CHAPTER XVIII

PHARMACOLOGY OF THE COFFEE DRINK

_General physiological action--Effect on children--Effect on longevity--Behavior in the alimentary régime--Place in dietary--Action on bacteria--Use in medicine--Physiological action of "caffetannic acid"--Of caffeol--Of caffein--Effect of caffein on mental and motor efficiency--Conclusions_

By Charles W. Trigg

Industrial Fellow of the Mellon Institute of Industrial Research, Pittsburgh, 1916-1920

The published information regarding the effects of coffee drinking on the human system is so contradictory in its nature that it is hazardous to make many generalizations about the physiological behavior of coffee. Most of the investigations that have been conducted to date have been characterized by incompleteness and a failure to be sufficiently comprehensive to eliminate the element of individual idiosyncrasy from the results obtained. Accordingly, it is possible to select statements from literature to the effect either that coffee is an "elixir of life," or even a poison.

This is a deplorable state of affairs, not calculated to promote the dissemination of accurate knowledge among the consuming public, but it may be partly excused upon the grounds that experimental apparatus has not always been at the level of perfection that it now occupies. Also, to do justice to some of the able men who have interested themselves in this problem, it should be said that some of their results were obtained in researches, distinguished by painstaking accuracy, which have effected the establishment of the major reactions of ingested coffee.

_The Physiological Action of Coffee_

Drinking of coffee by mankind may be attributed to three causes: the demand for, and the pleasing effects of, a hot drink (a very small percentage of the coffee consumed is taken cold), the pleasing reaction which its flavors excite on the gustatory nerve, and the stimulating effect which it has upon the body. The flavor is due largely to the volatile aromatic constituents, "caffeol," which, when isolated, have a general depressant action on the system; and the stimulation is caused by the caffein. The general and specific actions of these individual components, together with that of the hypothetical "caffetannic acid," are considered under separate headings.

Coffee may be considered a member of the general class of adjuvant, or auxiliary, foods to which other beverages and condiments of negligible inherent food value belong. Its position on the average menu may be attributed largely to its palatability and comforting effects. However, the medicinal value of coffee in the dietary and _per se_ must not be overlooked.

The ingestion of coffee infusion is always followed by evidences of stimulation. It acts upon the nervous system as a powerful cerebro-spinal stimulant, increasing mental activity and quickening the power of perception, thus making the thoughts more precise and clear, and intellectual work easier without any evident subsequent depression. The muscles are caused to contract more vigorously, increasing their working power without there being any secondary reaction leading to a diminished capacity for work. Its action upon the circulation is somewhat antagonistic; for while it tends to increase the rate of the heart by acting directly on the heart muscle, it tends to decrease it by stimulating the inhibitory center in the medulla.[188]

The effect on the kidneys is more marked, the diuretic effect being shown by an increase in water, soluble solids, and of uric acid directly attributable to the caffein content of the coffee taken. In the alimentary tract coffee seems to stimulate the oxyntic cells and slightly to increase the secretion of hydrochloric acid, as well as to favor intestinal peristalsis. It is difficult to accept reports of coffee accomplishing both a decrease in metabolism and an increase in body heat; but if the production of heat by the demethylation of caffein to form uric acid and a possible repression of perspiration by coffee be considered, the simultaneous occurrence of these two physiological reactions may be credited.

The disagreement of medical authorities over the physiological effects of coffee is quite pronounced. This may be observed by a careful perusal of the following statements made by these men. It will be noticed that the majority opinion is that coffee in moderation is not harmful. Just how much coffee a person may drink, and still remain within the limits of moderation and temperance, is dependent solely upon the individual constitution, and should be decided from personal experience rather than by accepting an arbitrary standard set by some one who professes to be an authority on the matter.

A writer in the _British Homeopathic Review_[189] says that "the exciting effects of coffee upon the nervous system exhibit themselves in all its departments as a temporary exaltation. The emotions are raised in pitch, the fancies are lively and vivid, benevolence is excited, the religious sense is stimulated, there is great loquacity.... The intellectual powers are stimulated, both memory and judgment are rendered more keen and unusual vivacity of verbal expression rules for a short time." He continues:

Hahnemann gives a characteristically careful account of the coffee headache. If the quantity of coffee taken be immoderately great and the body be very excitable and quite unused to coffee, there occurs a semilateral headache from the upper part of the parietal bone to the base of the brain. The cerebral membranes of this side also seem to be painfully sensitive, the hands and feet becoming cold, and sweat appears on the brows and palms. The disposition becomes irritable and intolerant, anxiety, trembling and restlessness are apparent.... I have met with headaches of this type which yielded readily to coffee and with many more in which the indicated remedy failed to act until the use of coffee as a beverage was abandoned. The eyes and ears suffer alike from the super-excitation of coffee. There is a characteristic toothache associated with coffee.

In apparent contradiction of this opinion, Dr. Valentin Nalpasse,[190] of the Faculty of Medicine of Paris, states:

When coffee is properly made and taken in moderation, it is a most valuable drink. It facilitates the digestion because it produces a local excitement. Its principal action gives clear and stable imaginative power to the brain. By doing that, it makes intellectual work easy, and, to a certain extent, regulates the functions of the brain. The thoughts become more precise and clear, and mental combinations are formed with much greater rapidity. Under the influence of coffee, the memory is sometimes surprisingly

## active, and ideas and words flow with ease and elegance.... Many

people abuse coffee without feeling any bad effect.

Discussing the use and abuse of coffee, I.N. Love[191] says:

The world has in the infusion of coffee one of its most valuable beverages. It is a prompt diffusible stimulant, antiseptic and encourager of elimination. In season it supports, tides over danger, helps the appropriate powers of the system, whips up the flagging energies, enhances the endurance; but it is in no sense a food, and for this reason it should be used temperately.

Also Dr. Jonathan Hutchinson[192] makes the following weighty pronouncement:

In reference to my suggestion to give children tea and coffee. I may explain that it is done advisedly. There is probably no objection to their use even at early ages. They arouse the dull, calm the excitable, prevent headaches, and fit the brain for work. They preserve the teeth, keep them tight in their place, strengthen the vocal chords, and prevent sore throat. To stigmatize these invaluable articles of diet as "nerve stimulants" is an erroneous expression, for they undoubtedly have a right to rank as nerve nutrients.

But Dr. Harvey Wiley[193] comes forth with evidence on the other side, saying:

The effects of the excessive use of coffee, tea, and other natural caffein beverages is well known. Although the caffein is combined in these beverages naturally, and they are as a rule taken at meal times, which mitigates the effects of the caffein, they are recognized by every one as tending to produce sleeplessness, and often indigestion, stomach disorders, and a condition which, for lack of a better term, is described as nervousness.... The excessive drinking of tea and coffee is acknowledged to be injurious by practically all specialists.

Dr. V.C. Vaughn,[194] of the University of Michigan, speaking of tea and coffee, expresses this opinion:

I believe that caffein used as a beverage and in moderation not only is harmless to the majority of adults, but is beneficial.

This verdict is upheld by the results of a symposium[195] conducted by the _Medical Times_, in which a large majority of the medical experts

## participating, among whom may be enumerated Drs. Lockwood, Wood,

Hollingworth, Robinson, and Barnes, agreed that the drinking of coffee is not harmful _per se_, but that over-indulgence is the real cause of any ill effects. This is also true of any ingested material.

Insomnia is a condition frequently attributed to coffee, but that the authorities disagree on this ground is shown by Wiley's[196] contention, "We know beyond doubt that the caffein (in coffee) makes a direct attack on the nerves and causes insomnia." While Woods Hutchinson[197] observes:

Oddly enough, a cup of hot, weak tea or coffee, with plenty of cream and sugar, will often help you to sleep, for the grateful warmth and stimulus to the lining of the stomach, drawing the blood into it and away from the head, will produce more soothing effects than the small amount of caffein will produce stimulating and wakeful ones.

The writer has often had people remark to him that while black coffee sometimes kept them awake, coffee with cream or sugar or both made them drowsy.

In the course of experiments conducted by Montuori and Pollitzer[198] it was found that coffee prepared by hot infusion when given by mouth or hypodermically with the addition of a small dose of alcohol proved an efficient means of combating the pernicious effects of low temperatures. Coffee prepared by boiling, and tea, showed negative effects.

The value of coffee as a strength-conserver, and its function of increasing endurance, morale, and healthfulness, was demonstrated by the great stress which the military authorities, in the late and in previous wars, placed upon furnishing the soldiers with plenty of good coffee,

## particularly at times when they were under the greatest strain. Various

articles[199] record this fact; and these statements are further borne out by the data given below in the discussion of the physiological effects of caffein, to which the majority of the stimulating effects of coffee may be attributed.

According to Fauvel,[200] with a healthy patient on a vegetable diet, chocolate and coffee increase the excretion of purins, diminishing the excretion of uric acid and apparently hindering the precipitation of uric acid in the organism. This diminution, however, was not due to retention of uric acid in the organism.

"Habit-forming" is one of the adjectives often used in describing coffee, but it is a fact that coffee is much less likely than alcoholic liquors to cause ill effects. A man rarely becomes a slave of coffee; and excessive drinking of this beverage never produces a state of moral irresponsibility or leads to the commission of crime. Dr. J.W. Mallet,[201] in testimony given before a Federal Court, stated that caffein and coffee were not habit-forming in the correct sense of the term. His definition of the expression is that the habit formed must be a detrimental and injurious one--one which becomes so firmly fixed upon a person forming it that it is thrown off with great difficulty and with considerable suffering, continuous exercise of the habit increasing the demand for the habit-forming drug. It is well known that the desire ceases in a very short period of time after cessation of use of caffein-containing beverages, so that in that sense, coffee is not habit-forming.

[Illustration: MEN AND WOMEN LABORERS PICKING COFFEE ON A SÃO PAULO ESTATE]

[Illustration: SACKING COFFEE IN A WAREHOUSE AT THE PORT OF SANTOS]

[Illustration: PICKING AND SACKING COFFEE IN BRAZIL]

It has been shown by Gourewitsch[202] that the daily administration of coffee produces a certain degree of tolerance, and that the doses must be increased to obtain toxic results. Harkness[203] has been quoted as stating that "taken in moderation; coffee is one of the most wholesome beverages known. It assists digestion, exhilarates the spirits, and counteracts the tendency to sleep." Carl V. Voit,[204] the German physiological chemist, says this about coffee:

The effect of coffee is that we are bothered less by unpleasant experiences and become more able to conquer difficulties; therefore, for the feasting rich, it makes intestinal work after a meal less evident and drives away the deadly ennui; for the student it is a means to keep wide awake and fresh; for the worker it makes the day's fatigue more bearable.

Dr. Brady[205] believes that the so-called harmfulness of coffee is mainly psychological, as evidenced by his expression, "Most of the prejudice which exists against coffee as a beverage is based upon nothing more than morbid fancy. People of dyspeptic or neurotic temperament are fond of assuming that coffee must be bad because it is so good, and accordingly, denying themselves the pleasure of drinking it."

The recounting of evidence, both _pro_ and _con_, relevant to the general effects of coffee could continue almost _ad infinitum_, but the fairest unification of the various opinions is best quoted from Woods Hutchinson[206]:

Somewhere from 1 to 3 percent of the community are distinctly injured or poisoned by tea or coffee, even small amounts producing burning of the stomach, palpitation of the heart, headache, eruptions of the skin, sensations of extreme nervousness, and so on; though the remaining 97 percent are not injured by them in any appreciable way if consumed in moderation.

So, if one is personally satisfied that he belongs to the abnormal minority, and has not been argued by fallacious reasoning into his belief that coffee injures him, he should either reduce his consumption of coffee or let it alone. Even those most vitally interested in the commercial side of coffee will admit that this is the logical procedure.

_Effects of Coffee on Children_

The same sort of controversy has raged around the question of the advisability of giving coffee to children as has occurred regarding its general action. Dr. J. Hutchinson[207] advocates furnishing children with coffee, while Dr. Charlotte Abbey[208] is strongly against such a practise, claiming that use of caffein-containing beverages before the attainment of full growth will weaken nerve power. Nalpasse[209] observes that until fully developed the young are immoderately excited by coffee; and Hawk[210] is of the opinion that to give such a stimulant to an active school-child is both logically and dietetically incorrect. Dr. Vaughn[211] advances this scientific argument against the drinking of coffee by children under seven years of age:

In proportion to body weight the young contain more of the xanthin bases than adults. They are already laden with these physiological stimulants, and the additional dose given in tea or coffee may be harmful.

In a study of the effects of coffee drinking upon 464 school children, C.K. Taylor[212] found a slight difference in mental ability and behavior, unfavorable to coffee. About 29 percent of these children drank no coffee; 46 percent drank a cup a day; 12 percent, 2 cups; 8 percent, 3 cups; and the remainder, 4 or more cups a day. The measurements of height, weight, and hand strength also showed a slight advantage in favor of the non-coffee drinkers. If these results be taken as truly representative, their indication is obvious. However, it seems desirable to repeat these experiments upon other groups; at the same time noting carefully the factors of environment, and other diet, before any criterion is made.

As a refutation to this experimental evidence is the practical experience of the inhabitants of the Island of Groix, off the Brittany coast, whose annual consumption of coffee is nearly 30 pounds per capita, being ingested both as the roasted bean and as an infusion. It is reported that many of the children are nourished almost entirely on coffee soup up to ten years of age, yet the mentality and physique of the populace does not fall below that of others of the same stock and educational opportunities.[213]

Pertinent in this connection is Hawk's[214] statement that young mothers should refrain from the use of coffee, as caffein stimulates the action of the kidneys and tends to bring about a loss from the body of some of the salts necessary to the development of the unborn child as well as for the proper production of milk during the nursing period. The caffein of coffee also increases the flow of milk, but the milk produced is correspondingly dilute and a later decreased secretion may be expected. Furthermore, some of the caffein of the coffee may pass into the mother's milk, thus reaching the child, so that the use of coffee during the nursing period is undesirable on this ground also. Naturally, the question arises as to whether this arraignment is purely theoretical or based upon analytical and clinical data.

It is a difficult matter definitely to set an age below which coffee should not be drunk, as the time of reaching maturity varies with climate and ancestral origin. Yet, from a theoretical standpoint, children before or during the adolescent period should be limited to the use of a rather small amount of tea and coffee as beverages, as their poise and nerve control have not reached a stage of development sufficient to warrant the stimulation incident to the consumption of an appreciable quantity of caffein.

_Coffee Drinking and Longevity_

There are many who would have us believe that the use of coffee is only a means toward the end of quickly reaching the great beyond; but it is known that the habitual coffee drinker generally enjoys good health, and some of the longest-lived people have used it from their earliest youth without any apparent injury to their health. Nearly every one has an acquaintance who has lived to a ripe old age despite the use of coffee. Quoting Metchnikoff[215]:

In some cases centenarians have been much addicted to the drinking of coffee. The reader will recall Voltaire's reply when his doctor described the grave harm that comes from the abuse of coffee, which acts as a real poison. "Well", said Voltaire, "I have been poisoning myself for nearly eighty years." There are centenarians who have lived longer than Voltaire and have drunk still more coffee. Elizabeth Durieux, a native of Savoy, reached the age of 114. Her principal food was coffee, of which she took daily as many as forty small cups. She was jovial and a boon table companion, and used black coffee in quantities that would have surprised an Arab. Her coffee-pot was always on the fire, like the tea-pot in an English cottage (Lejoncourt, p. 84; Chemin, p. 147).

The entire matter resolves itself into one of individual tolerance, resistivity, and constitution. Numerous examples of young abstainers who have died and coffee drinkers who have still lived on can be found, and _vice versa_, the preponderance of instances being in neither direction. Bodies of persons killed by accident have been painstakingly examined for physiological changes attributable to coffee; but no difference between those of coffee and of non-coffee drinkers (ascertained by careful investigation of their life history) could be discerned.[216] In the long run, it is safe to say that the effect of coffee drinking upon the prolongation or shortening of life is neutral.

_Coffee in the Alimentary Tract_

When coffee is taken _per os_ it passes directly to the stomach, where its sole immediate action is to dilute the previous contents, just as other ingested liquids do. Eventually the caffein content is absorbed by the system, and from thence on a stimulation is apparent. Considerable conjecture has occurred over the difference in the effects of tea and coffee, the most feasible explanation advanced being one appearing in the London _Lancet_.[217]

The caffein tannate of tea is precipitated by weak acids, and the presumption is that it is precipitated by the gastric juice and, therefore, the caffein is probably not absorbed until it reaches the alkaline alimentary tract. In the case of coffee, however, in whatever form the caffein may be present, it is soluble in both alkaline and acid fluids, and, therefore, the absorption of the alkaloid probably takes place in the stomach.

This theory, if true, goes far toward explaining the more rapid stimulation of coffee.

The statement has sometimes been made that milk or cream causes the coffee liquid to become coagulated when it comes into contact with the acids of the stomach. This is true, but does not carry with it the inference that indigestibility accompanies this coagulation. Milk and cream, upon reaching the stomach, are coagulated by the gastric juice; but the casein product formed is not indigestible. These liquids, when added to coffee, are partially acted upon by the small acid content of the brew, so that the gastric juice action is not so pronounced, for the coagulation was started before ingestion, and the coagulable constituent, casein, is more dilute in the cup as consumed than it is in milk. Accordingly, the particles formed by it in the stomach will be relatively smaller and more quickly and easily digested than milk _per se_. It has been observed that coffee containing milk or cream is not as stimulating as black coffee. The writer believes that this is probably due to mechanical inclusion of caffein in the casein and fat particles, and also to some adsorption of the alkaloid by them. This would materially retard the absorption of the caffein by the body, spread the

## action over a longer period of time, and hence decrease the maximum

stimulation attained.

In a few instances, a small fraction of one percent of coffee users, there is a certain type of distress, localized chiefly in the alimentary tract, caused by coffee, which can not be blamed upon the much-maligned caffein. The irritating elements may be generally classified as compounds formed upon the addition of cream or milk to the coffee liquor, volatile constituents, and products formed by hydrolysis of the fibrous part of the grounds. It may be generally postulated that the main causation of this discomfort is due to substances formed in the incorrect brewing of coffee, the effect of which is accentuated by the addition of cream or milk, when the condition of individual idiosyncrasy is present.

Without enlarging upon his reason, Lorand[218] concludes that neither tea nor coffee is advisable for weak stomachs. Nalpasse,[219] however, believes that coffee taken after meals makes the digestion more perfect and more rapid, augmenting the secretions, and that it agrees equally well with people inclined to embonpoint and heavy eaters whose digestion is slow and difficult. Thompson[220] also observes that coffee drunk in moderation is a mild stimulant to gastric digestion.

Eder[221] reported, as the result of an inquiry into the action of coffee on the activity of the stomachs of ruminants, that coffee infusions produced a transitory increase in the number and intensity of the movements of the paunch, but that the influence exercised was very irregular.

An elaborate investigation of the action of tea and coffee on digestion in the stomach was made by Fraser,[222] in which he found that both retard peptic digestion, the former to a greater degree than the latter. The digestion of white of egg, ham, salt beef, and roast beef was much less affected than that of lamb, fowl, or bread. Coffee seemed actually to aid the digestion of egg and ham. He attributed the retarding effect to the tannic acid of the tea and the volatile constituents of the coffee--the caffein itself favoring digestion rather than otherwise. Tea increased the production of gas in all but salt foods, whereas coffee did not. Coffee is, therefore, to be preferred in cases of flatulent dyspepsia.

Hutchinson, in his _Food and Dietetics_, opines:

As regards the practical inferences to be drawn from experiences and observations, it may be said that in health the disturbance of digestion produced by the infused beverages (tea and coffee) is negligible. Roberts, indeed, goes so far as to suggest that the slight slowing of digestion which they produce may be favored rather than otherwise, as tending to compensate for too rapid digestibility which refinements of manufacture and preparation have made characteristic of modern foods.

Regarding increase in secretory activity, Moore and Allanston[223] report that in their experience meat extracts, tea, caffein solution, and coffee call forth a greater gastric secretion than does water, while with milk the flow of gastric juice seems to be retarded. Cushing[224] and others support this statement. This action is partially explained by Voit on the grounds that all tasty foods increase gastric secretion, the

## action being partly psychological; but Cushing observed the same effects

upon introducing coffee directly into the stomachs of animals.

In general, a moderate amount of coffee stimulates appetite, improves digestion and relieves the sense of plenitude in the stomach. It increases intestinal peristalsis, acts as a mild laxative, and slightly stimulates secretion of bile. Excessive use, however, profoundly disturbs digestive function, and promotes constipation and hemorrhoids.[225] There is much evidence to support the view that "neither tea, coffee, nor chicory in dilute solutions has any deleterious action on the digestive ferments, although in strong solutions such an action may be manifest."[226] After conducting exhaustive experiments with various types of coffee, Lehmann[227] concluded that ordinary coffee is without effect on the digestion of the majority of sound persons, and may be used with impunity.

_Coffee in the Dietary--Food Value_

There are three things to be considered in deciding upon the inclusion of a substance in the dietary--palatability, digestibility without toxicity or disarrangement, and calorific value. Coffee is as satisfactory from these viewpoints as any other food product.

The palatability of a well-made cup of good coffee needs no eulogizing; it speaks for itself. It adds enormously to the attractiveness of the meal, and to our ability to eat with relish and appetite large amounts of solid foods, without a subsequent uncomfortable feeling. Wiley[228] says that the feeling of drowsiness after a full meal is a natural condition incidental to the proper conduct of digestion, and that to drive away this natural feeling with coffee must be an interference with the normal condition. However, if by so doing, we can increase our over-all efficiency without material harm to our digestive organs (and we can and do), the procedure has much in its favor both psychologically and dietetically.

The fact that coffee favors digestion without eventual disarrangement has been demonstrated above. On the subject of the relative agreement with the constitution of foods of daily consumption, Dr. English[229] said:

It is well known that there is no species of diet which invariably suits all constitutions, nor will that which is palatable and salutary at one time be equally palatable and salutary at another time to the same individual. I think the most natural food provided for us is milk; yet I will engage to show twenty instances where milk disagrees more than coffee.

Further in this regard, Hutchinson[230] considers that ninety percent of the "dyspepsias" attributed to coffee are due to malnutrition, or to food simultaneously ingested, no disease known to the medical profession being directly attributable to it.

No one cognizant of the facts will contend that a cup of black coffee has any direct food value; but not so with the roasted bean. This has quite an appreciable content of protein and fat, both substances of high calorific value. The inhabitants of the Island of Groix eat the whole roasted coffee bean in considerable quantity, and seem to obtain considerable nourishment therefrom. Also, the Galla, a wandering tribe of Africa, make large use of food balls, about the size of billiard balls, consisting of pulverized coffee held in shape with fat. One ball is said to contain a day's ration; and, because of its food content and stimulating power, serves to sustain them on long marches of days' duration.

When an infusion, or decoction, of roasted coffee is made, about 1.25 percent of the extracted matter is protein, it being accompanied by traces of dextrin and sugar. The same dearth of extraction of food materials occurs upon infusing coffee substitutes. This small amount can have but little dietetic significance. However, upon addition of sugar and of milk or cream, with their content of protein, fat, and lactose, the calorific value of the cup of coffee rises. Lusk and Gephart[231] give the food value of an ordinary restaurant cup of coffee as 195.5 calories, and Locke[232] gives it as 156.

Mattei[233] found that 8 cc. of an infusion of roasted Mocha coffee of five-percent strength suppressed incipient polyneuritis in pigeons within a few hours' time. Their weight did not improve, but otherwise they were completely restored to health. However, in from four to six weeks after the apparent cure, the symptoms rapidly returned and the pigeons perished, with symptoms of paralysis and cerebral complications. The temporary cure was probably due to caffein stimulation and secondary

## actions of the volatile constituents of coffee, which may be related to

the vitamines; for it is not likely that the vitamines would withstand the heat of roasting. If B-vitamine does occur in roasted coffee, it is present only in traces.[234]

The inclusion of coffee in the average dietary is warranted because of its evident worth as an aid to digestion and for its assimilating power, thus earning its characterization as an "adjuvant food."

_Action of Coffee on Bacteria_

The employment of coffee as an aid to sanitation has been but little considered. Coffee, when freshly roasted and ground, is deodorant, antiseptic, and germicidal, probably due to the empyreumatic products developed during the process of roasting. An infusion of 0.5 percent inhibits the growth of many pathogenic organisms, and those of 10 percent kill anthrax bacteria in three hours, cholera spirilla in four hours, and many other bacteria, including those producing typhoid, in two to six days.[235]

The maintenance of a low rate of contraction of typhoid fever has often been attributed to drinking of coffee instead of water, the action of the coffee being partly due to the bactericidal effect of the caffeol and partly to the boiling of the water before infusion. The stimulating tendency of the caffein to sustain and to "tide over" those of low vitalities is also evidenced.

_Use of Coffee in Medicine_

Coffee has been employed in medicinal practise as a direct specific, as a preventive, and as an antidote. The _United States Dispensatory_[236] summarizes the uses of caffein and coffee as follows:

Caffein is a valuable remedy in practical medicine as a cerebral and cardiac stimulant and as a diuretic. In undue _somnolence_, in _nervous headache_, in _narcotism_, also, at times when the exigencies of life require excessively prolonged wakefulness, caffein may be used as the most powerful agent known for producing wakefulness. In a series of experiments, J. Hughes Bennett found that within narrow limits there is a direct physiological antagonism between caffein and morphine. Coffee and caffein in narcotic poisoning are of value as a means of keeping the patient awake, and of stimulating the respiratory centres.

As a cardiac stimulant, caffein may be used in any form of heart failure; the indications for its use are those which call for the employment of digitalis. It is superior to digitalis in never disagreeing with the stomach, in having no distinctive cumulative tendency, and in the promptness of its action. It is pronouncedly inferior to digitalis in the power and certainty of its action, and in the permanence of its influence once asserted. As a diuretic it is superior; it is very valuable in the treatment of _cardiac dropsies_, and is often useful in _chronic Bright's disease_ when there is no irritation of the kidneys.

On account of its tendency to produce wakefulness, it is usually better to mass the doses early in the day, at least six hours being left between the last dose and the ordinary time for sleep. From eight to fifteen grams (of caffein) may be given in the course of a day in severe cases. If tried, it would probably prove a useful drug in cases of _sudden collapse_ from various causes.

Good effects of coffee are recounted by Thompson.[237]

It removes the sensation of fatigue in the muscles, and increases their functional activity; it allays hunger to a limited extent; it strengthens the heart action; it acts as a diuretic, and increases the excretion of urea; it has a mildly sudorific influence; it counteracts nervous exhaustion and stimulates nerve centers. It is used sometimes as a nervine in cases of migraine, and there are many persons who can sustain prolonged mental fatigue and strain from anxiety and worry much better by the use of strong black coffee. In low delirium, or when the nervous system is overcome by the use of narcotics or by excessive hemorrhage, strong black coffee is serviceable to keep the patient from falling into the drowsiness which soon merges into coma. In such cases as much as half a pint of strong black coffee may be injected into the rectum.

Strong coffee with a little lemon juice or brandy is often useful in overcoming a malarial chill or a paroxysm of asthma. It is a useful temporary cardiac stimulant for children suffering collapse.

Dr. Restrepo,[238] of Medellin, Colombia, claims to have cured many cases of chronic malaria and related diseases with infusion of green coffee, after quinine had failed. Wallace[239] states that tincture of green coffee is a natural and efficacious specific for cholera, and that she knows of more than a thousand eases of cholera and diarrhea which have been treated with it without an isolated case of failure. Landanabileo has been quoted as using raw coffee infusion in hepatic and nephritic diseases, venal and hepatic colics, and in diabetes.

In the Civil War, surgeons utilized coffee in allaying malarial fever and other maladies with which they had to contend, often under the most trying conditions, and with severely limited means of combating disease.[240] Its effect is to counteract the depressant action of low and miasmatic atmospheres, opening the secretions which they have checked. Travelers from the colder climes soon find that the fragrant cup of coffee is a corrective to derangements of the liver resulting from climatic conditions.[241]

Dr. Guillasse, of the French Navy, in a paper on typhoid fever, says:

Coffee has given us unhoped for satisfaction, and after having dispensed it we find, to our great surprise, that its action is as prompt as it is decisive. No sooner have our patients taken a few tablespoonfuls of it, than their features become relaxed and they come to their senses. The next day the improvement is such that we are tempted to look upon coffee as a specific against typhoid fever. Under its influence the stupor is dispelled, and the patient arouses from the state of somnolency in which he has been since the invasion of the disease. Soon all the functions take their natural course, and he enters upon convalescence.[242]

Also it has been reported that in extreme cases of yellow fever, coffee has been used most effectively by many physicians as the main reliance after all other well known remedies have been administered and failed.

According to Lorand,[243] the use of coffee in gout is strictly prohibited by Umber and Schittenhelm; but he considered it a mistake absolutely to forbid coffee, as, when a person has good kidneys, the small amount of uric acid furnished by the caffein can readily be eliminated. A curious remedy for gout and rheumatism, the efficacy of which the writer scouts, is said to be[244]--a pint of hot, strong, black coffee, which must be perfectly pure, and seasoned with a teaspoonful of pure black pepper, thoroughly mixed before drinking, and the preparation taken just before going to bed. If this has any value, it is probably purely psychological in its function.

Several writers[245] attribute amblyopia and other affections of the sight to coffee and chicory, without giving much conclusive experimental data. Beer,[246] a Vienna oculist, however, held that the vapor from pure, hot, freshly-made coffee is beneficial to the eyes.

Coffee and caffein are physiologically antagonistic to the common narcotics, nicotine, morphine, opium, alcohol, etc., and are frequently used as antidotes for these poisons. Binz found that dogs that have been stupified with alcohol could be awakened with coffee. It may thus be prescribed for hard drinkers to counteract the baleful excitability produced by alcohol; in fact, many topers taper off after a long debauch with coffee containing small amounts of alcoholic beverages. Considering its ability to counteract the slow intoxication of tobacco, it may be inferred that coffee is indispensable for hard smokers.

In general, the medicinal value of coffee may be said to be directly attributable to its caffein content, although its antiseptic properties are dependent upon the volatile aromatic constituents. Its function is to raise and to sustain vitalities which have been lowered by disease or drugs. Although some of the cures attributed to it are probably purely traditional; still, it must be admitted, that by utilizing its stimulating qualities in many illnesses the patient may be carried past the danger point into convalescence.

_Physiological Action of "Caffetannic Acid_"

It has been demonstrated in