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t.a:yin_~reactions of individuals. \\'ith coca this latter factor. 2s Slanltgazza has already reponed, is in senera1 of ~ ' C T ) ' great significance.

There are said to be.people \\.ha cannot tolerare coca at all; on the orher hand, I have found nor a few w.ho remained unsffected by Scg, which far me and others is an cffec-

cocaine dispels extreme fatigue 2nd a w l l justified feeling of hunger; at 6:OO P.M. this colleague, \vho had not eaten since the early morning and u.ho hJd worked exceedingly hard during t h e d 3 y , tool; 0.0Sg of cocai'nun? nwfio!icum. .\ f o r . minults lal*:r h e declared thzt he felt as though he h a d jcst e.?lc!1 t n
to undei1zl;e a

effect of coca is \.ouched for by a series o f reliable reports,
is completely l a c k i n g the characteristic urge for im-

d r u g at all.'

by coca in such doses is due not so much to direct siimulation as IO the disappearance of elements in ofie's gtncrzl state of well-being \vhich cause depression. One may perhaps assume that the euphoria resulting from good health is also nothing more rhzn the normal condition of a well-nourished cerebral coriex which "is not conscious" of the organs of the body to which it belongs. During this stzge of the cocaine condition, which is not otherwise distinguished, appear those sympI O ~ S which have been described z t h e wonderful s siinu:atirig effect of coca. Long-lasting, intensive rr;cntal or physic4 work can be performed \\.iihoot f Z i i g t i C ; i t is as though the need for food and sleep, \Vhich otherwhc makes itself felt peremprorily at cerrain times of the day, \vert completely banished. \{'hilt the effects of cocaine last one can, i f u q e d IO d o S O . cat copiously and without revulsion; but one has the clear feelins ;hat :>e m a l was superfluous. Similarly, a s the effect of cocz declines i t is pojsible 10 sleep on going to bed, but sleep can just as cnsily be omitted with n o unpleasant consequences. During

rhirst, and woke the next morning u.ithotir f::!izg all tired. O n yet anorher occzsion he climbed a 3OOO-foot mountain and arrived conplere!). exhzusted at the summit; he made the descent upon t h e i n f l u ence of coca, with youthful xifor and no feeling of fatigue. C I ~ m e n sand J . CoU2n'' have had similar ex~~ periences-rhe latter after wzlking for several hours over snow; Mason" calls coca "an excellent thing for a ?ong walk"; Aschcnbrandt" reponed recenliv how Bavarian soldiers, weary as a resu!t of hardships debilitating illnesses, were ncvenheless a p z b l e , z f i x taking coca, of participa:in_cin r n i n c a v m 2nd rnzrchel. 5lorino y >laYz50u.as able 10 s!zy 2:vrke \vhole nigh:^ u j t h i h c 2id of coca; M a n i e g z z z remzined for forty hours w,ithout food. W e =e, therefoie, justified in assuming that the effecr of coca on Europeans is the szme as that which the ccxa 1:aves have on t h e lndizns of South Amcricz. The effect of a moderate dose of coca fades a\va\so gradually that, in normal C ~ T C U ~ Z ~ ~ i:~ C C C . is difficult to define its duration. I f on: works inrensi\.el!'

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cceded in 2chieving a stare of greatly increased hzpp i n e s accompanied by 3 dcrirc for conplc:c intmobility: this \v2s interrupted occasionally, ho\\rver, by the most violent urge to move. T h e analogy with the results of the animal experiments performed by von Anrep is unrnistzkable. When h e increased the dose still further he remained in a sopore beoro: His pulse rzie xvzs exr:cmely high a n d there ~ 2 a s moderate rise in body temperature; he found that his speech H’ZS impeded a n d his hvldwriring unsteady; and eGenruz1:y he experienced t h e most splendid and colorful hallucinations. t h e tenor of which \\*as friEhtening for a short time, b u t invariably cheerful thereafter. This coca intosication, too, failed to pro< duce any state of d c p r e s h a n d left n o sign what‘ soever t h z i h e cxperimenrer h2d passed through a period of inioxicztion. h l o r t n o y 5fzj;z zlso experienced a similar powerful compulsion to move after tzking fairly l u g e doses of coca. Even after using 18 drams of coca leaves hlantcgazza experienced no impzirment of full consciousness. A chemist who atrempted to poison himself by taking 1.5g of coczine” became sick and showed symptoms of gutroenteriris, but-there uzs no dulling of t h e consciousness.
\’I. The Therapeutic Uses of Coca

a plant which had echicved such a reputation for marwlous effects in its country of orisin should have been used IO tre21 t h e most varied disorders 2ad illnesses of the human body. The first Europeans \ti10 became aware o f chis rreasurc of the nati\-c population were similarly unreserved in their recommendation of coca. O n the basis of wide medical experience, 5 l a n t e g u z a later drew up a list of the rhtrapeuiic properties of coca, tvhich one by one r r x i \ cd t ? x rcLnoukd_rmenr of orher doctors. In the

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p:epirarions \vhich ha\x 15: full or a; lezct the essenrizl c f f c a s of coca Ica\-c‘s. a) Coco us u srimulonf. The m i n use of cccz \vi11 undoubtedly remain that which ihe Indians have made o f it for cenruries: it is of v213e in 211 cases \\.here t h e primzry 2im is IO increase the physical capaciiy of the body for a given short periijd of rime 2nd to hold strength in reserve to meet further demands- especially when ourivard circumstances exclude t h e possibility of obtzining the rest 2na nourishment normally necessary for great exertion. Such situations arise i n wartime, on journeys, during mountain climbing and other expeditions, etc. indeed, they a r e siruations in tvhich t h e alcoholic siimulants are also generally recognized 2s being of v d u e . Coca is a f a r more potent and fzr less harmful stimulant than alcohol, and its uidesprczd uti!ization is hindered at present only by its high cost. &Xing in mind the effect of coca on the natives of South A m e r ica, a medical authority a carly a s Pedro Crespo (Lima, 1793) recommended its use b y Europezn navies; Neudorfer (1870), Clcmens (I 867) 2nd SurgconMajor E. Charles” recommended that i t should be adopted b y the armies of Europe as well; and Aschenbrandt’s experiences should not fail to dr2\\’ the zitention of army administrators to coca. If coczine is given a s a stimulant, i t i! be::er thar i t should be given in small effective doses (0.05-0.lOg)2nd repeated so often thzt the effects of the doses o\.erIap. .4pparcntly coczine is not stored in the body; I h a w alrezdy stressed the fact that there is n o state of deprcssion when the effects of c x a have worn off. At present it is impossible to assess \\.ith any cero tainty to \\hat exrent coca c2n be especred l increzsc human mental po\vers. I t z v e ihc impression that protracted use of coca can lea5 to a 1zs:ing inpro:’c. ncnr if the inhibitions manifested beio:e i: is ! a k m

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are doe o n l y to physical causes or to eshrustion. To be sure the instzntaneous effect of a dose of coca nnot be compared with that of a morphine injecn; bur, on the gGod side of the ledger, there is n o riser of general damzge I O the body as i s the case t h the chronic use of morphine. 5.lany dociors fell that coca would play an impori a n t role by filling a g a p in the medicine chest of the psychiarrisu. It is a well-knoun fact that psychiatrists have a n ample supply of drugs at their dispos f.c?r reducing the excitation of nerve cenrers, but non u-hich could serve IO increase the reduced functioning o f the nerve centers. Coca has consequently been prcscribcd f o r t h e most diverse kinds of psychic debility - h>*steria, hypochondria, melancholic inhibition. stupor. a n d similar maladies. Some suc;tsssj h2L.e been reported: for instance, the Iecci:, .~filoaia Julizn (Limz, 17S7) tells of a I r x n e d mirsionzry \vho u a s freed f r o m severe hypachondria; Vzniegazza p:aises coca as bein3 almost universally efiective in improving those functional disorders Xvhich 1r.e now g r o u p together under the name of neurasihenia; F l i e ~ s b u r g ' ~ reporrs excellent results from the use of coca in cases of "nervous prosuation"; and zccording to Caldwell," it is the best ionic for hysteria. E. 3iorselli a n d G. Buccola" carried out csperim e n s involiitig rhe systematic dispensation of coczine, over a period of months, to melancholics. They gave a preparation of cocaine, as prescribed b y Trommsdorf. in subcutaneous injections, in doses ranging f r o m 0.0025-0.10s per dose. After o n e or two months they confirmed a slight improvement in the condition of their patients, who became happier, took nourjjhnleilt, 2nd cnjoyed regulzr di_ezstion.' On the whole, t h e efficacy of coca in cases of nervous and psychic debility needs further investigation, u.hich will probably lead to partially favorable conclusi0r.s. According to klantegazza coca is of no use, and is sometimes even dangerous, in cases of organic of change aad i n f l a m n ~ t i o n the nervous systen;. b) The use of coco for digestive disorders of the srornoch. This is the oldest 2nd most firmly founded use of coca, 2nd at the same time it is the most comprehensible IO us. According IO the unanimous assertions of the oldest a s well as the most recent authoritics ( J u l i a n , Martius, Unanui, 3lzntegatza. Bingel," Scrivener.7 Frankl, and others) coca in its r?osi t w i o u s f o r m s banishes dyspeptic complaints ed and the disorders a n d debility- theretvith,

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and after protrac!ed use rcsults in a pcrrnancni curt. I have myself made a series of such observations. Like :\!anicgatza" and Frankl." 1 h2i.e expcrl. cnccd personally how. the pzinful S ! n F t O m s attendant upon large mez!s-Yiz, a fccling of pressure 2nd fullness in the stomach, discomfort 2nd a disinclination 10 work disappear u i l h eructation following small doses of cocaine (0.025-0.-e and a p i c I have brought such reljef I O my colleagues; and tivicc 1 Observed how the nausea resultjng from gzsrronornic excesses responded in a short time to tbe effects of cocaine, and gave way I O a normal desirt to ea! and a feeling of bodily well-being. I have also learned to spare myself stomach troubles by adiin; a smz!! amount of cocaine to szlicylzte of sodz. F l y colleague, Dr. Josef Pollzk, has g i v e n me the following accounr of 2n zs:onishizg e::?.-: of :o:iint, u.hich shows that i t cia be used to t i e 2 1 nor fileicl\. locel discomfort ia the s:omach but iiso s- i l O U S L refles reactions; one must therefore asscrne that acaine has a powcriul effect o n the mucocs ner;lb:a: 2nd the muscular system of [his organ. "A forty-two-year-oid, robust man. ivhorn the doctor knew very well, HZS forced to adhere most stricrly t o a certain diet and io prescribe2 .ne;llimes; otherwise he could no1 avoid the attacks about to b: described. \\'hen traveling or under the influenx of any emotional strain he \v2s pzrriculzrly susceptible. The artacks follo\ved a regular PZ:~C:K: T h y began in the evening h i t h a feeling o i dis:cr.fort in the epigastrium, followed by flushing of the fzce, te2ts in the eyes, throbbing in the temples a n d violent pain in the forehead, accompanied b y a feeling of great depression and a2athy. He cocld no! s!~?? during the . . nigh; to\vard morning : z v:e:c Ion2 p::,!~!s r s t: spz of vomiting which lasted fo: hours. R;:nc! zbou! midday he experienced some relief, 2 n d on drinking 2 few spoonfuls of soup hzd a fcfling '2s though the stomach would at last ejcct a bullet w h i c h hzd lain in it for a long time.' This was follo\ved by rancid eructztion, until, toward evening, his condition rcturncd to normzl. The patient trzs incapable of \vork throughout the day and had I O keep to his bed. "At 6:OO psi on the tenth of June the usuzl symptoms of a n attack began. At ten o'clo:k, zfter the violent hezdzche had developed. the patient \cas .. eiven 0 . 0 7 j g coco;'nuni i,:l:ric:jmt.v. S h ~ r i l : ; thereafier he experienced 2 feeling of \v2rni!h 27d eructation, tvhich seemed to him t~ bs 's!ill too little.' .A[ 10:30 a second dose of 0.075g of coczine \vas given; the erucrations increzscd; the patient felt some relief and \vas able io write a long letter. H e al!egcd rhzl he felt inrensi\.c nio\'emenl in the stom2ch; il t\le:**e

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o'clock. apart fioin a slight headache. he "as normal, e \ c n cheerful, and nalkcd for a n hour. He could nor clccy, until 3:OO AM. but that did not distress h~m. c a \ \ c L c the next morning healthy, ready for H ork. a n d w i t h a good appetite." The cffect of cocaine on the sromach ->lantegazza :isumcs rnis 2s weII-is t\t.o-fold: stimulation of mc\.emenr a n d reduction of the organ's sensitivity. The laitcr \\,auld seem probable not only because of rhc local sensations in the stomach after cocaine has been taken but because of the analogous effect of COczine o n other mucous membranes. hfaniegazra claims to h a \ x achic\,ed the most brilliant successes in treatments of Zastralgia 2nd enteralgia, 2nd 2!1 p 2 i ~ f u l and crzm2ing afflictions of the stomach z n 3 i!:iesrinc.c. \\.hi;h he 2r:rjbuies I O the znesthe;izing p:operties o i coca. On this point I c2nno: c o n f i r z \IanreSazza's cspericnces; only once, in connection u.irh a case ef gzstric cararrh, did I see the sensjri\-i:y ~f the siomzch to pressure disz?pear after the adminisIration of coca. O n other occzsions I have observed m:%'self. and Z ! j O hi.zrd fxxn ot!?cr doctcr.c, Ih?t pztients suspected of having ulcers or scars in the s!omach complained of increased pain afier using coca; rhis can be explained by the increased movement of t h e stomach. Accordingly, I should say that the use of coca is definitely indicated in cases of atonic dipestive weakness a n d t h e so-called nervous stomach disorders; in such-cLses.it is possible t o achieve not mere:y a relief of the symptoms b u t a lasting improvement. c) Coco in cachexia. Long-term use of coca is further strongly recommended-znd allegedly h been a
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m3n! of thl: aurhors \ r h o ha1.c \\ri:lcn on coca : C ~ Z ; J of sa\ ings"; i e . . t h e y arc of ~ h opjnion c l f i a t a system ithich has absorbed c \ c n a n c\trcmc!y $mill amount of cocaine is czpable, as 3 r w ! i of the rcaciion of the body to ceca. oi amassin: a ;rci:er :10;e of \iral energy \\hich can be C D : : \ C ~ I : ~ inlo nark than nould h a \ e been possible \ \ I I ~ O J ~ ;oca.': If rake the a m o u n t of uork as being constin[, t h e bod). which has absorbed cocaine shouid b: able 10 manage \vith a lo\vcr metabolism. \\.hiCh [Urn means a smaller intakc of food. This assumption \\.as ob\.iourly made I O account for the, according 10 yon uncxpkintd effect cf coca on the Indiznr. I t ~ X Si13t c\c;r :-,c:e:>zrii!. j T r i 0 I t . C a contrzdiction of the 1 2 . 1 ~oi coni:;\z;jcn c.j cze:s!.. Fer Izbcr u k i c 5 f:E:?.s L.;~C: f33.2 0; :isss: ;on-,por,snts in\ @ I \ cs 2 cei;iiiI loss, ei;hc; in !!.,e ntiiizziion of assimilrred food or i n the cor:.:rsion of energy into work; this loss :ol;ld perhzps be reduced i f ce:;iin appropriate steps \vert trker.. I r hzs nor Seen pia\.cd thzt such a process :akes ?!ece, box.. .
2:'cr. E.\peri;!lc;i!s d e s i ~ ; l c d:O dc::crni:nc ;r:: Z:i>Ou:1i cf urine climir.ated \vith 2r.d ivitkout :he cs: cf coca have not been altogether conclusive; indeed, these es-

phthisis. long-lasting febrile diseases, e x . ; a n d also during recovery from such diseases. T h u s McBcan"
to hzve a limiting effect on the fever a n d sweatin_e. Peckham" reporrs wi;h resard IO a case of definjtely diagnosed phthisis th2t after fluid extract o f coca had

been used for seven months there was a marked imp r o w m e n t i n the patient's condition. HoleCo gives m account of another rather serious case. in which chronic lack of zppetite had led to z n advanced condition of emaciation and exhaustion; here, too, rhe use of coca restored the patient IO health. R. Bartholo\^" observed. in general, that coca proved useful in trcaring phthisis and other "consumptive processes." ?lznregarzz and a number of other authorities attribule to coca the same invaluzble therzpeutic quality: thzt of limiting degenerztion of the body a n d increasing strength in the chcc of cachcsia. O n e might wish to attribute such successcs partly 1 0 the undoubted fa\orzble effect of coca o n the discstion, but one muat bear in mind that a good

perirnents h a w not always been conducied in such conditions that they could furnish :onclusi\.e results. .\loreover, rhep seem to ha\.e bcen curied out on the vsumption that the eliminztion of u:ine - \vhich is known not to be effected by lzbor - \vouli provide a meuure of metabolism i n general. Thus Christison noted a slight reduction in the solid componcilts of his urine during t h e walks o n uhich he took coca; Lippmann, Demarle. Marvzud, 2nd mo:e rxcntly Sfason" similarly concluded from thcir expt:im:n:s that the consumption o f c o c i reduces th: i r . o u n t of urine elimination. G u e z u , " on t n e o:h:r hand, csrzblished a increase of uiine eli;ninerion of 1 1-24To under the influence o f cocz. A berter a\~ziiability of mzterials already stored in the body explzins, in his opinion, the body's increzsed working p o w r and zbiljry to d o without f o o d when under the influence of coca. No experiments hzve been c x r i t d out with regard IO rhe elimination of c i r b o n dioxide. Voit proved rhat coffee, which z!;o riled a s a "source of sa\*ings," h a d n o influence on rhe brezkdown of albumen in the body. !$'e mus! regzrd th:conception of coca a a "source of sa\.ings" 2 diss s proven after c e n a i n expefimenrs in which znimals were starved, both with a n d \vithout cocaine, 2nd the reduction of their b o d y ueizht and the length of rime :he). were able to uithstand inanition \\ere observed. Such experiments \\.ere cairied out by Ci. Eernard," Slorino y h4aYz, Dcmarle, Gazeau, an3 v o n Anrep. The result \v2s that the animals to which co:zin: had been adminisicred succur;lb:d to inzfii:i ~2 jilst 2s soon- perhaps c\.cn sooner - i h a n l h o i e -A ?,i:h hhd rtceived no cocaine. T h e s:z:\,a:ion of 1.a P i r - i n

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experiment carried out by history itself, and reported by Ucanue- seems to contradict this conclusion, ho\rc\e;, for rhc inhabitants who had partaken of coca a e said to have escaped death by slayation. I n t t , i s cocnection one might recall the fact that the human n e n o u s s!'stem has an undoubted. if somewhat obscure, influcnce o n t h e nourishment of tissucs; psychologjcal factors can, after all, cause a healthy m a n to lose tveight. T h e therapeutic quality o f coca which u e took as o u r argument ar the outset does not, therefore, deserve to bc rejected out o f hand. T h e exciration of nerve centers by cocaine c a n have a favorable influence o n the nourishrnenr of the body afflicted by a consumptive condition, even t h o u z h thzt influence mighi u.ell not t2kc the f o r m of a slo\ving do\vn of netabolism. I should add htrc that coca has been tv2.rrdy praised in connection with the treatment of syphilis. R . b ' . T-zylor" claims that a patient's tolerance of mercury is insrcved and the mercury cachexia kept in check when coca is administered 2: the same time. J . Collan" recommends it a s the best rcm:dy for srornariris mercurioli3 a n d 'reports thrr Pzgva!i3 2 h 21s prescribes it in conjunction with preparations of n:rcury. d) Coca in rhe trearnient oJ morphine and alcohol addicrion. I n i b e r i c a the importznr discovery hzs recently been mzde that coca prepararions possess the -power to suppress the craving for morphine in habiiual addicrs, a n d dso to reduce to negligible p:oportions rhc s:rious symptoms o f collapse which a p p c t r uhile the pztient is being weaned zway from the morphine habit. According to my informarion (\v!iich is 12rgeIy from t h e Derruii Therapeuric Gorerre). i t was 1iI.H- Bcniley6' who anncunced. in>!2y 187s. that he had substituted coca f o r the cus;omz-y zlkaloid in the case of a female morphine addici. Two years later, Palmer, in an article in the Louissille hfedicu14'4ws, seems IO have aroused the Sreatest general interest in this treatrnenr of morphine addiction; for the ne\[ two years "€ryrhro.y*/on cocu in the opium habit" was a regular heading in the reporis of the Therapeufic Gumre. From then on informa-

their conclusiveness. S o r e 0; them ! ! - i C ~ ! \ c I:r:c doses of o p i u m or morphine 2nd ~ ~ ~ ' ~ I C L f l0::g I S o~ O T standing. T h e r e is nor much informarion on the subject of relapses, a s mobt cases Lvcrc reported ui;hin a very s h o n time of the cure ha\inS been effected. Symptoms \vhich apperr during rt.s!enrion zre not ahvaps reported in detail. There is cspccial value in those reports which contain the obser\*ation that the patients were able to dispense uirh coca afrcr a fcw weeks without experiencing any funhcr desire for morphine." Special attention is repea!cdly called to the fact that morphine czcheda _ca\'e w a y to excellent health. so that the pa ti en!^ were sczrecely recognizable after their cure." Concerning the mcthod wirhdraual, it should bc mzde clezr that in the maority of cases a graduzl r:duaion of the habituzl of the drug, accorr.pnitd b!. 2 g r a d u d incrczs \ of the coca dose, wzs the mtihod chosen: hou,ever, sudden discontinuation of the &ng zlso tried.:' In the Iztter cas: Pzlmer piescribes t h a t a certain dose of coca should be re2er:ed 2s cfre?. c!crkg t h ? day a s t h e desire for morphine :fc::j.* T h e dtily close of coca is lessened graduz!iy cnr:! i t is possil;!e to dispense with the zntidote zltopether. From the very beginning the attzcks experienced during abstinence were either slight or else b e t m e milder after a few days. In almost eveiy case the cure was effected by the patient himself, \\hereas the cure of morphine addiction without the help of coc-2, as practiced in Europe, requires surveillvlcc of the paricnt in a hospirzl. I once bad occzsion to o b s e n c the czje of a mzn who was subjected to th: t!.pe of c u e involving the sudden v.*ithdrz\\fal of morphine. zssisred by the usc of cocz; t h e s2mc patiear hzd suffered scvere s)mptoms as a result of zbstinencc in the cocrss of ir previous cuie. This time his condi!ion \v25 rolcreble; in particular, there was n o sign of depression or nausea as long as the effects of coca lasted; chills and d i u rhea \\.ere n o w the only ptimantni symproms of his a b s t i x n c e . T h e patient ~ v z s l?c?ri?,?cn. 2nd c ~ l d cat function normally. Durins thc first 12ys O rh: C u r e ! he consumed 3dg ofcoco:',~um i u r i c r i c u m daily, 2nd n after ten days he \vas ab]: to dispense \cith t h e coca

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(.! mo:rninc. 1 a m raiher inclined to assume that c w a has a directly an:agonistic cffcct on morphine, 3 n d i n suppcri of my view I quoic thc follo\vin_e obser\2:ions of Dr. J o x f Pollak on a case in point: .'.-I h ;r iy - ih r ec- !'c ? r - old \\'om2 11 has been su f f e r i n g : . for !'ca:s from se\*ere nienstrual inigraine \\ hich can t-: a!!?\ isizd o n l y try morphia injections. .Although i h c lady i n question ne\.cr takes morphia or expcric n c e s an!. desire i o d o so when she is free of migraine, dtiring the aitacks she behaves like a morphine addict. .\ few hours after the injection she suffers inicnse depresion. biliousncss, attacks of vomiting. \\ I:Ic!-I 2re slopped by a second morphine injectios; t!;c:e.Jpx, thc syn;p:oms of intolerance recur, \\ iih i h ? r e s u i t 1 1 i i t an iiitick of migrzine, along \vith all i i s cc!!:eq:enccs, Leeps ;!?e pa!iex in beit for ihrct days in a ~ o r \\.;etched condiiion. Coczine \\.as thea tried t to c e n b a t ihe m i g z i n e , but the treatment proved unsuccessful. I t 1 ~ 2 s necesszry to resort to morphine injeciions. But 2s soon 2s the s\:mptoms of morphine iziclcrrnce appeared, they were quickly relieved by ? of ;oc:inz, : \\*i!h 1 1 result t k t t!ie p t i e n t rc~ cohered from her nttack in a f2r shorter time 2nd consumed much less morphine in the process." Coca w2s tried in America for the treatment o f chronic ~ l c o h o l i s mat about the same time as i t was introduced in connection with morphine addiction, 2nd most reports dealt with the two uses conjointly." In t h e tre~trilentof alcoholism, too, there were cases of undoubted success, in which t h e irresistible compulsion to drink was either banished or alleviated, and the dyspeptic compldnrs of the drinkers were reliew3. I n general, however, the suppression o f the alconol craL-ing through t h e use of coca proved 10 be more difficult than the suppression of morphomania; in one case reported by Bentley the drinker became a coquero. One need only suggest the immense economic significance which coca would acquire a s a "source of savings" in another sense, if its effectiveness in combating alcoholism were confirmed. e) Coca and arrhma. Tschudi a n d Markham" report that by chewing coca leaves they were spared the usual symptoms of the so-called mounrain sickn w while climbing in the Andes; this complex of symptoms includes shortness of breath, pounding of the h e m . dizziness, etc. P o i z a ~ ~ ~ reports that rhe vthmz~ic ariacks of a patient were arrested in every case by coca. I mention this property of coca because i t appezrs to admit of a physiological explanation. \'on Anrep's esperiments o n animals resulted in early paralysis of certain branches of the vagus; and altif tude zsthma, as \vel1 as the attacks characteristic o chronic bronchitis, may be interpreted in terms of a r e f l n exirztion originating in the pulmonary branches o i :he 1 2 ~ ~ The use of coca should be considered s . !>r ihe : r e z : m n t of oihcr vagus neuroses.

.~r;;C;,g

:he p:;i~;.L

; 3 .A:.c:i I h ; . . ~ _~:..tz :c<z. sesczl excitement \>:hich they zttiibuied 10 the coca. .4 y o u n g \!.riier, by treiimeat n.iih coca to :csumc longish i l l a s s , gz:'e gp ccir.g the the undcsira5le sccondr-.::; cf;tc:s

\ \\

\

k q i 1 1 it

had 011 !;:Ill. .. g ) Lorel applicalion oJcoco. Cocain- 2 2 : i:s sz!:s ha1.e a marked anesthetizing effect when srm;ght in contact \vith rhe skin and mucous mcmSrane ir. con: centrated solution; this propen? sugges~si:s 0 x 2 sional use 2 a local anesthetic, especizlly in cons nection \virh affections of the mucous membrane. According t o Collin," Ch. F2u\ol strongly recommends cocaine f o r treating d i s e a e s of the pharynx, describing it 2 "le renseurpor ewellence des c h o r d s s vocoles." Indeed, the mesthetizing propertics of cocaine should m2ke it suirablt for 2 goxi m a ~f .m~ e r h a pplita ti ons .

1

SOTES
1. O.R. Markhan. Pemi*ian Barks, Lcndon: 1880. 2. According to Bibra'r esrimitc. .Vcrcoric S:irnul,-nfs. 16E5. 3. Wcddcll. Voyage d a m IC Piord de la Boliric, 1655. 4. Scrivener. "On the coca leal and iu us: in diet t n t ntCi:in:." Medical Tirncc and Ga:tile, 1E7 1 . < Carcilrrso dc la Vega. Cornrnccrcrios rech de i: Inccs. o 1609- 161 7. 6. Chrirtiron. "Obrcmations on t h e c l f m of C U ~ 0: c ~ i t h e , . l c a w s of E ~ ~ h r o x y l o nO ; ~ .B-;:uh ,J.leJ;rci .. C " I: c r .!. ! E?6.

-.

Bibra. LOC.cit.
7. )rlantepzza, "Sulle virru igicfiiche e rncdic;lrr=li a'eiic
C O C O ."

a.
9. 10.
11. 12.

13.
14.

Milan: lS59. Scrivcncr. LOC.cit. According I O C.110. whom Bibrz co$-r. S)slcma mal. med. brasil.. 1623. f i s a i s u r lo coio lu Ptrou. Thesis. Pa7r: 1662. cf. Fronmullcr. "Coca 2nd Cz:." Proper l ' i e I . c : i r h : ~ ~ ~ ; h r t : i j i r prak!ische Heilkunde. v. 7 9 . iS51. I'icgem de cidodc de Cu:co a de Brlcrn. 1649. & + d ; ~ ; o ~ ~ O P J le3 p c r ~ ; , = ~ ccr;r,-;cs c'c I : i m r r t C u e Sa?.

.:I

1651. 15. Sp:\'i 2nd 51inic:' J o a r c t l ; n Ef::;l. i F: I