ALKALOIDS 595 



_ A number of these alkaloids, such as caffein, thein, and nieotin, are con- 

 tained in substances which are in general use, such as tea leaves after steeping, 

 cofEee grounds, and tobacco; therefore, chronic poisoning by these alkaloids 

 is commonly observed. The scope of this article does not permit me to enu- 

 merate all of the alkaloids familiar to us, to which additions are made from 

 year to year by the discovery of new alkaloids in the vegetable kingdom. I 

 shall cite the effects of only those alkaloids which are of medical importance, 

 such as nieotin, morphin, atropin, and cocain. The symptoms of all poison- 

 ings due to alkaloids is quite similar, and the therapy in the majority of cases 

 is in the main analogous. 



NicoTiN is the active alkaloid of tobacco leaves (nicotiana tabacum) and 

 the different products manufactured from them. Poisoning with this exceed- 

 ingly virulent free base rarely occurs, and, therefore, is of no practical impor- 

 tance. Most significant are those forms of poisoning by tobacco in which, 

 besides nieotin, other deleterious agents, such as the pyridin bases, carbonic 

 oxid and prussic acid, etc., collectively give rise to the conditions known as 

 acute and chronic nicotinism. 



We shall first describe acute nicotinism. 



I may be brief, for every one who has smoked knows the disagreeable conse- 

 quences of the first attempt, and has retained the effects in memory. Headache, 

 nausea, vomiting, diarrhea, great debility and weakness are the symptoms 

 with which the unaccustomed organism responds to the poisonous proper- 

 ties of tobacco. Baths with cold affusions and the administration of alcohol 

 will rapidly relieve the symptoms. Tannin and dilute lugol solution may also 

 be employed internally in severe cases. Usually, however, such poisoning runs 

 a favorable course in a few hours, and only a headache, which sometimes con- 

 tinues for days, may remain. 



More important than acute nieotin poisoning due to the use of tobacco is 

 chronic nieotin poisoning which presents itself to the physician in a different 

 aspect. Tachycardia, arrhythmia, and cardiac weakness are the principal and 

 common symptoms in this toxicosis, though these symptoms are susceptible 

 of different explanations. How far severe anatomical changes of the heart 

 are related to chronic tobacco toxicosis I shall not attempt to decide ; the possi- 

 bility of such an occurrence cannot be disputed. Other and very important 

 symptoms are disturbances on the part of the eyes; amblyopia, amaurosis, 

 miosis and spasm of accommodation. Weakness of memory and melancholic 

 conditions are also among the signs of chronic nicotinism. 



The treatment consists only of prophylaxis, i. e., the moderate use of nieo- 

 tin. Disturbances of sight are to be relieved by keeping the patient in a 

 darkened room, and by injections of pilocarpin and strychnin. 



The next alkaloid to be considered is morphin. Opium, the dried juice of 

 the papaver somniferum, contains a number of alkaloids, but the symptoms of 

 poisoning which it produces are all closely akin to those due to morphin, so 

 that we may consider collectively the symptoms which these agents produce. 



Morphin and opium are two of the most valuable treasures of our materia 

 mediea. By their judicious use, the physician has brought amelioration to 

 countless numbers of sufferers, but no less has their improper use caused m- 



