Cocaine and Chloroform: Technologies of Pain and Progress in Victorian Medicine

This is a guest post by Dr Douglas Small, a Wellcome Trust Research Fellow in Literature and Medicine at the University of Glasgow and the author of ‘Sherlock Holmes and Cocaine: A 7% Solution for Modern Professionalism’ (English Literature in Transition, 58.3, 2015), and ‘Masters of Healing: Cocaine and the Ideal of the Victorian Medical Man’ (Journal of Victorian Culture, 21.1, 2016). Dr Small is currently preparing a monograph on the cultural history of cocaine in the late nineteenth and early twentieth centuries.

Nowadays, we tend to be most familiar with cocaine through narratives of addiction and criminality. The destructive excess of Scarface’s Tony Montana, Nancy Reagan’s earnest plea for young America to ‘Just Say No’, and the National Crime Agency’s recent ‘Every Line Counts’ campaign define modern conceptions of the drug. It was in the late Victorian period, however, that cocaine first came to widespread public attention, and at the time it was understood predominantly as a triumph of modern surgical technology: the world’s first practical local anaesthetic.

Albert Niemann had isolated the cocaine alkaloid from raw coca leaves as early as 1860, but it was only in 1884 that the Viennese Ophthalmologist (and friend of a young Sigmund Freud) Carl Koller discovered that a mild solution of the drug would, if introduced into the eye, deaden the nerves’ sensitivity to pain. Koller was too poor to afford the trip to the Heidelberg Ophthalmological Society’s annual conference himself, so he had to ask his friend Dr Joseph Brettauer to announce the discovery on his behalf. Koller might not have been present to witness his colleagues’ reactions first hand, but the result was that both he and cocaine were to become two of the premier medical celebrities of the age.


Cocaine Syringe

In the first six months of 1885, over sixty pieces on cocaine appeared in the pages of the British Medical Journal. Henry Power, president of the British Medical Association’s Ophthalmology Section, wrote that ‘in the discovery of cocaine, a new era seems to have dawned.’ Simeon Snell affirmed that the drug had ‘immediately wrought a complete revolution’ in medicine, and the doctor and journalist Alfred J H Crespi wrote in The Gentleman’s Magazine in 1889 that cocaine was ‘a discovery to captivate the imagination of mankind.’

Likewise, within a few months of the discovery, headlines also appeared in the popular press announcing ‘The latest cocaine miracle.’ The Scotsman newspaper evinced an almost religious veneration for the new drug, declaring: ‘[Christ] is the patron of infirmaries, hospitals and homes, and cocaine is one of the blessed instruments of his pain-removing and peace-instilling mission.’


The Problems of Painlessness

Cocaine’s miraculous character was in large part sustained by how favourably it compared with existing general anaesthetics. Unlike chloroform and ether, which stupefied recipients, cocaine seemed to eliminate pain with a simple touch or hypodermic injection, and without any loss of consciousness. Chloroform had been widely-used as an anaesthetic for almost forty years by the time cocaine reached its ascendancy, but the danger of anaesthetic death remained a constant concern in the minds of surgeons and patients alike. Dr J McNamara penned a somewhat melodramatic letter on the subject to the British Medical Journal in October 1894. McNamara’s letter began: ‘The records of death by chloroform are monstrous in their frequency.’ And ended: ‘Is it not time to discard the lethal chloroform, and thus put an end to the human sacrifice that is weekly offered on [its] alter?’ If Doctors were cautious of general anaesthesia, then patients were often even more so. Until the end of the century, it was not unusual for doctors to encounter patients who were so intensely afraid of chloroform that they would simply refuse to take it.


Ether Inhaler, c. 1900

The mortal dread of chloroform was also accompanied by the moral dread of scandal. Various medical commentators warned of the dangers of leaving male doctors alone with unconscious female patents. George Foy, author of “Anaesthetics Ancient and Modern” (1889) counselled his readers:

‘One of the most annoying results from [general] anaesthesia is the production of erotic hallucinations, which occur during recovery from the narcosis; and, as is the rule in subjective impressions, they are very vivid. This danger, if there were none other, would be sufficient to necessitate the presence of a second medical man during the administration of an anaesthetic.’

In The Young Practitioner (1890) Jukes De Styrap, issued a similar warning to those embarking on a medical career. ‘In all cases in which it is necessary to produce anaesthesia,’ wrote De Styrap, ‘take care to have another practitioner present, more especially if the patient be a female, with the view, moreover, to disprove, if necessary, possible hallucinations in regard to improper language or action, and so to avoid scandal.’


The Cocaine “Solution”

Cocaine by contrast could expunge pain without expunging consciousness; it had the potential not only to preserve life but also to preserve propriety. As such cocaine was often figured in contemporary sources as the final refinement – or perfection – of a previously imperfect branch of medical science. When cocaine first appeared, the Wesleyan-Methodist Magazine called it ‘the Ultima Thule of anaesthetics’. Chambers’s Journal put it even more strongly. In March 1886, the magazine described the alkaloid as free from the ‘blemishes’ that had previously besmirched ether and chloroform, and wrote that ‘cocaine is apt to produce impressions akin to the marvellous … in all branches of medicine and surgery.’ The piece concluded:

‘In an age when a surfeit of new discoveries seems to have bred the familiarity which produces contempt, it is refreshing to draw attention to a discovery which has surpassed the ordinary standard of greatness sufficiently to enable it to figure as a wonder of the age. Cocaine has flashed like a meteor before the eyes of the medical world’.

In contrast with older anaesthetics, cocaine seemed haloed, ‘like a meteor,’ with the celestial light of modern efficiency. For the last decades of the nineteenth century, cocaine offered the promise of a new age of medical innovation, an era in which pain could be conquered, surgery effortlessly undertaken, and morality immaculately preserved.

--Douglas Small