“Perhaps one of the most valuable as well as wonderful properties of Coca is the facility with which it meets and extinguishes the craving for opium in the victims to that fearful habit. Professor Palmer, of the University of Louisville, Kentucky, has an article upon this subject in the Louisville Medical Journal, for 1880, and he therein narrates three cases in which he found the Coca a complete and easy substitute for the opium or morphine which had been habitually taken. One sufferer had been in the habit of taking thirty grains of morphine daily, and yet abandoned that drug wholly, and at once, and without the slightest difficulty, by resorting to the fluid extract of Coca whenever the craving attacked him.”

“Nor can this be considered simply an exchange of masters, since the uniform testimony of even those who have used Coca for a long time, and continuously, is that abstention from its employment is perfectly easy, and is not accompanied by any feelings of distress or uneasiness whatever.”

“The patient at first only used morphine, but his physicians committed the imprudence of treating him by hypodermic injection. A notable change for the better was produced during the first month, but, unfortunately, abuse succeeded promptly the use of the medicament – so much so that when I commenced to treat the patient, he was taking daily from 1 gramme 50 centigrammes to 1 gramme 80 centigrammes of morphine hypodermically. When he was four hours without his dose there appeared insomnia, hallucinations and delirium; constipation lasting sometimes for fifteen days, which brought on in the spring a very alarming perityphlitis, jerking of the muscles, sudden frights, dyspepsia, and at last frightful congestion of the face whenever he drank a drop of wine or brandy.”

“After a month’s treatment I had succeeded in reducing the daily doses without causing alarming symptoms; the physiological functions seemed to awaken again. However, the congestion and especially the dyspepsia was very grave, and the cough which had been suppressed by morphine returned. It was then that I treated my patient with phosphate of lime, the pate and the Vin Mariani. Lacking his habitual stimulant, he was plunged in a semi-coma from which he could not always be relieved with weaker daily doses of morphine.”

“Should there be minor discomfort, one-half-ounce doses of fld. ext. coca, every second hour, have a good effect. Cases occasionally require nothing else. If, however, as usually occurs, despite the coca, the characteristic restlessness sets in, we give full doses of fluid extract of cannabis indica, and repeat it every hour, second hour, or less often, as may be required. When the disquiet is not marked, this will control.”

“Having thus crossed the opiate Rubicon, treatment relates, largely, to the debility and insomnia. For the former, of internal tonic-stimulants, coca leads the list.”

“On the discovery of cocaine, it was thought its use, hypodermically, might prove of value in the treatment of this disorder, and, on asserted foreign authority, somewhat extravagant claims. Statements were made of its merit in this regard; but repeated trials by the writer have failed to prove them, and, in his opinion, it is much inferior to a reliable fluid extract of coca.”

From: “The Modern Treatment of Alcoholism and Drug Narcotism”
C.A. McBride, MD, New York 1910

Cocaine is an alkaloid obtained from the coca leaves. The leaves themselves have a very
stimulating effect upon those who use them. The Indians of South America are known to chew coca leaves in order to enable them to carry heavy burdens over long distances and to climb mountains without undue fatigue. When taken in this form, the habit does not seem to be contracted in the same way as when the alkaloid cocaine is taken by itself. We ourselves have tested its use in connection with our army in order to ascertain whether our men could stand a more fatiguing march by its use than otherwise. For some reason or another we have not heard any- thing further of its use in that direction.

Athletes at one time were accustomed to chew the leaves before entering upon some strenuous competition. To a great extent I believe that that has also dropped out of fashion, but it is said that in some of the recent Marathon races a well-known athlete used these leaves to sustain his strength during the contest. That he came in fresher than most of his competitors might be accounted for in this way.

There are several preparations upon the market containing an extract of the leaves and sold as tonics. The general public will be well advised to take none of these preparations without first consulting their doctor.

She possessed a delicate organization, with hysterical tendencies, enjoying, however, apparently good health before forming the habit, although her immediate friends supposed her to be consumptive. Seeing her sister take the drug, she would occasionally indulge, and being frail and easily influenced, soon formed the habit.

Patient No. 2 on coming under our observation, was consuming twelve grains of morphia per day. When she was fatigued by over-exertion, the dose was increased; the morphia supporting her during such emergencies, as the power to undergo physical endurance under its action is wonderful. While prostrating in the end, its direct effects are to sustain the system.

Our patient’s natural tendencies rendered her susceptible to the pestiferous effects of the poison, so that she early foil under its influence and was reduced to a skeleton. In appearance her skin was dark and jaundiced, indicating a degeneration of the nutritive constituents of the blood; the hair and nails ceased to grow, the latter becoming brittle, showing a suspension of their nutrition.

As is usual with opium eaters, anorexia and constipation aggravated her case. She had not menstruated since forming the habit, and had imagined herself to be with child for some months. During the tenth month of the practice, her family were horrified by her having a
hemorrhage, apparently from the lungs. It did not suggest itself to them that the habit was the exciting cause of the suppressed menses and its vicarious elimination from the system, by hemorrhage. Her strength failed progressively from this time, the hemorrhages recurring, with some degree of regularity, every three or four months. She was given up as irrevocably doomed to slow consumption, a weak, hacking cough giving color to the supposition.

We considered her case a desperate one and so informed her family. She insisted, however, upon being treated, if only that she might die free from the monster, opium.
In order to decrease her consumption of morphia slowly, we prescribed:

Cannabis Indica, 3 v.
Belladonna Tr ? vi.
Glycerine, ; xv.
Alcohol, § xx.

Salt Baths were ordered to be taken three times a week; the diet to include a liberal allowance of fruit and vegetables and a lemon or orange was ordered to be taken
before breakfast and on retiring. If the bowels in these cases do not respond to a fruit diet, it is necessary to facilitate their action every other day by an enema, consisting of one ounce of castor oil. As there was general poverty of the nerve centres in this case, we ordered syrup of bypophosphites, taken alternately every other week, with the following:

IJ. Iodide Lime, gr. x.
Phosphate Iron, 3 i-
Quinia, 3 i-
Lactopeptine, 3 ii-
Syrup simple, 3 v.

M. Sig. Teaspoonful at nine, three and nine o’clock.

During the subsequent forty days this patient’s improvement was phenomenal, and was accompanied by a ravenous appetite. She gained flesh at the rate of three pounds per week. Her bowels did not, however, relax, or show any disposition to regulate themselves, displaying an atonic condition, which it was absolutely necessary to overcome before a cure could be effected. On the thirty- fifth day of treatment she had a hemorrhage, more profuse than usual, succeeded by hemoptysis for three days.

The lime, iron and quinia were discontinued, and the following pill was given: —

r£. Ferri sul. gr. xv.
Colocynth, ext. gr. x.
Henbane, ext. gr. iv.
Leptandrin, gr. lii.
Podophyllin, gr. li.
Aloes, gr. iv.
Capsicum, gr. v.

M. Pills xxv. Sig. One pill after meals.

Some years previous to forming the habit, the patient had suffered dysmenorrhcea and leucorrhcea, receiving treatment at that time for ulceration of the os-uten An examination displayed a congested and thickened os with two or three cicatrixes, the results of former ulceration. On the seventieth day of treatment, she experienced for the first time expulsive pains, severe in character accompanied with backache and followed by leucorrhcea. Warm injections of castile soap water, preceded an injection of tea twice the strength of that commonly used at the table, and as warm as was consistent with comfort. The next morning we ordered the castile soap water repeated, using the following as a final vaginal injection.

5- Glycerine, iii.
Carbolic acid, 3 ii.
Camphor aqua, 3 i.
Aqua, 3 x.
This, in a measure, controlled the symptoms, but we were hastily called three days afterwards, and found the patient suffering general prostration. The bowels had not acted for three days, the movements excited by injections were unsatisfactory, giving no relief. Anorexia being complete, the sight or smell of food induced nausea.

With our present experience we would not pursue the course resorted to in her case, where the bowels were unrelaxed. As it was, the prescriptions Nos. 1 and 2 were stopped and baths ordered. Electricity was applied with sponges over the abdominal viscera and rectum, exciting a passage, which was, however, scant, and forced, and not sufficient to relieve the system. Calomel of the tenth trituration, with full doses of podophyllin, was administered during the evening. At four o’clock the following morning, we were called and informed by the messenger that our patient was dead, having breathed her last a few moments before. She was indeed dead to all appearances, being in hysterical catalepsy, with no appreciable action of the heart or respiratory muscles.

She had suffered greatly during the night, vomiting incessantly, with no action upon the part of the bowels. We administered, hypodermically, one-half grain of morphia, when a little cold water sprinkled in the face excited reflex centric spinal action and revived her.

This instance only confirmed the conviction that it is impossible to cure the opium habit, and bridge the patient over the crisis, without having the bowels freely relaxed.

The condition unmistakably indicates – and the indication should not be misinterpreted – a state of the nerves’ periphery, which affects the system at large by a reflex action, showing that nature is oppressed by some obstacle which precludes the possibility of an immediate cure. The indications are broadly presented, demanding that no further effort be made to reduce the dose. The patient should be put on the smallest amount of opium consistent with a quiescent state of the nerves, and means should be taken to build up the general health by the judicious administration of tonics, to excite deposits of nutritive principles that give tone and strength to the nervous system.

A rule, scrupulously to be observed, is not to allow the patient to advance into the crisis until the bowels have freely relaxed, involving the entire canal. The crisis is a condition following the withdrawal of the last infinitesimal amount of opium. In preparation for it, patients may be kept as near the verge as the physician wishes, and they will improve, it being only a question of time when their improvement will revivify theantonic nerves.

The activity of the nerves’ periphery, presiding over the abdominal viscery, will be a true criterion of their condition throughout the system and a signal for the treatment to be resumed in safety, with victory near at hand. Drastic cathartics will not facilitate the action of the bowels, as paralyzed nerves recognize no such master.

We kept our patient on a small quantity of opium, slowly reducing that amount every third day, allowing the system time to recuperate. We prescribed the following:

IJ. Morphia, 3 ii.
Alcohol, 5 v.
Glycerine, 3 vi.
Aqua, I vii

M. Sig. Teaspoonful after meals.

Bottle No. 2 contained :

B/. Cannabis Indica, 3 vi.
Belladonna Tr. § iii.
Alcohol, 3 iv.
Ginger Tr. 3 v.
Gentian comp. Tr. 3 vi.
Syrup Ferri Iodide, 3 iv.

M. sig. Every third day replace what is taken from

No. 1, with the above.

“We directed the patient’s husband to inform us at once when her bowels fully relaxed. Thirty-seven days afterwards our presence was requested ; we found her greatly improved in every respect, presenting quite a natural appearance, her bowels having relaxed the previous night, moving twelve times before morning, with accompanying expulsive pains and profuse vaginal secretions, her catamenia appearing for the first time in three years. The attendants kept the first large discharge for our inspection, as it excited their curiosity by its peculiarity of character. It consisted of a mass of black coagulated matter, thickly studded with fibrinous laminae, or flakes, emitting a putrid odor; also a mass of remarkably bard scybala, baving stamped on their surface the imprint of numerous crescentic folds from the columnar epithelium, showing that it must have remained impact in one spot for some time. The relief experienced by the patient was complete, although she was exhausted. Prescriptions Nos. 1 and 2 were stopped and the patient was given one grain of quinia every hour, with instructions to chew coca leaves, retaining the juice extracted, which enabled her to pass safely through the crisis, without suffering nervous irritability. Within five days she was doing housework.”