Overcoming bashfulness: how cocaine aided Freud to summon the courage to meet Charcot.

Jean-Martin Charcot, the most celebrated neurologist of the 19th century, had a profound influence on Sigmund Freud's career. Freud spent the winter of 1885-1886 working in Charcot's neurology department in Paris. During this period, he went to Charcot's house on several occasions to participate in the very famous Tuesday soirées under the guidance of Gilles de la Tourette. Freud was always very proud to be invited and curious to meet the Parisian intellectual elite. On these occasions, however, he was very apprehensive and made frequent use of cocaine. Due to anxiety and the need to appear creative in front of Charcot, it is possible that Freud used cocaine at other times.

Overcoming bashfulness: how cocaine aided Freud to summon the courage to meet Charcot / Superando a timidez: como a cocaína ajudou Freud reunir coragem para se encontrar com Charcot

ABSTRACT Jean-Martin Charcot, the most celebrated neurologist of the 19th century, had a profound influence on Sigmund Freud's career. Freud spent the winter of 1885-1886 working in Charcot's neurology department in Paris. During this period, he went to Charcot's house on several occasions to participate in the very famous Tuesday soirées under the guidance of Gilles de la Tourette. Freud was always very proud to be invited and curious to meet the Parisian intellectual elite. On these occasions, however, he was very apprehensive and made frequent use of cocaine. Due to anxiety and the need to appear creative in front of Charcot, it is possible that Freud used cocaine at other times.

RESUMO Jean-Martin Charcot, o neurologista mais célebre do século XIX, teve uma influência profunda na carreira de Sigmund Freud. Freud visitou o Departamento de Neurologia do Hospital Salpêtrière, em Paris, chefiado pelo professor Charcot, durante o inverno de 1885-1886. Durante este período, ele foi várias vezes à casa de Charcot para participar dos famosos saraus de terça-feira, sob a orientação de GiUes de la Tourette. Nessas ocasiões, Freud ficava sempre muito orgulhoso pelo convite, curioso por encontrar a elite intelectual Parisiense, mas também muito apreensivo, e fazia uso frequente de cocaína. Devido à ansiedade e à necessidade de aparentar-se produtivo diante de Charcot, é possível que Freud tenha usado cocaína outras vezes.

["Epidemic" or Peripheral Phenomenon? : A Medical History of the "Cocaine Wave" in the Weimar Republic]. / "Volksseuche" oder Randerscheinung? : Die "Kokainwelle" in der Weimarer Republik aus medizinhistorischer Sicht.

An empirical investigation refutes the popular conception that excessive drug usage was a widespread social phenomenon in the Weimar Republic. Although physicians warned the public and politicians of a "cocaine wave" that threatened the public health, there is no evidence that indicates a significant increase of cocaine use during the twenties. The decisive cause for this moral panic was caused instead by the disease pattern of "Cocainism". The addiction carried the imprint of an infectious disease and would destroy the body, the will, and the civic life of its victims. According to medical doctrine, chronic cocaine consumption also produced the tendency towards deviant sexual activities and criminal activity. For this reason, the use of this substance was in particular linked to deviant social milieus like the so-called Bohemian or demimonde. However, historical sources in fact show that it was primarily a problem of the medical professions. Against the background of the desperate political, social and economic situation in Germany after the First World War, physicians regarded cocaine and morphine addictions as a threat to the hoped for political and biological renewal of the nation.

Seguimiento de dependientes del alcohol y/o de la cocaína después de su salida de una Comunidad Terapéutica: estudio piloto / Follow-up of alcohol and/or cocaine dependents after their discharge from a Therapeutic Community: a pilot study

En España, las Comunidades Terapéuticas (CT) constituyen un modelo de tratamiento común en las adicciones, aunque apenas existe investigación acerca de su eficacia y la persistencia de sus logros. Objetivos: Evaluarlos efectos a corto, medio y largo plazo del tratamiento de la adicción al alcohol o cocaína en las CT de la “Fundación Salud y Comunidad”. Diseño: Estudio piloto descriptivo, con un diseño secuencial de cohorte. Se aplicó una encuesta diseñada ad hoc a 91 usuarios para conocer su evolución en los diferentes periodos de seguimiento (1, 3, 5 ó 10 años después de su salida de la CT): variables sociodemográficas, de uso de la/s sustancia/s psicoactiva/s y relacionadas con la estancia en la CT. Se describe el cambio entre antes de la CT y en la actualidad respecto a variables académicas, laborales, de consumo de droga/s, salud, adaptación socio-familiar y comportamiento delictivo. Resultados: las cohortes mostraron un patrón previo relativamente común, recibiendo un tratamiento similar. Los usuarios afirman haber disminuido el hábito de consumo frecuente de la droga principal, encontrando un 48.9% que no ha recaído ni siquiera mediante un consumo ocasional de la/s droga/s. También perciben haber mejorado su salud y sus relaciones familiares, así como el comportamiento agresivo y problemas legales derivados del consumo de droga/s. Conclusiones: tras su rehabilitación en una CT, los usuarios manifiestan una disminución global del consumo de drogas y perciben una mejora a nivel de salud, familia, violencia y problemáticas derivadas del consumo (AU)

In Spain, the Therapeutic Community (TC) constitutes a common model of treatment in the field of addictions, although there hardly exists any investigation about its efficiency and the persistence of its attainments. Aims: To evaluate the short, half and long term effects of treatment of addiction to alcohol or cocaine in the TC run by “Fundación Salud y Comunidad” (Foundation Health and Community). Design: descriptive pilot study, with a sequential design of cohort. 91 users completed a survey specifically designed to know their evolution at different follow-up periods (1, 3, 5 or 10 years after their exit from the TC): socio-demographic, psychoactive substance use, other variables related to the stay at the TC. Changes between before the TC and the present time regarding variables such as academic, labour, drug consumption, health, family and social adaptation and their criminal behaviour are described. Results: the cohorts showed a relatively common previous socio-demographic pattern having received a similar treatment. The users reported to have diminished the frequent consumption of the main drug, having 48.9% never relapsed even through an occasional consumption of the drug/s. Also they perceived to have improved their health and family relations, as well as their aggressive behaviour and legal problems linked with their consumption of drug/s. Conclusions: after their rehabilitation in a TC, the users report a global decrease of the consumption of drugs and perceive an improvement of their health, family relations, violence and other problems linked to their former drug use (AU)

[Cocaine: historical background, neurobiology of the addiction and relapse and therapeutic perspectives]. / Cocaína: história, acções neurobiológicas do vício e recaída e perspectivas terapêuticas.

OBJECTIVE: Following more than a century of cocaine hydrochloride extraction from Erythroxylon coca, this drug remains representing a serious social and public health problema around the world. This paper intends to provide a review about the cocaine theme, focusing on historical background and on its different neurotransmission systems, as well as addresses therapeutics aspects about drug addiction. METHOD: Electronic search in databases Medline, Pubmed and Lilacs was accomplished in order to select classics and recent studies relevant to the discussion of issue addressed. DISCUSSION: Previous studies have shown high vulnerability to relapse to cocaine seeking following prolonged withdrawal periods. Such behavioral consequences have been cre-dited to induced changes in brain neurotransmitters provoked by repeated cocaine use. In recent years, the growing abuse of this drug has mobilized researchers worldwide in seeking for new therapies that reduce the behavioral and neurochemical changes resulting from addiction. CONCLUSION: Numerous advances regarding the treatment of cocaine abuse and dependence have emerged in recent years. However, researche aiming at a safe and effective users' pharmacological treatment remain necessary and should be continued.

Cocaine: history, social implications, and toxicity: a review.

The amount of positive cocaine results in an urban emergency department are staggering. The ages of use are becoming more common in older age groups. Most of these patients have underlying medical conditions, including end-stage renal disease (on hemodialysis) and heart and lung disease. Most of their visits to the emergency department are for cocaine exacerbation of underlying chronic condition, adding exponentially to health care dollars. This article describes the history and pharmacology of illicit cocaine use.

["Fabulous things". Drug narratives about coca and cocaine in the 19th century]. / "Fabelhafte Dinge": Arzneimittelnarrative zu Coca und Cocain im 19. Jahrhundert.

This contribution focuses on the history of Coca leaves and Cocaine in the second half of 19th century Europe. Even though, to date, no direct link has been established between the activities of the Milano physician Paolo Mantegazza, and the Göttingen chemist Friedrich Wöhler, it is not a mere coincidence that both published their findings in the same year, namely, 1859. Mantegazza authored the first treatise claiming that Coca had psychoactive qualities and touted its broad therapeutic faculties; he claimed that it should be introduced into European pharmacotherapy. In Wöhler's laboratory, cocaine was isolated from leaves by his pupil Alfred Niemann; later, Wilhelm Lossen refined and corrected Niemann's results. Narratives about medicinal drugs often streamline history into a story that starts with multiple meanings and impure matters and ends with well-defined substances, directed at clear-cut diseases and symptoms. In the case of Coca, however, the pure substance triggered no such process well into the 1880s, whereas the leaves continued to circulate as an exotic, pluripotent drug whose effects where miraculous and yet difficult to establish.

William S. Halsted and Harvey W. Cushing: reflections on their complex association.

William Stewart Halsted, the father of modern surgery, and Harvey Williams Cushing, the father of neurosurgery, are remembered for their countless innovations and contributions to the discipline of surgery. Between 1896 and 1912, they worked together at Johns Hopkins Hospital making many of their respective achievements possible. In the later years, their complex relationship, somewhat strained during Cushing's residency, grew into a mutual respect and deep appreciation for one another. In this offering, the authors attempt to elucidate the evolution of this complex relationship.

Historical review: Molecular and cellular mechanisms of opiate and cocaine addiction.

The National Institute on Drug Abuse was founded in 1974, and since that time there have been significant advances in understanding the processes by which drugs of abuse cause addiction. The initial protein targets for almost all drugs of abuse are now known. Animal models that replicate key features of addiction are available, and these models have made it possible to characterize the brain regions that are important for addiction and other drug effects, such as physical dependence. A large number of drug-induced changes at the molecular and cellular levels have been identified in these brain areas and rapid progress is being made in relating individual changes to specific behavioral abnormalities in animal models of addiction. The current challenges are to translate this increasingly impressive knowledge of the basic neurobiology of addiction to human addicts, and to identify the specific genes that make some individuals either particularly vulnerable or resistant to addiction. In this article, I present a historical review of basic research on opiate and cocaine addiction.

William Stewart Halsted--surgeon extraordinaire: a story of 'drugs, gloves and romance'.

As a surgeon William S Halsted's most notable contributions were in the development of a technique for radical mastectomy, the repair of inguinal herniae and the advancement of bowel anastomoses. However, he will perhaps be best remembered for his introduction of the use of the surgical glove and his reasons were probably the least scientific of all those given. Developed by the Goodyear Rubber Company, the gaunts were made to protect the hands of his scrub nurse, Caroline Hampton, the future Mrs William S Halsted. Another of Halsted's contributions was the development of topical anaesthesia using cocaine. A consequence of these experiments was the development of addiction to the drug and his later dependence on morphia. The last century has seen a 360 degrees turn in the reasons why we use gloves. Originally designed to protect the theatre staff from corrosive substances, subsequently to protect the patient from contamination by theatre staff, to today where gloves are worn to protect staff from blood-borne infection agents. This article introduces William S Halsted, and his story of romance, drugs and the introduction of gloves to medical care.