An Anatomy of Addiction Read online

  Copyright © 2011 by Howard Markel

  All rights reserved. Published in the United States by Pantheon Books, a division of Random House, Inc., New York, and in Canada by Random House of Canada Limited, Toronto.

  Pantheon Books and colophon are registered trademarks of Random House, Inc.

  Library of Congress Cataloging-in-Publication Data Markel, Howard.

  An anatomy of addiction : Sigmund Freud, William Halsted, and the miracle drug cocaine / Howard Markel.

  p. cm.

  Includes bibliographical references and index.

  eISBN: 978-0-307-37981-8

  1. Freud, Sigmund, 1856–1939. 2. Psychoanalysts—Austria—Biography. 3. Halsted, William, 1852–1922. 4. Surgeons—United States—Biography. 5. Cocaine—History. 6. Cocaine abuse. I. Title.

  BF109.A1M37 2011 362.29’80922—dc22 2010033782

  www.pantheonbooks.com

  Jacket design by Peter Mendelsund

  Book design by Virginia Tan

  v3.1

  For Bess and Sammy,

  with love from Daddy

  Contents

  Cover

  Title Page

  Copyright

  Dedication

  Acknowledgments

  List of Illustrations

  Prologue

  1. Young Freud

  2. Young Halsted

  3. Über Coca

  4. An Addict’s Death

  5. The Accidental Addict

  6. Cocaine Damnation

  7. Sigmund in Paris

  8. Rehabilitating Halsted

  9. The Interpretation of Dreams

  10. “The Professor”

  11. Dr. Freud’s Coca Coda

  12. Dr. Halsted in Limbo

  Epilogue

  Notes

  Index

  Other Books by This Author

  Acknowledgments

  IT IS A PLEASURE TO ACKNOWLEDGE and thank those who helped convert this book from a mere idea into an actual volume.

  To begin, I am most fortunate in finding an academic home at the University of Michigan in Ann Arbor. Working with so many talented scholars, scientists, and physicians in the midst of such extraordinary resources has advanced my work in more ways than I can enumerate. At the University of Michigan Center for the History of Medicine, I am grateful to Professor Alexandra Minna Stern for her warm friendship, encouragement, and careful reading of my work; Dr. J. Alexander Navarro, who is as able a digital and computer wizard as he is a historian; Mary Beth Reilly for her superb reference and fact-checking; and Scott Oosterdorp for his helpful library searches when I was otherwise occupied. I am indebted to Professor Daniel Herwitz, who directs the University of Michigan Institute for the Humanities, where I was the John Rich Professor during the 2005–06 academic year, and who patiently read every page of the manuscript, much to my delight and this book’s improvement. Similar thanks go to Professor Michael Schoenfeldt, the chairman of the University of Michigan Department of English Literature and Language. He is a treasured friend and a thoughtful reader.

  From 2004 to 2010, I was fortunate to serve as a physician at the University of Michigan Addiction Treatment Service. There I saw hundreds of patients with substance abuse and addiction problems in collaboration with a dedicated and talented staff of psychiatrists, psychologists, and social workers. I thank the medical director, Dr. Kirk Brower (who also read and helped improve the scientific portions of this book), Dr. Robert Zucker, Dr. John Greden, Dr. Maher Karem-Hage, Michael Wallace, and Randall Pomeroy for teaching me so much about this stubborn and crafty disease. Although I am honor-bound to respect the anonymity of my patients and many members of the Ann Arbor recovery community whom I met along the way, I thank them as well for enriching my work and life. Their experiences, hopes, and strengths were essential in helping me to better understand Sigmund Freud and William Halsted.

  I also thank Dr. David McDowell of Mount Sinai Medical School, Dr. Catherine DeAngelis, editor-in-chief of the Journal of the American Medical Association, Dr. James Harris of the Johns Hopkins Medical School, Dr. Sherwin B. Nuland of Yale University, Dr. Stephen Bergman (a.k.a. Samuel Shem, M.D.), Jonathan Cohn of The New Republic, Dr. Martin Cetron of the U.S. Centers for Disease Control and Prevention, Professor David Rosner of Columbia University, Don Bosco Hewlett, Eric Lax, and Dr. Sheldon F. Markel for taking the time to read the manuscript with careful and generous eyes.

  All historians claim libraries as their workshops, but once there they rely heavily on the librarians and archivists who curate the historical collections. The staffs of the University of Michigan Libraries, the Bentley Historical Library of the University of Michigan (Francis Blouin, William Wallach, and Brian Williams), the Alan Mason Chesney Archives of the Johns Hopkins Medical Institutions (Nancy McCall and Andrew Harrison), the Weill Medical College at Cornell University/New York Hospital Archives (James Gehrlich), the Freud Museum of Vienna (Claudia Muchitsch, Christian Humber, and Martina Gasser), the Freud Museum of London (Carol Siegel), the Josephinum Medical History Museum at the University of Vienna (Dr. Ruth Koblizek), the Gesellschaft der Ärzte / Society of Physicians in Vienna (Manfred Gschwandtner), the Historical Collections of the New York Academy of Medicine, the New York Public Library, the Yale University Archives (Geoff Zonder), the F. L. Erhman Medical Library of the New York University School of Medicine (Colleen Bradley-Saunders), the Enoch Pratt Free Library of Baltimore, the National Library of Medicine, the Library of Congress, the British Library, and the Wellcome Library of the History of Medicine in London all performed their tasks with professionalism and speed. I hope that a collective thank-you will suffice.

  I am also grateful to the Sigmund Freud Archives and the Sigmund Freud Collection at the Library of Congress for allowing me to quote several short passages from letters Sigmund wrote to his then fiancée and later wife, Martha Bernays, and to many of his colleagues, including Wilhelm Fleiss.

  My literary agents, Glen Hartley and Lynn Chu of Writer’s Representatives, are, quite simply, the best practitioners of their profession. They believed in this project from the very start and never flagged in their encouragement, creativity, and advice. It is a pleasure to thank them, once again.

  This is the second book I have completed under the tutelage of my extraordinary editor, Victoria Wilson, vice president and associate publisher of Alfred A. Knopf. She continues to hold me to the highest standards of writing, and I am grateful for her wise suggestions and counsel. I am also indebted to her editorial assistant, Carmen Johnson, for her cheerful demeanor and professionalism; to copy editor Bonnie Thompson for her superb attention to questions of language, grammar, and factual detail; and to the entire staff at Pantheon, especially Ellen Feldman, who performed their jobs with insight and ability.

  I must add that while all of these people have generously given me superb assistance, any errors or defects that remain in the book are mine alone. Those flaws, I hope, are neither glaring nor fatal.

  Finally, I thank my family for their support and love during the past seven years as I tracked the lives of Sigmund and William. My wife, Kate Levin Markel, scrutinized and improved every page of this book. Our daughters, Bess Rachel, age ten, and Samantha Louise, age five and who answers to “Sammy,” are the lights of our lives. They never complained as I isolated myself during the throes of composition and were especially encouraging when the work was not always going smoothly. This book is dedicated to my wonderful girls and signifies my hope for their brilliant and healthy futures.

  Howard Markel

  Ann Arbor, Michigan

  September 20, 2010

  Illustrations

  1.1 The University of Vienna, c. 1884. Collections of the University of Michiga
n Center for the History of Medicine, Ann Arbor, Michigan

  1.2 Sigmund Freud birthplace, Príbor, Moravia, 1931. Collections of the University of Michigan Center for the History of Medicine, Ann Arbor, Michigan

  1.3 Freud, age six, 1862. The Freud Museum, London, Great Britain

  1.4 Jacob Freud, age forty-nine, and son Sigmund, age eight, 1864. The Freud Museum, London, Great Britain

  1.5 The extended Freud family, 1878. The Freud Museum, London, Great Britain

  1.6 Martha Bernays and her sister Minna, c. July 1882. Library of Congress, Washington, D.C.

  1.7 Sigmund Freud, age twenty-eight, July 26, 1884. The Freud Museum, London, Great Britain

  1.8 Carl Claus, Vienna Institute of Zoology, c. 1885. Collections of the University of Michigan Center for the History of Medicine, Ann Arbor, Michigan

  1.9 Ernst Wilhelm von Brücke. Collections of the University of Michigan Center for the History of Medicine, Ann Arbor, Michigan

  2.1 William Halsted with his mother, sister, and older brother, c. 1860. Alan Mason Chesney Archives of the Johns Hopkins Medical Institutions, Baltimore, Maryland

  2.2 Halsted, age fourteen, with his father, Irvington-on-Hudson, New York, c. 1866. Alan Mason Chesney Archives of the Johns Hopkins Medical Institutions, Baltimore, Maryland

  2.3 Halsted, age sixteen, 1868. Alan Mason Chesney Archives of the Johns Hopkins Medical Institutions, Baltimore, Maryland

  2.4 Halsted, age twenty, with Yale football team, 1872. Collections of Manuscripts and Archives, Yale University, New Haven, Connecticut

  2.5 Halsted’s medical school: the New York College of Physicians and Surgeons. Collections of the University of Michigan Center for the History of Medicine, Ann Arbor, Michigan

  2.6 Bellevue Hospital, 1879. New York University School of Medicine, Ehrman Medical Library Archives

  2.7 Block Island. Collections of the University of Michigan Center for the History of Medicine, Ann Arbor, Michigan

  2.8 Bellevue Hospital’s main gate, 1878 or 1879. New York University School of Medicine, Ehrman Medical Library Archives

  2.9 Halsted’s internship class at Bellevue, 1878. New York University School of Medicine, Ehrman Medical Library Archives

  3.1 Coca leaves. Collections of the University of Michigan Libraries, Ann Arbor, Michigan

  3.2 Alexander von Humboldt, age seventy-one, 1840. Collections of the University of Michigan Center for the History of Medicine, Ann Arbor, Michigan

  3.3 William H. Prescott, c. 1840. Collections of the University of Michigan Center for the History of Medicine, Ann Arbor, Michigan

  3.4 Angelo Mariani, creator and masterful marketer of Vin Mariani, c. 1890. Collections of the University of Michigan Center for the History of Medicine, Ann Arbor, Michigan

  3.5 A bottle of Vin Mariani. Collections of the University of Michigan Center for the History of Medicine, Ann Arbor, Michigan

  3.6 An advertisement for Vin Mariani, c. 1890s. Collections of the University of Michigan Center for the History of Medicine, Ann Arbor, Michigan

  3.7 An advertising poster for Vin Mariani, c. 1890s. Collections of the University of Michigan Center for the History of Medicine, Ann Arbor, Michigan

  3.8 A Coca-Cola advertisement, c. 1905. Collections of the University of Michigan Center for the History of Medicine, Ann Arbor, Michigan

  3.9 Hervey Parke and George Davis, c. 1890. Bentley Historical Library, University of Michigan, Ann Arbor, Michigan

  4.1 Freud’s sketch of his room at the Krankenhaus, October 5, 1883. Sigmund Freud Collection, Manuscript Division, Library of Congress, Washington, D.C.

  4.2 First Psychiatric Clinic of the Vienna General Hospital. Collections of the University of Michigan Center for the History of Medicine, Ann Arbor, Michigan

  4.3 A portrait of Ernst von Fleischl-Marxow, about age thirty-six, c. 1882. The Freud Museum, London, Great Britain

  4.4 Sigmund Freud at the time of writing Über Coca, 1884. Library of Congress, Washington, D.C.

  4.5 The surgeon general’s catalog entry on cocaine, 1883. Collections of the University of Michigan Libraries, Ann Arbor, Michigan

  4.6 The title page of Über Coca, 1885. The Freud Museum, London, Great Britain

  4.7 Carl Koller, age twenty-seven, c. 1884. Collections of the University of Michigan Center for the History of Medicine, Ann Arbor, Michigan

  5.1 Bellevue Hospital grounds, c. 1880. National Library of Medicine, Bethesda, Maryland

  5.2 A surgical operation at Bellevue Hospital, c. 1880. National Library of Medicine, Bethesda, Maryland

  5.3 William H. Welch, age thirty, c. 1880. National Library of Medicine, Bethesda, Maryland

  5.4 Arthur Conan Doyle, 1894. Collections of the University of Michigan Center for the History of Medicine, Ann Arbor, Michigan

  6.1 A sagittal view of the brain. Collections of the University of Michigan Center for the History of Medicine, Ann Arbor, Michigan

  6.2 The synapse and the release of dopamine. Collections of the University of Michigan Center for the History of Medicine, Ann Arbor, Michigan.

  6.3 Pile dwelling, Windward Islands, c. 1890. Collections of the University of Michigan Center for the History of Medicine, Ann Arbor, Michigan

  6.4 Santa Lucia Island, Windward Islands, c. 1890. Getty Images

  6.5 Butler Hospital, Rhode Island. Collections of the University of Michigan Center for the History of Medicine, Ann Arbor, Michigan

  7.1 Sarah Bernhardt, age sixty-one, 1905. Collections of the University of Michigan Center for the History of Medicine, Ann Arbor, Michigan

  7.2 The Salpêtrière Hospital, Paris. Collections of the University of Michigan Center for the History of Medicine, Ann Arbor, Michigan

  7.3 Souvenir of the Salpêtrière, 1886. The Freud Museum, London, Great Britain

  8.1 Butler Hospital bedroom, c. 1886. Collections of the University of Michigan Center for the History of Medicine, Ann Arbor, Michigan

  8.2 Butler Hospital handicraft class. Collections of the University of Michigan Center for the History of Medicine, Ann Arbor, Michigan

  8.3 The St. Louis Medical and Surgical Journal (December 1884). Collections of the University of Michigan Libraries, Ann Arbor, Michigan

  8.4 The Butler Hospital library, c. 1890. Collections of the University of Michigan Center for the History of Medicine, Ann Arbor, Michigan

  8.5 Butler Hospital, Isaac Ray Hall, c. 1887. Collections of the University of Michigan Center for the History of Medicine, Ann Arbor, Michigan

  8.6 The Johns Hopkins Hospital, early 1900s. Collections of the University of Michigan Center for the History of Medicine, Ann Arbor, Michigan

  8.7 The Maryland Club, c. 1890s. Collections of the University of Michigan Center for the History of Medicine, Ann Arbor, Michigan

  8.8 The Old Pathological Building at Johns Hopkins, c. 1886. Alan Mason Chesney Archives of the Johns Hopkins Medical Institutions, Baltimore, Maryland

  8.9 Franklin P. Mall, 1893. Alan Mason Chesney Archives of the Johns Hopkins Medical Institutions, Baltimore, Maryland

  9.1 The Ring Theater. University of Michigan Center for the History of Medicine, Ann Arbor, Michigan

  9.2 Freud and the Vienna First Public Institute for Sick Children staff, c. 1893. The Freud Museum, London, Great Britain

  9.3 Freud, age twenty-nine, and Martha Bernays, age twenty-four, 1885. The Freud Museum, London, Great Britain

  9.4 Minna Bernays, age twenty-five, c. 1890. The Freud Museum, London, Great Britain

  9.5 A Clinical Lesson with Doctor Charcot at the Salpêtrière Hospital, 1887. Collections of the University of Michigan Center for the History of Medicine, Ann Arbor, Michigan

  9.6 Josef Breuer, c. 1880s. The Freud Museum, London, Great Britain

  9.7 The auditorium of the Vienna Medical Society, 1886. Collections of the University of Michigan Center for the History of Medicine, Ann Arbor, Michigan

  9.8 Bertha Pappenheim, age twenty-two, 1882. Photograph from the archive of the Sanatorium Bellevue, Kre
uzlingen, Switzerland

  9.9 Josef and Mathilde Breuer, c. 1895. Library of Congress, Washington, D.C.

  10.10 Dr. Osler teaching students at Johns Hopkins, c. 1900. Alan Mason Chesney Archives of the Johns Hopkins Medical Institutions, Baltimore, Maryland

  10.11 Joseph Colt Bloodgood, M.D., late 1910s to 1920s. National Library of Medicine, Bethesda, Maryland

  10.12 William Osler, c. 1888. University of Pennsylvania Collections, Philadelphia, Pennsylvania

  10.13 Halsted, North Carolina, c. 1904. Alan Mason Chesney Archives of the Johns Hopkins Medical Institutions, Baltimore, Maryland

  Prologue

  ON THE MORNING OF MAY 5, 1885, in lower Manhattan, a worker fell from a building’s scaffolding to the ground. A splintered bone protruded from his bloody trousers; a plaintive wail signaled his pain; and soon he was taken from the scene by horse-drawn ambulance to Bellevue Hospital. At the hospital, in the dispensary, a young surgeon named William Stewart Halsted frantically searched the shelves for a container of cocaine.

  In the late nineteenth century, there were no such things as “controlled substances,” 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. Consequently, it took less than a few minutes for the surgeon to find a vial of cocaine. He drew a precise dose into a hypodermic syringe, rolled up his sleeve, and searched for a fresh spot on his scarred forearm. Upon doing so, he inserted the needle and pushed down on the syringe’s plunger. Almost immediately, he felt a wave of relief and an overwhelming sense of euphoria. His pulse bounded and his mind raced, but his body, paradoxically, relaxed.

  A Bellevue ambulance arrives at an accident scene in lower Manhattan, c. 1885. (photo credit prl.1)