Discoveries seldom come out of thin air – there is almost always a back story. Before Karl Koller in 1884 could show that cocaine would be useful as a local anesthetic in eye surgery, his colleague at the General Hospital in Vienna, Sigmund Freud, had to have learned of the long tradition of native workers in Peru chewing coca leaves to withstand the fatigue and hunger of their brutal working conditions. Freud himself likely learned of this (possibly indirectly) from Paolo Mantegazza, an Italian physician who had worked in South America in the 1850s and published a paper extolling coca’s euphoric effect on energy and speed of thought. That the coca leaf numbed the mouth of its users was considered a minor side effect. When Freud discussed this with him, Koller immediately understood the potential of such an agent in eye surgery, experimented that same day and soon became famous. Freud went on to a different fame. Mantegazza became an anthropologist whose book The Sexual Relations of Mankind is still in print. He died in 1910, with his name rarely mentioned in telling the story of how local anesthesia was introduced to surgeons.

Submitted by Ron Fishman from the Cogan Ophthalmic History Society