HEALTH -- October 17, 2011 at 6:53 PM ET
Cocaine's Historical Ties to Rubber Gloves, Beverages, Freud's Nightmares
Dr. Howard Markel didn't need to look far for characters to help personalize his new best-selling book, "An Anatomy of Addiction." Simple snapshots of a handful of recognizable celebrities would have been enough to shed light on most corners of the disease.
F. Scott Fizgerald with a drink in his hand. Louis Armstrong smoking a joint. Chico Marx at the poker table. Humphrey Bogart dragging on a cigarette. History is full of people who stunned the world with their brilliance while silently struggling against darker impulses.
"But as I got to both Sigmund Freud and William Halsted's story with cocaine, I became obsessed, if not addicted, to their lives," said Markel, who is also the director of the Center for the History of Medicine at the University of Michigan.
So he scrapped the other addicts in favor of an exclusive look at two men who revolutionized modern medicine while caught up in a nearly fatal cycle of abuse, addiction and recovery.
But the final version of "An Anatomy of Addiction" is also a story of 1,000 fascinating yarns -- like the one about Halsted inventing rubber surgical gloves to impress a girl. Or how Pope Leo XIII carried around a flask of cocaine wine. And the story of how Freud's original fascination with analyzing dreams stemmed from a cocaine-induced nightmare that haunted him until the day he died.
When health correspondent Betty Ann Bowser met up with Markel at the The William S. Halsted Room at Johns Hopkins Hospital in Baltimore, the medical historian was brimming with side stories that make his book -- an otherwise haunting story of addiction and self-destruction -- so much fun to read.
Watch Betty Ann's conversation with Markel on the NewsHour broadcast Monday evening, then check out a few of the more quirky excerpts from their conversation, and from Markel's book, below.
Rubber Gloves: A Love Product?
There exists great debate by medical historians over whether it was true love or William Halsted's fetish for cleanliness that led him to create the rubber glove, the iconic symbol of modern surgery. Like all Listerians, William insisted that everyone entering his operating room vigorously scrub their hands in caustic, toxic chemicals that killed microbes. At Johns Hopkins, Halsted's assistants immersed their hands in a basin filled with permanganate, followed by a dip in a basin of oxalic acid, and then a five-minute soak in a corrosive bichloride of mercury solution. They used stiff brushes, along with plenty of soap and water, to scrape and clean every millimeter of their hands, from the nail beds and crevices between their fingers all the way up to the elbows. The fastidious Dr. Halsted preferred to wash his hands with a sterilized cloth in a special basin filled with rubbing alcohol.
In 1889, one of the Hopkins surgical nurses caught William's eye. Her name was Caroline Hampton. She was a tall woman with piercing eyes who hailed from a distinguished family of planters that included her uncle, the decorated Confederate general Wade Hampton II. A photographic portrait of Caroline in her nurse's uniform exhibits a bright air of confidence and a prematurely pear-shaped figure. Robust and horsy, Caroline was especially good at maintaining the various mechanical gadgets then in use at the Hospital. By some accounts, she was difficult, spirited, prone to haughtiness, and high-strung. But Dr. Halsted saw her worth and appointed her to be the head nurse in his operating room.
The abrasive chemicals Caroline doused her hands in every day rendered her skin rough, scaly, cracked and marred by red, angry rashes. None of these traits appealed to either the Southern belle or the surgeon who pursued her. As the dermatitis traveled up her fingers and hands and extended to her forearms, a besotted William grew determined to do something therapeutically definitive and sweetly chivalrous. In either the winter of 1889 or 1890 (in later years William could never recall precisely when), the surgeon took a train up to New York and met with an executive at the Goodyear Rubber Company. Armed with drawings of prototypes, he asked the rubber man if he would kindly manufacture "two pairs of thin rubber gloves with gauntlets." William's invention may have begun as a means to win Caroline's heart but it ultimately changed the way doctors operate, much to the benefit and safety of their patients.
A Papal High: Vin Mariani, the Cocaine-Infused Wine
Most thrill-seeking Europeans of the late 1850s and early 1860s found the chewing on coca leaves to be déclassé, if not disgusting. As a result, infusions, or teas, of coca leaves and, later, other liquid preparations became a popular means of consuming the drug in cafes and dining establishments. The credit for introducing this fashionable craze to Western consumers belongs largely to a French chemist named Angelo Mariani, originally from Corsica, who hailed from a long line of doctors and chemists. From 1863 well into the 1900s, Mariani and his associates concocted, manufactured, and distributed the second-most popular coca-based product in human history...
Undaunted neither by pooh-poohing medical experts nor cumbersome chemical production realities, Mariani worked day and night to manufacture palatable coca-laced beverages. His great Eureka moment arrived while mixing ground coca leaves with a far more traditional French intoxicant, Bordeaux wine...
Pope Leo XIII awarded the Mariani Company a special Vatican gold medal, allowed his face and name to be featured on a Vin Mariani advertisement, and was said to have carried around a flask filled with the wine under his cassock that was "like the widow's cruse, never empty"...
World leaders, too, loved the drink. For example, in 1885, former President Ulysses S. Grant was suffering from the end-stages of throat cancer (itself likely caused by an unhealthy devotion to alcohol and tobacco) and eking out the last chapters of his autobiography for Mark Twain's ill-fated publishing house. It became a book many historians laud as one of the best memoirs ever penned by an ex-president. Yet at the same time he scribbled down his thoughts about the Civil War, Grant was swilling down bottle after bottle of Mariani's wine. By the close of the 19th century, Queen Victoria, the Shah of Persia, and President William McKinley publicly declared their appreciation for Mariani's cocaine-enhanced tonic.
Mariani further exhibited his flair for marketing by sending cases of wine to celebrities around the globe requesting only a note of return expressing their thoughts on the product and an autographed picture. In the years to come, he published these celebrity endorsements in a series of albums called Portraits from the Album Mariani featuring some of the most prominent figures of the era. Thomas A. Edison, Auguste Rodin, Jules Verne, Arthur Conan Doyle, Robert Louis Stevenson, Henrik Ibsen, Emile Zola, Alexandre Dumas, and H.G. Wells, among others, all wrote exuberant letters about the product to their dealer, Angelo Mariani.
'An Interpretation of Dreams' and Freud's Cocaine Nightmare
Emma Eckstein was an attractive yet neurotic young woman who began consulting Dr. Freud in 1892. Immortalized as "Irma" in his book, Sigmund presents a somewhat disingenuous explanation of his late night reverie concerning cocaine and his patient: I was making frequent use of cocaine at that time to reduce some troublesome nasal swellings, and I had heard a few days earlier that one of my women patients who had followed my example had developed an extensive necrosis of the nasal mucous membrane. I had been the first to recommend the use of cocaine in 1885, and this recommendation had brought serious repercussions down on me. The misuse of that drug had hastened the death of a dear friend of mine. This had been before 1895 (the date of the dream).
In the dream, a disguised Irma meets him at a party hall filled with well-dressed and distinguished guests. She approaches Freud and complains, in the presence of others, that he had failed to cure her of her ailments and, in fact, worsened them. Descriptions of scabrous turbinate bones, blood, dirty syringes, injections with a series of agents including trimethylamine (the organic compound that gives semen its distinct smell), infection, and botched surgery abound in this dream.
Upon awakening, Freud was overcome with the unsettling thought that the dream suggested he did not take his medical duties seriously enough. After further scrutiny of the fantasy, however, he concluded "this group of thoughts seemed to have put itself at my disposal, so I could produce evidence of how highly conscientious I was, of how deeply I was concerned about the health of my relations, my friends and my patients...there was an unmistakable connection between this more extensive group of thoughts which underlay the dream and the narrower subject of the dream which gave rise to the wish to be innocent of Irma's illness."
Images courtesy of the Collections of the University of Michigan Center for the History of Medicine, Library of Congress, and The Freud Museum. All Johns Hopkins images courtesy of the Alan Mason Chesney Medical Archives of the Johns Hopkins Medical Institutions, with contributions from the William Stewart Halsted Collection (1890-1922); Johns Hopkins Hospital and School of Medicine Photograph Collection; J.M.T. Finney Collection (1863-1942); and People at Work Photograph Collection.