A Tale Of Two Addicts: Freud, Halsted And Cocaine

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In his book An Anatomy of Addiction: Sigmund Freud, William Halsted, and the Miracle Drug Cocaine, medical historian Howard Markel tells the story of how Freud, the father of psychoanalysis, and Halsted, the acclaimed surgeon, fell under the addictive spell of cocaine.

IRA FLATOW, Host:

You might think of cocaine as a party drug from the '70s and '80s. But 100 years before that, in the 1880s, a guy by the name of Sigmund Freud - yeah, the father of psychoanalysis - was suiting up in white tie and gloves, attending soirees in Paris, and snorting a little cocaine to quote, untie his tongue. Around the same time, Pope Leo XIII gave a special Vatican gold medal to the maker of Vin Mariani, a concoction of Bordeaux wine and cocaine. Pope Leo was said to carry around a flask of the stuff himself.

And across the channel, a young surgeon named William Halsted, who pioneered many techniques still used in surgery today - for example, he invented the surgical glove - was investigating the white powder and its anesthetic properties, a potential wonder drug for the surgical profession. And many times, his experiments involved injecting it into himself - cocaine right to the vein - to the point where he became totally hooked, leaving screaming patients in the operating room behind, and descending into a month-long cocaine binge.

FLATOW: Sigmund Freud, William Halsted and the Miracle Drug Cocaine," a fascinating read about two scientists who abused cocaine, and why they were so intrigued by it in the first place. And it was written by our monthly science fiction contributor Howard Markel, professor of history of medicine at the University of Michigan in Ann Arbor; also, director of the Center for the History of Medicine there. Welcome back, Howard.

HOWARD MARKEL: It's great to be here. Good afternoon, Ira.

FLATOW: Very - this is really a fascinating book. What made you decide to take this project on?

MARKEL: Well, I became very interested in seeing addicted patients in my own clinic, and I tend to understand the world as completely as I can, as both a historian and a physician. And I wanted to learn a little bit more about the origins of addiction. And as I studied more and more, and read more and more, I came across both Sigmund Freud and William Halstead and I - well, I became addicted to their life stories. They were so fascinating. They were so compelling. And I thought, using their lives and their struggles, I could really put a human face on this terrible disease.

FLATOW: Tell us about what there was - at that turn of the century, over 100 years ago, that period of time where cocaine seemed to be popping up everywhere: Sigmund Freud; you had it in these doctors; and you had in Arthur Conan Doyle, talking about Sherlock Holmes. The world seemed to - and we hear stories that Coca-Cola was invented around that time.

MARKEL: Absolutely. In the 1880s, even though coca leaves had been chewed by the aboriginals in South America for millennia, around the early 1800s as European explorers started traveling to South America, they brought some coca leaves back. And they were very impressed by the endurance and the stimulation that came from chewing coca leaves. But over the next several decades, in the 1800s, chemists and scientists began to search for that active ingredient, what was it that made chewing coca leaves so buzzy and exciting.

And indeed, they did find out how to crystallize an alkaloid salt, called cocaine hydrochloride. And the drug companies, the pharmaceutical houses of the era, loved it. It was their blockbuster drug. And they sold it as a cure for upset stomach, for flatulence, for consumption, for depression, for morphine addiction - well, perhaps they oversold it a bit. But it was truly the miracle drug of its era.

FLATOW: This is SCIENCE FRIDAY from NPR. I'm Ira Flatow, talking with Howard Markel, who's author of an incredible book, new book, "An Anatomy of Addiction." And how did Freud discover it and get hooked on it?

MARKEL: Well, Freud - and it was really fun to get to learn about Freud as a young, nervous man who was eager to make his career. We always think of Freud as this icon, with that beard and that grim countenance. But he was a nervous fellow and wanted to make good. And he was looking for something that would make his name. And he practiced medicine in Vienna, which was the - probably the most competitive medical marketplace in the world at that time. The Vienna General Hospital was the place to train. And he knew if he was going to get a professorship, he would have to discover something great.

So he read various little case reports in the journals about how great cocaine was for fighting off depression or fatigue, and he found an interesting little report that it could help you if you had morphine addiction.

And morphine and opium were terrifically overprescribed back then, and what the medical profession did was create a lot of addicts. And one of Sigmund's best friends, a man named Fleischl Marxow, was a great physiologist who injured his hand - he had to have his thumb amputated - and he had terrible, chronic pain, and he became a hopeless morphine addict. So Sigmund wanted to help his friend. He also knew that if he could write this up, he could really become famous.

And so he studied this. He began studying it in 1884; read the whole world's literature on the topic and wrote a very prominent monograph, called "Uber Coca" or "On Coca," that really, you know, excited the entire medical world about all of its medical and therapeutic uses - except for one. He missed the major use of cocaine as a medical agent. It is a terrific local anesthetic.

FLATOW: And a few months after Freud got his first shipment of cocaine, in 1884, he wrote a letter to his fiance describing how it feels. Can you read a little bit of that for us?

MARKEL: I thought you'd never ask. Yes. On June 2, 1884 - it's about a month or two after he started dabbling with cocaine - he writes to Martha Bernays, his fiance: (reading) Woe to you, my princess. When I come, I will kiss you quite red and feed you until you are plump. And if you are forward, you should see who is the stronger - a gentle little girl who doesn't eat enough, or a big wild man who has cocaine in his body. In my last severe depression, I took coca again, and a small dose lifted me to the heights in a wonderful fashion. I am just now busy collecting the literature for a song of praise to this magical substance.

FLATOW: Pretty racy stuff for that time.

MARKEL: Pretty racy, indeed. And the great thing about Freud is that he's an inveterate letter writer, and you can really track his entire life through his letters to his fiance, to his friends, to another friend named Wilhelm Fleiss. And he does get rather specific about how magical and exciting cocaine is for him.

FLATOW: All right. Let me take a break. We're talking with Howard Markel, author of "An Anatomy of Addiction: Sigmund Freud, William Halsted, and the Miracle Drug Cocaine." Our number, 1-800-989-8255. You can tweet us @scifri. Also, you can go to our website at sciencefriday.com, leave a message there, or go to our Facebook page, slash-scifri. Stay with us. We'll be back, take your questions, talk more about "An Anatomy of Addiction." Stay with us; 1-800-989-8255.

I'm Ira Flatow. This is SCIENCE FRIDAY from NPR.

(SOUNDBITE OF MUSIC)

FLATOW: You're listening to SCIENCE FRIDAY. I'm Ira Flatow.

We're talking with author Howard Markel about "An Anatomy of Addiction"; 1-800-989-8255. Before we move on to another protagonist in the book, the other - Halsted, the other major figure, let me ask you one question I'm sure that comes up all the time, and you address, is what did cocaine have to do with Freud and his theories? At the - did it have any influence, anything like that?

MARKEL: Well, it's a complicated answer. It's yes and no. I mean, there are points in Freud's early cocaine abuse where he was amazed at how loquacious it made him, how it freed up ideas that he thought were locked within his mind. Sound familiar?

FLATOW: Yeah.

MARKEL: And of course, that's what - a safer version of that is free association, where you're simply talking about things and going from topic to topic, to try to delve what's in your unconscious or subconscious mind. But I think he quickly learned - both with his friend Fleischl Marxow, who became not only a morphine addict, but also a cocaine addict, and also with another patient he nearly killed while treating her with cocaine - that this was a rather toxic substance.

Nevertheless, his most important dream, the dream that became the model for the interpretation of dreams, was indeed a dream about cocaine use and the problems that resulted from treating this patient, Emma Eckstein, with cocaine.

FLATOW: Hmm, interesting. Go ahead.

MARKEL: What he dreamed - go ahead, yeah.

FLATOW: No, go ahead. Finish up.

MARKEL: Well, he dreamed that he was at a party, and the Emma character came to him - a crowded party - and there were syringes and cocaine and scabs all around. And she accused him in front of this gathering - you nearly killed me; this was terrible. And Freud wondered about this and said well, I had this dream because I'm such a concerned physician that if any of my patients have a bumpy course, I feel it as well.

Well, in reality, Freud had this dream because he was rather upset and nervous that he nearly killed her while treating her - both himself under the influence, and while she was taking cocaine - with a surgical mistake. A colleague of his operated on Emma's nose and left a surgical sponge in the site, and she nearly died. So talk about dreams as wish fulfillment. Here's a perfect example of that. So cocaine did have some impact on his thinking and on his life.

FLATOW: Yes. And it certainly had an impact - and the other major protagonist in your book, the renowned surgeon William Halsted, who was a contemporary of Freud's. Tell us about what happened with him.

MARKEL: Well, Halsted, of course, they - Freud and Halsted probably never met, although they were both working at the Vienna General Hospital at the same time.

FLATOW: I found that hard to believe. As I'm reading your book and these parallel lives, knowing that, I'm saying they never, you know, bumped into - the cafeteria or something like that?

MARKEL: Well, you know, I've had fantasies many a night, while writing this, that they somehow passed each other and - but my historians at the...

FLATOW: Sniffing at each other down the hall.

MARKEL: Yeah.

(SOUNDBITE OF LAUGHTER)

MARKEL: Yeah, rubbing each other's noses. But I could not find any documentation. But they must have seen each other. It's not that big of a place. But Halsted, of course, read not only Freud's very famous paper on cocaine, but a subsequent paper that came out about a month later by a man named Karl Koller, that demonstrated that if you did a cataract operation and you took a dropper full of water and cocaine, you could anesthetize the eyeball.

And so Halsted was fascinated that here is a safe, local anesthetic that I could use on my operations - because back then, they had ether and chloroform, but those were very toxic and obnoxious drugs. They made you throw up a lot; they really caused a lot of sleepiness and sedation. So he started experimenting with that. And he used - as many doctors did - his own arm. He was his own guinea pig, and he was injecting it and very rapidly, went down the tubes as a cocaine addict.

FLATOW: To the detriment of his patients, you point out.

MARKEL: Yeah. Most - you know, he stopped going to the hospital. He stopped going to meetings. He stopped writing. And most infamously, he was called down to see a patient at the Bellevue Hospital. It was a serious fracture, a leg fracture in a laborer who fell off the roof of a building. And Halsted was quite the expert at repairing these types of injuries.

And you also have to remember that a broken leg of that magnitude, where the bone was literally sticking out of the skin, was almost always a fatal case if somebody did not intervene immediately. And Halsted was so bombed out of his mind on cocaine that he actually withdrew from the operating table and said, I cannot operate, and then went home and skittered away the next several months, high on cocaine.

FLATOW: Wow. And eventually - he eventually had that addiction his whole life.

MARKEL: Well, he did. Around that period, a good friend of his, William Henry Welch, who became one of the founders of the Johns Hopkins Hospital, promised he would bring Halsted with him and - in this great medical experiment, but only if he got clean. And first, he tried to take Halsted on an ocean voyage. That didn't work very well. Halsted brought along his own supply of cocaine, and then he broke into the first-aid kit when he ran out. And finally Welch said, you got to take care of this; this is a huge problem.

And Halsted admitted himself to an insane asylum, the Butler Hospital for the Insane in Rhode Island, and stayed there for many months to try and rid himself of this problem. Unfortunately, he gained another problem because while they were trying to get him off cocaine, they gave him morphine. So he emerged as both a cocaine and a morphine addict for the rest of his life.

FLATOW: Wow. You know, it's amazing the history - and you're a historian - about science, where people don't realize the impact of the stuff they're fooling around with, you know?

MARKEL: Yeah. And, you know, back then, nobody knew about addiction as we understand it, that certain drugs could be addictive, or that if you try to take somebody off of one addictive drug with another addictive drug, it was really a game of musical chairs. But they didn't realize that, and these guys were very heroic to, you know, be the first guinea pig. And yet, they really did major harm to themselves that they had to pay for dearly.

FLATOW: Let's go to Joel in Columbia University here in New York. Hi, Joel.

JOEL: Hi. I'm - my name's Joel Whitebook, and I'm writing a - intellectual biography of Freud for Cambridge University Press, actually. And there's a question that's come up, and I wonder whether Dr. Markel could help me with it. As I'm sure he knows, while Freud was experimenting with cocaine, he was also having all these heart problems; they called it a cardiac episode. And it seems so obvious that if it didn't cause the cardiac problems, that the cocaine must have been the enormous contributor to all the heart trouble he was having. I wonder what Dr. Markel thinks about the connection between the cocaine use and the cardiology pathology.

FLATOW: All right. Thanks.

MARKEL: Well, my answer is great minds think alike, Doctor. That's very true. And there are many letters where Freud is complaining of chest pain, of tachycardia - of all sorts of problems. And in fact, he sees one of his friends, Josef Breuer, to examine him, and Breuer misses a diagnosis. And Freud thought it was just due to other things. He never quite made that connection, as many addicts will do, you know? They don't want to stop using their treasured substance, so they'll find any excuse under the sun that's causing these physical problems.

But I agree with you. In my retrospective diagnosis, there's no question that the severe cardiac symptoms Freud was having, as well as severe nasal symptoms - he was plugging up his nose, he was so congested. He had to have a special hot bovie knife inserted to into his nose to burn a hole in the congested tissues. He had a number of physical problems as a result of his cocaine abuse, yes.

FLATOW: Hmm. I don't think we ever realized that - 1-800-989-8255. So when does cocaine - sort of the dangers of it get to be recognized and now, it's no longer available to anybody who wants to get it?

MARKEL: Well, that happened rather quickly after this big push that it was the miracle drug of all time. And that's one of the exciting things about writing about cocaine - is that, you know, you don't have a long period of safe use with that drug. You go downhill pretty quickly if you're abusing it. And within several, you know, a few years, there was a whole cohort of people - and William Halstead was one of them - who were just wrecked men. Many of them were doctors, by the way, but they were wrecked human beings. They were paranoid. They were thin. They were jittery. They couldn't sit still.

And they were true cocaine addicts. And the medical literature beginning in the late 1880s - and certainly by the 1890s - said hey, this is not something we should prescribe willy-nilly. And in fact, by the early 20th century, the United States Congress passed a law controlling things - not just cocaine but also narcotics such as morphine and opium and even marijuana, that you could not simply sell the stuff over the counter, that you had to have a doctor's prescription in order to obtain it.

FLATOW: Let's go to Bonnie(ph) in San Antonio. Hi, Bonnie. Bonnie, are you there? Bonnie? OK.

MARKEL: My Bonnie lies over the ocean.

FLATOW: I wasn't going to touch that. I'm glad you did.

(SOUNDBITE OF LAUGHTER)

FLATOW: I have enough pun trouble to begin with in my career. So cocaine then gets normally accepted as what? Or is it just put on a shelf? Did doctors turn the clock at it, that we now know about its medicinal benefits and how to use it correctly?

MARKEL: Well, there's all this generational forgetting. As you may recall in the 1970s and the 1980s, it was advertised as the safe and elite and cool drug to do. But we quickly found out that was not the case. All you had to do was read the old stuff in the 1880s. But no, it became a very popular recreational drug to be sure, well into the 1930s. Remember the Cole Porter song, I get no kicks from champagne? Well, the second verse is I get no kicks from cocaine. One sniff bores me terrifically. And if you watch Charlie Chaplin's "Modern Times" in the 1930s, he's accidentally given some cocaine.

It's one of the funniest scenes of all of Hollywood that was ever filmed. But it was also for many years - and to some extent, is still used as a local anesthetic by ear, nose and throat surgeons. And then a safer form of - what are called lidocaine and novocaine, which is a similar drug to cocaine but it doesn't have that euphoric effect, has been used and is used all the time by dentists and people who need to do local anesthesia.

FLATOW: Mm-hmm. After he finally went clean, did Halsted make any more contributions to the surgical field? Was he finished at that point?

MARKEL: No. That's the wonderfully fascinating part of his story - is that Welch really helped him, brought him down to Baltimore. He was his minder. They lived together. They had dinner together, and he took him under his wing. He did not have a surgical position, initially, at Johns Hopkins. He was in the lab. He was operating on dogs. And he was working on some of his greatest procedures: how you operate on the abdomen; how you operate safely and delicately so that the wounds heal safely; inventing the rubber glove; interesting procedures on breast cancer and thyroid disease.

And his most active periods coincided with the times he could lay off the drug. And his most fallow periods, in fact - where he couldn't operate at all, where he'd walked out of the operating room or he'd go AWOL from the hospital entirely, and no one knew where he was - was, you know, coincident with the time where he was abusing at the most point. Now, he probably went on binges of cocaine off and on every summer or so. But he used morphine, a dose of morphine, probably every night for the rest of his life.

FLATOW: Wow. This is SCIENCE FRIDAY from NPR. I'm Ira Flatow, talking with Howard Markel, author of "An Anatomy of Addiction." Cocaine, you know, I remember reading about it in Sherlock Holmes' adventures. What was it - quick, Watson, the needle - that sort of thing? Was it...

MARKEL: Quick, Watson, the needle - yes. And then Watson always said, why are you taking that drug? It's so dangerous.

FLATOW: Yeah. Did Sir Arthur Conan Doyle know these people, or was it just the times he was living in?

MARKEL: Well, Arthur Conan Doyle was not only a very astute physician, he was also a great medical journalist before he became the novelist that we recall today. And he really kept abreast of the medical literature, the latest scientific and medical discoveries. And so he undoubtedly read Sigmund Freud's "Uber Coca." By the way, later on in life, Sigmund Freud was a great "Sherlock Holmes" fan.

FLATOW: Oh, no kidding?

MARKEL: No, no kidding at all. And so he read "Uber Coca," and he likely read - because he was interested in eye surgery, he definitely read Karl Koller's paper about cocaine anesthesia, and probably played with it a little bit himself. And of course, he gave his character Sherlock Holmes, who was based on a doctor - Sherlock Holmes had the diagnostic, deductive capability of a doctor - and he gave him as one of his characteristics a love of 7 percent solution, a 7 percent cocaine solution that he injected in his mottled arm.

FLATOW: Yeah. Howard, we usually have you on as our guest for Science Diction; you do the origin of scientific words. And of course, the theme in your book is, where does the word addiction come from? You want to give us that...

MARKEL: Yes. And while - yes, of course. And while, you know, Freud and Halsted in the 1880s, with cocaine and even morphine, that's the birth of the modern addict as we understand it, as a - this excessive use to the point of loss of control of a substance, it really - it wasn't that term that - it didn't mean that at all until the late 19th century. In fact, the word comes from a Latin word, addictio.

And in antiquity, it was an edict of Roman law. So that if I owed you a great deal of money, Ira, and I couldn't pay you back, you would take me before a judge. And he would make me your addict, your slave, until - I'd have to work for you until I could pay you off.

FLATOW: if you ate too much, if you were too stubborn, if you smoked too much. But we don't see its use as, you know, the loss of control due to an exogenous substance that you take, until the late 1880s or early 1890s.

FLATOW: Wow. And it would make sense because the original definition, as you say, is you're basically enslaved to someone.

MARKEL: Yeah.

FLATOW: And so you're enslaved to this drug, I would imagine.

MARKEL: To this drug, yeah. And now, as we're learning more and more about the science of addiction and what these substances and perhaps even behavior - such as hypersexuality or gambling, or what have you - these stimulate the pleasure center of the brain, the limbic center of the brain in such a way that it really changes the architecture - the wiring, to put it crudely - of the brain so that you lose the ability to say no. And you know it's harming you, but you still do it.

FLATOW: Yeah. And the problem is undoing the wiring, yeah.

MARKEL: Exactly. Yeah.

FLATOW: So because - as you say, addiction is something that's physically changed in your brain.

MARKEL: Yeah. So that the first dose or two or 100 maybe voluntary. But you know, once you change a cucumber into a pickle, you can't change that pickle back into a cucumber. So you have to come up with other means, very clever means of medical and psychological treatment to try to help people get off their drugs of choice.

FLATOW: Well, Howard, I'm not clever enough to top that analogy, so I'll...

(SOUNDBITE OF LAUGHTER)

MARKEL: Oh, I think you are. I think you are.

FLATOW: That's a beauty, and it's a great way to end this segment. Howard, thank you very much for joining us today.

MARKEL: Well, thanks so much for having me, Ira.

FLATOW: Howard Markel is author of "An Anatomy of Addiction: Sigmund Freud, William Halsted, and the Miracle Drug Cocaine," an absolutely fascinating read. You can take it with you to the beach this weekend.

That's about all the time we have for this hour. We'll see you next week. I'm Ira Flatow in New York.

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