Thursday, December 25, 2008

William Tibbles on Coca and Tobacco, cocaine and nicotine

Dietetics and Hygiene Treatment


(excerpt- pp 266-268)

Coca, the leaves of Erythroxyloii coca, N.O. Erythroxylaceae.

A South American plant, grown largely on the Andes of Bolivia and Peru. The annual consumption in South America is said to exceed 100,000,000 pounds. It has been an incal-culable blessing to the natives in all ages. Its physiological action places it in the same category as tea and coffee, but its efiects are more strongly marked. Its power of preventing fatigue or of removing it has been well established.

Sir E. Christison made many experiments with it. He found during great exertion that fatigue was lessened and hunger and thirst prevented by it, and the mental faculties were liberated from the dulness and drowsiness which follow great bodily activity ; that the waste of the tissues was lessened by its use, although it did not diminish perspiration, nor were the digestive functions impaired by its use. The South American usually consumes coca by chewing it with a trace of lime or chalk. Its effects are those of a stimulant and restorative ; while quickening the heart and respiration, it prevents muscular and nervous exhaustion and diminishes the consumption of the bodily tissues, and enables a person to bear up against bodily fatigue with less food than usual, or even without any. It enables persons to climb high mountains without the difficulty of breathing customary in ascending from a low to a higher plane. The mental faculties are, however, said to be less stimulated by coca than by tea or coffee.

Composition. — Coca-leaves contain 02 per cent, of cocaine (C^-HgjNO^), an alkaloid occurring in colourless monoclinic prisms, having a bitter taste, which is followed by a tingling sensation and numbness ; secondary alkaloids are ecgonine and Iso-atropyl cocaine ; it also contains hygrin, which gives aromatic properties to the leaf, together with coca-tannin and coca wax."

The physiological effects of coca are due to the alkaloids, and are analogous to those of tea and coffee. It may therefore be used in the form of an infusion, wine, or elixir, as a general stimulant to diminish or remove the exhaustion due to muscular exertion and mental fatigue from overwork, worry or trouble, and in convalescence, nerve exhaustion, neurasthenia, nervous and muscular debility ; it may also be usefully employed in cases of insomnia, in gastric and intestinal indigestion, in which food is not properly assimilated, in cachectic conditions due to many diseases and blood poisons, and to combat the effects of opium and alcohol.

As in the use of other stimulants, a habit may be formed which is comparable in its results with the worst moral effects of opium-eating, morphinism, or alcoholism; but these cases are rare, except when cocaine is taken hypodermically for long periods and in excessive doses. Even chewing the leaf in excess will bring on various disorders, and the desire for it increases to such an extent with indulgence that a confirmed coca chewer is said to be never cured.

Of the alkaloids, iso-atropyl cocaine is a powerful heart poison, and cocaine will in time not only benumb the cerebral faculties, but reduce the subject to a state of complete mental imbecility, unable alike to perform his professional or social duties, and more or less unfitted for the companionship of his fellows. It is a good servant, but a bad master ! The increasing use of cocaine in the treatment of disease points to the necessity for care in prescribing it. ' A delicious beatitude' follows its application for hay-fever and other diseases, which has a tendency to make the patient a slave to the habit. Symptoms due to the habit usually begin with disorders of digestion, as loss of appetite and emaciation. But its chief pathological effect is, as indicated, upon the nervous system, in which some form of degeneration takes place which induces insomnia, tremors, incoordination ; even convulsions, paralysis, hallucinations or delusions, and delirium or insanity, may follow. It behooves all medical men to be extremely careful how and for whom they prescribe it, and to take especial care that the patient does not have a free hand in its use.

An agreeable coca essence or cordial may be made like an ordinary tincture by macerating 2 ounces of the leaves in 1 pint of proof spirit, with the addition of ginger, cloves, allspice, or other aromatics ; two teaspoonfuls added to a tumblerful of warm sweetened water makes a good beverage for all times of the year.

Coca wine may be made thus : Soak 4 ounces of ground coca- leaves in 16 ounces of hot water for three hours ; then add 64 ounces of port wine ; percolate 56 ounces ; and in it dissolve the sugar, add 6 ounces of alcohol, strain, and make up to 64 ounces with port wine. Each ounce represents 30 grains of leaves.


On Tobacco
(excerpt pp 271 - 278)

Tobacco {Nicotiana tabacum, N.O. Solanaceae). According to modern statistics, the average consumption of tobacco per annum by each inhabitant is as follows :

Netherlands, 3,400 grammes ; United States, 2,110; Belgium, 1,552 ; Germany, 1,485; Australia, 1,400; Austria and Hungary, 1,350; Norway, 1,335; Denmark, 1,125 ; Canada, 1,050 ; Sweden, 940 ; France, 933 ; Eussia, 910 ; Portugal, 850 ; England, 680 ; Italy, 635 ; Switzerland, 610 ; and Spain, 550 {Medical Becord, December 21, 1901).

Tobacco is a poison in every form in which it is used ; but use inures the individual to its effects, as it does to those of opium and other narcotics. The active principle is nicotine (Cj^H^^Np^), an acrid, oily, volatile liquid, of pale amber colour, smelling strongly of tobacco ; it can be resolved into nicotina, an alkaloid in the form of malates and citrates ; and nicotianine, or tobacco camphor, which is a concrete volatile oil. There are other principles besides nicotine in tobacco. Pictet and Eotschy4*5 extracted from 10 kilos of crude tobacco juice 1,000 grammes of nicotine, 20 grammes of nicoteine, 5 grammes of nicotinine, and 1 gramme of nicotelline, from which it is evident that nicotine is the principal agent, although the others probably have deleterious effects or become decomposed into secondary substances.

The proportion of nicotine varies according to place of growth, soil, and other circumstances. French tobacco contains as much as 7 or 8 per cent., Kentucky and Virginia 6 or 7, Havanna not more than 2 per cent. Sinnbold's analyses give the following results : European cigars contain 0-648 to 2-967 per cent, of nicotine ; Havanna cigars, 0-841 to 2-241 ; cigarette tobacco, 0-80 L to 2-887 ; and pipe tobacco, 0-518 to 1-584.-

"The physiological effects of tobacco are — (a) short stimulation of the central nervous system, followed by depression ; (b) similar stimulation of the sympathetic nerves, followed by a lasting paralysis ; (c) an action, like that of curare, on the terminal nerve-plates of the motor nerves in the muscles, also followed by paralysis. The heart is at first slowed and its contraction prolonged ; the blood-pressure is raised by constriction of the arterioles, due to excitation of the vaso-motor centres in the peripheral ganglia ; at a certain stage, however, this system is paralyzed and the blood-pressure is no longer affected by it ; motor paralysis is induced by its action on the intramuscular part of the nerves.' Other effects are trembling, giddiness, head-ache, salivation, contraction of the pupils, convulsions, paralysis, etc. That nicotine, the oily fluid containing the two alkaloids, is a powerful poison cannot be denied. The active principle in the smoke of a single cigar suffices to produce convulsions, paralysis, and death in a frog.

A drop of nicotine near the beak of a canary will kill it; two drops on the tongue will kill a terrier dog in a minute; two drops on the tongue of a cat caused convulsions and death in two minutes; and a mastiff dog was destroyed in five minutes by the application of ten drops in the same manner.

Death was always preceded in cases seen by the author by convulsions of a tonic character, and rigor mortis set in at once. In man, death has followed the injudicious application of a quid of tobacco to stop the bleeding of a wound ; the application of nicotine on the point of a needle to a decayed tooth caused serious collapse, and the use of an infusion of tobacco as an external application in skin diseases, and an injection into the bowels for intestinal obstruction, have caused death ; on the other hand, recovery is recorded after the injection of an infusion made from half an ounce of snuff and an infusion made from five tobacco-leaves.

The symptoms of acute nicotine-poisoning are observed when a person smokes a pipe or cigar for the first time ; there is confusion of the mind, giddiness, nausea, vomiting or purging, trembling of the limbs, faintness, feeble pulse, and a cold clammy sweat, which are the signs of shock or collapse as the result of a profound impression on the nervous and muscular systems. These symptoms have been observed in a man who was induced to chew a piece of ' twist tobacco ' to relieve him of toothache. When the dose is a large one, the breathing becomes difficult, the vision
dim, and convulsions occur ; death, preceded by more or less paralysis, may take place in fifteen to thirty minutes from tobacco, or in three or four minutes from the use of nicotine.

By custom most people become inured to the influence of nicotine in tobacco smoking, snuffing, or chewing. The moderate use of tobacco has a soothing and beneficial effect upon the nervous system of the man of business;' it soothes and cheers the weary toiler and solaces the overworked brain'; that it has a stimulating effect upon the cerebral functions can scarcely be conceded, although it temporarily increases the flow of blood through the cerebral arteries and may thereby spur a weary brain, and by the free supply of oxygen and food assist that organ in its work.
Many men of great intellect have been large smokers. In like manner, the after dinner pipe or cigar aids digestion by increasing gastric secretion and peristalsis, and has a hygienic effect in stimulating the corresponding intestinal movements.

The effects of excessive use of tobacco, or chronic nicotine-poisoning, are best understood by reference to its physiological action. The most immediate effect of tobacco or nicotine in any form is to make the heart beat slower, but more powerfully ; this is followed by an acceleration of the heart's pulsations by 30 to 50 per cent., due to the influence of nicotine upon the cardiac branches of the pneumogastric nerve.

Nicotine suppresses or paralyzes the inhibitory fibres of that nerve, and there is consequently an acceleration of the action of the heart. It also paralyzes the sympathetic ganglia and prevents the passage of impulses through them, and consequently the vasomotor nerves are paralyzed. Interference with the functions of the vasomotor nerves, especially those in the abdomen, causes dilatation of the arterial system and lowering of the blood-pressure. The vertigo, dizziness, and trembling are, in the first instance, a consequence of diminished supply of blood to the brain, and later of the toxic effects of nicotine on the nerve cells. The effect of a pipe of tobacco on the stomach is chiefly due to its influence upon the nerves ; the inhibitory fibres of the vagus being suppressed, the gastric mucous membrane becomes flushed with blood owing to vascular dilatation, the secretion of the gastric juice takes place with greater rapidity, and the peristaltic movements are accelerated ; intestinal movement and secretion are likewise increased. But excessive and long continued use of tobacco causes the gastric and intestinal secretions to be diminished and the peristaltic movements to be slower and feebler ; it enfeebles the nerves of the ganglionic system, secretion and movement are slower, the mucous membrane of the mouth and throat gets dry, the throat inflamed, thirst becomes great, appetite fails, dyspepsia or gastric catarrh appears, and nutrition is impeded.

Nicotine is a cardio-vascular poison acting through the nerves upon the muscular tissue. The influence of excessive smoking on the heart consists of an increase of the excitability of that organ ; the pulse becomes intermittent and irregular, periods of acceleration are followed by enfeeblement of its action. In some cases it causes abnormal quickening or tachycardia ; in others, abnormal slowing or bradycardia. Functional derangements of the heart and digestive organs are common results, and organic changes sometimes occur in the nervous system where it influences the
circulation unfavorably and leads to degeneration and paralysis of nerve cells.

One of the effects of chronic tobacco poisoning is shown by anemia of the brain, resulting in dizziness and vertigo on rising from a bed or chair, and enfeeblement of memory and power of concentration of thought. Further deleterious effects on nerve tissue are shown by general nervous debility ; by tachycardia, as the result of paralysis of the vagus, or bradycardia, from degeneration or paralysis of the ganglia; by defects of vision, as amblyopia or amaurosis and paralysis of the portio dura, which are due to the exhibition of small doses of the poison frequently absorbed and acting over a lengthened period.

Much discussion has taken place as to what produces the harmful effects of smoking tobacco. Some writers assert that nicotine does not, and others that it does, exist in the smoke; that pyridine and other products of its decomposition during combustion produce the injury. Pontag gives the following composition of tobacco smoke : Hydrocyanic acid, 0'080 per cent. ; pyridine, 0'146 ; nicotine, 1-165 ; ammonia, 0'360 ; carbon monoxide, 410 c.c. from 100 grammes of tobacco. Thorns says tobacco smoke contains nicotine and its decomposition products, pyridine and its homologues, and a peculiar ethereal oil only produced during the combustion of the tobacco.

He states that this oil causes violent headache, trembling, and giddiness, and he attributes the toxic effects of tobacco to it, since it is known that they do not depend altogether on nicotine. The quantity of carbon monoxide is too small to have any effect on the health. Brunton states that pyridine acts chiefly on the sensory nerves ; that small doses stimulate, but large ones have a paralyzing effect on, the heart muscle.' Nicotianine, the so-called tobacco camphor, is a mixture of nicotine valerianate, camphorate, oxy-camphorate, and pyridyl-carbonate; and nicotine-pyridyl-carbonate is the most highly toxic principle of tobacco, the other salts chiefly imparting fragrant characters to it. The influence of the frequent inhalation of carbon monoxide upon the blood, which is ordinarily injurious, should not be overlooked ; but Wahl says it is so highly diluted that it may be breathed for four hours without ill results. Arsenic is known to exist in some kinds of tobacco, and being volatile can be detected in the smoke, and may have an injurious effect upon the smoker. Smoking a pipe is healthier than cigars or cigarettes ; some of the carbon adheres to the pipe and forms a cake which absorbs a portion of the nicotine, and a plug of ashes and tobacco at the bottom of the bowl adds to the absorbent power. An oleaginous extract containing nicotine is deposited along the tube. The longer the pipe the less nicotine will there be in the smoke, and it has the advantage of being cooler and consequently less irritating to the mouth and throat. A hookah, with its bowl of rose-water through which the smoke is drawn, is as much superior to a pipe as the latter is to a cigar or cigarette. The pipe-smoker gets only half of the nicotine originally in the tobacco, while that in the smoke is only in contact with the mouth a short space of time. On the other hand, when smoking a cigar, the leaf is held constantly in the mouth, an infusion of tobacco is formed, and a considerable portion of the nicotine may be swallowed. In cigarette-smoking there is the additional temptation to inhale the smoke, which increases its injurious effects.

There can be no doubt whatever that the moderate consumption of tobacco, two or three pipes a day, is not injurious to the majority of smokers ; that it acts as a powerful sedative, soothing the brain and assisting in the concentration of thought ; that the after-dinner pipe aids digestion and the action of the bowels and kidneys ; but it adds no potential strength to the body, is not a food, does not spare the tissues, and its action is destructive rather than constructive. In excess, its influence upon the digestive organs, heart, brain, and nerves, indicate its powerful deleterious effects. Very many people have no idea that tobacco is capable of producing ill effects; in others a habit of excessive smoking is formed which is most diflicult to break. It is advisable never to form such a habit; in all cases the lightest and mildest tobaccos are the best, and a limit of 2 ounces per week is a moderate allowance, beyond which it is not safe to indulge. The anti-smoker tells of cases of sudden heart failure, loss of memory, dwarfed growth, and early death attributed to smoking. Ardent smokers point to the hale and hearty old man who has smoked for fifty or sixty years, and attributes his health and longevity to it. Both have arguments in their favour ; but the anti-smoker is prone to exaggerate, and the hearty old man does little justice to his sound constitution when he attributes his health and longevity to it. A well-known tobacco manufacturer says that tobacco is injurious in nine cases out often ; but this he attributes to the large consumption of inferior kinds of tobacco, and he states that sufficent attention is not paid to the growth and blending of the leaf, to the soil on which it is grown, nor to the paper of which cigarettes are made. The best tobaccos are grown on virgin soil ; the best cigarettes made with pure rice-paper. Many inferior tobaccos are used by mixing them with a better class of leaves ; the color is little to go by, as some leaves are blanched, others darkened by chemicals or colouring agents. Tobacco Leaf, which is a trade journal, says too much attention should not be paid to the outside of a cigar ; a light-coloured cigar is not necessarily a mild one, nor a dark-coloured one a strong cigar ; avoid greasy or streaky leaves, which contain an excess of nicotine, and pale yelloio ones, which contain too little and are flavourless ; unripe tobacco leaves are nauseous to the taste and have greenish blotches. Tobacco is neither better nor worse for being spotted. The ash should always be white or gray, never black or uneven. Good tobacco burns freely until it reaches the mid-rib or vein across a leaf, will never scorch or blister ; it is an infallible proof of a had cigar, made from inferior tobacco, if it shows a black rim or blister near the ash or if it goes out as soon as the light is withdrawn. Take off the outside cover of a cigar and apply a light to it ; in a good cigar it will burn, but in a bad cigar made of inferior tobacco it will not take fire.

When one considers the enormous growth of the cigarette trade, and the almost incalculable number of cigarettes consumed annually, the consideration of their use becomes an important sanitary question. One has only to observe the pale face, the marble brow, the haggard and dwarfed appearance of boys who indulge the habit freely to conclude that cigarette smoking is decidedly injurious.

This is, to some extent, due to the inferior tobacco from which so many of them are made; the commonest of tobaccos, frequently chemically treated and mingled with tobacco dust, are rolled in impure papers to make cheap cigarettes. The evil effects of cigarette-smoking are greatly enhanced by inhaling the smoke ; that it really is inhaled is proved by the fact that very little smoke is exhaled. The fact that the smoke of a cigarette is not very irritating does not lessen the evil effect of drawing it into the lungs, for by this method the absorption of the poisonous principles is more rapid. Some absorption takes place in the mouth, but it is trilling in comparison with that which takes place in the lungs. It is admitted that moderate smoking allays restlessness and irritability and is beneficial in other respects ; but the sequel to the habit of inhalation may be very bad indeed, the heart and nerves bearing chiefly the effects of it. The fumes likewise appear to create an unnatural desire to be always smoking cigarettes, and those who indulgethe habit generally consume more tobacco than they would by smoking a pipe, and the consumption is greater than is necessary for the ordinary enjoyment to be obtained from smoking. The habit should therefore be discountenanced by all medical men and others who have the interest of the human race at heart. Repressive measures are required to stop the practice of cigarette smoking by children, for it is firmly believed that it prevents growth and renders its devotees a ready prey to disease. It notonly makes them tired, lazy, and irritable, but it lowers their mental capacity and moral tone, makes them stupid, dull and weak, and prone to lying and cheating. Attempts are being made in America, Canada, Prince Edward's Island, and Norway, to suppress the habit by law ; in some places it is a misdemeanor to sell or give cigarettes to a minor, and in others it is unlawful for a minor to smoke tobacco in any form.
William Tibbles, a British physician, was author of Erythroxylon Coca: A Treatise on Brain Exhaustion as the Cause of Disease, (1877), which recommended the use of coca for a variety of physical and mental diseases.

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