THERAPEUTIC ACTION OF COCA.
Now that we understand the physiological properties of Coca and
Cocaine, we come to the study of the different morbid states in which
these substances may be usefully employed.
DISEASES OF THE MOUTH.
Gazeau advises the use of Coca for inflammations of the mouth and
gums. Pain is assuaged, ptyalism removed, and the inflammation itself
favorably influenced. He cites, in support of his opinion, the use
which the Peruvians make of it in affections of the mouth, and mentions
cases of mercurial stomatitis treated with this agent and cured in a
short time, in his practice.
Demarle[14], before him, expressed himself thus: "I have used Coca for
mercurial stomatitis. The affection disappeared on the third day of
treatment; nothing else had been administered."
In cases where the gums are soft, fungous, ulcerated, or bleeding, and
these changes depend on local or constitutional conditions, Coca is
equally indicated. Gazeau prefers it even to potassium chlorate.
According to Dr. Colombe[15], Coca is a potent factor in the treatment
of syphilis.[16] "It is demonstrated that potassium iodide and
potassium chlorate undergo double decomposition in the system, and thus
interfere with each other's action. Coca, substituted for the chlorate
under such circumstances, would not be open to the same objection. It
would find its application, therefore, when the mixed treatment is
found necessary."
DISEASES OF THE THROAT, PHARYNX AND THE LARYNX.
As regards the _anginæ_, the acute inflammations of the larynx and
pharynx, we might repeat what has been said about inflammations of the
mouth. In particular, the pain, so violent in certain _anginæ_, calls
for this method of treatment. The same is true of the dysphagia which
accompanies them.
Charles Fauvel first recognized the virtues of Coca in the tingling of
follicular _angina_ and the laryngeal pains of tuberculous subjects. In
those cases he specifies Mariani's extract of Coca leaves in preference
to solutions of Cocaine, which sometimes give rise to symptoms of
poisoning.
Dr. Rouquette[17] relates a case of tubercular laryngitis in which
symptoms of poisoning showed themselves as early as the third day; the
parts had been painted twice a day with a five-per-cent solution of
Cocaine.
Dr. Paul Legendre has quite recently mentioned anew the danger that
may result from a too free use of Cocaine[18]. The case was that of
an interne of the hospitals attacked with diphtheria who, in order
that he might the better bear the spraying with caustics, had his
throat painted with a solution of Cocaine. Toward the seventh day he
experienced very grave symptoms of poisoning, and the painting had to
be suspended.
It is better, in cases of this sort, to prescribe extract of Coca,
which answers the same purposes without the attendant danger of Cocaine.
One of the greatest triumphs of extract of Coca is assuredly its action
in dysphagia and in the vomiting of consumptives, as also in the
vomiting of pregnancy. The first two complications are of the gravest
kind, for they condemn to starvation patients whose only chance of
safety lies in the activity of the digestive organs (Ch. Fauvel and
Coupard).
DISEASES OF THE STOMACH.
Authors who have given attention to Coca speak very highly of its
employment in gastralgia and tardy and laborious digestion.
Demarle says on this subject: "Personally, I have found the use of
Coca, either before or after eating, excellent for gastrodynia and
pyrosis, to which I am subject; hardly have I swallowed the first bit
of saliva when the whole unpleasant feeling disappears."
Mantegazza speaks of its use in the same strain. The cephalic
congestion which accompanies his digestion is relieved; he can work
after eating without feeling any uneasiness.
Dr. Ch. Gazeau (_Thèse pour le Doctorat_, Paris, 1870, Parent, édit.,
pp. 61 _et seq._) thus sums up the physiological action of Coca: "On
the stomach, slight excitation, anæsthesia, and probably an increase
of the secretion of gastric juice; on the intestines, an increase of
the intestinal secretions, etc. These manifold physiological effects
upon the digestive tube unite in a specific action, so to speak, in the
numerous functional troubles, so varied and so ill-understood, of the
organs that compose it."
The same author cites a great number of cases of this sort in which
Coca "has never failed to exert an admirable action, often even
marvelous." And he concludes (page 65): "It seems to me useless to
bring forward more examples; these are enough to justify this positive
general conclusion: Coca is the remedy _par excellence_ for diseases of
the digestive tube."
Beugniès-Corbeau[19] prescribes it in chloro-anæmia, not only for
gastralgia, but for the frequent desire to eat which patients feel,
disappearing as soon as the first mouthful has been taken, only to
return a little while afterward.
Prof. O. Réveil ends his article on Coca as follows: "Much remains to
be done in the physiological and clinical study of Coca; it is known
that it acts on the motor and sensory nervous system. This substance is
destined some day to take an important rank in therapeutics."
In irritability and various affections of the cerebral centers, Dr. J.
Leonard Corning makes use of Coca, which he prefers to the bromides.
In a very remarkable essay on _Erythroxylon Coca_, published at
Ixelles, in 1885, a perusal of which we urge upon all who are
interested in the study of Coca, Dr. A. Feigneau says (page 61):
"There can be no mistake that, to a certain extent, Coca stimulates the
cerebra-spinal activity by suspending or retarding the destruction of
tissue in the economy, and that its action may modify the functions of
the nervous centers, provided there are no such contra-indications to
its use as active congestion, inflammation, or organic changes in these
organs."
"Consequently it would be indicated under all circumstances where a
nervous affection seemed to depend upon a state of ataxia."
"In irritations of the spinal cord, in mental aberration accompanied by
melancholia, as well as against idiopathic convulsions (Mantegazza) and
nervous paraplegia."
Dr. Beverley Robinson considers the Vin Mariani as a cardiac tonic[20]:
"On several occasions, when digitalis has proved to be useless
or injurious, I have had very excellent results from caffeine or
convallaria. Certainly, the latter drug is more easily tolerated by a
sensitive stomach than digitalis is; and whenever the nervous supply
of the heart is especially implicated, I believe that I secure more
quieting effects from its employment. Among well known cardiac tonics
and stimulants for obtaining temporary good effects, at least, I know
of no drug quite equal to Coca. Given in the form of wine or fluid
extract, it does much, at times, to restore the heart-muscle to its
former tone. I have obtained the best effects from the use of Mariani's
wine. From personal information given me by this reliable pharmacist,
these results are attributable to the excellent quality of the Coca
leaves and of the wine which he uses in its manufacture."
In cases of morphinomania, Dr. Dujardin-Beaumetz has pointed out the
advantage to be obtained with the Vin Mariani, and, following him, Dr.
Palmer, of Louisville, and Dr. Sigmaux Treux, of Vienna, have obtained
excellent results with this therapeutic agent. Further on, we give a
case of Dr. Villeneuve's, showing the cure of a morphinomaniac by the
combined use of the Vin and the Pâte (Mariani).
Dr. H. Libermann recommends the use of Coca, in the form of Vin
Mariani, against morphinomania, nicotinism and alcoholism.
"In _general diseases_ it is to the stimulating properties of the plant
that recourse is oftenest had. These properties make it the tonic _par
excellence_ whenever the object is to build up a system that has been
enfeebled from any cause. Its preparations, accordingly, may be ordered
in convalescence from all grave fevers, in anæmia and chloro-anæmia,
in all diathetic or cachætic conditions, whatever may have been their
original cause (chronic rheumatism, gout, genito-urinary affection,
cancer, etc.), in short, in all cases where the system is debilitated
from any cause whatever."
But it is, above all, in diseases that have a depressing action on the
nervous system that the effect of Coca is truly marvelous. Gubler, in
his _Commentaires de thérapeutique_, shows himself its warm champion.
"Coca," says he, "very much like tea and coffee, lends to the nervous
system the force with which it is charged, after the manner of a
fulminate, but with this difference, that it yields it gradually and
not all at once."
The theory of the _fulminates_, invented by M. Gubler, tallies so well
with observed facts, that Mantegazza, without generalizing and without
pretending to form a theory, but limiting himself to describing by
simile what he had seen, truer probably than he himself supposed, said:
"Under the influence of Coca, it seems that a new force is gradually
introduced into our organism, like water into a sponge." (A. Dechambre.)
This opinion has been corroborated by all authors who have given
attention to the question, and it may be looked upon as one of the
least contestible in therapeutics.
We will add, what is quite important, that as a tonic Coca has been
found far superior to cinchona, iron, strychnine, etc. Everybody knows
their astringent action, which makes them give rise to such obstinate
constipation that there are patients in whom it is often necessary
to suspend their use. There is no such objection to Coca; it never
constipates, and practically its use may be continued indefinitely.
[Illustration: COCA LEAVES.
(Branch in natural state.)]
[Illustration]