1890 Coca and its Therapeutic Application by Angelo Mariani

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manently,atleast temporarily. It is understood,of course, that I here refer only to those cases in which there is want of J^nervous force,' and not where there is paresis due to organic changes. "Vocalists and public speakers frequently complain of the distressing sequelae of follicular pharyngitis which manifest themselves when the voice is inordinately ex erted. The irritation of the throat in these cases is sometimes quite marked. The enlarged follicles, as also the large patches where the follicles have coalesced, be come turgid and deeply red, the tendency to cough is increased, and the voice, which may have been previ- , ously clear, becomes veiled and thin. There is a feeling of constriction present, painful as well as alarming to the patient. Coca in these cases, when exhibited in its proper form, is prompt in its effects, and can be ad ministered in suitable quantities for many months, or even years, without producing any of those objectionable symptoms attributed to it. "Dyspnoea due to laryngeal reflexes is often relieved by Coca,the first dose being a full one,and small doses follow ing at short intervals to sustain the effect produced in the first instance. "I have frequently observed that a sustained effort in Ihe matter of singing,lecturing, etc., will produce a con dition of 'fatigue' of the voice, in which there is no appreciable change in the appearance of the vocal ap- qjaratus, but which, nevertheless, interferes in a marked ■degree with the proper use of the voice. Whether this .state is due to over-exertion of the laryngeal or pharyn- igeal muscles, or whether irritation of the terminal nerve filaments of the upper air passages stands in causative relation thereto, be this as it may. Coca stands pre-emi nently forth as the only remedy which in my hands has given relief. True, Ihave many failures to record, but can trace them directly to either the manner of exhibit-