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Fri November 25, 2011
Health

A Tale Of Two Addicts: Freud, Halsted And Cocaine

Originally published on Fri November 25, 2011 6:20 pm

Transcript

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 through 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.

These are just a few of the stories in the new book "An Anatomy of Addiction: 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.

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

FLATOW: We won't be taking calls this hour, so don't try to call in. But if you want more information about what we're talking about, go to our website at sciencefriday.com, where you'll find links to our topic. 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 Halsted 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 it in Arthur Conan Doyle talking about Sherlock Holmes. The world seem 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: Mm-hmm. 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 fiancé describing how it feels. Can you read a little bit of that for us?

MARKEL: I thought you'd never ask.

(SOUNDBITE OF LAUGHTER)

MARKEL: It's June 2, 1884 - it's about a month or two after he started dabbling with cocaine - he writes to Martha Bernays, his fiancé: Woe to you, my princess. When I come, I will kiss you quite red and feed you till 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: We have to take a break. After that, lots more with Howard Markel and his book "An Anatomy of Addiction" Stay with us.

(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." Before we move on to another protagonist in the 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? 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...

FLATOW: Sniffing at each other down the hall.

(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 he eventually(ph) 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.

MARKEL: 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: 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: 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. Cocaine, you know, I remember reading about it in Sherlock Holmes' adventures. Was it quick, Watson, the needle, that sort of thing?

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

(SOUNDBITE OF LAUGHTER)

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 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.

And that was the nature of the term addiction or addict well into the 1500s. Later on, it became a term for describing someone's bad habits: 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 may be 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.

(SOUNDBITE OF LAUGHTER)

FLATOW: That's the beauty. And I think, Howard, that's a great place to end the segment and segue into this month's episode of science diction. What have you got for us this month, Howard?

MARKEL: Well, the word is stethoscope.

FLATOW: Stethoscope.

MARKEL: Yes.

FLATOW: Huh.

MARKEL: And, you know, doctors have been listening to patient's breath sounds since at least 1,500 B.C. But it really wasn't until the early 19th century that a French physician Rene Laennec systematically investigated the sounds that we make when we breathe, and also of our heartbeat.

And, you know, the time-honored way of doing that was literally to place your ear on a patient's chest. And Laennec didn't like that. For one, if he had an obese patient, it was very hard to hear through all that fat. And also, you know, he was treating the great unwashed, literally. And they had poor hygiene, and sometimes they were lice-ridden, and that sort of disgusted him. So he came up with this invention, the stethoscope, which - he was also a Greek scholar, and he took that name from two Greek roots: stethos, which means chest, and skopen, which means to look at or to observe.

FLATOW: This is SCIENCE FRIDAY, from NPR. I'm Ira Flatow, talking with Howard Markel, author of "An Anatomy of Addiction." The early stethoscope didn't look much like the one we have today, did it?

MARKEL: Not at all. It was a hollow tube made out of cedar or ebony. And, you know, there's really charming story of how that came to be. It was in 1816. He was late to see a patient, a woman with heart disease, and he was taking a short cut through the courtyard of the Louvre. And he saw some boys playing on a pile of timber, and two boys were playing with a long plank or a log. And one was taking a pin or a nail and scratching it on one end, and the other boy could hear it all the way on the other end, you know, as sound will travel through a solid body. And he said, wow, that's a great idea. And then he went to see his patient, and he asked for some paper. He rolled it up into a cylinder, and he put it against this woman's chest. And he was absolutely amazed at how he could hear the heart in a way that he had never been able to hear before.

FLATOW: Wow. But even if they could hear, you know, something rattling around in the chest, does - in those days, was there anything he could really knew about it?

MARKEL: Ah, well, back then, diagnosis was more important than treatment.

(SOUNDBITE OF LAUGHTER)

MARKEL: They didn't have a lot of treatment. But what was really remarkable about Laennec is that he figured out so many things about diseases of the chest, you know, things like tuberculosis or emphysema, and also of heart disease, whether they were heart murmurs or other problems of the heart, so that doctors could accurately diagnose these. And he experimented with a series of tubes, the hollow tubes. It's about a foot, to a foot-and-a-half long. And he wrote a textbook called "On the Practice of Auscultation." Now, auscultation comes from the Latin, auscultare, which means to listen. So it's on the practice of listening. It was published in 1819. It was a bargain at 13 francs, because you also got a stethoscope with it.

FLATOW: Wow.

MARKEL: But it did - took awhile for it to catch on. The book had to be translated in different languages. And finally, it became the iconic symbol. And by about 1851, the binaural stethoscope - what's very familiar to people today, with the two ear prongs and the tubes - began to develop. And that became the stethoscope as we know it.

FLATOW: Is the stethoscope as we know it becoming obsolete? You know, we have all these imaging technology.

MARKEL: Sadly, yes. I still know how to use my stethoscope. And I remember avidly listening to tapes of heart sounds and breathe sounds so that I could learn them on real patients. And it is sad. With all our wonderful, you know, non-evasive imaging techniques, you know, we can learn more and more about a patient without ever being in the room. And that's kind of sad, because as that distance has grown, we've lost something. And I think maybe we ought to hang onto our stethoscopes a little bit longer to remind - one of the principal aspects of being a doctor is listening to our patient.

FLATOW: All right, Howard. Thank you very much.

MARKEL: Well, thank you, and Happy Thanksgiving.

FLATOW: You, too. Howard Markel is a professor of the history of medicine at the University of Michigan in Ann Arbor and director of the Center for the History of Medicine there.

That's about all the time we have for this hour. We would like you to stay with us, but we don't have any more time. Transcript provided by NPR, Copyright NPR.

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