CHAPTER XVI.MEDICAL NOTES AND REFERENCES.

Cocaine is a mydriatic; slightly raises the temperature, quickens respiration, and pulse is more frequent; by long use, sleep is longer and more profound. Improves nutrition, useful in insomnia and simple melancholia.—M.R. 1883, 86.

Eleven successful cases, including three of operation for cataract, one double iridectomy, one removal of tumour from lid, and three for convergent strabismus. In cases of intolerance of light it acts like magic.—L. ii./84,911.

In papillomata of larynx, interior painted with 20 per cent. solution of hydrochlorate of Cocaine once, in five minutes was able to introduce the forceps four timesand remove large portions of tumours without patient experiencing any pain or subsequent shock.—L. ii./84,912.

In quinsy, a 20 per cent. solution useful to paint fauces.—Pr. xli. 47.

Coca and Cocaine are said to have a deleterious action on the voice, slackening and deadening the vocal cords through the paralysis of the extensor muscles. The aphony produced is painless.—Th. Gaz. May, 1889,353.

Physiological effects on the eye.—L. ii./84,911.

Seven eye cases under its influence.—Med. Rec. (N. Y.) 1884,510.

Use in the nasal cavity, cotton wool soaked in 2 per cent. solution applied at the end of a probe in over forty cases, including hypertrophy of the nasal mucous membrane (twenty-seven cases cauterized), acute coryza, nasal polypus and hay-fever, all having marked swelling of the nasal mucous membrane, both from chronic and acute causes; in every case there was complete subsidence of the turgescence of the membrane and the sinuses were emptied of their blood.—Med. Rec. (N.Y.) 1884,533.

Cocaine solution applied to a blistered surface anæsthetizes the part.—B.M.J. i./85,300.

Solution painted on or injected into piles relieves the pain of operating on them.—B.M.J. i./85,227.

References to its surgical use as a local anæsthetic:—L. ii./84,608 (ophthalmic), 683 (ophthalmic), 936 (laryngeal), 975 (ophthalmic), 975 (nasal), 992 (ophthalmic), 1022 (physiological action), 1023 (ophthalmic and aural), 1068 (ophthalmic), 1097 (ophthalmic), 1123 (ophthalmic and dental), 1167 (circumcision and catheter passing); L. i./85,86 (uterine, vaginal, and oral), 123 (in tenesmus), 130 (on mucous membranes), 168 (dental), 220 (rectal), 226,315 (minor surgery), 965 (ophthalmic), 1033 (fistulas, canals), 1067 (ophthalmic), 1097 (nasal), 1112 (ophthalmic); B.M.J. ii/84,761 (ophthalmic), 1074 (laryngeal), 1132, 1142,1143,1249,1256 (ophthalmic), 1133 (dysphagia), 1188 (throat and nose), 1255 (laryngoscopic), 1256 (midwifery and tinnitus); B.M.J. i./85,45,77,134,145,863 (effects onthe eye); B.M.J. i./85,24,36,77,235,286,456,792,1266 (ophthalmic surgery); B.M.J. i./85,36,47,209,456,479 (nose and larynx); B.M.J. i./85,377 (cancer); B.M.J. i./85,227,653,994 (rectal operations); B.M.J. i./85,17,36,47,361,994 (vagina and urethra); B.M.J. i./85,17,24,36,69,736,926 (in dentistry); B.M.J. i./85,402 (for scalds); B.M.J. ii./85,396 (tumour of lip removed); B.M.J. ii./85,1060 (removal of ingrowing toe-nail); L. ii./85,829; Th. Gaz., June, 1890, 415 (preceding iodine injection in hydrocele); B.M.J. ii./86,413 (dilatation of urethra); B.M.J. ii./88,491; i./8,1113 (minor surgery); B.M.J. i./89,943 (circumcision).

Translation of Carl Koller’s report of the earliest observations on the use of cocaine and its salts as local anæsthetics.—L. ii./84,990.

Hydrochlorate of cocaine, 20 per cent. solution allowed nitric acid to be applied to the tongue without pain.—L. ii./84,1023.

In skin diseases, relieves the inflammation in eczema and acne and the irritation of urticaria.—L. i. 85,76.

Fungoid growths in aqueous solutions of salts of cocaine and other alkaloids.—L. i./80,224,315,504,597,647.

Physiological action.—L. i/85,439; i./88,1041; B.M.J. ii./84,1313; i./85,17,97,863.

Summary of its pharmacy.—L. i./85,488.

Checks hæmorrhage from lips and gums in purpura.—L. i./85,581; Pr. xxxiv. 450.

Chemical researches by Paul.—P.J. 1888,781; B.M.J. i./88,709.

Hay fever relieved by solution applied locally to nose and eyes.—L. i./85,925: L. ii./85,50,99,123,232,820; B.M.J. i./85,1084,1291; ii./86,18; i./88,1329.

For moles, warts, &c., about 6 grains of cocaine to a drachm of nitric acid applied once or twice a day with the point of the rod of an acid bottle is painless; a ring of melted wax should be put round the mole first.—L. i./85,1052.

Résumé of action and uses.—B.M.J. ii/84,1081,1132 B.M.J. i./85,36; Pr. xxxiv. 56.

In senile gangrene, the intense pain of, relievedby a 4 per cent. solution on contiguous parts.—B.M.J. i./85,653.

In coryza, 4 per cent. solution useful applied on cotton wool.—B.M.J. i./85,430,1084.

The mydriatic effects on the iris, and on the tension of the eyeball, caused by its local application.—B.M.J. i./85,1303.

The painless removal of urethral caruncles.—B.M.J. ii./85,153; and of epithelioma.—L. i./87,56.

In obstetrics, several valuable applications.—Pr. xxxiv. 65; L. ii./87,754, 1061; ii./90,474.

The oleate is useless, except for sores on penis and anus.—Pr. xxxiv. 451.

Hypodermic injections apt to be followed by faintness.—Pr. xxxiv. 450.

Gonorrhœa, acute, 2 per cent. solution injected relieves the pain.—Pr. xxxiv. 222.

Rectal and prostatic pains relieved by ½-grain suppositories.—Pr. xxxiv. 128.

Summary of its effects on the eye, viz., dilatation of pupils, constriction of small peripheral vessels, paralysis of accommodation, and enlargement of the palpebral fissure; the effect is local only, by paralysing the endings of the sensory nerves, and irritating the sympathetic nerves.—Pr. xxxiv. 1.

Dysmenorrhœa, the pain of, removed by painting the cervix with 4 per cent. solution.—B.M.J. ii/85,399.

After lithotrity, ½ an ounce of 4 per cent. solution injected for painless removal of fragments.—Pr. xxxiv. 128.

In labour pain attending the dilatation of the os in primiparæ relieved by painting the os and cervix with 12 per cent. solution.—B.M.J. ii./85,473.

In supra-orbital neuralgia, a 10 or 20 per cent. solution in oil of cloves rubbed into the part affords immediate relief; with summary of its medical uses.—Pr. xxxiv. 59; M.R. 1884,516.

In sea-sickness, several cases, ¹⁄₁₆ grain doses every two or three hours in aqueous solution were successful. A girl of 18 had been sick 24 hours before it was tried; she had a double dose every half-hour with “truly magical effect.”—L. ii./85,451; B.M.J. ii./85,627.

German and Russian recommendations of its use in sea sickness.—L. ii./85,912.

Sea sickness effectually checked by two lozenges each containing ¹⁄₁₂ grain of hydrochlorate of cocaine taken when first threatened, and two more in twenty minutes. One grain doses in solution also effectual.—P. J. 1886,712.—B.M.J. ii./87,1236.

Thimble-shaped pessaries, composed of cocaine and oil of theobroma, relieved the pains of the first stage of labour, when inserted into the dilated os uteri. B.M.J. ii./85,1140,1159.

Morphine habit of three years’ standing, 8½ grains taken during three days was successful in curing.—B.M.J. ii./85,1112. Counteracting effects unsatisfactory.—L. i./89,287.

Poisonous effects attributed to local use in fourteen eye cases and three hypodermic injections.—B.M.J. ii./85,983.

Vaginismus, ointment and pessaries of cocaine useful.—B.M.J. ii./88,720,817; B.M.J. Supp. ii./90,30; Relief temporary only.—B.M.J. ii./88,790.

Cases of fainting when solution of cocaine salt was applied to the eye.—B.M.J. ii./85,1060; i./86,67. Also after hypodermic injection.—Pr. xxxiv. 450.

In eye operations, the diminished elasticity produced by cocaine may be a source of inconvenience.—L. ii./85,1158.

Dangers from use of cocaine in eye cases supposed to be due to decomposition accompanying fungoid growth. Graefe recommends the cocaine salt to be dissolved in solution of mercuric chloride 1 in 20,000.—L. ii./85,863,996,1070,1119,1167; B.M.J. ii./85,971,1184.

Cocaine craving, 5 to 7 drachms per day of 4 per cent. solution caused a state of system allied to delirium tremens.—L. ii./85,732.

Facial neuralgia relieved by quarter of a grain of salicylate of cocaine—L. ii./85,733.

Hydrocele, medical cure of, a preliminary injection of cocaine solution before the injection of iodine recommended.—L. ii./85,829.

Earache, a 2 per cent. solution of the hydrochlorate on wool is useful.—B.M.J. i./86,87.

Toe-nail ingrowing, removal of, local injections should precede.—B.M.J. ii./85,1060.

Larynx painted with 20 per cent. solution, a state of spasm was caused which required chloroform to subside it.—L. ii./85,946.

Whooping-cough, 15 to 20 per cent. solution a valuable pigment to the larynx.—B.M.J. ii./85,981,992. Also in spray with glycerine.—L. ii./89,1098.

For removal of a pile, after bathing it with hot water, some dry hydrochlorate was dusted over it, and one grain injected into its base; in 10 minutes after on applying the clamp and cautery, it was painlessly removed; the patient was next day able to attend his business; also found useful in many minor operations.—L. i./86,527.

General résumé of its effects and uses. B.M.J. i./86,527,574.

Thigh successfully amputated under the influence of cocaine, 1 per cent. solution injected into the skin and a half per cent. solution into the deeper parts; only during the sawing of the bone did the man complain of pain.—L. i./86,561ex Med. Jour.N.Y., Feb. 20th.

Angina pectoris, ½ grain three times a day.—L. ii./86,459.

Morphine and nitrite of amyl are the best antidotes.—B.M.J. i./88,757.

Vomiting of pregnancy relieved by internal use.—L. ii./87,754, and for sore nipples, 1061; B.M.J. ii./87,94.

Camphor 5, chloral 5, cocaine hydrochlorate 1, warmed, form an oily liquid which cures toothache.—L. ii./86,324.

Slight pains especially spasmodic, relieved by injection of a 20 per cent. solution into urethra.—L. i./88,871.

Painless tooth extraction if a 15 per cent. solution be injected into the gum.—B.M.J. ii./86,601.

In dentistry is of doubtful advantage, there is some danger, the gums do not absorb it.—L. ii./86,1190.

Two cases of poisonous symptoms following the injection of one grain in 20 minims into gums, in tooth extraction.—L. i./88,872. Another case.—Pr. xli. 288.

Lithotrity rendered painless by the injection of 16grains dissolved in 12 ounces of warm water into the bladder.—B.M.J. i./88,972.

Several cases of dangerous symptoms following its use in surgery.—L. i./87,780; St. Thomas Hosp. Rep. vol. xv.

Thirty cases of danger narrated, chiefly following its hypodermic use.—Th. Gaz. Jan. 1888, 16.

Cases of toxic action; from urethral injection of 12 grains,—Pr. xli./369; from vesical injection,—B.M.J. i./89,373; from rectal injection,—L. ii./89,656; from hypodermic injections—B.M.J. i. 89,382; L. ii./88,715; i./89,274; from internal use, 20 grains accidentally swallowed,—L. i./89,292; 4 grains in child of 4 years,—Th. Gaz. Jan. 1889,26; other cases,—B.M.J. i./89,382; Th. Gaz. June 1888,373.

Résumé of poisoning cases; more than ¾ grain should not be injected at once. Opium and morphine useless as antidotes; chloroform or ether inhalation recommended to prevent respiratory tetanus.—B.M.J. i./89,311. Toxic effects counteracted by ammonia.—L. i./88,394; ii./88,715; ii./89,1126.

Erosis after hypodermic injection.—Pr. xliii./449.

Against indiscriminate use, and formation of cocaine habit.—B.M.J. i./89,973.[32]

Best antidote is amyl nitrite.—B.M.J. i./88,757.

Pleurisy relieved by local hypodermic injection of ⅕ to ¼ grain.—B.M.J. ii./88,76.

In diabetes, after codeine treatment, cocaine, ¼ grain doses given; overcame obstinate constipation, and ataxic gait disappeared.—L. ii./89,735.

Pruritus, several cases relieved by cocaine 2 per cent. in oil of theobroma.—B.M.J. ii./89,194.

A successful anæsthetic in skin-grafting; the vitality of tissue is unaffected by its use.—B.M.J. ii./90,113; Pr. xlv. 295.

The morning sickness following hypodermic injectionsof morphine is prevented by combining ½ grain cocaine with the morphine solution.—B.M.J. i./90,1367.

Useful in psoriasis of tongue, used before a meal averts pain from passage of food; in painful affections of stomach, affords relief and averts vomiting, as that of pregnancy; in pruritus ani and itching skin diseases; and as an anal injection checks diarrhœa and straining of dysentery.—Ringer’s “Therapeutics,” 12th Edition.

Cocaine adopted to relieve morphine craving led to extreme cocaine abuse.—L. ii./90,424.

The addition of phenol to hypodermic solution, 1 part to 30, preserves the solution, increases anæsthetic action, and diminishes risk of toxic symptoms following its use. B.M.J. ii./90,94.

Resorcin prevents cocaine poisoning; value of both drugs enhanced by combination.—B.M.J. ii./90,506.

A 2 per cent. solution recommended in preference to stronger, as it appears to be more quickly absorbed. An overdose usually causes quick pulse, rise of temperature, dilatation of pupil, anorexia, and insomnia. This last yields best to chloral, but requires large doses.—L. ii./91,663.

Successful case of laparotomy under cocaine; 12 minims of 20 per cent. solution used.—B. M. J. ii./90, 1022.

Amputation of wrist under cocaine; no shock.—B. M. J., Supp. i./91,202.

Cystitis arising from cantharides blistering not prevented by camphor; intolerable pain, unalleviated by morphine, attended fresh blistering, but ceased instantly on the introduction into the prostatic urethra of 15 minims of 1 per cent. solution of cocaine hydrochlorate. The pain recurred in three and a half hours, but yielded at once to ten minims of the solution, and did not return.—L. ii./91,1351.

Cocaine decidedly useful in sea-sickness. In crossing Channel two ladies, usually ill, were kept free from the horrid feeling, one by taking six and the other three, ⅒ grain doses.—Mrs. Fenwick-Miller, in Ladies’ Column,Illustrated London News, August 27, 1891.

Printed at 74-76, Great Queen Street, London, W.C.

FOOTNOTES:[1]“Chemistry of Common Life,” Vol. ii., p. 398.[2]“The Seventeen Years’ Travels of Pedro de Cieza de Leon through the Mighty Kingdom of Peru,” chap. lxxxiii. p. 211 (English Translation, London, 1709).[3]“Simplicium Medicamentorum ex novo orbe delectorum quorum in Medicina usus est Historia.” liber iii. Antwerp, 1582 (translated from the Latin edition of Carolus Clusius). I have been unable to refer to the original “History of Aromatics” by Cieza, and corroborate the statements here made in regard to mastiche, tobacco, and oyster shells.[4]“Strange and delectable history of the Discovery of Peru” (translated T. Nichols, 1581, from the Spanish of 1555, book i. chap. viii.).[5]“Natural History of the Indies,” (translated into Latin by R. R. Cauxois, 1600) from the Spanish of 1590, book v. chap. xxii.[6]Travels in Peru, 1838 to 1842, p. 454. London: 1847.[7]Quoted in Markham’s Travels in Peru and India. London, 1862.[8]“An American Godling;” the names of others follow.[9]I have not been able to identify this plant; if intended to be anything more than a creature of the poet’s imagination, it probably yielded a sedative drug known two centuries ago, which is now lost to us.[10]Travels in Peru, by J. J. Von Tschudi. London: 1847, p. 450.[11]Op. cit. p. 454.[12]Companion toBot. Mag., 1835, i. 161, translated from “Reise im Chile, Peru und auf dem Amazon Ström, 1827 to 1832.”[13]Pharm. Journ.1854, pp. 162-4, 213-5, translated from Dr. Weddell’s “Voyage dans le nord de la Bolivie.” Paris: 1853, 8vo. ch. xxix.[14]Fromquitar, to take away, andcalzon, pantaloon.[15]“As it is easily damaged by damp in transit, the only absolute security is to have it soldered in tin or zinc, enclosed in wood; such packages generally contain two tambores, or about a Spanish quintal of 100 pounds. Although shipped from many ports along the whole coast, the principal port in Peru seems to be Salaverry, the port of entry to Truxillo, and the principal port for Bolivia is Arica, Mollendo being now closed by the civil war in Peru.”—Squibb’s Ephemeris, ii. 792.[16]“The Voyage of the Novara,” by Carl Scherzer, vol. iii. p. 402, London, 1863.[17]A custom, Scherzer says, of these Indians after long and fatiguing marches, which seems to be the result of an instinct, and teaches them how best to mitigate the pressure of the blood.[18]Chemist and Druggist, 1876, p. 155. Notes on Coca Leaf, by P. L. Simmonds, abstracted from “Mémoire sur le Coca de Pérou.” Par Manuel A. Fuentes (de Lima).[19]“Systema Materia Medica Vegetabilis Braziliensis,” by C. F. P. de Martius. Leipsic: 1843.[20]“Journal of a Voyage on the Amazon and Rio Negro,” Hooker’s Journal of Botany, Vol. v., 1853, p. 212.[21]“Peru, Incidents of Travel and Exploration in the Land of the Incas.” London: 1877.[22]“The Peruvians at Home,” by Geo. R. Fitzroy Cole. London: 1884.[23]From theTherapeutic Gazette(Detroit), January, 1886, p. 14, andPharm. Journ., 1886, p. 705.[24]“I have given altitudes and measurements approximately in English feet. By the Spanish measurements the altitudes are much greater.”[25]“It is desirable that there should be a more precise definition of the peculiarities here referred to.—Ed. Ph. J.”[26]Pharm. Journ., 1860, p. 616, exOesterreichische Zeitschrift für Praktische Heiikunde, Nov. 4, 1859.[27]“Travels in Peru and India.” London: 1862, p. 237.[28]Op. cit., p. 168.[29]Squibb’s Ephemeris, vol. ii. p. 790.[30]A Study of Coca Leaves and their Alkaloids:—P.J. 1891, 1109, 1129, 101.[31]This forms a stable 10 per cent. solution, which for the use of oculists may be diluted to a 2 per cent. solution, and still remain free from tendency to develop fungoid growths. The salicylic acid remains as free acid in the mixture, as with perchloride of iron it gives a more permanent violet coloration than the so-called salicylate of cocaine. The official solution may be used as an application for producing local anæsthesia or for hypodermic injection, for which purpose it is found to be unirritating. A solution up to the strength of 50 per cent. may be prepared in salicylic acid solution of the above strength, which is nearly saturated.[32]Cases of danger from cocaine have generally occurred from its quick absorption in hypodermic use, especially in dental operations. Those who have applied it otherwise most freely recognise little danger. In a large experience of the drug, I have not met with a case in which the so-called “Cocaine habit” has been formed.

[1]“Chemistry of Common Life,” Vol. ii., p. 398.

[2]“The Seventeen Years’ Travels of Pedro de Cieza de Leon through the Mighty Kingdom of Peru,” chap. lxxxiii. p. 211 (English Translation, London, 1709).

[3]“Simplicium Medicamentorum ex novo orbe delectorum quorum in Medicina usus est Historia.” liber iii. Antwerp, 1582 (translated from the Latin edition of Carolus Clusius). I have been unable to refer to the original “History of Aromatics” by Cieza, and corroborate the statements here made in regard to mastiche, tobacco, and oyster shells.

[4]“Strange and delectable history of the Discovery of Peru” (translated T. Nichols, 1581, from the Spanish of 1555, book i. chap. viii.).

[5]“Natural History of the Indies,” (translated into Latin by R. R. Cauxois, 1600) from the Spanish of 1590, book v. chap. xxii.

[6]Travels in Peru, 1838 to 1842, p. 454. London: 1847.

[7]Quoted in Markham’s Travels in Peru and India. London, 1862.

[8]“An American Godling;” the names of others follow.

[9]I have not been able to identify this plant; if intended to be anything more than a creature of the poet’s imagination, it probably yielded a sedative drug known two centuries ago, which is now lost to us.

[10]Travels in Peru, by J. J. Von Tschudi. London: 1847, p. 450.

[11]Op. cit. p. 454.

[12]Companion toBot. Mag., 1835, i. 161, translated from “Reise im Chile, Peru und auf dem Amazon Ström, 1827 to 1832.”

[13]Pharm. Journ.1854, pp. 162-4, 213-5, translated from Dr. Weddell’s “Voyage dans le nord de la Bolivie.” Paris: 1853, 8vo. ch. xxix.

[14]Fromquitar, to take away, andcalzon, pantaloon.

[15]“As it is easily damaged by damp in transit, the only absolute security is to have it soldered in tin or zinc, enclosed in wood; such packages generally contain two tambores, or about a Spanish quintal of 100 pounds. Although shipped from many ports along the whole coast, the principal port in Peru seems to be Salaverry, the port of entry to Truxillo, and the principal port for Bolivia is Arica, Mollendo being now closed by the civil war in Peru.”—Squibb’s Ephemeris, ii. 792.

[16]“The Voyage of the Novara,” by Carl Scherzer, vol. iii. p. 402, London, 1863.

[17]A custom, Scherzer says, of these Indians after long and fatiguing marches, which seems to be the result of an instinct, and teaches them how best to mitigate the pressure of the blood.

[18]Chemist and Druggist, 1876, p. 155. Notes on Coca Leaf, by P. L. Simmonds, abstracted from “Mémoire sur le Coca de Pérou.” Par Manuel A. Fuentes (de Lima).

[19]“Systema Materia Medica Vegetabilis Braziliensis,” by C. F. P. de Martius. Leipsic: 1843.

[20]“Journal of a Voyage on the Amazon and Rio Negro,” Hooker’s Journal of Botany, Vol. v., 1853, p. 212.

[21]“Peru, Incidents of Travel and Exploration in the Land of the Incas.” London: 1877.

[22]“The Peruvians at Home,” by Geo. R. Fitzroy Cole. London: 1884.

[23]From theTherapeutic Gazette(Detroit), January, 1886, p. 14, andPharm. Journ., 1886, p. 705.

[24]“I have given altitudes and measurements approximately in English feet. By the Spanish measurements the altitudes are much greater.”

[25]“It is desirable that there should be a more precise definition of the peculiarities here referred to.—Ed. Ph. J.”

[26]Pharm. Journ., 1860, p. 616, exOesterreichische Zeitschrift für Praktische Heiikunde, Nov. 4, 1859.

[27]“Travels in Peru and India.” London: 1862, p. 237.

[28]Op. cit., p. 168.

[29]Squibb’s Ephemeris, vol. ii. p. 790.

[30]A Study of Coca Leaves and their Alkaloids:—P.J. 1891, 1109, 1129, 101.

[31]This forms a stable 10 per cent. solution, which for the use of oculists may be diluted to a 2 per cent. solution, and still remain free from tendency to develop fungoid growths. The salicylic acid remains as free acid in the mixture, as with perchloride of iron it gives a more permanent violet coloration than the so-called salicylate of cocaine. The official solution may be used as an application for producing local anæsthesia or for hypodermic injection, for which purpose it is found to be unirritating. A solution up to the strength of 50 per cent. may be prepared in salicylic acid solution of the above strength, which is nearly saturated.

[32]Cases of danger from cocaine have generally occurred from its quick absorption in hypodermic use, especially in dental operations. Those who have applied it otherwise most freely recognise little danger. In a large experience of the drug, I have not met with a case in which the so-called “Cocaine habit” has been formed.

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