August 17, 2011

The dark side of a wonder drug

By Howard Markel
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When Sigmund Freud and William Halsted began experimenting on themselves with cocaine in the 1880s, “addiction” was not yet a medical diagnosis. Yes, people knew about the ravages of “Demon Alcohol” and saw a downside to widely prescribed opiates. But an understanding of the commonalities of something known as “addiction” was not yet documented. Cocaine, a newly popular ingredient in elixirs like Coca-Cola, was promoted as having astonishing medical properties.

In An Anatomy of Addiction, University of Michigan medical historian Howard Markel explores the impact of cocaine use on two of the period’s most prominent medical pioneers. It’s a story that has never before been told in such depth or in so readable a form. Markel, the author of the award-winning Quarantine! and When Germs Travel, has an unrivaled knack for research and narrative. So he is able to paint compelling and nuanced portraits of Freud and Halsted, the foremost surgeon of his day, and to convey the excitement and physical and psychological risk of an era of remarkable medical advances.

Halsted began exploring cocaine’s potential as anesthesia in major surgery by injecting the drug under his skin. A leading exponent of now-discredited forms of radical surgery and a highly influential leader in the adoption of sterile operating procedures, Halsted became addicted. After a number of hospitalizations he was rescued by a colleague and became leading professor at John Hopkins Medical School, which soon became the most influential medical institution in the world. Halsted remained an addict all his life, though a high-performing one, and Markel provocatively suggests that cocaine may have “given rise to the greatest school in surgery this country has ever seen,” though it also grievously stunted Halsted’s personal life.

Sigmund Freud began his self-experimentations with the drug in the dual hope of curing a friend of morphine dependency and writing a groundbreaking research article that would launch his career (and provide him the financial stability he needed to marry his long-enduring fiancée). The influence of cocaine on his early career is more difficult to precisely document, but here, too, based on his research, Markel is wonderfully suggestive.

Yet Freud managed to overcome his drug dependency. How? Markel says that Freud’s driving intellectual ambition demanded the predictable routines and accountability that “served as the ideal therapeutic program.” Soon thereafter, Freud entered the period “when he became one of the greatest intellectuals of his generation and provided a modern language for understanding the unconscious mind.”

“One only wishes,” Markel writes, “that [Freud had] had similar fortitude to put down his addictive and cancer-producing cigars, which, beginning in 1923 . . . robbed him of an intact, functioning mouth and forced him to undergo multiple painful surgeries and wear ill-fitting prostheses.” That addiction finally cost Freud his life.

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