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Freud, Sherlock Holmes and Coca Cola: the cocaine connection

The two most significant figures in the cocaine story are world renowned, but not for their connection with cocaine. The individual responsible for the introduction of cocaine into medicine, albeit indirectly, went on to other and greater things, his life work fundamentally changing our views of ourselves and the world. The other did not even exist, although there are plenty of devotees who behave as if he did.

The Pharmaceutical Journal Vol 265 No 7128p915-917, December 23/30, 2000 Christmas miscellany

By Ray Sturgess, MRPharmS

If it is surprising how long it took for cocaine to find its way into medicine as an anaesthetic, the identity of the individual responsible for its introduction is startlingly more so. Even given the information that at the time - the late 1880s - he was a young, debt-ridden, Jewish doctor in Vienna, anxious to find some means of achieving fame and fortune. It is still something of a shock to learn that his name was Sigmund Freud.

In 1883, when Freud, aged 27, first became interested in cocaine, he was struggling to make a living and repay his debts, and a future in psychiatry was the last thing on his mind. His curiosity about the drug was aroused by two reports on the stimulant action of cocaine, one published in 1859 by an Italian neurologist, Paolo Montegazza, who had himself experimented with coca leaves and believed that they improved digestion and increased mental alertness and physical vigour. The second report had just been published by a Dr Theodor Aschenbrandt describing how he had surreptitiously laced with cocaine the drinks of Bavarian soldiers on manoeuvres and shown that the drug increased physical endurance under strenuous conditions.

Freud may also have seen reports from the United States claiming the successful use of cocaine in the treatment of morphine addiction. He was certainly interested in finding such a cure, since his friend Dr Ernst von Fleischl-Marxow was trying to rid himself of morphine addiction acquired when he had taken the drug to relieve the pain after a thumb amputation. Von Marxow had lent Freud money to embark on his medical career and Freud, not able to repay him, tried in return to help him by treating his addiction, and after less than a month of self-experimentation with cocaine, Freud put his friend on to the drug. Believing he was on to something big, Freud wrote to his fiancee, Martha Bernays, that he not only hoped to cure his friend, but, by demonstrating a novel use for cocaine in Europe, to gain fame and financial security so that they could marry.

The result of the experiment was that von Marxow became addicted to cocaine and not long afterwards died in misery and pain. By this time, however, Freud had become a cocaine convert and, convinced that the drug had cured his own depression and stomach cramps, and still seeing it as the means to fame and fortune, preached its benefits for heart disease and nervous exhaustion, apparently unperturbed that these conditions had not been mentioned in the published reports nor were likely to have been encountered in Aschenbrandt’s strapping soldiery.

It was after a visit to Martha and while he was still extolling the virtues of cocaine for a wide variety of conditions for which its value had not been - and never was - established, that Freud treated a colleague suffering from intestinal pain with a 5 per cent solution of the drug. When the friend reported to Freud that the solution had numbed his lips and tongue (it is not reported if it helped his bowel ache) a third colleague was present, ophthalmologist Carl Koller. Koller went straight back to his laboratory, prepared a solution of cocaine and instilled it into the eye of a frog, and found that after a short interval the animal’s eye was insensitive to touching with a probe or to the application of heat or electricity.

Koller went on to try cocaine in his own and his assistant’s eyes and realised that he had found an agent that was not only an effective analgesic in painful eye conditions but, more importantly, would produce the local anaesthesia required for eye surgery. Koller, always with an eye to the main chance, straightaway carried out eye operations following anaesthetisation with cocaine, and after publishing an account of his successes became internationally famous, being dubbed, in a humorous reference to the American soft drink, Coca Koller.

Freud’s enthusiasm for cocaine as a cure-all gradually waned, although he continued to take the drug himself, probably to blot out the twin frustrations of poverty and failure that had been made worse by the burgeoning international stature of Koller, exasperatingly based on the drug Freud felt that he had pioneered. There is evidence that Freud had noticed the numbing effect of cocaine and had wondered about its suitability as a local anaesthetic at about the time of his visit to Martha. Even if this was the case he quite unfairly blamed Martha for enticing him away, claiming that had he not been absent from Vienna at a critical time, he and not Koller would have gained the plaudits.

Freud’s grievance may be put down to the frustrated ambition of a talented young man, but what is less understandable is that even after he had won an international reputation and many honours himself, he continued to let the cocaine episode rankle. Forty years later in his autobiographical study, after decades of marriage to Martha, he wrote: “I may here recount, looking back, that it was my fianc?e’s fault if I did not become famous in those early years.”Would Freud at the end really have preferred to be remembered as the discoverer of cocaine anaesthesia rather than as the author of The interpretation of dreams, the discoverer of the ego and the id, the founder of psychoanalysis? Such was Freud’s self-doubt and pessimistic view of man’s nature, that it is possible. Cocaine anaesthesia was an undisputed practical benefit. Only he could fully appreciate what a can of worms, in the form of the human psyche, his life’s work had opened up.

As was to happen with nitrous oxide, it was entrepreneurs who discovered the benefits of cocaine before the medical profession realised its potential. In 1863 in Paris, Angelo Mariani began selling his Vin Mariani, a tonic wine containing coca leaf extract that was soon the rage in the capital’s artistic circles. The tonic’s fame spread quickly, and before long men eminent in many fields, including Thomas Edison, Robert Louis Stevenson and Jules Verne, were singing its praises and it even hit the papal bull’s-eye with Leo XIII.

It is difficult to think of a pharmacist who has become a household name (who now remembers Jesse Boot?), but perhaps John Styth Pemberton came nearest when he concocted a soft drink based on an extract of coca leaf in Atlanta, Georgia, in 1885. He had settled in the Georgia capital in 1869, following service as a cavalry troop leader during the Civil War, and was soon producing Triplex Liver Pills and Globe of Flower Cough Syrup, but he had to wait for success until he formulated his coca leaf drink, which he at first called French Wine Coca. Within a few months of its launch, Pemberton ? who favoured the title Doctor ? formed the Pemberton Chemical Company and recruited the services of Frank M. Robinson as book-keeper. Robinson was efficient at his job and had another invaluable talent: he soon had a reputation for analysing the constituents of a batch of syrup merely by sniffing it. Before he put his French Wine Coca on widespread sale, Pemberton modified it by taking out the wine and adding a pinch of caffeine. The resulting tonic tasted less than pleasant and Pemberton added kola nut extract and some oils as flavouring before starting production in a three-legged iron pot in his back yard, stirring the concoction with an oar. He changed the name to Coca Cola and launched it in 1886, the year which, as the present Coca Cola company directors like to point out, saw the unveiling of Sherlock Holmes and the Statue of Liberty.

Pemberton managed to sell only 25 gallons of Coca Cola syrup ? distributed as a concentrate that was diluted and carbonated at the point of sale ? in the first year, and in 1867 he sold a two thirds interest in the business to two druggists for $1,200, disposing of the remaining third (thereby forgoing his chance of really becoming a household name) the following year. Further changes of ownership led to the company being acquired by another pharmacist, Asa Griggs Candler, who in 1903 had second thoughts about selling a cocaine drink to millions of young Americans and decided that the cocaine had better be extracted from the coca leaves before they were put into the drink. It was more profitable too, since the extracted cocaine could be, and still is, sold to the pharmaceutical industry.

The most famous cocaine user ? some would say addict ? never lived. He was of course the oddball with the pipe, deerstalker hat and uncanny intellect, Sherlock Holmes. Why Holmes was made to develop a cocaine habit, Arthur Conan Doyle never revealed, and it is not possible to suggest an explanation without taking a look at the character and life of his creator. There were two facets of Doyle’s character that fitted him for a career as a writer: a discontent with the established order of things and an unusually wide range of experience for the son of a poor family. He regarded with disfavour both his educational institutions, Stonyhurst College (how the family afforded to send him there has never been explained), with its Jesuitical austerity and aloof masters, and the faculty of medicine of Edinburgh university, which Doyle judged harshly considering it was there that he got a good medical education and also to know the character who would later serve as the model for Holmes. Nevertheless, he came out of medical school feeling something of an outsider.

Doyle’s unusual travels also helped to set him apart from the run-of-the mill Victorian doctor. They were undertaken out of necessity: he needed the money. This incentive led him to take time off from his medical studies to embark on a whaling ship sailing for the Arctic, although unqualified, as ship’s doctor, and later, immediately after qualifying, signing on as ship’s surgeon on a boat bound on a port-hopping run with passengers and cargo along the coast of West Africa.

Doyle had inherited creative genes. His father Charles was the only failure in the family, the other brothers? artistic abilities securing them comfortable lives in London while Charles toiled away in a dull and poorly paid post in the civil service in Edinburgh, where his lack of ambition, a succession of children and addiction to the bottle kept the family impoverished. It was Conan’s mother Mary who kept the family afloat and who encouraged her talented son to get on, and although in later life the son made allowances for his father’s addiction, alcoholism remained repugnant to him, and several villains in the Holmes stories are alcoholics.

Doyle seems to have been both born and shaped to become a writer, but how did he arrive at Holmes? The accepted version is that he became influenced by Auguste Dupin, the detective in several of Edgar Alan Poe’s stories. Having decided to write a detective novella, A study in scarlet  it was meant to be a single tale, Doyle at that stage not envisaging a series ? he based his investigator on Joseph Bell, the lecturer in clinical surgery whose dramatic style of observation and deduction had so impressed him at Edinburgh. Doyle had recorded several examples of Bell’s deductive reasoning in case notes, including this:

Bell, questioning a civilian male patient: Well, my man, you?ve served in the army?
Patient: Aye, sir.
Bell: Not long discharged?
Patient: Aye, sir.
Bell: A Highland regiment?
Patient: Aye, sir.
Bell: A non-commissioned officer?
Patient: Aye, sir.
Bell: Stationed in Barbados?
Patient: Aye, sir.

Bell’s explanation had been that the man was respectful but did not remove his hat, an army habit that would have gone by the board unless the man had been recently discharged. The man had an air of authority but not superiority, which indicated his non-com rank, and he was obviously Scottish. As to Barbados, his complaint was elephantiasis, a disease found in the West Indies but not in Britain.

There are some holes one could pick in this reasoning - neither elephantiasis nor the British army were confined to Barbados - but Bell was remarkable, perhaps unique, at a time when most hospital patients were regarded as mere bodies for examination, diagnosis and treatment. Bell’s style, together with his essential altruism, does seem to provide enough substance for the idea that he was the real-life precursor of Homes.

There was another factor. Once Doyle had set up in practice in Southsea, away from the teeming streets of London he loved, he found his life constrained by the twin chains of poverty and boredom. He had only a few patients a week and had to sit through long hours with empty surgeries. He lived on a shilling a day and slept in his coat on a mattress made from the straw which his first consignment of drugs had been packed in, the only furniture he possessed being needed for the surgery and waiting room. After the freedom of student life and voyages at sea, being cooped up in this way was made tolerable by living in the imagination as the bachelor of 221B Baker Street, the eccentric intellectual who was free to pursue and bring to justice a series of sinister criminals.

Doyle was instinctively a master story teller and sensed that Holmes must be unique and distinct from the other fictional detectives pouring from the pens of Victorian authors. He made Holmes superior to his fellow men, arrogant, a believer in scientific method, yet a Dionysian and an aesthete. To add to his uniqueness Holmes was to be a drug user, and opium must have crossed Doyle’s mind as a possibility. One or two highly creative individuals had been opium addicts, notably Thomas De Quincey, who had gained fame as well as notoriety in the 1820s on the strength of his best-selling Confessions of an English opium eater, and his more seriously addicted friend Samuel Taylor Coleridge. But opium had become the drug of the masses, found in most homes as the standard remedy for diarrhoea, and the only effective analgesic (aspirin did not appear until 1897). By contrast, cocaine was at that time the drug of the smart set, the artistic and intellectual elite, a mental stimulant untarnished by the images of low-life depravity in smoke-laden dens associated with opium. Holmes? addiction served one other valuable function: it made him appear flawed and the reader less overawed by his superiority. Cocaine addiction may not have been a laudable aspect of Holmes’s character, but by choosing it as the detective’s prime weakness, Doyle played something of a masterstroke.

Even when he had given up medicine for writing, Conan Doyle kept abreast of the developments in the medical profession and when, in the 1890s, the dangers of cocaine addiction began to receive publicity, Doyle responded by making Watson’s criticisms of Holmes’s habit, something he had always disapproved of, stronger and more reformist: “I gradually weaned him from that drug mania which had threatened once to check his remarkable career.”Even Holmes, earlier having confessed his reliance on cocaine for stimulating and clarifying his mind, is made to say that he found his hypodermic syringe an instrument of evil. Not that the reading public were critical of Holmes’s addiction. All they wanted were more Holmes stories and when Doyle had Holmes killed off by Moriarty in The adventure of the final problem there was a public outcry and 20,000 subscibers cancelled their orders for the Strand Magazine. When, eight years later, Doyle resurrected Holmes in The hound of the Baskervilles, the magazine’s circulation shot up by 30,000 and long queues formed outside the offices of the publishers and the nation’s newsagents. What mattered Holmes’s weakness for cocaine, the public reckoned, compared with the pleasure he gave?

Now that the full facts of cocaine addiction are known, we allow Holmes his idiosyncrasy, but for the world at large we can no longer take such a tolerant view.

Further reading

  1. Gay P. Freud: A Life for Our Time. London: Dent; 1988.
  2. Booth M. The doctor, the detective and Arthur Conan Doyle. London: Hodder; 1997.
  3. Kahn EJ Jr. The big drink: an unofficial history of Coca Cola. London: Max Reinhardt; 1950

 

Ray Sturgess is a pharmacist from Knaresborough, North Yorkshire, with experience in the pharmaceutical industry and in community pharmacy. He has now retired and writes on health-related matters

Citation: The Pharmaceutical Journal URI: 20003901

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