Aphrodisiac effects of cocaine shown in the case of a woman, married and highly respectable, who became a victim of cocaine, and who, while under its in fluence, would invariably utter expres sions and do things which she would not even have thought of when in her normal condition. These effects appear to be more pronounced in females than in males, and hence the inadvisability of the indiscriminate use of cocaine. M. K. Bowers (Med. Age, Dec. 26, '91).
Case of chronic eocainism, in which the patient suffered from hallucinations, un der the influence of which, according to his statement, he twice committed as saults. Regarded as a case of cocaine epilepsy, on account of the suddenness of his attacks of furor and a certain amount of amnesia. He formed the habit by using it for a nasal trouble. Lewin (Deutsche med.-Zeit., Jan. 1, '91).
iNlagnan's sign—an hallucination of cutaneous sensibility, characterized by a sensation of foreign bodies under the skin, which are described as inert and spherical, varying in size from a grain to a nut, or as living organisms, worms, bugs, etc.—observed in two cases. Ri bakoff (Gaz. degli Ospedali e delle Clin., Aug. 4, '96).
The first feeling a cocainist has is an indescribable excitement to do some thing great, to leave a mark. But this disappears as rapidly as it came. The second sensation—at first, at least, no hallucination—is that his hearing is enormously increased. Very soon every sound begins to be a remark about him self, mostly- of an offensive kind, and he begins to carry on a solitary life, his only companion being his syringe. Every passer-by seems to talk about him. After a relatively short time, lie begins the "hunting of the cocaine bug," and im agines that, in his skin, worms or sim ilar things are moving along,.
Personal opinion that there is a ques tion of disturbance in the frontal cortex, originating, perhaps, in skin dysmsthe sioe, and not a simple visual hallucina tion or retinal projection. Springthorpe (Quarterly Jour. of Inebriety, Jan., '97).
In acute cocaine poisoning there may, or may not, be the exhilaration stage, the poisoned somethnes falling rapidly into collapse and insensibility after ex ceedingly transient symptoms of pale ness, faintness, fullness of head and giddiness, skin creepings, profuse per spiration, pranordial distress, rapid hard or weak pulse, loquacity, restlessness, agitation, and hysterical excitement. The pupils are dilated and dull, the per spiration, at first quickened, becomes spasmodic and labored, unconsciousness sets in, convulsive seizures appear after muscular cramps, somethnes with tetanic spasms, followed, it may be, by deepen ing cyanosis, violent delirium, enuresis, and paralysis of the sphincters. -Withal
there are often localized areas of awes thesia. In non-fatal cases, though the acute symptoms may pass off in a couple of hours or so, feelings of languor, malaise, and local pains may linger for days.
Differential Diagnosis.—Though, in many cases, unless the presence of co caine can be determined by finding the drug or by the brown stain over the seats of hypodermic injection, this particular "habit" or mania cannot be diagnosed from other :Corms of narcotic addiction, there are one or two prominent symp toms which point to cocaine as the spe cial mania. Especially in the earlier stages, though to a larger extent in the more advanced, alcohol is excluded by the absence of symptoms pointing to organic functional bodily lesion. The cocainomaniac not only often shows no symptom of bodily or mental disturb ance, but manifests simply a sense of satisfaction, and an appearance of in creased capacity for intellectual and mnsmilar work. In many cases the closest physical examination has failed to reveal anything abnormal. Indeed, at times the only sy-mptom discernible has been an apparently improved condition. In some instances only the closest con tinuous scrutiny of a business partner or a wife has, after a time, disclosed even the slight falling off in the char acter of the work and of the judgment, the actual amount of work havin'g been occasionally increased. One point of differentiation, even from etheromania (which is more speedy in the appearance, progress, and cessation of toxic symp toms than either alcohol, opium, mor phine, chloral, or chloroform), is the greater quickness with which the char acteristic phenomena of cocaine poison ing set in and pass away. Still another discriminating symptom is the extra ordinary self-confidence and elation arising from cocaine. In etheromania the odor of the breath is characteristic, and the activity more effervescent and demonstrative. A point of distinction from alcoholomania is that, while this is mostly social and less often solitary, cocainomania is almost always solitary. Yet another difference from alcohol and morphine is that the prevailing delusions of cocainomania are delusions of perse cution. These rarely occur with alco hol, except temporarily sometimes in delirium tremens or in chronic alcohol ism, and still less often with morphino mania. They are frequently seen, how ever, with the chronic cocaine habit, and are at once more marked and more per sistent with cocaine.
ALcohousm. — The subject of this disorder shows greater evidence of mor bid change; the subjective and objective symptoms are more marked. There is distinct attraction for social pleasures, whereas the nareomaniac prefers soli tude.