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COCAINE                                                             689

had been plugged for ten minutes with a pledget of cotton wool soaked in a 4 per cent
solution or cocaine hydrochloride and sprayed twice with the same solution for sub-
mucous cauterization of the inferior turbinate. In all about a drachm of the solution
had been used. The patient became excited and restless, and began to shout and talk
at random. He was delirious. His mouth and throat were very dry, and his face became
flushed. He complained of intense thirst. The temperature was 101 °F. The pupils were
dilated. The respirations were hurried and the pulse was feeble and rapid. An attempt
was made to produce vomiting, but of no avail. He was then given a tablet of luminal
and became quiet within an hour (4 hours after the onset of the symptoms). The mouth
became moist 5 hours later. He recovered completely the next morning.

Fatal Dose.—The usual fatal dose of cocaine may be considered to be 10
to 15 grains administered by the mouth, but a much smaller quantity may
cause death if injected hypodermically or applied to the abraded skin or
mucous membrane. Two-thirds of a grain injected hypodermically has
caused the death of an old woman, and 7 ml. of ten per cent cocaine solution
injected into the urethra of a male patient, aged 60 years, proved fatal.32 It
should, however, be remembered that much larger doses can be tolerated
by habit.

Fatal Period.—Death usually takes place in from a few minutes to a few
hours. A young woman in Bareilly died in 3 to 4 hours as a result of having
taken cocaine in excess.33 A Parsi lad,34 16 years old, died in 3 hours and
50 minutes after the use of cocaine as a local anaesthetic for the removal of
the tonsils. The operation was successful.

Treatment.—Use emetics or wash out the stomach with warm water
containing finely powdered charcoal, potassium permanganate or tannic acid
if cocaine has been taken by the mouth. Wash out the mucous membrane,
if it has been applied to the nose or to the throat. Try to ligate off the part
as far as possible, if it has been injected hypodermically. Keep the patient
in a recumbent posture. Administer stimulants, such as ammonia, digitalis,
caffeine, strychnine, and nikethamide (coramine). Administer chloroform to
combat convulsions but do _r|Qt give morphineT which may endanger life, as
it hastens respiratory failure.

Amyl nitrite is considered an antidote and should, therefore, be given
by inKalatioru Carry on artificial respiration, if necessary.

Mayer35 advises the use of calcium chloride to inhibit the toxic action
of cocaine. M. Reese Guttman30 has found that phenobarbital (luminal) is
the best remedial agent in the treatment of cocaine poisoning, and suggests
the prophylactic use of three grains by the mouth 30 minutes before
anaesthesia. It can also be given hypodermically. Tatum. and his co-
workers 37 recommend the use of 100 mg. of soluble barbital dissolved in 5 cc.
of a standard solution of paraldehyde per kilogramme of body weight.
Slow intravenous administration of a short acting barbiturate, e.g. pento-
barbital sodium 0.3 to 0.5 gram; or amobarbital sodium 0.4 to 0.8 gram is also

Post-mortem Appearances.—Marked hyperserrxia of the brain, spinal
cord and other internal organs.

A woman, about 30 years old, was found alive at about 11 p.m> on the 16th June
1914, and was found dead on the following morning at 11-30 a.m., when .her paramour
came to visit her. Post-mortem examination showed that the mucous membrane of the
stomach was slightly congested. The stomach contained a quantity of semi-digested

32.    J. Cid. Dos. Santos, Lancet, Feb. 11, 1950, p. 283.

33.    U.P. Chemical Examiner's Annual Report, 1925, p. 4.

34.    Gaekwar, Med.-Leg. Jour., July-August 1931, p. 119.

35.  ^.Schw. Med. Wchnschr.j Aug. 18, 1921, p. 767 ; Jour. Amer. Med. Assoc., Oct. 15,
1921, P-. 1290; Fabry, Munch. Med. Wchnschr., 1922, Vol. 69, p. 969.                        x

36.    Jour. Amer. Med. Assoc., March 10, 1928, p. 753.

37.    Jour. Amer, Med. Assoc., March 10, 1928, p, 754.