Nervous System. - When given internally its first action is upon the cerebrum, moderate doses greatly stimulating the intellectual faculties and producing a feeling of ecstacy and well-being, in many respects akin to the sensations experienced under the action of cannabis Indica. In the course of a few hours the stage of cerebral excitement is succeeded by mental, moral, and muscular depression. The motor cortex is also stimulated, causing increased muscular excitement or restlessness. Garrulousness is usual.

Large doses result in incoherent speech and wild delirium, accompanied by swaying of the head, followed by epileptiform convulsions and narcosis. The convulsions are partly of cerebral or of basal ganglionic origin. There is a distinct increase in the ability to carry on mental labor.

The medulla is markedly stimulated where a distinct action on the centers of breathing and of circulation is manifested.

The sensory nerves are depressed by small and paralyzed by lethal doses. The motor nerves are also depressed by large doses, this action, however, being subordinate to that exerted upon the sensory nerves. The muscles are stimulated by medicinal doses through impression upon the motor tracts, although large doses greatly depress muscular activity. The chewing of coca, as practised by the natives of Peru and Bolivia, undoubtedly appears to augment muscular strength and powers of endurance.

Mosso claims that small doses of cocaine serve as a powerful muscular stimulant in cases of exhaustion from hunger or fatigue. The analgesia produced is largely responsible for the sense of muscular power. Tire is not felt as its physiological accompaniment.

Respiratory System. - Medicinal doses powerfully stimulate the respiratory center, increasing the rapidity and depth of the respirations. Poisonous doses paralyze the center, the result being dyspnea, slower, feeble breathing, and death from respiratory failure, usually ushered in by convulsions, and often Cheyne-Stokes rhythm.

Absorption and Elimination. - Cocaine is quickly absorbed, being eliminated principally by the kidneys in a form differing from its original nature. Much of it probably undergoes oxidation in the body. The amount of urine is increased, though the nitrogenous elements are diminished. The habitual use of the drug lessens urinary secretion.

Cocaine possesses no cumulative action. Metabolism is slightly increased by the augmented muscular activities, but the exact relations of cocaine to metabolism are not yet available.

Temperature. - Medicinal doses have no influence on bodily heat, but poisonous doses usually raise the temperature, owing, according to Reichert, to an increase of heat-production.

Eye. - Cocaine produces a noticeable dilatation of the pupil, as already explained under "Local Action," the maximum change being reached in about an hour, and the normal state regained in from twelve to twenty-four hours.

Cocaine-poisoning. - Among the most prominent physiological symptoms resulting from the ingestion of excessive doses of cocaine or repeated and continued injections are a tendency to coma or collapse; a feeble, thready pulse, often running extremely high; great emaciation; anorexia and impairment of the digestive powers, and increased frequency, and, again, alarming depression of respiration. There are other systems, scarcely less serious, which, as the majority of observations show, render cocaine one of the most generally deleterious of drugs, opium not excepted. Dropsy, marasmus, numbness, syncope, profound malaise, muscular twitchings with mild convulsions, insomnia, amblyopia, mydriasis, visual hallucinations, headache, vertigo, dangerously elevated temperature, dental decay, and fetid breath - even this admonitory catalogue of ills fails to complete the recorded phenomena attending chronic poisoning from cocaine.

Yet, grave as are the foregoing physical changes incident to an immoderate use of the drug, the mental and, above all, the moral effects of cocaine-poisoning are far more deplorable. It is a melancholy but indubitable fact that to one fully committed to the so-called "cocaine habit" there appears at times no principle of honor or decorum to which the vitiated sensibilities are amenable. The enfeeblement of the intellectual faculties, the loss of memory, inability to coordinate or control ideas, a consciousness occasionally merged in pronounced mania, possibly with homicidal inclination, and an intense selfishness of thought and purpose, in which apathy, neglect of domestic obligations, and complete debasement of nobler qualities are developed -these lamentable accompaniments manifest too clearly the degenerating influences exerted by a constant resort to the use of this ill-fated, if not fatal, drug.

It frequently happens that cocainism arises from a desire to relieve effects produced by the immoderate use of opium. Yet the latter drug, being taken to offset the influence of cocaine, in reality but aggravates the evil, the two agents interacting and still further lessening the chances of recovery. Some of the most deplorable cases of drug-habit are the combined morphine and cocaine habitues.

A number of catarrh remedies are on the market at the present time. These consist of mixtures of cocaine and indifferent substances, and are largely responsible for the spread of this pernicious habit. The negro roustabouts of the South are very prone to the habit, and the catarrh cures are in constant use among the prostitute class.

Treatment of Acute Poisoning. - Several antidotes have been favorably adopted - amyl nitrite, caffeine, atropine, and inhalations of ammonia. Chloroform, ether, subcutaneously injected, and strychnine have also proved more or less efficient remedies.

With regard to the withdrawal of cocaine, equally competent authorities appear to differ, the immediate cessation of the drug being advocated, and, again, this course condemned as liable to produce collapse. The general experience of those treating this class of patients is that a partial cure of the cocaine habit is comparatively easy under careful sanitarium supervision. General tonic treatment is imperative.