An Anatomy of Addiction: When Two Brilliant Minds Met a "Miracle Drug"

By Lev Grossman

On September 15, 1884, in Heidelberg, Germany, a demonstration took place that electrified the European medical establishment. An audience of distinguished eye surgeons at a medical conference watched as a dog was brought on stage. A doctor squeezed a few drops of a clear liquid into the dog's left eye, leaving its right eye clear. When the doctor waved his forceps in front of the dog's right eye, it naturally flinched. Then the doctor lightly touched his forceps to the surface of the dog's left eye. It didn't even blink.

The audience erupted. They had just witnessed one of the great moments in the history of anesthesia. The wonder drug was cocaine.

It wasn't the cocaine we know today, of course. When we first meet it in the distinguished medical historian Howard Markel's rich, revelatory new book, it's something else entirely. Markel's An Anatomy of Addiction: Sigmund Freud, William Halsted, and the Miracle Drug Cocaine is like the early pages of a family photo album, showing us cocaine as it has not been seen for over 100 years. The drug was pharmaceutically pure enough, to be sure, and plenty potent, but cocaine is now an institution, with its own politics and its own economics and its own malevolent cultural mythology. Back then it was just a novel chemical compound like any other: innocent, newly refined, culturally neutral, stripped of any meaning, its future bright and still full of promise. (See "Amy Winehouse and the Pain of Addiction.")

Of course cocaine wasn't really new. It had been present in the leaves of the coca plant, which grows in the Andes and the Amazon basin, for millennia. Indigenous people there chewed them for a mild buzz, with no ill effects. In some ways the most startling pages of Markel's book are the early passages, where he shows us how Western science took those unremarkable pale green leaves and turned them into a catastrophe. In 1860 a German graduate student figured out how to refine the active component in the leaves into its familiar crystalline form, and it quickly became a fad — a French chemist named Angelo Mariani made a fortune selling it mixed with red wine. His "Vin Mariani" was endorsed by, among others, Queen Victoria, President McKinley, and Pope Leo XIII. (Mariani ultimately lost out to the American claimant Coca-Cola, now available in de-cocainized form.)

But Vin Mariani was a relatively weak solution. The first people who used cocaine in significant quantities and concentrations were, naturally, doctors, and they became its first victims. As it turns out, the drug chose its victims from an exclusive list. One of them was a brilliant American surgeon named William Halsted, who would revolutionize his field. Another was an equally brilliant Viennese doctor named Sigmund Freud. (See a graphic about addiction and the brain.)

In 1884 Freud was a poor and obscure but wildly ambitious young doctor trying to scrape together enough kreutzers to marry his posh fiancée. In his first encounter with cocaine, he used it to try to wean an addicted colleague off of morphine. Freud had no idea how addictive the new drug was, but his friend found out pretty quick: he became dependent on both cocaine and morphine, and he eventually went mad and died. The experience haunted Freud for the rest of his life, but it didn't stop him from continuing to experiment with the wonder drug on himself. In fact, he loved the stuff. "In my last severe depression," he wrote to his fiancée, "I took coca again, and a small dose lifted me to the heights in a wonderful fashion. I am just now collecting the literature for a song of praise to this magical substance." That song would become the monograph Über Coca, Freud's first major publication.

Freud abused cocaine on and off for the next decade, but in the end he was just too tough a bastard for it to kill. Mild cocaine addiction was just one of the many compulsions and obsessions that warred within his personality, and it seems to have gotten shouldered aside in the psychic scrum. Freud also wasn't skilled enough as a clinician to inject himself directly with cocaine solution — he snorted it instead, which gives a milder buzz. In this he differed from the American surgeon Halsted, who didn't get off nearly so easily. (See "Sex Addiction: A Disease or a Convenient Excuse?)

Halsted was the scion of a wealthy New York City family, a Yale man who became an uncommonly masterly and forward-thinking surgeon. In 1884, the same fateful year as Freud, Halsted became interested in cocaine's potential as an anesthetic, and he got his students and colleagues experimenting on themselves. They had no idea what they were dealing with, and at this point Markel's account takes on the mesmerizing quality of an animal attack filmed in slow motion and high resolution, as the rapacious chemistry of the new drug falls on the refined intellectual elite of American medicine and paralyzes and consumes them. "In a matter of weeks," Markel writes, "Halsted and his immediate circle were transformed from an elite cadre of doctors into active cocaine abusers. Tragically, many of the medical students, resident physicians and surgeons who participated in these experiments were decimated by the drug and died early deaths." On May 5, 1885, Halsted himself walked out of an operation — a patient with a gory compound fracture lay in agony in front of him — took a cab to his Manhattan town house, and binged on cocaine for the next seven months.

Markel isn't a flashy writer, nor is he a big thinker. He leaves it to others to make major claims, which he keeps quarantined safely inside quotation marks. (For example, one of Halsted's colleagues attributes Halsted's later success as a surgeon to the discipline and fastidiousness he acquired as a cocaine addict. Markel lets this idea dangle there, suggestively, without endorsing it himself.) But he's a careful writer and a tireless researcher, and as a trained physician himself, Markel is able to pronounce on medical matters with firmness and authority.

In any case, Halsted's story doesn't require a lot of literary flair to lend it power and pathos. He would eventually return to public life, though it was the precarious double life of a high-functioning addict. After a stint in an asylum he rededicated himself to the scalpel; eventually, in spite of his troubled history, he was made the first professor of surgery at the newly formed, massively endowed Johns Hopkins medical school. Halsted hugely rewarded the faith that was placed in him: he more or less created the modern antiseptic operating room, complete with surgical scrubs and rubber gloves, and he pioneered major surgical procedures like the radical mastectomy in the case of breast cancer. But every day for the rest of his life, he retreated to his home at 4:30 in the afternoon to service his addictions to cocaine and, later, morphine, careful calibrating his doses: enough to keep his hands from shaking, not so much that his wits were dulled. He's not the household name Freud is, but he can claim one of the first and greatest second-chance stories of cocaine addiction. He never beat the drug, but he fought it to a draw, at a time when no one even understood what he was fighting.

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