fewer than “ten thousand Americans took some kind of formal medical
study at Vienna between 1870 and 1914.”^10 They were coming for the new
emphasis on laboratory medicine, and Billroth exemplified the German
experimental physiology and pathology and the ability to translate that
into meaningful clinical interventions, for the first time in human history.
Into that world had come William Stewart Halsted, from 1878 to 1880.
He had absorbed the mindset, the techniques and protocols, and had
observed what tools and machines were required. He would replicate the
structures (organizational and physical edifices) that Billroth had erected,
down to the building of a tent on Bellevue grounds. His rapacious animal
spirit, initially under Teutonic tutelage and now unbridled in New York
City, was on the prowl. Halsted demanded tailored suits, Parisian-made
Charvet shirts, French laundering (sending his dirty shirts by steamship to
Paris, and weeks later receiving back laundered garments), dandy hats,
ties, and eyeglasses. The same sartorial impulses and obsessions were
unleashed in his medical practice all over the city at all times of the day
and night.
Henry Welch left New York in March 1884, stranding Halsted in the
New World. Welch’s arrival in Europe coincided with a pharmacological
coup; the German pharmaceutical company Merck had isolated and
purified an alkaloid from the leaves of the Erythroxylon plant that was
indigenous to the eastern slopes of the Andes mountains. There was a
primordial Incan tradition of chewing and sucking the leaves to achieve an
energizing mood alteration, but the transoceanic voyage had always
neutralized and weakened the plant’s powers once back in European
capital cities. Scientists at Merck were able to cultivate the Erythroxylon
coca plant, and using the newly refined chemistry, were able to isolate the
active chemical compound, an alkaloid they labeled “cocaine.”
Alkaloids are a diverse group of simple chemical compounds with a
dizzying array of conformations, and to science novices, it is surprising
that bacteria, fungi, plants, and animals all make these “lock and key”
molecules that dock into certain cell receptors to effect a change.
Curiously, our mammalian brains have cellular receptors that anticipate
interactions with molecules from the coca plant from Colombia, opium
poppy seeds from Afghanistan, coffee beans from Ethiopia, and marijuana
from Mexico. These alkaloids have wide-ranging pharmacological
activities, including psychotropic, antiarrhythmic, anticancer,