/ \

% C l \a CLASSICS RE VISITED

\c Uber Coca: Freud’s Cocaine Discoveries

EDITOR’S I STRODUCTIOS

REGARDLESS OF TXE ~DJ-ECTWES used to describe con- temporary cocaine use and/or abuse, the trend to- ward increased and more widespread use h2s been well documented (e._e., Gold, 19s;). The history of cocaine goes back more than a millennium t o the early use of the coca plant (Erthroxylon coca) in South America. Dyke (1981) suggests that the reasons for the early practice of chening the coca plant leaves have been lost in antiquity, but that there is evidence from Indian burial sites thzt this activity began be- fore the 6th century AD. Dyke also notes that the coca leaves were considered “precious and were usually reserved for nobility and religious ceremonies” (1981, p. 158). Presently, it is estimated that over 4 million Peruvian and Bolivian Indians chew coca leaves regularly (Dyke, 1981).

Even though chewing the coca leaf could produce euphoria, this activity was not as popular in Europe as drinking tea or coffee, perhaps, Dyke (1981) sug- gests, because the leaves deteriorated during the long voyzges between Sourh America and Europe. In IS55 Gzrdeke was the first t o extract the active ingredient of the coca leaf, which he called erythroxylon. Ac- cording to Byck (1974), Niemann isolated the alka- loid 5 years later and named it cocaine. Once this psychoactive ingredient was isolated, there was a great flourish of personal experience and sc.ien1ific experimentation with the substance.

Sigmund Freud, the “father of psychoanalysis,” was initially responsible for the medical, scientific, and personal interest espressed by many of those who studied and used cocaine since Ihe nineteenth century. In fact, Freud’s work, Uber Cortl, has been considered !o be “the definitive description of the ef- fects o f cozaine in hzrr.sr.s”(Dyke, 19S1, p. 159) and renccis the history of the study and use of cocaine f rom the middle to the end of the nineteenth century.

Freud began his work with cocaine while he was a house officer at the l’ienna General Hospital. His firsi reference IO cocaine w3s expressed in a letter nritcen on April 21 , 16S1 IO his fiancrc .\lartha Ber-

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n a y Ishen he identified a “therapeutic project and a hope” (Byck, 1974, p. 5).

I have been reading about co;air:e. ihc essential c0ns:ituent of coca leaves which some I n d i a tribes chew to en?Slc them to resist privations and hardshjps. .4 Gcmm hrs S t e n emplojing it with soldiers and has in f2ct reponed ;h2t i r in- crezses their energy and capacity to endure. I am procuring some myself and will try it with cases of heart diseve and also of nervous exhaustion, particularly in the miserable condition after the wirhdraud of morphium . . . Perhzps others are working at it; perhaps nothing will come of it. But I shall certainly try it, end yo^ know that when one perseveres, sooner or later one succeeds. (Byck, 1974. pp. 5-6)

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This letter indicates several things about Freud and the context in which he worked. First, it reflecrs the passion and achievement motivation thzt ener- gized his creative life. Second, it hints at the willing- ness of Freud to fail, persevere, and ultimztcly suc- ceed at an endeavor that had little p s i l i ve consequence - nuaranteed. In addition, this letter reflects the lack of regulation surrounding rhe use of cocaine as well 2s the standard medical practice of that time for physi- cians to use and experiment uirh the drugs that they were studying or prescribing. Finally, Freud‘s willing- ness to experiment personally \vith cocaine indicares that he did not consider the drug experience 2s dis- continuous from the rest of his life; perhaps, with his willingness to alter his own consciousness and accept the potential risks inherent to this experience, Freud was, unknowingly, lsyicg the subjective ground\vork for his conceptual development of the unconscious.

Uficr Cu;a d<:s:rlbtj :h: histor)., phzrmacology, animal and human effects. as \\ell as the medicinal ap- plications of cocaine. Although Freud d x r i b e d a variety of medical applications for cocaine, i r \vas onlp later. in an addenda to this paper. that he considered s he anestSetic properties of the substance 2nd its a g plication for eye surgcry. Consequently, Karl Kollcr, a colleague of Freud. is considered by most sources to be the dirco\,erer of local anc~ihes i3 ( B ~ c k . 1974).

C bcr Coco srands 2s a beacon to the understanding of cocaine and its nztural history \rithin a social and scientific col;test t h a t \vas essentially unregulated. and rherefore; not influenced by government intertmtion. I n addition. Uber Coco illustrates the naive tendency of some energetic in\.esligators to believe that i t is possi'clc I O "cure" chemkal dcpendcncy to one drug sim- ply by substituting another, i.e., treatiny the s y m p ton:s of morphine and alcohol dependence with co- ciine. Freud displayed similar naivete- as h a \ e scores of other clinicians-by not recognizing the in- s id icus 2nd potent abuse potential of cocaine. Ye\.er- rhelcss, Freud's analysis of the psychological 2nd ~ \ h y s i o l o ~ i ~ r l effects of cocaine remain as irifor- r n Z t i \ e End precise 2s \\hen thes: de$cript iox \\ere o-;r:F* .,=.,.-!Iy formulaitcl. A s a result , Fr tgd ~ z n

Uber Coca

SIGMVSD FREUD

I. T h e Coca Plant

The coc2 plant, Eryd-uoxylon coca, is a bush four to six'fect in height, similar io our blackthorn. It is culti\.ated extensively in South America, in p a n i c u i v in Peru znd Bolivia. It thrives best in the u'2rm valleys o n the a t e r n slopes of h e Andes, 5000-6000 feet above sea level, in a rainy climate free f rom ex- tremes of temperature.' The leaves, which provide 2n indispens2Slc stjmulant for some 10 million people,' 2rc egg-shaped, 5-6 cm long, stalked, undivided, and pruinose. They arc distinguished by two linear folds, especially prominent on the lo\vtr surface of the leaf, which, Like lateral nerves, run along the medial nerve f rom the b u e of the leaf to its point in a flat arc: The bush b a r s small white flowers in lateral clusters of two or three, and produces red egg-shaped fruits. I t can be propagated either by seed or by cuttings; the young plants are transplznted after a year and yield their first crop of leaves aft& eighteen months. The

'I o w this docription I O Professor Vogl of Vicnna. uho h u most kindly placed his notes and books oboui coca ai my disposal.

"i)ber Coco.' Yon D r . Sigm. Freud, Pcundororft im k.k. All- pemrincn Krcnkcnhorrtc in H'ien. Ceniralblorr f u r die tu. Thcropie. 2 , 389-314. 1864 Juli. On Coa. By Dr. Sigmund Freud, house officer of the Gcnc:aI

Hospi:rl of Vienna. T:rnslaied by Steven A. Edminsier; addjiions IO the irans!s:ion

by Frcocrick C. Rcdlich. Rc?:i:.:cl from Cocsinr Pipers (19:z). R . B y i k (Ed.). S:on:t,ill

PuS:st.ing C o n p m y . Xcu I'o:L.

leaves are considered ripe when they h i v e become so stiff that their stalks b i e k upon being toached.

They 2re th:n dried r i ~ i d l y , eirhtr in the sun or u i t h the ai3 of fire, and into szcks (cesros) for transpon. In favorable conditions a coca bush yields four or five leaf crops annuzlly and will continue to produce a yield for between thiny and f o n y yezrs. The large-sczle production (allesedly 30 million pounds annually) makes coca leaves zn imporant item of trade and raxarion in the countries where they are grown.'

11. The Hislory and Uses of Coca i n i ts Countn of Origin

\Vhen the Spanish conquerors forced their way into Peru they found that ihe coca plant w a cultivated and held in high esteem in thzt country; and indeed that it was closcly connected u i th the religious cUS-

toms of the people. Legend held that Manco Capac, the divine son of the Sun, had descended in pirnevd times from the cliffs of Lake Titicaca, bringkg h5 father's light to the wretched inhabitants of the coun- try; that he had brought them knowledge of the gods, taught them the useful 2m, 2nd given them the coca I d , this divine plant whjch satiates the hungry, strengthens the weak, and causes them to forget their 1'

misfortune: Coca leaves were offered in sacrifice 10 the gods, .\\'ere chewed during religiou~ ceremonies, and were even placed in the mouths of the dead in order to assure them of a fa\*orable re:ep:ion in I h c be\ond. The hir ;or izn of ;he Spanish C O ~ O ' J C ! ~ . ' bairn-

sc l f a dcsccndant of the Incas. reports that coca was 3:. first a scarce commodity in the land and its use a prerogative of the rulers; by2he time of the conquest, ho\vc\.er, i t had long since become acccssiblc to c\'cryonc. Gzrcilzsso endeavored to defend coca against the ban which the conquerors laid upon i t . The S p a n i u d s did not believe in the marvelous cf- fccts of the plant, which they suspected as [he work of the det-il, mainly bccause of the role which it played in the religious ceremonial. A council held in Lima went so far as to prohibit the use o f the plznt on the ground that it was heathenish a n d sinful. Their atti tude changed, however, when they observed that the Indians could not perform the heayy labor imposed upon them in the mines if they uere for- bidden to parteke of cocz. They compromised to the extent of 6is:riburing coca leak-es io the workers three or f o u r times daily and allowing them shorL periods of respite in which to chew the beloved leaves. And so the coca plant has mzintained its position among [he nz:i:.es to ihc present day; there even remziil tr2ces cf !he religious vcnerztion uh i ch was once ac- corded to it.*

T h e Zndjzn alu,ays carries a bundle of coca leaves (c211e3 chwpa) on his wanderings, a s well as a bottle conrzinir.? plant esh (Ncru).' I n his mouth he forms rhe lezvts into a b2U, which he pierces several times Lvir'n 2 thorn dipped' in the u h , a n d chews slowly and thoroughly wirh copious secretion o f saliva. It is said that i n other areas a kind of c a n h , ronro, is added io the leaves in place of the plant ash.' It is not con- sidered immoderate to chew from three IO four ounces of leaves daily. According to 'Mantegazza, the Indian begins to use this stimulant .in early youth and con- tinues 10 use it throughout his life. %'hen h e is faced \vith a difficult journey, w h r n he takes a woman, or , in g e n e i d , \\-henever his strength is more than usua!ly taxed, h e increases the customary dose.

(11 is not clezr what purpose is achieved through ihe admixture of the alkalis contained in the ash. blantegazza claims to have chewed coca leaves both \vith and \vithout Nicro and to have noticed n o dif- ference. .Axo:lizg I O .\.!artius'O a n d Demarle,l ' the cocaine. probably held in compound tvith tannic acid, is released by the action of the alkalis. A Ilicfa 2nal!.zed by Bibra consisted of 29To carbonate of lime a n d magnesia, 3 4 r o potassium salts, 307, zrgillaceous ezrrh and iron, 17010 . insoluble com- pounds of zrgillaceous earth. siliceous earth and iron, 5?0 carbon and 10To water.)

There is ample evidence that Indians under the in- fluence o f coca .can withstand exceptional hardships

nau," Alartius," 2nd Scrit'cnc:" confirm [h i s , and Humboldt spcaks of i t in connection with his trip to the equatorial regions as a generally kno\\n fact. Often quoted is Tschudi's" report concerning (he performance of a cholo (half-brced) whom he was able to observe clostly. T h e m2n in qucstion carried out laborious cxca\,ation work for five days and nights, without sleeping more than tueo hours each night, and consumed nothing but coca. Aftcr the work was completed he accompm'ed. Tschudi o n a two-day ride, running alongside his mule. He ga\'e every assurance that he would gladly perform the Same H . o r k again. without er:ing, i f he were gi\-en enough coca. The man was sixty-tu.0 years old zn;! had never been i l l .

I n the / o u r m y of the Frigc:? ' .~ 'OI.C~; ' , sinilzr ex- amples are recounted of incicrsed physic21 powcrs resulting from Ihe use of coca. \\'e3dell," \.on >leycn," hlzrkham.'O and eves Poeppig" (whom \ve have :o thank f o r many of :he sl.?i~derous repor:s &out coca) can only confirm this cffecr of the leaf, which, since i t first became knau.2, !?: ci?n!ir,.u:d :o be a source of astonishment thiouchoilt the world.

Other reporrs stress the czpacity of the coqueros (coca chewers) to abstain from iood for long periods of time without suffering any ill effects. According to Unanut,12 when n o food w a s avdab l c in the besieged city of La Paz in the year 1781, only those inhabitants sur\ived who par took of coca. According to Stewcn- son," the inhabitanrs o f many districts of Peru f 2 r r , sometimes for days, a n d mith the aid of coca are still able to continue working.

In view of 211 this evidence, and bearing in mind the role which coca has played for centuries in South America, one mus t reject the v!e\v sometimes ex. pxssed, that the eifect of coca is an irnaginzry one and that through force of circumstznccs 2nd with practice the natives would be zble to perform the feats attributed to them even without the aid of coca. One might expect to learn thzt the coqueros compen- sate for abstention from food by eating correspond. ingly more during the inrervals bctucen their fasts, or that as a result o f their mode cjf l i f e they fall into a rapid decline. T h e reports of rrivelers on the formrr point are not conclusive; as foi t h e latrcr. i t has been denied emphatically by reliable witnesses. To be sure, Poeppig painted a terrible picture of thc physical and intellectual decadence which are supposed to be [he inc~i tablc conscquencc of the hzbitual use of coca. But all other observcrszffirrn t:;zt t h e use of coca i n

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moderation is more likely to ?;omore health thzn 10 d impair i t , and that the

eddcll and ncrur i shrmt during that time." Valdez y c!sims th21 by using coca the Indians are able to [ : ~ \ ' c I a n foot for hundreds @i hours and run faster 1!-1an horses \tii!-iOut shc\ting s igns of

2nd perform heavy labor, without

apathy to\rzrd c\r.:!ihins ncu cCi.:

ncc:r.d i i h i h e znjo! inen1 o f t h e siirnu1:nt. \\'hit$ p o p l e sometimes succumb as \tell to Ih:s state, \ \ l i ich bears a g r e a t similarity to the symploms of chronic alcoholism and morphine addiction: I t is not- IzLcn i n \ \ho l ly immoderate quzntilies; and ne\er f:om a presumpii\.e disproportion beineen the zrnouni of nouiishmcnl taken and the 2mount of N ork performed by the c~qrreroS.

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i l l . Coca Le3t.e~ in Europe-Cocaine

,~ccording I O Do\vdes\vell," the earliest recom- mcndzrion for coca is contained in an essay by Dr. \lona:des (SeL ille. 1569) \vhich appeared in English trznslaiioii in 1535. Like the lzrer ieports of t h ~ J e i u i r Fither .Ar.tonio Julian," znd the docior Pedro Creipo.:' both of Lima, 3lonardes' esszy estols tne mzrvelous effect of the plant in combating hunger an3 fatigue. Both of the former authors had _eretit hopes for the iniroducrjon of coca into Europe. In IS49 the p imt brought to Europe; i r was de- scribcd by X.L. de Jussicu and clzcsed \vith the nen!is Erythrosylon. In 1786 it appezred in Lamzrck's €1;-

cylopidie .kfirhodique Boranique under the name of Erj.fhroxjlon coca. Reports of travelers such as T s h a i and 31xkham, among others, pro\ided proof ihat the eifcst of coca leaves is not confined to the In- dim race.

In 1659, Paolo Manteguza, who had lived for a number of years in South America's coca regions, published his discoveries about the physiological and iherrpcutic effecu of coca leaves in borh hcmi- spheres2' 3 l an teguza is an enthusiastic eulogist of coca and illustrated the versatility of its therapeutic uses i n reports of case histories. His report aroused much inrcrert but little confidence. Howver, I have come across so many correct obscwations in Manic- g w ' s publication that I am inclined IO accept his allegations even when I have not personally had a;l opportunity to confirm them.

In 1859. Dr. Scherrer, a member of the expedition in the Austrian frigate Novuru, brought a batch of coca leaves 10 Vierma, some of which he sent to Pro- fessor Wohler for examination. Wohlcr's pupil N e - mann2' isolated the alkaloid cocaine from them. After Niemann's death, Lossen,'O another pupil of U'ohler, 'continued the investigation of the sub- stances contained in coca lea\*es. *

/ M e m a n ' s cocaine crystallizes in large, colorless, 4-6-sided prisms of the monoclinic type. It has a somewhzt bitter taste and produces an anesthetic cf- fect on the mucous membranes. I t melts ai a tempera- ture of 96'C. is difficult to dissolve in water. but is

'There is \*cry li i i lc rprecmcni among authors about the ro1ubili:y of co-aine in u-rier. 1 1 is evident that various prepzationr of ':e ciin:" c z m c o n the marlci and ucrc b:oughi inio use.

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marle ( I 862), Gosse’s monograph on Eryhroxylon coca ( I 862), Reiss ( 1 866)’ Lippmann’s €rude fur la coca dir PProu (1 868). MorCno y Mdiz ( 1 668), who pro\,ided certain new facts about cocaine, Gazeau ( 1 870). Collins (1S77), and Marvaud in the book L a olimznrs d’eporgne (1671), the only of the above essays at my disposal.

In Russia Nikolsky, Danini (1673). and Tarkhanov ( 1 S72) concentrated particularly on studying the ef- fects of cocaine o n animals. hlany reports, all of which have been published in the Detroit Therapeuric Gazerre, have emerged from North America in recent ycars on the scccessful therapeutic use of coc.5ae preparations.

T h e earlier of the investigations referred to here led, on the u,hole, to great disillusionment and to the con\.iciion that effects from the use of coca such 2s had been reporred so enthusiastical!y from South .qmeiica could not be expected in Europe. Investi- _eations such 2s those carried out by Schroff, Fron- muller, a n d Dowdeswell produced either negative or, 2t the most, insignificent results. There is more than one esplanztion fo r these failures. Certainly the quzl- iiy of the prepzrations used u a s largely to blame.? I n a number o f cases the authors themselves doubt as to

> t h e quality of their preparations; and to the extent that they believe the reports of travelers on the effecis cf coca, they assume that these effects must be attrib- uted to a volatile component of the leaf. They base

\this assumption o n the report of Poeppig, a m o n g ’ others, tha t even in South America lezves which have

been stored for a long t i n e 2re considered ivonhless. T h e experiments carried out recently with the cocaine prepared by 3lerk [sic] in Darmstadt alone justify the claim that coci ine is the true agent of thc coc2 effect, which can be produced just as well in Europe a s in Sou th A m e i i a and turned to Qood account in diete;ic a n d therapeutic rreatment.

I \ ’ . The Effect of Coca on Animals

\\*e kno\v that animals of different species- and even individGz!s of the same species- differ most markedly from one another in those chemical characteristics ivhich determine the orgznism’s receptivity to foreign substances: \!‘e would, therefore, as a matter of course, not espect to find that the effect of coca o n znimals in zny way resembled the effects ivhich i t has been described to h2ve on man. \Ye msy be satisfied n i th the results of o u r inquiry IO the extent that \ \ e

can ccmprehcnd the way cocaine affects b@:h m a n and animals from a unified standpoint.

We a re indebted to von Anrep” for the most ex- haustive experiments regarding the effects o i coca on animals. Before him. such csperiments NC:C cariicd out by Schroff senior,” 3 lorcno y 31212,~‘ Tzrk- hanov,” Nikolsky.J6 Danini,” A. B:nneit,” and Ott.’* The majority of these authors introduced [he alkaloid either orally or subcutzneously.

The most general result of such experiments i that, in small doses, coca has a stimulating, and in larger doses a paralyzing, effect on the nervous sys- t e n . In the case of cold-blooded 2nirr.23 tht,pz;a- Iyzing effect is particularly noticeable, while in jvarm- blooded animals symptoms of stimvlirion are the mosr apparent.

According to Schroff , coczine p r o d x e s in frcgs a soporific condition accompenied by p2rAysiz of the voluntzry muscles. hloreno !’ 5la’iz, Dznini, Siko!- sky, and Ott made fundamental!y the s2mc disco\,- eiv; Sforeno y Maiz alleges [hat the general pzralysis ensuing from moderats doses is preceded 5y r::znus; under the s a n e conditions Sikc l sky describes i j : ige of escitation of the muscular system, w.hi;e Dtn in i , on the other hand, never observed a r , spzsms.

\’on Anrep likewise reports a p2ralyzing effect of cocaine on frogs after a short period of es5:Z:ion. .4r first the sensory nerve endings 2nd later t h t sensory nerves rhemsclves a re affected; breathing is at first accelerated and then brought to 2 standstil!; 2nd the functioning of the heart is slowed down until the point o f diastolic failure is reached. Doses of 2mg suffice to provoke symptoms of poisoning.

-4ccording to Schroff’s accounts of his esperi- ments with rabbi!s (Lvhich in d t t r i l z:e fr2nS:St n:i!h contradictions), coca produces mu!Lipl: s p s m s in rzbbits, increased respiratioa and pulst rzie, dilziion of the pupils, and convulsive death. Th: effexiveness of the poisoning depended to a large es:eni on the mode o f application. According IO Dznini, cocaine poisoning in \varm-b!ooded animals produce! 21 iirst agitation, ivhich manifesrs i:self in con:inuoas jzmp- ins and running, then paralysis of the T.Gs:~!z: fcnc- tions, a n d finally spasmodic (clonic) c r z y p . T i r k - hanov discovered a n increzss of mucous secretion i n dogs dosed \vith coca, and also sugar ir t h e u r i n e .

In von Anrep’s espsriments, the cficcr of cocaine, even in large doses. on \\.zrm-bloodsd znimzls mani- fested itself first of all in po\\eriiil psychic agiration and an escitation of the brain ccnlers \\ h i i h c o x r o l voluntary movement. Afrcr doses of 0.01g of cocaine per kg. dogs shot\. ob\-ious signs of h a p p y excircment and a maniacal compulsion 10 rn3i.e. F r o n [ h e c h a r - actcr of t!ic,c rno\emcn;s \c‘n .-\nrsp s c t j c\id:nce ih3t all ncr \e ;cnir.rs a rc af<cc;cd ty t ! ~ siimu:a!iL-n. 2nd hr. inicrprc:s Ccrl3i;; i :\ ing:ng : s s : i ~ n s C’ i ! l C ti233 A j 2;) i:ri13:i.T? pr,-:c:d:ns i:,-n; !F.c

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<::cc!zr c z n ~ l s . Furthcr m3nifc~t3tior8s of cocaine in- ioxici t ion are accclcraied rcrpiraiion. a great increase in the pulse raie owing I O early paralysis of Ihc 8. \ h g i . dilation of the pupils, 2n accelcration of in- tc5tinaI mo\.emcni, a great increase in blood- pressure, and diminution of secrerions. E \ r n after d c e s large er,ou_ch to produce eventual coniulsions. s\ mproins of paralysis and deaih due to paral).sis of rhe respiraiory ientcr, the striated muscle substance remains intact. \ 'on .%nrep does not establish the leiha1 dose for dogs; for rabbits i t is 0.10s and for

\ \ 'hen :!IC spins1 cord is se\.cred from the oblon- se t a . cocaine produces neither cramps nor a rise in b lood-prssure [Drnini); when the dorsal portion cf t i e 5pir.sl cnrd is severed. cocaine spasms occur in t5e ironr bur not in the rear extremities (von Anrep). Dznini and \'on Xnrep assume, therefore, that co- crine zffccts primarily the virrl 2rea of the medullz o?.lcn_cz:a.

I shocl3 add thzr only the elder Schroff refers to c x a i n c 2s a nzrcotic and clacscs it ivith opium a d crnnabis. while almost everyone else ranks it with caffeinc, erc.

C 3 I S 0.02s per k_p:

Y . The Effect of Coca on the Nealthy Human Body

I have carried out experiments and studied, in myself and o)hers, the effect o f coca o n the healthy human body; my findings agree fundamentally with h4ante- g a u z ' s description o f the effect of coca leaves:

The first time I t ook 0.05g. of cocai'num muriari- cd:'.; ix 2 190 water solution was when I was feeling 5l:ghiiY O'JI of sons f rom fatigue. This solution is rather viscous, somewhat opalescent, and has a suange eromatic smell. A t first it has a bitter taste, which yields efterwards to a series of very p l w a n t aromatic flzvors. Dry cocaine salt h2s the same smell and taste,

During this first trial 1 C.\pCriCnCed 3 s!iOrt period of io,\ic effects, u.hich did not rccur in subsequent ex- pcrimenls. Brcaihing became slo\\cr and decpcr and 1 felt iired and sleepy; I ya\\.ned ficqucntly and fclr some\vhat dull. After a fcw minutes t h e aclual co- caine euphoria began, introduced by rcpearcd cool- ing erucration. Immediately a f i t r tzLing the coiainc ] noiiced a slight slackenins of Ihe pulse 2nd 1a;er a moderate increase.

I ha\.e obscr\.ed rhe szme ph!.ciczl si_cns of ihe e f - fect of cocaine in others, mostly p-oplc of my o\\n age. The mosr constant s!'np:on p:o\.ed I O be t h e :e- ptzred cooling eruclarion. This often iX@mpzn icd by a rumbling \vhich must originate from h igh .up in the intes!ine; t\vo of the peosle 1 observed. \\!IO srid ;hey \Yere able to reco_c2iz: mc\cmenis of t h e i r stomachs, declared emphziiczily :ha t they hzd re- peatedly detected such mc\emen:s. Oficn. .it the outset of the cocaine effeci, the subjects z!leged that they cspcricnced a n inter.se feeling cf h::: in the head. I noriced this in myseif 2s \\e!] i n 15: :curse of >@me l a i t r crpcrimenrs. b!~r on c ther occ2c i c i l s ii \\zs absent. In only two cases did COG git,e rice IO diui- ness. O n the whole the toxic effects of coca are of short duration, and much less intense thzn those pro- duced by effeclive doses of quinine or salicy1r;c of soda, they seem to become even wezkei zfter re- ptated use of cocaine.

h fan iegaua refers IO t h e follou.ir!g octz : icx ! ef- fects of coca: iemporary cr)?hema, an increzse in rh: quantity o f urine, dryness of the conjuncri\ra and nasal mucous membranes. D c n e s s of the mucous membrane of the mouth and of the throat is a regular symptom which lzsts f o r hours. Some observers (Mamaud, Collan)'' report a slight czthanic effect. Urine and feces are said IO t2ke on rhc smell of coca. Different obsene r s give different accounts of the effect o n the pulse rate. According t o Mznre- gaua, coca quickly produces a considerzbly in-

One feels a certain fumness o n the lips and palate, follou*ed by a feeling of wannth in the s a m e areas; if one now drinks cold water, it feels warm o n the lips and cold in the throat. On other occasions the pre- dominant feeling is a rather pleasant coolness in the mouth and throat.

I V

* .4 d A nis:cr e$ in subcutancour injecrion. ' LiLr Xschcnbrandt (Druischr mcd. H'ochcnschrijr, Dcc.. 1SS3) I uIcd :he hydro:hlo:ic p:cparation of couinc as described by Merk [!IC] ir Dcmsiadt. This preparation mry be bought in \'ienna in Haubner'r Engelapthekc am Hof ai a price which is not much higher th rn Slc:k's [si:], but uhich must. neucrthclcrs. be rcgardtd ZI \ e > h i ~ h . The management of rhc pharmrq in quu:ion is try- i7g . 2s ih:? ha\c bzcn Lind enough to inform me. io lou.cr the F X C of :he drus b> establishing neu sources of supply.

creased pulse rate which becomes e\.en higher with hisher doses; Collin," too, nored 2n acceleration of the pulse after coca was taken, while Rossier," De- marle," and Manpaud experienced, after the init id acceleration, a longer lasting retardation of the pulse rate. Christison noticed in himself, after using coca, tht physical exertion caused a smaller incicase in i h t ~ u l s e rate than otherwise; Reiss" dispurcs a n y effect on the pulse rate. I do not find any difficulty in ac- counting for this lack of agreement; i t is partly owing to the variety of the preparauons used (\\.arm infu- sion of the leaves, cold coczine solution. etc . ) . and the way in which they are zpplied,' and pzrtly 1 0 the