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

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An Anatomy of Addiction by Howard Markel

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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.

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 townhouse, 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, carefully 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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