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THE ELIXIR OF LIFE
Just as the visions of opium or hashish were not contained in the drugs
themselves but in the otherwise inaccessible dimensions of mind to
which they allowed access, the increase of physical and nervous energy
on cocaine might be the product of a mind optimised to a higher pitch
of functioning.
If this hypothesis was true, it should be measurable, and Freud
turned next to the brass-instrument experimentation favoured by his
professor, Ernst Brücke. Euphoria was a subjective sensation, but
mental or physical energy generated by it should have objectively
measurable correlates. Cocaine, as Freud had already learned from
trying it on a handful of friends and colleagues, had different effects on
different subjects; it should therefore be possible to show whether the
increase in physical energy correlated simply with the dose administered, or whether those who experienced greater euphoria also evinced
a more powerful stimulant response. To test this, Freud had the use of
two experimental devices: a dynamometer, which measured the pressure exerted on it and locked its needle at the point of maximum pressure, and a neuroamoebimeter, a vibrating metal strip that registered
reaction times. It was the first and, as it turned out, the only time that
Freud ever experimented on living human subjects: predominantly on
himself, as his response to cocaine seemed more predictable and more
positive than those of the volunteers he enlisted.
In January 1885 he published his results in a short paper,
‘Contribution to the Knowledge of the Effect of Cocaine’. From his
tabulated columns of dates, doses, mechanical pressures and reaction
times he was able to demonstrate that the subjective sense of increased
strength and energy induced by cocaine was objectively real: when on
the drug, he and his volunteers exerted more pressure on the dynamometer, maintained it for longer and had faster reaction times. He was also
able to demonstrate that this increase in energy began as soon as the
rush of euphoria was felt, which was before most of the drug had been
absorbed into the bloodstream. From this he concluded that cocaine’s
stimulant action was not produced directly by the nervous system
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but was ‘indirect, effected by an improvement of the general state of
well-being’.
87
Freud’s hybrid methods, like his hybrid literary style, had produced
a striking outcome: he had used physical measurement to track a
subjective alteration in consciousness, and produced objective data to
suggest that the mind was the source of a physiological effect. Around
this time he switched from dissolving his cocaine in water to sniffing
the powder. This was a far more cost-effective route: the drug is partially
broken down and rendered inactive in the stomach, but the nasal
membranes relay it directly into the bloodstream. Sniffing also makes
the onset of its effects more rapid and pronounced.
By now medical and pharmaceutical interest in cocaine was on the
rise, and other physicians were beginning to hail it as a miracle
drug. Parke, Davis were expanding their supply and range of preparations; John Pemberton, a patent medicine entrepreneur in Georgia,
announced a new cocaine-based beverage, Coca-Cola, touting it as ‘a
great invigorator of the brain’.88 ‘Über Coca’ was reprinted, and Freud,
whom interested doctors and pharmacists now considered the leading
medical authority on the drug, was working on an expanded version.
His ingenious experiments had squared the circle of objectivity and
introspection; his innovative writing style captured the subjective
sensations of cocaine while his laboratory work underpinned them
with quantitative data. He had in his sights a cure for the nervous
disease of the age, a performance enhancer to correct the growing
disparity between the powers of the human mind and the demands of
modern life, and the world was racing to catch up with his discoveries.
What could possibly go wrong?
62
CHAPTER TWO
PROSTHETIC GODS
mong the colleagues Freud had enlisted in his dynamometer
experiments was a young intern in Vienna Hospital’s ophthal-
A
of cocaine in water, both noticed the instantaneous numbing sensation
around the lips and throat that Freud had described after his first experiment. Köller, however, was particularly attentive to it. His consuming
professional interest was in optical physiology – to the extent that Freud
privately found him rather a bore – and he grasped immediately that
this might make cocaine invaluable for eye surgery. Even the most
powerful analgesics were unable to prevent reflex twitching and blinking,
making common procedures such as removing cataracts almost unendurably painful. Köller’s hunch was easily validated: he dripped cocaine
solution into a frog’s eye and established that he could touch its bulging
cornea without making it blink. He promptly arranged a demonstration
where, in the presence of witnesses including a senior ophthalmologist,
he repeated the procedure with a dog.
Society on 17 October 1884. ‘Cocaine’, he announced, ‘has been
prominently brought to the notice of Viennese physicians by the thorough compilation and interesting therapeutic paper of my hospital
colleague Dr Sigmund Freud.’1 Freud was initially thrilled that ‘a
colleague has found a striking application for coca in ophthalmology’:
his new discovery was on the march. But it gradually became clear that
this was to be cocaine’s only uncontroversial medical application, and
mology department, Karl Köller. As they swallowed their doses
Köller’s paper on his discovery was read before the Vienna Medical
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that Freud had been relegated to a minor supporting role. He had been
the first to propose it in print: ‘Über Coca’ concluded with a series of
therapeutic suggestions for the drug, the last paragraph of which had
noted that its ‘marked anaesthetising effect when brought into contact
with the skin’ might lead to ‘a good many further applications’.2 As
Köller’s career took off, Freud began to wonder why he himself had not
taken the step, obvious with hindsight, of applying his suggestion to
surgery. On occasion he cursed himself for his laziness; later, unchivalrously, he blamed Martha’s distracting influence. Forty years later, he
concluded that the root cause was that cocaine had ultimately been a
distraction from his specialism in neurology and he had never properly
committed his attention to it. To the extent that his investigation of
cocaine had been an opportunistic pursuit of career advancement, it
was ironically fitting that the prize should go to another. Köller rode
his success to a lucrative ophthalmology practice in New York; in later
life Freud drolly referred to him as ‘Coca Köller’.
The episode carried a curiously precise echo of Humphry Davy’s
nitrous oxide researches. In his Researches Chemical and Philosophical
(1800), Davy had made a very similar suggestion, that the gas was
‘capable of destroying physical pain’ and consequently could ‘probably
be used with great advantage during surgical operations’.3 But the
suggestion went no further, and by the time nitrous oxide anaesthesia
emerged fifty years later it had been all but forgotten. Both Davy and
Freud were absorbed by the novel states of consciousness they were
exploring, and the profound questions they raised about the nature of
the mind and its relations to the body – specifically, in both cases, the
nature of the connection between chemical stimulus and pleasure.
Both were interested in measuring and recording physiological data,
but their primary focus was introspective, mapping previously unexplored landscapes of thought and sensation.
Freud may have been slow to appreciate the importance of Köller’s
discovery, but it acted as an immediate spur to the nascent cocaine
industry. In the US, Parke, Davis ramped up production and by 1887
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they were one of several suppliers offering the pure drug at wholesale
prices that had dropped from a dollar a grain to as little as 2 cents.4 Six
months after the publication of Köller’s paper, the price of Merck
cocaine, already high at 6 marks per gram, had quadrupled, and Merck
followed Parke, Davis in importing crude cocaine extracts from the
Andes instead of shipping unprocessed coca leaves in bulk to Europe.
Under pressure from the US competition, Merck justified their price
hike by advertising that their cocaine was of the highest quality, a claim
they supported with Freud’s use of their product in ‘Über Coca’.
5
It was another of Freud’s therapeutic suggestions, however, that
tipped his cocaine researches from promise to disaster. As part of his
case that it was a remedy for nervous weakness and depression, he
relayed the claim with which Parke, Davis had originally launched the
drug in the USA that it was ‘an antidote to the opium habit’, removing
cravings and the pains of withdrawal.6 The evidence for this, as Freud
had noted, was largely drawn from the Therapeutic Gazette, Parke,
Davis’s in-house pharmaceutical journal, which now regularly published
case histories and testimonials of successful opium cures. These had
been a significant spur to Freud’s own researches, not least because he
had an experimental patient in mind.
In the letter to Martha in which he first announced his interest in
cocaine, he wrote that he intended to try it in cases of heart disease and
nervous exhaustion, and ‘particularly in the awful condition following
withdrawal of morphine (as in the case of Dr. Fleischl)’.7 Ernst von
Fleischl-Marxow was a brilliant older colleague of Freud, a junior
professor under Ernst Brücke at Vienna Medical School, where he had
made pioneering studies of electrical activity in the nerves and brain.
Freud idolised him; as he wrote to Martha, ‘I admire and love him with
an intellectual passion, if you will allow such a phrase.’8 For years
Fleischl had lived with a terrible injury. He had infected his right
thumb with a scalpel during an autopsy, and the subsequent amputation left him with nerve damage and constant, often excruciating pain.
He bore his condition stoically and as gracefully as possible, but by
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1884 he was relying on morphine to manage it, injected in ever larger
doses. His escalating drug habit, combined with the pain it only
partially suppressed, was destroying him.
Fleischl was one of the first to hear of Freud’s discovery of cocaine; he
was enthusiastic, and asked Freud to try the cocaine cure on him. The
effects were instantaneous: the pain disappeared, the cocaine lifted his
spirits and he was quickly able to reduce and then dispense entirely with
his morphine. Fleischl wrote a short note on the success of his case, in
which he theorised that opiates and cocaine were somehow antithetical
to one another. Freud, writing ‘Über Coca’ at the same moment,
included the case of an anonymous patient who had successfully substituted morphine for cocaine and ‘after ten days was able to dispense with
the coca treatment altogether’.
9
But the miracle was short-lived. Within a week, Fleischl was using
cocaine in quantities Freud had never imagined was possible. Over the
following three months, he returned to morphine while also using at
least a gram of cocaine a day, taking it by subcutaneous injection. He
was spending a hundred times more on it than Freud did even during
his periods of most regular use. He developed insomnia, paranoia, and
a nerve-shredding delirium in which he felt snakes crawling all over his
skin. Freud spent harrowing nights with him in which Fleischl talked
incessantly and crazily: ‘every note of the profoundest despair was
sounded’, leaving Freud wondering ‘if I shall ever in my life experience
anything so agitating’. Pain, exhaustion, morphia and cocaine: ‘all that
makes an ensemble that cannot be described’.
10
This was a dimension of cocaine that Freud’s cautious selfexperiments had entirely failed to uncover. Confronted every morning
with the embroidered injunction ‘If in doubt, abstain’ on his wall, he
had never felt the urge for more than ‘an effective dose’ of 50mg, nor
to follow one dose with another. Rather, he had noted ‘a slight revulsion’ at the prospect of taking a second dose before the first had worn
off.11 He had relied for his descriptions of high doses on Mantegazza,
who ‘experienced the most splendid and colourful hallucinations, the
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PROSTHETIC GODS
tenor of which was frightening for a short time, but invariably cheerful
thereafter’;12 Mantegazza, however, had been chewing coca leaves,
which set a practical ceiling on the quantity of cocaine he absorbed.
Depending on the potency of the leaf, his most extravagant doses probably amounted to around a gram spread over a day and an evening; and
his method of gradual ingestion, combined with the other alkaloids
and minerals in the leaf, muted the nervous effects that Fleischl’s
method of injection heightened. Freud’s experiments on animals had
shown that high doses produced undesirable physical effects – rise in
pulse and blood pressure, gastric upset – and he assumed that, as with
caffeine, higher doses would prove self-limiting.
Freud was, however, heavily invested in his belief that cocaine was a
miracle drug, a belief now shared by many of his medical colleagues. In
March 1886 Chambers’s Journal, a popular British review of the arts and
sciences, described it as a ‘discovery which has surpassed the ordinary
standard of greatness sufficiently to enable it to figure as one of the
wonders of the age’. In 1884, with Freud’s support, it ‘flashed like a
meteor before the eyes of the medical world, but, unlike a meteor, its
impressions have proved to be enduring’.13 It was being marketed in
various forms – a sniff or a syrup, a lozenge or a herbal cigarette – for a
huge range of conditions, and its public reputation and image reflected
the enthusiastic claims of its promoters. Its customers found symptomatic relief for bronchial and sinus conditions, and an elevated mood
into the bargain. In a modern world where fatigue and depression were
endemic, it promised miraculous relief from previously intractable and
chronic suffering.
It was equally popular as a mental stimulant, and doctors were among
the categories of brain-worker to whom it particularly appealed. In
October 1888, an article in the Edinburgh Review connected cocaine to
the heroic role required of medicine in the modern world. Doctors, it
argued, were busier than ever, with complex and demanding work that
afforded limitless stimulation ‘to the most enlightened and far-reaching
mind’. The modern practitioner ‘has scope for muscular exercise; he has
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always to be acquiring new information, which keeps the mental
organism employed’. In all these respects, cocaine was ‘invaluable as an
internal remedy’, boosting not only stamina and mood but intellectual
capacity.14 The vivid portrait Freud presented of the cocaine-enhanced
mind and body, firing vigorously on all cylinders to meet the demands
of the modern world, was a perfect fit with the self-image of the modern
medical profession.
* * *
Fleischl’s case was a medical first, though not in any sense that Freud
wished for. It was soon joined by others. In July 1885 the neurological
journal Centralblatt für Nervenheilkunde carried a commentary by its
editor, the physician and asylum superintendent Friedrich Albert
Erlenmeyer, describing the novel condition of cocaine addiction.
Erlenmeyer was the author of one of the earliest books on morphine
addiction and its treatment, and he paid close attention to new and
emerging forms of drug craving. The following year he wrote another
article for the Centralblatt pronouncing cocaine the ‘third scourge of
humanity’, after alcohol and opium. The third edition of his book
included a short passage crediting Freud as a pioneer of cocaine therapeutics and adding that ‘he recommends unreservedly the employment
of cocaine in the treatment of alcoholism’.15 It was a difficult accusation
to contest, especially once Ernst von Fleischl-Marxow had become the
first patient to be diagnosed with a dual addiction to morphine and
cocaine, acquired while under Freud’s supervision.
Despite opium’s great antiquity, addiction was a modern diagnosis.
It had been noted by classical Greek and Roman physicians and pharmacists that those who used opium regularly were obliged to increase
their dose, and it was fifty years since Thomas De Quincey had spelled
out the agonies of withdrawal in unsparing detail. Yet this factor
remained of less concern to doctors than the more acute danger of
opium, its narrow dosage window: only two or three times the effective
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PROSTHETIC GODS
dose could be enough to induce a potentially fatal respiratory depression. But opium – and, after around 1850, its more potent synthetic
extract, morphine – were too valuable for pain relief for doctors to
avoid them on these grounds. There were plenty of other drugs that
needed to be taken every day, and chronic use was a lesser concern in
an era when opium was widely available and relatively inexpensive.
In many respects Fleischl was typical of the first cohort to be diagnosed as ‘narcomaniacs’, later to be known as ‘drug addicts’. The condition was originally described by physicians who specialised in nervous
diseases and offered residential care to private patients, and was yet to
become familiar outside this milieu. It was first formulated during the
1870s as ‘morbid craving’ by doctors such as Eduard Levinstein, director
of one such institution in the Schöneberg district of Berlin. In 1877
Levinstein published the first book on the morbid craving for morphine
(‘Morphiumsucht’), describing its symptoms with reference to the case
notes of his patients, supplemented with animal experiments on dose
and toxicity. He saw the craving not as a mental disease, but a novel
addition to ‘the category of other human passions, such as smoking,
gambling, greediness for profit, sexual excess etc.’.16 He was equally
clear that it was not an intellectual deficit: in fact, many of his patients
were ‘authorities in military matters, artists, physicians, surgeons,
bearing names of the highest reputation’.17 If anything it seemed to
select its victims chiefly from the upper echelons of society – as, of
course, private clinics such as Levinstein’s did.
Addiction, in his view, was ultimately a by-product, or side-effect,
of modern civilisation: a consequence of advancing science, the accelerated speed of life, the global diffusion of knowledge, mass marketing,
consumer choice and individual freedom. As such it was curiously
symmetrical with the enervated state of neurasthenia that many of its
sufferers had first turned to morphine to cure. George Miller Beard
considered that the dangers of drugs had ‘greatly extended and multiplied with the progress of civilisation, and especially in modern times’.18
He grouped it together with other diseases of ‘overcivilisation’ – suicide,
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pre-marital sex, homosexuality – as an unwanted but inevitable
by-product of the inventions he saw as the core drivers of modernity:
the printing press, the steam engine and the telegraph.
As the number of cases grew and medical specialists proliferated, it
became clear that this disease of civilisation had two primary classes of
victim. One was wealthy private patients; the other was doctors themselves. In 1883 the American physician J.B. Mattison claimed that his
colleagues formed the largest group of habitués, or morphine addicts,
in the nation, and might include as many as a third of all physicians,
surgeons, dentists and nurses. By the early twentieth century, the
leading German pharmacologist Louis Lewin estimated, around 40 per
cent of addicts were doctors, and a further 10 per cent doctors’ wives.19
By 1886, cocaine was beginning to be considered by some doctors as
comparable in its dangers to morphine: as the British Medical Journal
put it, ‘we have already found out that this sweet rose of our therapeutic
bouquet has a bitter thorn’. It was particularly prevalent among anaesthetists and surgeons, the specialists who worked with it on a daily
basis. Its addicts did not suffer the same agonies of withdrawal as
morphinists, but it could be more insidious: the Irish addiction specialist
Conolly Norman wrote in the Journal of Mental Science in 1892 that
‘cocaine is more seductive than morphia; it fastens on its victim more
rapidly, and its hold is at least as tight’.
20
The dangers of morphine and cocaine were considerably magnified
by the modern method of administration that they shared. In the first
sentence of his book, Eduard Levinstein had noted that the new condition was intimately connected to ‘Pravaz’s method’ of subcutaneous
injection, named for the French surgeon Charles Pravaz who, in 1853,
designed and commissioned a hypodermic syringe, made entirely of
silver, to dispense 1 cubic centimetre of liquid through a fine, hollow
needle.21 The US Civil War and the Crimean War in Europe had
entrenched morphine injections in battlefield medicine, and during
the 1870s the Pravaz, together with morphine vials and tablets, became
an indispensable element of the doctor’s bag.
70