Finding Sanity

by Greg de Moore

  There are times, when reading John’s carefully written accounts of his experiments, that it is virtually impossible to follow his line of thinking. He was wrong when he concluded that urine from manic patients was more toxic than other urine. He was also probably wrong when he thought the guinea pigs were resting after lithium. Many of his observations cannot be replicated when tried today, so reproducibility, the gold standard for scientific sturdiness, is absent. But none of this mattered. Because when John nimbly sifted through the options, his mind intuited something remarkable: that giving lithium to guinea pigs soothed them in a way that was worth pursuing. There was something special about lithium.

  But where did lithium come from, and what did anyone really know about it?

  14

  Lithium, from the Greek lithos meaning stone, is, aptly, dug from the earth. Discovered in 1817, any high school chemistry student will know its place in the Periodic Table—the lightest and most reactive of all metals. So light is it, that this soft silvery metal floats on water. Lithium has been around from the very beginnings of the universe—at the Big Bang only three elements were fused in that furnace: hydrogen, helium and lithium. It is found and used in the most astonishing variety of places—everyone knows about lithium batteries, but probably not that lithium is a lethal component of the hydrogen bomb. When you gaze upwards on New Year’s Eve and marvel at the incandescent pyrotechnics and the night sky turning blood-crimson, you are gazing at lithium burning in the heavens.

  Lithium is a bewitching element and, when in the form of lithium chloride powder, absorbs moisture from the air and melts before your eyes. But what would John have known about lithium, alone in his shed, tinkering with his chemical concoctions?

  To find a clue to that question, we can start with the 1947 Australian and New Zealand Pharmaceutical Formulary. This was the drug manual available to young doctors in Australia. It is a book steeped in apothecary lore. Its powders and brews are balanced on beams, and measured in terms carved from antiquity—grains for mass and minims for volume. On page 55, typical of this craft, we find the mystical ingredients of rhubarb powder; and of syrup of ginger; and of a tincture of cudbear, whatever that may be (apparently a colouring obtainable from certain lichens). And as for lithium? Well, there is nothing. Not on page 55, nor on any other page.

  But if we turn back just six years to Martindale’s Extra Pharmacopoeia of 1941 (22nd edition) or further back to a classic of the genre, Squire’s Companion to the British Pharmacopoeia of 1916, that’s where lithium finds its form. In the latter there are no less than ten densely packed pages dedicated to the healing powers of lithium. And it is here that the well-known forms of medicinal lithium are laid out for the reader—lithium carbonate, lithium citrate and lithium chloride. In these older hospital texts John Cade would have found plenty on lithium, but only a little to advance his thinking.

  To understand how lithium entered medicine we have to go back to the mid-nineteenth century when it was introduced for the treatment of gout. Indeed some of its proponents suggested that recurrent gout could cause mania and melancholia, and that lithium might heal these states. Then, in 1871, American military physician and neurologist William Hammond reported using lithium bromide in the treatment of mania. But nothing further came from it. Around the same time, two Danish doctors, Carl Lange and his brother, Fritz, treated recurring depression with lithium but publication of their work in Danish and German restricted their audience and their approach fell into disuse. John Cade, it seems, was completely unaware of these early endeavours to use lithium in psychiatric illness.

  By the late 1940s, notions of lithium’s supposed curative properties in all diseases had lost favour and it seems to be included in reference books, almost apologetically, as a testament to past faulty medical thinking. But importantly the doses used for the various lithium preparations were noted: something that John would need.

  Although in the late nineteenth century, lithium was mistakenly heralded as a treatment for gout, it did propel lithium into homes and hospitals around the world. And when it was found to be present in natural spring waters, lithium was celebrated as part of a water cure. In Squire’s Companion of 1916, no less than fourteen pages are devoted to the healing claims of spa waters around the globe: in Baden-Baden, Germany, ‘The Lithia Waters contain about 3 grains of lithium chloride in 20 oz . . . For rheumatoid arthritis, chronic gouty affections and paralysis’. In another spa in Germany it was held to ‘stimulate the intestines and urinary organs’ and the Bavarians found it wonderfully congenial for managing ‘haemorrhoids and constipation’. In the drawing rooms of medical establishments in England and Wales, lithium waters held hope for those afflicted with ‘hepatic and intestinal congestion, gastric affections, for gouty and rheumatic affections, diabetes, eczema, kidney troubles’. Nothing, it seemed, was too much for the all-curative power of lithium. People flocked to the waters and lithium soon found a favoured place in popular culture.

  It was almost inevitable, therefore, that lithium’s supposed power of restoration would also find a home in fiction. And it did.

  H.G. Wells, grandmaster of science-fiction writing, could have used the soothing power of lithium waters in his own turbulent life. Whether he did we don’t know, but he found a use for it in his writing.

  Lithium, and its calming powers entered at a crucial point in his 1895 short story ‘The Reconciliation’, which told of two men—Temple and Findlay—once the warmest of friends but now the most bitter of enemies. As lithium is swallowed, momentarily an old friendship returns:

  ‘There’s no woman worth a man’s friendship,’ said Temple abruptly. He sat down in an easy chair, poured out and drank a dose of whisky and lithia. The idea of friendship took possession of him, and he became reminiscent of student days and student adventures. For some time it was, ‘Do you remember’ this, and ‘Do you remember’ that. And Findlay grew cheerful again.

  In this story, the two men meet after a prolonged separation, but as they continue to talk, spiteful memories are rekindled and resentment festers. The men, both intellectuals and scientists, wrangle with their own bestial emotions. They struggle to quell violent desires to hurt one another. As the memory of their dispute over a woman surfaces, civility cracks. Temple, drinking to excess, warmed his cheeks to a fighting red.

  Lithium water stirred with whisky was a gentleman’s drink in H.G. Wells’ tale, a balm to settle unsteady heads—although perhaps not a balm of sufficient strength. For as the drama concludes, the whisky clouds their humanity and, like the savages within that they sought to conceal, they brawl viciously until Temple crushes the skull of his one-time friend.

  If nothing else, Wells’ story of these two men suggests the drinking of lithium as a restorative was seen to be natural and available to a nineteenth-century English gentleman. But John Cade’s life was lived beyond the rim of such fiction. Lithium had assumed a place in late-nineteenth-century English life that was vastly different to the post-war Melbourne that John inhabited. In the late 1940s lithium was not only absent in Australian popular culture, it was barely mentioned within the medical world.

  It has always been a mystery as to where John found his lithium. Sadly, he never commented on this, and we are left dangling and guessing. It is possible that different preparations of lithium were stored in hospitals, remnants from the end of the nineteenth century and early twentieth century, stockpiled in the backrooms and dispensaries—overlooked and unused. If one stumbled into an asylum dispensary in the 1940s, one stepped into a world of the past, and along the rows of deep-brown medicinal jars you might have found some filled with lithium powders. Relics from the heyday of lithium, they stood as silent witness to earlier medical theory when John Cade made the decision to resurrect them for his experiments. Or perhaps John sought lithium from a drug house; we don’t know. In the end he had enough lithium to continue his work.

  In lithium, John had something tangible to work with, but his notes reveal that it
was not only lithium that attracted his notice. During his experiments, at different times John tried just about every element he could lay his hands on: calcium, magnesium, titanium, rubidium, beryllium, cobalt, nickel, zinc, tungsten, molybdenum, selenium. A who’s who of the Periodic Table. But, in the end, only lithium worked.

  His years in Changi offered John a different view of life: that you take your chances, knowing that they will, as all life will, run dry. That you have to work out pretty quickly what’s important and what’s not, and that bunkum and squandering of time is not to be tolerated.

  John Cade’s observation, that lithium soothed guinea pigs, was intriguing but it could have remained just the stump of an idea. It took a decisive act—courageous and maybe even a little reckless—to make something of that moment.

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  In the weeks leading up to March 1948, John Cade did something that was unexpected, secretive. Not shameful, as his cryptic act might suggest, but certainly an action he wished no one to observe, much less challenge him about.

  He resolved to test lithium on himself, before giving it to his patients.

  To a naive eye, this might seem daring, boldness bequeathed to few. Or perhaps it was just ill-considered, or foolish. If he wanted someone to experiment on, why didn’t he just give the solution to the first patient he thought suitable?

  The answer, most likely, lay in John’s character.

  John Cade in 1948 was a blend of the military and the medical; it was never likely that he would inflict an untried potion on an innocent man until he had weathered its effects himself. For a man who had survived three and a half years’ incarceration as a POW, the act of self-experimentation and a preparedness to take chances had become a way of life.

  Of course, no mortal eye will ever know what stream of thought pushed John over that line to test lithium on himself, but the stakes were high: 1948 was a peak year for deaths in Melbourne asylums. In one asylum alone, Royal Park, John recorded in that year there were ‘183 deaths—that’s three and a half a week’. He kept a death tally, recording that two in every fifteen admissions, like the victims of a plague, ended up as a cold slab of flesh.

  What we do know is that, strangely, for a man who documented with Swiss precision each injection into his experimental guinea pigs, John left no written vestige of the experiments upon himself. Perhaps this reflected the secretive nature of his act; or awareness of his eccentricity; or of his terror of things going terribly wrong. And of course there was the fear of exposure to ridicule. He knew that, almost certainly, those about him—his psychiatric colleagues, his wife, his father—would frown in disapproval. Some of his colleagues, especially, would smirk if he stumbled; it would confirm that the ‘mad major’ of Changi was loopy indeed. But John had enough sense of self-preservation to know he’d only be considered loopy if caught.

  All John knew for sure was that lithium had led his guinea pigs to lie vacant-eyed and dreamily insensitive to the prodding of human fingers.

  As John prepared to take lithium, the spirit of the alchemist stirred within, knowing he was doing what many would regard as against the natural order. He emptied the lithium powder into a test tube, stirred a solution and raised the transparent fluid to his lips. Whatever the nature of the force that guided his hand, it was deep-rooted and arcane.

  He held the elixir to his lips: his nostrils sensed no odour, and, with the courage and recklessness anything truly original must embrace, he opened his mouth.

  Eyes closed, he drank.

  At first, the taste was probably a little salty, almost metallic—something to note for how a patient might react. And then, nothing. Pleasingly, nothing. No collapsing to the floor, no maniacal convulsions, no agonising clutching of body parts about which—in a more hesitant moment—he may have fantasised. Nothing happened; wonderfully, nothing. He cleansed the vial of the solution and put it back on the rack. The world, for the moment, remained as it had five minutes earlier, with equanimity undisturbed.

  The following day John returned and did the same. And the next. Each day he returned and subjected his body to whatever his God and the Periodic Table would deal him.

  As the clear liquid drained from the glass and into his body, he could only have imagined its course. The mechanic in him knew that the liquid would descend from mouth to oesophagus, and that it would be absorbed, rapidly, all along his gut. The writings from the nineteenth century, familiar to John, suggested that lithium would seek out every organ, seeping into every cell and across the blood–brain barrier, that Great Wall of China, which separated the brain from blood. And it was the brain that was lithium’s final target.

  As a sophisticated voyeur of the natural world, John now observed his own body and felt its perturbations. It is hard to know what he expected when he felt the liquid upon his tongue, but apart from an involuntary grimace as he experienced its elemental tang and the gurgling of his tummy in faint dispute, he remained well over the next few days. He knew that he must, by logical extension, trial lithium on a patient.

  There was, however, one final matter to resolve before he could try out his lithium potion on the diggers about him: telling his wife.

  All marriages are a journey of trust, of its observance and of its breaking. And for John Cade, as any good Catholic knew, confession was a cleansing force. He felt compelled to spill the news to Jean that he had ingested lithium for days on end. Years afterwards, she recorded how her fury flickered into a full flame after hearing his confession; how her anger rose from anxiety about losing a husband and a father from reckless experimentation. Whether such marital friction was ever more than a moment’s distraction in what he planned next, John does not record. But seemingly without flinching or taking a wavering step, he sought out a patient for whom lithium might work its spell.

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  John’s keen eye did not have to scour the wards to find prospective patients; a sweeping glance from his backyard saw all that needed to be seen. Manic patients encircled John, and he penned his thoughts on each one:

  An older man of 63 with mania for the last ‘two and a quarter years’ claimed to those who listened (and most who did not) that he was valued at over 800,000 pounds and was a fearless soldier. At times, when his grandiosity settled, this warrior proclaimed that he might only be valued at a paltry 500,000 pounds.

  A younger man, in his 40s, manic for 2 months—strode triumphantly across the asylum grounds, flinging his arms about, gesticulating wildly to those who crossed his path, and bellowed into the night until the sounds dissipated miles beyond the asylum walls. He ate ravenously, when anything was put before him, pouring food into his gob to feed his thin frame and fuel a rampant energy.

  One man had been in and out of asylums for 30 years, tormented by the delusion of a wireless tampering with his brain; another ex-soldier communicated only by a form of magical telepathy with those he trusted; and another who, with elastic ease, ranted for hours on end at the mysteries of a brick wall.

  Or there was the young immigrant Polish doctor, now a manic patient at the neighbouring Mont Park asylum, whose buoyant mood compelled him to perform somersaults on admission to the asylum and, when landing upright, flashed a grin and beamed to his psychiatrist that he needed ‘intercourse 12 times’ every evening to quell his urgent appetite. Cursing his fate, agitated and screaming, he struck another patient, giggling unrepentantly. He was locked in a single room, daubing faeces over the walls.

  Other men, though prodigious beings of overwhelming physical power, remained pleasantly elevated, amiable giants. Some manic patients were vagrants, scooped up by police from the streets of Melbourne and unloaded at Bundoora.

  But for all their eccentricities, their oddness, and the hazy worlds into which they withdrew, John’s writing reflects his fondness for them. Not only were most ex-soldiers—an affinity that cut deeper for him than any other—they were men of a common, decent cut.

  As evening set in, and the sun sank behind the hills where the Cade bo
ys had primed their rabbit traps, the wards of the asylum unbolted their heavy timbered doors, inviting in and welcoming for the night all those who wandered the grounds. At day’s end, the commotion and the laughter and the crying finally came to a halt—the daily din exhausted. It was then that the manic patients settled in their beds. When the lights went out—and all was still and dark—the only sound heard was the human hum of 200 crackling brains.

  Urgency snapped at John’s heels: to find, without delay, a patient suitable for his lithium experiment. That sentiment and his need to make up for lost time from the war pressed him towards his goal.

  Among the wriggling mass of the mentally ill was one patient whom John knew well: William Brand, more commonly known as Bill or Billy.

  It was Bill who he thought might respond to lithium.

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  Bill Brand’s embattled story is his own, but it is also a universal one. The struggle to survive with a mental illness on the streets of an unforgiving world scarred him, as did dealing with a brutish bureaucracy that slapped him down whenever he sought a raise in his army pension. It is not a stretch to suggest that his life story is probably the most important in Australian psychiatric history.

  Bill arrived in Australia as part of that great heave of Commonwealth migration in the early twentieth century. South African by birth, he entered the world near Cape Town sometime in the mid- to late 1890s. The exact date of his birth is elusive in official records, and, unofficially, Bill’s age shifts about; even Bill was never sure of his precise age. The manifest of the Cycle—the ship upon which his family arrived in Australia—records Bill as a boy of primary school age when he stepped upon Australian soil in 1907.