[Reprint from The Alienist and Neurologist, Jan., 1886.] . 
On the Use of Cocaine in the Opium 
Habit. 
WITH A FEW PRELIMINARY REMARKS ON ITS PHYSIOLOG- 
ICAL PROPERTIES. 
By Edward C. Mann, M. D., 
Sunnyside Home for Nervous Invalids, 204 Leffert’s Place, Brooklyn. 
THE most exhaustive and important researches, as to 
the action of cocaine, have been those made by 
Schroff, Fronmuller, Ploss, Moreno y Maiz, Bucheim 
and Eisenmenger, A. Bennet and Dr. Isaac Ott. The 
action and properties of erythroxylen coca by Drs. 
Unanue of Lima, Tchudy, Scherzer, Mantegazza, Demarle 
Moreno y Maiz and Dr. Isaac Ott. Owing to the po- 
liteness of my friend Dr. Ott, I have had access to 
the results of the work of the observers above named, as 
well as to his own experiments with cocaine, and am thus 
enabled to present them to this society as preliminary to 
my own results obtained from the use of this drug in the 
treatment of the opium habit, in neuralgia of the pelvic 
viscera in women and in sciatica. 
The researches of Schroff showed that gramme 
per oz. in the rabbit caused slight changes in the pulse and 
respiration, with transitory dilatation of the pupil, whilst 
the same dose, subcutaneously, killed the animal in twenty- 
eight minutes. Epileptiform convulsions and considerable 
mydriasis being present, the latter yielding immediately 
after death. On section, the whole venous system and 
the ventricles were distended with blood. There seemed 
to be an increase of the salivary secretion, whilst there 
was no change in regard to defecation and diuresis. 
Locally, cocaine contracted the pupil. Schroff’s conclusion 
1 2 
Edward C. Mann. 
was that cocaine, in small doses, increased the brain func- 
tions, later depressed them, causing sleep, and belonged 
to the narcotics of which cannabis indica is an example. 
Fronmuller experimented with six males and eight females, 
using cocaine in doses of from to fW gramme. In 
four only was complete sleep obtained, and in only a few 
cases were narcotic symptoms present with tinnitus aurium 
and vertigo. With doses of from to gramme, 
delirium, headache, restlessness, severe chill and weakness 
in extremities were added. The gastric system seemed to 
be more disturbed, as there was observed a bitter taste 
in the mouth, belching and vomiting. Defecation was 
not increased. Uninary secretion rather lessened than 
increased. Pulse and respiration in beginning somewhat 
accelerated. The axillary temperature depressed o. i°-0.4° 
and pupil dilated. 
The conclusions of Moreno y Maiz, respecting cocaine 
as the result of experiments on frogs, was that the con- 
ducting power of the cord was not affected, but that the 
nerves were attacked, that the peripheral sensibility was 
acted upon, that it caused phenomena similar to those 
produced by strychnine, such as spontaneous tetanic con- 
vulsions on the least excitation. In feeble doses it 
caused a remarkable excitation of sensibility, dilating of 
pupil and diminution of movement. The animal seemed 
to lose co-ordinating power. That large doses produced 
a diminution, then abolition of sensation, without com- 
plete loss of motricity. 
In A. Bennet’s experiments with cocaine he observed 
the symptoms already detailed, and also observed that the 
posterior columns of the cord were insensible after death, 
that the temperature was at first diminished, then increased, 
and permanent congestion in the ear of the rabbit. Dr. 
Ott’s conclusions, respecting the action on the nervous 
system from his experiments on frogs and guinea pigs, 
are that cocaine in small and large doses causes loss of 
co-ordination and decrease of motricity. It does not 
paralyze the anterior columns of the cord. Cocaine in Cocaine in the Opium Habit. 
3 
small doses exaggerates the sensibility which, upon the 
least irritation, throws the animal into general convulsions, 
whilst large doses abolish the functions of the posterior 
columns and the sensory nerves. Cocaine, when gradu- 
ually introduced, kills by stoppage of respiration, but 
when large doses are thrown suddenly upon the heart, 
death takes place by respiratory and cardiac arrest. 
Cocaine always prolongs muscular contraction and it 
always dilates the pupils. The effect of cocaine on the 
circulation is to produce a fall of pulse and blood pressure 
succeeded by a rise of them. That the fall is not due to 
central irritation of the pneumogastrics, is proved by the 
fact that it takes place after their division. That it is 
not due to the irritation of peripheral ends of pneumogas- 
trics, is shown by the previous paralysis of them by 
atropia and cocaine producing a fall. 
Circulation.—Experiments show that cocaine acts on 
the heart itself, either its imbedded ganglia or the mus- 
cular structure. Whether the muscular structure or the 
contained ganglia is most affected it is difficult to deter- 
mine. Experiments as to the action of cocaine on the 
respiratory system demonstrate that the action of cocaine 
is an excitant of the medulla, which passes into complete 
paralysis. Section of the pneumogastrics does not cause 
any alteration in the sequence of the respiratory changes 
induced by cocaine. Finally, the results of the ex- 
periments of Ott show that cocaine diminishes the 
excitability of the motor nerves and causes loss of 
co-ordination. 
In small doses it increases the excitability of the 
sensory neves and in large doses paralyzes them. It 
does not affect the conducting power of the anterior 
columns of the spinal cord, but seems to attack the pos- 
terior columns. Cocaine depresses the pulse and blood 
pressure momentarily, and afterwards increases them. 
This effect is produced by the action of the poison on 
the heart itself and the vaso-motor center. It does 
not paralyze either the sympathetic pn:u n >gastric or 4 
Edward C. Mann, 
vaso-motor center. It acts as an excitant on the centers 
of respiration and afterwards depresses, or paralyzes them. 
The pupils are always dilated. It has an action like that 
of veratria on the striated muscle. It depresses and then 
increases the temperature. 
On a warm afternoon last July, I commenced experi- 
ments on myself with a 40 solution of muriate of 
cocaine. I injected ten minims into the cellular tissue of 
the thigh and lay down to watch my sensations. I 
experienced an indefinable sensation, something analogous 
to that which would be produced by the hypodermic 
administration of grains of atropia, and a sense of 
refreshing coolness. There was a perceptible dryness of the 
mucous membrane of the mouth, and both physical and 
intellectual excitation. There was a pleasant sensation 
irradiated over the whole body. As the result of several 
such experiments, I should consider it an excitant pro- 
ducing exaltation of nerve force, showed by an increase 
of intellectual power, but I did not experience Schroffs 
symptoms of lassitude or depression of brain functions 
causing sleep. I should say, from my own experience, 
that cocaine in small doses was an excitant increasing 
the brain functions, later allowing them to drop back to 
the normal, and a dilatation of the pupil and increase 
of pulse and temperature. 
Cocaine in the Opium Habit. — The following case 
illustrates perfectly all I would say of the use of cocaine 
in the treatment of the opium habit, and illustrates, 
graphically, the magical results from its hypodermic use 
to relieve the terrible muscular and nervous restlessness 
which is apt to appear, even under the most careful and 
judicious retrocessive plan of treatment, by which much 
suffering and nervous derangement is avoided. Cases 
that are at once cut off from opium are very apt to be 
a failure as regards treatment, and it is the height of 
cruelty to subject a patient to any such treatment. It is 
a matter of deep regret that the victims of opium 
inebriety are generally to be found in the higher and Cocaine in the Opium Habit. 
5 
more cultivated classes of the community. A great many 
professional and literary men and women, who have 
special demands made upon their nervous systems every 
year, become morphine habitues, probably commencing 
its use at first for some attack of illness or nervous 
prostration. Some day they find to their surprise that 
they cannot stop its use and they gradually increase 
the dose, not to obtain relief from pain, but to be freed 
from the torments to which they are subjected when 
deprived of the morphine or opium. It is simply impos- 
sible for a delicate nervous woman or man either to 
abandon this habit voluntarily, and even physicians can- 
not do it. The most intelligent people contract the 
opium habit in spite of their intelligence, their desire 
and their will; and many of them end as utter wrecks 
of mind and body. There is, in addition to degradation 
of moral feeling and of impotence of will, a physical 
deterioration of nerve element, for the opium enters the 
blood and is carried by it to the inmost minute recesses 
of the brain, and act there injuriously upon the elements 
of the exquisitely delicate structures. Its finest, latest 
organized and least stable parts, which subserve moral feel- 
ing and supreme will, are marred. To cure the opium 
habitue, he must be restrained forcibly from the insane 
impulse for a long enough time to allow the brain to get 
rid of the poison, and its tissues to recover their healthy 
tone. 
I have noticed, in not a few cases, that the tissues 
had the congenital misfortune to begin with the original 
taint of a depraved tone. They have inherited the pro- 
clivity to seek for some stimulant. The craving, if once 
gratified, is readily led by gratificationin to an uncontrolla- 
ble desire. I would urge upon the medical profession the 
great importance of the prompt withdrawal of the drug in 
every case of illness, just as soon as the therapeutic indi- 
cations for its use have been fulfilled, and will also sug- 
gest, that for pain in the pelvic viscera in women, that 
atropia, hypodermically, in doses of from T of a gr. tc -jV 6 
Edward C. Mann. 
of a gr., will stop pelvic neuralgia quite as promptly as 
opium will. A great many women take a great deal 
of morphine and chloral to procure sleep, and become 
habit cases in this way. If sleep must be produced, 
we have a near nnd physiologically safe sleep produc- 
ing agent in paraldehyde, which may be given in one 
drachm doses at bed time, in I oz. syr. orange, and 
I oz. of water at bed time. From its chemical nature, 
I do not believe that it can do harm, while its phys- 
ical action in producing sleep is akin to chloral in 
certainty. There is no unpleasant reaction after it. I 
treat chloral cases by withdrawing chloral, giving par- 
aldehyde for a few nights, and antagonize the effect of 
chloral on the nervous system by giving strychnia 
hypodermically, commencing with of a grain of the 
nitrate of strychnia, and gradually increasing it until 
the brain takes on healthy action. 
The case alluded to was that of a gentleman aged 
forty years, of more than unusual culture and refinement, 
occupying a high position of trust and honor. At 
the time of coming under my care he was taking six 
grains of morphine per diem, and could not perform his 
daily duties without it. I reduced the amount one-half 
from the start. Gave Warburg’s tincture in capsule at 
breakfast and put patient on a Bromide mixture, in 
gradually increasing doses, while the morphine was grad- 
ually reduced. The formula of this mixture is as fol- 
lows : 
K Sodii Bromid: 
Am. Bromid. aa §ss 
Pot. Bromid. 5i 
Syr. Hypopbosphite Comp. §iij 
Syr. Tolu gi 
Aqua Menth. Pip. §iss 
Liq. Pot. Arsenit 3i 
M. Dose, from one teaspoonful upwards. 
The physiological effect of this combination is re- 
constructive and at the same time sedative, and the Cocaine in the Opium Habit. 
7 
bromide cachexia is entirely avoided by the use of this 
mixture. 
This treatment was pursued until on the tenth day 
the patient was taking one-sixth grain of morphia and the 
maximum of the bromide mixture. A great muscular 
and nervous restlessness now appeared. The patient ap- 
plied to me at io p. m., complaining that he “could 
not sit still or lie still for a moment, much less sleep.” 
I now administered io minims of a 4 per cent, solution 
muriate of cocaine made by Schiefflein. Before reaching 
his room he returned and knocked at my office door, 
saying that he wished to tell me that the nervousness 
and restlessness had entirely disappeared. He slept 
well. The next day hot baths, diuretics and iron and 
strychnia mixtures was begun to follow the bromides. 
Toward night the intense nervous restlessness came on, 
and as before, it was immediately relieved by the 
hypodermic of ten minims of cocaine, and uninterrupted 
sleep followed. The instantaneousness of the relief is some- 
thing magical. The patient passes at once from a con- 
dition of great nervous restlessness into a condition of 
perfect comfort. 
The treatment of the opium habit is rendered in- 
finitely more pleasant to the patient by the use of 
cocaine, and I should now feel that I was deprived of 
a most important therapeutic aid, in the treatment of 
this disease, if I had to do without it. The case re- 
ferred to made a perfect cure in five weeks, and 
resumed the position which he was before unfitted for. 
I have also used hypodermics of cocaine in sciatica 
with perfect relief to the patient, making deep injections 
in the neighborhood of the sciatic nerve. In ovarian 
neuralgia I have also used it successfully, making the 
injections on the affected ovary. 
I would caution the profession, first, not to tell the pa- 
tient what they are giving; and second, not to continue the 
use of cocaine more than a very few days, as the patient 
gets to depend on it if administered for a length of time.