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April 6, 2011

Über Coca: Sigmund Freud, Carl Koller, and Cocaine

JAMA. 2011;305(13):1360-1361. doi:10.1001/jama.2011.394

In the spring of 1884, a 28-year-old Viennese neurologist named Sigmund Freud published “Über Coca,” a superb medical analysis of cocaine hydrochloride.1,2 Although the monograph was an early career milestone for the ambitious physician, it also represented a missed opportunity. Using himself as his experimental subject over several months, Freud consumed a great deal of cocaine as he recorded the drug's physiological effects and potential therapeutic uses. However, he skimmed over cocaine's most important clinical use as a local anesthetic. In a hurried last paragraph, a postscript really, Freud noted that “cocaine and its salts have a marked anesthetizing effect when brought into contact with the skin and mucous membrane in concentrated solution.” Without offering any additional data or experiments, Freud merely concluded that these properties “should make it suitable for a good many applications.”2

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