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Treating Drug Problems: Volume 2, Commissioned Papers on Historical, Institutional, and Economic Contexts of Drug Treatment
partially chewed leaves were used as topical local anesthetics for trephining operations (Hrdlicka, 1939) and to relieve posttrephining distress (Moodie, 1923). The juice of chewed leaves is still used to treat eye and throat irritations (Grinspoon and Bakalar, 1976), and the dosages necessary for effective local anesthesia could be as low as just a few milligrams (Martindale, 1982). The sacrificial burning and smoking of coca leaves and seeds in magico-religious practices, as well as for the relief of upper respiratory problems, probably delivered less than 25 mg of cocaine (Siegel, 1982).
There is little evidence that these patterns and dosages were associated with abuse or toxicity. However, because coca use was considered a habit connected with idolatrous Indians of poor health, it was continually condemned starting in 1567 (Mortimer, 1901). This view of coca as "wicked" and with "no true virtue" was expressed throughout the first cycle and set the stage for future treatment of the habit to include religious and moral education.
THE SECOND CYCLE: ABUSE (1860-1914)
Coca was introduced to Europe by the reports of sixteenth-century explorers, seventeenth-century chroniclers, eighteenth-century naturalists, and nineteenth-century botanists (Mortimer, 1901). After Mantegazza's 1857 and 1859 essays on the virtues of coca, medical and nonmedical coca products appeared, and European use initially followed the same low-dose patterns observed in South America. The first coca wines and tonics were introduced in France in the 1860s and eventually were advertised throughout the rest of the world. These promotions, lacking medical or scientific support, encouraged frequent use of escalating doses, a pattern that inevitably led to a new cycle of cocaine abuse. Recent analysis of these preparations reveals that changing dose regimens were inextricably tied to this abuse (Siegel, 1985a).
An analysis of representative pharmaceutical bottles and formulas in the author's collection reveals that these tonics and extracts contained approximately 3 to 160 mg of cocaine per dosage unit. The coca wines and related alcoholic beverages contained approximately 35 to 70 mg of cocaine per dosage unit (glass). Some, like Vin Mariani, were concentrations of 2 ounces of leaves in 18-ounce bottles of wine. The coca leaves themselves were not standardized for cocaine content and may have varied from less than 0.01 percent to 1.5 percent cocaine (Hanna, 1970; Novak et al., 1984; Plowman and Rivier, 1983; Rivier, 1981). The leaves used in manufacturing wines and tonics averaged 0.65 percent, a concentration remarkably similar to assays of contemporary cultivated coca leaves (Coca