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Effects of alcohol and coca on foot temperature responses of highland Peruvians during localized cold exposure.

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Effects of Alcohol and Coca on Foot Temperature
Responses of Highland Peruvians During a
Localized Cold Exposure '
MICHAEL A. LITTLE
Department of Anthropology, The Ohio State University,
CoEumbus, Ohio
ABSTRACT
Two groups of highland Quechua Indian males were tested under
conditions of local foot exposure to cold air (0°C). Foot temperatures were monitored
throughout the hour cold test and for 16 minutes recovery at room temperature
(24OC). In the first group (age range 14-20 years), 29 subjects were tested while
chewing coca leaves and while under control conditions. The second group (age
range 20-50 years) of 25 subjects was tested while consuming 1.1 gm of ethyl
alcohol per kilogram of body weight and again under control conditions. Both drugs
(coca and alcohol) are habitually consumed by members of the native population.
The mastication of coca leaves had no effect on foot skin temperatures. Alcohol
consumption, however, elevated foot temperatures to between 4 and 6°C higher
than control values at the end of 60 minutes of cold exposure. It is suggested that
alcohol consumption gives the Indian a slight thermal advantage and increases
levels of comfort during natural cold exposure.
Two of the most important drugs to the
highland Quechua Indian are alcohol and
coca. Ethyl alcohol is regularly consumed
by most adults in the form of sugarcane
alcohol, and the coca leaf (Erythroxylm
coca) is chewed by a large proportion of
adult highland natives. In the district of
Nufioa (Puno department), where the present study was conducted, estimates were
made that between 20 and 40% of the
trade can be attributed to purchases
of sugarcane alcohol and beer (Escobar,
'68). Moreover, the department of Pun0
has one of the highest per capita consumption rates of coca in Peru (Anon.,
'62). Both drugs have important ritual significance and are incorporated into wedding, funeral, house building, and agricultural ceremonies as libations as well as
for general consumption (Mishkin, '46;
Mangin, '57; Adams, '59; Stein, '61). During fiestas and celebrations, drinking is
prescribed behavior, and rather large
quantities of alcohol may be consumed
over the space of a number of days. In
addition to ritual functions, alcohol reduces
social tension and often facilitates rapport
between individuals, while the practice of
chewing coca tends to contribute to the
establishment of social solidarity and group
AM. J. PHYS. ANTHROP.,32: 233-242.
identity. Thus, the behavioral value of the
use of these drugs in improving social integration is great.
Alcohol and coca may also be of value
to the biological maintenance of the highland Indian. For example, the southern
highlands of Peru are characterized by two
climatic parameters that tend to produce
stress in resident populations : ( 1 ) reduced
atmospheric oxygen and ( 2 ) low ambient
temperatures. One worker (Monge, '52)
has suggested that coca chewing may improve the native's tolerance to altitude induced hypoxia. Others (Gutierrez-Noriega,
'48; Wolf€, '52) have contended that coca
use is socially and biologically destructive
to the native. The problem, far from resolved, does raise the possibility that coca
serves more than just a social and psychological function. Consumption of alcohol at
high altitude may have a slightly detrimental effect upon resistance to hypoxia, especially during exercise (Mazess, PiconReategui, Thomas and Little, '68). The
problem of hypoxia is dealt with briefly
here, since the concern of the present study
is with relationships between temperature
and the use of these two drugs.
1 This research was supported in part by U. S. Surgeon General Contract Dh-49-193-MD-2260 and by
a grant from The Ohio State University.
233
234
MICHAEL A. LITTLE
The coca leaf contains a number of alkaloids of which cocaine is the best known
(Schultes, '63). When the leaf is masticated with lime, many of the alkaloids are
released and ingested. It i s clear, however,
that there are qualitative and quantitative
differences in responses to the drug when
coca use is compared with direct use of
cocaine (Zapata Ortiz, '52). A number of
possible physiological effects have been
attributed to the use of coca and cocaine
without general concensus, yet there does
seem to be more agreement with respect
to the thermal effects of coca and cocaine.
Herbst and Schellenberg ('31 ) demonstrated an increase in metabolism and body
temperature with cocaine administration.
Zapata Drtiz ('44) found similar increases
in body temperature with coca chewing
over a period of one and one-half hours.
More recently, all-night cold tests were performed by Elsner and Bolstad ('63) on
Quechua Indians under conditions with
and without coca. They found no increases
in metabolic rate, rectal temperature, or
average skin temperature with the use of
coca, although skin temperature of the
foot appeared to be slightly higher with
coca use. Finally, in a metabolic balance
study of Quechua Indians (Picon-Reategui,
'68), slight increases in resting skin temperatures were observed in a thermoneutral environment when coca was chewed.
When alcohol is orally administered in
moderate doses to human subjects (0.5
g/kg body weight or less), cutaneous blood
flow to the fingers increases and skin temperatures rise, whereas the same response
is slight or absent in the toes (Horton,
Roth and Adson, '36; Montgomery, '42;
Schulze, '47;Horwitz, Montgomery, Longaker and Sayen, '49). In general, the response is confined to blood vessels in the
skin (Fewings, Hanna, Walsh and Whelan,
'66) and distal portions of the limbs
(Abramson, Zazeela, and Schkloven, '41 )
and results from vasodilation of peripheral
blood vessels. Apparently, larger doses of
alcohol are necessary to elicit increases in
blood flow to the toes (Montgomery, '42),
although increases in toe temperatures
have been observed with moderate doses
in one study (Cook and Brown, '32).
Forney and others ('64) presented evidence
that blood alcohol values from the toe tip
and dorsal foot vein are between 24 and
46% lower than values from the finger
tip and cubital vein. This finding may
partially explain the differences in temperature responses between the hand and foot.
The present study deals with temperature responses of the foot to cold air exposure and the possible effects of coca and
alcohol on these responses. Coca was tested
under the assumption that coca-induced
metabolic increases should be reflected by
increases in skin temperatures. Alcohol
was tested to assess the degree of warming
produced by the drug among Quechua
Indians.
METHODS
Subjects
All tests were conducted at the high altitude laboratory in the town of Nufioa,
Peru (elevation 4000 m). At this elevation, barometric pressure is roughly 62%
(474 mm Hg) of that at sea level and mean
annual temperatures give values close to
8°C (46°F). The town is the capital of a
district of the same name and is located
in the altiplano of Southern Peru about
280 km southeast of the city of Cuzco. Most
of the residents of this region are biologically Indian with minimal white admixture
(Baker, '69). Only subjects who appeared
native were used for the cold tests. Of the
subjects who were tested, about 90% were
born in the district and all were lifelong
residents of the altiplano.
Two separate experiments were carried
out: the first to test the effect of coca and
the second to test the effect of alcohol on
foot skin temperatures. In the first experiment 29 late adolescent boys were tested.
Measures of age and some of their physical
characteristics are given in table 1. These
values fall within the normal range of
other age-mates sampled from the same
area. Subjects for the second experiment
included 25 adult males. Physical characteristics and age of these subjects are given
in table 2. The Quechua Indian tends to
be shorter, lighter in weight, and leaner
with less body Eat when compared with
his U. S. counterparts. Most of the ages of
subjects who participated in both experi-
235
DRUG EFFECTS ON FOOT TEMPERATURES
TABLE 1
Physical characteristics and age of 'Coca' subjects (N=29)
Age (years)
Stature (cm)
Weight (kg)
Surface area (mz) 1
Sum of 8 skin folds (mm)
Foot length (cm)
Foot breadth (cm)
Foot volume (ml)
1
Mean
S.D.
Range
17.1
156.5
50.1
1.48
55.9
23.7
9.3
835
1.8
8.4
7.3
0.15
10.7
1.2
0.5
114
1420
138.1-166.8
35.8-60.8
1.17-1.65
40.0-89.9
21.4-25.3
8.2-10.0
590-975
From stature and weight according to the equation of DuBois and DuBois ('16)
ments were verified by vital statistics from
the local district records.
Procedures
For a period of at least one hour before
the cold exposure, the subjects rested at
room temperature (24°C)in order to a p
proximate a thennoneutral steady state.
Food intake of the subjects prior to their
arrival at the laboratory was not controlled,
but it was estimated that no subject was
tested less than two hours post prandium.
During both the pre-exposure and cold exposure periods, the subjects were fully
clothed except for the feet, and were instructed to add or remove clothing at any
time to maintain a state of comfort. In
addition, the test procedures were carefully outlined to each subject in an attempt
to mitigate any feelings of anxiety.
The cold test involved locally exposing
the foot to cold air at 0°C for a one-hour
period. Skin temperatures on both feet were
recorded at two-minute intervals during
the 60-minute cold exposure and 16-minute
recovery period at room temperature. Dur-
ing the entire test period, only the left foot
was exposed to cold air, while the right
foot remained at room temperature. The
test chamber was a well-insulated styrofoam box designed to accommodate four
test subjects at one time. Air temperatures
in the test chamber were maintained at
0°C with an absolute deviation of 2 l.O"C,
and turbulent air flow was within the range
of 25 to 35 m/minute. Chamber air, room
air, and skin temperatures were recorded
with 26-gage copper-constantan thermocouples (Thermo-Electric Co.) and a manual multi-point potentiometer (Honeywell
Electronik 15 Precision Indicator). Skin
temperatures were recorded at two sites on
the foot: (1) the distal pad of the large toe
(Toe 1) and (2) the dorsal surface of the
foot at the midpoint of the second metatarsal bone (Dorsum). Previous studies
(Little, '69) indicated that differences in
temperature responses between the large
and small toe are slight, and thus the large
toe can be taken as representative for the
foot. Thermocouples were attached to the
skin with adhesive tape and a liquid s ~ r g i -
TABLE 2
Physical characteristics and age of 'Alcohol' subjects ( N = 2 5 )
Age (years)
Stature ( c m )
Weight (kg)
Surface area (m2)
Percent fat 2
Lean body mass (kg)
Sum of 8 skin folds (mm)
Foot length (cm)
Foot breadth (cm)
Foot volume (ml)
Mean
S.D.
33.9
157.8
54.6
1.54
8.6
49.9
48.9
23.9
9.8
910
8.6
5.9
5.3
0.10
1.2
4.6
13.1
1.0
0.7
105
Range
20-50
144.9-168.4
44.0-67.6
1.32-1.75
7.611.6
40.6-59.8
35.9-76.7
21.6-25.5
8.4-11.1
690-1160
From stature and weight according to the equation of DuBois and DuBois ('16).
According to the equation of Pascale et al. ( ' 5 6 ) .
This value was calculated by multiplying per cent fat by body weight and subtracting the weight
of fat from the body weight.
1
2
3
236
MICHAEL A. LITTLE
cal adhesive without covering the temperature sensing junction.
The subjects who participated in the
first experiment were given about 3 to 4 gn-~
of coca with lime (Zlipta) at the beginning
of the tenth minute of cold exposure. They
were instructed to chew the coca until the
termination of the experiment. All subjects were familiar with coca-chewing
techniques. The choice of young subjects
facilitated comparisons of the responses of
naive and experienced coca-users, since
most adult Indians are experienced in the
use of coca. The adult subjects who participated in the second experiment were given
the equivalent of 1.1 gm of absolute ethyl
alcohol per kilogram of body weight orally
in the form of sugarcane alcohol diluted
with water a (corresponding to about 4.5 oz
of 100-proof whiskey for a 55 kg man).
They were instructed to drink the alcohol
between the tenth and twentieth minute of
cold exposure.
The coca experiment was always carried
out in the morning and the alcohol experiment in the afternoon. All subjects acted
as their own controls during the cold tests
with no drug administration. An additional
control for any anxiety produced by the
first exposure was incorporated by testing
about half of the subjects with the drug
during the first exposure and the other half
with the drug during the second exposure.
The double-blind control, however, was not
employed because of the difficulty of devising suitable placebos.
Oral temperatures and heart rates were
taken about five minutes preceding the
cold exposure to assess the general thermal
state of the subjects. These values are listed
in table 3. There are no differences between the drug treatment and control exposures for oral temperature or heart rate.
Additional information regarding the
normal use of each of the two drugs was
gathered by questionnaire. This will be
treated in the following section.
RESULTS
Coca experiment
Of the 29 subjects who participated in
this experiment, 19 indicated that they do
chew coca, although the frequency of use
ranged from about two times/year to
two times/week. Most responded that they
take coca principally when working in the
fields or when traveling, and about 75%
stated that they used the drug more often
during rainy or cold weather. From this
sample, the average age when coca is first
chewed is 14.5 years and the range is between 10 and 18 years. This age range is in
conformity with other estimates (Zapata
Ortiz, ’52). When asked the question ‘Bow
do you feel when you take coca?” the 19
subjects responded with terms such as
“normal,” “good,” “better,” “tranquil,”
and ‘Tiappy” (probably indicating a general
feeling of well-being). Other statements
included the feeling of being “warmer”
(over 5 0 % ) and two subjects indicated
zThe undiluted sugarcane alcohol was analyzed in
the U. S. and gave a value of 94.5% alcohol by volume
(91.7% by we!ght). Evaporatlon of samples indicated
that sugar resldues were absent. This is an important
point, since it has been documented that sugar will
slow down the absorption rate of alcohol (Hme and
Turkel, ’66: p 14).
TABLE 3
Pretest oral temperatures and heart rates
Without drug
Coca experiment
(N=29)
Oral temperature
(“C)
Heart rate
(beatdmin)
Alcohol experiment
(N=25)
Oral temperature
(“C)
Heart rate
(beats/&)
Mean
S.D.
37.2
0.3
74
8
37.3
0.2
76
9
With drug
Range
36.2-37.8
62-92
36.9-37.6
60-96
Mean
S.D.
37.2
0.2
73
8
37.2
0.2
76
8
Range
36.8-37.7
56-92
36.8-37.5
64-96
237
DRUG EFFECTS O N FOOT TEMPERATURES
subjects' impressions of the effects of the
drug were and can be compared with the
experimental results.
Figures 1 and 2 illustrate the skin temperature responses at the two sites on the
that when they chew coca during warm
weather they develop headaches and feel
lazy, yet when they chew coca during cold
weather they feel normal or warmer. These
responses, then, express roughly what the
TOE 1
I
control: warm n
cold o
coca
0
20
30
40
50
EXPOSURE TIME (min)
10
70
60
Fig. 1 Skin temperatures of the large toe (Toe 1 ) during cold exposure (O'C) and
exposure to room temperature (24°C). Solid figures signify experiments when coca was
being masticated.
30
I
DORSUM
A
Y
-
u 25
oi
3
I-
2
2 20
zLu
I-
Z
y
m
a
I
control: worm P
cold o
I
cold
15
recovery
1
coca
10
I
0
I
10
%
I
I
I
I
20
30
40
50
EXPOSURE TIME (rnin)
I
I
60
70
Fig. 2 Skin temperatures of the dorsum of the foot during cold exposure (O'C) and
exposure to room temperature (24°C). Solid figures signify experiments when coca was
being masticated.
238
MICHAEL A. LITTLE
foot. Under these conditions, chewing coca
appears to have no effect on skin temperatures, whether the foot is exposed to room
temperature or to cold air. The t-test was
applied and none of the slight differences
in means approached levels of statistical
significance. A further division of the sample into the 19 subjects who occasionally
chew coca and the ten subjects who do not
also failed to show any effect of the drug.
Alcohol experiment
All of the men who participated in the
alcohol experiment acknowledged that they
consume alcohol regularly. It is consumed
as sugarcane alcohol, chicha (corn beer),
ponche (sugarcane alcohol punch), wine,
beer, rum, and pisco (brandy). The most
popular drink is sugarcane alcohol. Over
half of the subjects said that they often
drink to a level of intoxication, and the
frequency of alcohol consumption ranged
between once each month to every day.
A few subjects indicated that they drink
while working in the fields and during
cold weather.
The experimental results of oral alcohol
administration are presented in figures 3
and 4. Under control conditions, the skin
temperatures of the foot exposed to cold
air declined throughout the cold test at the
rate of about O.l"C/minute. At the end
of the 16-minute recovery period skin temperatures returned to between 8 and 9°C
of the pre-exposure temperatures. Under
the same conditions, the skin temperatures
of the foot exposed to room air remained
fairly constant throughout the test. When
alcohol was administered, both the warm
and cold foot responded with increases in
skin temperatures. The response was more
pronounced and occurred earlier at the toe
site. At the end of the recovery period, skin
temperatures of the cold-exposed foot were
close to pre-exposure values. Maximal
alcohol-control differences for the cold exposed skin sites occurred at about the
sixtieth minute (figs. 5, 6 ) . The means
were statistically significant (t-test) at
p < 0.05 after the forty-fourth minute and
at p < 0.01 after the sixty-second minute.
Alcohol-control differences in skin temperatures did not reach levels of statistical
significance for the foot at room temperature.
I
-30 -
TOE 1
V
e
u
e
3
225
p?
u
2u
c
-
Z
20 -
Y
with alcoho1:warm rn
cold
control: warm o
cold o
I
v)
15
j
I
I
I
0
10
20
I
I
I
30
40
50
EXPOSURE TIME (min)
recovery
I
I
60
70
Fig. 3 Skin temperatures of the large toe (Toe 1 ) during cold exposure ( 0 ° C ) and
exposure to room temperature (24°C). Solid figures signify experiments when alcohol
was consumed.
239
DRUG EFFECTS O N FOOT TEMPERATURES
DORSUM
L
I
I
I
-
with alcohol: warm B
cold 0
control: warm o
cold o
I
I
I
I
i
-
t
1
I
0
10
I
I
1
40
I
50
EXPOSURE TIME ( m i n l
20
30
recovery
I
I
60
70
Fig. 4 Skin temperatures of the dorsum of the foot during cold exposure (O'C) and
exposure to room temperature (24°C). Solid figures signify experiments when alcohol was
consumed.
DISCUSSION
The results of tests to assess the effects
of coca and alcohol on foot temperature
responses indicate that a moderately high
dose of alcohol produces a distinct rise in
skin temperature. A standard amount of
coca, however, fails to elicit a response.
An absence of skin temperature responses
with coca mastication might have been
predicted from the findings of prior studies.
For example, the increase in body core
temperature with coca use that was documented by Zapata Ortiz ('44) only
amounted to O S T , and would probably be
too slight to produce a corresponding rise
in skin temperatures. Moreover, these core
temperatures reached maximal values after
90 minutes of continuous coca use, while
the duration of the present test after first
administration of coca was 66 minutes. It
appears unlikely that coca would have
shown any effect had the present test been
extended, since there appeared to be no
developing trends to foot temperature responses that could be attributed to coca use
(see figs. 1, 2). The combined results of
the present study on local cold responses
and the study by Elsner and Bolstad ('63)
on total body cooling suggest that if coca
chewing does produce a temperature effect
among Quechua Indians, any advantage
gained in maintaining warmer skin temperatures under cold conditions would be
minimal.
The consumption of alcohol, on the other
hand, should give the Indian a thermal
advantage during natural exposure to cold.
Alcohol would certainly not contribute to
the maintenance of thermal balance, since
heat loss via the skin would be elevated.
Yet over short periods of time, the advantage in terms of comfort should outweigh
the disadvantage of a negative heat balance. One potentially dangerous situation
might arise if an individual were to lose
consciousness ("pass out") and remain
exposed throughout the night. In this case,
if ambient temperatures were low, the
individual's core temperature might drop,
producing a critical level of hypothermia.
However, Indians in Nuiioa were on occasion observed after having slept outside
throughout the night with what appeared
to be no ill effects.
240
MICHAEL A. LITTLE
TOE 1
-
- COLD
I
EXPOSED
I
I
I
-
I
-
I
I
I
I
I
I
I
j
-
l - 1
0
10
recovery
I
I
I
20
30
40
50
EXPOSURE TIME [rnin]
60
70
Fig. 5 DifFerences between Toe 1 temperatures during cold exposure and recovery when
alcohol was consumed and under control conditions.
-
DORSUM
- COLD
EXPOSED
-.
II
recovery
I
i
0
10
20
30
40
50
EXPOSURE TIME [min]
60
70
Fig. 6 Differences between dorsum foot temperatures during cold exposure and recovery when alcohol was consumed and under control conditions.
There do seem to be some differences in jects during total body cold exposure at
response to alcohol between the thoroughly 20°C and 15°C and found no differences
chilled individual and one who is either in metabolic rate, rectal temperature or
mildly chilled or who only has the ex- skin temperatures when comparisons were
tremities exposed to cold. Andersen, Hell- made between control exposures and exstrom and Lorentzen ('63) tested nude sub- posures with intake of alcohol. One of
DRUG EFFECTS O N FOOT TEMPERATURES
their most significant findings was the
complete absence of vasodilation during
the exposure with alcohol.
The cold conditions under which Andersen’s tests were performed are seldom experienced by the highland Quechua native.
Although the distal portions of the extremities are always exposed, the rest of
the body is well insulated with homespun
wool clothing. At night when the highland
Indian is exposed to temperatures slightly
above freezing and is consuming alcohol,
the only parts of the body that are exposed
to cold are the face, the hands, and the
feet. At this time activity levels are low
and some degree of heat loss may occur.
During fiestas or celebrations, many individuals are active and much of the heat
loss resulting from alcohol-induced vasodilation is probably replaced by increases
in metabolic activity.
ACKNOWLEDGMENTS
I should like to express my thanks to
the following individuals for their contributions to the study. Mrs. Margay Blackman assisted in data analysis and Mr. Dale
Hershberger kindly analyzed the alcohol
samples. Valuable aid in data collection in
Peru was provided by Mrs. Adrienne V.
Little. In addition, computer services were
furnished by The Ohio State University
Computer Center.
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drinkers. Everyone who was tested consumes alcohol to some extent. It was found
that more of the drinking occurs in the
evening, late afternoon, and on weekends.
Of course, during fiestas there is a great
deal of alcohol consumed by both adult
men and women. In terms of general behavior, alcohol is very important.
DR. JOHNSTON: In both males and females?
DR. LITTLE: Yes, and probably late
adolescents as well, but I am not sure at
what age alcohol consumption begins.
DR. MARSHALL
T. NEWMAN:
Pathologist
Ralph Brauer told me that when he was
operating at about 20,000 feet elevation,
he tried chewing coca for altitude improvement. He said himself it really
worked. Now this, of course, is not objective. But wouldn’t you think that the
real effect of chewing coca would be to
accommodate the effect of hypoxia rather
than to cold?
DR. LITTLE: There is a great deal of
controversy over this. Monge, I think,
feels that coca is important to the highland native for adaptation to hypoxia. I do
not really think that there is enough exDISCUSSION
perimental evidence to demonstrate this.
DR. FRANCISJOHNSTON: What kind of Also, I corresponded with a botanist who
behavioral differences did you find among chewed coca for several years while working in the lowlands, and to some extent, in
individuals in alcohol consumption?
DR. LITTLE: I administered a rather the highlands. He periodically abstained
brief questionnaire to see if I could dis- from chewing and noted no effects whattinguish between heavy drinkers and light ever.
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effect, highlander, coca, response, exposure, temperature, foot, localized, cold, peruvian, alcohol
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