Cocaine Use In The Medical Casebook

 

This Week

We are going to move from psychiatry into the related field of addiction. We’ll start with cocaine use, as that is the drug most associated with Sherlock Holmes.

 

Sherlock Holmes And The Adventure Of Masongill Hall

A story to accompany publication of The Medical Casebook Of Sherlock Holmes And Dr John Watson.

Sherlock Holmes has retired to his farm on the Sussex Downs, whilst Dr John Watson has become a GP in the Yorkshire Dales. Watson is struggling to deal with the first weeks of the COVID outbreak, yet Holmes discovers that an old enemy is about to carry out a terrible crime right under Watson’s nose. It is down to the heroic Watson to save the day.

Available from the Amazon Kindle Store.

 

The Illustrator

Our Cocaine Use chapter features another fine illustration from Alex Holt.

Alex Holt is an artist specialising in original ink illustrations. He has a special interest in Comic Art, single image illustrations and covers. Alex is a student of the Edinburgh Atelier of Fine Art. He works in private commissions and commercial projects. More of his work can be found in Instagram @alexholtart.

 

Cocaine Use

Cocaine Use + Sherlock

Sherlock Holmes is a habitual cocaine user. As we will see in our Victorian medical texts, cocaine use was not seen as a problem at this time. Rather it was seen as a drug that could be used to boost mental function. There are references to Holmes using cocaine in five of the stories.

There is a detailed description of intravenous cocaine use at the start of “The Sign Of Four”.

Sherlock Holmes took his bottle from the mantelpiece, and his hypodermic syringe from its neat Morocco case, With his long, white, nervous fingers he adjusted the delicate needle and rolled back his shirtcuff. For some little time his eyes rested thoughtfully upon the sinewy forearm and wrist, all dotted and scarred with innumerable puncture-marks. Finally, he thrust the sharp point home, pressed down the tiny piston, and sank back into the velvet-lined armchair with a long sigh of satisfaction.

“Which is it to-day,” I asked, “morphine or cocaine?”

“It is cocaine,” he said, “a seven-per-cent solution. Would you care to try it?”

 

Sherlock using cocaine:-

“Sherlock Holmes injecting himself with cocaine.”

© Alex Holt

 

Later, we appear to get recognition from Holmes that his cocaine use can be a problem, which he needs distracting from [our excerpt also contains one of Holmes’ much-quoted logical statements].

“Why, of course I knew that you had not written a letter, since I sat opposite to you all morning. I see also in your open desk that you have a sheet of stamps and a thick bundle of postcards. What could you go into the post-office for, then, but to send a wire? Eliminate all other factors, and the one which remains must be the truth.”

“In this case it certainly is so,” I replied after a little thought. “The thing, however, is, as you say, of the simplest. Would you think me impertinent if I were to put your theories to a more severe test?”

“On the contrary,” he answered, “it would prevent me from taking a second dose of cocaine. I should be delighted to look into any problem you might submit to me.”

We then get another cocaine reference after another excellent piece of Sherlock logical deduction involving a scratched pocket watch [we had the actual deduction in our Alcoholism chapter].

“It is as clear as daylight,” I answered. “I regret the injustice which I did you. I should have had more faith in your marvellous faculty. May I ask whether you have any professional inquiry on foot at present?”

“None. Hence the cocaine. I cannot live without brainwork. What else is there to live for?”

“The Sign Of Four” then concludes with another cocaine reference.

“The division seems rather unfair.” I remarked. “You have done all the work in this business. I get a wife out of it, Jones gets the credit, pray what remains for you?”

“For me,” said Sherlock Holmes, “There still remains the cocaine-bottle.” And he stretched his long white hand up for it.”

We next head to “A Scandal In Bohemia”, the first short story [and the next work chronologically]. Unusually for the early stories, this is our only medical reference in the famous tale of Holmes’ encounter with “the woman”, Irene Adler.

I had seen little of Holmes lately. My marriage had drifted us away from each other. My own complete happiness, and the home-centred interests which rise up around the man who first finds himself master of his own establishment, were sufficient to absorb all my attention, while Holmes, who loathed every form of society with his whole Bohemian soul, remained in our lodgings in Baker Street, buried among his old books, and alternating from week to week between cocaine and ambition, the drowsiness of the drug, and the fierce energy of his own keen nature. He was still, as ever, deeply attracted by the study of crime, and occupied his immense faculties and extraordinary powers of observation in following out those clues, and clearing up those mysteries which had been abandoned as hopeless by the official police.

In “The Five Orange Pips” there is a splendid description of Sherlock’s attributes.

“If I remember rightly, you on one occasion, in the early days of our friendship, defined my limits in a very precise fashion.”

“Yes,” I answered, laughing. “It was a singular document. Philosophy, astronomy, and politics were marked as zero, I remember. Botany variable, geology profound as regards the mud-stains from any region within fifty miles of town, chemistry eccentric, anatomy unsystematic, sensational literature and crime records unique, violin-player, boxer, swordsman, lawyer, and self-poisoner by cocaine and tobacco. Those, I think, were the main points of my analysis.”

In “The Man With The Twisted Lip”, Watson finds Holmes in an opium den, where he is working undercover to find a missing businessman, Neville St Clair [we looked at this story in more detail in our Opium Use chapter].

“I suppose, Watson,” said he, “that you imagine that I have added opium-smoking to cocaine injections, and all the other little weaknesses on which you have favoured me with your medical views.”

And finally in “The Yellow Face”.

Sherlock Holmes was a man who seldom took exercise for exercise’s sake. Few men were capable of greater muscular effort, and he was undoubtedly one of the finest boxers of his weight that I have ever seen; but he looked upon aimless bodily exertion as a waste of energy, and he seldom bestirred himself save where there was some professional object to be served. Then he was absolutely untiring and indefatigable. That he should have kept himself in training under such circumstances is remarkable, but his diet was usually of the sparest, and his habits were simple to the verge of austerity. Save for the occasional use of cocaine, he had no vices, and he only turned to the drug as a protest against the monotony of existence when cases were scanty and the papers uninteresting. 

What I find interesting is that Watson clearly disapproves of Holmes’s cocaine use. This would appear to have been a very enlightened view at the time – I can’t find any reference to cocaine use being something doctors should advise against in the medical books of the time. One suspects Watson is reflecting Conan Doyle’s personal views. This is again from “The Sign Of Four”.

“But consider!” I said earnestly. “Count the cost! Your brain may, as you say, be roused and excited, but it is a pathological and morbid process which involves increased tissue-change and may at last leave a permanent weakness. You know, too, what a black reaction comes upon you. Surely the game is hardly worth the candle. Why should you, for a mere passing pleasure, risk the loss of those great powers with which you have been endowed? 

Conan Doyle appears to eventually decide that he shouldn’t portray Holmes as a drug user. Our cocaine references are from the stories published between 1890 and 1893, with no subsequent portrayal of Holmes as an addict.

 

Cocaine Use In Victorian Times

The only references to cocaine in the Victorian medical texts are for the drug being used as a treatment. The following extracts are all taken from a fascinating book written in 1886, by a London pharmacist, William Martindale.

The earliest extant accounts of Coca are contained in the writings of the historians who treat of the Spanish conquests in South America in the sixteenth century, and of Spanish travellers and Jesuit missionaries who followed in their wake.

The employment of Coca as a masticatory goes back to the time of the first Incas, being used in their religious rites as an offering to the sun; the sacrificing priest never consulted the oracles without holding some Coca leaves in his mouth, and throwing some into the fire which consumed the victims. It was reserved for this use and that of the monarch, and those who for services rendered had become worthy of partaking of it with their sovereign. [50]

The Hon Richard Gibb, US minister to Bolivia, for some years resident at La Paz, gives a similar account to Weddell of the cultivation of Coca at the present day. He says the consumers of Coca, both in Peru and in Bolivia, are the native races; the whites seldom use it, except as in infusion, and then the first water is thrown away as being too strong. The habitual consumers of it, he says, know nothing of toothache, and have their teeth in a good condition to a great age. The Peruvian Government is said to record and tax a production of over 15,000,000 lb, and the Bolivian Government 7,000,000 lb annually; of the latter about 55 per cent is consumed in Bolivia; the Argentine Republic and Chili about 15 per cent each; Peru, 10 per cent; while about 5 per cent is exported to Europe and the United States.

Of late the importations of Coca into London, Liverpool, Havre, and Hamburg have overstocked the European market. Some of it comes in tin-lined cases containing two tambores, but most of the large leaves [Bolivian variety] still arrive in rough canvas bales, generally lined with waterproof tarpaulin, and weighing from 120 to 150 lb each, two of which it is said to form a load for a mule for transportation through mountain passes or across the Andes for exportation. [50]

Whether, in Europe, it will ever share the field of favour with tea, coffee, and cocoa, and become a common beverage, is doubtful. It certainly is worthy of the attention of students who have a tendency to become drowsy. An infusion, 1 in 50 of distilled water, has a bitterish grass-like taste – much the same flavour as the selected tea supplied at the Chinese kiosk during the Fisheries Exhibition, 1884. It may be taken after meals as a refresher; it is not unpalatable; if sweetened, with milk or a slice of lemon added or infused with tea it may be taken as an ordinary cup of tea. The writer finds that the dose, taken hot, produces a slight diaphoretic action, quickened circulation, slight fulness in the head, buoyancy of spirits, and wakefulness; on one occasion, taken late, this was succeeded by rather restless sleep. There is no good reason why it should not be tried among ourselves. [50]

Coca has been praised as a nervine and muscular tonic, preventing waste of tissue, appeasing hunger and thirst, relieving fatigue, aiding free respiration, and as being useful in various diseases of the digestive and respiratory organs. It is said to be specially useful in many forms of asthma, chronic bronchitis, obstinate cough, phthisis and general debility. It is recommended for indigestion, gastralgia, gastrodynia, nausea, sickness, distaste for food, is given to relieve pain, nausea, vomiting or discomfort caused by excess in either eating or drinking or by pregnancy, and as a cure for morphine and alcohol craving. In using it for this in America it is said in some cases to have produced “Coca Craving.”

Coca is also said to cause mental exhilaration, and to overcome diffidence or bashfulness in company, and to be an excitant of the vital functions. It has been used in melancholia, in cases of inordinate hunger or thirst, such as occur in some forms of diabetes, and in cases of generative debility. [50]

The curious property cocaine possesses of producing local anaesthesia was even noted by the discoverer of the alkaloid – Niemann, who, so far back as 1860 wrote: “It produces temporary insensibility on the part of the tongue with which it comes in contact.”

Besides rendering the superficial structures of the eye anaesthetic, it is a mydriatic and paralyses the accommodation, which passes off sooner than the dilatation of the pupil.

Solutions of hydrochlorate of cocaine have been employed topically in excision of the tonsils, cauterizing the turbinated tissue of the nose, painting chancres previous to the application of nitric acid or other caustics, opening abscesses, removing polypi, and many cases of iridectomy and operation for cataract, squint, and removal of foreign body from the eye.

In obstetrics, its local application relieves the pain of the dilating os uteri, and diminishes the sensibility of the perineum in first labours. The spasmodic and painful affections of the vagina, causing dyspareunia and vaginismus, may be minimised, by vaginal injections of a quarter of a grain of cocaine in 1 per cent. oily solutions. [50]

As regards the toxic properties of cocaine, its effects appear to be mild and not cumulative. It causes cessation of respiration – small doses have an exhilarating effect on the nerve-centres and other parts of the nervous system. In a case of attempted suicide by an apothecary, a dose of 1.5 grammes [23 grains] seemed to have no seriously injurious effect.

Inasmuch as the writer – whose nervous system is of an almost unfortunate degree of sensitiveness – has taken dose of the hydrochlorate, equivalent, in the aggregate, to no less than 32 grains of cocaine itself within the space of three hours, without [as the present lines sufficiently prove] a fatal result following, this remarkable body cannot fairly be classed among the poisonous alkaloids. [50] 

So it would appear that cocaine was very much the wonder drug of the time [our pharmacist writer is clearly a huge fan], being used for all sorts of medical applications. There is just the one reference, rather brushed over, to addiction: “Coca craving”.

Conan Doyle would very likely have had experience of using the drug medically, as it was commonly used as a local anaesthetic for eye procedures [as we met in the cataract chapter]. 

In a splendid coincidence, in the same year as this book was written, 1886, an American pharmacist, John Stith Pemberton, invented a new “temperance drink”, made from coca leaves and kola nuts, and marketed as … “Coca-cola”.

It was not unusual at the time for doctors and pharmacists to perform drug experimentation on themselves. Indeed, Arthur Conan Doyle’s first published writing was a letter to the BMJ in 1879 [51], whilst he was a third year medical student. It details his experimentation with taking increasing amounts of tincture of gelsemium [an extract of jasmine root, used at the time to treat neuralgia].

Cocaine use was very popular around the turn of the century, strong advocates of its use including Sigmund Freud, Thomas Edison, and Sarah Bernhardt. Yet by 1912, the US government was reporting 5000 deaths related to cocaine use in the preceding year, and in 1922, the use of the drug was officially banned in the US. Thus Holmes’s abandonment of cocaine use may just have represented medical and societal views of the time.

 

Next Week 

We shall move from cocaine use to alcoholism – an area where Sir Arthur Conan Doyle had family knowledge of the impact of the condition.

 

Buying The Book

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