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.

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.

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 "Uber 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 fiancee
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.

- -Ms. Blum is the author of "The Poisoner's Handbook."