2. Therapeutic Retrospect

Abstract

The use of cocaine is so widespread that a few words of caution against its indiscriminate employment may not be superfluous. From time to time cases in which alarming symptoms have followed the use of cocaine are noted, but they do not attract much attention. Dr. Edmund Falk, of Berlin, is the more to be thanked for having collected and tabulated 176 cases of poisoning by therapeutic doses of cocaine. The dose employed, with its method of employment, and the results following the use, are carefully set down. Dr. Falk excludes from his table not a few cases of syncope which have been set down to cocaine, but which he considers may be referred to the operation itself. He is also of opinion that a majority of cases have not been published, and further that a large number of cases of insanity are to be found in the asylums, which have arisen from the prolonged use of cocaine. The 176 cases which he has tabulated will, therefore, fall very short of representing the real toxic dangers of cocaine. Ten fatal cases are to be found in the list. Two of these fatal cases followed the use of a four per cent, solution of cocaine applied to larynx or pharynx. One case followed the injection of 0·06 gramme (10 grain) beneath the mucous membrane of the gums; another, the subcutaneous injection of a little over three grains. The smallest dose causing death was 0·6 grain (0·04 gramme) injected subconjunctivally. Short of death, very alarming symptoms are frequently noted, such as pallor, cyanosis, vertigo, fainting, collapse, unconsciousness, more or less prolonged, delirium, hallucinations, diminished general and special sensibility, impairment of vision, deafness, etc., etc.