t.a:yin_~reactions of individuals.
\\'ith coca this latter cocaine dispels extreme fatigue 2nd a w l l justified
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-
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 depres-
sion. 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 symp-
I O ~ Swhich have been described zs t h e 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 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
hunger, sleep, and fatigue and steels one
".\ : I ~ C : ' S a.-:cGnr c i 15c c!f:i:s 01 co:a:nc on him?,!!' cri:iidc
(;.. _ . * .... \:., . ;'::I
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,
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 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 ~ ~ i:~ Cis Cdiffi-
C .
cult to define its duration. I f on: works inrensi\.el!'
IO intcllec-
 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. 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 as
moderate rise in body temperature; he found that his
speech HZS 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 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 t h e 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 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 medi-
cal 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
p:epirarions \vhich ha\x 15: full or a; lezct the essen-
rizl c f f c a s of coca Ica\-cs.
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 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 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 na-
vies; Neudorfer (1870), Clcmens (I 867) 2nd Surgcon-
Major E. Charles recommended that i t should be
adopted b y the armies of Europe as well; and As-
chenbrandts 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 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.
I
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 if the inhibitions manifested beio:e i: is ! a k m
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 n o
riser of general damzge I O the body as i s the case
i
I
t h the chronic use of morphine.
5.lany dociors fell that coca would play an impor-
i a n t role by filling a g a p in the medicine chest of the
psychiarrisu. It is a well-knoun fact that psychia-
trists 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
r prcscribcd f o r t h e most diverse kinds of psychic
i I debility - h>*steria, hypochondria, melancholic in-
\,.I
, hibition. stupor. a n d similar maladies. Some suc-
' ~ j ;tsssj h2L.e been reported: for instance, the Iecci:,
,-I .~filoaiaJulizn (Limz, 17S7) tells of a I r x n e d mir-
sionzry \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 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 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 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 nof 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 ( 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
and the disorders a n d debility- ed theretvith,
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 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 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-L i l O U S '
refles reactions; one must therefore asscrne that a-
caine 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 de-
pression and a2athy. He cocld no! s!~??. during . the
nigh; to\vard morning :tz:v:e:c Ion2 p::,!~! spzsrs
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 eruc-
tztion, until, toward evening, his condition rcturncd
to normzl. The patient trzs incapable of \vork through-
out the day and had I O keep to his bed.
"At 6:OO psi on the tenth of June the usuzl symp-
toms 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 : ; 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 a n hour. He
could nor clccy, until 3:OO AM. but that did not distress
h~m. H c a \ \ c L c the next morning healthy, ready for
\\ 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 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 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 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 t h e stomach.
Accordingly, I should say that the use of coca is
definitely indicated in cases of atonic dipestive weak-
ness 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 fur-
ther strongly recommended-znd allegedly ha been
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 im-
p r o w m e n t i n the patient's condition. HoleCogives 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 a n d increas-
ing 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
m3n! of thl: aurhors \ r h o ha1.c \\ri:lcn on coca : C ~ Z ; J
i t as a"source 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 ntiii-
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.-
. .
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-
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\~ziiabilityof
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 brezk-
down of albumen in the body. !$'e mus! regzrd th:-
conception of coca as a "source of sa\.ings" 2s dis-
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
.. .
 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 some-
what obscure, influcnce o n t h e nourishment of tis-
, sucs; 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, de-
serve to bc rejected out o f hand. T h e exciration of
nerve centers by cocaine c a n have a favorable influ-
ence 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
i netabolism.
/I 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
// i
! habiiual addicrs, a n d 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 t h e Derruii Therapeuric Go-
rerre). 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 Louis-
sille hfedicu14'4ws, seems IO have aroused the Sreat-
est general interest in this treatrnenr of morphine ad-
I diction; for the ne\[ two years "ryrhro.y*/oncocu 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 Lo f~ l0::g O T I S
standing. T h e r e is nor much informarion on the sub-
ject 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 recogniz-
able after their cure." Concerning the mcthod
wirhdraual, it should bc mzde clezr that in the ma-
ority 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 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-
pirzl.
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)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 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 scat l?c?ri?,?cn. 2nd c ~ l d
function normally. Durins thc first 12ys O! rh: C u r e
he consumed 3dg ofcoco:',~umn i u r i c r i c u m daily, 2nd
after ten days he \vas ab]: to dispense \cith t h e coca
. * $
(.! 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 expcri-
c 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 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 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 .~r;;C;,g :he p:;i~;.L ; 3 .A:.c:i I h ; . . ~ _~:..tz:c<z. \
in a ~ o r \\.;etched
t condiiion. Coczine \\.as thea tried sesczl excitement \>:hich they \\
to c e n b a t ihe m i g z i n e , but the treatment proved un- zttiibuied 10 the coca. .4 y o u n g \!.riier, \
successful. I t 1 ~ 2 snecesszry to resort to morphine in- by treiimeat n.iih coca to :csumc
jeciions. But 2s soon 2s the s\:mptoms of morphine longish i l l a s s , gz:'e gp ccir.g the
iziclcrrnce appeared, they were quickly relieved by the undcsira5le sccondr-.::; cf;tc:s
?: of ;oc:inz, \\*i!h 1 1 result~
cohered from her nttack in a f2r shorter time 2nd
t k t t!ie p t i e n t rc- k q i 1 1 it had 011 !;:Ill.
..
g ) Lorel applicalion oJcoco. Cocain- 2 2 : i:s sz!:s
1
consumed much less morphine in the process." ha1.e a marked anesthetizing effect when srm;ght in

I
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 com-
; pulsion to drink was either banished or alleviated,
and the dyspeptic compldnrs of the drinkers were re-
liew3. 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 eco-
nomic significance which coca would acquire a s a
"source of savings" in another sense, if its effective-
ness 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 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 cariacks of a patient were arrested in every
contact \vith rhe skin and mucous mcmSrane ir. con:
centrated solution; this propen? sugges~si: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 f o r treating d i s e a e s 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 ti ons .
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 io: Inccs.
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 oCnO ; ~ .B-;:uh
" ,J.leJ;rci .Ic.:r .!. ! E?6.
Bibra. LOC.cit.
7. )rlantepzza, "Sulle virru igicfiiche e rncdic;lrr=li a'eiic C O C O ."

case by coca. I mention this property of coca because Milan: lS59.

i t appezrs to admit of a physiological explanation.
a. Scrivcncr. LOC.cit.
9. According I O C.110. whom Bibrz co$-r.
\'on Anrep's esperiments o n animals resulted in early 10. S)slcma mal. med. brasil.. 1623.
paralysis of certain branches of the vagus; and alti- 11. f i s a i s u r lo coio lu Ptrou. Thesis. Pa7r: 1662.
tude zsthma, as \vel1 as the attacks characteristic of 12. cf. Fronmullcr. "Coca 2nd Cz:." Proper l ' i e I . c : i r h : ~ ~ ~ ; h r t : i
chronic bronchitis, may be interpreted in terms of a j i r prak!ische Heilkunde. v. 7 9 . iS51.
13. I'icgem de cidodc de Cu:co a de Brlcrn. 1649.
r e f l n exirztion originating in the pulmonary branches 14. & + d ; ~ ; o ~ ~ O P J le3 p c r ~ ; , =ccr;r,-;cs
~ .:I
c'c I : i m r r t C u e Sa?.
o i :he 1 2 ~ ~ The s . use of coca should be considered 1651.
!>r ihe : r e z : m n t of oihcr vagus neuroses. 15. Sp:\'i 2nd 51inic:' J o a r c t l ; n Ef::;l. i F: I