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A Miracle Drug's Dark Side

It was William James, really, who introduced me to the Victorian enthusiasm for experimenting with narcotics. Oh, not literally—although wouldn't that have been interesting?—but as a consequence of researching his life for a book several years ago. James overturned quite a few of my notions about the staid nature of life in the late 19th century. In particular, I found his description of experiments with nitrous oxide—the formula nicknamed "laughing gas"—both hilarious and wonderfully pragmatic.

In the late 1800s, cocaine was an ingredient in patent medicines and popular drinks. ENLARGE

The hilarious part came from the gas-derived insights he carefully jotted down: "What's mistake but a kind of take? What's nausea but a kind of -usea? Sober, drunk, -unk, astonishment. . . . By George, nothing but othing! That sounds like nonsense, but it is pure onsense!" And the practical ending to the story? His narcotic night, James concluded in "The Subjective Effects of Nitrous Oxide," was an interesting experiment only; readers couldn't help noticing how often he "ended up losing the clue."

Still, if one had to experiment, at least nitrous oxide was a relatively safe compound compared with others in circulation. James published his essay in 1882, at a time when many of his friends and colleagues were self-dosing with drugs ranging from chloroform to hashish. Although people today tend to think of the 1960s as the era when the drug culture crept into even academic circles—Harvard's Timothy Leary extolling LSD—the experiments of intellectuals with narcotics were more common, and widely accepted, during the late 19th century.

An Anatomy of Addiction

By Howard Markel
Pantheon, 314 pages, $28.95

It's within this milieu of medical curiosity and optimistic experimentation that Howard Markel, an M.D. and medical historian, sets his incisive—and often damning—story of the "miracle drug cocaine." The word "miracle" is exactly right to describe cocaine's first, rapturous reception by the medical community, which had only just discovered how to alleviate pain with narcotics. Ether had only come into use in 1846; before this, no relief was available for the agony of surgery. No wonder doctors and patients sought ever more of this amazing chemistry to improve their lives.

The title of Dr. Markel's book, though, "An Anatomy of Addiction," serves as a warning that the author is not going to embrace these Victorian enthusiasms. Dr. Markel's tale is a narrative of two leading figures in medical history, the Viennese psychoanalyst Sigmund Freud and the American surgeon William Halsted. It is also a chillingly clinical examination of both men's longtime cocaine addictions and the drug's influence on their lives.

One of the founding surgery professors at Johns Hopkins Medical School in 1889, Halsted pioneered sterile operating procedures, new surgical techniques and the use of local anesthetics. It was the last interest that led him to study cocaine in the 1880s. Gradually that study led him into addiction. Previously a friendly, outgoing person, he was transformed by his lifetime struggles with narcotics into someone else—secretive, often angry, impatient with students and colleagues alike. His friends tried to rescue him—even forcing him to seek recovery in an asylum—but evidence suggests that he never really did so.

In Dr. Markel's telling, Freud's story is more disturbing—he becomes not only an addict but a proselytizer, using his position to promote cocaine as a means to improve everything from mood to intellectual function. In 1884, Freud published his admiring "Über Coca" ("On Cocaine")—"a treatise filled with adulatory descriptions of 'the magical drug,' " as Dr. Markel describes it. Freud was among the first to praise the qualities addicts that know so well—the narcotic rush, the sense of energy and confidence. The effect was transient, he admitted, but it was amazingly effective. He wrote to his fiancée that, before going to a medical-school party, he put on his best clothes, brushed his hair and took "a little cocaine to untie my tongue."

The drug's energy-producing high would lead it to become an ingredient in commercial products of the time, from Coca-Cola, which touted its ability to "quicken the tired brain," to tonic wines sold across Europe and consumed by everyone from peasants to the pope. Drug manufacturers rushed to adopt it. The American pharmaceutical company Parke-Davis proudly advertised its "Coca Cordial" in medical journals.

While the problem of addiction became rapidly apparent to most practitioners, the science behind such obsessive neediness was not understood. Like many others, Freud at one point recommended cocaine as a treatment for morphine addiction, "a harebrained theory," Dr. Markel writes, which today we know could only cause further harm.


It's worth asking whether Freud's addiction led him to overstate the drug's benefits. He was certainly less than circumspect about the heavy doses he took to maintain his working habits. "I need a lot of cocaine," he confessed in 1895. "The torment, most of the time, is super human."

Freud's chattiness makes him Dr. Markel's central character. Halsted's reserve encumbers his side of the tale; the surgeon never comes to life as the psychoanalyst does. But they are linked by fascinating questions: Can we define the personality of addiction? And is the answer to be found in the insecurities and desperate need to succeed, shared by Freud and Halsted—or did the drug itself foster those characteristics?

The author can't really answer such questions—I'm not sure anyone could—but he raises them in an elegantly subversive way, intertwining the two men's horrific struggles with modern scientific findings that illuminate the nature of addiction and cocaine's almost uniquely destructive chemistry. By the end, both Freud and Halsted have achieved professional success. They've also come to seem so remarkably unlikable that I found myself wondering about the drug's corrosive effect on basic human decency.

The author's insights and analytical skills make "An Anatomy of Addiction" an irresistible cautionary tale. But I remain fond of the more hopeful lesson in William James's encounter with nitrous oxide—that most people are smart enough to distrust that narcotic glow. Or maybe I just prefer my insights into Victorian drug enthusiasms with a dose of a Jamesian humor. That may seem like nonsense, but I assure you that it's pure onsense.

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