By Dr. Kate Scannell, Syndicated Columnist
First published in print: 10/23/2011
After injecting himself with cocaine, the acclaimed New York surgeon -- who would come to be known as the "Father of Modern Surgery" -- proceeded to the trauma room where he'd been summoned by hospital staff. Awaiting his arrival was a construction worker with life-threatening bone fractures who was "writhing in agony." But, rather than picking up a scalpel and treating the laborer, the surgeon, Dr William Halsted, "turned on his heels, walked out of the hospital, and hailed a cab to gallop him to his home. ... Once there, he sank into a cocaine oblivion that lasted more than seven months."
Meanwhile, across the Atlantic and 12 days after Halsted fled the hospital, the Viennese physician who would become the "Father of Psychoanalysis" began composing love letters -- about cocaine -- to his fiancée, Martha. In those letters, Sigmund Freud wrote about his self-experimentation with "this magical substance" -- the way it lifted him "to the heights in a wonderful fashion." Two months later, he would publish his legendary monograph, "Über Coca" -- a "song of praise" to cocaine.
Through compellingly told stories of these two physicians, author and medical historian Howard Markel takes us on a sometimes-cringing tour of the medical establishment during the late-19th and early-20th centuries -- and, as we discover, much of what we encounter seems hauntingly familiar today. In his new book, "An Anatomy of Addiction -- Sigmund Freud, William Halsted, and the Miracle Drug Cocaine," Markel also tells a timeless and over-arching tale about medical practice "under the influence" of commerce and happenstance.
From the author's vividly detailed research, we learn that Halsted and a group of colleagues began to self-experiment with cocaine in 1884, hoping to discover new anesthetic techniques that would allow safer, tolerable and more successful operations. At the time, the medical profession had just discovered how to use narcotics to alleviate pain, but no one truly appreciated the addictive potential of "miracle drugs" like cocaine.
Fortunately, Halsted did discover how to use cocaine to block the spinal cord and numb nerves, thus giving rise to modern surgical and dental anesthesia. He also promoted cleanliness and sterility in the operating room -- a radical notion at a time when "surgeons who did subscribe to the germ theory of disease still numbered in the minority." Furthermore, he developed novel surgical methods for operations on the breast, intestines, gallbladder and thyroid.
Unfortunately, as a consequence of self-experimentation, "in a matter of weeks, Halsted and his immediate circle were transformed from an elite cadre of doctors into active cocaine abusers." Despite some inglorious public displays of grossly unprofessional behavior, Halsted -- described by Markel as a "remarkably high-performing addict" -- continued to work, never breaking his addiction through the time of his death in 1922.
In contrast, Markel suggests that Freud stopped using cocaine in his lifetime, by 1896 and just prior to launching his psychoanalytic legacy. However, he would frequently ruminate over the death of a close friend whose morphine addiction he had misguidedly tried to "treat" with cocaine. And years would pass, during which he'd obsessively yearn for professional recognition as an authority on cocaine's (purported) clinical powers.
Drawn to the particulars of these men's lives, we also get a good (or, sometimes, bad) view of social norms and Western medical practice, imbued with the Victorian enthusiasm for experimenting with mind-altering drugs in the latter half of the 19th century. This may surprise many readers who link the beginning of "the" drug culture to the 1960s.
But in the mid-to-late 1800s, "controlled substances" did not exist, —... let alone illegal drugs. Bottles of morphine, cocaine, and other powerful, habit-forming pills and tonics were easily found in virtually every hospital, clinic, drugstore, and doctor's black bag." Self-dosing with nitric oxide (laughing gas), hashish and narcotics was common and legal. "Energy-boosting" commercial beverages and "tonic" wines contained cocaine.
Caught in the hype, physicians began recommending cocaine products as a cure-all to their patients for ... well, anything. Here, Markel underscores the attendant hazards when physicians sacrifice sound scientific principles to the gods of popular culture in a cautionary tale involving a Corsican chemist named Angelo Mariani.
From 1863 through the turn of the century, Mariani mass-marketed "Vin Mariani" -- a "tonic wine" concocted from ground coca leaves and Bordeaux, each ounce containing at least six milligrams of cocaine. Advertisements proclaimed, "It nourishes, fortifies, refreshes, aids digestion, strengthens the system ... it is a stimulant for the fatigued and over-worked body and brain, it prevents malaria, influenza and wasting diseases."
Mariani's cocaine-enhanced tonic was enjoyed by Queen Victoria and two U.S. presidents -- Ulysses S. Grant and William McKinley. Celebrity endorsements were obtained from Thomas Edison, Auguste Rodin and Robert Louis Stevenson. Even Pope Leo the 13th permitted his name and face to be featured in a Mariani ad.
Angelo Mariani also became a prototypic pharmaceutical salesman. He marketed his elixir directly to physicians, offering free samples to initiate patient treatment. As Markel summarily notes, "Mariani predated by more than a century and a half the unholy alliance of pharmaceutical houses and too many practicing doctors, a partnership that continues to conspire, inundate, and overmedicate us all in the 21st century."
As a sign of the times, Markel further notes: "... the alarming number of male doctors who prescribed opium, morphine, and laudanum ... to ever greater numbers of women patients. Any female complaining to her physician about so-called women's problems was all but certain to leave the doctor's office clutching a prescription."
Halsted's and Freud's cocaine promotion both reflected and reinforced prevailing societal norms. But, as physicians -- and their great medical contributions not withstanding -- they also bore a responsibility to temper their personal enthusiasms for the greater good of science and the patients they served. As Markel pointedly concludes: "Each man actively participated in the birth of the modern addict, and their clinical histories prefigure the ever-challenging spectrum of substance abuse, addiction, and recovery."
In the light of current day and in the giant shadows of these men, it is sobering to acknowledge that our two celebrated "Fathers of Medicine" were both drug addicts. It is discomforting to witness familial resemblances in us 21st century offspring, we modern-day American physicians who, with our patients, helped to create Prozac Nation and run up $240 billion in annual prescription drug costs.
Markel's engaging book reminds us that the practice of medicine has always been both cultural and scientific in nature. And through his vivid portrayals of two legendary physicians' lives, we are also reminded that its practitioners are all too human.
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Kate Scannell is a Bay Area physician and syndicated columnist. Her books include the memoir "Death of the Good Doctor" and the novel "Flood Stage."
Copyright 2011, Kate Scannell