Historical perspective--the long and colorful history of Erythoxylon coca.

Abstract

Abstract The rate of increase in the use of cocaine among college students has been greater even than the increase in the use of marijuana during the past ten years. Nationwide surveys indicate that 9 million Americans within the 18–25 age group, or 28.7%, have used cocaine. This compares with 2.9 million, or 9.1%, just a decade ago. The history of cocaine begins with the history of the coca plant. Even prior to the inca period the plant was used in South America; for centuries use of the plant remained restricted primarily to that continent. In 1859, an Austrian explorer brought home from Peru coca leaves that he sent to the University of Gottigen where Dr. Albert Niemann extracted and purified a crystalline compound he called cocaine. Several prominent physicians including Sigmund Freud and William Halsted, the father of modern surgery, experimented with cocaine on themselves and on their patients. Their published observations helped effect widespread use of cocaine in patent medicines, tonics, wines, and soft drinks. That earlier epidemic and the rest of the long and colorful history of cocaine brings into perspective the current epidemic of cocaine use. “Mild Hypertension: When and How to Treat,” NORMAN H. KAPLAN. “Early and aggressive” drug therapy for mild hypertension, now widely prescribed in the United States, may be inappropriate for many of the 30 million patients with this condition. Although all of these patients are at greater risks of premature cardiovascular disease, the risks are manifested neither quickly nor uniformly. Drug therapy has not proved beneficial for patients with a diastolic (D) BP reading below 100 mm Hg, particularly those patients who are otherwise at low risk. Those antihypertensive drugs that are available now carry risks along with their benefits. Therefore, persons with mild hypertension who are at low risk should be encouraged to use nondrug therapies for at least six to 12 months. If their DBP remains below 100 mm Hg, they may be better off than if they were given drugs. The drug used in initial therapy has usually been a diuretic. For many patients, however, an adrenergic inhibitor may be a more appropriate choice. (Archives of Internal Medicine, 1983;143:255–259) “Persistence of Normal BP After Withdrawal of Drug Treatment in Mild Hypertension,” PAUL D. LEVINSON, IBRAHIM M. KHATRI, EDWARD D. FREIS. Antihypertensive therapy was discontinued in 24 patients with mild hypertension whose BPs had been well controlled with diuretics alone. Eleven patients (46%) maintained normal diastolic BPs (≤ 90 mm Hg) for six months after stopping treatment and five patients (21%) for 12 months. All patients who remained normotensive for six to 12 months had mean diastolic BPs of 82 mm Hg or less during treatment. There was no signficant correlation between maintenance of normotension and any of the following: pretreatment BP, presence of target-organ damage, duration of known hypertension, family history of hypertension, heart size, body weight, weight gain after stopping diuretic therapy, 24-hour urinary sodium and potassium excretion, serum electrolyte values or renin profile. This study demonstrates that hypertension may be favorably modified, sometimes for many months, by effective antihypertensive treatment. (Archives of Internal Medicine 1982;142:2265–2268)