>>> Part 5 of 9...
At the *scientific* meeting held in the same room on the same day,
however, Dr. Baden described the same death in quite different terms.
To the scientists he stated that the addict in question "died of acute
reaction to injection of heroin, a so-called overdose." When even this
description was challenged by a fellow physician, who pointed out that
addicts don't die following even enormous doses, [35]  Dr. Baden went
on to explain that "whenever I say 'overdose,' it is in quotation
marks." [36]
The reporters, of course, could not see those invisible quotation marks
when they listened to Dr. Baden at his press conferences and interviews.
They quite naturally took him literally - and continued to inform the
public that addicts were dying of overdose. [*]
Even Chief Medical Examiner Helpern eventually became convinced that
the "heroin overdose" publicity emanating from his office was
"dangerously wrong." In testimony before the Select Committee on Crime
of the United States House of Representatives on June 27, 1970, Dr.
Helpern stated:
"A difficulty has been that people have considered these fatal reactions
the result of overdose. Now, to some people the designation overdose
means [taking] more than usual with the implication that if you are
careful of how much is taken there is no danger of anything other than
the usual effect. This impression which many addicts have is dangerously
wrong." [38]
Yet a full year after Dr. Helpern testified, neither he nor Dr. Baden
nor anyone else had yet ventured to correct the "dangerously wrong" view
that was being foisted on the New York and national news media. Almost
everyone who did not read Dr. Helpern's and Dr. Baden's papers in the
medical journals still believed that heroin addicts by the hundreds were
dying of overdose. Worse yet, nobody had as yet even begun to
investigate seriously the crucial question:  If these hundreds of addicts
a year aren't dying of overdose, what are they dying of?
Fortunately, enough is already known to suggest some promising directions
for immediate research.
Most deaths from so-called overdose, as noted above, are characterized
by suddenness and by pulmonary edema. No other cause of death - such as
tetanus, bacterial endocarditis, hepatitis, or a knife or gunshot
wound - is found. In approximately 60 percent of autopsies, a 1970
study indicates, there is also cerebral edema (accumulation of fluid in
the brain) along with widespread fragmentation of the astrocytes (star-
shaped cells) in the brain. [39]  A death with these characteristics,
occurring in a heroin addict, constitutes a dramatic and readily
identifiable syndrome which Dr. Helpern has called "acute fatal reaction
to the intravenous injection of crude mixtures of heroin and other
substances." We shall here apply a less cumbersome label: "Syndrome X."
One clue to the true cause of Syndrome X is its initial appearance about
1943, its relative rarity for the next few years, and its recent rapid
increase in frequency. The time sequence obviously suggests that the
cause of Syndrome X must be some factor introduced about 1943 and
affecting a vastly increased number of addicts during 1969 and 1970.
Heroin clearly does not qualify; it was widely used long before 1943.
Indeed, a highly significant fact about Syndrome X is that it has become
more and more frequent as the amount of heroin in the New York City bag
has gone down and down. These deaths are, if anything, associated with
"underdose" rather than overdose.
One theory sometimes advanced is that Syndrome X deaths are caused by
the quinine in the bag. Quinine was introduced as an adulterant of
heroin sometime after 1939, when an epidemic of malaria spread by
contaminated injection needles hit New York City addicts; [40]  thus the
time of introduction fits the Syndrome X timetable. Some addicts
discovered that the quinine contributed to the sensation known as a
"rush" immediately after injection. Heroin traffickers also discovered
that the bitter taste of the quinine makes it impossible for addicts to
gauge the concentration of heroin in the bag by tasting the mixture. For
these and possibly other reasons, quinine has remained a standard
adulterant of New York City heroin ever since.
Perhaps the first suggestion that quinine might be causing New York
City's Syndrome X deaths came from Dr. F. E. Camps, the United Kingdom
Home Office pathologist in charge of investigating opiate deaths in
England. At a conference of the Society for the Study of Addiction held
in London in September 1966 (which Chief Medical Examiner Helpern
attended), Dr. Camps stated: "The only comparable drug to heroin which
causes rapid death with pulmonary edema is quinine. In this case
patients start off with discomfort in their chest, and then rapidly die.
It is conceivable that this could have some relation to [New York
City] heroin deaths." [41]
At the same conference an American pathologist, the late Dr. Rudolph
J. Muelling of the University of Kentucky Medical School, added that a
type of lung lesion similar to that found in Syndrome X deaths "is
found to occur when one studies pure quinine cases. In the United States
this kind of lesion has been found in several nurses attempting to
induce abortions on themselves. They take the quinine orally and the
condition comes on quite rapidly. The patients die of quinine
alone." [42]
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