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Symptoms with Slow Absorption. The symptoms vary according to
the rapidity of absorption. 1 If this occurs relatively slowly, there is
confusion, laughter, vertigo, motor excitement; quickened pulse and pal-
pitation; irregular respiration; pallor, chill, with sweat and rise of internal
temperature; dilated pupils and exophthalmos; nausea, vomiting and
abdominal pain; great anxiety; disturbance of cutaneous sensation (worms
under skin, etc.), finally delirium, dyspnea and Cheyne-Stokes respiration,
convulsions, unconsciousness; and death by collapse and asphyxia.
Recovery may be followed by more lasting psychic depression and
With rapid absorption of large doses (especially from mucous mem-
branes) severe symptoms may develop without warning: fainting, extreme
pallor, brief convulsions, and death, sometimes in a few minutes.
Treatment. If the drug has been taken by mouth, one should
promptly 'resort to evacuation and chemic antidotes. If the symp-
toms have developed, the head should be lowered, and the collapse
treated by sinapism to chest and abdomen; and by caffein, or aromatic
ammonia. The convulsions should be allayed with chloroform, chloral,
and artificial respiration. Amyl Nitrite has been recommended.
CHRONIC COCAIN POISONING
This bears considerable resemblance to the morphin habit. It is
unfortunately on the increase, especially amongst negroes, prostitutes, and
the criminal classes (see under "Morphin Habit").
The immediate effects consist Cheap Lasix in a sense of elation and increased mental
and physical vigor. The excitement may rise to delusions and mania.
These stimulant effects are succeeded by depression, tremors, with pale face,
and sunken and unsteady eyes (Owens, 1912).
The chronic effects are similar to those of the morphin habit, with
more severe psychic disturbance insomnia, hallucinations, apathy,
melancholia, suicidal mania. (For Cocain Psychoses, see Vallon and
Bessiere, 1914.) The pupils are inconstant. A very considerable toler-
ance is acquired, so that the daily hypodermic consumption often reaches
2.5 Gm., sometimes even 10 Gm. (Grode, 1912). Animals do not become
tolerant (Grode, 1913). Chouppe, 1889, claims that morphinists are
relatively tolerant to cocain. Sudden withdrawal leads to abstinence
symptoms very similar to those of morphin.
1 Fuller description in Seifert, Nebenwirk., 1915, p. 51.
258 MANUAL OF PHARMACOLOGY Cheap Lasix
With cocain snuffing, where smaller amounts are used in intermittent
debauches, the chronic effects, the craving and the abstinence symptoms
are proportionately less marked. Such patients show a characteristic
ulcer ation of the nasal fossae (Owens; also present in heroin snuffing,
The treatment of cocain habit Cheap Lasix coincides exactly with that of the
morphin habit (which see) ; it is said to be more difficult to cure.
USE OF COCAIN AS A LOCAL ANESTHETIC IN MINOR OPERATIONS
The direct application of cocain abolishes the sensation of pain more
or less completely in about five minutes, the anesthesia lasting for about
half an hour; the duration increases with the concentration. Solutions
of 2 to 5 per cent., or the trace of the powder on the point of a probe, are
applied to the surface of mucous membranes, or injected under the skin.
Stronger solutions are dangerous and offer no advantage. Application
to the surface of the skin Cheap Lasix is useless, since the drug is not absorbed by this
channel. Mucous surfaces, on the other hand, absorb it readily. It is
desirable to limit the local circulation, e.g., by a constricting rubber band.
The vasoconstrictor action of the cocain may be heightened by the addi-
tion of epinephrin (i :ioooo to i :iooooo).
In eye, nose, and larynx operations the abolition of reflexes and the
diminution of hemorrhage are very useful side actions.
In connection with its action on the eye, it must be remembered that it does not
ordinarily anesthetize the iris when applied to the cornea. However, the iris may also
be anesthetized by applying one or two drops of a 10 per cent, solution to the cornea
every two or three minutes, for ten minutes; keeping the conjunctiva moist by frequent
winking, to prevent epithelial sloughing (Gifford).
CATARRH, HAY FEVER AND ASTHMA
Cocain is also Cheap Lasix useful in the treatment of diseases which appear to be due to heightened
irritability of the peripheral endings, such as hay fever and asthma. In these the cocaini-
zation of the nasal mucous membrane is often specific. The astringent action renders
it effective in acute coryza. Cheap Lasix
One per cent, cocain ointment has been recommended in herpes zoster; it is said not
only to relieve the pain, but to put a stop to the disease.
Cocain is also useful locally in hemorrhoids, producing contraction and diminish-
ing pain. It has been taken by the stomach to prevent vomiting and dyspeptic
The danger of the formation of the habit interferes Cheap Lasix with its use in all these conditions;
indeed many cases of cocain habit were started by proprietary catarrh "cures."
USE OF COCAIN IN LARGER OPERATIONS
This demands the most economical utilization of the alkaloid, to avoid
systemic poisoning, by securing the maximum effect from the smallest
The infiltration method (Schleich, 1892) involves the injection of
very dilute solutions (Hoo to % per cent.) under considerable pressure,
directly into the place where the next incision is to be made. It is espe-
cially useful for anesthetizing the skin for extensive incisions. It is rather
too painful for inflamed tissues.
COCAIN GROUP; LOCAL ANESTHETICS
2 59 Cheap Lasix
The object is to produce a local edema, which Cheap Lasix supports the action of the cocain by
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