Therapeutics Of Coca

External

A 5 to 10 percent. solution of the hydrochlorate may be injected subcutaneously as a local anaesthetic when any small operation has to be performed. In the infiltration method of Schleich three solutions are employed: cocaine hydrochlorate, 0.2 (strong); 0.1 (normal); or 0.01 (weak); morphine hydrochlorate, 0.025; sodium chloride, 0.2; sterilized distilled water or saturated boric acid solution to 100. These are injected into the substance of the skin forming wheals. This method requires less of the drug than when used subcutaneously. Yet it should be borne in mind that the anaesthetic properties of the two weaker solutions depend largely upon the mechanical anaesthesia produced by injection of water, which had been previously pointed out by Halsted. Solutions, painted or dropped on, may be used for operations on the mouth, throat, teeth (4 per cent.), eye (1 to 4 per cent.), ear, vagina, urethra and rectum (4 to 10 per cent.), and they may be applied to any of these parts when they are very painful. Congestive urethral stricture may be temporarily relieved by it so that instruments may be passed, but it should be used with great care in urethral operations. Cocaine will relieve vaginal pruritus, and has been used locally applied in the nose in hay fever. Painful ulcers, fissures, etc., are beneficially treated with it. Ointments, bougies, and suppositories, usually containing 2 to 5 per cent. of cocaine, which mixes better than the hydrochlorate, are very useful. A 15 per cent. solution has been injected into the gums for tooth extraction, but is not strongly recommended. Ophthalmic surgeons employ it very largely to produce local anaesthesia of the eye. If inflammation is present anaesthesia is produced with great difficulty.

Internal

Mouth. - A solution is useful for painting or spraying on the throat previous to laryngeal examinations. Lozenges of the hydrochlorate, containing 1/12 gr.; .005 gm., in each, are valuable for painful sore throat. Often in addition each lozenge contains 3 gr.; .20 gm. of extract of krameria.

Stomach. - Cocaine in some cases allays excessive vomiting, and has been said to cure sea-sickness.

It is not often used in Europe as a medicine for its restorative effects; as already mentioned, it is not a food, and the good it does is only temporary.

Medullary Ancesthesia. - It has been recently proposed to obtain surgical anaesthesia by injection of from 1/10 to \ gr.; .006 to .012 gm., into the arachnoid space. Puncture is made between third and fourth lumbar interspace of the spine with a specially prepared needle as for diagnostic purposes. A few drops of the spinal fluid is allowed to escape and the solution is injected. Anaesthesia supervenes, gradually extending from the feet upwards, and may reach to the chest or even higher; this persists for a variable time, but generally sufficient for the performance of surgical operations. This method of anaesthesia does not interfere with labor further than abolishing its pain. Strict asepsis must be observed. Although thus far no accidents have been recorded, it is by no means clear that it will supplant ether or chloroform narcosis, nor that it can be employed when con-tra-indications exist to either. Beyond some nausea, vomiting and headache, after-effects are not noticed. It is yet too early to formulate an opinion as to the practical value of this method.

Toxicology

Symptoms

It is a respiratory depressant; but symptoms of poisoning have rarely been noticed unless the drug has been injected under the gums or skin. Then it may quickly cause vertigo, pallor, fainting, profound cardiac and respiratory depression with tremors and other nervous symptoms which may persist for months, even if the other symptoms are overcome.

In the chronic forms, known as cocamania, the sufferer takes cocaine either for its pleasant effects or because he thinks it will help break himself from the morphine habit, or he takes it with morphine. It is usually administered sub-cutaneously. The pulse is rapid, and fainting is common. There is much wasting, and the patient looks pale and death-like. Usually he suffers from insomnia, and he may become acutely maniacal with delusions of persecution. Visual and other hallucinations are often present, and it is very characteristic that patients complain of little animals creeping on the skin, "cocaine bugs," they say. They are extraordinarily prolix in both conversation and writing. Cocaine habitue's are by no means infrequently met with. The moral degradation is fully equal to that of opium-eaters.

Treatment

This should consist in stimulation, and emptying the stomach, if the drug has been ingested, by means of hypodermatic injections of apomor-phine. Artificial respiration may be required. Since cocaine asphyxiates by constricting the blood-vessels at the base of the brain, strychnine hypodermatic-ally or alcohol may remove this danger.

For the chronic forms confinement in an asylum, with careful treatment during the period of severance, is essential.