Narcotics are medicines which stupefy and diminish the activity of the nervous system. Given in small doses, they generally act as stimulants, but an increased dose produces a sedative effect. Under this head are included alcohol, camphor, ether, the hop, and opium.
693. Alcohol, or rectified spirit, is a very powerful stimulant, and is never used as a remedy without being diluted to the degree called proof spirit; and even then it is seldom used internally. It is used externally in restraining bleeding, when there is not any vessel of importance wounded. It is also used as a lotion to burns, and is applied by dipping a piece of lint into the spirit, and laying it over the part. Freely diluted (one part to eighteen) with water, it forms a useful eye-wash in the last stage of ophthalmia. Used internally, it acts as a very useful stimulant when diluted and taken moderately, increasing the general excitement, and giving energy to the muscular fibres; hence it becomes very useful in certain cases of debility, especially in habits disposed to create acidity; and in the low stage of typhus fevers. Dose.--It is impossible to fix anything like a dose for this remedy, as much will depend on the individual; but diluted with water and sweetened with sugar, from half an ounce to two ounces may be given three or four times a day. In cases of extreme debility, however, much will depend upon the disease. Caution.--Remember that alcohol is an irritant poison, and that daily indulgence in its use originates dyspepsia, indigestion, and many other serious complaints. Of all kinds of spirits the best as a tonic and stomachic is brandy.
694. Camphor is not a very steady stimulant, as its effect is transitory; but in large doses it operates as a narcotic, abating pain and inducing sleep. In moderate doses it operates as a diaphoretic, diuretic, antispasmodic, increasing the heat of the body, allaying irritation and spasm. It is used externally as a liniment when dissolved in oil, alcohol, or acetic acid, being employed to allay rheumatic pains; and it is also useful as an embrocation in sprains, bruises, chilblains, and, when combined with opium, it has been advantageously employed in flatulent colic, and severe diarrhœa, being rubbed over the bowels. When reduced to a fine powder, by the addition of a little spirit of wine and friction, it is very useful as a local stimulant to indolent ulcers, especially when they discharge a foul kind of matter; a pinch is taken between the finger and thumb, and sprinkled into the ulcer, which is then dressed as usual. When dissolved in oil of turpentine, a few drops placed in a hollow tooth and covered with jeweller's wool, or scraped lint, give almost instant relief to toothache. Used internally, it is apt to excite nausea, and even vomiting, especially when given in the solid form. As a stimulant it is of great service in all low fevers, malignant measles, malignant sore throat, and confluent small-pox; and when combined with opium and bark, it is extremely useful in checking the progress of malignant ulcers, and gangrene. As a narcotic it is very useful, because it allays pain and irritation, without increasing the pulse very much. When powdered and sprinkled upon the surface of a blister, it prevents the cantharides acting in a peculiar and painful way upon the bladder. Combined with senna, it increases its purgative properties; and it is also used to correct the nausea produced by squills, and the irritating effects of drastic purgatives and mezereon. Dose, from four grains to half a scruple, repeated at short intervals when used in small doses, and long intervals when employed in large doses. Doses of the various preparations.--Camphor mixture, from half an ounce to three ounces; compound tincture of camphor (paregoric elixir), from fifteen minims to two drachms. Caution.--When given in an overdose it acts as a poison, producing vomiting, giddiness, delirium, convulsions, and sometimes death. Opium is the best antidote for camphor, whether in excess or taken as a poison. Mode of exhibition.--It may be rubbed up with almond emulsion, or mucilage, or the yolk of eggs, and by this means suspended in water, or combined with chloroform as a mixture, in which form it is a valuable stimulant in cholera and other diseases. (See Mixtures, 556-564).
695. Ether is a diffusible stimulant, narcotic and antispasmodic.
696. Sulphuric Ether is used externally both as a stimulant and a refrigerant. In the former case its evaporation is prevented by covering a rag moistened with it with oiled silk, in order to relieve headache; and in the latter case it is allowed to evaporate, and thus produce coldness: hence it is applied over scalded surfaces by means of rags dipped in it. As a local application, it has been found to afford almost instant relief in earache, when combined with almond oil, and dropped into the ear. It is used internally as a stimulant and narcotic in low fevers and cases of great exhaustion. Dose, from fifteen minims to half a drachm, repeated at short intervals, as its effects soon pass off. Give in a little camphor julep, or water.
697. Nitric Ether is a refrigerant, diuretic, and antispasmodic, well known as "sweet spirit of nitre." Used externally, its evaporation relieves headache, and it is sometimes applied to burns. It is used internally to relieve nausea, flatulence, and thirst in fevers; also as a diuretic. Dose, from ten minims to one drachm. The smaller dose taken in a little warm water or gruel is useful as a sudorific in cases of cold and chill, to induce and promote the proper action of the skin which has been checked. If a larger dose be taken, it acts as a diuretic and not as a sudorific, and so fails to produce the diuretic effect.
698. Compound Spirit of Sulphuric Ether is a very useful stimulant, narcotic, and antispasmodic. Used internally in cases of great exhaustion, attended with irritability. Dose, from half a drachm to two drachms, in camphor jalap. When combined with laudanum, it prevents the nauseating effects of the opium, and acts more beneficially as a narcotic.
699. The Hop is a narcotic, tonic, and diuretic; it reduces the frequency of the pulse, and does not affect the head, like most anodynes. Used externally, it acts as an anodyne and discutient, and is useful as a fomentation for painful tumours, rheumatic pains in the joints, and severe contusions. A pillow stuffed with hops acts as a narcotic. When the powder is mixed with lard, it acts as an anodyne dressing in painful ulcers. Dose, of the extract, from five grains to one scruple; of the tincture, from half a drachm to two drachms; of the powder, from three grains to one scruple; of the infusion, half an ounce to one and a half ounce.
700. Opium is a stimulant, narcotic, and anodyne. Used externally it acts almost as well as when taken into the stomach, and without affecting the head or causing nausea. Applied to irritable ulcers in the form of tincture, it promotes their cure, and allays pain. Cloths dipped in a strong solution, and applied over painful bruises, tumours, or inflamed joints, allay pain. A small piece of solid opium stuffed into a hollow tooth relieves toothache. A weak solution of opium forms a valuable collyrium in ophthalmia. Two drops of the wine of opium acts as an excellent stimulant in bloodshot eye; or after long-continued inflammation, it is useful in strengthening the eye. Applied as a liniment, in combination with ammonia and oil, or with camphorated spirit, it acts as a very powerful stimulant: then as a sedative, and finally as an anodyne and narcotic, allaying pain in the most extraordinary manner, by acting directly upon the nervous system. In acute rheumatism it is a most excellent medicine when combined with calomel and tartrate of antimony; but its exhibition requires the judicious care of a medical man. Doses of the various preparations.--Confection of opium, from five grains to half a drachm; extract of opium, from one to five grains (this is a valuable form, as it does not produce so much after derangement of the nervous system as solid opium); pills of soap and opium, from five to ten grains; compound ipecacuanha powder ("Dover's Powder"), from ten to fifteen grains; compound kino powder, from five to fifteen grains; wine of opium, from ten minims to one drachm. Caution.--Opium is a powerful poison when taken in too large a quantity (See Poisons, (pars. 1340-1367), and thus should be used with extreme caution. It is on this account that we have omitted some of its preparations. The best antidote for opium is camphor.