The Poison Review

TPR received a number of comments about this weekend’s post reviewing a recent article about Spice; and other smoking mixtures containing synthetic cannabinoids.  Much of the interest centered on an incidental comment that the article referenced another paper from Journal of Mass Spectrometry, in which two of the researchers, in addition to running various mixtures through GC-MS and TLC to identify exactly what they contained, did a self-experiment by smoking a sample of “Spice Diamond” to assess its physiologic and psychotropic effects.

That got us thinking about the glorious history of self-experimentation in medicine, as described in Lawrence Altman’s wonderful book “Who Goes First?”. One reader pointed out the Altman left out the incredible episode of of Jack Barnes and his discovery of the cause of Irukandji syndome. This was a serious omission.  But Altman also did not include what is without doubt the most bizarre example of self-experimentation ever published in the medical literature.

The year was 1884. Cocaine had just recently arrived in Europe and the United States. That same year Sigmund Freud published On Coca, a monograph in which he was enthusiastic about using cocaine for a number of indications, including the treatment of morphine addiction.  Noting cocaine’s numbing properties, he also suggested it could be an effective local anesthetic. Ophthalmologists and otolaryngologists were very excited about this potential

In the October 25, 1884 issue of the Medical Record, there appeared a paper with the unremarkable title: “Hydrochlorate of Cocaine – Experiments and Application”.  The author was Dr. H. Knapp, a professor of ophthalmology at the University of the City of New York.  He writes that he became interested in the anesthetic properties of cocaine, and tested its effects on the eyes and nasal mucosa of his wife, his 15-year-old son, and himself.

And then he went one step beyond. Let’s read from his paper:

The urethra.  My urethra is very sensitive to the introduction of instruments.  I injected, by means of an Eustachian catheter and a balloon, a four percent solution of cocaine, and held it in for a few minutes.  In ten minutes the glans had become pale and insensible to touch.  I repeated the injection.  Seven minutes later I introduced a catheter and other instruments into the urethra.  I did not feel them at all as far as 3″; when pushed farther I felt them very unpleasantly painful.  Evidently the cocaine had not penetrated more deeply.

Before the injection of cocaine I felt the instruments very keenly from the beginning of the urethra.  To test the loss of sensibility of the cocainized urethra in another direction, I injected a one percent solution of arg. nitr. [silver nitrate] into the anterior part by means of an Anel’s syringe, introducted as far as 1-1/2″.  I had no sensation at all. . . . This esperiment shows, and I feel convinced that cocaine will prove most beneficial in uro-genital surgery.  It not only destroys the sensibility of the parts, and therefore admits the easy performance of many surgical procedures, but by being painless these procedures will not incite reflex phenomena, spasm, and the like.

The rectum. – For the sake of completeness, I injected also cocaine into the rectum.  The sensibility, which was not great anyhow, was reduced.

They don’t do research like that anymore! To read my column in Emergency Medicine News describing other incredible and historical self-experiments with cocaine, click here.

Addendum (8/4/10): In a tweet, Dr. Ves Dimov of The University of Chicago and the blog Clinical Cases and Images provided a link to the original 1884 article in Medical Record.