The intoxicant was the unwitting catalyst for many surgical breakthroughs“Woe to you, my Princess, when I come. I will kiss you quite red. And if you’re forward you shall see who is the stronger, a gentle little girl who doesn’t eat enough or a big wild man who has cocaine in his body.” Thus wrote the resident physician of the nervous diseases ward of Vienna General Hospital to Martha, his affianced beloved.
All the minutiae of his day’s work involved a chorus line of neurological refuse: the brainsick and the batty, the hysterical screechers, the catatonics too transfixed to know that they were vomiting or had shit themselves. Nights were spent in his room adjacent to the ward, on his cluttered desk, under a crepuscular light, in a wholly admirable endeavour: putting together the first seminal treatise on the history, uses and therapeutic effects of a magical drug that had, almost for a year, beckoned him with its lubric swagger and bulged and frayed his mind every night. It had given him a nightly dose of Wagner, humping a piano, set to the pounding of his heart. The monograph was published in 1884 as Über Coca. On Cocaine. It was Sigmund Freud’s first published paper.
Actually, it made huge claims and read more like an encomium, almost like a review sponsored by the Merck company of Dramsdtadt, the sole manufacturer of cocaine hydrochloride in Europe. Cocaine was everything Freud wanted it to be — antidepressant, aphrodisiac, and quite fraudulently, the vaunted corrective for colds, asthma, irritable gut, migraine and morphine addiction. What he missed completely was the anaesthetic fallout of the drug, though he mentioned it in a throwaway line about a strange, lasting numbness on the tongue and the lips after ingestion of cocaine. If he could’ve just held that thought, and taken it to its conclusion, the pre-Freudian Freud, at the age of 28, would have become the father of local anaesthesia.
A fellow Jew and cocaine zealot, Carl Koller, Freud’s confrère from the Vienna General Hospital, an aspirant (as interns were called then) in ophthalmology, around the same time, was allowing the white powder to numb his own lips and then putting cocaine solution into the eyes of dogs and rabbits before plunging his lancet into them.
Koller’s paper was read by a proxy at the Ophthalmological Congress in Heidelberg in September 1884. For the denouement, a live mutt was brought into the amphitheatre to have its cocainised eyeball gored (without as much as a whimper) in front of a stunned audience. Koller, by the end of the day, was on the marquee. By the end of the month cocaine was headlining in Europe and across the Atlantic.
The only attention that came Freud’s way was a financial offer from Parke, Davis and Company of Detroit to compare its compound to Merck’s.
By October 1884, the most maverick anatomist and surgeon on the eastern American seaboard, William Stewart Halstead of New York, had already hustled a four per cent cocaine solution from Parke, Davis and Company and had begun injecting himself and his students with it. What he was attempting was the first ever experiment of infiltrative nerve block anaesthesia. A carefully calibrated solution of cocaine was injected into the inner aspect of the jawbone from inside the mouth, somewhere above the last molars, which Halstead knew (from countless cadaveric dissections) as the realm of the inferior alveolar nerve. In all subjects, quite consistently, it achieved a complete loss of sensation of the tongue, the lower jaw, the gums (and all its teeth), the floor of the mouth and the mucosa and skin of the lower lip and chin. Ten minutes after the injection, the subjects also experienced a bipartite rush — a sudden acuteness of sensibility commingled with a sort of gilt-edged, uncharted euphoria and strength that slowly resolved itself in about half an hour.
Thenceforth, for the remainder of the year, Halstead, pickled in cocaine himself, sallied forth, operating relentlessly. And audaciously. That year, a thousand surgical procedures were performed by him entirely under local cocaine anaesthesia. He was injecting cocaine into the brachial plexus of his patients — at the root of the neck — to paralyse the upper limb and render it insensate for surgery; into the sciatic and tibial nerves for the lower limbs; into the dorsal nerves for the penis. And showboating his technique across hospital amphitheatres in New York.
Halstead wrote about those 1,000 cases in the New York Medical Journal in 1885. The paper was titled ‘Practical Comments on the Use and Abuse of Cocaine’ and was manifestly written under its influence. The prose can be seen teetering over into absolute drivel after the first paragraph. It was clear by then to his staff at the Bellevue hospital that his appetite for the white stuff had become unappeasable. There were occasions when the cocaine crash came in the thick of surgery; he’d stand suspended in a state of cerebral transfixion for minutes over an open abdomen. And then walk away. At 32, he was ready to be put out to pasture.
In Vienna, Freud, with his gift for hucksterism, was trying to make the cocaine soufflé rise again. In collaboration with his friend Wilhelm Fliess, he was trying to treat neurological and sexual afflictions by smearing large doses of cocaine on the turbinates inside the nose, followed by cauterisation or even partial removal of the turbinate bones from the nasal passages. Mainstream neurology was beyond Freud’s talents; he was a quester for secret patterns. The nasogenital neurosis reflex — the kinship between the nasal passages, the brain and the genitalia — was Fleiss’s idea, the cocaine was Freud’s. At this point Freud was cocaine dependent himself. His own cocainised nasal passages were a piece of work, honeycombed as they were with purulent sores and debris from his prodigal daily insufflation. The experiment came to an abrupt end when they almost killed Emma Eckstein, one of Freud’s patients, who sought treatment for dysmennorhoea and excessive masturbation. Fleiss, the surgeon, while removing the turbinate, nicked an artery somewhere high up on the nasal septum, packed it with half a metre of gauze and forgot all about it. The resultant suppuration brought her to the brink of septicaemia. Freud, who was taking care of her postoperatively, continued to cocainise her for pain. After a month, when her face was unrecognisable from all the purulence, he called in another surgeon. The gauze was found and pulled out to relieve a copious gush of pus. The artery opened again and she almost bled to death before they could pack a tampon into her nose to staunch the bleeder. Freud’s shameless apologia for the episode was that Eckstein was a hysterical bleeder. The bleeding, Freud said, was a manifestation of her repressed desire for him.
Halstead’s resurrection and subsequent life of surgical greatness at Johns Hopkins hospital is a story for another day. It can be said, ad hominem, that perhaps the greatest leaps in surgical antisepsis and the surgical treatment of cancer of the breast, thyroid disease and hernias were made on the springboard of a cocaine-addled mind.
It can also be said for Freud, whatever one’s slant on him (charlatan-quack/ Viennese prefigurement of Baba Ramdev/ seer), that it is plain to the objective eye that all of his work — the seeking and finding of figures in the carpet, the fantastic theories of libido and the subconscious — whatever its worth, was the produce of cocaine intoxication.
Ambarish Satwik is a Delhi-based vascular surgeon and writer; asatwik@gmail. com
(This article was published on August 26, 2016)