This section is from the book "Materia Medica And Therapeutics - Vegetable Kingdom", by Charles D. F. Phillips. Also available from Amazon: Materia Medica And Therapeutics: Vegetable Kingdom.
1 Vohl and Eulenburg, Arch. Phar. Chem. 147.
2 E. g., in M. Bean's cases of angina pectoris from this cause.
3 Bull, de Therapeutique, Juin 15, 1809. 4 Quoted by Taylor on Poisons.
5 Taylor, op. cit.
It would appear from a comparison of different reports that, in the most swiftly fatal cases, the action of the poison has been almost entirely expended upon the nervous system and the heart; while patients who survive longer, suffer from severe inflammatory affections of the alimentary canal.
The physiological effects of nicotine are nearly those of tobacco solution, but in a more powerful form, more especially as regards the action upon the heart. An example of its most decided action is afforded by the case of the victim of Count Bocarne, who was poisoned with nicotine, and was believed to have died in less than five minutes; and by a case of suicide recorded by Taylor, in which the alkaloid proved fatal in from three to five minutes.
The most exact recent researches are those of Traube,1 Rosenthal,2 Krocker,3 Erlenmeyer,4 Schroff,5 Van Praag,6 Kolliker,7 etc., and from these may be derived the following resume: Nicotine paralyzes the brain, producing loss of consciousness and of voluntary movement, after a more or less brief interval of excitement.8 The primary action on the spinal cord is exciting, and produces clonic and tonic convulsions; this is followed by paralysis, the cord becomes insensible to direct and to reflex irritation, apparently from affection of the gray matter of the anterior cornua. The motor nerve-trunks are but little affected, but their terminals in the muscular substance are at first strongly irritated, and then paralyzed. Small doses affect the heart in a double manner, the vagus branches being in comparison slightly, the cardiac motor nerves much more powerfully affected; the excitement is followed by paralysis. If the vagi be divided, nicotine nevertheless acts on the peripheral vagus-twigs, and the ganglionic apparatus in connection with them. The cardiac muscular structure does not appear to be directly affected; respiration is at first quickened, and there may even be tetanus of the inspiratory muscles; apparently this action is exerted upon the nerve termini among the muscles, for section of the vagi does not prevent it; the respiratory excitement is followed by paralysis. A very constant lowering of superficial temperature has been observed by Tscheschichin, which probably depends on rapid cooling of the body in consequence of vaso-motor paralysis. Intestinal peristalsis is hurried, and there may even be intestinal tetanic spasms; while in women there are vigorous contractions of the uterus. The action upon the pupil has been much disputed, but the most recent and reliable researches seem to prove that nicotine (in opposition to the mydriatic group of Solanaceae) produces contraction of the circular fibres of the iris.
1 Allg. med. Centralzeitung, 38, 1862.
2 Med. Centralblatt, 47, 1863.
3 Ueber die Wirkung des Nicotins, Berlin, 1868.
4 Corresp.-blatt. Psych., 16, 1864.
5 Mat. Med. d. reinen Pflanzenstoffe.
6 Arch. path. Anat., 1855.
8 Headland and some others style tobacco an inebriant.
Finally, it may be said that the administration of very large doses seems to produce death by direct paralysis of the heart, without the preliminary so-called phenomena of excitement.
Of the more chronic forms of mischief which are said to be produced by smoking, it is more difficult to speak with confidence. Among adults, beyond the mere local change which is known as granular inflammation of the fauces and pharynx, the injury which has apparently been proved to occur with some frequency is amaurosis, from atrophy of the retina. Chronic dyspepsia, also, which is thought to be caused (or at least greatly aggravated) by the waste of saliva which should have gone to assist digestion, is an undoubtedly frequent result of prolonged excesses in tobacco. The occurrence of angina pectoris as the result of the prostrating influence of great and prolonged excess upon the heart, has been noted by M. Beau and others, but is fortunately an extreme and rare event. General nervous depression has far more frequently been produced, showing itself in restlessness, insomnia, and a tremulous condition of the limbs, not very unlike the phenomena of chronic alcoholism. About all the above forms of chronic mischief from tobacco there is, however, great dispute; that is to say, as to the proportion of cases in which they occur, and the possibility of their production at all, except by very great excess. But as to one matter, now to be mentioned, there can be no doubt, viz., the unmixedly evil effects of smoking in early youth. The use of tobacco in the years before and immediately succeeding the development of puberty has a most prejudicial influence. There can be no question that more than anything, except drinking, it hinders the growth and development of the higher nervous centres, and that both intellect and moral character are capable of being most seriously damaged by this depressing agency continuously exerted during the developmental period. And not merely does this result, but by its interference with digestion and assimilation the use of tobacco by the young impairs the whole process of the consolidation of the bodily frame. There seems to be good evidence that this especially tends to produce amaurosis, from atrophy of the retina.
Therapeutic Action. - By far the most important of the purposes to which tobacco or nicotine has been applied in medicine is the rapid and complete relaxation of muscular spasm. The most familiar instance of its application for this purpose is (or rather was, for chloroform has superseded it) the employment of tobacco enemata for the treatment of strangulated hernia. There can be no doubt that this proved successful in many instances, but, on the other hand, the remedy was found to be very uncertain, and occasionally dangerous: in fact, several fatal accidents occurred. More recently, chiefly upon the authority of Mr. Curling, tobacco has been put forward as a remedy for tetanus, and there is really much evidence in favor of its being more potent than most of the remedies that have yet been tried. It is not desirable, however, that tobacco should be used any longer even in so desperate a disease as tetanus, in the objectionable form of watery solution. The subcutaneous injection of nicotine offers every facility for handling this potent agent with precision, as well as effectiveness. A convenient solution for its use is as follows: - Nicotine, m x.; mucilag. acaciae, m xl.; distilled water, m ccccl. Of this solution five minims may be injected every four hours.
A less important, but still very distressing spasmodic affection, for which tobacco has often proved very useful, is nervous asthma. The late Dr. Hyde Salter placed great value upon it. He, however, employed it solely to cut short actually commencing paroxysms, and pushed its influence quite to the poisonously paralyzing stage, not being content until he had rendered the patient faint and sick. It is probable, however, that asthmatic patients, like sufferers from many other forms of nervous irritation, can derive considerable benefit from a less pronounced action of tobacco than this, and that a mild and stimulant dose of tobacco smoke may not infrequently, by at once bracing and calming the respiratory nervous system, avert an otherwise impending attack. And although tobacco cannot be called a direct hypnotic, yet, by soothing the minor forms of neuralgic pain and general restlessness, it often helps to make sleep possible. To aged persons, provided they have learned to overcome the difficulties of smoking in early life, there can be no doubt tobacco often proves most useful in quieting that nervous restlessness which produces a variety of discomforts, including wakefulness at night. Tobacco is one, and one of the least harmful, of those agents by which soldiers and others, who are compelled to undergo strenuous exertion at times, with a sadly insufficient supply of food, are enabled to hold out, and do their work effectively. What opium is to the Tartar courier, tobacco is to the British soldier or sportsman, in supporting him under severe and continuous physical efforts, when rest and sufficient food are alike beyond his reach. Finally, tobacco seems to be an antagonist to strychnia. The Rev. Professor Haughton published a very interesting account of experiments on the antagonism of nicotia and strychnia. And Dr. Smyley publishes a case of a boy who, having taken about four grains of strychnia, recovered under the influence of an infusion of tobacco. These and many other published cases tend to prove the curative power of tobacco and its alkaloid over strychnine-poisoning.
Preparations and Dose. - Infusum Tabaci (enema)
(15. - 60.); Vinum Tabaci, m v. - xxx. (.30 - 2.); Ungt. Tabaci; tobacco mixed with linseed meal is frequently employed as a poultice, especially in epididymitis. If the proportion of tobacco is large, the practice is not altogether safe.