EXCITING INFLUENCES. — Over and above the psychological excitation of the drug itself, the exciting causes seen by me have practically been confined to urgent clamor for relief from physical agony, such as occurs at times in asthma or neuralgia.
Cocaine, which has hut recently been introduced in India, is generally taken in the form of powder sprinkled on a paste of slaked lime, which is buttered on a betel-leaf. The nia:,,s is rolled up and chewed for about fifteen minutes. The first symptom of the so-called hilarity is a heaviness of the head. Then quickly follow a wild throbbing of the arteries of the neck and palpita tion of the heart. The pulse never ex ceeds 110. The inebriate wishes to be left alone; he will not speak lest saliva escape from the mouth. The ears be come hot, the cheeks pale, the nose pinched and cold. The height of intoxi cation is marked by coldness of the finger-tips and dilatation of the pupils. This stage lasts from thirty to forty five minutes, when the victim longs for a fresh dose.
The teeth and tongue of old habitues turn absolutely black. The craving for an increased dose is pronounced. In one case it was so Marked as to cause a jump from 1 to 20 grains in a month. The worst sequelm are very obstinate forms of diarrlicea and dyspepsia. Cif the mental dera.ngements, hallucinations, and delusions causing dejection and fear, are common. .A more miserable object than a confirmed Hindoo cocaine-eater cannot be pictured. The drug is alto gether more disastrous in its effects than is opium or any other narcotic used in India. To quote the words of a victim, "To eat cocaine is to court misery." Kailas Chunder Bose (Brit. Med. Jour., April 211. 1.902).
I have not seen insomnia incite to cocainomania as it frequently does to morphinomania. Physical pain has been the initial starting-point. The use, for any purpose.. of cocaine is an able influence inciting to the "cocaine habit" in constitutions predisposed to narcotic excitation. Other narcotic stances also both predispose and cite to the cocaine mania. Morphine, for example, long continued is apt to create a crave or impulse too imperious to be satisfied with morphine narcotism alone.
Case of mixed addiction. morphine and cocaine, the habit for the latter drug having been acqiiired by its use as a substitute for tbe former, with the usual disastrous results, namely: loss of ap petite and sleep, vertigo, syncopal and epileptiform attacks, and, finally, hallu cinations and delusions, ideas of sus picion, jealousy, and persecution: also hallucinations of anima.lcules on the skin, which are so characteristic of the action of cocaine. Cocaine is a toxic agent far more formidable than morphine on account of the rapidity and intensity with which the sensory, motor, and in tellectual derangements develop under its use. Warning against employing it itS a substitute for morphine with those addicted to the latter drug. Laury (La Sem. Med., Aug. 10, '90).
In morphinomaniacs cocaine is some times resorted to simply with the object of heightening the pleasurable sensations of intoxication. ln not a few instances cocaine addiction has been rapidly set up in the vain attempt to cure alcoholo mania or morphinomania by substituting cocaine. This attempt at the cure of the original form of narcomania (a mania for narcotism by any narcotic) is sometimes openly attempted with the best intentions; but is more often un knowingly tried simply because cocaine has been a component of the so-called "cure," though not disclosed by the manufacturers. In this way even soine abstainers from alcoholic liquors who pride themselves on their consistent tem perance have insensibly become cocaine slaves, they haying had no idea that they and theirs were partaking of a nar cotic poison more fascinating and peril ous than the object of their aversion: alcoholic intoxicants. A striking object lesson of medical unwisdom was the ap pearance of a crop of cocainomaniacs in England shortly after the announce ment, in a British medical annual, of the reputed cure of alcoholomania and mor phinomania by means of cocaine, in another country.