Anatomy of Addiction (eBook)

Prologue On the morning of May 5, 1885, in lower Manhattan, a worker fell from a building's scaffolding to the ground. A splintered bone protruded from his bloody trousers, a plaintive wail signaled his pain, and soon he was taken from the scene by horse-drawn ambulance to Bellevue Hospital. At the hospital, in the dispensary, a young surgeon named William Stewart Halsted frantically searched the shelves for a container of cocaine.

In the late nineteenth century, there were no such things as 'controlled substances,' let alone illegal drugs. Bottles of morphine, cocaine, and other powerful, habit-forming pills and tonics were easily found in virtually every hospital, clinic, drugstore, and doctor's black bag. Consequently, it took less than a few minutes for the surgeon to fi,nd a vial of cocaine. He drew a precise dose into a hypodermic syringe, rolled up his sleeve, and searched for a fresh spot on his scarred forearm. Upon doing so, he inserted the needle and pushed down on the syringe's plunger. Almost immediately, he felt a wave of relief and an overwhelming sense of euphoria. His pulse bounded and his mind raced, but his body, paradoxically, relaxed.

The orderlies rushed the laborer into Bellevue's accident room (the forerunner of today's emergency departments) for examination and treatment. A compound fracture--the breaking of a bone so severely that it pokes through the soft tissue and skin--was deadly serious in the late nineteenth century. Before X-ray technology, it was diffi,cult to assess the full extent of a fracture other than by means of painful palpation or cutting open the body part in question for a closer look. Discounting the attendant risks of infection and subsequent amputation, even in the best of surgical hands these injuries often carried a 'hopeless prognosis.' At Bellevue, above the table on which these battered patients were placed, a sign painted on the wall suggested the chances of recuperation. It read, in six-inch-high black letters: PREPARE TO MEET YOUR GOD.

As the worker writhed in agony, one surgeon's name crossed the lips of every staff member working in the accident room: Halsted. When it came to a crisis of the body, few surgeons were faster or more expert than he. Leg fractures were a particular interest of his in an era when buildings were being thrown up daily and construction workers were falling off them almost as frequently. One of Dr. Halsted's earliest scientifi,c papers assessed the surgical repair of fractured thigh, or femur, bones using a series of geometric equations based on how the leg adducted (drew toward) and abducted (drew away) from the central axis of the body. Such meticulous analysis was essential to repairing the break in a manner that accounted for the potential of the injured limb to shorten after the injury. Otherwise, the broken leg would heal in a manner that resulted in a decided limp or, given the intricate mechanics of the hip joint, much worse.

An orderly was dispatched to fi,nd Dr. Halsted as soon as possible. Running through the labyrinthine corridors of the hospital, he shouted, 'Paging Dr. Halsted! Fresh fracture in the Accident Room! Paging Dr. Halsted!' Down one of these halls, in a rarely used chamber, the surgeon was entering a world of mindless bliss. He heard his name but didn't really care to answer. Yet something, perhaps a refl,ex ingrained by his many years of surgical training, roused him to stagger out into the hallway and make his way downstairs. The pupils of his eyes looked like gaping black holes, his speech was rapid-fi,re, and his whole body seemed to vibrate as if he were electrifi,ed.
Upon entering...