SCIENCE. 



FRIDAY, APRIL 8, 1887. 



COMMENT AND CRITICISM. 

 The discussions as to cocaine and its effects 

 proceed with vigor, and, while no consensus of 

 opinion seems to have been arrived at by medical 

 authorities, yet the number of cases of the use of 

 the drug that have been observed and studied is 

 rapidly increasing, and will afford the ultimate 

 investigator a large amount of material to go 

 over. The Brooklyn physicians have lately taken 

 a public stand in the matter, based on a paper by 

 Dr. J. B. Mattison, which emphatically opposes 

 the views expressed by Dr. Hammond and others, 

 which have been heretofore commented on in these 

 columns. The action of the Brooklyn physicians 

 takes the form of the draught of a bill to be pre- 

 sented to the legislature, which places cocaine on 

 the list of poisonous drugs to be sold only on a 

 physician's prescription. In his paper. Dr. Matti- 

 son says that " no advent in the therapeutic arena 

 during the last decade has been attended with 

 such varied and extensive claims for favor as co- 

 caine. Its marvellous effect in ophthalmic surgery 

 roused a spirit of experimental research in other 

 directions which has added largely to its well- 

 proven power for good ; but a potency for good 

 implies a potency for harm, and the risk impends 

 of its ardent advocates being carried by over- 

 enthusiasm beyond the limit of a safe regard for 

 the welfare of their patients or themselves that 

 may imperil an otherwise well-founded success." 

 He believes that the time has come when the evi- 

 dence justifies a strong statement of the harmful 

 effects of the drug ; and, in combating Dr. Ham- 

 mond's views, Dr. Mattison adduced fifty-one cases 

 of the use of cocaine which attested a power in 

 the drug, on some patients, that warrants caution 

 with all. 



Of the cases brought forward by the speaker, 

 one was that of a young woman, twenty-three 

 years of age, who died from an application of 

 cocaine made during an operation for the removal 

 of a tumor in the intestines. Another was the 

 case of a man, aged thirty-three, to whose larynx a 

 four-per-cent solution of cocaine was applied, and 



No. 218 — 1887. 



who died from cocaine-poisoning after the second 

 application. A third was the case of a woman in 

 middle Ufe, whose death resulted from the use of 

 a four-per-cent solution for tooth-ache. Numer- 

 ous cases were given of the poisoning resulting 

 from the use of cocaine as an anaesthetic in surgi- 

 cal operations. Among the effects noted were de- 

 pression of the brain, profuse sweating, impend- 

 ing syncope, difficult respiration, twitchings of 

 the muscles, mania, paralysis of the heart, nausea, 

 rigors, and so forth. Dr. Mattison further insist- 

 ed that Dr. Hammond's assertion that there is no 

 danger of cocaine addiction because he himself 

 took half a dozen doses at intervals of from one 

 to four days without ' acquiring a habit,' is value- 

 less as evidence, because " cocainism is not the 

 outcome of using the drug at long intervals. Its 

 transient effect and the demand of an impaired 

 nerve status compel frequent taking, — more than 

 alcohol or opium, — so that habitu6s have been 

 known to take it ten, twenty, or more times daily; 

 and it is this — growing by what it feeds on — 

 that tends to create and continue the disease." 

 Dr. Mattison's own professional experience has 

 proven for him two things, — first, that cocaine 

 quid cocaine possesses a pernicious power ; and, 

 second, it finds in the opium-taker a peculiar con- 

 dition that specially favors its ill effects, making 

 it for such patients peculiarly dangerous. In con- 

 cluding his paper, the writer summarized thus : 

 " Cocaine may be toxic, sometimes deadly, in 

 large doses. It may give rise to dangerous or 

 even fatal symptoms in doses usually deemed 

 safe. The danger, near and remote, is greatest 

 when given under the skin. It may produce a 

 diseased condition, in which the will is prostrate 

 and the patient powerless, — a true toxic neurosis, 

 more marked and less hopeful than that from 

 alcohol or opium. 



Dr. Crothers, in the Medical and surgical re- 

 porter, gives the following statement of his views 

 on cocaine : "Among alcohol inebriates and drug 

 maniacs, cocaine inebriety is no doubt increasing. 

 Its peculiar dangerous effects on the body will 

 prevent its general use as an intoxicant to any 

 great extent. It acts more rapidly than opium, 

 but its effects pass off more quickly. Its first ef- 



