FREUD’S DISCOVERY In April 1884 Freud read of a German army doctor who had successfully employed cocaine as a means of increasing the energy and endurance of soldiers. He determined to obtain some for himself and try it as a treatment for other conditions—heart disease, nervous exhaustion and morphine addiction. It was little known at that time and the extensive ethical and methodological rules governing modern drug trials did not exist. Freud took some himself and was immediately impressed with the sense of well-being it engendered, without diminishing his capacity for work. Having read a report in the Detroit Medical Gazette concerning its value in the treatment of addictions his next step was to recommend the substance as a harmless substitute to his friend and colleague, Ernst von Fleischl-Marxow. Fleischl. Who had become a morphine addict following repeated therapeutic administrations for intractable neurological pain and was in desperate straits, took to cocaine with enthusiasm and was soon consuming it in large quantities. Meanwhile Freud continued to extol the virtues of the drug, writing a review essay on the subject, taking it himself and pressing it upon his fiancee, friends as a panacea for all ills, He had gone overboard with enthusiasm, writing to Martha when he heard she had lost her appetite,“Woe to you, my Princess. When I come. I will kiss you quite red and fees you ‘till 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.’’ Among the people to whom Freud introduced cocaine was his colleague Carl Koller, a young doctor working in the department of ophthalmology. Freud published his essay in the July issue of the Centralblatt für Therapie, concluding it by drawing attention to the possible future uses of the drug as a local anaesthetic. Koller was impressed, thought it likely to be useful in eye operations and two months later tried it out , first on animals and then on his own eyes with complete success. He was quick to publish his findings, thus securing a place in world history as the discoverer of what turned out to be virtually the only medical use for the substance. Freud had missed his chance, but worse was to follow. Fleischl’s temporary improvement on taking cocaine was short lived. Within a week his condition deteriorated, his pain became unbearable and he relapsed into morphine consumption. He now had not one addiction but two, taking cocaine in doses a hundred times larger than Freud used to do. He suffered toxic confusional states in which he became agitated, experiencing severe anxiety and visual hallucinations. Yet Freud continued to advocate the use of cocaine in morphinism, presumably on the basis that (as had been reported by others) it was beneficial in selected cases. His paper On the General Effect of Cocaine. Written in the spring of 1885, was published in August and subsequently abstracted in the Lancer, By the following year, however, cases of cocaine addiction and intoxication were being reported from all over the world. Freud came under severe criticism for his advocacy of the drug and defended himself by claiming(inaccurately)that he had never advised its use in subcutaneous injections. He expressed the following view, “Theory is fine but it doesn’t stop facts from existing.” This became a favorite warning against the uncritical acceptance of received wisdom. 1884年4月弗洛伊德讀到一篇關於一位德國軍醫成功地使用可卡因來增加士兵體能和耐力的文章。他決定去搞一些並把它用於治療心臟病、神經衰弱及嗎啡嗜癮等病症。當時這種藥物鮮爲人知，同時也沒有像現代藥品試用管理中廣泛制定的道德上和使用上的規則。 弗洛伊德自己服用了一些，即刻就感到在不降低工作能力的情況下它所帶來的快感。他在《底特律醫學報》上讀到一篇關於癮品治療價值的文章後，隨即便向他的朋友和同事恩斯特·馮·弗雷氏馬科斯科推薦了這種無害的替代物。弗雷氏由於患有頑固的神經方面的疾病而處境艱難，經過不斷地藥物療法，他已嗜嗎啡上癮，當他充滿熱情地服用可卡因後，很快便開始大量使用。 與此同時，弗洛伊德繼續頌揚這種藥物的好處，寫有關該藥的評論文章，除自己服用外還把它當作靈丹妙藥推薦給他的未婚妻、朋友們、同事們和病人們。他已然極度癡迷，當他聽說瑪撒沒有食慾時便寫信說,‘唉，我可憐的公主。我回來後會熱烈地吻你並使你吃得胖胖的。如果你樂意，你會看到誰更強壯，是一個胃口欠佳的柔弱女子還是一個體內充滿可卡因的高大莽漢。’ 在這些弗洛伊德推薦給可卡因的人中，有一位是他的同事卡爾·科勒，他是個年輕的眼科醫生。弗洛伊德在七月號的《醫療專刊》上發表了一篇文章，在篇末他指出將該藥用於局部麻醉的可能性。這給科勒留下了深刻印象，他覺得這可用於眼部手術並在兩個月後開始試驗，先是在動物身上，之後在自己的眼睛上，並取得了完全的成功。他即刻公佈了這一發現，因此他作爲在醫療實用中運用的唯一的該物質的發現者在世界歷史上佔有一席之地。 弗洛伊德失去了這次機會，但更糟的事又接踵而至。弗雷氏服用可卡因的短期效益沒有持續多久。不出一週他的情況每況愈下，痛苦不堪同時又陷入服用嗎啡的惡習。他現在不是隻沉溺於一種而是兩種，可卡因的服用量要比弗洛伊德當時大一百倍。他遭受着中毒性的恍惚狀態，他變得焦躁不安，極度憂慮併產生幻覺。而弗洛伊德仍繼續倡導在嗎啡上癮時服用可卡因，據其他人的報道這可能是建立在某些病症上會產生效應的理論基礎上的。 他的論文《關於可卡因的普遍效應 》寫1885年春季,八月份發表後就在《持矛騎兵 》雜誌上登出摘要。可是到了第二年，世界各地都報道了可卡因上癮及中毒的情況。弗洛伊德因倡導這種藥物受到了嚴厲的批評，他爲自己辯護道（不確切地）他從沒建議過以皮下注射來使用它。他表達瞭如下的觀點，“理論固然不錯，但它無法制約已經存在的事實。”這對於全盤接受常理的人無疑是個良好的忠告。
