The Anatomy of Addiction
Sigmund Freud, William Halstead,
And the Miracle Drug Cocaine

Howard Markel
One of my all-time favorite poems is Roy Fuller's odd "January 1940" which begins,

    Swift had pains in his head.
    Johnson dying in bed
    Tapped the dropsy himself.
    Blake saw a flea and an elf.
    Tennyson could hear the shriek
    Of a bat. Pope was a freak.
    Emily Dickinson stayed
    Indoors for a decade.
    Water inflated the belly
    Of Hart Crane, and of Shelley.
    Coleridge was a dope.
    Southwell died on a rope.

Samuel Taylor Coleridge (1772 - 1834) was indeed a dope (and Robert Southwell indeed was hung by Good Queen Bess in 1595), but Coleridge chose laudanum over martyrdom as his preferred poison. Markel tells us that laudanum is "a tincture of macerated raw opium in 50 percent alcohol," and, apparently, it cranks up the creative juices. Coleridge claims to have written his great "Kubla Khan" while blitzed on a laudanum martini, stirred not shaken.

The Anatomy of Addiction focuses on the dopey habits of two contemporaries: Sigmund Freud and William Halstead. Freud we all know about, with his weird ideas about mothers and fathers and sexuality (which may, in retrospect, not be so dopey, if you had to put up with my mother and father). Halstead was the American counterpart of Freud, operating mostly at Johns Hopkins University. Along with three others medical professionals, he practically dragged American medicine into the present precise, ritualized practice that we know today.

According to Markel, Halsted invented several medical techniques: operations for goiters, inguinal hernias, and aneurysms, the removal of gallstones, and radical mastectomies (now no longer used, but in the dark ages of medicine, the only hope for a woman with breast cancer).

Most of all, he implemented Lister's demands for a germ-free / bacteria-free operating theatre. In fact, his demands for pre-operating scrub-downs were so ruinous to the hands of his assistants (and his future wife) that he went off to New York and told B. F. Goodrich himself to make a glove that was suitable for doctors to use when cutting people, reminding us of that romantic trochee by the ever-famous Anon:

    There was a man with a hernia
    Who said to his doctor "Goldern-ya,
    When cutting my middle,
    Be sure you don't fiddle
    With matters that do not concern-ya."

§   §   §

During his time at Johns Hopkins, Halsted was, according to Markel, sticking cocaine in his arm. It was known and accepted that he had been an addict during his student days, but Markel's contention here is that Halstead continued to have a lust for both cocaine and morphine until his death in 1922; indeed, that the drugs probably hastened his demise.

William Halsted, Markel claims, "was a remarkably high-performing addict for almost four decades."

    Armed with a controlling personality of epic proportions, more times than not the surgeon restricted satisfying his drug hunger to a precise schedule of furtive morphine injections. He also managed to contain his cocaine cravings to those safe periods when he was far away from the hospital and could afford to binge.

The author's respect for Halsted comes partly from what he did to make American medicine respectable ... indeed, to make it the wonder of the Western world. But Markel seems to think less of Freud. Even though, apparently, the good doctor of Vienna was able to shake off his twelve-year addiction to cocaine and soon went on to shape his astonishing theory of the way the mind works, and in the process, to write one of the great novels of the 19th Century, The Interpretation of Dreams. (Others refer to it as a scientific paper or some such. Forget it. It's as good as that other bleak novel of 19th Century life, Das Kapital.)

Markel is certainly not impressed with Freud's previous operations (in both senses of the word) and, for good reason: Freud's believed (and wrote) that cocaine was the be-all and end-all cure for pain. Worse, Freud blew it when he didn't report cocaine's ability to serve as an impressive local anesthesia.

He also faults Freud's addiction to a doctor named Wilhelm Fliess. Fliess came up with a batty theory about the origins of hysteria, a condition that plagued the women-folk of Europe at the time. He said that it all had to do with their noses.

I didn't make that up ... although I wish I had. It was screwy enough to convince Freud to operate on one of his patients, a lady known in FreudLit as "Emma" (in reality Irma Eckstein).

The tale of the botched operation, the pain of her poor mangled nose, along with her subsequent addiction to cocaine --- she was introduced to it by Freud --- is enough to make the rest of us swear off the Oedipus Complex and penis envy for the rest of our days.

Fortunately Freud gave up Fliess, cocaine, and Emma ... but unfortunately not penis envy ... and sometime around the turn of the century he traded his addiction for cocaine in addiction to cigars (twenty a day) and booze (Barolo and Marsala) ... and soon after became the sole traveling star of the brain-change routine.

§   §   §

An Anatomy of Addiction is a crackerjack piece of writing ... so good that I read it straight through like a novel. Anatomy is tricked out with great stylistic touches. In one operation on a very wealthy lady for removal of bile duct stones, Halsted "had the gall(!) to submit a bill for $10,500, or almost $260,000 in 2010 dollars."

    However, the woman recovered from both her financial and her surgical extractions quite nicely.

And those of us, gack, who have gone through cataract removal will treasure this passage: "Although practiced since the days of antiquity, it had long remained a dreaded procedure. After all, without pharmaceutical assistance, cataract removal is not only excruciating; it packs the extra punch of requiring the patient to watch as the surgeon literally pokes him in the eye." Both Bach and Handel went through it without benefit of anesthesia, as did Thomas Hardy, who wrote, "It was a like a red-hot needle in yer eye whilst he was doing it. But he wasn't long about it."

    Oh no. If he had been long I couldn't have beared it. He wasn't a minute more than three quarters of an hour at the outside.

§   §   §

Anatomy is teeming with facts about Halsted and his spotless operating rooms and his cocaine shots and his rubber gloves and his being forced to pose, with three other notables for a portrait by John Singer Sargent (Markel calls it "a divine gem of portraiture:")

    Initially, Sargent could not make up his mind about the painting's composition. He paced up and down the room, chain-smoking cigarettes, while the doctors, none of them known for their patience, allowed themselves to be positioned and repositioned according to the artist's latest whim.

And the revelations about Freud... Not only do we get twelve years of his enervating cocaine use, along with Emma's poor ruined nose, but there is the characterization of Freud as a "cranky" hysteric (who had been inducted into treating hysterics no less). And there is this blockbuster set right at the very end: "A year after he fled Nazi-dominated Austria for London, a cancer-riddled Freud asked his physician Max Schur for a fatal dose of morphine to end his life."

    "Schur, you remember our 'contract' not to leave me in the lurch when the time had come. Now it is nothing but torture and makes no sense."

And Schur, true to his word, administers "a large dose of morphine" not once but three times ... "and Freud went into a coma from which he did not awake."

--- L. W. Milam
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