Coca

Volume I — Special Symptomatology

(Erythroxylon coca.)

[A plant used by the natives of Peru, for the purpose of stimulation, and to enable them to perform arduous labor. These symptoms are collated mainly from Hering's pathogenesis. — Hale.]

Pharmacology. — This is a shrub growing wild, in South America, and largely cultivated in Bolivia, for the sake of its leaves, which are much

used in that country for chewing. The plant which is propagated from the seed in nurseries, begins to yield in eighteen months, and continues productive for half a century. The leaves, on being picked, are dried in the sun, and then packed in bags. They are known in South America by the name of Coca. They were in general use among the natives of Peru, at the time of the conquest, and have continued to be much employed to the present time.

The leaves resemble in size and shape those of tea, being oval-oblong, pointed, two inches or more in length, by somewhat over .an inch in their greatest breadth, and furnished with short delicate footstalks; but they are not, like the tea leaves, dentate, and are distinguished from most other leaves by a slightly curved line on each side of the mid-rib, running from the base to the apex. When well dried, they resemble, in odor, tea, and a peculiar taste, which, in decoction, becomes bitter and astringent. It has been found so impossible to import the leaves to this country without injury to their medicinal properties, that the tincture ought to be prepared from them as soon as gathered.

Officinal Preparations. — Tincture with strong alcohol, from fresh leaves, dilutions.

Analogues. — Coffea, Thca, Scutellaria, Ignatia, Paullinia, Cannabis indica, Cypripedium, Phosphoric acid, etc.

Mental Sphere.

• Slow in finding the words to express himself at times.

• Brain feels so muddled that he cannot read understandingly. ° Mind much clearer; spirits much better.

A peculiar sensation of isolation from the outer world.

On any one speaking to him, it seems as if the person were

at a great distance. Their excited imaginations conjure up the most wonderful

visions; at one time consisting of indescribably beautiful

and delightful forms; at another, however, of the most

horrid figures.

Inclination to work, with sleeplessness all night; disinclination.

An irresistible inclination to feats of strength.

Shy; they flee the society of their fellow-men; seek concealment in gloomy woods or lonely dwellings.

Instinctive desire to make no motions at all.

° Always relieves him from unusual fatigue; producing perfect calmness of mind and body, and is never followed by any depression.

A kind of numbness, with a feeling of security, with retention of clear self-consciousness, and the instinctive desire to

make no motion, not even to move a single finger, for an entire day.

During the evening, after the first dose at six o'clock, his hearing became painfully acute; he felt something like expectation; brain excited; and a rather painful pressure on the sides of the head.

0 Mental depression.

Great anxiety, palpitation, humming in the ears the whole

day, and sparks before the eyes. "Peevish temper; hypochondria.

Nausea and vertiginous feeling, incapaciting for carrying on

literary labors. 0 Loss of energy.

Head.

Giddiness and dizziness; involuntarily stopping quickly when

walking; the head inclined forward, with giddiness and

fear of walking. Giddiness, though slight, on going out in the open air early in

the morning; objects appearing to turn before the eyes,

for an hour's time. Great dullness in the head, like the effects of a debauch. Fullness of forehead; dull feeling over the whole brow; slight

shooting pains in right temple; sensation of tension over

forehead, as if an india rubber band were stretched over it. Violent headache immediately over the eyes, with low ringing

in the ears.

Dull frontal headache, which vanished with the setting of the sun, followed by a state of mental exhilaration.

A pressing headache on the right side of the occiput as well as of the right side of the forehead, with giddiness and chill after dinner, disappearing toward evening.

Headache in the afternoon, with chilliness.

Rather violent headache, with sensation of dryness in the throat.

° Migraine; a one-sided headache.

Eyes.

Great intolerance of light, with remarkable dilatation of pupils. Black spots flying lightly before the eyes several times while reading.

White spots before the eyes, so that on reading the book seems moulded white. (Chloral has " everything looks white.")

Flickering before the eyes; the letters seem to run together on the paper; it seemed as if he were writing with two pens; fiery specks float before the eyes. A sensation comes on as if some one were knocking about the eyes, with loud ringing in the ears; two hours later he can write without double vision or swimming.

Dullness of the head, with flying of fiery points from above downwards, and swimming together of the letters.

White spots and glittering serpentine lines before the eyes, with great uneasiness on going out after dinner, for an hour.

The eyes become very sensitive, reading cannot be endured long; some are troubled with slight headache, while others suffer from nausea and various disorders of the digestive apparatus, which may be compared with seasickness.

Disposition on the part of the upper lids to fall, without being sleepy.

After using for a number of days, on himself and others, there broke out a circumscribed erythema — on one an exanthema resembling herpes — around the eyelids. Ears.

Acute hearing, and excited brain. Loud ringing and buzzing in the ears.

Difficulty of hearing; it seems as if the sounds came from a great distance.

Nose.

Running of clear water from nose, and occasional sneezing, without having properly a coryza as he usually has it. Face.

Burning, redness of cheeks, first left then right; white spot

in the centre of latter. Small boils t. u the face.

Quivering, trembling lips; pale lips and gums, with green, blunt teeth.

Ugly, blackish border around the angles of the mouth.

On the lips a nettle rash; scabs; bleeding.

Mouth.

Toothache in a hollow tooth, at noon till evening, violent.

• Prevents caries of teeth.

• No taste in the morning.

• Much furred tongue. Dryness of mouth on waking.

Throat.

Irritability of the pharynx, so that the stomach would not retain food.

*A distinct feeling of swelling of the uvula; difficulty of swallowing.

Swelling of the uvula without any particular redness, lasting from five o'clock in the afternoon and through the whole evening.

Feeling as if some mucus were at back of pharynx; not removed by coughing or hawking.

Early in the morning, after a very comfortable sleep, a sensation of dryness in the throat, very disagreeable on swallowing, as if swollen.

Appetite.

Not hungry at noon, as usual, nevertheless ate a good deal, and with appetite.

Quickly satiated, notwithstanding great hunger and good appetite at noon.

Wants food at an earlier hour in the forenoon, notwithstanding a distension of the abdomen, as if from overloaded stomach.

Digestion goes on with great activity.

An intense gnawing, hungry sensation at the pit of the

stomach. (Abies.) Morbid hunger, even to swallow animal excrements; (chronic

symptom of chewers.) Very little need of food, even with hard labor; incredible

fatigues are endured with unusual vigor on the most

meagre diet.

Always felt a sense of great satiety after taking the infusion

in the morning, and did not feel a desire for his next meal until after the time at which he usually took it.

Prevents getting hungry; feels no hunger.

Retards approach of hunger, when taken as tea.

Enables the body to feed upon itself, without the hunger pains and weakness usually accompanying prolonged abstinence from ordinary food.

Drinking the decoction at three or four o'clock p. m., it has invariably and totally deprived him of all appetite for dinner, and of his rest at night; under these circumstances he always passed the night in reading or writing; he feels no fatigue or hunger on the following morning.

° Want of appetite (a remedy of doubtful value). {Hale.)

Stomach.

At noon, a peculiar feeling of emptiness in the stomach and abdomen; when walking, a painful contractive sensation in the stomach, and close to the latter, on the left side, a pain similar to the so-called stitches in the spleen.

Debility of the digestive organs; at first it seems to be slight uneasiness; soon reaches a frightful intensity.

° Catarrh of the stomach ; a cup of Coca after dinner.

° After taking for five days twenty drops of the tincture, once or twice a day, his digestion became extraordinarily good, and continued so.

When walking, a pain about region of cardiac end of stomach, gradually increasing; would have amounted to a cutting pain; after standing it went off, returning in a week.

° Gastralgia, similar to that caused by coffee.

Abdomen.

• Violent belly ache, with rumbling, as if from flatulence;

tympanitic distension of the abdomen, diminished by a

frequent discharge of inodorous flatus. ° Spasmodic colic; given in the hospitals in Bolivia; had no

effect in Valparaiso. c Pituitous disease of the abdominal organs.

• Tympanitic distension of abdomen, diminished by frequent

discharges of inodorous flatus. 0 Ilypochondriac pressure and tension after meals.

Stool.

The dangerous obstructions which would result from the diet of the Indians — roasted maize and roasted barley, pounded into meal, and swallowed dry without anything — are prevented by the well-known purgative action of the Coca.

Stool easier than usual in the morning, and thinner; for three minutes after a feeling of want of further evacuation, without any; the soft stool of a normal color.

Teaspoonful musty diarrhoea, four stools during the early afternoon, without pain; stools different from his habitual looseness; stopped taking Coca, and had natural stools.

Ineffectual urging to stool ; constipation, with abdominal distension.

Urine.

° Absence of the usual incontinentia u rinse nocturna.

Hose at night to urinate, as he had to do constantly a long time ago, but not lately, and it ceased after the proving.

Urine had an unbroken film over its surface, iridescent in certain lights, with an appearance like fissures in it, mapping it out, and a flocculent, pale sediment floating at the bottom, seen through the film.

Generative Organs.

Women. — Menses delayed for two days, came on about noon ; got very profuse during the night, with some pain in the lower part of the abdomen; not in a steady flow as usual, but in gushes, awakening from sound sleep; after drinking the infusion morning and evening for a whole week. Larynx.

Hoarse voice on waking at night.

Hoarseness, with tickling in the upper part of the trachea,

and some cough. ° Feels much stronger invoice; can sing much louder and

clearer.

0 In phthisis laryngea, when from irritability of the pharynx,

the stomach would not retain food. After a strong infusion he could, during the whole day, climb

the heights, and follow the swift-footed wild animals,

without experiencing any greater difficulty of breathing than in similar rapid movements on the coast.

Great ease in ascending high mountains, and running amongst them, without any difficulty of breathing.

0 Mitigates the difficulty of breathing, haemoptysis, and sleepiness, incident to traveling among the hills, four thousand feet above the sea level.

° A. strong tea prevents the usual breathlessness in climbing hills.

0 Shortness of breathing, especially on making an ascent; in the forenoon, a tickling cough would cause a tingling.

° Expectoration of small lumps, like boiled starch, which he has had for some time, immediately after rising in the morning.

0 Hawking up of small transparent lumps of mucus, chiefly

in the morning;. ° Asthma; (a useful palliative.) {Hale.) ° Oppression of breathing during nocturnal hours.

Chest.

Rather painful weight on the chest, with constant necessity to imbibe deeply, when sitting in the evening; sensation as if the lungs were too much distended; difficulty of breathing, even in bed; palpitation, with a weakness of the whole body, though not disagreeable, as if from great exertion.

° Emphysema; (a palliative, like Chloral.)

Heart.

After an infusion of the leaves, pulse becomes much accelerated, the beats of the heart being nearly quadrupled.

Great anxiety, and strong palpitation; he broke out in a copious sweat in the evening, nine o'clock, while in bed.

° Disease of the heart, functional, from over exertion.

Sleep.

5 Inclination to sleep, but can find no rest.

Skin.

' Dry, papular eruption on back of the hand, of three years' standing, not cured by Kali, chrom., Sulph. ac, Fluor, ac,

etc., soon ceased to spread, gradually got paler, and has in some spots, where it was worse, disappeared.

c Protection from cutaneous diseases. (?)

Generalities.

Numbness of hands and feet.

° Suffered frequently from rheumatism, came on from the slightest cold ; now not from the first of October till first of November, even not with very unfavorable weather.

During manual labor Coca has very little influence.

Ease in breathing, and feeling of freshness and vigor of the whole body, with great pleasure in walking quickly and far, notwithstanding the great heat and great power of the sun, in the forenoon.

Great bodily vigor, and endurance of great fatigue, notwithstanding extremely little nourishment and no sleep.

• Can nowhere find rest; nervousness and nightly restlessness of children during dentition.

° Erethism in the sensitive sphere; ° hysterical complaints.

0 Debility during convalescence from typhus.

° Fainting fits from nervous weakness.

The Stramonium patient likes company, the Coca patient solitude; the Stramonium patient light, the Coca patient darkness.

Volume II — Special Therapeutics

proportion as he has abused the stimulant. The first use of Coca in the United States was as a tobacco antidote. I do not know the originator, but suspect it was the erratic Dio Lewis, M.D. In the many cases in which I saw it tried, no permanent good resulted from its use.

If you will refer to the symptoms of the mental sphere in “New Remedies,” fourth edition, you can readily separate* the primary from the secondary.

I doubt if the drug will ever come into extensive use in our school in the treatment of diseases, unless they are complicated with or are caused by abuse of other nerve-stimulants. It may be a good antidote to the secondary effects of tea, coffee, and perhaps Opium. You may find it useful in some nervous affections of the eyes. It causes white spots, dark spots, and fiery spots before the eyes (Chloral has — “ everything looks white ”).

It has symptoms closely resembling the dyspepsia and cardialgia caused by abuse of tea and coffee; it may be worth a trial in such cases.

These symptoms of the respiratory organs are very striking. The natives of Peru after chewing the leaves or drinking the tea are enabled to climb with ease the highest mountains, and carry heavy loads where the air is so rare that the traveller (unless he takes the Coca) can breathe only with the utmost difficulty. It is said to prevent the haemorrhages caused by high altitudes and rare air.

In partial paralysis of the nerves of respiration it may be very useful in removing or palliating the distressing dyspnoea, or it may be very useful in the dyspnoea of weak persons, who easily get “ out of breath ” during the slightest physical exertion.

You may find it a valuable palliative in emphysema and pulmonary oedema. It may even assist in the cure of these distressing conditions.

I have used it with apparent good results in some cases of functional heart disorder, and in one of organic disease, to relieve the excessive dyspnoea. It palliated some, and seemed to be the chief means of cure in others.

It is indicated in that condition which we so often find in women and children, which is best described by the word “ fidgetiness,”

or nervous erethism. The patient can find no rest anywhere ; wants to sleep but cannot; finally becomes hysterical ; feels like fainting; wants to be alone in the dark. (The Stramonium patient likes company and light.)

In the cases just mentioned the 6th or 30th attenuations appear to be best indicated ; while for dyspnoea, the matrix tincture must be used.