Sigmund Freud, William Halsted and cocaine addiction

Howard Markel's "An Anatomy of Addiction" starts, like a shot, on May 5,1884. A Bellevue Hospital orderly summons Dr. William Stewart Halsted to save the leg of a laborer who has fallen from a scaffolding.

Famous for the speed and virtuosity of his surgery, Halsted notes the shattered shinbone piercing through the skin — and abruptly retreats from the examination table, because he's not fit to operate. He takes a cab home and sinks "into a cocaine oblivion that lasted more than seven months."

Halsted would regain his professional footing years later — in Baltimore, at Johns Hopkins. There he would pioneer modern surgical technique. But he never licked his habit.

Published on Tuesday by Pantheon, Markel's history — subtitled, "Sigmund Freud, William Halsted and the Miracle Drug Cocaine" — tells how two men who conquered their intellectual worlds succumbed to the wonder drug of the 1880s. Freud beat his addiction. Halsted controlled it with massive doses of morphine and the occasional cocaine binge.

Freud, the neurologist who became the father of psychoanalysis, and Halsted, the surgical innovator who also pioneered the safe and sterile operating room, viewed cocaine, early on, as a marvel of the age. Halsted experimented with it as a potent anesthetic. Freud explored its powers to combat depression, neurasthenia and, ironically, addiction to other drugs.

"They were all too human," Markel said last week from the University of Michigan, where he teaches and directs the Center of the History of Medicine. "You want to ask them, 'You're so smart, you're so accomplished — how could you do something so dumb?'"

Markel makes their battles with the drug revelatory and suspenseful. He never commits the errors of using their addictions to explain their genius — or wondering why men with mighty intellectual firepower could imperil their careers to feed their risky appetites.

Halsted was also the subject of Gerald Imber's nimble 2010 biography, "Genius on the Edge." Imber filled out the surgeon's story with tales of the other founders of the Johns Hopkins Hospital — he playfully referred to his book as "Halsted & Company."

Markel lavishes attention on Halsted's colleagues, too, but the brilliance of "An Anatomy of Addiction" is its strong dual focus. Markel's editor, Victoria Wilson (who also worked with him on his eye-opening "When Germs Travel"), thinks that this book's split perspective will help spread the word about Halsted as well as generate new interest in Freud.

"Outside the medical world, and outside of the Baltimore area," Wilson said, "people don't really know what Halsted did — how much of a pathfinder he was. Reading about him, you learn where so many things we take for granted got started — and that's fun. And when you talk about Freud, a lot of people don't even know that he was a cocaine addict, which surprises me. I think this is going to mark a rebirth of interest in Freud. People have denounced Freud long enough — now they'll bring him back."

The bigger story around this book is a tale of three doctors: Markel, as well as Freud and Halsted. A fluent, incisive and often subtly funny writer, Markel is also a Hopkins-trained physician.

Dr. Julia McMillan, professor of pediatrics at Hopkins, knew Markel when he was completing his pediatric residency, doing a fellowship in adolescent medicine and earning a doctorate in the history of medicine. She thinks it's "characteristic" of Markel to "identify individuals he sees as genuine heroes" and "dissect their vulnerabilities — while never reducing their heroic stature in his eyes."

Both Freud and Halsted used themselves as guinea pigs. For Markel, that's a point of understanding, not an excuse.

"I never met an addict who set out to become one," he said. "But all addicts want to feel that they are the authors of their own addictions — they want to feel that they create their own realities."

Throughout, Markel depicts typical druggie behavior in two atypical protagonists, whether it's Freud entering into a folie a deux with his friend and co-user, Dr. Wilhelm Fleiss (who theorized that "the nose was the major organ of the body") or Halsted developing intricate deceptions to keep his drug life secret.

Amazingly, Freud rid himself of cocaine despite bouts of alcohol abuse and depression. The "famously muscular" Halsted found relief in 195-milligram doses of morphine. (Morphine is normally prescribed for pain at 5 milligrams to 20 milligrams every four hours.)

Happily, Markel is a humanist, not a moralist.

"Someone lies, and you get mad," Markel said. "But addicts lie all the time to protect the secrecy of their drug use. What to you are lies are for the addict a matter of survival. You have to treat their lying and duplicity as symptoms — like depression or paranoia."

Markel plummets readers into a world where psychoanalytic models for mental disease — and sanitary practices for hospitals — don't exist. So when Freud refines talk therapy or Halsted establishes a sterile operating room, you feel the thrill of discovery: You are there at the dawn of modern consciousness.

Markel is, as Wilson says, "a storyteller" — when he grew up in suburban Detroit, he always wanted to be a writer.

"My ambition was to work on 'The Alan Brady Show' [the setting for 'The Dick Van Dyke Show'] — it was a huge disappointment for me when I found out that it was fiction."

At the University of Michigan, Markel devoured "Shakespeare — and Dickens, all the great 19th-century storytellers." But he loved medicine, too, and developed the ambition to become a writer/physician like, say, Richard Selzer. Markel graduated summa cum laude in English, and also earned his medical degree there.

For Markel, as a medical man, going to Hopkins was "like playing for the Yankees." Halsted's legacy is one reason that doctors for over a century have viewed Hopkins as the top club in the big leagues. He created surgical procedures — like the radical mastectomy — and antiseptic practices — like the use of surgical gloves — that saved untold numbers of lives.

After southeastern Michigan, Markel found Baltimore "wonderfully exotic." He lived near the central Enoch Pratt Free Library. He dove into its "lush H.L. Mencken Collection" and emerged with his first book, "The H.L. Mencken Baby Book."

"I love Baltimore," Markel said. "I went through remarkable times in that city."

They included his marriage to Dr. M. Deborah Gordin, a clinical pharmacist at Hopkins' Children's Hospital. She was diagnosed with a rare cancer a month before their wedding; she died thirteen months after the diagnosis.

In the preface to "Quarantine," his riveting chronicle of two epidemics in 1892 New York City, he wrote that he understood "being 'quarantined,' cut off entirely from normal human society simply because I was the husband of a dying woman." (In his new book, he thanks his second wife, Kate Levin Markel, for the way she "scrutinized and improved every page" — and he dedicates it to their two daughters.)

As a young widowed resident at Hopkins in the 1980s, Markel poured himself into a routine that Halsted had helped establish in the 1890s. But in "An Anatomy of Addiction," Markel's admiration for the surgeon never blinds his 20-20 critical vision.

Halsted instituted America's first surgical residency training program, leaving the postoperative care of his patients to his residents. It was a terrific regimen for ambitious sawbones. It was also, Markel notes, "the perfect vehicle for a surgeon with severe addiction problems. Halsted needed the nightly comfort of his narcotics … without having to worry that those he operated on while sober in the morning might suffer from his indisposition that evening."

Still, Markel concludes, "Genius is not found in a bottle, pill, or potion. … The titanic legacies of Sigmund Freud and William Halsted were ground out page by page, stitch by stitch, patient by patient, insight by insight, day after day, year after year."