Below sixteen years of age there would appear to be a lessened susceptibility as the years go down, children showing less cocainomaniacal proclivities than adults, and not responding so readily to the narcotic properties of the drug in doses relatively corresponding to their years. Though the young are readily intox icated by cocaine, they are not so prone to become subject to the mania for in toxication by cocaine.
As to sex, the majority of the cases have been male; but this has not arisen because of a lesser susceptibility that is found in man, but probably is owed to occupation exercising a stronger in fluence.
Occupation is a predominant factor, most of the victims having been medical men (I have seen a number of cases in members of the legal profession), literary men and women, and the cultured gen erally.
Climate exercises considerable influ ence, which may account for the greater prevalence of cocainornania in the United States of America and northern France, as compared to Great Britain. Racial characteristics and atmospheric conditions modify purely climatic en vironment, however; witness the prac tical absence of cocainomania among the great community of the Jews, and the rapid electrical disturbances, as well as the tremendous temperature alterations, of North America.
The cocaine inheritance has not had time to show itself, if it exist; but the "cocaine habit" as an outcome of trans formed narcomaniac transmission I have seen in several families.
Pathology.— ACUTE COCAINISM.— Though a large niimber of cases of acute cocaine poisoning have been recorded by Germain See, Mattison, Schede, and others, comparatively few have proved fatal. Probably the fatalities have run
not much over 10 per cent. Even in exceedingly grave eases, when the suf ferer appears almost moribund, the dis tress and collapse often suddenly and unexpectedly give way and the appar ently dying patient makes a good recov ery. Hence there has been little op portunity for post-mortem inspection. Clifford Allbutt says that the heart is found in diastole and the nervous cen tres are congested. According to Ehr lich, vacuolary degeneration is found in the hepatic cells, the latter being greatly enlarged and the nuclei atrophied. The convulsive respiratory paralysis is ascribed by Mosso to tetanus of the respiratory muscles, and the great rapid ity of the circulation to paralysis of the vagus. The peripheral blood-vessels are contracted. Cocaine is stated to alter and injure the leucocytes; Maurel and Beaumont Small state that these become spherical and rigid, with increase of size. They seem also to have a tendency to locate next to the vessel-wall.
Death may supervene at an early stage from syncope, or at a later from as phyxia. Cocaine acts on the central ' nervous system, first exciting and after ward paralyzing this. Doubts have been expressed as to whether the ansthesia produced by cocaine is due to the vaso motor disturbance or whether the drug directly paralyzed the nerve-termina tions. Brown-Sequard believes the latter, holding that cocaine acts through the peripheral nerves on the nerve-cen tres, which reacts in inhibiting sensi bility. I am inclined to think that the central nerve-centres are affected in both ways: by vasomotor paralysis and by peripheral excitation.