The Banana Peel Project

I just finished reading a really interesting article by Daniel Nunn (pdf) that details William Halsted’s thirty-year cocaine addiction.  Halsted was the first professor of surgery at Johns Hopkins University, and has been widely credited with being the first to describe the principle of local anesthesia by blocking nerves.  In the 1880s, Halsted developed a whole series of techniques for applying cocaine to specific areas of the body and thus safely and effectively blocking pain.  Halsted’s discovery completely transformed medicine.  It was, by most accounts, a medical revolution.

But Halsted, together with his illustrious friends and colleagues at Johns Hopkins, was (at first) unaware of cocaine’s tendency to escape the contexts of use in which it appears.  Cocaine, like many narcotics, are extremely dangerous when not used carefully.  In the 1880s, the deadly (and sneaky) nature of cocaine addiction was not yet widely recognized.  And even worse, physicians like Halsted had easy access to all of the latest medical gadgetry, including one particularly fascinating piece of then-recent technological wizardry that was to play a considerable role in the later explosion of cocaine and opiate abuse: the hypodermic syringe.

Suffice it to say that Nunn’s article does a great job describing the surprising quickness with which Halsted and his friends found themselves beholden to the effects of cocaine:

Unaware of the insidious ease and rapidity of cocaine addiction and its disastrous effects, the group used the drug freely and sometimes indiscriminately, but often noticed that larger doses resulted in nausea and dizziness.  Those with a cold sniffed cocaine to clear nasal passages, whereas others sniffed during theater performances, as the drug seemed to “add color to the play.”

Soon after discovering that cocaine could be far more than a simple surgical tool, far more than a way of getting patients to hold still on the operating table, Halsted discovered an ingenious way of alleviating the side-effects of cocaine addiction.  He had found a new drug, one that did a great job eliminating the pain and sickness that he found accompanied his attempts to stop using cocaine.

Halsted’s love affair with morphine would ultimately land him in a psychiatric hospital, and might have ended his career if it had not been for his continued and somewhat surprising success in publishing medical journals.  In 1885, however, at the beginning of Halsted’s journey through cocaine addiction, he published an intelligent, widely read, but nearly incomprehensible article on the anesthetic properties of cocaine.  It began with this “sentence:”

Neither indifferent as to which of how many possibilities may best explain, nor yet at a loss to comprehend, why surgeons have, and that so many, quite without discredit, could have exhibited scarcely any interest in what, as a local anesthetic, had been supposed, if not declared, by most so very sure to prove, especially them, attractive…

You get the picture; the rest is too excruciating to reproduce here.  Cocaine, and his attempts to escape its grasp, had very nearly transformed Dr. Halsted from a brilliant physician into an aphasic charlatan.  But morphine, somehow, had saved him.

This is an intriguing, and revealing, episode that shows how intertwined the histories of addiction, drugs, medicine, and medical technology really are.  But to me, the most interesting part of Nunn’s article comes right at the end.

Halsted endured a life of controlled addiction in which he apparently cured himself of cocaine abuse by substituting morphine; no less a habit, but one that allowed him to live a “courageous 30 years of fruitful activity with the haunting enemy always at hand” but without deterioration of self, health, or mentality.

What, one might well ask, is “controlled addiction”?  If addiction is marked by a loss of control, by a kind of progressive giving-up of whatever techniques of self-control and self-knowledge are important to an individual, then what does it mean for that loss to be controlled?  I think Nunn is pointing to something important here, but I’m not quite sure what it means.

Halsted is a fascinating case, and probably deserves a lot more attention than he’s already gotten–especially if his experience can tell us something about current understandings of drugs and drug addiction.  And I think that it can, particularly given the current controversies around the complete lack of effectiveness of methadone (a patented, synthetic opioid) as a treatment for opiate addiction.  Yeah, I know, we should have seen it coming.

(Thanks for pointing me in the direction of Halsted, David!)