Coca-Cola’s illustrious history began in 1886, soon after the citizens of Fulton County, Georgia, voted to ban the sale of alcohol. The local prohibition law proved to be the mother of invention as Pemberton scrambled to come up with something new and legal. Creating a recipe that included coca leaves and kola nuts (in proportions that to this day remain a closely guarded secret), Pemberton concocted his now famous drink. The first “Coke” was served in Atlanta, at the Jacob’s Pharmacy soda fountain, on May 8, 1886. Originally selling the product as a patent medicine for 5 cents a glass, Mr. Jacob moved only ten Coca-Colas a day. Undaunted, Pemberton was relentless in his promotion of the “health drink” he claimed was a cure for neurasthenia, impotence, headaches, and morphine addiction. That first year, Pemberton cleared gross sales of $50 (or more than $1,180 in 2010 dollars), but his expenses were more than $70 (or more than $1,650 in 2010 dollars).
Eventually, the drink began to gain favor. Pemberton sold Coca-Cola syrup in bulk to pharmacists around Georgia and beyond. Soda jerks took dollops of the dark brown syrup and added the “2 cents plain,” or carbonated water, drawn from their soda fountains. Thousands of drugstores served it daily to clamoring customers, all eager to quench their physical and, with successive ingestion, addictive thirsts.
Although the beverage’s popularity was on the ascent, Pemberton grew impatient with the returns on his investment. In 1887, he abruptly sold the recipe for Coca-Cola to a lapsed medical student named Asa Griggs Candler for the then remarkable sum of $2,300 (more than $54,000 in 2010 dollars), constituting one of the greatest blunders in the history of the soft-drink industry.
Cynically, Pemberton also sold the rights to Coca-Cola to a few other investors, and for a brief period there were at least three different versions of the soft drink on the market. As the sales of Coke increased throughout the 1880s and 1890s, scores of “copycat” products cluttered grocers’ and druggists’ shelves. Their labels displayed such enticing names as Inca Cola, Roco Cola, Kola Ade, and the like. All were basically similar to Coca-Cola and contained either extract of coca leaves or small amounts of cocaine mixed with syrup and soda. In 1892, Candler prevailed over his competitors and incorporated what is today known as the Coca-Cola Company, the leading purveyor of soda pop in the world.
BY THE EARLY 1880S, a gaggle of pioneering pharmaceutical manufacturers, too, had entered the cocaine market. They ordered their armies of chemists to take batches of coca leaves, add touches of hydrochloric or sulfuric acid here, solutions of bicarbonate of soda and alcohol there, followed by careful extractions, distillations, and crystallizations. And tinker they did, until eventually emerging from their laboratories with the means to mass-produce a pure substance known as cocaine hydrochloride. Such complex chemical machinations facilitated the combination of the active ingredient of the coca leaf with a chloride salt, producing a product that could then be easily crystallized as a powder, measured, weighed, and dispensed. These critical accomplishments allowed the drug to be successfully marketed and distributed to physicians, pharmacists, and patients as a modern medication. Such chemical developments were underwritten by several firms, including John Searle and E. R. Squibb, both based in New York, and Boehringer and Merck, a company with factories in Germany, New Jersey, and St. Louis. But while they all became adept at making and selling pure cocaine hydrochloride, none was as proficient as Parke, Davis and Company of Detroit.
“To refresh the parched throat, to invigorate the fatigued body, and quicken the tired brain.” Coca-Cola advertisement, c. 1905. (photo credit 3.8)
Hervey Parke, a savvy Detroit businessman (left) and George Davis, a brilliant salesman (right), founded the pharmaceutical company Parke, Davis and Company in 1873. Portraits are c. 1890. (photo credit 3.9)
Parke, Davis and Company of Detroit, c. 1875. (photo credit 3.10)
Built on the banks of the Detroit River, the firm opened its doors in 1866. Its original partners included a Michigan businessman named Hervey C. Parke and a physician and German-trained Ph.D. in medicinal chemistry named Samuel P. Duffield. Joining them a year later was George S. Davis, an energetic and creative salesman credited by many with making Parke, Davis the pharmaceutical powerhouse it was for nearly a century, before being bought out by larger and larger corporations beginning in 1970. In the decades before Henry Ford ever dreamed of assembly lines manufacturing millions of Model T’s and Detroit became the “Motor City,” Parke, Davis and Company constituted one of the city’s biggest industries.
Initially, Parke, Davis specialized in marketing a number of medicinal herbs. One of the firm’s major products was an extract of the purple-flowered foxglove plant called digitalis, which helped failing hearts beat more strongly. By 1884, however, the company had turned its attention to the uses of cocaine. In the competitive world of selling medicine, the principals at Parke, Davis determined to place a lock on the coca-leaf market, so that they could roll out a huge line of cocaine products. But the demand for coca was far greater than the actual supply. Just as it had been decades earlier, in the 1880s delivering large supplies of intact, fresh, and biologically active coca leaves to European and American pharmaceutical houses for further refinement and processing remained the rate-limiting step in this chemical bonanza.
Instrumental to Parke, Davis and Company’s attempt to assume a cocaine monopoly was Henry Hurd Rusby, an intrepid physician and botanist described by one historian of narcotics as “the Theodore Roosevelt of bio-imperialism.” As Rusby recounted in his 1933 memoir, Jungle Memories, he was invited to the office of George S. Davis in the fall of 1884, only months after receiving his medical diploma from New York University. Nearly half a century later, Dr. Rusby recalled how cocaine’s ability to “wholly destroy the local power of sensation in an eye, on coming in contact with the eyeball” had inspired his future bosses “to investigate it thoroughly.” In other words, Parke, Davis executives sensed what pharmaceutical companies today call a “blockbuster drug” and promptly positioned themselves for a profitable windfall. The very afternoon they met, an impatient Davis gave Rusby his travel orders from Detroit to Bolivia, with the mission of securing the largest possible supply of coca leaves.
Over the next few years, Dr. Rusby made seven journeys to Central and South America on behalf of Parke, Davis, collecting 35,000 to 40,000 different biological specimens. On the first trip alone, he gathered together 20,000 pounds of coca leaves, but they spoiled while enduring the rain, mud, and long delays encountered in crossing the Colombian isthmus. It was, as Rusby later described, an “insane journey”—accompanied by hostile encounters with indigenous people and a host of pestilential swamp diseases. He subsequently recommended to his employers that it made much better business sense to extract a crude but stable version of the alkaloid from the coca leaves in South America and then ship it back to Detroit for further chemical refinement. Mr. Parke and Mr. Davis listened carefully to their employee’s advice from the field and soon became one of the largest suppliers of pharmaceutical-grade cocaine in the world.
A Parke, Davis advertisement, c. 1880s. (photo credit 3.11)
To amplify their sales, Parke, Davis and Company worked hard at encouraging doctors to recommend the new product to their patients. The nineteenth-century equivalent of “detail men” enticed physicians and patients on both sides of the Atlantic to give cocaine a try by offering them impressive publications replete with descriptions of the “drug’s history, botanical origin, production and cultivation, chemical consumption, therapeutic action, physiological action and medical preparation.” These reports also featured, if not exaggerated, cocaine’s ability to energize the most indolent of patients and to cure a wide variety of chronic maladies such as dyspepsia, flatulence, colic, hysteria, hypochondria, back pain, muscle aches, nervous dispositions, pain resulting from dental, eye, or nose surgery, and the fatigue that often followed acute infections such as influenza. Similar advertisements were aimed directly at medical consumers. As was true of morphine, opium,
and cannabis during this era, patients themselves could easily purchase cocaine products from their local druggist without a prescription or medical supervision. With such ready access to addictive substances, subsequent sales rates skyrocketed.
George Davis’s genius as a pharmaceutical salesman was amply demonstrated in the many highly regarded medical journals he edited and published, which were prominently displayed in medical libraries across the United States and as far away as the august reading rooms of the University of Vienna. Inquiring doctors eagerly awaited and avidly leafed through each month’s issue of Detroit Lancet, American Lancet, New Preparations, Medical Age, and Therapeutic Gazette.
During the early 1880s, cocaine was one of the most exciting medical topics reported in Europe and North America. But by far, the best place to read the latest invited reviews and clinical studies on cocaine was George Davis’s attentively packaged and widely distributed Therapeutic Gazette. Indeed, this now forgotten and crumbling periodical loomed largest among Sigmund Freud’s many sources of information on cocaine.
For a brief period, beginning in 1885, Davis went as far as to take control of the publication of Index Medicus, which would later become the leading print index of every medical publication in the world. This multivolume set of catalogs represented a rather laborious but reliable search engine. Doctors who needed to research a particular medical topic turned to thick, dog-eared copies of the Index Medicus to see what had recently been published on it and then proceeded through the stacks of their local medical libraries to dig up the actual papers. The idea of one pharmaceutical company controlling and publishing one of the dominant indexes of the world’s medical literature constitutes a definite conflict of interest. But Davis conveniently chose to ignore such ethical niceties because the endeavor resulted in a veritable gold mine of advertising opportunities. Incidentally, many an issue of Index Medicus during this period contained Parke, Davis and Company’s illustrated pitches for cocaine.
In light of all these factors, underscored by the drug’s enticing and miraculous powers, the desire for cocaine traveled fast and wide. Like an influenza epidemic that starts with merely a few sniffling or sneezing people before spreading like wildfire to those around them, the abuse of cocaine hydrochloride was quickly taken up from person to person and across national borders. Unwittingly or not, the medical profession, pharmaceutical companies, and too many patients entered into a decades-long toxic relationship with cocaine abuse and addiction.
CHAPTER 4
An Addict’s Death
DR. FREUD’S SECOND-FLOOR, twelve-foot-by-twenty-foot cell in Courtyard 6 of the Krankenhaus represented a significant accomplishment in his career advancement. Along with its newly whitewashed plaster walls and eleven-foot-high ceiling, its most haimish feature was an arched window complete with a seat and southern exposure. The furnishings consisted of a narrow bed near the window, a pitcher and water bowl placed on a thin marble shelf, a bureau and mirror, a few shelves for his books, a desk and chair, coat hooks for his clothes, and an erratic stove for heat. Above his cluttered desk, the young physician hung pictures of Goethe and Alexander the Great; he adorned the wall closest to his bed with three embroidered votive panels lovingly sewn by Martha. They were inscribed with lines written by Saint Augustine, Voltaire, and the Parisian neurologist Charcot, declaring, respectively: “When in doubt, abstain,” “Let us work without philosophizing,” and “One must have faith.” Sigmund needed all of these sustaining homilies, considering that he slept, studied, and ate within earshot of the screaming and insane patients assigned to the nervous diseases ward.
Freud’s sketch of his room at the Krankenhaus, October 5, 1883. (photo credit 4.1)
Freud’s accommodations were spartan, but living conditions for patients at the Krankenhaus were appalling. Cleanliness was less a concern than an absolute impossibility. The sweat-soaked mattresses were infested with bedbugs and vermin; the sheets were filthy and the floors slick with rancid blood, urine, vomit, and feces. During the day, the long, interconnected dank wards were illuminated by trickles of sunlight piercing through blackened and smudged windows. By dusk, a paucity of gaslights and candles forced many patients to remain in bed cursing the darkness. When called for a late-night request, doctors often stumbled over both beds and bones for want of a much-needed lantern.
The First Psychiatric Clinic of the Vienna General Hospital, where Freud was a resident physician. (photo credit 4.2)
Dr. Franz Scholz, the superintendent of the psychiatric clinic’s nervous diseases ward, only exacerbated matters of hospitality by devising all sorts of ways to keep costs down, resulting in insufficient food, supplies, and medications for the patients. Penury aside, Dr. Scholz encouraged his underlings to take up any and all medical research in their limited spare time, with the tacit understanding that he would receive some of the credit. Sigmund, who hardly needed any incentive in his quest for a slice of medical fame, added a few hours of scientific pursuits each night to his already exhausting twelve- to fourteen-hour schedule. The task he chose for himself was nothing less than composing a seminal synthesis of the world’s medical literature on the uses and actions of cocaine. Freud’s initial attraction to cocaine was motivated by far more than an impulse to climb up a few rungs on the career ladder. Instead, his main inspiration for researching cocaine’s powers was Dr. Ernst von Fleischl-Marxow, a treasured friend and desperate morphine addict whom Sigmund hoped to cure.
FLEISCHL-MARXOW WAS BRILLIANT, charismatic, and well mannered, easily one of the best in Vienna’s crop of talented doctors and the first assistant (or junior professor) in Brücke’s laboratory. At the age of twenty-five, while conducting anatomical pathology research under the great Carl von Rokitansky, Fleischl-Marxow accidentally nicked his right thumb with a scalpel he was applying to a cadaver. What began as an annoying wound rapidly progressed into a raging infection that ultimately led to an amputation. The procedure may have prolonged his life, but it effectively ended his medical career.
The wound never properly healed, resulting in a tangle of red, heaped, fragile, and easily irritated scar, or granulation, tissue. Nineteenth-century surgeons applied a descriptive bit of clinical nomenclature to this condition: “proud flesh.” Healthy skin had a difficult time filling in the ends of the opening of the incision line, setting up a vicious cycle of skin ulceration, infection, and more surgery. To make matters worse, below the gnarled scar tissue, abnormal growths of sensory nerve endings called neuromata formed around the stump of what had formerly been his opposable digit. To say that neuromata are painful is an insult to the power of pain. They are excruciating, inescapable, and unrelenting in their ability to burn and sting the flesh. Despite a series of operations by the great Billroth to revise the wound and remove the errant nerve fibers nestled within, the lesions had a life of their own and kept growing back, enlarging and multiplying, leading only to more pain and, ultimately, Fleischl-Marxow’s demise in 1891, at the age of forty-five.
A portrait of Ernst von Fleischl-Marxow at about age thirty-six, c. 1882. After Fleischl-Marxow’s death in 1891, Freud hung this portrait in his study as a reminder of his beloved friend. (photo credit 4.3)
Dr. Fleischl-Marxow rarely complained about his condition; repulsed by the slightest hint of pity, he was determined not to let his disability interfere with his academic responsibilities or progress. Indeed, after his injury he was more productive than ever, taking on a multitude of students and publishing a raft of important neurophysiological studies. But on many nights, Fleischl-Marxow’s discomfort was so intense that he was unable to sleep. As the rest of Vienna retired for the evening, he pored over precariously perched textbooks while soaking in a hot tub. At first, he studied mathematics to keep his mind occupied. After he had mastered the intricacies of trigonometry and calculus, he turned to classical physics. Once adept at Newtonian principles of gravity and other physical facts, he pondered the ancient language of Sanskrit; and so it went, in the secluded chambers o
f this determined, stoic young man, until the pain finally proved unbearable. In fact, his life was “an unending torture of pain and of slowly approaching death.” Such courageous behavior only served to inspire Sigmund to admire Fleischl-Marxow all the more, or as he explained to Martha: “I could not rest until we became friends and I could experience pure joy in his ability and reputation.”
With a slow accumulation of deductive dribs, drabs, and diagnostic clues, sometime in late 1883 or early 1884 Sigmund realized that Fleischl-Marxow’s only respite for his constant pain was a hypodermic syringe filled with morphine. Such a protracted process of discovery underscores one of the great conundrums of addiction: many addicts learn to hide the truth of their malady from those around them while actively pursuing their drug of choice.
In many cultures across time, physicians have often anthropomorphized the diseases they battled. Such identifications, undoubtedly, help put a human face or character on the sworn enemies of both doctor and patient. In the modern Western world, this custom has lost favor when confronted by modern, scientific understandings of the precise workings of the human body. One wonders what we have lost by embracing this form of intellectual sophistication. As a physician who has long treated substance-abusing patients, I have learned all too well that addiction is one of the most recalcitrant diseases known to humankind. “Cunning, baffling, and powerful” is how the Big Book of Alcoholics Anonymous describes it. These three simple words carry a great deal of weight for anyone who has suffered from it or who cares for an addict or alcoholic. One of the most maddening features is the malady’s stealthy ability to convince the sufferer and his family that nothing, nothing at all, is askew or dangerous about something that most decidedly is. Indeed, if you were going to design addiction as a disease, one that conspires within the brain for long periods before eventually killing that person off and proceeding on to the next vulnerable victim, you would be hard-pressed to come up with a more diabolical symptom than denial, the need to lead a double life; the subject feeds the addiction in private while struggling to starve, or at least conceal, it in public. Until, that is, the addiction completely takes over, with disastrous results, and public masquerade is no longer possible.
An Anatomy of Addiction Page 7
