Thread. Udta Freud and the surgical campaigns of cocaine hydrochloride.

"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," wrote Sigmund Freud, in 1884, to Martha, his affianced beloved.

Freud was then the resident physician of the nervous diseases ward of Vienna General Hospital. His day’s work involved a chorus line of neurological refuse: the brainsick, the batty, the screechers, the catatonics too transfixed to know 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 putting together the first seminal treatise on the history, uses and effects of a magical drug that had, for a year, beckoned him 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 Darmstadt, 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 anesthetic 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 anesthesia.

A fellow Jew and cocaine zealot, Carl Koller, Freud’s colleague from the same hospital, an intern in Ophthalmology, around the same time, was allowing the white powder to numb his own lips and putting cocaine solution into the eyes of dogs 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 climax, a live mutt was brought into the amphitheatre to have its cocainized 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 4% 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 anesthesia. A solution of cocaine was injected into the jawbone from inside the mouth, above the last molars, which Halstead knew (from cadaveric dissections) was the realm of the 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 double 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 (he was now shooting in his veins, entirely for recreation), sallied forth, operating relentlessly. That year, a thousand surgical procedures were performed by him entirely under cocaine anesthesia

Halstead was injecting cocaine into the nerve plexus at the root of the neck of his patients to paralyze the upper limb and render it insensate for surgery; into the sciatic and tibial nerves for the lower limbs; into the nerves of the penis.

And showboating his technique across hospital amphitheaters in New York. It was cocaine-fuelled surgical libertinage. In front of a New York theatre audience.

Halstead wrote about those thousand cases in the New York Medical Journal in 1885. The paper titled Practical Comments on the Use and Abuse of Cocaine 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 almost unappeasable.

There were occasions when the cocaine crash came in the thick of surgery; he would 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 cauterization 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.

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.

The clinical material for this therapeutic experiment was supplied by Freud from his fledgling practice. At this point, Freud was cocaine-dependent himself. His own cocainized nasal passages were a piece of work - honeycombed with purulent sores and debris from daily insufflation

The experiment came to an abrupt end when they almost killed Emma Eckstein, one of Freud’s patients, who sought treatment for dysmenorrhoea 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 meter of gauze, and forgot all about it. The resultant suppuration brought her to the brink of septicemia.

Freud, who was taking care of her postoperatively, continued to cocainize her for pain. After a month, when her face was unrecognizable from all the purulence, he called in another surgeon to intervene. 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 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.

Halstead never really weaned himself off cocaine; chased its comedowns with a lot of morphine, but never gave up the habit. His legions of students maintained that it was very fortunate for American surgery that he acquired it.

The same can also be said for Freud, whatever one’s slant on him: charlatan-quack, Viennese prefigurement of Baba Ramdev, seer.

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.