JOHN F. HACKETT,
Madam, - It is an old adage, relating as much to human behaviour as to drugs that there are two sides to any story. While complimenting Dr Muiris Houston on his excellent article (Cocaine Users on a Path to Destruction, November 17th) there is another side to the story. At the outset I wholeheartedly agree with him that the "recreational" use of cocaine is legally and medically wrong. However, cocaine and its derivatives have been of huge benefit to doctors and dentists for nearly 120 years.
One of the first people to experiment medically with cocaine was Dr Sigmund Freud. He became an enthusiastic self-taster and liked the taste of his own medicine so much that he once wrote to his fiancée, Martha Bernays: "Woe to you my princess when I come over to you. I will kiss you red and feed you until you are plump. And if you are forward, you shall see who is the stronger, a gentle little girl who doesn't eat enough or a big wild man who has cocaine in his body".
However, it was Freud's young assistant, Carl Koller, who first showed the effects of the drug as a local anaesthetic in 1884. He was working with a dilute solution of the drug for something else when he put some on his tongue and noticed the numbness and loss of taste. Medically, his career interest was ophthalmology and he began testing the drug for anaesthesia in eye operations and this proved extremely successful and safe.
Nevertheless, he was well aware of the addictive nature of cocaine which saw many doctors and dentists succumb to its deadly charm. In an article he wrote for the Journal of the American Medical Association in 1928 he said: "The time may be near when we can look forward to the synthetic development of an ideal local anaesthetic, without any objectionable qualities or by-effects".
He was right.
The synthetic local anaesthetic, lignocaine, was made in 1948 and is credited to Nils Lofgren. It is non-addictive and is still used especially in the practice of dentistry. Millions of cartridges are used worldwide everyday to provide pain-free procedures.
Another synthetic derivative of cocaine, bupivacaine which has a longer duration of action is widely used in accident and emergency units, orthopaedics and more familiarly as an epidural in obstetrics.
The medical and dental professions have much to be grateful for in the discovery of this two-faced gift to mankind. - Yours, etc.,
JOHN F. HACKETT,
Dental surgeon and medical student,
University College,
Cork.