Monday, April 25, 2011

Coca for Treating Epilepsy?

Coca, Cocaine.—After all that has been written on the subject during the last few years, not much new can be expected in the 12 months just past. It has been asserted that the value of coca wine or extracts does not depend on the alkaloid alone. Nachtigall,12 for instance, insists that coca wine and "coca tobac," must be made from the leaves and not from a cocaine solution. This is a question outside of our province to determine, and we shall discuss the drug and its alkaloid together.

In diseases of the digestive tract, Eller57 recommends for toothache, absorbent cotton saturated with a solution of cocaine and morphia and allowed to dry. A pledget of this is to be introduced into the diseased tooth. Dailly50 also praises the action of cocaine hypodermically before the extraction of teeth, though severe constitutional symptoms may be produced in this way. Dujardin-BeaumetzTM recommends cocaine to facilitate lavage of the stomach. In gastric pain and vomiting it is also useful in tablespoonful doses of a solution of 1 part in 600, given every quarter of an hour until the patient is relieved. Frey*' has used | grain dissolved in water in a case of constant vomiting where other means had failed. Immediate relief followed for 2 hours; another dose stopped the vomiting for 6 hours, and after the third dose it entirely ceased. In gastric and intestinal catarrh, as a palliative in carcinoma ventriculi, and to dispel or prevent the sense of hunger, coca wine is highly recommended by Nachtigall.12 Perhaps the most important communication is that of Diederich's,58 who has employed the tincture (1 part of the leav es to 5 of alcohol) in 45 cases of diarrhoea in children, in doses 4—6 drops at 3 months of age, and up to 15-20 drops in older children every 2 hours. In all but 2 cases, the diarrhoea was promptly checked at latest after 48-70 hours.

For the diseases of the respiratory apparatus, cocaine has been previously recommended in pertussis, and its use here is again upheld by our Corresponding Editor, Dr. Gougenheim,''3 who paints the walls of the nasal fossa with it in solution; and bv Diederichs,58 who used the tincture of the leaves (1 part to 5) internally, and sometimes a cocaine solution locally to the pharynx with most satisfactory results. The last-mentioned writer has also given coca in bronchitis and in spasm of the glottis. Nachtigall12 employs cigarettes made of coca leaves in the treatment of asthma, and considers them preferable to those made of hyoscyamus or stramonium.

As a cardiac tonic the preparations of coca have frequently been recommended, and Lcyden has already declared the wine of coca to be a very useful agent in cardiac overstrain. Beverly Robinson4 has used it (Mariani's) on several occasions where digitalis proved useless or injurious, and considers it one of the best means to restore the heart muscle to its normal tone.

Under genito-urinary diseases, Dujardin-Beaumetz'"" relates a case of incontinence of urine in a young man of 17, cured by injections into the bladder of 0.5 grams of cocaine in 100 ccm. of water. Very little absorption takes place from the vesical mucous membrane, but it is necessary to assure ourselves that no dissolution in the continuity of the lining of the bladder is present, otherwise dangerous symptoms might follow.

For the treatment of burns, Eller67 has recommended to employ absorbent cotton saturated with cocaine and boric acid in glycerine. Wende13 uses it with lanoline as an ointment in burns and in itching cutaneous diseases. Finally, as a nervine, the coca tincture, and especially the coca cigarettes are recommended by Nachtigall12 in migraine; and Diederichs58 reports a few favorable results from the use of the tincture or extract of coca in epilepsy or chorea. The number is, however, too small to base any conclusions upon it.

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