How a medical pioneer's cocaine addiction helped shape modern-day residency programs

Hundreds of medical school graduates, donning their hard-earned white coats, start their residencies every summer, during which they take on at least a few more years of training in a specialized field, like surgery or pediatrics, before they're licensed to practise.

Residencies are known to be rigorous learning and work environments, where new doctors move their way up to taking on more responsibility under the guidance and supervision of attending physicians.

Two University of Calgary researchers believe that very program structure can be connected to the man who revolutionized medical training in North America, William Stewart Halsted — and his addiction to cocaine.

Considered the pioneer of modern surgery, the American surgeon is credited with many advances in the field, from perfecting the radical mastectomy surgery for breast cancer to inventing surgical gloves.

Another one of his contributions to medical practice: a novel residency training model he developed at the reputable Johns Hopkins Hospital in Baltimore, Md., during the late 1800s.

The program, characterized by a tiered system in which residents were ranked by seniority and given graded responsibility, may have been designed by Halsted as a way to help him hide his addiction and mask his own deteriorating speed and precision, according to a study in the Canadian Journal of Surgery.

"He brought in all these young students who wanted to be surgeons. He set it up [as a training program], but really they were backing him up," said Dr. Norman Schachar, a professor emeritus at the University of Calgary's Cumming School of Medicine, and co-author of the study.

"He started a system where he could weed out the best ones in a pyramidal sort of structure, where the guy who got to be the 'senior resident' was the one he hand-picked, who was the most skilled and the smartest. And then he said, 'You come to the [operating room] with me. Better yet, you go start, and I'll catch up to you.'"

Co-author and professor emeritus at the University of Calgary's Cumming School of Medicine James Wright said, "much of the design of the residency program was pretty self-serving in that it basically provided a way for [Halsted] not to have very much contact with patients yet still provide high-quality surgery."

Halsted began his career in New York, where he routinely experimented with procedures like the blood transfusion, pushing the boundaries of medical knowledge at the time.

But in 1884, one experiment went too far.

Then-32-year-old Halsted came across a report out of Australia that mentioned a potential new local anesthetic: cocaine.

Experimenting on himself with the drug, Halsted became addicted, and his career as a young surgeon rapidly declined as he went in and out of treatment facilities.

To treat his cocaine addiction, Halsted was given morphine, which he also got addicted to.