, takes a look back at that time doctors injected themselves with cocaine in the name of science.
Following is a rough transcript:
Rohin Francis, MBBS: Good evening and welcome back to the Old England Journal of Medicine. It's off to the former colonies today, as recently I had the sterling fortune to while away an evening with two gentlemen from the North American continent -- of course, one of whom has recently taken up appointment here in Great Britain, a Sir William Osler, with whose work no doubt many of you will be familiar.
Syrup-guzzling Canadians are mostly tolerable company, but he insisted on bringing with him one of those uncouth Americans, a certain Dr. William Halsted, who by jove is a ruddy addict. A fine surgeon no doubt, but gadzooks, man. He was buzzing like a canary with his chuff in the snuff. Osler told me in confidence that the blighter is unable to operate unless he has injected cocaine, to mention nothing of the three grains of morphine that has become his daily ritual, according to my wife, who spoke with his wife, who overheard his valet's wife.
I am sure you utilize in your practice cocaine as an effective and safe local anesthetic, but you might not be aware that it also has some recreational uses. Nevertheless, when not boring the company collected at the Royal College with interminable talk of radical mastectomies, he shared with us the most entertaining recent correspondence from the noted German physician, Dr. August Bier.
The Yankee dodge, ether, has been in common use as an anesthetic agent since the recently departed Queen Victoria's early reign. But as we are all aware, patients were often discourteous enough to expire mid-operation. Dashed inconsiderate.
Personally, I didn't see any problem with this, but Bier, evidently possessing the sensitive heart of a woman, wished to examine cocaine's properties not only as a local anesthetic, but as a regional block, allowing major surgeries to be performed by cocainizing the spinal cord itself.
He begins by detailing how to inject into the correct cerebrospinal space, a procedure that causes a beastly headache due to leakage of the fluid contained therein, and then he lists his initial subjects. I shall read directly:
1. A 34-year-old laborer who was hopelessly riddled with tuberculosis. He had suffered many complications from earlier general anesthetics and dreaded another one. I therefore proposed spinal cocainization to him and he accepted. After administration, he felt nothing in the lower half of his body and I sawed off his leg and he felt no pain. Two hours after the operation, his back and left leg became painful and the patient vomited and complained of severe headache which persisted for 2 days.
2. A 17-year-old baker suffered from osteomyelitis of the tibia. He witters on a bit as Germans are wont to do about protocol. Waffle, waffle, Fritz ... yes. Just get on with it. Aha! I enjoyed this part: "After administration of the cocaine, the operation delighted the patient, who laughed and chattered with great enthusiasm and excitement. But lo, a crashing depression and severe headache ensued."
3. A 14-year-old boy suffered from the tuberculous, ankylosis of the left knee ... and no other problems. The boy complained unceasingly and was too backward and uncooperative for any tests of sensation.
These cases demonstrate that a small volume of cocaine solution introduced into the dural sac renders a large part of the body insensitive, enabling major operations of that region to be performed without causing pain. However, I still encountered complications.
To reach a well-informed opinion, I decided to perform some cocaine investigations on myself. On August 24, 1898, I had Dr. Hildebrandt perform a lumbar puncture on me and inject a half-syringe of a 1% solution of cocaine. Unfortunately, most of it escaped and no insensibility was achieved. Because of the considerable loss of cerebrospinal fluid, I postponed repetition of the procedure on myself until a later occasion, but Dr. Hildebrand immediately offered to have the same study performed on himself without delay.
The study was a great success, and its performance on a well-informed physician resulted in an excellent account of the action of cocaine on the spinal cord. I shall describe my findings:
I introduced cocaine in the usual way.
After 7 minutes: Needle pricks in the thigh were perceived as pressure; tickling of the sole of the foot was barely felt.
After 8 minutes: A small incision in the skin of the thigh was felt as pressure; introduction of a large, blunt, curved needle into the soft tissues of Dr. Hildebrandt's thigh produced no pain at all.
After 10 minutes: A long needle was pushed down to the bone without evoking the least pain. Pinching the skin severely and seizing and crushing it in toothed forceps was experienced as only pressure.
After 13 minutes: A burning cigar was applied to both of Dr. Hildebrandt's legs, felt as heat, but not as pain.
After 18 minutes: Strong pinching was hardly felt at all below the nipples.
After 20 minutes: Avulsion of pubic hairs was felt simply as elevation of a fold of skin, but avulsion of chest hair above the nipples on the contrary was very painful. Strong hyperextension of the toes was not unpleasant.
After 23 minutes: A strong blow to the shin with an iron hammer did not provoke pain.
After 25 minutes: Strong pressure and traction on the testicles was not painful.
After 32 minutes: Tickling the sole of the foot was perceived as faint touch. Needling repeatedly down to the femur and strong pressure on the testicle were not painful.
After 40 minutes: Strong blows on the shin did not hurt. The entire body began to perspire gently.
After 42 minutes: Constriction by a rubber tube tourniquet around the thigh produced no pain, but around the upper arm, was extremely painful.
After 45 minutes: Pain sensibility began to recover, but was still considerably obtunded.
After performing these experiments on our own bodies, we proceeded without feeling any symptoms to dine and drink wine and smoke cigars. I slept the whole night, awoke the next morning hale and hearty and went for an hour's walk. Toward the end of the walk, I developed a slight headache, which gradually got worse and I was forced to take to bed for 9 days, after which I thoroughly enjoyed an 8-day hunting trip.
Dr. Hildebrandt, for his part, went to bed feeling entirely well, but was nevertheless unable to get to sleep due to an agitated state. At midnight, a violent headache set in that quickly became insupportable.
At 1 a.m, he began to vomit and this recurred once later in the night. The next morning he felt very ill, but as I was unable to work, I told him not to neglect his duties and with much effort he was able to operate on the day's patients.
His legs became painful and bruises developed in many places, especially over the tibia where sensibility had been tested by crushing and heavy blows. These researches demonstrate that an extremely small solution of cocaine (0.005 g) injected into the subarachnoid ...
These Germans are an absolute riot, to waste all that good cocaine on an assistant surgeon. If I want to wallop Percy with an iron hammer or crush his testicles, I'll bally well do it with cocaine and if he wants to be employed by any surgeon in the Empire he will thank me for it. After all, the Germans invented that infernal homeopathy. I'll just tell him I'm using German homeopathic cocaine.
German medicine is like German automobiles -- unlikely to last. British manufacturing -- now that will last forever. Oh, Germans. They really have no ambition. I doubt we'll hear a peep from that meek country this century.
What a privilege to unearth this entirely real and genuine archive footage from over 100 years ago -- so many thanks to the Old England Journal of Medicine's archivists for digging it out.
I'm sure you all know the fact that Coca-Cola did indeed use to contain cocaine, leading to their famous first corporate slogan, you just "Can't beat the real thing." "No, man. You just can't beat it. It's f*cking great."
"It's awesome, man. Have you heard about Coca-Cola? It's better than Pepsi. Yes, Pepsi can ... because Coke is so great ...
But you might not know that cocaine was indeed commonly used in medicine around the turn of the 20th century. German pharmaceutical company Merck, a major player today, started by producing small amounts around 1860. Through the 1870s, total annual production was only 50 g of cocaine, which frankly is a quiet night for some of my friends.
From the 1880s, its medicinal uses really took off as Merck started marketing it as a cure for morphine addiction A young doctor called Sigmund Freud wrote a glowing 70-page document called Uber Cocaine, extolling its virtues. It was Freud's friend, Dr. Koller, who realized its use as a topical, meaning on the surface, anesthetic agent for the eye, not only numbing it, but reducing bleeding as well.
In 1885, Merck produced 83,343 kg of cocaine, which frankly is a quiet night for some of my friends. Here are some patents taken out around this time: Cocaine toothache drops, "Instantaneous Cure!" Metcalf's Coca Wine "for fatigue of mind or body" and Voice "Tabloids" with cocaine, chlorate of potash and borax.
In 1887, the U.S. Surgeon General recommended that cocaine be used to treat depression, claiming that there was no such thing as cocaine addiction. This was when William Halsted, about whom you've already heard, started experimenting on himself.
Have you ever wondered why U.S. doctors start rounding their patients so damn early in the morning and work such crazy hours? It can be directly traced back to Halsted, whose manic nature and work ethic, driven in part by cocaine, combined with his huge impact on modern American medicine, has resulted in generations of residents starting their ward rounds of patients at 5 a.m. for no good reason.
Now, I literally wrote the book on recreational drugs and the heart, and believe me, cocaine is not advisable. It can cause heart attacks in even the most healthy young person for a number of quite interesting reasons, such as making the blood vessels spasm and kind of clamp shut, as well as making the blood itself more sticky.
Instead of doing cocaine, why not do what I do when I want an upper, watch some forbidden movies?
, is an interventional cardiologist, internal medicine doctor, and university researcher who makes science videos and bad jokes. Offbeat topics you won't find elsewhere, enriched with a government-mandated dose of humor. Trained in Cambridge; now PhD-ing in London.