CHAPTER IV THERAPEUTIC ACTION OF COCA

NOW that we understand the physiological proper-ties of Coca and Cocaine, we come to the study of the different morbid states in which these substances may be usefully employed.

DISEASES OF THE MOUTH.

Gazeau advises the use of Coca for inflammations of the mouth and gums. Pain is assuaged, ptyalism removed, and the inflammation itself favorably influenced. He cites, in support of his opinion, the use which the Peruvi-ans make of it in affections of the mouth, and mentions cases of mercurial stomatitis treated with this agent. and cured in a short time, in his practice.

Demarle (1), before him, expressed himself thus : " I have used Coca for mercurial stomatitis. The affection disappeared on the third day of treatment ; nothing else had been administered."

In cases where the gums are soft, fungous, ulcerated, or bleeding, and these changes depend on local or constitu-tional conditions, Coca is equally indicated. Gazeau pre-fers it even to potassium chlorate.

According to Dr. Colombe (1), Coca is a potent factor in the treatment of syphilis. (2) " It is demonstrated that potassium iodide and potassium chlorate undergo double decomposition in the system, and thus interfere with each other's action. Coca, substituted for the chlorate under such circumstances, would not be open to the same objec-tion. It would find its application, therefore, when the mixed treatment is found necessary."

DISEASES OF THE THROAT, PHARYNX AND THE LARYNX.

As regards the angina, the acute inflammations of the larynx and pharynx, we might repeat what has been said about inflammations of the mouth. In particular, the pain, so violent in certain angina', calls for this method of treat. ment. The same is true of the dysphagia which accompa nies them.

Charles Fauvel first recognized the virtues of Coca in the tingling of follicular angina and the laryngeal pains of tuberculous subjects. In those cases he specifies Mari. ani's extract of Coca leaves in preference to solutions of Cocaine, which sometimes give rise to symptoms of poison ing.

Dr. Rouquette (8) relates a case of tubercular laryngitis in which symptoms of poisoning showed themselves as early as the third day ; the parts had been painted twice a day with a five-per-cent solution of Cocaine.

Dr. Paul Legendre has quite recently mentioned anew the danger that may result from a too free use of Cocaine (1). The case was that of an interne of the hospitals attacked with diphtheria who, in order that he might the better bear the spraying with caustics, had his throat painted with a solution of Cocaine. Toward the seventh day he experienced very grave symptoms of poisoning, and the painting had to be suspended.

It is better, in cases of this sort, to prescribe extract of Coca, which answers the same purposes without the at-tendant danger of Cocaine.

One of the greatest triumphs of extract of Coca is assur-edly its action in dysphagia and in the vomiting of con-sumptives, as also in the vomiting of pregnancy. The first two complications are of the gravest kind, for they con-demn to starvation patients whose only chance of safety lies in the activity of the digestive organs (Ch. Fauvel and Conpard).

DISEASES OF THE STOMACH.

Authors who have given attention to Coca speak very highly of its employment in gastralgia and tardy and laborious digestion.

Demarle says on this subject : " Personally, I have found the use of Coca, either before or after eating, excellent for gastrodynia and pyrosis, to which I am subject ; hardly have I swallowed the first bit of saliva when the whole un pleasan t feeling disappears."

Mantegazza speaks of its use in the same strain. The cephalic congestion which accompanies his digestion is relieved ; he can work after eating without feeling any uneasiness.

Dr. Ch. Gazeau ( These pour le Doctoral, Paris, 1870, Parent, edit., pp. 81 el seq.) thus sums up the physiological action of Coca : " On the stomach, slight excitation, amesthesia, and probably an increase of the secretion of gastric juice ; on the intestines, an increase of the intestinal secretions, etc. These manifold physiological effects upon the digestive tube unite in a specific action, so to speak, in the numer-ous functional troubles, so varied and so ill-understood, of the organs that compose it."

The same author cites a great number of cases of this sort in which Coca " has never failed to exert an admirable action, often even marvelous." And he concludes (page 88): " It seems to me useless to bring forward more ex-amples ; these are enough to justify this positive general conclusion : Coca is the remedy par excellotet for diseases of the digestive tube."

Beugnies-Corbeau (1) prescribes it in chloro-antemia, not only for gastralgia, but for the frequent desire to eat which patients feel, disappearing as soon as the first mouthful has been taken, only to return a little while afterward.

Prof. O. Revell ends his article on Coca as follows : " Much remains to be done in the physiological and clinical study of Soca ; it is known that it acts on the motor and sensory nervous system. This substance is destined some day to take an important rank in therapeutics."

In irritability and various affections of the cerebral cen-ters, Dr. J. Leonard Corning makes use of Coca, which he prefers to the bromides.

In a very remarkable essay on Erythroxylon Cot-a, pub-lished at Ixelles, in 1886, a perusal of which we urge upon all who are interested in the study of Coca, Dr. A. Feigneau says (page 81):

" There can be no mistake that, to a certain extent, Coca stimulates the cerebro-spinal activity by suspending or re-tarding the destruction of tissue in the economy, and that its action may modify the functions of the nervous centers, provided there are no such contra-indications to its use as active congestion, inflammation, or organic changes in these organs."

" Consequently it would be indicated under all circum-stances where a nervous affection seemed to depend upon a state of ataxia."

" In irritations of the spinal cord, in mental aberration accompanied by melancholia, as well as against idiopathic convulsions (Mantegazza) and nervous paraplegia."

Dr. Beverley Robinson considers the Vin Mariani as a cardiac tonic (1) :

" On several occasions, when digitalis has proved to be useless or injurious, I have had very excellent results from. caffeine or convallaria. Certainly, the latter drug is more easily tolerated by a sensitive stomach than digitalis is; and whenever the nervous supply of the heart is especially implicated, I believe that I secure more quieting effects from its employment. Among well known cardiac tonics and stimulants for obtaining temporary good effects, at least, I know of no drug quite equal to Coca. Given in the form of wine or fluid extract, it does much, at times, to re-store the heart-muscle to its former tone. I have obtained the best effects from the use of Mariani's wine. From per-sonal information given me by this reliable pharmacist, these results are attributable to the excellent quality of the Coca leaves and of the wine which he uses in its manufac-ture."

In cases of morphinomania, Dr. Dujardin-Beaumetz has pointed out the advantage to be obtained with the Vin Mariani, and, following him, Dr. Palmer, of Louisville, and Dr. Sigmaux Treux, of Vienna, have obtained excellent results with this therapeutic agent. Further on, we give a case of Dr. Villeneuve's, showing the cure of a morphino-maniac by the combined use of the Vin and the Pate (Mariani).

Dr. H. Libermann recommends the use of Coca, in the-form of Vin Mariani, against morphinomania, nicotinism and alcoholism.

" In general diseases it is to the stimulating properties of the plant that recourse is oftenest had. These properties make it the tonic par excellence whenever the object is to build up a system that has been enfeebled from any cause. Its preparations, accordingly, may be ordered in convales-cence from all grave fevers, in anwmia and chloro-anmmia, in all diathetic or cachmtic conditions, whatever may have been their original cause (chronic rheumatism, gout, genito-urinary affection, cancer, etc.), in short, in all cases where the system is debilitated from any cause-whatever."

But it is, above all, in diseases that have a depressing action on the nervous system that the effect of Coca is truly marvelous. Gubler, in his Commentaires de therapeutique, shows himself its warm champion. "Coca," says he, " very much like tea and coffee, lends to the nervous system the force with which it is charged, after the manner of a ful-minate, but with this difference, that it yields it gradually and not all at once."

The theory of the fulminates, invented by M. Gubler, tal-lies so well vrith observed facts, that Mantegazza, without generalizing and without pretending to form a theory, but limiting himself to describing by simile what he had seen, truer probably than he himself supposed, said : " Under the influence of Coca, it seems that a new force is grad-ually introduced into our organism, like water into a sponge." (A. Dechambre.)

This opinion has been corroborated by all authors who have given attention to the question, and it may be looked upon as one of the least contestible in therapeutics.

We will add, what is quite important, that as a tonic Coca has been found far superior to cinchona, iron, strych-nine, etc. Everybody knows their astringent action, which makes them give rise to such obstinate constipation that there are patients in whom it is often necessary to sus-pend their use. There is no such objection to Coca ; it never constipates, and practically its use may be contin-ued indefinitely.
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1 These de Paris, 1862.

1 These de Faris, 1885.

(2) Bonnetead and Taylor on Venereal Duran:.

(3) Theirapentigale contemporaine, January. s888.

(1) Concours MIdisal Aug. r, 1888.

(1) Balletia gest. de The, ap. 1884.

(i) " Heart-strain and Weak Heart," N.Y. AlitEral Reeeni, Feb. 26, page 238.