Good evening and welcome back to the Old England Journal of Medicine. It is off to the former
colonies today as recently I had the sterling fortune to while 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 3 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 utilise, in your practice, cocaine as an effective
and safe local anaesthetic but you might not be aware that it also has some, ahem, 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 anaesthetic 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 sensitive the heart of a woman, wished to examine cocaine’s
properties not only as a local anaesthetic, but a regional block, allowing major surgeries
to be performed by cocainising the spinal cord itself. He begins by detailing how to
inject in to the correct cerebrospinal space, a procedure that causes a beastly headache
due to leakage of the fluid contained therein, and then lists his initial subjects:
1. A 34-year old labourer who was hopelessly riddled with tuberculosis. He had suffered
many complications from earlier general anaesthetics 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 two days. 2. A seventeen year-old baker suffered from
osteomyelitis of the tibia. He witters on a bit about protocol as Germans are wont to
do, waffle waffle Fritz ah yes 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 fourteen-year old boy suffered from the
tuberculous ankylosis of the left knee joint...
...there were no other problems. The boy complained unceasingly and was too backward and uncooperative for any
tests of sensation.
These 6 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 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 per cent 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 me 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 will report my findings in great detail.
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 the 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 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 very 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, upon which I thoroughly enjoyed an 8 day hunting trip.
Dr. Hildebrand, 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 amount of cocaine solution (0.005
g) injected into the subarachnoid space suffices to render almost two thirds of the body
insensible enough for the painless performance of the most major operations. In the legs
the insensibility sets in within 5 - 8 minutes. Presumably this is due the action of cocaine
HAHAHA! 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 keine 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 hahaha. German medicine is like German
automobiles, unlikely to last. British manufacturing, that will last forever. Oh Germans 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 used to contain cocaine,
leading to their first corporate slogan, you can’t beat the real thing you just can’t
beat it man it’s f*cking great it’s awesome have you heard about Coca Cola it’s better
than Pepsi yeah Pepsi can suck a f*cking d*ck because coke is so great yeah boi I f*cking love coke!
But you might not know that Cocaine was indeed commonly used in medicine around the turn
of the 20th century. German pharmaceutical company Merck, who are a major player today,
started by producing small amounts around 1860. Through the 1870s total ANNUAL production
was only 50g of cocaine, which 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 to [checks notes] morphine addiction A young doctor called Sigmund Freud wrote
a glowing 70 page document called Uber Cocaine, extolling its virtues. And it was Freud’s
friend Dr Koller who realised its use as a topical, meaning on the surface, anaesthetic for the eye - not only
numbing it but reducing bleeding. In 1885 Merck produced 83,343kg of cocaine. Which
is a quiet night for some of my friends.
Here are some patents taken out at 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 US Surgeon
General recommended that cocaine be used to treat depression, claiming that there was
no such thing as cocaine addiction. And this was when William Halsted started experimenting
on himself. Have you ever wondered why US doctors start rounding patients so damn early
in the morning and work such insane hours? It can be directly traced back to Halsted,
whose manic nature and work ethic, driven by cocaine, combined with his huge impact
on American medicine, has resulted in generations of residents starting their ward rounds of
patients at 5am for no good reason. 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 interesting reasons, such as making
the blood vessels spasm and close, as well as making the blood more sticky. So instead
of doing cocaine, why not do what I do when I want an upper, watch some forbidden movies.
You’re probably bored with content creators swearing they love
whatever is sponsoring their video.
Right, where was I? Ah yes, content creators being a bit disingenuous when they pretend to love whatever's sponsoring their video
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I use public wifi networks a lot, and I like
the extra layer of security. Like here in the hospital where it's unencrypted
but I found it had gone from UK Netflix, however I knew it was on Canadian Netflix, so by changing
my online location to the home country of syrup-guzzling Dr William Osler and I could
watch it while eating poutine and punching a hockey player
What’s more I recently
learnt you can sign up for Peacock via the USA on ExpressVPN and watch Premier League
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Well, I’m off to inject potentially lethal drugs into my subordinate’s spine, I trust
you are spending your day in a similar way. Till next time. HILDEBRANDT!