Salts of cocaine are precipitated from solu tion by numerous reagents, among which are ammonia, caustic potash, sodium carbonate, picric acid, tannic acid, gold trichloride and platinum tetrachloride. Cocaine when taken internally is a cerebral stimulant, and moderate doses usually cause a pleasant sense of exhilara tion and temporary increase in mental and physical power, though accompanied by a more or less complete loss of moral sensibility. This condition is followed by a corresponding period of depression. The sense of hunger and fatigue is lessened so that privations may for the time being be better endured under the influence of the drug. Moderate doses powerfully stimu late respiration, and, to a less degree, the heart and circulation. The body temperature is not affected by small amounts, but in overdose it may be elevated several degrees. The drug is to a large extent oxidized in the body, though small amounts may be excreted by the kidneys It is alleged that the quantity of nitrogenous material eliminated in the urine is decreased, indicating a reduction in tissue waste, but this has not yet been clearly proved. In poisonous doses cocaine produces narcosis— sometimes with epileptiform convulsions—with depres sion, followed by paralysis, of die sensory nerves and to a less degree of the motor nerves. The symptoms of poisoning vary greatly in dif ferent individuals. Moderately toxic amounts may give rise to disagreeable mental excitement and unrest, nausea, faintness, pallor, cold per spiration and prostration, or to a sense of mal aise and depression. Large doses cause rapid respiration, feeble and accelerated heart action, dilated pupils, headache, dryness of the throat and muscular twitchings. General convulsions may supervene —or collapse occurs, the sldn is and cold, the blood pressure falls through great cardiac depression, respiration be comes slow and shallow and death occurs through failure of this function. The treatment of poisoning includes the evacuation of the stomach if the drug has been taken by inouth, and the use of stimulants such as ammonia, coffee, strychnine, ether or alcohol. If con vulsions are present these must be combatted by the inhalation of small amounts of ether or chloroform and the cautious administration of sedatives. Morphine is said to be the best physiological antidote. Cocaine is used inter nally to some extent as a stimulant in certain febrile and mental conditions, as well as on account of its topical action in gastric disorders or in obstinate vomiting, but its most important field of utility is the production of local anzthesia in minor surgery. When applied ex ternally in proper strength it produces a loss of sensation, particularly to pain and touch, through paralysis of the terminations of the sensory nerves. Applied to the eye it causes anmsthesia, contraction of the blood vessels, re duction of intraocular tension and dilation of the pupil, but the reflex to light is not lost and there is little or no paralysis of accommodation. Brought into contact with the tongue it destroys the sense of taste for bitter substances, though salt may still be recognized and sweet and sour fluids do not entirely lose their flavor. The sense of smell may be entirely abolished by the application of cocaine to the mucous mem brane of the nose, but it is not absorbed from the unbroken skin. When injected under the skin or applied to mucous membranes a feeling of numbness is produced and incisions or other painful manipulations may be practised on the part so. treated without giving rise to discom fort. For this purpose solutions varying in strength from 2 to 10 per cent are usually employed.
The applicability of local anmsthesia has been greatly extended by means of what is called nerve blocking. It has been found that on the injection of a small amount of a weak solution of cocaine into the trunk of the main nerve supplying a part, sensation is cut off in that region and painless operating is possible. A plan which enables extensive areas to be anws thetized with but small amounts of the drug is called Schleich's infiltration method. For this purpose a very weak solution of cocaine, mor phine and sodium chloride is injected into the tissues until considerable local swelling or edema is caused. In this way the effect of pressure on the local nerve filaments and the local anzmia combine to aid the action of the very small amounts of the alkaloids.
A very great advance was made when it was found that it was practicable to produce anaesthesia embracing almost the entire body by injecting cocaine solutions into the spinal cord by means of a long hypodermic needle usually inserted between the fourth and fifth lumbar vertebrm. Anaesthesia of the legs and
trunk about as high as the breasts is produced within 15 minutes and lasts from two to five hours. For this purpose as for use in other ways small quantities of adrenalin are often added to the cocaine solution with the idea of neutralizing some of its undesirable quali ties. Spinal anmsthesia, however, is not alto gether without dangers or drawbacks, and will probably never be used as a routine procedure.
Owing to the more or less serious dis advantages of cocaine, particularly its tendency to produce grave poisoning in some persons even when in small doses, and also because of the difficulty of sterilizing its solutions without impairing their virtue, substitutes have been sought by the synthetic chemists, and with much success. By various combinations with the groupings in atropine, to which cocaine is closely allied chemically, there have been de veloped eucaine-B, or beta-eucaine, nirvanine, novocaine, holocaine, stovaine and alypine. These all produce, when administered in suffi cient quantity, a slowing down and diminution in the extent of the respiration and a fall in blood pressure. Use is also made of tropacocaine, an alkaloid found in the Java coca leaves. It is less toxic, though quite as effective in local anmsthesia, as cocaine. The relative toxicity of these substances as compared with cocaine is approximately : cocaine, 100; alypine, 90; holo caine, 60; stovaine, 55; tropacocaine, 50; beta eucaine, 40; nirvanine, 30; novocaine, 30.
Cocaine is sometimes used in the treatment of the morphine habit, not infrequently with the result that the victim only exchanges one form of bondage for another no less pernicious. Many persons innocently acquire the cocaine addiction through the use of various nostrums in the form of snuff or snuffing liquids, os tensibly intended for the cure of nasal catarrh, hay fever, etc. The temporary alleviation of his symptoms produced by the compound induces the sufferer to continue its use until he is fairiy in the grip of a servitude leading to certain de struction unless its fetters are cast off by the exercise of almost superhuman fortitude. The cocaine habitué has to suffer from necrosis of the nasal cartilages, progressive loss of flesh and strength, digestive and circulatory disorders, trembling of the limbs, insomnia, headache, vertigo, etc. Hallucinations and even outbreaks of maniacal fury are not unusual and there is complete decadence of the mental and moral qualities. The cocaine fiend respects no con vention or obligation, and will lie steal or use any other base means to gratify his passion for the drug, lost to all considerations of duty or social position.
In the endeavor to check the ravages of cocaine and other habit-forming drugs several of the States have passed laws more or less stringent. The Federal government has also aided to some extent with the so-called rison bill,)) requiring the registration of all per sons who sell or administer the drug, and these persons are required to record all sales. This law went into effect on 1 March 1915, and affected ((every person producing, importing, manufac turing, compounding, dealing in, dispensing, selling, distributing, or giving away coca leaves or any derivative or preparation therefrom? During the first three months of the fiscal year ending 30 June 1916, the registry showed 167 importers, 567 manufacturers, 1,106 wholesale dealers, 47,156 retail dealers, 36,504 dentists, 123,734 physicians and surgeons, besides 10,726 veterinarians. The records of the bureau of foreign and domestic commerce show that in the fiscal year ended 30 June 1915 there were brought into the United States 1,048,312 pounds of dry coca leaves, and 179 ounces of cocaine, ecgonine and their derivatives — the equivalent of 218,000 ounces of cocaine. According to the United States Pharmacopeia of 1900 the aver age dose of cocaine is said to be 30 milligrams, or one-half grain, but deaths have been recorded from amounts not much larger than this. On the other hand recovery has been observed in cases in which 20 grains and more of the drug had been taken by mouth. See DRUG HABIT.
Bibliography.— Knapp, H., and Its Use in Ophthalmic and General Surgery' (New York 1885) ; Mariani, A., and Its Therapeutic Application' (New York 1891) ; Mortimer, W. G., (Peru: History of Coca' (New York 1901) • Wharton, F., and Stille, A., (Medical Jurisprudence' (Philadelphia 1882) ; Wood, H. C., (Philadelphia 1891).