COCAINE. 
427-] 
359 
from the external application of cocaine ; few, however, end fatally. 
Cocaine has thus produced poisonous symptoms when applied to the eye, 
to the rectum, to the gums, to the urethra, and to various other parts. 
The cocaine habit is on the increase, and there have been a few fatal 
cases, both from its external and internal administration. Three cases 
are recorded in England and Wales during 1911-1916. Mannheim has 
collected eleven of such instances. 
The action of cocaine is twofold : there is an action on the central 
and the peripheral nervous system. In small doses cocaine excites the 
spinal cord and the brain ; in large it may produce convulsions and then 
paralysis. The peripheral action is seen in the numbing of sensation. 
There is always interference with the accommodation of vision, and 
dilatation of the pupil. The eyelids are wider apart than normal, and 
there may be some protrusion of the eyeball. 
The usual course of an acute case of poisoning is a feeling of dryness 
in the nose and throat, difficulty of swallowing, faintness, and there is 
often vomiting ; the pulse is quickened ; there is first cerebral excitement, 
followed usually by great mental depression. Occasionally there is an 
eruption on the skin. Hypersesthesia of the skin is followed by great 
diminution of sensation, the pupils, as before stated, are dilated, the eyes 
protruding, the eyelids wide open, the face is pale, and the perspiration 
profuse. Convulsions and paralysis may terminate the scene. Death 
takes place from paralysis of the breathing centre ; therefore the heart 
beats after the cessation of respiration. As an antidote, nitrite of amyl 
has apparently been used with success. 
There is a form of chronic poisoning produced from the taking of 
small doses of cocaine daily. The symptoms are very various, and are 
referable to disturbance of the digestive organs, and to the effect on the 
nervous system. The patients become extremely emaciated, and it seems 
to produce a special form of mania. 
In the trial of Raoul Reginald de Veuille for the manslaughter of 
Florence Leonora Stewart, known better under her stage name, Billie 
Carleton, it was proved that the latter was an habitual consumer of 
cocaine, and that she often took it as snuff. There was no precise evidence 
as to the time elapsing between the sniffing of the cocaine into the nostrils 
and death, but it may be gathered that it was something like six or 
seven hours. No cocaine was found in the organs, but yth of a grain was 
recovered from the nostrils. The post-mortem appearances were those 
of general congestion of the organs. The pupils were dilated. It was 
stated in evidence that fth grain of cocaine injected hypodermically had 
caused death, and that, administered in this way, a fatal effect would 
ensue within three or four hours. The defence attempted to show that 
the death was not due to cocaine, but to a slower-acting poison such as 
veronal or trional ; neither of these poisons was detected. . 
