This immortal line was written, not by Stringer Bell, but by Sigmund Freud. In 1884, the young researcher — long before psychoanalysis was a glimmer in his eye — was fascinated by cocaine.

Freud saw it as a way to mitigate pain, both from physical injury and from the effects of morphine withdrawal. He also saw it as a drug capable of curing most of the ailments of modern life: fatigue, indigestion, low spirits. It was the cure for what ails you.

Freud’s enthusiasm for cocaine helped one of his colleagues, ophthalmologist and surgeon Carl Koller, make a sudden realization: If cocaine could block pain, perhaps it could numb tissue altogether. If so, cocaine might solve the problem of local anesthesia.

General anesthesia — ether — had been introduced about 40 years prior, but it had drawbacks. First, sometimes you needed the patient conscious and responsive. Even the most compliant patient, however, would have involuntary motions that may work against the surgeon’s purposes.

Second, general anesthesia was often accompanied by vomiting and other side effects that were undesirable. Finally, doctors and patients alike usually preferred to use the most specific, rather than the most general, treatment.

Consider what it was like to undergo cataract surgery in the 19th surgery. Author Thomas Hardy recorded an old man discussing his own surgery:

It was like a red-hot needle in yer eye whilst he was doing it. But he wasn’t long about it. Oh no. If he had been long I couldn’t ha’ beared it. He wasn’t a minute more than three-quarters of an hour at the outside.

Not more than 45 minutes of wakeful consciousness of a red-hot needle in your eye! During those 45 minutes, your eye would involuntarily twitch and shrink away from the needle. A mere nuisance, scarcely worth mentioning — except that it was so painful that Thomas Hardy’s interlocutor didn’t bother with the other eye.

Koller was a 26-year-old ophthalmic surgeon at the Vienna General Hospital and had discussed with Freud his research into cocaine’s effects. After another colleague had noted that a solution of cocaine made his mouth numb, Koller seized upon the possibility that it might prove useful in surgery. One of Koller’s colleagues describes an early experiment with cocaine as a local anesthetic:

A few grains of the substance were thereupon dissolved in a small quantity of distilled water, a large, lively frog was selected from the aquarium and held immobile in a cloth, and now a drop of the solution was trickled into one of the protruding eyes. At intervals of a few seconds the reflex of the cornea was tested by touching the eye with a needle….

After about a minute came the great historic moment, I do not hesitate to designate it as such. The frog permitted his cornea to be touched and even injured without a trace of reflex action or attempt to protect himself — whereas the other eye responded with the usual reflex action to the slightest touch.

Koller’s colleague goes on to describe how the scientists proceeded to stick pins in one another’s eyes, all in the interest of science!

Cocaine dampens the excitation of nerve endings and the transmission of information along nervous pathways. It does so by temporarily blocking sodium channels, which are the conduit for information to travel along the nervous system. That’s why you don’t experience pain under local anesthetic: The nerves in the affected tissue can’t transmit the news, as it were, of sensation or injury.

Koller’s experiment came together so quickly that he was in fact unable to publicly present his research himself. His first surgical proof was Sept. 11, 1884, and the general congress of ophthalmology was to meet in Heidelberg, Germany, on Sept. 15. Because he was just starting out in his career, he could not afford the trip, and so a colleague presented it on his behalf.

The import of Koller’s experiments was quickly taken up, not just in Germany, but around the world. And not just eye operations: Almost any type of surgery that might require local anesthetic was tried with cocaine.

In particular, American doctor William Halsted pioneered the injection of cocaine for local anesthesia. It became so standard a procedure that Freud sent Koller a reprint of an essay he’d written on cocaine and fatigue, dedicating it to “Coca Koller.”

Cocaine is rarely used today as an anesthetic, both because of its addictive potential and because it degrades the cornea.

After an illegal duel with sabers in 1885 — those surgeons just love to cut! — Koller fled Vienna. He settled in 1888 in New York, where he set up practice as a respected ophthalmologist. In 1892, he refined his technique with the use of subconjunctival cocaine in eye surgery, particularly for cataract surgery and other procedures involving the iris.

He was honored in 1922 by the American Ophthalmological Society with the very first Lucien Howe Medal (.pdf). One of Howe’s biographers believes that the award was established specifically to honor Koller for his breakthroughs in anesthetic eye surgery.

Koller died in 1944.

Source: Various

Photo: Carl Koller pioneered the use of cocaine as a local anesthetic/Wikimedia Commons

See Also:

• March 30, 1842: It's Lights Out, Thanks to Ether
• Dec. 11, 1844: Laughing Gas Dulls the Pain of a Savage Dentist
• Sept. 30, 1846: Ether He Was the First or He Wasn't
• When Anesthesia Fails and You Feel Your Surgery
• Old, Brutal Surgeries Inspire Elegant Modern Devices
• The Painful Truth
• May 1, 1884: Everything's Up to Date in Windy City
• May 13, 1884: Electrical Engineers Meet Up, Light Up
• June 16, 1884: Roller Coasters — A Technology With Plenty of Ups and Downs
• August 16, 1884: Birth of Sci-Fi Publisher Gernsback
• Oct. 13, 1884: Greenwich Resolves Subprime Meridian Crisis
• Sept. 15, 1916: All Disquiet on the Western Front
• Sept. 15, 1947: Association for Computing Machinery Gets Whirring

Authors: Jason B. Jones

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