The third class of poisons, the narcotico-acrids, includes those which possess a double action, the one local and irritating like that of the irritants, the other remote, and consisting of an impression on the nervous system.
Sometimes they cause narcotism; which is generally of a comatose nature, often attended with delirium; but in one very singular group there is neither insensibility nor delirium, but merely violent tetanic spasms.
At other times they excite inflammation where they are applied. This effect, however, is by no means constant. For Orfila justly observes, that under the name of narcotico-acrids several poisons are usually described which seldom excite inflammation. Those which inflame the tissues where they are applied rarely occasion death in this manner. Some of them may produce very violent local symptoms; but they generally prove fatal through their operation on the nervous system.
For the most part, their narcotic and irritant effects appear incompatible. That is, when they act narcotically, the body is insensible to the local irritation; and when they irritate, the dose is not large enough to act narcotically. In large doses, therefore, they act chiefly as narcotics, in small doses as irritants. Sometimes, however, the narcotic symptoms are preceded or followed by symptoms of irritation; and more rarely both exist simultaneously.
Most, if not all, of them, to whatever part of the body they are applied, act remotely by entering the blood-vessels; but it has not been settled whether they operate by being carried with the blood to the part on which they act, or by producing on the inner membrane of the vessels a peculiar impression, which is conveyed along the nerves. Some of them produce direct and obvious effects where they are applied. Thus monkshood induces a peculiar numbness and tingling of the part with which it is placed in contact. The organs on which they act remotely are the brain and spine, and sometimes the heart also.
The appearances in the dead body are, for the most part, inconsiderable; more or less inflammation in the stomach or intestines, and congestion in the brain; but even these are not constant.
As a distinct class, they differ little from some poisons of the previous classes. Several of the metallic irritants, and a few vegetable acrids are, properly speaking, narcotico-acrids: they excite either narcotism or irritation, according to circumstances. But still, the poisons about to be considered form a good natural order when contrasted with these irritants. For the irritants which possess a double action are nevertheless characterized by the symptoms of inflammation being at least their most prominent effects; while the most prominent feature in the effects of the poisons now to be considered is injury of the nervous system. It is more difficult to draw the line of separation between the present class and the pure narcotics; for many narcotico-acrids rarely cause any symptom but those of narcotism.
The narcotico-acrids are all derived from the vegetable kingdom. Many of them owe their power to an alkaloid, consisting of oxygen, hydrogen, carbon, and azote.
The characters which distinguish the symptoms and morbid appearances of the narcotico-acrids from those of natural disease, do not require special mention; for almost all the remarks made in the introduction to the class of narcotics are applicable to the present class also. A few of the characters, however, which have been laid down, do not apply so well to the narcotico-acrids as to the narcotics. In particular, it appears that what was said on the short duration of the effects of the narcotics does not apply so well to the present class of poisons; some of which, in a single dose, continue to cause symptoms even of narcotism for two or three days. But the rule, that they seldom prove fatal if the case lasts above twelve hours, is still applicable,—at all events they rarely prove fatal after that interval by their narcotic action. The poisonous fungi, however, have proved fatal as narcotics so late as thirty-six hours, or even three days, after they were taken; and perhaps digitalis has proved fatal narcotically at the remote period of three weeks. But such cases are extremely rare.
Some narcotico-acids, such as the different species of strychnos, are quite peculiar in their effects; so that their symptoms may be distinguished at once from natural disease.