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

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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!