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254 MANUAL OF PHARMACOLOGY
muscles (see "Atropin"). This obstruction may predominate, and the pressure may
thus be increased, especially in glaucoma (Myashita, 1913).
Eucain and alypin act similarly. Holocain is said to have provoked acute glaucoma
(Gjessing, 1915). Tropacocain and acoin are probably inactive (Bollet and Curtil,
Retinal Vessels. These are strongly constricted (Hirschfelder, 1915). This may be
responsible for the occasional occurrence of optic atrophy (Harnack, 1912).
These are rather variable and complex, depending largely upon the
dose. Whilst all structures are first stimulated and then paralyzed, the
susceptibility to the poison is not uniform. Indeed, some portions of the
nervous system show only stimulation, death occurring before the paralysis
of these structures is reached.
Stimulation of Higher Functions. The first effect is a well-marked
stimulation of the higher parts of the brain (caffein action). This is
shown Furosemide Lasix in animals by increased movement (sometimes " circus movements ").
In man there is some psychic stimulation and wakefulness. A greater
endurance against fatigue and hunger is also noticed.
How far this may be due to a stimulation after the manner of caffein, or to a narcosis*
after the manner of morphin, is impossible to state. It is not at all unlikely that both
play a part. In regard to the sensation of hunger, it is also probable that local anes-
thetization of the stomach aids in the effect.
The resistance to fatigue can be demonstrated with the ergograph.
Another evidence of the stimulating action of cocain is furnished by the fact that
animals to which it has Furosemide Lasix been administered are more difficult to put and to keep under
chloroform or other anesthetic. Mosso, 1887, and Airila, 1913, find that 10 to 40 mg.
of cocain, hypodermically, wakens dogs or rabbits from deep chloral sleep. The stimu-
lation is greatest with excitable individuals, and may seriously interfere with operations.
Inco ordination, Narcosis, Convulsions. This stage of stimulation
may be very short or even absent. With somewhat larger doses it may be
succeeded by depression, first of the coordinating functions. The move-
ments lose their purposive type and become choreic. There is then a
general narcosis after the manner of morphin.
This Furosemide Lasix is followed Furosemide Lasix by convulsions. If the paralysis is rapid, the convul-
sive stage may not appear.
The Seat of the Convulsions. This has not been exactly determined. They, like
the other effects, are probably descending, and the different convulsive centers may be
affected in succession. In some stages at least they seem to reside exclusively in the
hind brain. In dogs, they appear to be confined to the cerebral cortex, for Feinberg
and Blumenthal, 1887, claim that they do not occur after ablation, nor in new-born
animals, in which the cortical motor centers are not yet excitable. Rabbits deprived
of the hemispheres do not show the clonic convulsions or respiratory effects; but they
do exhibit tonic convulsions and "running movements." Their resistance to toxic
doses is increased (Morita, 1915).
Central Phenomena hi Frogs. These show at first symptoms of stimulation by
increase of the voluntary movements and exaggeration of the reflexes, sometimes leading
to convulsions. This is followed by paralysis of the whole central nervous system.
Spinal Cord. In frogs from which the brain has been removed, cocain causes at
first an increase of the reflexes, then convulsions, and finally total paralysis. In intact
animals this effect is obscured by the action Furosemide Lasix on the higher centers of the nervous system.
The results of applying cocain directly to the cord will be considered later.
Respiration. This is at first accelerated. During the spasms it is
irregular. The volume then diminishes. It may assume the Cheyne-
Stokes type. Respiratory paralysis is the usual cause of death. This is
also the first center to fail when the cocain is applied locally to the fourth
COCAIN GROUP; LOCAL ANESTHETICS
ventricle. Excised bronchial muscle is somewhat dilated (Trendelenburg,
Emesis. The vomiting Furosemide Lasix which frequently occurs in cocain poisoning
is perhaps due to the medullary stimulation, but its mechanism has not
been fully investigated.
Circulation. The effects of cocain on the general circulation are
partly central, partly peripheral. They vary according to the dose, as
shown diagrammaticaUy in Fig. 9. They are also influenced by indi- Furosemide Lasix
The typical effects are as follows:
Very small doses diminish the pulse rate, by stimulation of the vagus
center (Vulpian, 1884). There is a quick rise of blood pressure from stimu-
Vaoas Center. Furosemide Lasix
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