Cocaine

If today it’s impossible to imagine surgery without narcosis, then medicine in general is impossible without cocaine. It is the basic component of local anaesthetics (novocaine, tetracaine, trimecaine, lidocaine and others), without which dentistry, surgery, traumatology, gynaecology, oncology, neurology and other disciplines can’t be imagined.

The conquerors of South America — Spanish conquistadors — have noticed that locals, Peruvians, descendants of the Ancient Inca, easily bore pain, hunger and hard physical work after chewing coca leaves. Travellers brought coca leaves in Europe. In 1859, in the laboratory of a famous German chemist Friedrich Wöhler (1800–1882) in Göttingen, his pupil, Albert Niemann (1834–1861), first determined the main active substance that reduces sensitivity of nerve endings — an alkaloid cocaine. Soon Niemann died, never finished the initiated work. Later his colleague Wilhelm Lossen (1838–1906) managed to obtain cocaine in its pure form.

An Austrian neurologist Sigmund Freud (1856–1939) carried out experiments with cocaine. He was putting cocaine on his tongue, and it was losing its sensitivity. Freud has written about his experiments with cocaine in one of his studies, but hasn’t made any practical conclusion, which (if made) would have led to the discovery of cocaine’s significance for medicine.

This step was made by a Russian pharmacologist and physiologist professor Basilius von Anrep (1852–1927). After a thorough study of cocaine, he discovered its local anaesthetic activity and in 1879 suggested to use it in medicine. Later, in 1884, a Russian ophthalmologist Ivan Katsaurov (1855–1914) and his Austrian colleague Karl Koller (1857–1944) used it as a local anaesthetic for eye surgery (1884).

Next step was made in 1890s — a German surgeon Carl Schleich (1859—1922) added cocaine to 0.05% solution of salt obtained an anaesthetic solution, which can be kept in vials for long. Schleich used the new method for removing tumours, amputations, lancing of abscesses — all of this he did without narcosis and absolutely painlessly for a patient. Daily the physician performed 10–12 such operations.

In April 1892, the International Congress of Surgeons took place, on which Schleich told his colleagues about the discovery of local anaesthesia. Nevertheless, the method didn’t win approval. However, ambitious Schleich continued research, as he understood that only toxicity prevents wide application of cocaine in medicine. Meanwhile, all across Europe the number of doctors who used his expertise was growing.

Toxicity of cocaine has always been daunting physicians. The possibility of narcotic addiction has also been threatening (by the way, that’s why Sigmund Freud didn’t want the episode of his ardour for cocaine to appear in memoirs and biographies).

Novocaine, obtained from cocaine by Alfred Einhorn (1856–1917) in 1905, has promptly displaced the latter owing to lower toxicity (16 times less). In addition, it has a good anaesthetic effect stability during sterilization. Later on basis of cocaine tetracaine, trimecaine, lidocaine and other local anaesthetics were synthesized.

The discovery of the means of general and local anaesthesia signified the end of fight for pain relief. All the following achievements in this field have become only their improvements and additions.