Monday, February 1, 2016

Cocaine Comes to Alabama in 1884

In an earlier post on this blog I wrote about early anesthesia in the state. I noted that Dr. William Sanders of Mobile had reported the use of cocaine for local anesthesia in 19 eye surgeries in April 1885. Apparently that drug had been used for a similar purpose several months earlier in Montgomery.

In September 1884 Carl Koller's use of topical cocaine for eye surgery was reported in Germany. The use of cocaine for local anesthesia reached America in a matter of weeks, and surgeons in New York and elsewhere used the method both on patients and in self-experiments. Several of these doctors, including the great William Halsted, became addicted. At the time of his discovery Koller was a surgeon in Vienna and a colleague of Sigmund Freud. 

By the end of 1884 more than 180 articles had appeared in the world medical literature describing cocaine use for local anesthesia in eye, nose, throat and other areas. A newspaper article in the Montgomery Advertiser in late November 1884 noted use by a local doctor named B.J. Baldwin.

That article is reproduced in full below from its reprinting in the Huntsville Weekly Democrat of November 26, 1884. Baldwin was apparently Benjamin James Baldwin. He appears in the listing of Montgomery County physicians in the 1889 Transactions of the Medical Association of the State of Alabama. He is identified as a medical school graduate of "Bellevue" in 1877. That apparently means Bellevue Hospital Medical College, which operated in New York City until 1898 when it merged with New York University. Baldwin was certified via exam by the Montgomery County medical board of examiners in 1883. 

Baldwin was born in Montgomery on February 6, 1864. He became a prominent figure in state medical circles. In 1892 he served as President of the Medical Association of the State of Alabama. His presidential address at the annual meeting in Montgomery in April of that year can be found here. Baldwin died on June 9, 1936, in Chilton County. 

Here is the entire Montgomery newspaper article as reprinted by the Huntsville Weekly Democrat. The author has the chronology of ether and chloroform anesthesia development reversed. Efforts to use nitrous oxide and ether as surgical anesthetics culminated in October 1846 in Boston when William Morton provided ether inhalation for a patient of surgeon John Collins Warren. Simpson and colleagues did not establish the anesthetic properties of chloroform until November 1847.

The article notes about cocaine, "Its discovery marks a new era in surgery" and that is very true. Koller's work with that drug inaugurated decades of clinical use and research into various other drugs for local and regional anesthesia; and the techniques enjoy wide medical application today. The many wounded Civil War soldiers who became addicted to morphine and then the quick spread of cocaine into the non-medical population in the late 1880's also created the kinds of addiction issues society deals with to this day.

The "poet Cowley" who is quoted in the article is Abraham Cowley [1618-1667], an English poet and essayist. His 1662 poem "A Legend of Coca" is one of the earliest mentions of the coca plant in English literature. The entire poem can found in Mortimer's 1901 book Peru.History of coca on pages 26-27 here. And now the article:

The science of medicine has made another step towards the relief of pain, and this time it comes through an humble medical student of Vienna. England can boast of the discovery of chloroform, and, through it, the relief of millions of sufferers. The name of Sir James Y. Simpson, it discoverer, will live through eternity and the statue erected to his memory in Westminister Abbey tells the thousands of visitors who walk through its sacred halls in what esteem the mother land holds this great benefactor. America can claim the discovery of ether a few years later, and while its discoverers have not been rewarded as was Sir James Y. Simpson, yet our people bow in reverence and gratitude to Wells, Long and Morton. 

It does not detract from the great blessings which ether and chloroform bestow upon human race, for they both have their special places, to say that the new German anesthetic for certain purposes has entirely supplanted them. About one month ago Dr. Koller, a student in a Vienna hospital, gave the startling news to the medical world that, by dropping a few drops of the Hydrochorate [SIC] of Cocaine in the eye any operation could be performed without pain and that the same was true of other parts of the body. 

American surgeons at once cabled to Germany for a supply of this marvelous drug, but only succeeded in getting a small amount. Last week, Dr. B.J. Baldwin, of this city, received a few grains from New York and under its influence performed eleven operations on the eye with entire satisfaction and absolutely without pain. 

The Cocaine is dissolved and dropped into the eye at intervals of five minutes until it has been used four times. It produces no pain, and leaves no unpleasant after effects. It seems to act by destroying the sensibility of the parts to which it is applied, but it does not, like chloroform, produce unconsciousness. Its discovery marks a new era in surgery and its action is the marvel of the medical age.

A short history of Cocaine in this connection will prove interesting. Cocaine is obtained from the leaves of the ordinary coco plant which is found wild in the mountains of Peru and Bolivia. The natives of the Western countries of South America chew these leaves as a stimulant when fatigued. So much vaunted is the coco as a stimulant that the poet Cowley represents an Indian chief as addressing Venus thus:

"Our Varichoca first this coco sent,
Endowed with leaves of wondrous nourishment,
Whose juice suck'd in, and to the stomach taken,
Long Hunger and long Labor can sustain,
From which our faint and weary bodies find
More succor, more to cheer the dropping mind
Than can your Bacchus and your Cerea joined.
The Quitoitla with this provision stored,
Can pass the vast and cloudy Andes."

It was used by the Indians of Peru in ancient times as an offering to the sun, and it is still held in veneration by the miners, who believe it has a softening effect upon the veins of one when chewed and thrown upon it. The cost of ordinary coco is very little, but he hydrochlorate of cocaine is very expensive. At present it is only manufactured by one firm, in Germany, and it costs two hundred and forty dollars an ounce or three thousand eight hundred dollars a pound. 

It will probably become cheaper when other chemists begin to manufacture it. The discovery of the action of cocaine is regarded by the medical profession as more wonderful than chloroform. Let suffering humanity build a mountain of gratitude to this humble medical student of Vienna. Though scarcely out of his teens Dr. Koller is now famous over the civilized world, and the good he has done is a greater glory than the crown of his own Imperial Land.  

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