Coca leaf and local anesthesia.

Abstract

Pontificia Universidad Catolica de Chile, Santiago, Chile. jdagnino@med.puc.clTo the Editor:— I enjoyed the fine article about the history of the coca leaf and local anesthesia 1and would like to make a few comments, by way of addition and amendment.Among the Spanish chronicles, no mention was made of the contribution of Inca Garcilaso de la Vega (1539–1616). Apart from his having a particular cultural insight, as the son of the Spanish captain Sebastián Garcilaso de la Vega and the Inca princess Chimpu Ocllo, he was himself a coca grower on the Beni. Of particular interest is his reference to the lost writings of the priest Blas Valera (1548–1598; Jesuit priest, writer, and linguist) on the medical uses of coca:“Cuca [sic] protects the body from many ailments, and our doctors use it in powdered form to reduce the swelling from wounds; to strengthen broken bones, to expel cold from the body or prevent it from entering, and to cure rotten wounds or sores full of maggots.”2It is interesting to note that cocaine is a natural insecticide because it blocks the recapture of octopamine, a neurotransmitter in insects.Another episode that deserves mention is the role played by Jean Baptiste de Monet (physician and botanist, professor at the Musée National d’Histoire Naturelle after the French Revolution; 1744–1829), chevalier de Lamarck and better known by this name, who classified the shrub after receiving samples from Joseph de Jussieu (1704–1779), who had taken part in a French scientific expedition to South America, organized to settle an old argument between Sir Isaac Newton (1643–1727) and Jean Dominique Cassini (1627–1712; first of a family of famous astronomers, head of the Paris Observatory from 1671) over the shape of the earth, the dispute being if it was an oblate or a prolate sphere. As is generally known, Newton won the argument.Perhaps the greatest coca connoisseur of the nineteenth century was Angelo Mariani (1838–1914), Corsican by birth, who invented a medicinal wine made with coca leaves, vin Mariani , and built an economic empire on it. 3He was the greatest importer of coca of his time and grew several species, experimenting with them in his estate near Paris. His wine was the forerunner of many imitators, most notably John Pemberton’s French Wine Coca that gave origin to Coca Cola. He wrote a monograph on coca in 1888, and authorities and celebrities all over the world endorsed his product, among them, to name but a few, Pope Leo XIII, Thomas Alva Edison, William Mackinley, Jules Verne, and Frederic Auguste Bartholdi, the sculptor of the Statue of Liberty who had finished his work in Paris just 3 months before Koller’s discovery.The contribution of Vassili Konstantinovich von Anrep (1852–1925; Russian nobleman and physician who had done postgraduate research on cocaine at Professor Michael Rossbach’s laboratory at Würzburg) would have been greater had he taken the trouble to publish his experiments with cocaine injections; in an article published in Russian 4after Koller’s discovery and prompted by it, he describes the use of cocaine to relieve the pain of a costal fracture, preceding Hall and Halsted’s description of nerve blockade with cocaine. As mentioned in the current article, 1Halsted became addicted to cocaine, but there is no evidence that Freud did, although he used cocaine at least until 1895.Finally, the article gives the impression that Koller reached his discovery through methodic experimentation, but his own recall points to a serendipitous discovery. Serendipity, following Horace Walpole (1717–1797; English writer and antiquarian), who invented the word, requires a discovery made by accident and sagacity of a thing of which one is not in quest, and this is what happened to Koller. One day, he was taking some cocaine with Dr. Engel, who mentioned that it caused numbness of the tongue; Koller replied that this had been noted by all who had worked with cocaine and that “in the moment it flashed upon me that I was carrying in my pocket the local anesthetic for which I had searched some years earlier.”5Koller’s testimony and that of the direct witness of his first experiment, Gustav Gärtner (1855–1937; physician and researcher, Stricker’s assistant), point to the fact that a “big and lively frog” from Professor Stricker’s laboratory (1834–1898; head of the Institute for Experimental Pathology) was indeed that first subject of the experiment.Pontificia Universidad Catolica de Chile, Santiago, Chile. jdagnino@med.puc.cl