CIIRONIC POISONING. — Chronic poisoning by cocaine, or the "cocaine habit," occurs sometimes alone, some times associated with the opium habit.
The symptoms after cocaine habit sist of marked loss of body-weight, ordered circulation, loss of mental power and moral perception, and delusion, sim ilar to those affecting the subjects of chronic alcoholism. (See COCAINO MANIA.) Treatment of Cocaine Poisoning. — The treatment of acute poisoning where the symptoms are those of depression consists in the exhibition of sal vola tile, coffee, strychnine, caffeine, digitalis, ether, and alcohol. If the symptoms are of the convulsive type, the treatment should be the same as that of strychnine poisoning: inhalations of amyl-nitrite, bromides with chloral; if convulsions prevent swallowing, use chloroform amesthesia and give antidotes by rectum in starch-water. Amyl-nitrite and mor phine by hypodermic injection are indi cated if relaxation does not occur.
From experiments upon animals in re nrd to lavage of organism in acute co caine poisoning, the following deductions made:— 1. While the minimum fatal dose of cocaine muriate administered hypoder mically is 0.02,5 gramme per kilogramme, one can inject, of the same drug, with out fatal result: (a) gramme 0.03, if we follow the said injection with hypo dermoelysis; (b) and 0.035 gr. per kilo gramme if we follow the said injection with lavage of the organism by the in jection of the physiological solution of sodium chloride.
2. While the minimum fatal dose of cocaine muriate administered fasting by the alimentary canal is 31/2 centi grammes per kilogramme, one can, with lavage of the organism, administer as much as centig,rammes per gramme without fatal results. Carlo Bozza (Cior. Internaz. delle Sci. Med., Feb., '98).
Therapeutics. — The therapeutics of this drug may be conveniently treated under three heads: the internal, hypo dermic, and topical administrations. Coca and cocaine are contra-indicated in fatty heart, arterial atheroma, pernicious ancemia, hysteria, and epilepsy.
The first and greatest precaution to be taken before the hypodermic injection is the preliminary physical examination; this should be made with the utmost thoroughness; if the patient is suffering with organic disease of the brain, heart, lungs, or kidneys, or any confirmed neurotic disorder, injection of the drug must not be attempted. The patient should be placed in a recumbent posi tion, with the head low, and lie should not be allowed to rise for at least fifteen minutes after the cocaine has entered the general circulation. Where it is possible to use constriction, it should never be omitted. After the operation, tourniquet is loosened and immediately tightened. This is repeated at intervals of a few minutes until the cocaine has probably all entered the circulation. C. A. Dunmore (Codex Medicos, Dec., '95).
Cocaine administration in medical practice can be rendered absolutely safe by refusing. its use in persons with kid ney and heart affections, and the em ployment of means which will fortify against the possible occurrence of acci dents. Accidents can he avoided by the administration of morphine and atro pine. Oxygen-gas is the only true anti dote. Charles Wilbon Ingraham (Med. News, Jan. 22, '96).
Internal Administration.—For inter nal administration. the fluid extract of coca or a good coca-wine, such as vin Mariani, is preferred. The elixir and tincture are not sufficiently active or re liable.
Cocaine successfully used in several cases of seasickness. A cathartic was first administered, then 5 minims of a 4-per-cent. solution of cocaine repeated every hour or two until three doses were taken. A. D. Rockwell (Med. Record, Apr. 1, '96).
FEVER.—The stimulating and sup porting effects of coca are well known and may be utilized in all forms of low fever. In yellow fever it is of especial value on account of its anti-emetic prop erty.