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28 of 28 people found the following review helpful
In Howard Markel's "An Anatomy of Addiction," two renowned figures are attracted to "a miracle drug" that reduced appetite and the need for sleep, sharpened one's focus, relieved depression, and induced a feeling of euphoria. It also had anesthetic properties that could be useful for surgeons performing dental or ophthalmological procedures. Both Sigmund Freud, the pioneering psychoanalyst, and William Halsted, one of the greatest surgeons of his time, were fascinated by this drug and decided to try it out on themselves. As a result, both became addicted to cocaine.

Dr. Markel's command of his subject is impressive; his excellent source materials include letters, journal articles, and monographs. The author provides enlightening background information about medical practice in the nineteenth century, especially in the United States and Vienna. He vividly describes Bellevue Hospital in New York City, Johns Hopkins in Baltimore, and the Allgemeines Krankenhaus in Vienna, large complexes that were bursting at the seams with both affluent and indigent patients. Young physicians-in-training flocked to these institutions to learn from more experienced and skilled medical practitioners.

It is fascinating to learn how naïve people were concerning cocaine's short and long-term effects. The same could be said of opium, morphine, and laudanum, all of which were dispensed liberally to treat a host of complaints. No one understood the underlying nature of addiction. There were no "rehabs." If someone were unfortunate enough to become dependent on a drug, he or she would have a very difficult time breaking the habit. Freud and Halsted were particularly susceptible to this disease because of who they were. Freud was "a bright, ambitious, and socially insignificant Jewish boy" (he would sometimes hear his peers uttering anti-Semitic jibes). He had little money, conducted a lengthy, long-distance romance with his future wife, and was frustrated by his slow ascent up the ladder of success. Cocaine gave him a lift, alleviated his melancholy, and boosted his self-esteem.

Halsted came from a wealthy background, but his parents were cold and distant. He became a workaholic who was determined to excel as a teacher, surgeon, and medical pioneer. He had to work long hours and operate on patients whose lives were in his hands--literally. At first, cocaine seemed like a godsend, but the long-term effects proved to be devastating. It is instructive that two such knowledgeable and insightful individuals as Freud and Halsted were both brought to their knees by cocaine. "Their clinical histories prefigure the ever-challenging spectrum of substance abuse." No one--rich or poor, highly educated or illiterate, socially prominent or unknown--is immune from the terrible effects of chronic addiction.

Beautifully written, with scores of evocative black and white photographs, richly detailed anecdotes, and marvelous biographical information, "An Anatomy of Addiction" is a must-read for anyone interested in the history of medicine. Adding to the narrative's excellence are its extensive endnotes and thorough index.
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26 of 26 people found the following review helpful
on August 9, 2011
In finishing this book, which was hard to put down, sent me searching for other books by this author. It is one of the best presentations that I have read, complete with excellent notes, and close to 100 pertinent illustraions, The scholarship of this Medical Historian is extraordinary.

While the focus is on two contemporay physcians, both trapped by the addictive powers of cocaine, Markel details enlightens us as to the ways of the era of modern medicine. Freud and Halsted (the premier surgeon-in-chief of the John Hopkins Hospital) belief that the super drug potentially capable of curing anything. It would bring them fame and fortune as a pharmaceutical. Sadly there personal trials brought them a debilitating curse. The study details the pathological dispersion of addiction in a manner that is very easily understood by a layman. Through-out the book is written to be understood, and the story line will captivate you. To readers,as myself, the author Markel may be addictive!
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10 of 10 people found the following review helpful
"An Anatomy of Addiction" by Howard Markel examines two famous doctors, Sigmund Freud and William Halsted and their addiction to cocaine. Freud, who invented psychoanalysis, the search for self-truth, became convinced that cocaine was a miracle drug with no side effects. Halsted, considered to be the father of modern surgery was probably the first cocaine addict to come to the attention of medical professionals in the United States.

Peruvian Indians on the eastern slopes of the Andes have been chewing coca leaves for centuries. Their Inca ancestors used it in many religious rituals and initiation rites. Chewing coca leaves was found to have the remarkable ability to suppress hunger, increase tolerance, and stretch the bounds of human endurance, but is no more harmful than several cups of coffee. It wasn't until around 1860 that the devil was unleashed by a German scientist who converted the leaves into the highly purified coca alkaloid.

If there is such a thing as an addictive personality, Freud certainly had it. He became so enamored with cocaine and fascinated with its effects on the mind that he considered it a treatment for morphine addiction and depression among many other ailments. Halsted was interested in the drug's anesthetic qualities and how it could aid him in surgery, so began experimenting on himself by injecting the drug into his arm.

Both men consumed great quantities of the drug and eventually encountered serious problems because they had done so. At the time, the late 1800's, addiction as a bona fide medical diagnosis was not in the medical vocabulary. Freud struggled with this demon for twelve years and Halsted, it is speculated, struggled with cocaine as well as morphine addiction until his death in 1922.

"An Anatomy of Addiction" is a fascinating read. It is a study in the diabolical power of addiction and the role cocaine played in the budding careers of two world-changing geniuses. Engrossing and interesting from the first page to the last.

David Allan Reeves
Author of "Running Away From Me"
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9 of 9 people found the following review helpful
Both Sigmund Freud, father of psychoanalysis, and William Halsted, originator of modern surgery, practiced medicine in the 1880s and experimented on themselves and others with cocaine's possible therapeutic uses. Freud was interested in it as an antidote for morphine addiction and as treatment for addiction, Halsted saw it as a possible anesthetic. Freud found the drug cured his indigestion, dulled his aches, and relieved his depression. After taking the drug for a few months Freud shifted from his initial focus on neurology to psychology/psychiatry. Halsted became professor of surgery at Johns Hopkins Hospital and devised new and safer surgical techniques - while struggling with his addiction acquired experimenting.

'An Anatomy of Addiction' opens with a laborer being admitted to Bellevue Hospital with a serious compound fracture of the leg. Staff called upon Halsted, their best surgeon, but he had just taken a dose of cocaine. He took one look at the patient and went home to a seven-month cocaine oblivion. Meanwhile, in Europe Freud was using the drug to self-medicate his own anxieties. At the time almost 15% of prescriptions contained cocaine, there were no controlled substances, and addiction was not yet a medical diagnosis. Other users of the day included Ulysses Grant, Queen Victoria, the Shah of Peria, Thomas Edison, and Arthur Conan Doyle (also a physician).

Freud's career goals was to be appointed to a faculty position at the Vienna Medical School, and saw lab experimentation as his preferred means of getting it. His focus on cocaine was initially motivated by a desire to help a friend, Dr. Fleischl-Marxow, addicted to morphine because of the intense, chronic pain created by a non-healing amputation. Freud himself began using it in 1885, and wrote an article initially lauding its value. Despite awareness of its anesthetizing effect on the tongue, Freud did not pursue this benefit, and an ophthalmology colleague whom he told about it (Carl Keller) did, and received credit for its use in cataract surgeries. Freud also learned cocaine offered access to deeper, unconcious levels of psychological meaning. His oral and mostly nasal administration was not as destructive as Halsted's injections.

Author Howard Markel adds considerable credibility to the book's accounting, given his stature as a physician and professor and Director of the Center for the Hisotyr of Medicine at the University of Michigan. Markel adds medical insights throughout the book, such as the fact that heavy cocaine users suffer much more rapid physical and mental deterioration than those using heroin.

Fortunately, Halsted was steered into a Rhode Island recovery program at its Butler Hospital for the Insane, where he was one of three drug rehab patients. The program was enlightened for its day, building up self-confidence and also ensuring patients were aware of the consequences of continued use. Unfortunately, it also administered morphine to help wean patients off cocaine. Halsted was discharged after a six-month stay, under the supervision of Dr. Welch.

Dr. Welch was a key figure in the founding of Johns Hopkins medical school and hospital. Halsted was initially assigned to the pathology lab where he worked on dogs and cadavers to perfect surgery - eg. determining the best intestine layer to use for stitching. Halsted relapsed and went back to Butler for another nine months. Returning to Johns Kopkins, his experiments continued - this time in wound healing and the surgical treatment of various maladies, including breast cancer. After a short period he was appointed Acting Surgeon, and in March of 1890, Surgeon in Chief. Cleanliness was essential to Halsted - he wore sterilized gowns, rubber gloves, painted incision sies with disinfectants, and draped the surgical area with a sterile cloth that exposed only the incision area. Author Markel, however, suspects Halsted continued to use cocaine or morphine for the rest of his life - based on his record of tardiness and absenteeism, unavailability during evening hours, and the observations of fellow physician william Osler. Halsted was also a chain smoker.

Markel, on the other hand, believes Freud stopped using cocaine in 1896. Prior to that point he had seen the initial benefits to Dr. Fleischl-Marxow reversed, and personally experienced arrhythmia, shortness of breath, and other signs of heart stress. His most obvious and persistent symptom involved scarring and blockage of nasal passages. Markel also believes Freud then relied on alcohol to relieve his stress and depression.

Bottom-Line: Drs. Halsted and Freud were obviously very talented physicians - yet, it took all their strength to beat back cocaine's attraction; in Halsted's case, he only succeeded in reducing its impact, not eliminating it. Thus, this interesting book serves as a credible warning to those thinking they could beat the odds. On the other hand, readers are still left wondering about the reported large numbers of current casual users, and those more famous prior users.
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19 of 22 people found the following review helpful
Sigmund Freud's first major published paper, in July 1884, reported his praise of the "magical substance" of "Über Coca", which he had been studying and experimenting with personally. It also marked the beginning of a transition for Freud, in moving from controlled scientific observations within the laboratory environment, to including his own personal thoughts and experiences into his work. Was experimentation with cocaine an important factor in Freud's revolutionary work in psychology? The reader can reach his or her own conclusions, with this book providing a fascinating accounting of the journey that Freud made (he is said to have discontinued his use of cocaine by 1896, prior to the publishing of his most influential works).

William Halsted, a contemporary of Freud, was a Yale trained chief of surgery at John Hopkins Hospital who developed important surgical techniques while also dealing with his own addiction to cocaine. His efforts to control the addition also resulted in a profound self-control which contributed to his development of surgical techniques with significant theraputical benefits, including the introduction of germ-free operating rooms at Johns Hopkins Hospital. He is also created with first using the now mandatory rubber glove in surgery.

The story of these two scientific pioneers, and the role that cocaine played in their personal and professional lives, is fascinating. Also included are stories of famous advocates of the cocaine-enhanced wine "Vin Mariani", developed in the 1860's, who included Ulysses S. Grant, Jules Verne, and Thomas Edison, among many others.
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7 of 7 people found the following review helpful
Two medical pioneers -- including pioneers in the potential medical use of, and actual personal misuse of, cocaine. Howard Markel paints a cautionary tale of addiction that powerfully resonates a century and more later.

Many people know a bit about Sigmund Freud's history with cocaine, despite the best efforts of generations of Freudian acolytes and disciples to cover up just how much he used (or abused), how long he used it, and how much it affected his general work habits and his psychological theorizing.

Markel gets behind the story, not just with Freud, but a somewhat older near-contemporary, William Halsted. Halsted, less familiar to many, was essentially the father of modern American surgery, a pioneer in introducing the use of antiseptic techniques in surgery, introducing new operating techniques and more, mainly from his perch of director of surgery and one of the founding doctors at Johns Hopkins School of Medicine.

When I was a kid, I read a mini-biography of Halsted in a compendium of lives of great doctors, so I had heard about his "sea cruise" attempt to overcome his cocaine addiction. But, the story closed with what Markel notes was long the "official line" about Halsted: that he had no major problems, or problems at all, after that.

How wrong I was, Markel shows.

I had no idea he was "committed" to Butler Hospital, a "sanitarium." Nor that he was given morphine to "help" with cocaine withdrawal. Nor that he, as a result, apparently became a lifelong morphine addict. Nor that he apparently struggled to some degree with cocaine addiction for the rest of his life.

Markel, an M.D. and Ph.D. with addiction support help background, shows a clinician's skill in diagnosing how addiction affected Halsted's life, his work at Johns Hopkins, his relation to surgical interns and patients and more.

In parallel chapters, he also looks at how cocaine use affected Freud's personality, his own medical theorizing (including, in reverse of Halsted's time at Butler, the idea that cocaine could be used to treat morphine addiction), his psychological theorizing (including how "The Interpretation of Dreams" was likely largely affected by guilt trip over his participation in how a doctor friend and fellow cocaine touter, Wilhelm Fliess, medically mistreated one Emma Eckstein) and more.

Was Freud, like Halsted, an addict? Markel carefully uses the distinction between "abuse" of a drug and "addiction" to a drug to say that Freud was clearly a cocaine abuser, and may have crossed the addiction line, without us being able to know for sure.

A few lines from the epilogue show Markel's insight:

"When Freud and Halsted first became acquainted with their chemical bete noire, they fully expected cocaine to become the wonder drug of modern medicine. Neither had any idea of its potential to dominate and endanger their lives. Addiction as a bona fide medical diagnosis was not yet in the doctor's lexicon, let alone his textbooks. ...

"Each man actively participated in the birth of the modern addict, and their clinical histories prefigure the ever-challenging spectrum of substance abuse, addiction and recovery. Freud somehow escaped from his cocaine dependency even as he was plagued by periods of sexual turmoil, increased alcohol consumption, and depression. Decades after Halsted restricted his cocaine use to occasional binges, he still availed himself of daily morphine injections to quell his addictive urges, often with negative results."

Going beyond the parallel biographies, Markel then discusses issues of drug addiction in general, from how it was understood at the time of Halsted and Freud to how our understanding has evolved today. Without being harsh, he also notes his medical peers today are often like those of a century ago in still often offering biochemical help to addicts that turns out to promote a substitute addiction.

He then, behind that, notes the development of cocaine from a raw substance in coca leaves to its refinement into cocaine hydrochloride of snorting use both then and today, as well as other methods to use it. Besides Coca-Cola, which did, yes, originally have a bit of cocaine in it, though not much,there were cocaine-laced alcohol products, quite popular then. I had heard of them, but didn't know the details, including that alcohol actually combines with cocaine to produce an even more intoxicating compound, cocaethylene, in the liver. So, in addition to the "speed-ball" like effect Halsted had when he was using both morphine and cocaine, we already were having cross-addiction being promoted back then.

I definitely now want to read Markel's "Quarantine" about East European Jewish emigration to the U.S. and the diseases that came with this.
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5 of 5 people found the following review helpful
on November 15, 2011
This book is good on so many levels; historical, biographical, cultural, medical and for anyone interested in addiction. It is superbly written and researched. The pictures throughout make the people and places really come alive. And believe it or not, it's a page turner. I read well into the night and finished it the next day. Highly recommended.
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6 of 7 people found the following review helpful
TOP 100 REVIEWERVINE VOICEon September 19, 2011
Heroin was first marketed as a miracle drug, a cure for morphine addiction and other ailments and helped soldiers perform heroic acts in battle. Hence the HERO in heroin. The drug ended up being more addictive than morphine.

Like heroin after it, cocaine was once thought to be the new wonder drug, and exciting answer to many medical conditions. At the turn of the century (late 1800s) the ubiquitous cocaine was readily available, thought to be a cure for numerous conditions, and used as a topical and total anesthetic. Cocaine was freely consumed by the rich and famous, especially in Vin Mariani a coca laced wine produced by Angelo Mariani. It was in this atmosphere that two of the greatest medical men of their time experimented with and became enslaved by cocaine. An Anatomy of Addiction is the fascinating saga of cocaine's hold on Sigmund Freud and William Halsted against the backdrop of medicine's advances during their lives.

When this book arrived at the local library, I had already started another book, one I wasn't sure I really wanted to finish. Anatomy of Addiction, however, had me hooked with the first page which I enthusiastically devoured after reading the cover's inside flaps.

As others have said, this book in itself is addictive. It's one I uncharacteristically read in four days, and one I always looked forward to taking up again. Witnessing the self destruction of two such gifted men is mesmerizing and often shocking. For this reader, learning about the addictions and excesses of Freud, especially, was shocking.

Markel keeps the reader enthralled page after page with his even handed writing style and well documented information. The writer learns not only about Freud and Halsted, but also about cocaine's history, early medicine, and the evolution of Johns Hopkins hospital. This is an informative book I thoroughly enjoyed and highly recommend.
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2 of 2 people found the following review helpful
This is a study of the first medicinal uses of cocaine and the resulting addiction of two medical practitioners who went on to fame. As cocaine came on the scene, it appeared to be a legitimate replacement for morphine in surgery. American drug companies touted it as a replacement for (vomit causing) morphine. The initial feeling of well-being it gives suggested that it had some overall healing properties. Beverage companies on both sides of the Atlantic capitalized on the good feelings it brought and Sigmund Freud wrote a scholarly paper on its perceived medical value.

It was inevitable that members of the medical profession would experiment with it. Howard Markel shows how William Halstead, who eventually went on to head the surgery department at Johns Hopkins, tried it for fun; Sigmund Freud tried it for "research purposes".

After a widely known withdrawal, the record shows that Halstead secretly continued his cocaine habit. He was able to mask it somewhat since his imperious classroom style (even lecturing with his back to the class) was the norm for the times as was his overreliance on surgical and other assistants. Freud documents his usage in letters and papers; when he stopped writing about it, he started using alcohol, so is concluded he stopped his cocaine usage.

It may be that Halstead never kicked the habit because he found that intravenous use produced a faster high and that Freud was able to withdraw (around 1896, after over 10 years of documented use) because he inhaled it.

The book was interesting as a history of cocaine and for its portrait of Freud. He is clearly a young man on the make. He seems to be looking for a niche in medicine to achieve fame. The cocaine episodes featured in this book, demonstrate rush to find the "big thing" before all the facts are in. It seems he repeated this approach with psychoanalytic theories. The hints of bi-sexual experiences also round out this portrait. I'll be looking for a full scale bio. that integrates these aspects of his personal life on the development of his most famous work.

Perhaps medical niche works like this have always been around, or maybe I've just become aware of them. Two others I've enjoyed in the past few months are Destiny of the Republic: A Tale of Madness, Medicine and the Murder of a President and The President Is a Sick Man: Wherein the Supposedly Virtuous Grover Cleveland Survives a Secret Surgery at Sea and Vilifies the Courageous Newspaperman Who Dared Expose the Truth.
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2 of 2 people found the following review helpful
on January 2, 2012
This book rotates between the story of how cocaine use personally and professionally affected two historically significant medical doctors, each of whom trained in Vienna during the late 19th century, and what is known clinically about cocaine addiction. The author does an excellent job of demonstrating how one drug may lead to another, as the user tries to manage their dependancy on the preferred substance. The result is an interesting read with some thought provoking insights on the dynamic nature of "recovery".
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