Book Review: An Anatomy of Addiction by Howard Markel

My favourite book this year turns out to be An Anatomy of Addiction: Sigmund Freud, William Halsted and the Miracle Drug Cocaine by Howard Markel. Such an enjoyable read: a good story, well written with humour and insight from a doctor and professor of the history of medicine.

Markel provides some entertaining chapters on the discovery and early use of cocaine. It was used as a pick-me-up added to soft drinks and wine, as a cure-all for the depressed and liverish and as a local anaesthetic that revolutionised surgery. By the time cocaine's addictive and destructive properties were recognised thousands were addicted to the drug.

Markel's account of Freud's cocaine use is fascinating, fair and balanced, an antidote to E.M. Thornton's tendentious Freud and Cocaine - also reviewed on my blog here. He describes Freud's early research into the drug's medicinal properties, including the disastrous treatment for morphine addiction of his friend, Ernst von Fleischl-Marxow. Despite his friend's double addiction to morphine and cocaine and resulting death, Freud became an advocate of cocaine and used the drug himself for around ten years. It is fascinating to consider how much cocaine influenced Freud's ideas in the 1890s, including his Analysis of Dreams.

William Halsted was a contemporary of Freuds. He has been called the father of modern surgery. He advocated the antiseptic approach of Lister, and at a time when surgeons operated in dress coats, insisted his staff wear surgical garb, scrubbed their hands and don rubber gloves. He developed new operations and new treatments and yet throughout his career he was addicted to morphine and cocaine. Halsted's cocaine addiction began when he started testing the drug's anaesthetic qualities, injecting himself under the skin and cutting himself to see how deep he could cut without pain. Soon he was addicted. His friends and colleagues attempted to rehabilitate Halsted whilst preserving his reputation. Thus they sent him on a sea voyage to wean him off the drug and when this failed he was sent to a mental hospital where he was prescribed morphine in order to manage the symptoms of cocaine withdrawal. Halsted was addicted to drugs for the remainder of his life but managed to control his drug use (but with frequent relapses) thanks to a huge effort of will. After some years working in the pathology lab at the new Johns Hopkins University Medical School he was appointed to a professorship and continued to advance the profession of surgery until his death in 1922.

Markel's book provides an entertaining account of the lives of these two great Victorians, advancing the cause of medicine whilst battling their own demons and the problems of drug misuse and dependency. An excellent read!