Narcotics are substances having the physiological action, in a healthy animal, of producing lethargy or stupor, which may pass into a state of profound coma or unconsciousness along with complete paralysis, terminating in death. Certain substances of this class are used in medicine for the relief of pain, and are then called anodynes, whilst another group produce profound sleep and are consequently known as hypnotics. In one sense, aneasthetics, such as chloroform and ether, may be held to be narcotics, but, as they are usually volatile substances causing unconsciousness for a comparatively short time, they are conveniently separated from the true narcotics, the effects of which are much more lasting. These distinctions are to a great extend artificial, as it is evident that a substance capable of producing partial insensibility to pain, or sleep, will inevitably in larger doses cause profound coma ending in death. Hence we find the same substances sometimes classed as anodynes and at other times as hypnotics. For example, small doses of opium, or of one or other of its preparation, relieve pain, whilst larger doses act as hypnotics, causing deep sleep passing into coma. As examples of anodynes, we have opium and some of the alkaloids in it, Cannabis indica or Indian hemp, belladonna and its alkaloid atropia, hyoscyamus or henbane and its alkaloid hyoscyamia, and the anaesthetics properly so called, such as chloroform, ether, ethidene &c. The hypnotics are such substances as opium and its alkaloids, chloral hydrate, hyoscyamus, lactucarium (obtained from Lactua virosa, the strong-scented lettuce), and preparations of Humulus Lupulus (the common hop), such as inhalations of the steam of infusions, or hop-pillows. In addition we may group as narcotics certain substances which cause not only narcotism, but also the specific effect
Name of Substance Name of Plant Common Names Alkaloids Physiological Action Poisonous Dose Treatment of Case of Poisoning
Opium. Inspissated juice of Papaver somniferum, or poppy. Opium In 100 parts of fine opium to parts of morphia, 6 of narcotina, 1 of papaverina, 15 of thebia or paramorphia, 03 of codeia, 02 of narceia, and 4 of meconic acid. Described in text. Acts on all classes of a nimals. May cause convulsions from increased activity of reflex centers in the spinal cord, especially in animals having small brains. Causes slowing of hearts action by stimulation of inhibitory nerves of heart. Destroys the action of the respiratory centers in medulla. Stimulates oculo-motor centers, and hence causes contraction of pupil Varies according to habit. Opium eaters can take 20 to 30 grains with impunity. 1 to 3 grains produce wellmarked symptoms in ordinary persons. Medicinal dose for adult is _ to 2 grains. Evacuate the stomach by an emetic or by the stomach-pump. Give at once a large spoonful of mustard in a tumblerful of tepid water, and repeat in a quarter of an hour if necessary; to be followed by a powder containing 30 grains of sulphate of zinc and 30 grains of ipecacuanha powder. Keep up respiration by constantly inducing the patient to breathe voluntarily. Cause the patient to walk about, and endeavor to keep him awake. Give him very strong infusions of coffee or tea, especially green tea. In the last stages use artificial respiration.
Morphia. From opium. See above. Morphia. Morphia, C17H19NO H20, employed as hydrochlorate of morphia or acetate of morphia. Similar to opium. Papaverina, narceia, meconia, cryptopia, codeia, and thebaia or paramorphia have all actionsof a narcotic character, but codeai and thebaia have more of an exciting action and little of a narcotic action. Varies according to habit. 2 to 3 grains by stomach dangerous. 1/6 of a grain for an adult man or 1/10 for an adult woman is the largest safe dose when injected under the skin. Same as for opium.
Indian Hemp. Alcoholic extract of Cannabis sativa, as it grows in India and in America. Indian hemp. Gunjah is the dried plant sold in Calcutta bazaars for smoking; Churrus is the resinous exudation of the epidemis; Hashish is an Arabian preparation. No alkaloid has been separated. The resin is the active preparation. Exhilaration; great mental excitement, with pleasant and often gorgeous visions; a state of ecstasy, with loud laughter; loss of sense of time,or a feeling as if pleasurable sensations were infinitely prolonged. Pupils dilated. Loss of strength, drowsiness, sleep, coma. Varies much with different specimens of resin. 1/8 of a grain may cause marked effects 2 to 3 grains dangerous. Seldom fatal. If a large dose has been taken, use emetic of mustard and water, or stomach pump; after this keep the patient quiet, allay excitement, and if symptoms of depression come on small doses of alcohol are useful.
Belladonna. Leaves and roots of Atropa Belladonna. Deadly nightshade. Atropia. See Atropia. ---- ----
Atropia. Atropa Belladonna. Atropine. Atropine, C17H23NO3, employed as sulphate of atropine. See description in text. Increased frequency of pulse, with very large doses. Paralyses the inhibitory action of the vagus nerve, so that stimulation of this nerve during atropine poisoning does not cause slowing of heart. Small doses cause contraction of capillary vessels, thus acting as a stimulant to vaso-motor centers. Destroys the excitability of motor nerves passing to muscles generally, thus producing inability to move. Weakens and finally abolishes the reflex excitability of the spinal cord. Large doses weaken action of motor nerves concerned in the movements of respiration. Suppresses secretion of the mucous and salivary glands, probably by paralyzing secretory nerves. Large doses lower the temperature of the body. Cause dilatation of pupil, lessened intra-ocular pressure, and paralysis of accommodation. 80 grains root have caused death. Sometimes the medicinal extract of belladonna is so weak that a dose of 2 drachms may not be fatal. 1/10 or 1/15 of a grain of atropine may cause alarming symptoms, and half a grain would almost certainly be fatal. Same treatment as for opium poisoning. The object aimed at is to prevent absorption of the poison by the free use of emetics. External stimulation by bathing the feet in mustard and water, by rubbing or kneading the skin, along with the free use of tannic acid suspended in water, are the best remedial measures. There is often retention of urine. This must be relieved by the catheter.
Stramonium Leaves and seeds of Datura Stramonium. Jamestown weed, thorn-apple. Daturia, identical with atropia. Same as belladonna and atropia. Not ascertained Children have been poisoned by eating the seeds. Treatment the same as for belladonna and atropia.
Hyoscyamus Leaves and seeds of Hyoscyamus niger. Henbane. Hyoscyamia Almost identical with atropia. There is even greater excitement than in case of belladonna poisoning, indicating a stronger action on the cerebrum. The action of the heart is first stimulated as with atropia, but it is afterwards much depressed, as shown by the lessening number of pulse beats. Pupil dilated. Mouth dry and parched. 1/60 of a grain of hyoscyamia will cause appreciable effects. 1/48 of a grain causes sleepiness, dryness of mouth, and dilatation of pupil. 1/24 causes quickening of hearts ac tion; and 1/12 will produce first quickening and then slowing of the heart. The half of a grain would be dangerou Treatment the same as for belladonna and atropia.
Hops. The dried strobiles of the female plant of Humulus Lupulus. The hop or hop vine. Lupulina. A feeble narcotic, causing, when infusions are taken freely heaviness, and perhaps sleep. Not regarded as a poison. -----
Lactucarium Concrete juice of Lactuca virosa. Juice of lettuce Lactucinia. Very feeble narcotic. In very large doses, say half an ounce, has a soothing sedative effect. Not regarded as a poison. ---
of dilatation of the pupil of the eye, and disorder of the mechanism of focusing the eye for various distances, resulting in dimness and confusion of vision. Such are sometimes called mydriatics (___, dimness of sight); thy embrace belladonna, henbane, stramonium, cryptopia (one of the alkaloids in opium), and Indian hemp.
All of these substances act on the nervous system, and although the physiological action of each is characteristic, there are many symptoms common to the whole group; indeed the course of action of all show three well-defined stages:- (1) there is first a period of apparent exaltation of function; (2) this is followed by a period of diminution and perversion of functional activity; and (3) there is a time of loss of function, in which there is profound coma and paralysis. This is well illustrated by a description of the symptoms caused by opium. A small does not unfrequently acts as a stimulant; there is a sense of vigor, a capability of severe exertion, and an endurance of labor without fatigue. A larger dose often exerts a calming influence, with a dreamy state in which images and ideas pass rapidly before the mind without fatigue, and often in disorder and without apparent sequence; time seems to be shortened as one state of consciousness quickly succeeds another, and there is a pleasant feeling of grateful rest. This is succeeded by sleep which, according to the strength of the dose and the idiosyncracy of the person, may be light and dreamy, or like natural profound sleep, or deep and heavy, passing into stupor or coma. From this a person may awaken with a feeling of depression, languor, or wretchedness, often associated with sickness, headache, and vomiting. If a person to not thus awaken, and the dose be large, there is the condition of deep coma. The pupils are strongly contracted, the face usually flushed and often purplish in hue, the skin dry and warm, respiration deep and slow, often with the rattle in the throat called stertorous breathing; the pulse is slow, strong, and compressible under the finger; and the is deep unconsciousness, from which, however, the person may sometimes be aroused by shaking or shouting, and into which he at once relapses when left to himself. This condition is succeeded by one of even deeper prostration. The person cannot be aroused; the pupils may now become somewhat dilated, especially on the approach of death; the countenance has a death-like aspect, and a bluish-white tint; the pulse quickens and becomes smaller, and more and more feeble; and the skin is covered with a cold clammy sweat. The vital functions are reduced to the lowest ebb, and death then occurs from failure of respiration. Such a train of symptoms is called narcotism. These general symptoms are of course largely modified by the amount of the dose. If it be very large, the person may pass very quickly into the deeply comatose stage.
A somewhat different mode of action is illustrated by the physiological effects of belladonna, or of its alkaloid atropine or atropia. A small dose causes dryness of the throat and mouth, dilatation of the pupils, dimness of vision except for distant objects, and often double vision. The pulse becomes quick, rising, in an adult, from 80 or 120 or 160 beats per minute; and there is often a bright red flush over the skin. The intellectual powers are at first acute and strong, but they soon become confused. There is giddiness, confusion of thought, excitement, a peculiar talkative wakeful restiveness, in which the person shows that his mind is occupied by a train of fancies or is haunted by visions and specters. Often there is violent delirium before sleep comes on. The sleep after a large dose deepens into stupor, with great muscular prostration or paralysis. During all the time the pupils are widely dilated. Death occurs from failure both of the hearts action and of respiration.
The chief facts regarding the true narcotics are briefly summarized in the accompanying table.
Conium or hemlock (the leaves and the fruit of Conium maculatum) and its alkaloid conia are sometimes erroneously classed as narcotics. These substances act more in the way of depressing or weakening muscular activity, by influencing the motor nerves, or the nerve-endings in the muscles, and they have no effect on sensory nerves and sensory centers. Neither is aconite a true narcotic (see. Aconite).
Hydrate of chloral has since 1872, when it was introduced as a therapeutic agent by Dr Oscar Liebreich of Berlin, come into great favor as an anodyne and narcotic. It is ethylic aldehyde in which 3 atoms of chlorine are substituted for 3 atoms of hydrogen; thus:-
C2H40 + 6Cl = C2H Cl30 + 3HCl
Aldehyde Chlorine Chloral Hydrochloric acid.
The formula for the hydrate is C2HC130.H02. In small doses, say 10 to 20 grains, chloral is a pure hypnotic, and the sleep obtained is quiet and refreshing. In larger doses it is narcotic, abolishing though and motor power, with profound coma. Respiration is much enfeebled, and the pulse becomes small and weak. The pupils are widely dilated. It is not uniform in its action, so that occasionally death may occur after a comparatively small doe, even in persons have been in the habit of taking the medicine. For this reason, the habit of taking chloral without medical advice, and of taking it frequently, is to be strongly deprecated. An allied substance called croton-chloral hydrate (C8H3C1302,2H0) has no hypnotic properties, but is of use when applied externally for severe neuralgia of the face, due to affections of the fifth cranial nerve (tic douloureux).
Narcotics are used in medicine for various purposes. (1) To relieve pain. The best one for this purpose is opium, either in the solid form or a laudanum (tincture of opium). It is most useful in cases of spasmodic pain. (2) To cause sleep. In some cases opium may be useful for this purpose; but it causes disorder of the digestive functions, and there is the further danger of producing the "opium habit," a vice ruinous alike to body and mind. On the whole hydrate of chloral is the best and safest hypnotic, but it is not without its dangers, and it ought not to be taken except under medical advice. (3) To allay irritation. Where there is increased sensibility, with continued-irritating though not severe pain in any part, opium or hyoscyamus may be used with benefit. (4) To cause dilatation of pupil. For this purpose, solutions of atropine are in constant use by ophthalmic surgeons. A few drops of solution of atropine, or a soluble disk containing atropine, introduced into the eye, cause dilatation of the pupil and diminished tension in the eyeball, at the same time soothing pain. (5) To arrest secretion. For this purpose opium, or belladonna, and atropine are especially useful. Small doses of atropine are given to arrest secretion in cases of profuse salivation, and extract of belladonna applied to the skin is used for stopping the secretion of milk from the mammary gland. (J. G. M.)
The above article was written by: Prof. J. G. McKendrick.