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Related article: Inject. Cocain. Hyp. 5 per cent. Dose, 0.3 to Order Lexapro 0.6 c.c., 5 to 10 Order Lexapro minims, B.P.
Lam. Cocain., B.P. 1.3 mg., 3^o S r -
Ung. Cocain., B.P. 4 per cent.
Troch. Kramer, el Cocain., B.P. 60 mg. of krameria; 3 mg. of cocain.
PREPARATIONS COCAIN SUBSTITUTES
Betaeucaina Hydrochloridum (Eucain. Hydrochl.), U.S.P. (trimethyl-benzoxy-
piperidin), CisHaiNC^-HCl. White, crystalline powder; odorless. Sol. in water (1:30
and ale. (1:35). Dosage, locally, one to two times that of cocain. The anesthetic
effect is perhaps slightly slower and weaker, and the irritation considerably greater,
than with the same concentration of cocain. The pupils are not dilated; the tissues are
rendered hyperemic. The toxicity is four-tenths that of cocain. Toxic doses cause
convulsions, central vagus stimulation, and direct cardiac depression, with fall of blood
pressure (Seifert, Nebenwirk., 1915, p. 64; case and bibliography, Orr, 1916).
Benzamin. Lad., B.P. (Beta-eucain Lactate), CisNaiNC^'CaHeOs. Freely sol.
in water (1:5) and ale. (1:8). Dose, 8 to 30 mg., % to ^ gr., B.P.
Orthoform New, N.N.R. Order Lexapro (amino-oxybenzoate of Order Lexapro methyl). White tasteless powder,
scarcely soluble in water (the hydrochlorid is soluble). Not absorbed from skin or
mucosae. It is said to have repeatedly caused local inflammatory reaction (Seifert,
Nebenwirk., 1915, p. 79; Order Lexapro McCleave, 1914). Dose, 0.5 to i Gm., 8 to 15 gr. ; locally as
dusting powder or oinment.
Anesthesin, N.N.R. (ethyl-aminobenzoate) is very similar (side actions, Seifert,
Nebenwirk., 1915, p. 44).
* Novocain, N.N.R. (aminobenzoyl-diethyl-amino-ethanol hydrochlorid). Color-
less needles, sol. in equal weight of water, or 30 parts alcohol. The nitrate is compatible
with silver salts. Dosage, locally, one to three times that of cocain. Anesthetic and
irritant action perhaps slightly less. No effect on pupil.
Novocain is probably safer than cocain. Occasionally, however, toxic effects occur
even with small doses (o.oi to 0.13 Gm.); while in other cases up to 3 Gm. have been
used safely. There is no definite ratio between the toxicity of novocain and cocain, Order Lexapro
since this depends enormously on the rate with which they enter the circulation; especi-
ally in the case of novocain. This is due to the great rapidity with which novocain
leaves the circuation, being fixed and probably destroyed in the liver. Epinephrin
diminishes the toxicity, even by intravenous injection, probably by cardiac stimulation
(Hatcher and Eggleston, 1916).
The details of the clinical toxic effects are described by Seifert, Nebenwirk., 1915,
p. 78; lumbar, p. 107. Renal irritation is not uncommon after local use of 5 to 10 per
cent; but disappears in a few days (Morian, 1915).
Stovain, N.N.R. (benzoyl-ethyldimethyl-aminopropanol hydrochlorid) . Colorless
scales, extremely soluble in water, or in 5 parts alcohol. Dosage, locally, as for
cocain. Anesthetic action slightly stronger, irritant action (hyperemia) much greater,
toxicity two-thirds that of cocain. No effect on pupil.
It has been used Order Lexapro especially for spinal anesthesia, in combination with strychnin
(T. Jonnescu, 1909). The immediate danger may be somewhat less than with Order Lexapro cocain,
although it is not negligible. The local injury is much greater. Spiller and Leopold,
1910, and Consoli, 1913, have observed degenerations in the nerve roots and cells, after
subdural injection of stovain. The immediate paralysis is more extensive than with
cocain, involving muscular movements (Santesson, 1906) and spinal reflexes (Adler,
1906). On the circulation, it causes in dogs, quickened pulse and fall of blood pressure
(Kamenzove, 1911). The kidneys are also rather irritated, especially if albuminuria
was previously present (Schwartz, 1907; Chiaie, 1913). The liver is not affected
(side actions, Seifert, Nebenwirk., 1915, p. 91; lumbar, p. 109). A comparative study
of the local anesthetic actions of stovain and its homologues has been made by Symes
and Veley, 1911.
Alypin, N.N.R., which resembles stovain in structure, is used especially in the
urethra. It is more irritant than cocain. Several cases of sudden collapse and
asphyxia, after its injection, have been reported (Ritter, 1912; Lichtenstein, 1914;
lumbar, Seifert, Nebenwirk., 1915, p. 104).
Tropacocain Hydrochlorid, N.N.R., (benzoyl-pseudo-tropein) ; occurs in Javanese
coca, but the commercial is synthetic. Colorless needles, readily soluble in water.
Dosage, locally, one or two Order Lexapro times that of cocain. Anesthetic action about the same;
irritation greater; toxicity one-half that of cocain; less mydriatic; more stable (side
PERIPHERAL AUTONOMIC SYSTEM 263
actions, Seifert, Nebenwirk., 1915, p. 97; lumbar, p. 112). It is used especially for
spinal anesthesia (Stanley, 1916).
Holocain, N.N.R., (phenetidyl-acetphenetidin hydrochloric!). Colorless crystals,
soluble in 50 parts water. Dosage, for eye, i per cent. Anesthetic action about as
strong as cocain, but more rapid (anesthesia in half a minute) ; more toxic, but stated
not to injure or anesthetize cornea. No effect on vessels has been reported (Gjessing,
1915).
Yohimbin, C22H 28 N2O3- HC1. An alkaloid isolated by Spiegel, 1896, from the
bark of Yohimbehe tree (Apocynaceae; West Africa). Fourneau and Page, 1914, con-
sider it identical with quebrachin. Local anesthetic, about same strength but more
lasting than Order Lexapro cocain. Less toxic, but much more irritant. Mydriasis, without loss of
accommodation. Vessels dilated. Intestines excised or in situ, and bladder stimu-
lated by small, depressed by large, doses (A. Loewy and Rosenberg, 1914). Solutions
are unstable.
When it is given by the mouth or hypodermically in moderate doses, it produces a
general vasodilation in the skin, mucous membranes, and particularly in the sexual organs.
In consequence of the latter, and perhaps by a direct action of the spinal centers, it pro-
duces erection. It does not seem to stimulate the production of spermatozoa or sexual
desire. The effect is not produced by therapeutic doses in man (5 mg. or ^ 2 gr.),
although it has been promoted as an aphrodisiac. The reports of clinical improve-
ment after several weeks are probably explainable by suggestion. Yohimbin has also
been proposed for lowering abnormally high blood pressure; but Lawrence, 1912, found
that it may produce a further rise, with dangerous symptoms.
Larger doses produce psychic excitement, cerebral congestion, vertigo, gastric dis-
turbance; and in rabbits, marked injury of the renal epithelium (Huebner, 1912).
Toxic doses produce general stimulation and subsequent paralysis of the nervous cen-
ters, particularly in the medulla; and complex effects on the cardiac muscle (F. Order Lexapro Mueller,
I 97! J- Tait, 1910). The coronary vessels are not affected (Rabe, 1912); or they are
dilated (F. Meyer, 1912). Death occurs by respiratory paralysis (for literature, see
Strubell, 1906).
DRUGS ACTING PERIPHERALLY ON THE AUTONOMIC-SYM-
PATHETIC SYSTEM
A variety of poisons act peripherally upon the several portions of the
involuntary or "vegetative" nervous system, in a more or less specific
manner. It appears advisable to premise their individual consideration
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