Tuesday, September 30, 2014

The Essence of Quackery 2- A Blurred Understanding of Vastly Different Dosing

Some interest in cocaine had indeed been rekindled in 1878-79 by reports from North America in which it was claimed that 16 cases of morphine addiction had been successfully treated by injections [sic!!!] of cocaine.  Bentley (1878, 1880), an American physician, published an enthusiastic article on this type of treatment.  A method was then adopted which consisted of injecting 0.1 grams of cocaine every time the patient showed morphine withdrawal symptoms.  This method was apparently adopted by all the private clinics of North America, but it did not give rise to any significant publications until Hammond (1886) and Brower (1886) drew attention to the dangers involved.

p 20 Maier' Cocaine Addiction (Der Kokainismus) translated by Oriana Josseau Kalant

This is a serious problem with 'scholastic' works that frame a given drug as simply one of 'addiction'- altogether neglecting the abuse of the drug as something intrinsic to that drug regardless of the form/mode of administration.

The above quote seriously blurs the distinctions between vastly different modes of cocaine use, and is wrong, as Bentley reported such successes with dilute cocaine in the form of Coca infusions- with isolated cocaine suitable for injections not even commercially available until 1884 or 1885!


From the book by Joseph Kennedy, Coca Exotica:
In July of 1878, Bentley was called to a house somewhere in the hills of Kentucky; when he arrived there, he was astonished to find a tenth of an acre in opium poppies (Papaver somniferium). The lady of the house, a forty year old widow, confessed to the doctor that she had been an opium eater for quite some time, consuming about a half pound of the drug a year. Bentley says: “I persuaded here to give up the habit. She declared that she could not. She agreed, however, to try, so I sent her one pound of the fluid extract of coca to begin with. When used up, she sent for half the quantity, stating that she thought it would complete the cure. I sent her one half pound. She sent me her opium crop that winter, with the message that the medicine had cured her.

The medicine Bentley prescribed for her was the fluid extract of coca manufacture red by Parke Davis and Company in Detroit, Michigan. The preparation they offered was standardized in the United States Pharmacopoeia, 6th to 8th editions (1880—90), and contained 0.5 grams of coca alkaloids per one hundred cubic centimeters of solution. Of course, cocaine was one of those alkaloids contained in the fluid extract, but according to Bentley’s recommended dose (1 drachm of fluid extract when the desire for whiskey or opium is quite urgent), a patient would only consume .0185 grams (slightly more then 1/200 of a gram) of cocaine per dose, and even then it would automatically be taken in conjunction with coca’s natural complement of other alkaloids; because it was prescribed to be drunk, this solution would necessarily have to pass through the liver and kidneys. In these two important respects the use of the fluid extract closely resembled the Indian method of taking the drug, a procedure proven harmless by centuries of use. It is also interesting to note that one would have to take 13.5 one drachm doses of Parke Davis fluid extract just to get the amount of cocaine alkaloid consumed daily by an average Peruvian Indian. This is based upon Hanna’s study that estimates the average Indian digests approximately 0.25 grams of cocaine a day by normal coca use.
This would be akin to condemning caffeine, and thus Coffee, by taking ultra concentrated doses of caffeine by injection, and stupidly assuming that made caffeine in coffee unacceptably dangerous.

It represents an extremely poor - blurred understanding of cocaine adopted in medicine, particularly within the field of anesthesiology as injected cocaine was used as a nerve block.  It alas plagues medical schools and the medical profession to this very day.

This sort of sloppiness is also unfortunately rampant with too many historians.