The 1884 Discovery: Cocaine and Painless Eye Surgery

In the late summer of 1884 a 26-year-old junior doctor at the Vienna eye clinic, Carl Koller, put a few drops of a cocaine solution into the eye of a frog and found that he could touch its cornea without the animal blinking. Within weeks he had shown the same thing in rabbits, dogs, his colleagues and himself, and on 15 September 1884 a short paper announcing it was read aloud at a meeting of eye surgeons in Heidelberg. Before the year was out, surgeons in Europe and America were operating on fully awake patients’ eyes without pain. Local anesthesia — numbing one part of the body while the person stays conscious — had arrived, and it came from an Andean leaf.

This page tells the story of the discovery itself: what eye surgery was like before it, what was already known about cocaine’s numbing effect, what Sigmund Freud’s famous essay on coca did and did not say, the self-experiments of the Vienna group, the animal experiments Koller ran with Joseph Gärtner, the notebooks that survive in the Library of Congress, the Heidelberg reading, the papers that followed, how fast the news travelled, and the long argument over who deserves the credit. Koller’s life, the coca plant and the drugs that came after cocaine each have their own page in this series. Cocaine appears here as history and pharmacology only.

Table of Contents

  1. Eye Surgery Before 1884
  2. What Was Already Known About Cocaine’s Numbing Effect
  3. Freud’s “Über Coca”
  4. Self-Experiments in Vienna
  5. The Frog, the Rabbit and the Dog
  6. Koller’s Laboratory Notebooks
  7. Heidelberg, 15 September 1884
  8. The Vienna Report and the English Papers
  9. News That Crossed the World in Weeks
  10. Who Discovered Local Anesthesia? The Priority Question
  11. Key Research Papers
  12. Connections
  13. Featured Videos

1. Eye Surgery Before 1884

By the 1880s surgeons had had general anesthesia for nearly forty years. Ether and chloroform, introduced in the 1840s, could put a patient fully to sleep, and they had transformed long operations on the abdomen and limbs. For the eye, though, they were an awkward fit. An eye operation such as the removal of a cloudy lens in cataract is short, delicate and done millimetres from the surface; the surgeon needs the eye still and, ideally, the patient able to look where they are asked.

General anesthesia of the period worked against both. Patients going under and coming round from ether or chloroform often struggled, retched and vomited, and the historian Howard Markel describes exactly this — vomiting and movement after general anesthesia putting freshly operated eyes at risk — as the problem the young Koller wanted to solve. The alternative was to do the operation with the patient awake.

Surgeons had long looked for a way to numb just one part of the body. Zimmer’s review of the early forms of local anesthesia traces the attempts that came before 1884: cold, and sprays of volatile liquids that chilled the tissue as they evaporated. These could deaden skin for a moment, but none of them could be used on the living surface of the eye. What was missing was a substance that would numb the cornea and conjunctiva — the clear front window of the eye and its moist lining — and leave everything else untouched.

Koller had come to the eye clinic of the Vienna General Hospital (the Allgemeines Krankenhaus) in 1883, after a doctorate in 1882 and student years of laboratory work in Salomon Stricker’s institute of experimental pathology. According to the historians of his work, he had been thinking about the problem of an eye anesthetic for some time before cocaine came his way. His career is told on the Life and Career page.

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2. What Was Already Known About Cocaine’s Numbing Effect

Cocaine was not new in 1884. The leaves of the coca shrub had been chewed in the Andes for thousands of years, and an Austrian expedition had brought a supply of leaves back to Europe in the late 1850s. From them the chemist Albert Niemann, working in Friedrich Wöhler’s laboratory at Göttingen, isolated the leaf’s main alkaloid in 1860 and named it cocaine. His paper in the Archiv der Pharmazie describes the new base and its properties, and Wilhelm Lossen refined the chemistry in 1865. That story belongs to The Coca Leaf page.

A numb tongue in the laboratory

What matters here is that the numbing effect was noticed almost at once. Niemann and Lossen recorded that the substance left the tongue numb, and Wöhler noted that it tasted bitter and had a peculiar effect on the nerves of the tongue, leaving it temporarily without feeling. Andrzej Grzybowski’s history of cocaine in medicine lists these observations as the first steps toward the discovery.

Animal work in Peru and Germany

Others went further. The Peruvian surgeon Moreno y Maíz carried out animal experiments with cocaine, and in 1880 Basil von Anrep published a study of cocaine’s effects and suggested that it be tried as a local anesthetic. Grzybowski counts both among Koller’s forerunners. Meanwhile, as Bettina Wahrig’s study of nineteenth-century writing about coca shows, the leaf itself was being praised as a near-universal tonic — the Italian physician Paolo Mantegazza published an enthusiastic treatise on coca in 1859 — long after the pure alkaloid was available.

Why the step was not taken earlier

So by 1884 the key fact — cocaine numbs the surfaces it touches — had been written down several times. What nobody had yet done was connect it to a practical surgical need and prove it in a clean experiment on the eye.

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3. Freud’s “Über Coca”

Cocaine reached Koller through a friend. Sigmund Freud, about a year and a half older and then a young neurologist at the same hospital, had become interested in cocaine in the spring of 1884 and published a long review, “Über Coca” (“On Coca”), that year. Howard Markel’s essay in JAMA, “Über coca: Sigmund Freud, Carl Koller, and cocaine,” tells how the two men’s paths crossed over the drug.

What the essay was about

Freud’s essay was mainly about cocaine’s general and psychological effects — what the drug did to the whole person rather than to one patch of tissue — and the therapeutic hopes he placed in it. Those hopes did not survive: the addiction and toxicity that soon came to light are told on the After Koller page.

What it said about numbness

In passing, Freud mentioned cocaine’s numbing effect on the skin and mucous membranes. Markel quotes him remarking that this property should make cocaine suitable for a good many applications. But Freud did not propose using it in surgery, did not test it on the eye, and did not pursue the point. Dos Reis, who reviewed the record in a 2009 history, concludes that Freud studied cocaine as a stimulant and therapeutic agent but had no direct part in the discovery of local anesthesia.

Freud’s later view

Markel reports that Freud later regretted not having followed up the hint himself, and that he inscribed a copy of his work to his friend as “Coca Koller” — a nickname that also appears in the title of Amm and Holubar’s 1997 article on Koller, Freud and their friend Sigmund Lustgarten.

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4. Self-Experiments in Vienna

In the 1880s, trying a new drug on oneself was an accepted part of research. Freud and his circle at the Vienna General Hospital — among them Koller and the ophthalmologist Leopold Königstein — took cocaine by mouth to see what it did. López-Valverde and colleagues, writing in the British Dental Journal on “the oral mucosa and the Vienna group,” describe how these self-experiments made the numbing of the lips, tongue and lining of the mouth familiar to everyone involved.

For most of the group the numb mouth was a curiosity, a side effect of a drug they were studying for other reasons. For Koller, who had been looking for a way to anesthetize the eye, it was the clue. In the account the historians give, he recognised that a substance that numbed the mucous membrane of the mouth might do the same to the cornea and conjunctiva, which are also moist surface tissues richly supplied with sensory nerves.

Goerig’s study of Koller’s own notes confirms that the work moved through stages: self-observation, then animals, then colleagues and Koller himself. That order — idea, animal test, careful human test — is part of why historians treat the discovery as Koller’s even though the numbing effect had been noticed before.

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5. The Frog, the Rabbit and the Dog

Koller ran his decisive experiments in Stricker’s institute of experimental pathology, where he had worked as a student, with the help of Joseph Gärtner, an assistant there. The best-known description of the first test comes from Gärtner’s own later recollection, reproduced in the secondary literature, and is paraphrased here rather than quoted.

The first test

As Gärtner remembered it, Koller dissolved a little cocaine and dropped the solution into one eye of a frog. After a short wait they touched the cornea of that eye. The frog did not react: it let its cornea be touched without the protective blink. When they touched the other, untreated eye, the frog blinked at once. The treated eye was not paralysed; it simply could not feel.

Rabbits, dogs and people

The same result followed in a rabbit and a dog. Then, Gärtner recalled, the two men tried it on each other’s eyes and on their own, with the same result. Goerig, working from Koller’s own notes, confirms this sequence of animal experiments, self-experiments and tests on colleagues.

Why the design mattered

The experiment was simple, but it was well designed. Using one eye as the test and the other as the control, in the same animal at the same moment, ruled out the obvious objection that the animal was simply drowsy or poisoned. The corneal blink reflex is one of the most reliable signs of sensation there is, which made the result easy to see and hard to argue with. It was this kind of controlled demonstration that turned an old observation into a usable method.

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6. Koller’s Laboratory Notebooks

For most of the twentieth century the story of these weeks rested on Koller’s later reminiscences, Gärtner’s recollection and his daughter’s memoir. Koller himself published a short account in 1928, “Personal Reminiscences of the First Use of Cocain as a Local Anesthetic in Eye Surgery.” In 1963 his daughter, Hortense Koller Becker, published a long memoir, “Carl Koller and cocaine,” drawing on family papers and letters.

The papers themselves survived. Hortense Koller Becker gave her father’s papers — correspondence, documents and his notes on the 1884 experiments — to the Library of Congress in Washington, where they are catalogued as the Carl Koller Papers, 1866–1988, with most of the material dating from 1884 to 1934.

In 2015 the German anesthesia historian Michael Goerig published an analysis of Koller’s handwritten experiment notes in the journal Der Anaesthesist, under the title “From the legacy of Carl Koller. Notations on his experiments with cocaine.” The notes record the animal experiments, the self-experiments and the trials on colleagues, giving historians a contemporary record against which the later accounts can be checked.

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7. Heidelberg, 15 September 1884

Koller moved quickly to make his finding known. The Ophthalmological Society, the meeting of German-speaking eye surgeons, was gathering in Heidelberg in mid-September. Koller could not afford the journey. Instead he wrote a short preliminary communication and asked a colleague who was attending, the ophthalmologist Josef Brettauer, to present it for him.

On 15 September 1884 Brettauer read Koller’s paper to the meeting and followed it with a practical demonstration of the numbed eye. For the surgeons in the room the significance was obvious: here was a way to operate on the front of the eye with the patient awake, still and free of pain, without the risks of putting them to sleep.

The preliminary communication was printed that year as “Vorläufige Mittheilung über locale Anästhesirung am Auge” (“Preliminary communication on local anesthesia of the eye”) in a supplement to the Klinische Monatsblätter für Augenheilkunde.

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8. The Vienna Report and the English Papers

Before the Vienna Medical Society

Once the preliminary notice was out, Koller presented his full work at home. On 17 October 1884 he read a detailed report before the Vienna Medical Society (the Gesellschaft der Ärzte), the city’s leading medical body. Dos Reis notes that Koller made two presentations in Vienna, describing the animal and human studies and the first operations on the eye done under local anesthesia.

In English: the Lancet and Chicago

English-speaking readers soon had the work in Koller’s own words. Late in 1884 the Lancet carried his paper “On the use of cocaine for producing anæsthesia on the eye.” In February 1885 the Chicago Medical Journal and Examiner published a longer English paper, “The Application of Cocaine to the Eye as an Anæsthetic,” with Koller bylined as House Physician at the Allgemeines Krankenhaus in Vienna.

What Koller claimed, and what he did not

Koller’s claim was specific: that cocaine applied to the surface of the eye produced an anesthesia deep enough for operations on the cornea and conjunctiva. He did not claim to have discovered cocaine or its numbing effect. Later in life, in the 1928 reminiscence, he returned to those weeks and his own part in them.

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9. News That Crossed the World in Weeks

Few discoveries of the nineteenth century spread as fast. Goerig and colleagues write that news of Koller’s finding went around the world in less than a month. Part of the reason was simplicity: the experiment needed no apparatus, only the drug and an eye, so any eye clinic could check the claim for itself.

America

By November 1884 American surgeons were reporting their own results. The American ophthalmologist Lucien Howe published “The effect of cocaine upon the eye” in the Lancet that month, and further reports from American eye surgeons appeared in December 1884 and January 1885. Lucien Howe’s name later returned to Koller’s story: in 1922 Koller became the first recipient of the American Ophthalmological Society’s Lucien Howe Medal.

Beyond the eye

In Vienna itself other specialists took up the method almost at once. Helmut Wyklicky’s centenary article on local anesthesia notes that it was quickly applied in laryngology by Jelinek and in general surgery by Wölfler. Within a few months New York surgeons had gone further still, injecting cocaine to block whole nerves — the beginning of nerve-block and dental anesthesia, and the start of the problems with addiction and toxicity that drove the search for safer drugs. That later history, from cocaine to procaine and lidocaine, is told on the After Koller page. Altman and colleagues review how ophthalmology itself went on using cocaine over the following century, and Grzybowski’s overview of cocaine and the eye describes how its harms pushed medicine toward safer drugs.

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10. Who Discovered Local Anesthesia? The Priority Question

A discovery this important, made among friends in one hospital in one summer, was bound to raise the question of credit. Goerig and colleagues call what followed a controversial priority discussion, and it has been argued over by historians ever since.

Freud’s share

Freud brought cocaine into the group, wrote about it, and mentioned its numbing effect. Some later writers have suggested that he deserves part of the credit. Most historians of anesthesia disagree. Dos Reis, after reviewing the documents, concludes that Freud had no direct part in the discovery of local anesthesia: his interest was in cocaine as a stimulant and a remedy, and he never applied it to surgery. Markel reports that Freud himself later regretted the missed opportunity.

Königstein’s share

Leopold Königstein, Freud’s friend and an ophthalmologist, had also been using cocaine in the eye. Wyklicky writes that Königstein tested cocaine as a treatment in eye disease at Freud’s suggestion, while Koller independently conceived of using it to anesthetize the eye for surgery. López-Valverde and colleagues describe the disputes that followed within the Vienna group. The difference the historians draw is between treating a painful eye and making surgery painless: the second, with its controlled demonstration and its public announcement at Heidelberg, is Koller’s.

The verdict of the historians

The subject has been retold many times, from Becker’s memoir and Liljestrand’s 1967 monograph “Carl Koller and the development of local anesthesia” to the papers of Wyklicky, dos Reis and Goerig. The broad picture that emerges is that the observation of cocaine’s numbing effect belonged to many people, from Niemann and Wöhler to von Anrep and Freud, and that the discovery of local anesthesia as a method belongs to Carl Koller. He was the one who saw what the numbness was for, proved it in a clean experiment, and announced it to the people who could use it. What happened to Koller himself in the months after his triumph — an insult, a duel and the end of his career in Vienna — is told on the Life and Career page.

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Key Research Papers

  1. Goerig M, Bacon D, van Zundert A. Carl Koller, cocaine, and local anesthesia: some less known and forgotten facts. Reg Anesth Pain Med. 2012;37(3):318-24. PubMed PMID: 22531385
  2. Goerig M. [From the legacy of Carl Koller. Notations on his experiments with cocaine]. Anaesthesist. 2015;64(6):469-77. PubMed PMID: 26018815
  3. Markel H. Über coca: Sigmund Freud, Carl Koller, and cocaine. JAMA. 2011;305(13):1360-1. PubMed PMID: 21467292
  4. dos Reis A Jr. Sigmund Freud (1856-1939) and Karl Köller (1857-1944) and the discovery of local anesthesia. Rev Bras Anestesiol. 2009;59(2):244-57. PubMed PMID: 19488537
  5. Becker HK. Carl Koller and cocaine. Psychoanal Q. 1963;32:309-73. PubMed PMID: 13970115
  6. López-Valverde A, de Vicente J, Martínez-Domínguez L, de Diego RG. Local anaesthesia through the action of cocaine, the oral mucosa and the Vienna group. Br Dent J. 2014;217(1):41-3. PubMed PMID: 25012333
  7. Wyklicky H. [100 years of local anesthesia]. Wien Klin Wochenschr. 1985;97(10):449-50. PubMed PMID: 3892931
  8. Koller C. On the use of cocaine for producing anæsthesia on the eye. The Lancet. 1884;124(3197):990-992. DOI: 10.1016/s0140-6736(02)28859-5
  9. Koller K. The Application of Cocaine to the Eye as an Anæsthetic. Chic Med J Exam. 1885;50(2):91-100. PubMed PMID: 37618465
  10. Koller C. Personal Reminiscences of the First Use of Cocain as a Local Anesthetic in Eye Surgery. Anesthesia & Analgesia. 1928;7(1):9-11. DOI: 10.1213/00000539-192801000-00004
  11. Niemann A. Ueber eine neue organische Base in den Cocablättern. Archiv der Pharmazie. 1860;153(2):129-155. DOI: 10.1002/ardp.18601530202
  12. Grzybowski A. [The history of cocaine in medicine and its importance to the discovery of the different forms of anaesthesia]. Klin Oczna. 2007;109(1-3):101-5. PubMed PMID: 17687926
  13. Wahrig B. [“Fabulous things”. Drug narratives about coca and cocaine in the 19th century]. Ber Wiss. 2009;32(4):345-64. PubMed PMID: 20481059
  14. Zimmer M. History of anaesthesia: early forms of local anaesthesia. Eur J Anaesthesiol. 2014;31(1):1-12. PubMed PMID: 24225728
  15. Altman AJ, Albert DM, Fournier GA. Cocaine’s use in ophthalmology: our 100-year heritage. Surv Ophthalmol. 1985;29(4):300-6. PubMed PMID: 3885453
  16. Howe L. The effect of cocaine upon the eye. The Lancet. 1884;124(3195):911. DOI: 10.1016/s0140-6736(02)28778-4
  17. Grzybowski A. Cocaine and the eye: a historical overview. Ophthalmologica. 2008;222(5):296-301. PubMed PMID: 18566545
  18. Amm M, Holubar K. [“Coca-Koller” and hist friends. On the 140th birthday of the Vienna Jewish trio: Carl Koller (1857-1944), Sigmund Lustgarten (1857-1911) and Sigmund Freud (1856-1939)]. Wien Klin Wochenschr. 1997;109(5):170-5. PubMed PMID: 9173665
  19. Liljestrand G. Carl Koller and the development of local anesthesia. Acta Physiol Scand Suppl. 1967;299:1-30. PubMed PMID: 4867543

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