; quote is from p. ix.
7 “Dr. Halsted did not escape”: MacCallum, Halsted, pp. 55–56.
8 For more than two decades: The George J. Heuer papers are preserved at the Weill Cornell Medical College/New York—Presbyterian Hospital Archives in New York City. An editor at Macmillan, W. H. Seale, expressed interest in the book in 1940; see W. H. Seale to Heuer, April 10, 1945, Box 2, File 12, Item 7. Two years after Heuer’s death in 1950, his biography of Halsted was published as “Dr. Halsted,” in the Johns Hopkins Hospital Bulletin, Supp. 90 (1952): 1–104.
9 “You are indeed a sturdy friend”: Halsted to Matas, May 30, 1921, Box 59, Folder 8, W. S. Halsted Papers, Alan Mason Chesney Archives, Johns Hopkins Medical Institutions, Baltimore.
10 “How can I ever express”: Halsted to Matas, April 3, 1922, Box 18, Folder 4, W. S. Halsted Papers, Alan Mason Chesney Archives, Johns Hopkins Medical Institutions, Baltimore. These letters were also published in William S. Halsted, “Practical Comments on the Use and Abuse of Cocaine,” Surgical Papers, vol. 1, pp. 167–77; and MacCallum, Halsted, pp. 224–25.
11 “All said there was no direct evidence”: Heuer to MacCallum, December 9, 1940, and MacCallum to Heuer, December 18, 1940. George J. Heuer Papers, Box 2, File 13, Item 3, Weill Cornell Medical College Archives, New York.
12 Similarly, two of Mrs. Halsted’s nieces: Heuer, “Dr. Halsted,” p. 25; see also Dr. Heyward Gibbs of Columbia, South Carolina, to Heuer, March 11, 1941. Gibbs had heard from a mutual colleague, Harry Slack, about Heuer’s biography and the “whispering campaign to the effect that the Professor had resumed the taking of cocaine, or some other sedative, after he had succeeded in ridding himself of the habit in early years.” Gibbs goes on to categorically deny such an occurrence based on his intimate association with Mrs. Halsted’s nieces Lucy Bostick and Gertrude Barringer. The former stated that “she feels perfectly positive that there was noever [sic] the slightest indication of Dr. Halsted using drugs of any nature during the time that she knew him.” Interestingly, Gibbs admits to having only “casual contacts” with Halsted and his wife. George J. Heuer Papers, Box 2, File 13, Item 5, Weill Cornell Medical College Archives, New York. Heuer replied on March 21, 1941, thanking Gibbs for his concern and to assure him that he was simply trying to run down every item, adding, “I can find no evidence thus far that Dr. Halsted continued to use drugs”; Box 2, File 13, Item 6, Heuer Papers, Weill Cornell Medical College Archives, New York.
13 So powerful and controversial: Heuer, “Dr. Halsted,” pp. 22–23.
14 Moreover, Cushing labored: Cushing was a great admirer of Osler’s and for a time rented the house next to Osler’s on Franklin Street in Baltimore. He spent considerable time basking in the glow of this charismatic medical professor, even though he was a surgeon assigned to Halsted’s service. There is no evidence that William Osler told anyone about his sealed “Inner History of the Johns Hopkins Hospital.” See Cushing, Sir William Osler; Michael Bliss, Harvey Cushing: A Life in Surgery (New York: Oxford University Press, 2005), pp. 84–203; John F. Fulton, Harvey Cushing: A Biography (Springfield, Ill.: C. C. Thomas, 1946); J. A. Barondess, “Cushing and Osler: The Evolution of a Friendship,” in The Persisting Osler II, ed. J. A. Barondess and C. G. Roland (Malabar, Fla.: Krieger Publishing, 1994), pp. 95–120; and A. M. Harvey, “Harvey Williams Cushing: The Baltimore Period, 1896–1912,” in Research and Discovery in Medicine: Contributions from Johns Hopkins, ed. A. McGehee Harvey (Baltimore: Johns Hopkins University Press, 1981), pp. 71–91.
15 “Here I am, a youth”: Quoted in Bliss, William Osler, p. 254; Cushing to Kate Crowell, March 15, 1898, Harvey Cushing Papers, Microfilm Reel 17
, p. 343, Sterling Library, Yale University, New Haven.
16 “In a discussion of MacCallum’s book”: “Notes on Dr. Halsted from Harvey Cushing, March 1, 1931, Given to me (G.J.H.) by Elliott Cutler, November 10, 1939,” George J. Heuer Papers, Weill Cornell Medical College Archives, Box 2, File 14, Item 5. Apparently, Cushing had had a similar conversation nine years earlier with his Yale colleague and future biographer, the neurophysiologist John F. Fulton, on December 5, 1930. In a brief note in the Cushing papers at Yale, Fulton mentions that Cushing had been in the Halsted home only twice in fifteen years and that “he never suspected the cocaine habit, and only with difficulty was he led to accredit it many years later.” Cited in Sherwin B. Nuland, Doctors: The Biography of Medicine (New York: Vintage Books, 1988), p. 398. Fulton had long suffered from a serious drinking problem and wrote his 1945 biography of Cushing in “a kind of alcoholic haze.” See Bliss, Harvey Cushing, p. 520. Cushing died on October 7, 1939.
Reid Hunt (1870–1948) was a prominent pharmacologist and a colleague of Halsted’s at Johns Hopkins before becoming the chairman of pharmacology at Harvard. Heuer wrote Hunt a letter asking for confirmation of this point on December 4, 1940, but Hunt did not reply. In the published version, Hunt’s name is omitted and he is, instead, referred to as an “eminent scientist.” Heuer does quote in the published version the letter he wrote Hunt but notes, “No reply to my letter was received and he has since died.” Heuer also adds, without evidence or explanation, that he does not believe Hunt was close enough to Halsted to rule in or out such an assertion. Heuer, “Dr. Halsted,” p. 25; see also Heuer to Reid Hunt, December 9, 1940, George J. Heuer Papers, Box 2, File 13, Item 1, Weill Cornell Medical College Archives, New York.
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