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 un- sffected 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. th is 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 had jcst e.?lc!1 t n

to undei1zl;e a

effect of coca is \.ouched for by a series of reliable reports,

is completely lack ing the characteristic urge for im-

d rug 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 depres- sion. One may perhaps assume that the euphoria resulting f rom 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 symp- I O ~ S which have been described zs t he wonderful 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 cer- rain times of the day, \vert completely banished. \{'hilt the effects of cocaine last one can, i f u q e d IO d o SO. 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 no 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 s ~ ~ and J . CoU2n'' have had similar ex- periences-rhe latter af ter wzlking for several hours over snow; Mason" calls coca "an excellent thing for a ?ong walk"; Aschcnbrandt" reponed recenliv how

debilitating illnesses, were ncvenheless apzble , z f i x taking coca, of participa:in_c in r n i n c a v m 2nd rnzrchel. 5lorino y >laYz50 u.as able 10 s!zy 2:vrke \vhole nigh:^ u j t h i h c 2id of coca; Maniegzzz remzined for fo r ty hours w,ithout food. We =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 ln- L, dizns of South Amcricz.

The effect of a moderate dose of coca fades a\va\- so gradually that, in normal C ~ T C U ~ Z ~ ~ ~ C C C . i: is diff i - cult to define its duration. I f on: works inrensi\.el!'

Bavarian soldiers, weary as a resu!t of hardships

hunger, sleep, and fatigue and steels one I O intcllec-

".\ : I ~ C : ' S a.-:cGnr c i 15c c!f:i:s 0 1 co:a:nc on him?,!!' cri:iidc

(;.. . . _ . * .. \:., . ; ' : : I

. -

cceded in 2chieving a stare of greatly increased hzp- p i n e s accompanied by 3 dcrirc for conplc:c int- mobility: this \v2s interrupted occasionally, ho\\rver, by the most violent urge to move. The analogy with the results of the animal experiments performed by von Anrep is unrnistzkable. When he increased the dose still further he remained in a sopore beoro: His pulse rzie xvzs exr:cmely high and there ~ 2 s a moderate rise in body temperature; he found that his speech H’ZS impeded and his hvldwrir ing unsteady; and eGenruz1:y he experienced the most splendid and colorful hallucinations. the tenor of which \\*as friEhtening for a short time, bu 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 lo r t no y 5fzj;z zlso experi- enced 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 im- pzirment of full consciousness. A chemist who at- rempted to poison himself by taking 1.5g of coczine” became sick and showed symptoms of gutroenter- iris, but -there uzs no dulling of the consciousness.

‘

\’I. The Therapeutic Uses of Coca

I t was inevitzble that a plant which had echicved such a reputation for marwlous effects in its country of orisin should have been used IO tre21 the 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 medi- cal experience, 5 lan teguza 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

- _

p:epirarions \vhich ha\x 15: fu l l or a; lezct the essen- rizl 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: i t is of v213e in 211 cases \\.here the 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 de- mands- especially when ourivard circumstances ex- clude t h e possibility of obtzining the rest 2na nour- ishment normally necessary for great exertion. Such situations arise in wartime, on journeys, during mountain climbing and other expeditions, etc. - indeed, they a re siruations in tvhich t h e alcoholic siimulants are also generally recognized 2s being of vdue . Coca is a fa r more potent and fzr less harmful stimulant than alcohol, and i ts 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 as Pedro Crespo (Lima, 1793) recommended its use by Europezn na- vies; Neudorfer (1870), Clcmens (I 867) 2nd Surgcon- Major E. Charles” recommended that i t should be adopted by the armies of Europe as well; and As- chenbrandt’s experiences should not fail to dr2\\’ the zitention of army administrators to coca. I f coczine is given as a stimulant, i t i! be::er thar i t should be given in small effective doses (0.05-0.lOg) 2nd re- peated 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 de- prcssion when the effects of c x a have worn off.

At present it is impossible to assess \\.ith any cer- tainty to \\hat exrent coca c2n be especred lo 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 i f the inhibitions manifested beio:e i: is ! akm / I c

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 injec- n ; bur, on the gGod side of the ledger, there is no riser of general damzge I O the body as i s the case

5.lany dociors fell that coca would play an impor- t h the chronic use of morphine.

i an t role by filling a g a p in the medicine chest of the psychiarrisu. I t is a well-knoun fact that psychia- trists have an 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 of the nerve centers. Coca has consequently been

r prcscribcd for the most diverse kinds of psychic i I debility - h>*steria, hypochondria, melancholic in-

, hibition. stupor. a n d similar maladies. Some suc- ' ~ j ; tsssj h2L.e been reported: for instance, the Iecci:,

,-I .~f i loaia Julizn (Limz, 17S7) tells of a I rxned mir- sionzry \vho u a s freed f rom severe hypachondria; Vzniegazza p:aises coca as bein3 almost universally efiective in improving those functional disorders Xvhich 1r.e now g roup 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 prosua- tion"; and zccording to Caldwell," it is the best ionic for hysteria.

E. 3iorselli a n d G. Buccola" carried out csperi- m e n s involiitig rhe systematic dispensation of co- czine, over a period of months, to melancholics. They gave a preparat ion of cocaine, as prescribed by Trommsdorf. in subcutaneous injections, in doses ranging f rom 0.0025-0.10s per dose. After one 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, the efficacy of coca in cases of ner- vous and psychic debility needs further investigation, u.hich will probably lead to partially favorable con- clusi0r.s. According to klantegazza coca is of no use, and is sometimes even dangerous, in cases of organic change aad i n f l a m n ~ t i o n of 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 com- prehensible IO us. According IO the unanimous as- sertions of the oldest a s well as the most recent authoritics ( Ju l ian , Martius, Unanui, 3lzntegatza. Bingel," Scrivener.7 Frankl, and others) coca in its r?osi t w i o u s forms banishes dyspeptic complaints and the disorders and debility-ed theretvith,

I

i \,.I

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!nFtOms atten- dant upon large mez!s-Yiz, a fccling of pressure 2nd fullness in the stomach, discomfort 2nd a disinclina- tion 10 work - disappear u i lh 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 t ime 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 ly colleague, Dr. Josef Pollzk, has g iven me the following accounr of 2n zs:onishizg e::?.-: of :o:iint, u.hich shows that i t cia be used to t ie21 nor fileicl\.

locel discomfort ia the s:omach but iiso s- Li lOUS '

refles reactions; one must therefore asscrne that a- caine has a powcriul effect on 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 to 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 th 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 by a feeling of great de- pression and a2athy. He cocld no! s!~?? . . during the nigh; to\vard morning :tz: v:e:c Ion2 p::,!~! spzs r s of vomiting which lasted fo: hours. R;:nc! zbou! midday he experienced some relief, 2nd 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 eruc- tztion, until, toward evening, his condition rcturncd to normzl. The patient trzs incapable of \vork through- out the day and had IO keep to his bed.

"At 6:OO psi on the tenth of June the usuzl symp- toms of an attack began. At ten o'clo:k, zfter the violent hezdzche had developed. the patient \cas

... eiven 0.07 jg coco;'nuni i,:l:ric:jmt.v. S h ~ r i l : ; there- afier he experienced 2 feeling of \v2rni!h 27d eruc- tation, 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

o'clock. apart fioin a slight headache. he "as nor- mal, e \ c n cheerful, and nalkcd for an hour. He could nor clccy, until 3:OO AM. but that did not distress h~m. H c a \ \ cLc the next morning healthy, ready for \ \ ork. and 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 and reduction of the organ's sensitivity. The lai tcr \\,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 CO- czine 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 IO the znesthe;izing p:operties o i coca. On this point I c2nno: con 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 admin- isIration of coca. O n other occzsions I have observed m:%'self. and Z ! j O hi.zrd fxxn ot!?cr doctcr.c, Ih?t pz- tients suspected of having ulcers or scars in the s!omach complained of increased pain afier using coca; rhis can be explained by the increased move- ment of the stomach.

Accordingly, I should say that the use of coca is definitely indicated in cases of atonic dipestive weak- ness and the so-called nervous stomach disorders; in such-cLses.it is possible to achieve not mere:y a relief of the symptoms but a lasting improvement.

c) Coco in cachexia. Long-term use of coca is fur- ther strongly recommended-znd allegedly ha been

phthisis. long-lasting febrile diseases, ex . ; and also during recovery from such diseases. Thus McBcan"

to hzve a limiting effect on the fever and 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 im- prowment in 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 con- dition of emaciation and exhaustion; here, too, rhe use of coca restored the patient IO health. R. Bartho- lo\^" observed. in general, that coca proved useful in trcaring phthisis and other "consumptive processes." ?lznregarzz and a number of other authorities attri- bule to coca the same invaluzble therzpeutic quality: thzt of limiting degenerztion of the body and increas- ing strength in the chcc of cachcsia.

One 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

m3n! of thl: aurhors \ rho ha1.c \\ri:lcn on coca : C ~ Z ; J

i t as a"source of sa\ ings"; i e . . t hey arc of ~ h c opjnion l f ia t a system ithich has absorbed c \ c n a n c\ t rcmc!y $mi l l 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.': I f rake the amount of uork as being constin[, t h e bod). which has absorbed cocaine shouid b: able 1 0 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 S i13t c\c;r :-,c:e:>zrii!. j T r i 0 I t . C a contrzdiction of the 12.1~ oi coni:;\z;jcn c.j cze:s!.. Fer Izbcr uk i c5 f:E:?.s L.;~C: f33.2 0; :isss: ;on-,por,snts in\ @ I \ cs 2 cei;iiiI loss, ei;hc; i n !!.,e nt i i i - zziion 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.-

cf urine climir.ated \vith 2r.d ivitkout :he cs: cf coca have not been altogether conclusive; indeed, these es- 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 in general. Thus Christison noted a slight reduction in the solid componcilts of his urine during the walks o n uhich he took coca; Lippmann, Demarle. Marvzud, 2nd mo:e rxcnt ly Sfason" similarly concluded from thcir expt:im:n:s that the consumption o f c o c i reduces th: i r .ount 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 food 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 rbon dioxide.

Voit proved rhat coffee, which z!;o r i led as a "source of sa\*ings," had no influence on rhe brezk- down of albumen in the body. !$'e mus! regzrd th:- conception of coca as a "source of sa\.ings" 2s dis- proven after cena in expefimenrs in which znimals were starved, both with and \vithout cocaine, 2nd the reduction of their body ueizht and the length of rime :he). were able to ui thstand 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. The s:z:\,a:ion of 1.a P i r - i n

. . 2:'cr. E.\peri;!lc;i!s d e s i ~ ; l c d :O dc::crni:nc ;r:: Z:i>Ou:1i

.. .

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 nenous s!'stem has an undoubted. i f some- what obscure, influcnce o n the nourishment of tis- sucs; psychologjcal factors can, after all, cause a healthy man to lose tveight.

The therapeutic quality o f coca which u e took as ou r argument ar the outset does not , therefore, de- serve to bc rejected out o f hand. T h e exciration of nerve centers by cocaine can have a favorable influ- ence o n the nourishrnenr of the body afflicted by a consumptive condition, even thouzh thzt influence mighi u.ell not t2kc the form of a slo\ving do\vn of

i netabol ism.

,

their conclusiveness. S o r e 0; them ! ! - i C ~ ! \ c I:r:c doses of opium or morphine 2nd ~ ~ ~ ' ~ I C L ~ O T I S o f l0::g standing. There is nor much informarion on the sub- ject of relapses, as 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 recogniz-

wirhdraual, it should bc mzde clezr that in the ma- ority of cases a graduzl r:duaion of the habituzl

able after their cure." Concerning the mcthod

of the drug, accorr.pnitd b!. 2 gradud incrczs

praised in connection with the treatment of syphilis. R .b ' . T-zylor" claims that a patient's tolerance of

in check when coca is administered 2: the same time. mercury is insrcved and the mercury cachexia kept

J . Collan" recommends it a s the best rcm:dy for srornariris mercurioli3 a n d 'reports thrr Pzgva!i3 2 h 21s prescribes i t 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, and dso to reduce to negligible p:o- portions 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 the Derruii Therapeuric Go-

187s. that he had substituted coca for the cus;omz-y zlkaloid in the case of a female morphine addici. Two years later, Palmer, in an article in the Louis- sille hfedicu14'4ws, seems IO have aroused the Sreat- est general interest in this treatrnenr of morphine ad-

the opium habit" was a regular heading in the reporis of the Therapeufic Gumre. From then on informa-

diction; for the ne\[ two years "€ryrhro.y*/on cocu i n

i ! /

'

/ ,/ rerre). i t was 1iI.H- Bcniley6' who anncunced. in>!2y

I

\ /I I should add htrc that coca has been tv2.rrdy of the coca dose, wzs the mtihod chosen: hou,ever, sudden discontinuation of the &ng zlso tried.:' In the Iztter cas: Pzlmer piescribes tha t a certain dose of coca should be re2er:ed 2s cfre?. c!crkg t h ? day as the desire for morphine :fc::j.* T h e dt i ly 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 ab- stinence 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 hos-

I once bad occzsion to obsenc 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; the s2mc patiear hzd suffered scvere s)mp- toms as a result of zbstinencc in the cocrss of ir pre- vious cuie. This time his condi!ion \v25 rolcreble; in particular, there was no 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 pt imantni symproms of his abs t ixnce . T h e patient ~ v z s cat l?c?ri?,?cn. 2nd c ~ l d function normally. Durins thc first 12ys O! rh: C u r e

he consumed 3dg of coco:',~um niur icr icum daily, 2nd after ten days he \vas ab]: to dispense \cith the coca

pirzl.

. * $

(.! mo:rninc. 1 am 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. Joxf Pollak on a case in point:

.'.-I : h ; r i y - i h r ec- !'c .? r - old \\'om2 11 has been su f f e r i n g

t-:: a! !?\ isizd o n l y try morphia injections. .Although i h c lady i n question ne\.cr takes morphia or expcri-

dtiring the aitacks she behaves like a morphine ad- dict . .\ few hours after the injection she suffers in- icnse 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 su i t 1 1 i i t an i i itick of migrzine, along \vith all i i s

for !'ca:s from se\*ere nienstrual inigraine \\ hich can

c n c e s an!. desire i o d o so when she is free of migraine,

.~r;;C;,g :he p:;i~;.L ; 3 .A:.c:i I h ; . . ~ _~:. . tz :c<z. \ i n a ~ o r t \\.;etched condiiion. Coczine \\.as thea tried to c e n b a t ihe migz ine , but the treatment proved un- successful. I t 1 ~ 2 s necesszry to resort to morphine in- jeciions. But 2s soon 2s the s\:mptoms of morphine iziclcrrnce appeared, they were quickly relieved by

cc!!:eq:enccs, Leeps ;!?e pa!iex in beit for ihrct days 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

\

?: 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 ~ lcohol i sm at 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~trilent of alcoholism, too, there were cases

and the dyspeptic compldnrs of the drinkers were re- l iew3. I n general, however, the suppression o f the alconol craL-ing through the use of coca proved 10 be

; pulsion to drink was either banished or alleviated,

more difficult than the suppression of morphomania; in one case reported by Bentley the drinker became a coquero. One need only suggest the immense eco- nomic significance which coca would acquire as a "source of savings" in another sense, if its effective- ness in combating alcoholism were confirmed.

e) Coca and arrhma. Tschudi and Markham" report that by chewing coca leaves they were spared the usual symptoms of the so-called mounrain sick- n 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 v t h m z ~ i c 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 on animals resulted in early paralysis of certain branches of the vagus; and alti- tude zsthma, as \vel1 as the attacks characteristic of chronic bronchitis, may be interpreted in terms of a re f ln exirztion originating in the pulmonary branches o i :he 1 2 ~ ~ s . The use of coca should be considered !>r ihe : r e z : m n t of oihcr vagus neuroses.

/ I of undoubted success, in which the irresistible com-

k q i 1 1 i t had 011 !;:Ill. . . 1 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~s i:s 0 x 2 -

sional use 2s a local anesthetic, especizlly in con- nection \virh affections of the mucous membrane. According t o Collin," Ch. F2u\ol strongly recom- mends cocaine for treating d i seaes of the pharynx, describing it 2s "le renseurpor ewellence des c h o r d s vocoles." Indeed, the mesthetizing propertics of co- caine should m2ke it suirablt for 2 goxi m a ~ . ~ f m h e r a pplita t i ons .

1. 2. 3. 4.

< -. 6.

7.

a. 9.

10. 1 1 . 12.

13. 14.

15.

SOTES

O.R. Markhan. Pemi*ian Barks, Lcndon: 1880. According to Bibra'r esrimitc. .Vcrcoric S:irnul,-nfs. 16E5. Wcddcll. Voyage dam IC Piord de la Boliric, 1655 . Scrivener. "On the coca leal and iu us: in diet tnt ntCi:in:." Medical Tirncc and Ga:tile, 1 E7 1 . Carcilrrso dc la Vega. Cornrnccrcrios rech de io: Inccs.

Chrirtiron. "Obrcmations on t h e c l f m of C U ~ , 0: c ~ i . the l caws of E ~ ~ h r o x y l o n C O ; ~ . " B-;:uh ,J.leJ;rci .Ic.:.r .!. ! E?6. Bibra. LOC. cit. )rlantepzza, "Sulle virru igicfiiche e rncdic;lrr=li a'eiic COCO."

Milan: lS59. Scrivcncr. LOC. cit. According IO C.110. whom Bibrz co$-r. S)slcma mal. med. brasil.. 1623. f i sa i sur 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. 79 . iS51. I'icgem de cidodc de Cu:co a de Brlcrn. 1649. &+d;~;o~ ~ O P J le3 pcr~; ,=~ ccr;r,-;cs c'c I : i mrr tCue .:I. Sa?.

1 6 5 1 . Sp:\'i 2nd 51inic:' J o a r c t l ; n Ef::;l. i F: I

1609- 161 7.