Providentia

The Addicted Surgeon

For 19th century medicine, there were few new drugs that were welcomed more enthusiastically than cocaine.   Though coca leaves had long been recognized for their analgesic properties, it was not until 1860  when Albert Niemann published his doctoral dissertation describing the purification process for extracting the colourless alkaloid that he christened "cocaine."   Almost from the beginning, the prospect of a safe and non-addictive alternative to opium-based medications such as morphine seemed too good to be true.  

And so it turned out eventually.

In the meantime however, eminent medical doctors and neurologists across Europe and North America began experimenting with cocaine, both on themselves and on patients seeking to be cured of their morphine addictions.   It also seemed like the ideal anesthetic with doctors and dentists using the drug on their patients for various medical and tooth extraction procedures.    Sigmund Freud was an early cocaine advocate who recommended its use in treating various addictions. 

Though cases of cocaine intoxication were reported as early as 1885, physicians were still skeptical about the idea of cocaine being as addictive as morphine.   And they were right, since it eventually proved to be even more addictive.  Not only was it useless in helping morphine addicts cure their addiction, but they often developed a joint cocaine-morphine habit.    Episodes of cocaine psychosis began being reported and an 1886 editorial in the New York Medical Journal would comment that "no medical technique with such a short history has claimed so many victims as cocaine."   Friedrich Albrecht Erlenmeyer, a German physician who became best known for his in-depth description  of the symptoms of cocaine intoxication, denounced cocaine as "the third scourge of mankind" after alcohol and morphine in his 1887 monograph, "Cocaine in the Treatment of Opiate Addiction."   

By 1890, more than 400 cases of cocaine addiction were reported in the medical literature, and physicians gradually realized they had unleashed a new social problem on society.   Even Freud turned against cocaine and openly regretted his early support which had led to many of his patients becoming addicted.   Lack of reliable statistics makes it hard to chart the actual rise of the cocaine epidemic since cocaine addicts rarely used that drug alone but tended to combine it with other addictions, including alcohol.     Despite the medical warnings, it would take time for drug laws to catch up and many commercial products containing cocaine or coca leaves were widely available and often legal.  Even the popular soft drink Coca Cola had coca leaves as one of its ingredients (it was removed in 1903 in favour of caffeine).   

Ironically, while physicians were the first to document the dangerous addictive properties of cocaine, they were also in danger of becoming addicts themselves.   By 1901, an estimated 30 percent of cocaine addicts in the United States alone were physicians or dentists.   Since they had easy access to cocaine,  which was widely used as an anesthetic and even more popular than morphine, addiction became an occupational hazard.   

Which brings us to William Stewart Halsted....

One of the most eminent surgeons in the United States and a champion of anesthetic medicine, Halsted was a founding professor of the John Hopkins Hospital when it first opened in 1889.  Along with his work with anesthesia, he conducted one of the first gall bladder operations in the United States (on his own mother, no less) as well as the first radical mastectomy.   After reading an 1884 research paper in a European medical journal describing how cocaine could be used as a safe alternative to morphine in anesthesia, Halsted decided to conduct his own experiments.  Along with his medical students and several fellow physicians, he injected cocaine into himself and others and developed the first practical nerve block method to eliminate pain during surgery.   Unfortunately,  Halsted had no idea that cocaine was dangerously addictive.    As his student, Wilder Penfield, would later describe, "cocaine hunger fastened its dreadful hold on him" which was then followed by a "confused and unworthy period of medical practice."    To save his career and to avoid becoming a danger to his patients, William Halsted was sent to the Butler Sanatorium in Providence, Rhode Island.

Though he stayed at the sanatorium for a year,  his doctors had no real experience dealing with cocaine addiction (actual cases were still rare at the time).   In what seems like a bizarre strategy today, Halsted's doctors decided to cure his cocaine addiction by having him become addicted to morphine instead.   All that accomplished was to give their patient two addictions rather than just one.    After leaving the sanatorium and taking a cruise to recover, Halsted returned to his medical practice though, as observer pointed out, "the brilliant and gay extravert seemed brilliant and gay no longer."   There would be more hospitalizations and he eventually stopped using cocaine but his addiction problems were hardly over.  

According to a manuscript written by his colleague, William Osler, which only became public in 1969, Halsted continued to take three grains  (200 mg) of morphine a day secretly.   While this was eventually reduced to one and a half grains, William Halsted would "struggle against the dreadful discomfort of drug hunger" for the rest of his life.  In a letter that he wrote to Osler in 1918, Halsted would comment that three of his assistants also became addicted to cocaine and eventually died without ever overcoming their dependence.    He lated admitted that some of the New York Medical Journal articles he published between 1884 and 1885 on cocaine anesthesia were largely written while he was under the influence of cocaine.   Referring to them as "not creditable", he acknowledged that he was "not in good form" when he wrote them. 

Certainly his writing style when he was under the influence of cocaine was very different than his usual standard.   The first sentence of one of these papers seems to reflect the "cocaine influence" on grammar and syntax:

Neither indifferent as to which of how many possibilities may best explain, nor yet at a loss to comprehend, why surgeons have, and that so many, quite without discredit, could have exhibited scarcely any interest in what, as a local anaesthetic, had been supposed, if not declared, by most so very sure to prove, especially to them, attractive, still I do not think that this circumstance, or some sense of obligation to rescue fragmentary reputation for surgeons rather than the belief that an opportunity existed for assisting others to an appreciable extent, induced me, several months ago, to write on the subject in hand the greater part of a somewhat comprehensive paper, which poor health disinclined me to complete.

Despite the blow to his reputation stemming from his drug abuse, Halsted managed to recover enough to function as a surgeon.   While still suffering from physical dependence on morphine,  he was able to conceal the signs of his addiction from his colleagues and patients.  As one of the founders of John Hopkins Hospital and a major pioneer in surgical education, he was widely praised for his expertise by the time of his death in 1922 from pneumonia.    Obituaries described his medical achievements at length though his addictions remained a well-guarded secret in the John Hopkins medical community. 

While warnings about cocaine addiction spread rapidly, so did its popularity.  Though very much an "upper-class" drug at first, cocaine became more widely available as people discovered the various ways it could be ingested, whether mixed in alcohol or snorted in powder form.    Enterprising salesmen even sold it door-to-door in some places and many pharmacists dispensed cocaine over the counter to anyone wanting a stimulant to work long hours.    Though laws surrounding cocaine became more rigid, at least to the point of requiring a prescription, finding a willing source was rarely that hard.   

As cocaine became more of a social problem, police and legislators began cracking down in earnest.  Pharmacists refused to carry it and police chiefs began publicly linking cocaine to crime.   Not surprisingly, given the time period, there was also a definite racial tinge to the health warnings as newspapers and social reformers talked about "negro cocainists" who were readily influenced by the drug along with other "lower classes."    The spread of cocaine use among African-Americans is probably not that remarkable since many employers freely offered it to workers as a stimulant to make them work longer hours.   Fears of drug use among African Americans led to at least one race riot in 1906,  Still,  Federal legislation restricting cocaine manufacture in the United States was only passed in 1914 (a full ban would not take place until 1922).  Though similar bans existed on heroin and other opium-based medications, morphine would still be available to medical doctors, even if heavily restricted.

Actual statistics relating to physicians and dentists addicted to drug such as cocaine and morphine during those early years of prohibition are hard to find considering the stigma surrounding drug use.   While William Halsted is the most well-known early case of cocaine and morphine addiction in a medical doctor, he was hardly the only one.  His life story and the struggle he went through to cope with his addiction still resonates today given the ongoing problem faced by physicans addicted to prescription medications.   Not to mention the stigma that often prevents them from getting help before it's too late.     For many medical doctors and dentists coping with addiction, the world hasn't really changed that much since William Steward Halsted's day.

 

 

 

 

Children, Trauma, and Natural Disasters

More than 500 million people worldwide live within exposure range of an active volcano and children are a vulnerable subgroup of such exposed populations. However, studies on the effects of volcanic eruptions on children’s health beyond the first year are sparse. A study recently published in the European Journal of Psychotraumatology examines the effect of the 2010 Eyjafjallajökull eruption on physical and mental health symptoms among exposed children in 2010 and 2013 and to identify potential predictive factors for symptoms.  In a population-based prospective cohort study, data was collected on the adult population (N = 1615) exposed to the 2010 Eyjafjallajökull eruption and a non-exposed group (N = 697). The exposed group was further divided according to exposure level. All participants answered questionnaires assessing their children´s and their own perceived health status in 2010 and 2013. Results showed that, in 2010, exposed children were more likely than non-exposed children to experience respiratory symptoms (medium exposed OR 1.47; 95% CI 1.07–2.03; high exposed OR 1.52; 95% CI 1.03–2.24) and anxiety/worries (medium exposed OR 2.39; 95% CI 1.67–3.45; high exposed OR 2.77; 95% CI 1.81–4.27). Both genders had an increased risk of symptoms of anxiety/worries but only exposed boys were at increased risk of experiencing headaches and sleep disturbances compared to non-exposed boys. Within the exposed group, children whose homes were damaged were at increased risk of experiencing anxiety/worries (OR 1.62; 95% CI 1.13–2.32) and depressed mood (OR 1.55; 95% CI 1.07–2.24) than children whose homes were not damaged. Among exposed children, no significant decrease of symptoms was detected between 2010 and 2013. Researchers conclude that adverse physical and mental health problems experienced by the children exposed to the eruption seem to persist for up to a three-year period post-disaster. These results underline the importance of appropriate follow-up for children after a natural disaster. (PsycINFO Database Record (c) 2018 APA, all rights reserved)

For the abstract

Schizophrenic Man Beaten to Death in Exorcism to Cure Him of "Evil Spirits"

Police in Azerbaijan have arrested six men for their role in the beating death of a schizophrenic man during an attempted exorcism.  The battered body of 25-year-0ld Murad Soltanov was found in an apartment in the Azeri town of Shabran, located not far for the nation's capital city, Baku.   The apartment had been rented for the purpose of the exorcism by  Shahin Soltanov, the father of the deceased and is there that the six men charged carried out the exorcism.    The deceased man had been recently diagnosed with schizophrenia accompanied by seizures.   Though he was receiving treatment, his condition had deteriorated and his father apparently decided that his illness was caused by demons that needed to be exorcised.  After a previous exorcism failed to cure his son,  Shahin Soltanov apparently decided on more extreme measures.  

Not telling anyone of his plans, the father then took his son from their home town of Mashtaga to nearby Shabran for the exorcism.   Among the men he consulted was Fizuli Garibov, an Islamic mullah who apparently "specialized" in exorcisms.  After paying Garibov ₼400 ($240) for the exorcism, Shariv Soltanov then brought the cleric and his helpers to the apartment.  He then watched as they beat his son with pomegranate branches to "drive out his inner demons.".   According to a statement provided to police following the interrogation, Soltanov began screaming and crying when the beating began but nobody came to his aid.  Later, when he began coughing up blood, the exorcists referred to it as a positive sign that the "demons were leaving his body."  Even after begging them to stop, the men insisted that "it was not him speaking;  it was the demon."

By the time police discovered Murad Soltanov's body, it was reportedly black and blue from the numerous bruises along with evidence of vomited blood.    Pictures of the deceased have been circulated online along with pictures of Soltanov when he was alive.   The six men have been charged with "inflict­ing fatal injuries and using forbidden treatment methods resulting in death."    When asked to comment, one of the men charged insisted that the method used was a common one.   “We have treated him this way before, but during the last session Soltanov suddenly died," he was quoted as saying.

While psychiatric treatment is becoming more widely available worldwide, the stigma surrounding most forms of mental illness often lead to families seeking more unconventional forms of treatment.   Since belief in demonic possession remains strong in many parts of the world, cases of mental patients being killed during attempted exorcisms continue to be reported.    

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Who Killed The Evangelist Family?

 Even for hardened police officers, it must have been a gruesome sight.

On July 2, 1929, police were called to the house on St. Aubin Street in Detroit, Michigan that real-estate entrepreneur and "divine prophet" Benny Evangelist shared with his wife and four children.    Evangelist's headless body had been discovered by one of his real-estate associates who had gone to the house to discuss a business deal.   But that was only the beginning of the horrors that waited to be discovered by officers arriving on the scene.

Though the body of the 44-year-old Evangelist was still sitting slumped in a chair, his head was lying nearby.  While he was fully dressed and obviously waiting for his business meeting, the bodies of his wife and four children all lay upstairs where they had apparently retired for bed already.   The body of 33-year-old Santina Evangelist was found lying in her bed, her head horribly mutilated and nearly severed from her body.   Lying in bed with her was 18-month-old Mario Evangelist whose head had been badly lacerated.   In an opposite bedroom, connected to their mother's room by a single door, police found the bodies of the three other children, seven-year-old Angeline, five-year-old Margaret, and four-year-old Jean.  All three girls had been killed by axe blows to the head and one of them had her arm nearly severed from her body.

Based on their investigation, police concluded that the robbery was not the motive for the murders given that nothing was stolen from the home.  Though the deaths bore a disturbing resemblance to another family killing that had taken place in a Detroit suburb two weeks earlier, there was no apparent connection between the Evangelist family and the previous victims.   Instead, investigators decided to focus on Benny Evangelist himself and his colourful history.   

Born in Naples, Italy in 1885, Beniamino Evangelista (as he was then known) had little formal education and, like many other young Italian men of his generation, emigrated to the United States in 1904.   While working as a carpenter and construction worker, the man who now called himself Benny Evangelist later claimed to have received a series of divine inspirations that led him to found his own cult which he called the "Union Federation of America."    Originally established in Philadelphia, Evangelist eventually moved to Detroit to take advantage of the better business opportunities there.

Cultivating a reputation as a psychic and a religious figure, Benny Evangelist also self-published a four-volume work titled "The Oldest History of the World: Discovered by Occult Science.”    Literally intended as a rewriting on the history of the world as described in Genesis, Evangelist's book described the early wanderings of a prophet named "Miel" who spread God's word with the aid of two disciples.  It was also filled with references to the author's own divine mission and began with a preface reading: 

"My story is from my own views and signs that I see from 12 am to 3 am.  I began on February 7, 1906 in Philadelphia, PA and it was completed on February 2, 1926 in the City of Detroit, County of Wayne, State of Michigan.   On the new earth, the last one was created by God, the Father Celestial and the great Prophet Miel.   We call it today the Great Union Federation of America.   I am with the power of God and I respect this nation. In this book, I shall express all my views of the past 20 years.  In this great continent, we are all the generations."

Beginning with a description of God's creation, Evangelist continued his great work through the creation of the world, eternity, light, the sun, the moon, and the creation of the ruler he called Eldom who, along with seven other "commanders" then united to rule the Earth.   The book proceeds through the various ages of Biblical history and continued up to the dawn of what he termed the Third World (at the birth of Christ).   Evangelist apparently had grandiose schemes of continuing his great work considering that this was only the first volume and that he intended to write three more.   

It was a bizarre work that did little else but serve as a "Bible" for Evangelist's cult.   As cults go, it didn't seem to have been that popular and Evangelist largely supported himself and his growing family by working as a carpenter and presiding over a respectable real estate business.  

Still, Benny Evangelist was much more than a real estate entrepreneur.   With business cards stating that he was as a "divine prophetil (sic), author, and private history writer", he had a prosperous side business giving "readings" and "spiritual healing" sessions to paying clients.  Certainly nobody was in any doubt where Benny's real interests lay (even his otherwise reticent neighbours described him as a "confirmed religious fanatic."   Certainly the police was agog at what they found in the Evangelist house during their investigation.  

Though the first two floors of the house seemed normal enough, their search of the basement turned up a special room that Evangelist had apparently used as a "religious sanctum."    The room itself was lined with light, green cloth which bulged out as if it were a padded cell.   There was also a window with a large sign visible from the street that read, "Great Celestial Planet Exhibition."   The "celestial planets" in question were the eight to ten grotesque wax figures that were hanging from wires over the elaborate altar at the centre of the room.   Among them was a huge eye, electrically wired to give off light, which apparently represented the sun.  

As for Benny Evangelist's office where his body was later found, the furnishings were a little more sedate, including a crucifix mounted on the wall behind his desk (along with a wooden cross and a picture of the Last Supper).   Police also found two swords ( testing determined that neither one had been used in the murders) as well as a wig and a beard which Evangelist apparently wore to impress his clients during his "readings".   As well, there were three large pictures of a child in a coffin found strewed on the office floor,  The child was later identified as Benny's son who had died some years earlier and the photographs had apparently been taken post-mortem. though nobody knew what this meant.  Aside from some bloody footprints and a single fingerprint, no other meaningful clues could be found.

While the house itself didn't provide any additional clues about who could have killed the family, investigators continued to turn up surprising new information on Benny Evangelist, himself.   Evangelist's physician, Dr. Alf E. Thomas  considered Evangelist to be completely insane and, interestingly enough, had apparently not been married to Santina all that long (all the children were reportedly hers from a previous marriage.)   The doctor also said that Evangelist had been planning to make a motion picture describing the history of the world as laid out in his Bible.    As for Evangelist's lawyer, Anthony Esperti, Evangelist had been involved in multiple lawsuits over his various real estate deals though nothing that seemed like a reason for mass murder.   

As for Evangelist's criminal history, he had no prior offences despite his bizarre ministry -  just one misdemeanor charge for improperly installed plumbing.  Even Evangelist's side business of selling "love potions", herbal remedies, and "spiritual invocations"  was considered perfectly legal by city officials (he had a permit to practice medicine so long as he "didn't use drugs or prescribe medication").   As for his neighbours, most of them were Sicilian immigrants who were reluctant to say anything to the police but, overall, they largely regarded Evangelist as harmless despite his tendency to engage in frequent religious demonstrations on the street.

Still, whatever people may have thought of Evangelist while he was alive, the gruesome murder of his family exerted a powerful fascination for the public.  Just about every police official of any importance came down to the crime scene and a squad of officers were needed to keep back the hundreds of spectators who had gathered to watch the bodies being sent to the morgue.   As for the funeral which was held for the family on July 4, over 3000 people showed up, mostly due to the notoriety of the murders.    Police carefully examined everyone present in the hope that the killer might have been present but nothing really came of it. 

In the months that followed, the actual investigation slowly ground to a halt as police failed to find any real clues to who might have been responsible.   Hundreds of people were questioned and numerous arrests were made, usually involving people known to have been living in the area at the time and who had a history of mental illness, but they were all eventually released.   Police even checked Evangelist's client list to see if he had any disgruntled customers Not surprisingly given the notoriety of the murders, several people tried confessing but police ruled them out as well.  Much like today, psychics continued to offer their "services" to the police and newspaper but nothing conclusive ever came of it.  Police even offered a $1000 reward for information leading to an arrest but there were no takers. 

One plausible suspect that police briefly investigated was an escaped mental patient named Aurelius Angelino.   Born in the same town as Benny Evangelist, Angelino reportedly immigrated to the United States at about the same time as Evangelist and they apparently knew each other quite well while living in York, Pennsylvania around the same time.   Also, by all accounts, both Angelino and Evangelist were both religious fanatics and may even have belonged to the same cult.   In 1919, Angelino was confined to a psychiatric asylum after killing his two children with an axe and, after escaping in 1923, was never seen again.   As part of their investigation, police found that Benny Evangelist's fingerprints matched the bloody fingerprints that had been found on the walls in Angelino's home near the bodies of his children.   

Had Evangelist framed Angelino for the murder of his children and had Angelino or a family member finally tracked him down for revenge?   Another theory that the police seemed to favour for a while was that Evangelist was Angelino and that he had successfully changed his identity until his past later caught up with him.  Despite their investigation, police could find nothing further to link the Evangelist murders to that earlier murder in York, Pennsylvania.   

Eventually, the Evangelist murders slowly faded into local legends and the house was finally demolished after being on the market for years (nobody seemed interested in buying a place where a family had already been murdered).   Even today, there are stories about the vacant lot where the house once stood, including claims of ghostly screams at night.   Those stories, along with the availability of Evangelist's book on the Internet, and the occasional newspaper story about the case seem to be the only remaining legacy of Detroit's most notorious unsolved murder.

 

 

 

Seeking the Belladonna Cure

For alcoholics and drug addicts at the beginning of the 20th century, Charles B. Towns must have seemed like a gift from Heaven.  That his famous cure seemed like utter quackery to legitimate medical experts of the time hardly seemed to matter to the countless patients who flocked to Towns' hospital.   At least, they did for a while...

Born on a small Georgia farm in 1862, Charles B. Towns had a wide range of careers ranging from farm hand to insurance salesman. In 1901, he moved to New York City where he became a partner in a brokerage firm (which failed). At some point, he launched himself into a new crusade to combat the twin problems of alcoholism and drug abuse. During this same period, temperance workers like Carry Nation were drumming up support for the anti-alcohol movement that would eventually lead to Prohibition. Drug and alcohol treatment centers sprang up around the United States and substance abuse experts, even ones without medical credentials, could establish themselves as dominant players in the growing field.  Town’s description of his early life is rather vague (likely deliberately).   As a result, it’s hard to say when he came into contact with the mystery benefactor who provided him with the recipe for what was later described as a "sure-fire cure" for alcoholism and drug abuse.  As Towns later described this fateful meeting, he was approached by the still-unnamed source who offered him the cure and announced that they could both "make a lot of money out of it."  Although his own physician said that the "cure" was just a quack remedy, Towns placed newspaper advertisements to recruit drug addicts to take part in his informal testing of the miracle cure. 

Using hotel rooms for his test subjects, Towns even went so far as to restrain the more-or-less willing guinea pigs to keep them from leaving while he worked the kinks out of his formula.  While he remained mum about actual failures, Towns eventually perfected his treatment approach to reduce the suffering involved.   After establishing that his treatment was nearly 100 per cent effective (largely based on the assumption that the unsuccessfully treated ones would return for more treatments), Towns was mystified by the cold reception that he received from the local medical community, most of whom regarded him as a quack.  That failed to stop Towns from establishing the Charles B. Towns Hospital in New York City in 1901.  Located at 293 Central Park West, the hospital became one of the most expensive detoxification hospitals in New York and  a favourite "drying out" spot for the rich and famous (alcoholism and drug use crossed all social boundaries).

Unfortunately, even with his enthusiastic praise for a “cure” that he regarded as being effective in over 90 % of cases, there was still the pesky problem of his lacking medical credentials.  Which brings us to Dr. Alexander Lambert…

One of the most eminent medical doctors in New York City, Dr. Lambert was a professor of medicine at Cornell University and the personal physician of then-President Theodore Roosevelt.   He was also one of the foremost authorities on treating drug addicts and alcoholics with decades of experiencing dealing with alcoholics at New York's Bellevue Hospital.  Exactly why such a respected physician would associated himself with someone like Towns remains a mystery.   Still, 0nce Lambert lent his name to Towns' miracle remedy, the Towns-Lambert treatment (as it would be called from then on) became the dominant treatment for alcoholics in "drunk wards" across the United States.   And that began with Dr. Lambert's own patients at Bellevue.

In describing the effectiveness of the new treatment, he stated that:  "The obliteration of the craving for narcotics is not a matter of months or weeks . . . but is accomplished in less than five days. The result is often so dramatic that one hesitates to believe it possible."   Though other medical experts were still leery, Lambert's testimonial and his willingness to stake his own professional reputation over something that had been dismissed as a quack remedy was enough for them to take a serious look at Towns' remedy.

Part of the problem was that Charles B. Towns continued to insist that the recipe he used remained his own personal secret.   While the formula eventually became public knowledge, the actual ingredients were enough to make the skeptics leery all over again.  Particularly since the main ingredient was belladonna.  

Extracted from the berries of the atropa belladonna bush (also known as deadly nightshade), belladonna is an extremely toxic hallucinogenic.   Among the different alkaloid toxins that would later be derived from belladonna are scopolamine and hyoscyamine.   Though known since ancient times as a deadly poison, it also gained a strange fame as a beauty aid (belladonna takes its name from the Italian phrase for "beautiful woman" and relates to the custom of using belladonna to dilate a woman's pupils to make her appear more alluring).    While also used as a traditional pain reliever for centuries, belladonna was usually mixed in with other ingredients to dilute its toxicity. 

Towns' own recipe called for a fifteen percent tincture of belladonna mixed in with with fluid extract of xanthoxylum (prickly ash) and the extract from  hyoscyamus niger.   Since hyoscyamus niger was also toxic (being another nightshade alkaloid), the patients needed to be carefully monitored to make sure they were not poisoned by the belladonna mixture.   The Towns-Lambert cure was usually administered on an hourly basis over two days or more and patients had to be watched for side effects such as a flushed face, dilated pupils, hallucinations, or delirum.   These symptoms were often hard to gauge in many patients since they were frequently  experiencing delirium tremens as well due to alcohol withdrawal.   As part of the  treatment, patients also received cathartics and mercury pills (which were an all-purpose purgative to prevent constipation).  

Once patients were admitted to hospital, Lambert often prescribed chloral hydrate and morphine to put them to sleep before starting them on the Towns-Lambert cure.    After the two-day treatment was completed, it was followed up with a heavy dose of castor oil and and tonics to help patients return to regular foods (the entire course of the treatment, often accompanied by heavy vomiting, was known as "puke and purge").  

Gross as it might have seemed to observers, Lambert was filled with praise for Towns' belladonna cure and he introduced Charles B. Towns to government officials as "an honest man.   No faker".    With Lambert's backing, Towns traveled to China to sell his cure for dealing with opium addicts there.    Lambert wrote to Assistant Secretary of State Robert  Bacon and asked him to make all the arrangements.    By 1908, Charles B. Towns was able to meet with the American delegation to the Shanghai Opium Commission to announce that he had cured more than 4,000 opium addicts  which, along with the political backing that Lambert provided, gave his treatment what was essentially an official  endorsement by the U.S. government.  

Along with  writing three popular books on substance abuse, Towns also became influential in drafting some of the most far-reaching drug and alcohol bills, including the Harrison Narcotics Tax Act of 1914.    Despite Lambert's backing, there were still skeptics who warned that the Towns-Lambert treatment was potentially more dangerous than the disease it was supposed to cure.   Advertising the effectiveness of their cure, Towns and Lambert downplayed the extreme physical distress they caused their patients, and the deaths that could occur.   In one year alone, 130 patients were treated and there were six deaths (suggesting a fatality rate as high as four or five percent).    

Whether because of the death toll or simply due to the increasingly elaborate claims that Towns was making (including using his belladonna cure to treat kleptomania and bedwetting), Charles Lambert eventually broke off all association with Towns and his hospital.   There was also the troubling fact that the "cure" was not as effective as he and Towns had hoped and that numerous patients were returning after failing to quit their drug and alcohol habits.    During the 1920s, much of the hospital's revenue came from repeat business.   Even that repeat business largely ended with the Stock Market crash of 1929 and the resulting Depression since most of their well-to-do repeat patients were wiped out financially. 

After Towns lost his medical expert, his cure lost most of the respectability it enjoyed in the medical community.   Other medical experts weighed in on the problems with the belladonna cure and Charles B. Towns eventually faded into obscurity.    Despite his former fame as an addictions expert, Charles B. Towns would be largely forgotten today except for the identity of one of his patients.

William Griffith Wilson, a.k.a. "Bill W.", had been a severe alcoholic who was admitted to Towns' hospital on four occasions.   Along with his chronic alcoholism, Wilson also suffered from severe depression and had largely hit rock bottom by 1933 when he entered the Towns hospital under the care of Dr. William Silkworth.   Gaining hope from his doctor's theory that alcoholism was a disease instead of a moral weakness,  Wilson eventually realized that he needed to conquer his alcoholism before it destroyed his health and sanity.   Inspired by Ebby Thatcher and other alcoholics who had recovered successfully from drinking problems,  Wilson would later describe how he "saw the light" and underwent a spiritual conversion (how much of that experience was linked to the belladonna and other hallucinogenics he was being treated with at Towns' hospital is open to question). 

Whatever the reason for his spiritual conversion, it was profound enough to inspire an increasing number of alcoholics in New York and the surrounding area to join with Wilson in renouncing alcohol.  By 1938, Wilson and his fellow alcoholics published a book titled "Alcoholics Anonymous" which became the The Big Book for their growing movement (Wilson was the book's lead author).  Charles B. Towns was impressed enough by Wilson to lend him and his supporters $2500 to help publish the book (a princely sum in those days).    Though Towns' own reputation as a substance abuse expert was on the decline, his support was still crucial during the early days of the AA movement.  Along with offering the unemployed Wilson a job as a lay therapist (which Wilson refused), Towns also helped publicize AA and helped sell hundreds of copies of The Big Book. 

Charles B. Towns died in 1947 and his belladonna cure died with him.   His only lasting legacy is the role he played in launching Alcoholics Anonymous and the various Twelve Step programs founded on AA principles.   Whether that would have been enough for a man who hoped to provide the world with a medical miracle is anybody's guess.

 

Can Trans-Cranial Magnetic Stimulation Help Traumatic Pain Patients?

Pain is a multifaceted condition and a major ongoing challenge for healthcare professionals having to treat patients in whom pain put them at risk of developing other conditions. Significant efforts have been invested in both clinical and research settings in an attempt to demystify the mechanisms at stake and develop optimal treatments as well as to reduce individual and societal costs. It is now universally accepted that neuroinflammation and central sensitization are two key underlying factors causing pain chronification as they result from maladaptive central nervous system plasticity. Recent research has shown that the mechanisms of action of repetitive transcranial magnetic stimulation (rTMS) make it a particularly promising avenue in treating various pain conditions. A new review published in the journal Progress in Neuro-Psychopharmacology & Biological Psychiatry examines the contribution of neuroinflammation and central sensitization in the transition from acute to chronic pain in traumatically injured patients. A detailed discussion on how rTMS may allow the restoration from maladaptive plasticity in addition to breaking down the chain of events leading to pain chronification will follow. Lastly, this review will provide a theoretical framework of what might constitute optimal rTMS modalities in dealing with pain symptoms in traumatically injured patients based on an integrated perspective of the physiopathological mechanisms underlying pain. (PsycINFO Database Record (c) 2018 APA, all rights reserved)

For the abstract

Should Heroin Be Prescribed?

 Should heroin be prescribed by medical doctors?

While many countries have experimented with methadone clinics aimed at weaning people off of heroin and other addictive opiates, there is little doubt that the problem has been getting worse.   One alternative that continues to be advocated in countries such as Canada involves making heroin available by prescription, something that continues to be vehemently opposed by conservative politicians and anti-drug activists.   Despite promised changes by many governments, this continues to be an uphill battle in most places.

But Switzerland is not most places....

Due to the sharp rise of heroin use throughout the 1980s,  "needle parks" sprang up in Swiss cantons across the country.   Intended to limit the spread of intravenous drug use, the parks basically meant forcing users to congregate in small areas where users could shoot up without too much fear of arrest.   That one of these parks sprang up just across from the seat of the Swiss Federal Assembly in Bern demonstrated to the politicians meeting there just how out of control the problem had become.

 To combat the widespread drug use, not to mention the risk of HIV and other diseases spread by the sharing of needles, the Swiss Federal Council decided to take action.  In 1992, they approved the first five-year experimental program for dealing with the heroin epidemic.   Based on the "four pillars policy" (prevention, therapy, risk reduction, and repression), the first injection centre for prescribed heroin opened up soon afterward.   Despite opposition from conservative politicians, medical prescription for heroin is currently available in all of Switzerland's cantons.  In all there are 22 injection centers  at present- including on in a prison- are managed by public hospitals or private care clinics supported by the state.  There are currently 1500 patients at these centers, all of whom receive regular injections of diacetylmorphine -  a form of heroin much stronger and safer than anything they might purchase on the streets.  

As to how successful the program has been to date, the patients themselves remain candid on how their lives have changed for the better.  In a recent article, several of these patients shared their experiences.   “Methadone didn’t work for me,"  said 44-year-old Marco.  "The side effects were terrible, and I didn’t get any tranquilizing effect. So I was taking other drugs on top of it. I’ve been registered here for the last six months. I’ve put on weight, and cut my heroin use by 80 percent. Eventually, I want to get clean.” Chantal, 54, an addict for 30 years, said: “The treatment gives me structure. I don’t have to chase after my dealer any more.” Jeff, 54, had just injected his daily dose; his pupils were dilated, and he spoke in a loud voice: “My quality of life has definitely improved. It’s stabilized my day. Before I got into the program, I was a dealer. I was cunning, I found ways to get money, I did stuff.”

In the same article, Yves Saget, an addictions nurse described how heroin treatment can be so effective.  “Addiction happens when taking drugs becomes the only strategy for dealing with difficult situations,"  he said.  "We don’t say ‘fix’ here, we say ‘treatment.  The brain becomes dependent, and needs heroin to maintain its balance. At this center, we are treating 63 patients with diacetylmorphine. Medical heroin is pure, unlike the drug you buy in the street, which is cut with caffeine, paracetamol, and other substances. Street heroin isn’t satisfying, so addicts often take other narcotics with it, or alcohol, or psychotropic drugs such as benzodiazepine. Our dosage, which is individually tailored, allows patients to live as normal a life as possible.” He added: “We emphasize good citizenship—patients must treat our staff and the neighborhood with respect. This is their treatment center, so it’s up to them to protect it.”

For now, the experimental program remains popular in Switzerland.   Whether or not the success of the current program will inspire other countries to establish similar programs elsewhere remains to be seen.

P.T. Barnum and You

Imagine, if you will, that someone gave you a personality test and provided you with the following feedback on your personality:

You have a need for other people to like and admire you, and yet you tend to be critical of yourself. While you have some personality weaknesses you are generally able to compensate for them. You have considerable unused capacity that you have not turned to your advantage. Disciplined and self-controlled on the outside, you tend to be worrisome and insecure on the inside. At times, you have serious doubts as to whether you have made the right decision or done the right thing. You prefer a certain amount of change and variety and become dissatisfied when hemmed in by restrictions and limitations. You also pride yourself as an independent thinker and do not accept others' statements without satisfactory proof. But you have found it unwise to be too frank in revealing yourself to others. At times you are extroverted, affable, and sociable, while at other times you are introverted, wary, and reserved. Some of your aspirations tend to be rather unrealistic.

How likely are you to endorse this as an accurate description?   If you were to rate it on a scale of accuracy with "1" being completely innaccurate and "10" being extremely accurate, where would your score fall on the continuum?    In an average group of people, the majority are going to endorse it as being fairly to extremely accurate with only the occasional dissenter suggesting that the report was not a good personality description. 

Certainly that was the result that psychologist Bertram Forer got when he administered the personality test to the students in one of his classes in 1948.   More than forty percent of his students described the personality description as being a perfect fit to their personality while more than half the class rated it as being at least a "fair" description.   Except, of course, for the fact that every student in the class received the same personality description you see above.   Forer, an arch-skeptic, had previously tried to debunk a nightclub graphologist by accusing him of providing vague personality descriptions during his "readings" with clients that would be true of everyone.   The graphologist fought back and insisted that the personality descriptions had to be accurate.  After all, didn't his clients agree that the reading he provided was correct?  Surely they knew themselves best!

As a test of how gullible people could be, Forer bought an astrology book from a newsstand and wrote out the general personality sketch you see above.  Ever since he first published his results in 1949, this tendency of people to endorse generalized statements as being true for them specifically has been known as the Forer effect.    Also called the P.T. Barnum effect,  why this happens stems from the fact that personality is never fixed and often changes depending on the situation in which we find ourselves.  Sometimes, we're shy, sometimes we're confident, sometimes we're calm, sometimes we're worried.   Given a vague statement about personality, we usually find something there that matches up how we can be at some point in time. 

With the generalized description that Forer provided, at least some of the statements that make up that description are so broad as to be almost meaningless.  More importantly, many of the statements are almost polar opposites, i.e. "You have a need for other people to like and admire you, and yet you tend to be critical of yourself."     Since statements such as this are going to be true at least some of the time, people will endorse them as being accurate.  As a result, we often end up "picking out" the statements that happen to apply to us and ignore the rest.

Psychologists have come to refer to these kind of overgeneralizations as Barnum Statements after circus showman P.T. Barnum who was famous for saying "A circus should have a little something for everybody.”    What Forer discovered, and what fortune tellers had known for generations, was that people often view these vague statements as applying to them uniquely and often regarded them as accurate descriptions of their own personality.   This is especially true if the statements tend to be flattering rather than critical (people like to be complimented).  Many of Forer's students were enthusiastic about how the personality description matched what they thought of themselves.   In the decades since Bertram Forer first ran this experiment, it has been repeated hundreds of times in psychology classses around the world.  Overall, students have been remarkably consistent with over eighty percent endorsing or partially endorsing the accuracy of the personality statement.

Further research looking at the Forer effect also suggested that people were more likely to regard a Barnum statement as being accurate if they were told that it applied to them specifically.   In one study, research participants were given a bogus horoscope and asked to rate its accuracy.   What the researchers found was that they viewed it as more accurate if told that the astrologer who prepared it knew the month, day, and year of their birth (a.k.a., a natal horoscope) as opposed to being told that it was based only on the year and birth month.   It is this belief in the accuracy of astrology and other systems intended to "reveal" hidden aspects of personality based on a horoscope that helps explain its staying power (along with the selective recall that seems to "prove" the power of the stars in predicting the future). 

And it isn't just astrology.  Whether it involves Tarot card readings, palmistry, numerology, biorhythms, graphology, or predictions based on blood type, the Forer effect is a standard tool of almost all fortune tellers.  It is also one of the major features of cold reading by which "psychics" appear to deliver devastatingly accurate estimates of their client's personality.   Every time someone gets a false validation of a fortune teller's powers, he or she also becomes overconfident that the fortune teller can accurately predict future events.  This tendency  to embrace vague statements as being personally meaningful is known as subjective validation.  If people have enough confidence in what they are being told, they often ignore statements that are contradictory or just plain wrong in favour of statements that they feel are completely accurate. 

Unfortunately, this isn't just limited to fortune tellers.  The personality tests used by psychologists, psychoanalysts, social workers, etc. can also be vulnerable to the Forer effect.   It can also lead to the overuse of certain tests of only limited validity including projective tests such as the Rorschach and the Thematic Apperception Test.  Part of the popularity of the Myers-Briggs Test and other misused tests of personality largely stems from the misplaced faith caused by the Forer effect.   It is hardly a coincidence that the Church of Scientology offers "free personality readings" to draw in new members.

So, what is the solution?  We certainly need better education to teach people to be less trusting of Barnum statements and the role they often play in the acceptance of bogus "personality readings".    It is also important to be wary of how these readings are often used as "foot in the door" techniques to gain the trust of clients by convincing them that the "readers" ability is real.   Even with psychometric tests that are supposedly valid, you need to be more critical of what you are being told and how specific the personality description really is.    Personality is a lot more fluid than you might think.

In the end, you need to have a healthy degree of skepticism about what people are trying to tell you about yourself.  

Are Criminal Brains Different from Non-Criminal Brains?

Over 100 years ago Lombroso [(1876/2006). Criminal man. Durham: Duke University Press] proposed a biological basis for criminality. Based on inspection of criminals’ skulls he theorized that an imbalance of the cerebral hemispheres was amongst 18 distinguishing features of the criminal brain. Specifically, criminals were less lateralized than noncriminals. As the advent of neuroscientific techniques makes more fine-grained inspection of differences in brain structure and function possible, a new article published in the journal Laterality: Asymmetries of Body, Brain and Cognition examines criminals’ and noncriminals’ structural, functional, and behavioural lateralization to evaluate the merits of Lombroso’s thesis and investigate the evidence for the biological underpinning of criminal behaviour. Although the body of research is presently small, it appears consistent with Lombroso’s proposal: criminal psychopaths’ brains show atypical structural asymmetries, with reduced right hemisphere grey and white matter volumes, and abnormal interhemispheric connectivity. Functional asymmetries are also atypical, with criminal psychopaths showing a less lateralized cortical response than noncriminals across verbal, visuo-spatial, and emotional tasks. Finally, the incidence of non-right-handedness is higher in criminal than non-criminal populations, consistent with reduced cortical lateralization. Thus despite Lombroso’s comparatively primitive and inferential research methods, his conclusion that criminals’ lateralization differs from that of noncriminals is borne out by the neuroscientific research. How atypical cortical asymmetries predispose criminal behaviour remains to be determined. (PsycINFO Database Record (c) 2018 APA, all rights reserved)

For the abstract

New Bill Calls For Better Mental Health Services for Traumatized Jurors

For Mark Farrant, the struggle began after he served as jury foreman for a 2014 murder trial.   During the course of that trial, Farrant and his fellow-jurors were subjected to often-graphic testimony describing how the defendant killed his girlfriend by slicing her throat and strangling to death.  Then he set their rooming house in Toronto's Annex on fire.   He would eventually be convicted of second-degree murder.

Not surprisingly, Farrant developed psychological problems coping with what he had seen and heard.   Though he would be later diagnosed with posttraumatic stress disorder (PTSD), he was mystified to discover that the Criminal Code barred him from seeking help.    Under the Code, jury members are specifically barred from discussing the case deliberations with anyone outside of the courtroom, and that included mental health professionals.  Though the Ontario government has since implemented free counseling for jurors following pressure from the media, Farrant launched a lawsuit earlier this year seeking compensation for his lengthy battle with emotional issues.   Arguing that the attorneys- general of Ontario and Canada breached their duty of care to protect jurors, the suit is seeking $100,000.

But a new bill tabled by Conservative MP Michael Cooper may change that.  The bill specifically amends Section 649 of the Criminal Code to allow jurors to discuss aspects of the trial with medical practitioners.   In discussing the bill with reports, Cooper insists that it "just cracks the Criminal Code open slightly", and only to medical professionals who already uphold patient confidentiality.   It provides a narrow exception to the jury secrecy rules so that after a trial a juror who is seeking mental health treatment could disclose what took place during the course of jury deliberations," Cooper said in a recent medial interview .   "It's a step in the right direction... No one should be unable to get mental health treatment for simply doing their civic duty."

An all-party committee has already recommended the Criminal Code change as well as making psychological counseling available to jurors but governments at the federal and provincial levels have been slow to respond.    Farrant has been supportive of the new bill and has already expressed hope that future cases like his can be avoided.  ""I'm hoping that members will look at the bill for what it is and not political or partisan lines. That this is really a bill designed to help Canadians who are participating in really what is the last form of mandatory civic action, which is being a member of a jury," he told the media.  "We don't conscript people for the military anymore but we do conscript people to do that duty as a juror."