Effects of alcohol and coca on foot temperature responses of highland Peruvians during localized cold exposure.код для вставкиСкачать
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. LITERATURE CITED Abramson, D. I., H. Zazeela and N. Schkloven 1941 The vasodilating action of various therapeutic procedures which are used in the treatment of periuheral vascular disease. Am. Heart J., 21: ?56-?65. Adams, R. N. 1959 A Community in the Andes: Problems and Progress in Muquiyauyo. Americ a n Ethnological Society, University of Washington Press, Seattle. Andersen, K. Lange, B. Hellstrom and F. Vogt Lorentzen 1963 Combined effect of cold and alcohol on heat balance in man. J. Appl. Physiol., 18: 975-982. Anonymous 1962 Ten years of the Coca Monopoly in Peru. Bull. o n Narcotics, 14 ( 1 ) : 9-17. Baker, P. T. 1969 Human adaptation to high altitude. Science, 163: 1149-1156. Cook, E. N., and G. E. Brown 1932 The vasodilating effects of ethyl alcohol on the peripheral arteries. Proc. Staff Meetings Mayo Clinic, 7: 449-452. DuBois, D., and E. F. DuBois 1916 A formula to estimate the approximate surface area if height and weight be known, Arch. Intern. Med., 17: 863-871. 241 Escobar M., G. 1968 The socio-political organization of Nufioa. In: Human Adaptation to High Altitude: A biological case study of a Quechua population native to the high Andean region with special reference to hypoxia and cold. Final Progress Report U. S. Army Surgeon General Contract DA-49-193-MD-2260, Paul T. Baker, Principal Investigator. The Pennsylvania State University, University Park, Pa. Fewings, J. D., M. 5. D. Hanna, J. A. Walsh and R. F. W h e l m 1966 The effects of ethyl alcohol on the blood vessels of the hand and forearm in man. Br. J. Pharmacol. Chemother., 27: 93-106. Forney, R. B., F. W. Hughes, R. N. Harger and A. B. Richards 1964 Alcohol distribution in the vascular system: Concentration of orally administered alcohol in blood from various points in the vascular system, and i n re-breathed air, during absorption. Quart. J. Stud. Alc., 25: 205-217. Gutierrez-Noriega, C. 1948 Errores sobre la interpretacidn del cocaismo e n las grandes alturas. Revista de Farmacologia y Medicina Experimental (Lima), 1: 100-123. Herbst, R., and P. Schellenberg 1931 Cocain und Muskelarbeit. I1 Mitteilung: Weitere Untersuchungen iiber die Beeinflussung des Gasstoffwechsels. Arbeitsphysiologie, 4: 203-216, Hine, C. H., and H. W. Turkel 1966 Research of the scientsc literature and reports on the effects on man of alcohol alone and in combination with other drugs. Arctic Aeromed. Lab. Technical Report 63-22, Ft. Wainwright, Alaska. Horton, B. T., 6.M. Roth and A. W. Adson 1936 Observations on some M e r e n c e s in the vasomotor reactions of the hands and feet. Proc. Staff Meeting Mayo Clinic, 2 2 : 433437. Horwitz, O., H. Montgomery, E. D. Longaker and A. Sayen 1949 Effects of vasodilator drugs and other procedures o n digital cutaneous blood flow, cardiac output, blood pressure, pulse rate, body temperature, and metabolic rate. Am. J. Med. Sci., 228: 669-682. Little, M. A. 1969 Temperature regulation a t high altitude: Quechua Indians and U. S. whites during foot exposure to cold water and cold air. Hum. Biol., in press. Mangin, W. 1957 Drinking among Andean Indians. Quart. J. Stud. A h , 18: 55-66. Mazess, R. B., E. Picon-Reategui, R. B. Thomas and M. A. Little 1968 Effects of alcohol and altitude on m a n during rest and work. Aerospace Med., 39: 403-406. Mishkin, B. 1946 The contemporary Quechua. In: Handbook of South American Indians, Vol. 2 The Andean Civilizations. J. H. Steward, ed. Smithsonian Institution Bureau of American Ethnology Bulletin 143, Washington, D. C., 411470. Monge M., C. 1952 The need for studying the problem of coca-leaf chewing. Bull. on Narcotics, 4 ( 4 ) : 13-15. Montgomery, H. 1942 The effect of drugs on the circulation in normal hands and feet. Am. J. Med. Sci., 203: 882-890. 242 MICHAEL A. LITTLE Pascale, L. R., M. I. Grossman, H. S. Sloane and T. k a n k e l 1956 Correlations between thickness of skinfolds and body density in 88 soldiers. Hum. Biol., 28: 165-176. Picon-Reategui, E. 1968 Effect of coca chewing on metabolic balance in Peruvian highaltitude natives. In: Human Adaptation to High Altitude: A biological case study of a Quechua population native to the high Andean region with special reference to hypoxia and cold. Final Progress Report U. S. Army Surgeon Paul T. General Contract DA49-193-MD-2260, Baker, Principal Investigator. The Pennsylvania State University, University Park, Pa, Schultes, R. E. 1963 Botanical sources of the New World narcotics. Psychedelic Rev., 1 : 145166. Schulze, W. 1947 Untersuchungen iiber den Einfiuss des Alkohols auf die periphere Durchblutung bei lokaler Kalteeinwirkung. Klinische Wochenschrift, 25: 646-654. Stein, W. W. 1961 Hualcan: Life in the Highlands of Peru. Cornell University Press, Ithaca, N. Y. Wolff, P. 0. 1952 General considerations on the problem of coca-leaf chewing. Bull. on Narcotics, 4 (2): 2-5. Zapata Ortiz, V. 1944 ModiGcations psicologicas y fisiologicas producidas por la coca y la cocaina en 10s coqueros. Revista de Medicina Experimental (Lima), 3: 132-162. 1952 The problem of chewing of the coca leaf in Peru. Bull. on Narcotics, 4 (2): 2W3. 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.