One of the friends of this blog has an illness that this person, out of a personal sense of privacy and reserve, doesn’t ever identify in her blog, but which I have reason to believe is Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). After reading the Twitter feed from one of her recent messages I discovered that a lot of her interactions were with bloggers who had this terrible condition, which I was not previously aware of. (Twitter is such a gossip!) I will respect her privacy completely, but after reading about this disease I am moved to make this post.

Reading the commentary on ME/CFS set me thinking how many times in the Coca Leaf source literature from the 18^th-19^th centuries the beneficial effects of Coca Leaf on fatigue is mentioned. Not just in terms of Incas being able to carry heavy loads over the Andes with little food or water, and not just in terms of re-invigorating people after strenuous exercise.

These source materials talk of the wide-ranging effects of Coca Leaf on blood, nervous system, muscle, digestion, and brain function – and this made me think. Why aren’t the multitudes of caring, dedicated scientists and physicians who are researching ME/CFS investigating the possibility the something as simple as Coca Leaf tea might – just possibly – make a difference for the people who, currently, have so little hope of successful treatment?

Of course the answer is – because Coca Leaf has been effectively excluded from consciousness by a calculated conspiracy extending over decades, and it would never enter the minds of even these dedicated healers to ever consider for a brief moment that Coca Leaf might hold at least a small key to amelioration of this terrible source of suffering and death.

If you, as I was, are unaware of the scope of this problem there is a widely recommended Canadian document that you can read to inform yourself: Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Clinical Case Definition and Guidelines for Medical Practitioners.

This is a disease that affects a huge number of people, according to this document:  “Epidemiological studies indicate a wide range of prevalence. However, in a large American sample of more than 28,000 adults, 422 per 100,000 had ME/CFS, suggesting that between 125,000 and 150,000 adult Canadians suffer from ME/CFS. (This also translates to 1,266,000 people in the US.) It is more prevalent than lung cancer and AIDS. This illness affects all age groups, including children, all racial/ethnic groups, and all socioeconomic strata. There is a higher prevalence in females.” I would challenge you to reflect on how many of the diagnostic criteria for ME/CFS,  shown below, a disease that was unknown in the 18th and 19th centuries, are nevertheless remarkably similar to the conditions that physicians in those times treated successfully with simple Coca Leaf preparations. This isn’t to say that Coca Leaf is the answer here – but there are enough such ‘coincidences’ to surely merit investigation.

So, with that said, let me present just a small sampling of the findings of the physicians of the 18^th-19^th centuries regarding Coca Leaf and Fatigue – deadly fatigue in the case of ME/CFS. A search of my collection of these writings in “The Coca Leaf Papers” reveals hundreds of similar observations. 

Coca Leaf & Healthy Blood Circulation

History Of Coca, Dr. Mortimer – Chapter 8

As has been shown, fatigue and its ills are occasioned by a diminution of the elements necessary to activity as well as to an excess of waste materials in the blood. This latter cause alone explains many problems dependent upon this condition which are commonly assigned to other causes. Under this hypothesis it is easy to appreciate not only the cause of muscle fatigue, but the irritability from nerve tiredness as well as the restlessness in wasting disease. When the tissues are not supplied with a blood stream that is pure and uncontaminated they cannot respond healthfully. A blood current already overburdened with waste can neither stimulate to activity nor carry off the burden of excreta.

The power of Coca to relieve the circulation, and so bring about a condition indicating a free blood stream, has been emphasized by a host of observers. Speaking of the action of but one of its alkaloids, Dr. Haig says: “Some have asserted that it is oblivion men seek for when they take opium, cocaine, etc., I believe this to be a great error. Give me an eternity of oblivion and I would exchange it for one hour with my cerebral circulation quite free from uric acid, and opium or cocaine will free it for me. When the blood stream is free the pulse tension is reduced, the rate is quickened, and the increased flow alters the mental condition as if by magic; ideas flash through the brain; everything is remembered.”

Hitherto the usual explanation that has been advanced as to the influence of Coca – when any influence has been accorded – has been its stimulant action upon the nerves. In view of the facts set forth in this research such a theory seems inadequate. I have endeavored to show by a succession of facts and many examples, that the sustaining influence of Coca in fatigue, as well as its curative power in so many diseased conditions, as to render it a seeming panacea, is largely due to a direct action upon the cells of the tissues, as well as through the property which Coca has of freeing the blood from waste. This influence may chiefly be upon the brain or upon the muscular structure, in accordance with the relative  proportion of the associate principles present in the Coca leaf employed. Under this hypothesis, based upon physiological research as well as upon the theory of the formation of proteid in plants and in animals. Coca not only stimulates the cells to activity and so sets free energy, but may build up new tissue through exciting the protoplasm to appropriate conversion. Such an hypothesis is certainly plausible when we consider the action of amides and other nitrogenous elements in plant structure. This is again emphasized by its harmony with recent theories of Pflüger regarding the building up of proteid tissue in the animal organism. So much testimony points to this conclusion that in the entire absence of other scientific explanation this is certainly worthy of serious consideration.

Modern Civilization – A Bad Case Of Nerves

History Of Coca, Dr. Mortimer, Chapter Nine

Among the annoyances incidental to a modem civilization are those troubles produced from a possible nervous perversion, engendered through overtaxing the powers mentally or physically in the modem whirl and bustle of a busy life. We  all realize the effects of muscular fatigue, but few seem to appreciate the extreme tiredness which is possible to the nervous system of the purely sedentary worker. This may manifest itself in the mildest form as a mere irritability or restlessness, or more profoundly as peevishness and even despondency.

It is not as easy to demonstrate nerve fatigue in the laboratory as it is to show the fatigue of muscle, yet there can be no doubt that similar factors are at work to induce either. It is known that all the activity of the tissues, of whatever kind, is due to a chemical conversion of the substance contained in the minute cells which go to complete the organism. Fatigue results from the retention of products of waste in the blood  which normally should be excreted. As a result the tissues are not properly nourished by a purified circulation for their work, and exhaustion is a consequence, whether the structure under this influence be muscle or nerve.

When we learn that Coca relieves muscular fatigue, mental depression or nervous fatigue, that it calms to refreshing sleep or stimulates to wakefulness and activity, that it allays hunger or induces appetite as the case may be, we can only harmonize such seemingly opposite applications through appreciating that this influence is extended to the tissues through the fluid which supplies them with nourishment. We have already seen that the blood is so speedily purified under the action of Coca that the circulation may at once return an appropriate pabulum to all the cells of the body and so may promote in them a normally healthful action.

The brain may be broadly considered as made up of cells and nerve fibres. The outer portion, which is termed the cortex, consists of many convolutions which through this arrangement affords a greater superficial area for the brain cells. These cells are located in layers over the surface, as well as arranged in groups at the base of the brain and in the medulla and spinal cord. The convolutions are merely rudimentary in animals and are poorly developed in the lower orders of the human race and in the uneducated. By intellectual development these are increased in a manner quite analogous to that in which muscle is increased by exercise. Gross bulk of brain substance does not necessarily indicate giant intellect, but merely the structure for such possible development.

The brain practically attains its greatest size in early childhood, at least this is the period of its most active increase, and remembering the law that the part of the body which is subject to the greatest physiological growth is most liable to disease, it will keep before us the fact that children are particularly susceptible to disorders of the brain and nervous system. In childhood the tendency should be to restrain these  organs, which are already too alert, from an undue excitement. From birth an education of the individual cells of this intellectual centre should be carefully conducted. A refinement of nerve tissue progressing by easy gradations until strength and power shall be secured. It is through this alone that man may be raised superior to the beast or savage. Not only present enjoyments but future comforts and realizations are so absolutely dependent upon this that even “Spiritual life can only reach the human form by and through the brain  cell.”

Quite as important as the brain in maintaining mental stability is the action of the sympathetic nerve in controlling physical well being, while both brain and sympathetic nerve must act together to sustain the organism in true harmony. The sympathetic nerve runs on either side and in front of the spinal column as a double chain of little brains. From these centers not only the great organs are supplied, but also the coats of the blood vessels, through which association a controlling influence is maintained over the entire organism. Along its route these nerves are intimately connected with branch nerve fibres from the brain and spinal cord. Through groups of fibres sent to the heart, to the stomach and to the organs of the pelvis the functions of either one of these may be influenced in sympathy from the derangement of some other organ far distant, the workings of which are not directly associated, but the action of which is affected by a reflection of the troubles elsewhere. This reflex effect between distant parts of the body is analogous to the switching on of a branch telegraph loop to the main line to carry news to points with which it was not directly connected.

So intimate is the relation of this regulating nerve with the various functions of the body that it is possible for these to be seriously interfered with through action of the sympathetic on the blood vessels, by which the tension of their walls is altered and the circulation is accordingly hastened or retarded. Common examples of this effect are seen when the emotions are excited and occasion the capillary vessels to contract as in pallor, or, when these are suddenly dilated, to cause blushing. The idea that the emotions have their seat in the heart because of this influence of the blood vessels in occasioning an irregularity of its action has led to an erroneous and sentimental regard for that organ.

This intricate nervous development suggests the extreme importance of a well trained organization as a factor toward  preventing that broad class of cases which are grouped under the generic title of neurasthenia. In this condition – rather  than disease – a similar restlessness and over-sensitiveness is  present as in profound fatigue. In chronic illness the same symptoms are seen, but when these are complained of without any characteristic signs of disease the indications point to nerve irritability through imperfect elimination of tissue waste. If with this excess of waste materials in the blood there be associated a defective will, then the influence on the sympathetic nerve must be pronounced. Either cause may unbalance the circulation through the arterial system and so disarrange various functions of the body, while a low power of resistance intensifies the mental disability. It is remarkable that these sufferers are at first rarely treated appropriately, but are often impatiently urged to exert will power. While it is undoubtedly true, as so aptly phrased by Shakespeare: “There is no condition, be it good or ill, but thinking makes it so,” will power must emanate from a primary store of bodily health.

The greatest factor, however, must be derived through the guidance of the emotions, particularly during the formative period of development. An early education of the will should form a basis for mental control. In this will be found a prominent factor in the production of future happiness, as well as a means of support in many a physical ailment, and even a source of contentment in hopeless disease. But as has  already been indicated, the greatest benefit can only result  from a healthful working of the entire organism. That there shall be a sound mind in a sound body is an old adage, and recently the great universities have appreciated this sufficiently to officially recognize physical training as an important  part of a collegiate education.

Neurasthesia – The Language Of Diagnosis

History of Coca, Dr. Mortimer, Chapter 8

Whether the title neurasthenia be scientifically correct for the peculiar train of symptoms which go to make up the complainings of the victims of over-nervous irritability, it has served since the classification of some thirty years ago to enable the acute medical examiner to group the particular sufferers from this morbid condition. As defined by Dr. Beard, neurasthenia is: “A chronic functional disease of the nervous  system, the basis of which is the impoverishment of nervous force; deficiency of reserve, with liability to quick exhaustion, and the necessity for frequent supplies of force. Hence the lack of inhibitory or controlling powers, both physical and mental, the feebleness and instability of nerve action, and the  excessive sensitiveness and irritability, local and general, and the vast variety of symptoms, direct and reflex.”

The condition may be summed up as one of nervelessness, or a weakness of irritability akin to the symptoms which indicate profound fatigue. A host of modem physiologists regard fatigue as due to some poison in the blood. If we accept this theory founded upon chemical facts which may be clearly  demonstrated by experiment, there is ample means for explaining the multiplicity of nervous symptoms as resulting from this cause alone. Waste matters in the circulation by clogging the capillaries prevent the venous blood from being appropriately purified. The nerve centers do not receive suitable stimulus for repair, and the increased irritability occasions an excessive waste which still further impedes the  circulation. Functional changes must necessarily result in the heart, kidneys, liver and the brain from this continued irritation.

The subjective symptoms of neurasthenia are not so much engendered by a weakness of the nervous system, nor any lack of susceptibility of the nervous protoplasm to respond to irritation, as through excessive irritability, which renders the organism over-sensitive to normal and healthful stimulus. It is a condition which may be allied to the harp, so strung up as to permit the slightest breath to set its strings in a discordant  hum. Often the subjects of this form of trouble are found among those who are in the prime of activity, in early adult life, when the various forces for the production of energy are being vigorously employed.

As it is that part of the body which is most active at any one period of life – particularly of growth – that is most liable to disease, so during the different epochs of pubescence, adolescence, and the early marital life in either sex, the symptoms of neurasthenia may be exhibited. These symptoms are particularly manifest when there has been at these periods a condition of overstrain, associated with malnutrition. Among all possible causes my experience has been that the genetic factor, through repeated explosive shocks upon the nervous system, is pre-eminent in the production of neurasthenic symptoms in those already overworked or suffering from imperfect nutrition.

Neurotics are prone to excesses as well as to extremes in any particular line. They are the class to which habits cling and “habit drugs” belong, and the apparent candor of their sufferings might often lead the sympathetic, unwary listener astray. In such subjects these habits and excesses should be regarded rather as symptoms than the underlying cause of the condition. If this fact were more generally thought upon we should hear less of those who have been wrecked by alcohol or opium. Indeed it is a fact that a perfectly healthy man rarely becomes a morphinist, cannabist, etc., but that such individuals are without exception neuropathic.

The numerous symptoms which go to make up the condition of nervous prostration have only been made prominent through the push for supremacy, and even for maintenance, in the various specialisms of life. While the causes always have existed, modem civilization has greatly exaggerated them, and the present dwellers in cities are consequently eminently of the nervous type. The sufferers are not all from one class, but are numbered among the high, the low, the rich and the poor, though the symptoms may be varied in accordance with the cultivation and environment of the patient.  What the poor Andean Indian, working laboriously for days on scanty food, might regard as the ban of some “spirit of the mountain” cast upon him for presuming to invade some hallowed precinct and as a charm against which he chews the sacred Coca, the used up subject of protracted social functions considers in a different light. But the symptoms and conditions are similar, whether occasioned from over-indulgence and overwork, because of exalted ambition or from enforced labor associated with hygienic errors.

The title neurasthenia has been made responsible for a multitude of evils, quite as bad as has that of “malaria” or “biliousness.” While the group of subjective symptoms which Beard classed under this head has been expanded to embrace about every condition generated from nervous irritability, it remained for the classic guidance of Charcot to accentuate the importance of a certain few symptoms into what he styled  “the stigma of neurasthenia,” in an effort to combine these as an exact disease.

It is very different whether we consider this classic form or the commonly accepted type. On the one hand there may be mere nervous irritability, while on the other this is accentuated until it approaches the border line of psychical aberration. The more grave condition has been traced from a neurotic heredity or degeneracy, while the simpler application is made to embrace all forms of mental worry, from a mere nervous headache to some pronounced phobia, or dread. The two types, however, often intermingle on the threshold of some severe nervous affection, with hypochondriacal, epileptic or paralytic symptoms, or even insanity.

The popular idea of nervous debility held by the laity as well as by the general practitioner in medicine is not the serious disorder of the alienist any more nearly than is a “fit of  the blues” – which, since the days of Burtons Anatomy of Melancholy has been attributed to “biliousness” – is true melancholia. The two terms are used by the unknowing or the unthinking ones as interchangeable, the one being a simple temporary mental despondency, which may arise from any one of many causes, while the more serious ailment manifests this condition profoundly and characteristically all the time.

Charcot claimed that neurasthenia was entitled to a definite place in mental pathology, because the disease as witnessed by him maintains its identity under varying circumstances of origin. He believed the condition to be essentially distinct from hysteria, although it might be associated with that disease, and so present a complex hystero-neurasthenia –  a combination which was also described by Beard. That is,  the patient may exhibit only neurasthenic symptoms, or united with these the symptoms may be of positive hysteria.

Levillain has, with many other authors, described two varieties of neurasthenia – that from heredity and the acquired. The two forms differ not only in their progress, but in their response to treatment. Among the peculiar train of symptoms commonly seen in this disorder are curious feelings of morbid fear or dread experienced by its subjects. This is similar to the hallucinations which the Germans term “zwangsvorstellungen” and “zwangshandlungen,” and which others have given a long list of terrible names. Agoraphobia is a dread of open spaces, anthropophobia is a fear of society,  the antithesis of which is monophobia – the fear of being alone. Then there is pantophobia, a fear of everything, and a culmination which must be the last straw – phobophobia, a  fear of being afraid. The French term this condition ”peurs maladies.” “Folie de doute” is the name given by Le Grande du Saulle to a condition of chronic uncertainty when there is a morbid doubt about everything.

Hereditary neurasthenia, it is asserted, may develop in those whose parents were distinctly nervous, even though the usual determining cause may not be present. Among predisposing causes, over-excitation including all forms of over-strain, whether sudden or gradual, is predominant, while the condition is not markedly influenced by alcohol or narcotics. The essential symptoms which Charcot described as the stigmata of the disease are: (1) Headache of a special  kind; (2) Digestive troubles; (3) Incapacity for work; (4)  Loss or diminution of sexual desire; (5) Muscular lassitude, marked by easily induced fatigue, and painful stiffness; (6) Spinal pain; (7) Insomnia; (8) Hypochondriacal views of  life. Other symptoms which may appear are vertigo, cardialgia simulating angina pectoris, palpitation of the heart, feelings of faintness, and irritable pulse; but these may not be constant. The muscle weakness, with an indescribable irritability expressive of fatigue, Charcot considered so prominent a symptom that he reserved for it the term “amyosthenia” The headache is of a peculiar character, suggestive of a weight or constriction over the back of the head or vertex, and sometimes over the whole cranium, described as the “neurasthenic  helmet.” In some cases this sense of pressure may be hemi-cranial. The insomnia, or troubled sleep, so annoying in pronounced cases, is a very important symptom. The backache may be limited to the sacral region, or to the neck, or may at times be in the coccyx, and is commonly aggravated by pressure. The digestive symptoms are of a general nervous type.  With these there is incapacity for mental work, and particularly a lack of concentration of thought.

From the classic grouping it will be seen that it is often difficult to draw the line between actual organic nerve trouble and neurasthenia. Perhaps the usual type, as seen by the general practitioner, presents a nerve depression – an inability of the organism to speedily repair itself after some call for unusual strain, while the two most prominent factors of this condition are sleeplessness and mal-assimilation. Under such  influences it is easy to understand that the symptoms presented may be manifest as cerebral, spinal, genital, chlorotic, vascular, cardiac, or gastric, while there may be an especial indication pointing toward the liver. It is quite plausible, as Boix has shown, to have a “nervous dyshepatia” as well as a nervous dyspepsia, due to defective innervation.

It should be understood that the vast array of symptoms which go to make up the condition known as neurasthenia are largely those of reflex irritation, an irritation which may arise from any part of the organism and be transmitted through the sympathetic, and acting chiefly upon the blood vessels through  the vaso-motor nerves. It is because of this reflex nature of the symptoms that the condition is often confounded with other diseases, and the sufferer may go the round of the various specialists, and receive “local treatment” for conditions which are erroneously considered to be the chief cause of trouble. What the oculist regards as occasioned from eye strain the rhinologist may look for in the nose. If the patient be a woman, the gynaecologist locates the concentration of troubles in predominant functions. On the other hand, the genito-urinary expert has predetermined that in any nervous man the seat of ills is the prostate gland. It is, therefore, a very common occurrence to find that patients who are nervously irritable have become in themselves multiple specialists. Through constantly going the rounds in search of relief they become familiar with various local conditions, which may give rise to similar symptoms to those they suffer.

These subjects, as a class, are acute and quick; they belong to the clever people, and they are either all elation and prone to overdo or way down “the blues.” It is not surprising then that they soon become familiar with the various remedial efforts toward relieving their symptoms. They not only know in advance what their medical advisers may suggest, but are often prepared to offer a long series of protests against each particular effort toward aiding them to recover from their deplorable condition. If to such a patient, complaining of insomnia, the physician suggests sulphonal – that drug keeps them awake. Then ensues a hasty enumeration of the several hypnotics they have employed, while they recount wherein each had proved in their case an utter failure. If the symptoms complained of are pronouncedly about the head, they know all about refraction, astigmatism, and the cutting of eye muscles, or they have had their turbinated bodies taken out, or hypertrophied tissue removed from nose or throat, their ears inflated, or they have inhaled and been sprayed to an alarming extent. If by chance the stomach but manifests a twinge of protest, then that poor organ has been dieted and washed, both gavage and lavage – ad nauseam. Thus these patients are commonly treated through all the operative procedures until it is no wonder they should finally become nervous wrecks, ultimately going about from one resort to another, unable to find relief, unable even to find what they deem a competent trained nurse to cater to their imaginings, while a kindly disposed helpmate dances attendance upon their peevish whims.

Frequently these cases are subjects of plethoric prosperity, who, if not constitutionally weak, have had no education in self-control. They have spoiled themselves by fretting, and are being more rapidly ruined by petting; the very kindness and consideration that is bestowed upon them at home only adds fuel to their weakness. Often an entire change of environment affords the best condition for the treatment of such cases, such as the rest cure of Weir Mitchell, or one of the German watering establishments, where the regimen is rigid and exact. They must be coerced into recovery or else they will go through the balance of life a nuisance alike to themselves as well as to those who would wish to be their friends.  Examples of this condition are legion, and the complainings are as multiple and varied as the ideas of man.

There are instance of self-control when sufferings are held in check while continuing at work. Some of the ablest men in the world’s history have been those of weak nervous organization. “Wise judges are we of each other,” says Bulwer. Often those whom we look upon as of indomitable will may suffer keenly from some seemingly trivial nervous symptom. A few years ago a prominent justice, who though outwardly was the very picture of health, assured me he suffered more keenly than the abject criminals brought before him, and was literally a coward from nervous dread. He came a long distance for consultation. Possibly it was a satisfaction to get out of his immediate environment and relate his sufferings to one who could listen patiently with a wish to guide him understandingly. Being a popular politician, he was often called upon to make speeches at the most inopportune times – for him, and he seriously proposed to give up a life position because he felt he could not stand the nervous strain.

This is but one example of many similar cases occurring among professional men, with mental faculties constantly at full tension. Whenever there is a lull in their work their thoughts revert to themselves, and the symptoms of an over-tired nervous organism are magnified into some serious physical ailment. These are the cases that maintain the advertising quacks. They wish to be treated confidentially because they would not have their friends know for the world that they are ailing in any particular. They, who are seemingly so strong, would feel humiliated to recount a tale of personal weakness even to a medical man. It can readily be appreciated how necessary it is that a physician shall listen attentively to the story these patients tell, and advise with them openly and candidly as to the plan of treatment, which primarily must consist in some better means of living rather than a dependence upon medication alone. An interchange of confidence between patient and physician, while always advisable, is more necessary in these particular cases than in any other in the entire field of practice of medicine. There must be faith, and in this much I am an advocate of the faith cure. Indeed, faith is necessary in every walk of life. A chimney may blow off the roof, one may fall on a slippery pavement, a horse may run away, a bridge might fall, a boat might sink, and a hundred and one possibilities might occur to the nervously imaginative. Fear often becomes so exaggerated in the minds of these weak patients that they finally become too timid to attempt anything serious. Such a subject must be assured why and how he is to get well. I once had a patient who would be excited to an indescribable dread if, when walking in the street, he met a truck having any part of the load projecting, such as a chair leg or plank. To avoid  it he felt compelled by some uncontrollable influence to turn off into a side street. In another case – a young man, could never go into the society of women, and actually avoided meeting them as much as possible in the street because of an expressed fear that he “must punch them.” These were cases of simple neurasthenia, which appropriate hygienic measures, combined with the administration of Coca – a remedy which the homoeopaths have long associated as a specific in cases of timidity and bashfulness – completely cured.

The numerous examples which Kraft-Ebing relates of the “Jack the Ripper” order belong to this same class. The complainings of these patients should not be treated flippantly, for the subjects are earnest in their endeavor to find relief from a form of suffering which, while not actually painful, is profoundly humiliating and mentally agonizing. It can be well understood how readily such cases might adopt a drug habit in an unguided effort to find some means of relief.

There is a tendency in the human mind which is overweighted to seek support in unburdening a portion of trouble by recounting mental sufferings, whether of illness or not, to another. The celebrated actor, Mr. Frank Drew, related to me a curious example illustrating this, which occurred to him on a recent visit to England. He was dining alone in a restaurant, when a gentleman approached with the remark : “I trust you will not mind if I take a seat at your table?”  “Not at all,” replied the actor; “I shall enjoy company.”

The two fell into a casual chat, which was resolved into the stranger telling a long and intricate story regarding a purely personal matter, of no interest to an outsider, yet which was patiently listened to without interruption to the end. Then, as though having unburdened himself of a weight of woe, he arose, saying:

“You will excuse my having troubled you with this story, but really it has been a great source of comfort to me to have found some one to whom I could tell it. Knowing that we are absolute strangers, and shall never meet again, I have not hesitated to talk freely to you.” On the assurance of a hearty sympathy, and that the secret should remain inviolate, they parted, neither expecting to ever see the other. But it so chanced, in the littleness of this world, that the following night brought them together again at a dinner party, where they were introduced under embarrassing recollections.

Not long since, a physician told me of an incident bearing upon this same tendency, which had occurred to him. One day at the close of his office hours he was preparing to leave for some outside work, when a lady was ushered into the consulting room, and instead of relating any physical ailment, entered into a long story of family history, which was listened to attentively, in expectation that it was to lead up to the real cause of her visit.

After this story was completed, the relator asked what she was indebted for the consultation, to which the physician, conscious of his hurry and delay, said in a perfunctory way: “Five dollars.” “Five dollars? Why, I should think that was altogether too little for having taken up so much of your time.” “Well, then, I will say ten dollars,” said the doctor, treating the whole matter very much as a joke. But the sincerity was shown by the willingness with which the fee was extended with the query: “When shall I come again?”  “Say in two weeks,” said the consultant smilingly. “Two weeks! Hadn’t I better see you in one week?” “Very well, make it one week.” And so for several weeks in succession this patient returned and continued to revert to this same story, each time leaving well satisfied after having deposited the customary ten-dollar fee. A case of insanity! Oh, no, merely an over troubled mind which, without apparent physical ailing, had sought relief of mental worries from a physician, who undoubtedly prevented more serious trouble and effected a cure simply through being a good listener. While such instances are not rare in the routine of any practitioner, they seem almost incredible.

I was recently talking with a leading laryngologist, whose practice is in Philadelphia, upon this same line of thought, when he related an anecdote which had occurred in his own practice. He had gone to Paris for a short visit and had left instructions that his assistant would continue his practice.  One day he was visited at his hotel in Paris by one of his Philadelphia patients, who, entering in the most casual way, said: “Doctor, I have a little trouble with my throat I would like to have you look at to-day.” The physician, being really surprised to see his patient thus unexpectedly so far from home, asked him how long he had been in Paris and how long he proposed to remain, and was the more astonished at the  reply: “Oh, I just ran over to have my throat treated, and shall take the steamer back to-morrow.”

These examples, while in a measure indicating the smallness of the world, illustrate the fact that patients recognize and require the personal factor in the treatment of their troubles. An element of confidence is established, not necessarily in consequence of any superior preliminary qualifications on the part of the medical man, but because perhaps he has applied his knowledge understandingly.

Dr. Tuke has written scientifically and very entertainingly regarding the subtle relations existing between mind and body – a subject which surely has a very important bearing upon the entire range of functional nervous troubles. The mind has an extraordinary influence, even in health, in causing disorders of imagination, sensation and also of organic functions. An outgrowth from this – a going off as it were on a tangent – leads to various beliefs in phenomena of a superstitious nature and forms a fertile field for the growth of unfortunate methods of treatment; unfortunate because disappointment must follow after the loss of valuable time in experimenting. In this connection I recall a remark made at an alumni dinner by the late Dr. John Hall in speaking of the so-called Christian science: “There is no Christianity in it, and it is not at all scientific.”

It is a well-known fact to the physiologist that the mind may excite or depress the various nerve centres, and through these occasion functional changes in muscles or nerves. I hope it has been conclusively shown that this is the underlying factor occasioning many of the numerous subjective symptoms among that immense class known as neurasthenics. When the famous Dr. John Hunter’s attention was drawn to the phenomenon of animal magnetism – which was exciting  the scientific world more than a century ago, he recognized the possible influence of expectancy upon the imagination, and in his lectures said: “I am confident that I can fix my attention to any part until I have a sensation in that part.” It is because this possibility of the influence of the will is overlooked that greater success is not more commonly met with in the treatment of functional nerve troubles. Mr. Braid emphasized this fact when he said: “The oftener patients are hypnotized from association of ideas and habit, the more susceptible they become, and in this way they are liable to be affected entirely through the imagination. Thus, if they consider or imagine there is something doing, although they do not see it, from which they are to be affected, they will become affected; but, on the contrary, the most expert hypnotist in the world may exert all his endeavors in vain if the party does not expect it,  and mentally and bodily comply, and thus yield to it.” A trite application of this thought is the example of the patient who felt “better” as soon as the clinical thermometer had been  placed under his tongue.

Coca Leaf & Disorders Of The Mind and Nervous System

History of Coca, Dr. Mortimer, Chapter Ten

In the answers received to my inquiry in this research regarding therapeutic application, fully one-half of those who went at all into detail advocated the use of Coca for cases of neurasthenia, and for the various symptoms of nerve and muscle depression grouped under that title. The whole train of ills resulting from debility, exhaustion, overwork, or overstrain of nerve or mind, recalls the early designation given to the classification of this long group of symptoms by some of the European physicians as “the American disease,” the derangement of an overworked and overhurrying people. The general advocacy of Coca for this condition indicates that the causes which tend to produce such derangement are not only important problems to the general practitioner throughout our country, but must be predominant factors wherever there is an impulse to supremacy. It makes little difference under just what name the symptoms may be treated so long as the patient shall be relieved of suffering.

There is a general idea in the minds of the laity which, unhappily, is also shared by some physicians, that to name a disease is far more important than its treatment. I well recall, when attending lectures upon medicine, how eager the first year students were to make notes of the various remedies which each lecturer might advocate for different conditions.  It is a difficult task to fill such a therapeutic notebook, but far more difficult to find an appropriate application for the prescriptions suggested. Diseases are of necessity broadly taught in types, and treatment is wholly a result of judgment on the part of the individual practitioner. When a physician has advanced far enough in his struggles in medicine to realize how few specifics there are, he surely broadens himself by cutting loose from the narrow channels of thought he had originally traced in his early student days.

Dr. Tibbles, Brain Exhaustion, Chapter 8

Clements R. Markham in his “Travels in Peru and India” bears out fully the statements of Garcilasso de la Vega, Bias Valera, and Von Tschudi. This gentleman had charge of Government expeditions to Peruvian territories in order to procure cinchona plants for transportation to India, and while there, in forest districts around Bolivia, had ample opportunities of obtaining information respecting the influence of Erythroxylon coca upon the native Indians and likewise upon himself. He says the properties of Erythoxylon coca are such as to enable a greater amount of fatigue to be borne with less nourishment (in the form of ordinary food,) and to prevent difficult breathing in the ascent of steep mountainsides; that, although when used to excess it is prejudicial to health, yet “of all the narcotics used by man, it is the least injurious and most soothing and invigorating.” He frequently chewed it, and, besides imparting an agreeable soothing feeling, found he could endure long abstinence from food with less inconvenience than he otherwise would have felt; and further, that he was enabled by it to ascend precipitous mountain-sides with feelings of lightness and elasticity, and without shortness of breath. “It enabled him to ascend the mighty passes of the Andes with ease and comfort. It is a stomachic, soothing, nutritive.”

Beniley says “The Peruvian Indians have always ascribed to the coca the most extraordinary virtues. Thus they believe that it lessens the desire and the necessity for ordinary food; and, in fact, that it may be considered as almost a substitute for food.” Dr. Bennet of Edinburgh, in the British Medical Journal, publishes an elaborate investigation of the properties of the Coca leaf; his conclusions are that coca has a marked effect in diminishing the waste of the tissues, conferring thereby the power of sustaining prolonged exertion, also that it possesses the power of regulating the temperature of the body. Prescot treats Coca as an article possessing so invigorating a quality that with a small quantity of it in his pouch and a handful of roasted maize, the Peruvian Indian of our time performs his wearisome journeys day after day without fatigue. The Indian miners are furnished by their employers with little food but as much coca leaves as they want, some Indians consuming as much as a pound a week of it, and they work twenty to thirty hours at a stretch without sleep. Wittingham gave an account of two men who had been buried in a mine for eleven days before they could be got out, and they lived all that time on a few coca leaves they happened to have with them.

Dr. Tibbles – Physiological Action and Medicinal Uses Of Coca Leaf

Mental labour is frequently productive of such arterial tension – an exhausted Brain, whereby its influence over the heart’s action is diminished, will give rise to it; the diminution of nervous influence over the excretory organs whereby an increased amount of urea is produced and collected in the blood will give rise to it; as will also abnormal nutrition during exertion. These variations are abnormal and give rise to ill effects. In extremely low tension of the arterial and capillary vessels, the increased supply of blood to the muscles causes anemia of (being a deficiency of supply of blood to) the brain, and there is produced a feeling of fatigue, giddiness, or fainting. In this condition there is abnormal rise in the internal temperature. On the other hand, if the arterial tension be increased, then the strain will fall upon the heart, which will become overtaxed, dilated, and in some cases entire failure will be produced, either by over-distention and paralysis, or, by gradually increasing signs of dilatation, producing breathlessness, a sensation of lightness in the head, coldness of the extremities, pallor of face, anxious expression, and the temperature is abnormally decreased. These are the results of discordant action of the circulatory system, produced by exertion or excitement.

It may be asked, what has all this to do with the action of coca-leaf? Well, it is found by experiment that coca-leaf regulates the action of the heart and circulatory system and thereby nearly altogether preventing such results as above recorded as the consequence of muscular exertion or mental excitement. I, myself, have made experimental walks and performed other forms of exertion, physical and mental, and during which I have observed various functional differences, and of these observed experiments many might be quoted, but let my own observations be exemplified by the following:

My pulse, normally are 70 per minute, and at the end of a sharp walk of two hours’ duration, had risen to 92 pulsations per minute, and did not subside until after a period of six hours had elapsed. A walk performed under like conditions of distance, speed, and with like dietary as before, but during which twenty-five drops of a concentrated preparation, representing twenty-five grains of coca-leaf, was twice taken; the first dose before starting and the second at the end of the first hour. At the end of this walk the pulse beat eighty-four per minute, and, in less than two and a half hours, subsided to a normal condition.

Coca Leaf & The Elimination Of Physical Fatigue

History of Coca, Dr. Mortimer, Chapter 8

The influence of Coca in banishing the effects of extreme fatigue is well illustrated in an account of its use communicated to me by Dr. Frank L. James, Editor of the National Druggist, St. Louis. While a student at Munich he experimented with the use of Coca upon himself at the request of Professor Liebig, whose pupil he was. On one occasion, when exceedingly tired both physically and mentally, he was  induced to try chewing Coca after the proper Peruvian fashion with a little llipta. Before commencing this experiment he was hungry, but too tired to eat and too hungry to sleep. In a few moments after beginning to chew hunger gave place to a sense of warmth in the stomach, while all physical weariness disappeared, though mentally he was still somewhat tired and disinclined to read or study, though this condition soon passed away, giving rise to an absolute eagerness to be at some sort of exercise. These sensations lasted altogether for probably three hours, gradually passing off after the first hour, leaving the subject none the worse for his experience and able to eat a hearty dinner the same evening.

Some years afterward, while practicing in the South, this gentleman returned from a thirty-six hours’ ride so tired as to necessitate being helped off the horse and up-stairs to his  room. While preparing for bed his eyes fell upon a package of Coca leaves which he had recently received by way of San Francisco, and the idea immediately occurred to him to repeat the experiment of his student days. In the course of a quarter of an hour – following the chewing of probably a drachm of Coca leaves – he felt so refreshed and recuperated that he was able to go out and visit patients about the town to whom he had previously sent word that he was too tired to call on them that night. In describing the result, Dr. James said: “I was not very hungry at the time before taking the Coca, but all sense of the necessity or of a desire for food  vanished with the weariness.”

Professor Novy, of the University of Michigan, is referred to by one of his former classmates as having formed one of a group of experimenters upon the use of Coca leaves. The influence being tested during a walk of twenty-four miles, taken one afternoon without any other nourishment but water and Coca. Over four miles an hour was averaged, and although unaccustomed to such long walks or vigorous exercise, no special muscular fatigue was experienced by four of the party who chewed the leaves almost constantly during the journey. No change was noted in the urine and no depression was experienced the next day. One who did not chew Coca, but was addicted to alcohol and chewed tobacco constantly, was somewhat more fatigued than the others, and suffered considerably from soreness of the muscles on the following day.

The experience of Sir Robert Christison, of Edinburgh, with the use of Coca upon himself and several of his students, is full of interest because of his extended experiments and the high rank of the investigator. Two of his students, unaccustomed to exercise during five months, walked some sixteen miles without having eaten any food since breakfast. On their return they each took two drachms of Coca made into an infusion, to which was added five grains of carbonate of soda, in imitation of the Peruvian method of adding an alkali. All sense of hunger and fatigue soon left, and after an hours walk they returned to enjoy an excellent dinner, after which they felt alert during the evening, and their night’s sleep was sound and refreshing. One of these students felt a slight sensation of giddiness after drinking the infusion, but the other experienced no unpleasant symptoms. Ten students, under similar conditions, walked varying distances, from twenty to thirty miles, over a hilly road. Two of these were unable to remark any effects from the use of Coca, several felt decided relief from fatigue, while four experienced complete relief, and one of these had walked thirty miles without any food. Professor Christison, though seventy-eight years  of age and unaccustomed to vigorous exercise, subsequently experimented on himself by chewing Coca leaves with and without llipta, some of which had been forwarded to him from Peru. He first determined the effect of profound fatigue by walking fifteen miles on two occasions without taking food or drink. On his return his pulse, which was normally sixty-two at rest, was one hundred and ten on his arrival home, and two hours later was ninety. He was unfit for mental work in the evening, though he slept soundly all night, but the next morning was not inclined for active exercise. Then, under similar conditions, he walked sixteen miles, in three stages of four, six, and six miles, with one interval of half an hour, and two intervals of an hour and a half. During the last forty-five minutes of his second rest he chewed eighty grains of Coca, reserving forty grains for use during the last stage, even swallowing some of the fibre. He felt sufficiently tired to look forward to the end of his journey with reluctance, and did not observe any particular effect from the Coca until he got out of doors and put on his usual pace, of which he said: “At once I was surprised to find that all sense of weariness had entirely fled and that I could proceed not only with ease, but even with elasticity. I got over the six miles in an hour and a half without difficulty, and found it easy when done to get up a four and a half mile pace and to ascend quickly two steps at a time to my dressing room, two floors up-stairs; in short, I had no sense of fatigue or any other uneasiness whatsoever.”

During this walk he perspired profusely. On reaching home his pulse was ninety, and in two hours it had fallen to seventy-two, showing that the heart and circulation had been strengthened under the influence of Coca. The urine solids were the same as during the walk without Coca. In describing this walk, he said: “On arrival home before dinner, I felt neither hunger nor thirst, after complete abstinence from food and drink of every kind for nine hours, but upon dinner appearing in half an hour, ample justice was done to it.”  After a sound sleep through the night he woke refreshed and free from all sense of fatigue. An influence of Coca not anticipated was the relief of a tenderness of his eyes, which during some years had rendered continuous reading a painful effort. In another trial at mountain climbing, he ascended Ben Vorlich, on Loch Earn, 3,224 feet above the sea. The climb was along a rugged foot path, then through a short heather and deep grass, and the final dome of seven hundred feet rise was among blocks and slabs of mica-slate. The ascent was made in two and a half hours, the last three hundred feet requiring considerable determination.

His companions enjoyed a luncheon, but Sir Robert contented himself chewing two-thirds of a drachm of Coca, and after a rest of three-quarters of an hour was ready for the descent. Although this was looked forward to with no little distrust, he found upon rising that all fatigue was gone, and he journeyed with the same ease with which he had enjoyed mountain rambles in his youth. The experimenter was neither weary, hungry nor thirsty, and felt as though he could easily have walked four miles to his home. After a hearty dinner, followed by a busy evening, he slept soundly during the night and woke refreshed in the morning, ready for another days exercise. During the trip he took neither food nor drink of any kind except chewing sixty grains of Coca leaves. Eight days after this experiment was repeated, using ninety grains of Coca. The weather had changed and the temperature was forty-four degrees at the top of the mountain and a chilly breeze provoked the desire to descend. While resting sixty grains of Coca was chewed. The descent was made without halt in an hour and a quarter, and followed by a walk of two miles over a level road to meet his carriage. He then felt slightly tired, because three hours had elapsed since he had chewed Coca.

In summing up his experience Professor Christison says: “I feel that without details the general results which may now be summarized would scarcely carry conviction with them. They are the following: The chewing of Coca not only removes extreme fatigue, but prevents it. Hunger and thirst are suspended, but eventually appetite and digestion are unaffected. No injury whatever is sustained at the time or subsequently in occasional trials.” From sixty to ninety grains are sufficient for one trial, but some persons either require more or are constitutionally proof against the restorative action of Coca. From his observations there was no effect on the mental faculties except to prevent the dullness and drowsiness which follow great bodily fatigue.