The Therapeutics of Kola. 
BY 
REYNOLD W. WILCOX, M.D., LL.D. 
Press of 
Parke, Davis & Company, 
DETROIT, MICH. THE THERAPEUTICS OF KOLA.* 
BY REYNOLD W. WILCOX, M.D., LL.D., 
Professor of Clinical Medicine and TKerapeutics at the New York Post- 
Graduate Medical School and Hospital; Visiting Physician 
to St. Mark’s Hospital. 
To one who carefully reads the contributions to therapeu- 
tical literature, the various papers, scientific, semi-scientific 
and popular, which have been published in recent months 
about kola are by no means unfamiliar. There are two reasons 
why this statement is true; first, the press reports to be 
found in the daily journals suggest in the general tenor of their 
contents that they are the same old reports which appeared in 
the earlier years of the last decade concerning the increased 
powers of muscular endurance which came about after the 
ingestion of the Erythroxylon Coca; the same properties now 
are attributed to the kola seeds. Secondly, ten years ago the 
physiological action of the African kola was well known, 
thanks to the work of Monnet, so that the drug is known to 
the well-read physician, and it is a little difficult to understand 
why, at the present time, kola is attracting so much attention. 
Within a few years West Indian kola has been introduced into 
the market, but since no variation in therapeutic effect is 
claimed, it need not be considered, apart from the likelihood 
of its being obtained in fresher condition than is the African 
kola; but of this more will be said later. The patience of the 
average medical reader has doubtless been sorely tried and his 
credulity severely taxed by the above-mentioned daily press 
reports; yet, since out of the exaggerations of the literature 
concerning Erythroxylon Coca came an accurate and working 
* Read before the Clinical Society of the New York Post-Graduate 
Medical School, October 35, 1895. 2 
physiology of cocaine, so even from these contributions to 
journalistic fiction the medical profession may come to a proper 
appreciation of the true value of kola. 
In 1883 the seeds as then obtained were very dirty and 
associated with all sorts of refuse. My personal experience 
with kola dates to 1887, although I knew something of it from 
the literature six years earlier, when I used a fluid extract of 
the seeds made by a skillful local pharmacist I well remem- 
ber the seeds. As then obtained they were dry, sound and 
free from intermixture with decayed seeds, but from them was 
obtained a preparation which gave one symptom in a more 
marked degree than any preparation of kola, and I have used 
all which I could obtain, and that symptom was persistent 
wakefulness. It was this preparation to which I alluded in 
the discussion on pneumonia at the New York Academy of 
Medicine in 1892, and the statement then made has been quoted 
by Shoemaker and others. These observations and the infer- 
ences to be drawn from them have an important bearing upon 
the claims, so persistently advanced, that freshness is a neces- 
sary quality of the seeds if one would be assured of their 
therapeutic activity. As is well known, the caffeine percen- 
tage increases in coffee on drying; why not in kola? Further, 
although it is possible to obtain fresh specimens of kola seeds 
in the market, is it likely that this will be the case when the 
transportation is via the Soudan from Central Africa, which is 
certainly well beyond the limits of express traffic? Certainly 
there is no preparation at present in the market, whether made 
from seeds certified to be fresh or from seeds that are fresh, 
without its being claimed that they are, which will give rise to 
such persistent wakefulness as did the fluid extract made from 
the old and dried seeds above mentioned. The suggestion is 
that caffeine is the more important constituent in kola; that 
was my opinion in 1887, and from frequent use of the many 
preparations in the market, I have never seen any reason to 3 
change it. If caffeine, then, is the principal constituent of 
kola, drying the seeds not only does not impair their thera- 
peutic efficacy, but on the contrary may even increase it. The 
physiology of caffeiue is, as regards muscular work, precise. 
We know that it augments the activity of the motor part of 
the nervous system and that it prevents the breathlessness and 
palpitation consecutive to violent exertion. As an explanation 
of its action upon the central nervous system, we may say that 
the motor voluntary influx starts from the cerebrum with a 
greater energy, and that it acts on the motor spinal centres in 
a more excitable state. So far as its action upon the pulse and 
respiration go, not only are they not so much accelerated upon 
exertion, but the painful oppression consecutive to it is not 
felt. In other words, the caffeine puts a person who has not 
gone through a course of training in the state of one that has. 
Thus may be explained the results obtained from kola when 
used before and during active muscular exercise. When, 
further, it is borne in mind that in kola caffeine is contained 
in kola-red (Heckel) or kolanine (Knebel) in a nascent condi- 
tion, to the extent, as has been claimed, of over 80 per cent., 
it can be readily seen that the conditions are favorable for the 
speedy utilization of the Caffeine and rapid development of its 
physiological effects. In this respect, then, kola is preferable 
to caffeine, but it should be regarded as a drug and not as a 
food. It is a drug of no mean potency when we remember 
that Lascelles-Scott found that kola contained 2.71 per cent, of 
the active principle. 
Theobromine, differing from caffeine only by the omission 
of a methyl group, contained in kola to the extent of two 
hundredths of one per cent., possesses diuretic effects, and 
these more lasting than those of caffeine. Since theobromine 
does not exert any action upon the nervous system as does 
caffeine and it is but very slightly poisonous, even in large 
doses, which could not possibly be brought about by the use 4 
of kola, because it is contained in it in so small a percentage, 
and because it is not likely to produce digestive disturbances, 
this constituent is a valuable one. Further, the patients do 
not become habituated to its use, nor is it cumulative in its 
action. Since, as Huchard has pointed out, the future of 
therapeutics lies in the diuretics, because the permeability of 
the kidney is the safeguard of the organism, be it healthy or 
diseased, permitting the elimination of the toxins which it 
produces or it receives, theobromine is an important constitu- 
ent, for it has been shown to be a non-irritant diuretic, acting 
solely upon the epithelial renal cells and frequently producing 
copious diuresis even after a small dose. This effect is useful 
in that the results of nitrogenous waste from muscular exercise 
would be more rapidly eliminated and thus the feeling of 
fatigue lessened. 
So far as the kola-tannic acid is concerned, about one and 
a half per cent., to this may we look for the beneficial effects 
upon diarrhoeas. Although the statements of authors in regard 
to the results of its administration in diarrlioeal conditions are 
true, so far as they relate to diarrhoeas in debilitated individ- 
uals, I do not believe that there is sufficient tannic acid present 
to cause constipation in normal conditions of the intestinal 
tract; at least I have never observed that result. What is true 
of the action of kola upon persons who employ it as an assis- 
tance to the accomplishment of muscular exercise, that its 
action depends upon the nascent caffeine, is equally true when 
the drug is used as an agent for improving nutrition. Partly 
by increasing the force and frequency of the pulse the blood 
tension rises and metabolism is carried on more rapidly. 
Monnet believes that kola either augments the secretion of the 
gastric juice, or it acts upon the smooth fibres of the stomach, 
so that digestion is improved. This conclusion is undoubtedly 
correct, although the explanation may not be quite so simple 
as Monnet believed. 5 
During the past eight years I have used kola, in various 
forms, in a large number and variety of pathological conditions 
and in varying amounts. It is not often that morbid somno- 
lence appears as an absolute therapeutic indication, yet there 
are instances in which the cause can be definitely stated to be 
not dependent upon dyspepsia in its various forms, diabetes, 
lithaemia, gout, nervous exhaustion, or malarial diseases, which 
call for direct medication. In a recent instance a fluid extract 
of kola, made by Parke, Davis & Company, succeeded when 
caffeine alone and when combined with strychnine had failed. 
In this case it was necessary to increase the dose beyond that 
laid down (10 to 30 minims). When fatiguing literary work, 
protracted inspection of reports, long continued and especially 
monotonous mental exercise must be performed, kola is pre- 
ferable to any which I am familiar. In such con- 
ditions as pneumonia, when a cardiac stimulant is necessary, 
and caffeine is particularly indicated, kola is frequently ser- 
viceable, but as I have stated at another place, it is liable to 
cause wakefulness, and for that reason is not so useful as 
might be expected. The great role which kola plays in modern 
therapeutics is, without doubt, in diseases which are character- 
ized by great nervous weakness and in the convalescence from 
acute diseases in which wasting is pronounced, of which 
typhoid fever is the type. Here I have found its greatest 
field of usefulness. Its marked effect in relieving the mental 
depression, the diminution of the natural tendency to faintness, 
the improvement in the appetite and digestion, the disappear- 
ance of nervous irritability, the acquisition of the ability to 
undergo muscular exertion, is too well known an essential to 
be lightly passed over. Much as the scientific physician may 
wish to discard the term ‘ ‘ tonic ” from his vocabulary, there 
yet remains a class of drugs, in which *kola is of high rank, 
which is best so designated. No one disease is an indication 
for its employment, nor is any one disease an absolute contra- 6 
indication. During the past year I have used the compound 
elixir of the manufacture noted above, which contains kola, 
coca and celery seed, of each forty grains to the fluidounce of 
menstruum, which has given me excellent results where neu- 
rasthenic conditions were prominent. This is of itself valuable, 
but is as well an excellent vehicle of pleasant taste for the 
administration of tincture of strophanthus, of nux vomica, or 
of digitalis. In the various other preparations, many of which 
are elegant, I have not had the same confidence; also some are 
so strongly alcoholic as to possess considerable attraction to 
those who prefer to take their indulgence under other than its 
true name. That kola is an antidote to the effects of alcohol 
cannot, I believe, be maintained. 
Although the extravagant claims which have been made 
for Kola cannot be upheld, I am firmly of the opinion that it 
is a drug of sufficient value to have a permanent and important 
place in the Materia Medica. We may then conclude that 
1. Kola is of value in the performance of muscular feats 
from the caffeine which it contains in a nascent condition. 
2. Kola is invaluable for the relief of the symptom of 
morbid somnolence. 
3. Kola is specially indicated in the convalescence from 
acute diseases, in chronic affections marked by nervous de- 
bility, and as a vehicle for the administration of cardiac 
stimulants. 
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