General Considerations on the Problem of Coca-Leaf Chewing

Abstract

In preparing the "Annotated Bibliography on the Effects of Chewing the Coca Leaf",1 general conclusions were reached which ha Bulletin on Narcoticsve not so far been published. Consequently, the offer to include them in the is accepted with pleasure.

Details

Author: P. O. Wolff
Pages: 2 to 5
Creation Date: 1952/01/01

RUINS OF MACHU PICCHU Photo: Martin Chambi

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General Considerations on the Problem of Coca-Leaf Chewing

M.D., Ph.D., M.A P. O. Wolff
Chief, Addiction Producing Drugs Section, World Health Organization

In preparing the "Annotated Bibliography on the Effects of Chewing the Coca Leaf",1 general conclusions were reached which ha Bulletin on Narcoticsve not so far been published. Consequently, the offer to include them in the is accepted with pleasure.

Although this paper was written three years ago it is felt that the observations figuring therein are still valid today. These observations have, moreover, been confirmed in the meantime by the important statements formulated by the Commission of Enquiry on the Coca Leaf of the Economic and Social Council. We therefore publish the text unchanged.

1 Report of the Commission of Enquiry on the Coca Leaf, Economic and Social Council, Special Supplement No. 1, E/1666, 1950, pp. 119-160.

The numerous works cited in the above-mentioned bibliography bring out, in our opinion, the great importance of the subject under consideration, namely "the terrible problem of the intoxication", as it was so aptly termed by Carlos Enrique Paz Soldán, Director of the Social Hygiene Institute, University of Lima. With the aim of improving the position, Paz Soldán and some of his compatriots have waged an incessant war on coca-leaf chewing. Among those who have helped in this praiseworthy effort we may mention in particular Luis N. Sáenz, to whom we owe an encyclopaedic work on the question; Carlos A. Ricketts, who attempted, unfortunately without success, to have the necessary legislative measures adopted; and, more recently, Carlos Gutiérrez Noriega and his co-workers, who defined the basic pharmacological and clinical factors of the problem.

The accounts of scientific travellers, especially those of the first half of the eighteenth century, contain information which sometimes should be used only with caution, since despite their remarkable general culture and their extensive knowledge of the natural sciences, and despite their experience in the art of observation, these travellers were not always free from error. Thus the fits of hallucination caused by coca-leaf chewing and described by a traveller as eminent as the archaeologist J. J. Von Tschudi (1832-1842) are "relatively very rare", as observed by Luis N. Sáenz and as recently confirmed by Gutiérrez Noriega.

Such caution is in agreement with the views formulated by H. W. Maier, the Zurich psychiatrist, whose competence as regards cocainism is generally recognized. In his monograph on the question (1926), he states that he encountered so many unsatisfactory features in Tschudi's clinical descriptions that he found himself unable to draw conclusions of a medical nature.2

Despite these authoritative criticisms, certain authors never fail to refer to Tschudi's description, considering them an essential source for the discussion of the effects of coca-leaf chewing.

It is, in fact, only within the last few decades that the concepts "habit formation" and "drug addiction" have become more clearly defined, although we still have not thorough knowledge of the mechanism by which they develop within the organism.

It will therefore be understood that observations on coca-leaf chewing recorded about a century ago-including those due to physicians-were relatively vague, since even members of the medical profession could base their opinions only on the scientific knowledge of their period. We would like to stress this point, so as to avoid the mistake made by certain contemporary authors who believe they can gauge the present position on the basis of observations made at the time of the Conquest or during the following three centuries.

This same criterion of judgment should be applied to a work which has often been quoted, the thesis of the famous Peruvian physician, Dr. Hipólito Unanue, entitled "Dissertation on the appearance, cultivation, trade in and virtues of the famous plant of Peru known as Coca".3 Already in 1913, Hermilio Valdizán, the eminent Peruvian psychiatrist and medical historian, affirmed that this was "an agronomical study and that considerations concerning the effects of coca on the degeneration of the indigenous races should not be sought in it". Consequently. we deem it unfortunate that today the supporters of the continued use of coca by the Indians rely principally on the evidence of Unanue, thus making abusive use of the solid and perfectly well-justified reputation enjoyed by the founder of the Peruvian school of medicine.

2 "Im Uebrigen sind die Krankheitsbilder zu wenig gut geschrieben, als dass sich medizinisch Weiteres daraus ableiten liesse."

3 "Disertación sobre el aspecto, cultivo, comercio y virtudes de la famosa planta del Perú, nombrada coca" (Lima, 1794).

For the same reasons, the research carried out and the opinions expressed during the second half of the last century have also been rendered relatively obsolete by present knowledge of drug addiction and the related problems, and are of little use in a modern study of the question, although their authors showed themselves to be already more aware of the nature of addiction. The difficulties encountered in this respect have been very well expressed by H. W. Maier in the monograph previously mentioned, where he declares: "Unfortunately, I have found no modern medical work on the pathological symptoms which develop among coca leaf chewers, no doubt since this addiction is found, above all, in regions which even today are little civilized. Our knowledge of these states is consequently based on the accounts of travellers, and this will continue until such time as these gaps in medical literature are filled by clinical and morbid anatomical studies made on the spot."4

However, since this period the position has greatly improved, thanks to research carried out above all by Peruvian workers, who have succeeded in considerably clarifying this problem from the experimental, clinical and social viewpoints.

On the other hand, relatively little is known of the work of Bolivian authors, as is noted, for example, by Aliaga Suárez. Nevertheless, certain distinguished physicians of that country have since expressed their views, and it may be concluded therefrom that they are seriously concerned with this problem.

Articles and reports which do nothing but exalt the "virtues" of the plant represent a factor contributing greatly to increased consumption of coca leaves and the development of the consequences thereof. Certain coca planters went so far a few years ago as to recommend, for example, under the pretext that the leaf contained vitamins, "that exportation be extended to... Europe and other countries where famine is rampant among the inhabitants". It is hardly necessary to say anything further with respect to such an attitude.

4 "Leider fand ich keine moderneren medizinischen Arbeiten uber die pathologischen Erscheinungen bei den Kokakauern, was wohl daran liegt, dass diese Sucht ihre starkste Entwicklung in Gegenden hat, die auch heute noch wenig kultiviert sind So sind wir einstweilen fur die Kenntnis dieser Zustande auf Reisebeschreibungen angewiesen, bis diese Lucke der medizinischen Literatur einmal durch klinische und pathologischanatomische Studien an Ort und Stelle ausgefullt sein wird."

Luis N. Sáenz points out, for example, that "it is precisely...the owners of coca plantations...who have in all periods brought to nothing the campaigns aiming at the liberation of the Indian from this addiction, even before these efforts commenced, or at their very outset". He recommends, consequently, that "indispensable" measures be taken, insisting that "the State, independently of measures of all kinds adopted to diminish consumption, also intervene to limit production and to submit the producer to strict control..., in order to avoid the coming to pass of what has been observed as concerns other forms of drug-addiction in countries where the drug producers have spread propaganda in favour of narcomania and advocated their baleful industry, defending it in such a way that Legrain was led to say of them, that 'they had, in fact, no heart other than their purse'".

In this connexion mention should be made of the remarkable Colombian Decree of 17 November 1948, forbidding the sale of coca leaves in markets and in establishments of any kind, with the exception of pharmacies and druggists. In our opinion, this is the first step - an excellent and decisive one - towards remedying and improving the present position.

On the other hand, it must be borne in mind that for the worker in mountainous regions who chews coca, the leaves of that plant have a value much greater than that of money as a constituent element of his wages. It is believed that the Peruvian Indian devotes 25 per cent of his income to purchasing coca leaves. "The whole life of the mountain dwellers", says Sáenz, "circles around coca."

Furthermore, the evil custom of paying part of the wages in coca-sometimes even the greater part-is a special feature of the exploitation of the Indian worker. One of those most familiar with the Indian and his inmost being, the Peruvian writer, Henrique López Albújar, goes so far as to say, "perhaps it is coca which makes the Indian resemble the donkey; but it is also coca which makes this human donkey work without complaint . . .".

Among the extensive investigations which have been carried out there are some which in our opinion are particularly important, namely those involving observations confirmed by control experiments, so that the results obtained can be compared-in so far as this comparison is possible in dealing with biological phenomena-with the reaction produced in normal persons. In the field of experimental science such a method represents the best, if not indeed, the only way of arriving at the most accurate and precise conclusions possible on biological questions.

It is clear that scientific problems cannot be decided by vote-despite examples of this which may be found in history-and that the opinion of a single worker, although opposed to that of the majority, may in the end be recognized as the correct and true one. Nevertheless, in the present case one fact appears significant to us: the great number of authors who hold the chronic chewing of coca leaves to be harmful as compared with the small number of those who consider it as being harmless. This is shown in the following table:

Opinion expressed

Physicians Number Of works Of authors 5

Non Physicians Number Of works Of authors 5

Harmful effects...
67 35
Harmless effects...
8 8

The social aspect of coca-leaf chewing has been intentionally taken into consideration. According to personal observations which we made in a region where the coca leaf is chewed, as well as according to the results of discussions which we had with physicians born in those regions and practising there, we feel justified in saying that the problem of coca-leaf chewing, considered as a whole, constitutes nothing more than the last link in a chain, unfortunately all too long, of social and medico-social scourges, which include pauperism, bad housing conditions, deficient nutrition, rudimentary or completely absent education, alcoholism, tuberculosis, venereal disease and other infections, and promiscuity, to mention only the worst calamities and miseries.

Furthermore, it is evident that the chewing of these leaves for pleasure is incompatible with the regular and normal taking of meals. We are convinced that coca-leaf chewing is a social evil; the chronic consumption of these leaves constitutes a social poison which undermines the physical and mental health of the population and lowers its moral and economic level.

In our opinion, the essential measure making effective suppression of cocaism possible is to be found in the improvement of general living conditions, the raising of the primitive population which chews the coca leaf and whose condition very often borders on extreme destitution. Suitable education of Indian youth would certainly yield good results and would reduce the large number of "infra-socials" produced by chewing the coca leaf. The results which have been obtained in evangelized Indian settlements and which have been described by Ricketts and other authors, afford a particularly striking example of this. Christianized Indians, in fact, no longer live in the former wretched conditions and thus show themselves physically and mentally capable of freeing themselves from coca-leaf chewing.

Our ideas are supported by the statement of Huamán Poma de Ayala, "the most extraordinary intellectual of the Indian race" (Gutiérrez Noriega), who affirms that "by providing the population with abundant supplies of fruit and vegetables the vice of coca leaf chewing could be abolished".

5The main author of each work has been considered as the sole author, without taking his co-workers into account.

We hope that we have shown that the coca problem cannot be considered by itself, but that it is intimately connected with the social state of the peoples in question, so that it should be considered against a background much more extensive than that represented by the plant alone.

History shows us that coca-leaf chewing was formerly known and practised in much more widespread areas than today, even as far as Central America (Nicaragua). It is worth while considering more closely the reasons which, in Ecuador for example, have led the Indians, who live at the same altitude as those chewing coca in Peru and Bolivia, to give up this vice.

In the last issue of América Indigena (vol. 12, no. 1, 7-32) there is an article by Luis A. León entitled "Historia y extinción del cocaismo en el Ecuador. Sus resultados" (History and abolition of cocaism in Ecuador and its results). He emphasises the fact that even in pre-Colombian times almost all the inhabitants of Ecuador chewed coca leaves, although this practice has now practically disappeared.6

In considering this subject, we must also take into account a question the study of which is still in full course of development, i.e., changes in certain functions and reactions of the organism at high altitudes. There are already numerous observations on this subject, particularly those made by F. Verzir as well as by A. de Muralt, and their respective co-workers in Switzerland. They have studied, in particular, the general functional reaction of the organism, thermal adaptation, etc., changes in the endocrine and vegetative functions, bearing in mind the fact that our therapeutic methods are based in large part on modifications of neurovegetative equilibrium. Many phenomena of great interest have been confirmed in this way: increased sensitivity, intensified reflexes, excitation of animal functions, etc., all observations which can only be mentioned in passing here, but which suffice to illustrate the importance of high-altitude physiology. Furthermore, Carlos Monge, who directs the Andean Institute of Biology in Peru, Alberto Hurtado, Professor of Physio-pathology at the University of Lima, and their co-workers, are actively investigating this same subject and have published papers of great value on the question.

6Editor's note: see below page 21.

We are not yet in a position to evaluate the repercussions which observations of this nature may have on the subject with which we are concerned here. In any case, we feel that the systematic pursuit of studies similar to those which the above-mentioned research workers are carrying on is of the greatest interest. Indeed, certain of these investigations have already reached an advanced stage, particularly as concerns the effects of coca.

We confess to optimism in scientific matters, an optimism which alone, we believe, makes progress possible. Criticism is necessary but, on the other hand, hyper-criticism often kills a seed which should be left to develop. If it has been possible to abolish from the cordilleras of Ecuador the urge to chew the coca leaf, why cannot the same result be obtained in countries so greatly affected by this scourge? The social improvement of the life of the Indian will no doubt open the way to attaining this objective. This is a worthy task -to aid the former masters of the South American continent to attain conditions of life better than those they have so far endured.

For the time being, however, the problem of cocaleaf chewing remains unsolved, like that of the Sphinx which defied the centuries. When will he appear, the Oedipus able to solve the riddle set us by the Kkoka, a word which signifies in the Aymara language, the plant par excellence, the plant above all others?