Morphinum

Authorities. 74, Le Cliniq. (Loud. Med. Gaz., vol. iii, 1829, p. 851), Mr. G. took 24 grains of the Acetate dissolved in 1 ounce distilled water; 75, ]\I. Martin-Solon, Bull, de I’Acad. Roy. de Med., 1836, and Brit, and For. Med. Rev. (Am. Journ. of Med. Sci., 22,1838, p. 202), effects of dipping the pointof a lancet in an aqueous solution and inserting beneath theepidermis ;t 76, same, effects of the Muriate experienced by Dr. Lafargue, from thirteen punctures on the front of the forearm ; 77, Blancard Roseate, M.D., Amer. Journ. of Med. Sci., New Ser., 1, 1841, p. 112, for toothache took 1 ounce of a solution containing 11 grains of the Sulphate, after taking no food nor drink for eighteen hours; 78, omitted; 79, Loud. Med. Gaz. (Bost. INIed. and Surg. Journ., vol. xxxiii, 1845, p. 128), a young woman, for scirrhus of uterus, vomiting, and pain in the stomach, applied to the epigastrium, from which the skin had been removed by a blister, 3’^ grain of the Initiate; the same was repeated the next morning; 80, Chas. Foulke, M.D., Amer. Journ. Med. Sci., New Ser., 15,1848, p. 568, Mrs. R., cet. sixteen years, eight months pregnant, for labor-pains, took lU grains of the Sulphate in three hours; 81, C. S. S., Bost. Med. and Surg. Journ., 63,1860, p. 325, a young man made habitual use of Morphine, generally taking one-fifth of a bottleful (1-8 ounces) in water ; 82, J. S. L., ibid., p. 391, Mrs. A. H. S., jet. forty-two years, had taken Morphine for years; when fi rst seen she was taking from 4 to 6 drachms per week ; 83, B. Woodward, M.D., ibid., vol. Ixv, p. 157, I took ^ grain of the Sulphate at 7, 10, 1, and 4 oclock. I repeated this experiment four times, at intervals of five days, with same effects ; afterwards subjected five young men to same experiment, and with four obtained a very large increase and lower specific gravity of the urine; with one of them, on two trials, I found no perceptible increase or diminution of, but a marked lessening of, specific gravity; I did not obtain same results from Opium itself, but there was no difference whether the Muriate or Sulphate

f from inoculation of all common preparations of Opium he saw the same effects. except that the papilla? sometimes acquired a diameter of an inch and a half, and then became radiated and diffuse. were used ; 84, Wm. Norris, M.D., Amer. Journ. Med. Sci., New Ser., 44, 1862, p. 395, a person, set. nineteen years, took 75 grains of Sulphate in water; 85, Medical Circular, June 10th, 1863 (Brit. Journ. of Horn., 22,348), effects of solution of Mor. nuir., taken in the usual doses, but too frequently, for cold in the chest; 86, Dr. J. L. Prentiss, Chicago Med. Journ., December, 1866 (Amer. Journ. of Med. Sci., New Ser., 53, p. 565), a woman was said to have taken 5 grains of Morphia; 87, J. R. Wiest, M.D., Cincin. Journ. of Med., May, 1867, p. 265, Mr. W., let. fifty years, took an unknown number of pills, each containing ^ grain of the Sulphate ; 88, Benj. B. Wilson, M.D., Med. and Surg. Reporter, vol. xix, 1868, p. 369, a woman who had been receiving hypodermic injections of i grain of the Sulphate, now received a somewhat larger one; 89, J. J. Lyons, M.D., New Orleans Med. and Sur. Journ., vol. xxii, 1869, p. 292, a girl, set. five years, took 5 grains of Sulphate to prevent the return of an intermittent, from which she had been suffering the previous week; 90, John Sprout, M.D., ibid., p. 506, for rheumatism, used daily for three years, from 2 to 4 grains of Sulphate; 91, C. H. Alden, Philad. Med. Times, vol. i, 1871, p. 295, L. R. took by enema between 12 and 15 grains of Sulphate, dissolved in 2 fluid ounces of water; 92, W. W. Crimson, M.D., St. Louis Med. and Surg. Journ., 1872, p. 353, a woman, set. thirty-one years, took 6 grains of Morphine; 93, Geo. Bayles, M.D., Virginia Med. Rec., 1875, }). 188, JMr. S., for pleuritis of the right side, took within three hours and a half 50 minims of Squibb’s solution of Morphia; 94, Dr. A. P. Hull, Philad. Med. Times, September, 1876, p. 581, a child, set. six weeks, took ^ grain of Sulphate; 95, E. H. Coover, Philad. Med. and Surg. Reporter, vol. xxxvi, 1877, p. 452, John H., set. thirty years, for an abscess on the left parotid, took 2 powders, containing probably 2^ grains of Sulphate, at an interval of twelve hours ; 96, S. B. Chase, ibid., vol. xxxiv, p. 37, a man, set. thirtyfive years, took 6 or 7 grains of Morphia.

Mind p. 586

I found her, as she had been for some hours, crazy, with three or four holding her in bed; during the intervals of slight convulsions she was in this crazy condition

Subsequent to the commencement of the nausea, and previous to the exhibition of a gill of cold strong coffee, ray mind was depressed, and considerable anxiety pervaded it, but it was at the same time restrained to a consideration of the condition of my system, and no pleasurable sensations had been experienced. The coffee, however, soon raised this weight of oppression, and, I may add, also the controlling power of reason, and in their stead, fancy in her wildest range roved on through scenes of rapture and splendor, which the mind of the patient, unassisted by such powerful influences, is utterly incapable of attaining. This delightful revelling of the imagination continued five or six hours, and during this interval my attendants, who spoke to me several times, could not determine whether I was asleep or not; neither can I settle the question myself, for, if asleep, I awoke so easily that the transition could not be perceived. But I am conscious that this state of mental delirium ended in a sound sleep, which was succeeded by a few hours of lassitude

So nervous that the least movement in the room would make her spring from the bed

Sometimes talking in a partially incoherent, excited manner (after three hours)

Incoherency in speech for three weeks,™.

Mind much confused, but when persistently addressed, her attention was aroused, and she replied, though rather incoherently (after three hours) ; mind (quite clear (fourth day )

Lost his recollection (after six or seven minutes),'h

Stupor

Stupor was fast approaching, but was not complete, occasionally she would wake and fret (after three hours)

Complete insensibility,etc.

Comatose, although by persistent shaking and loud talking, he could he roused for a brief period,*k

Head p. 587

Dizziness.’®.

Slowly rolling her head tatter three hours

Pain in the head

Head felt very heavy (after three hours)

Heaviness of the head

Eyes sunken in the head

Eyelids half closed; conjunctivte injected, pupils contracted to mere points ; irides immovable (after three hours); pupils natural size or nearly so, and the irides movable (fourth day)

Pupil contracted (after three hours),*®, etc.

Pupils contracted to a pin’s point etc.

Pupils contracted to a little more than a pin’s point

Contracted pupil and complete insensibility

Great contraction of the pupils, almost perfect blindness

Saw every object double and very indistinctly (after three hours)

She saw only one-half of surrounding objects ; for instance, in the case of a person standing before her, she could see only the right or left half of the body ; it was three weeks before vision was completely restored

Eyes p. 587

Ringing in the ears

Suffused and purple countenance

Complexion cyanotic

Countenance of a dark color

Face and lips livid

Constantly rubbing the nose, eyes, and face

Jaws rigid

Masseter muscles rigid (after six hours)

Ears p. 587

Teeth firmly closed (after six hours)

Tongue dry and cracked in places

['^10.] Clamminess of the mouth

The saliva of the mouth was being churned into a froth, which welled up and then disappeared at every return and subsidence of the respiratory movement

Slow of speech, although if sharply questioned he would answer his name

It was with great difficulty that she could talk so as to be understood

Stomach p. 587

Thirst

Great nausea and many efforts to vomit (after five hour.')

Vomited at intervals (after three hours)

Vomiting in the evening

The pain in her stomach recurred every few minutes, and became at times very intense ; she made loud cries, ground her teeth, and threw her arms about violently ; she described the pain as like that of cramp (after six hours); the pain became gradually less, and was felt more in the region of the umbilicus (after nine hours)

It often produces a painful cramp of the stomach, and especially is it liable to do so in persons not in the habit of using it. This effect is readily relieved by a small quantity of some stimulant, brandy or spirits of camphor being the most effectual. One-eighth of a grain acts more powerfully on an empty stomach than half a grain after eating

Urinary Organs p. 587

Pain across the kidneys, followed by diuresis

Vesical tenesmus, but was unable to pass urine; about 8 or 10 fluid ounces removed by the catheter (after three hours) ; urine removed twice, about2 fluid ounces each time (second day); passed urine naturally (third day)

It acts almost invariably as a diuretic in from one to two hours

Passed 28 ounces of urine, with specific gravity of 1014, in twenty-four hours (before the experiment) ; measured all the urine passed at 9 P.M., aud found it to be 48 ounces, very limpid, specific gravity 1003 (the day of the experiment)

Respiratory Organs p. 587

When taken in a full dose it changes the voice, producing a temporary hoarseness

Respiration hurried

Breathing not more than once in forty-six seconds (after five hours and a half)

The child breathed about once in fifty seconds for seven hours,*®. •

Respiration stertorous, 10 to the minute

Stertorous breathing

Stertorous breathing was strongly marked, in fact, the patient ceased to breathe, the interval being lengthened out one-fourth ol a minute or nearly so

Breathing was stertorous, irregular, and very slow, not more than two respirations in a minute

Respiration stertorous and feeble, so much so that he breathed but four times a minute (five hours after second dose)

Breathing stertorous; at times arrested fora minute (after six hours)

Breathing peculiar to the last stage of Opium poisoning

Respiration suspended

Heart and Pulse p. 588

Circulation full but slow

Strong and frequent pulse

Pulse 130 and feeble

Pulse 120 and of moderate strength

Pulse 110,®®.

Pulse 80, moderately full (after six hours)

Pulse 80 and soft

Pulse full and slightly excited (after three hours)

Pulse 60 (after three hours)

Pulse feeble and irregular (five hours after second dose)

A slow, laboring pulse

The pulse was intermittent, and so weak as to be almost imperceptible at the wrists, and there was a fluttering movement observable on both sides of the neck

Pulseless

Inferior Extremities p. 588

Gait staggering

Lower extremities deficient in sensibility and lying motionless (after three hours)

Generalities p. 588

Very much emaciated

Some half dozen slight convulsions

Convulsions

Frightful convulsions

After half an hour a sensation of thickening and stiffening of the muscles of the back of the neck, which soon extended to the flexor muscles of all the limbs, and which continued until the morbid action was broken in upon. This was not a condition of rigidity such as obtains in cramps, but subject to volition, and was rather of that feeling that we imagine would be experienced in a paroxysm of catalepsy could the patient be made sensible of the movements of his limbs

The child was under the influence of the Morphia; perfectly limber, for seven hours

Suddenly collapsed (four hours after second powder)

Considerable degree of prostration and apathy

A few hour's of lassitude, after the sound sleep

By keeping slightly under its influence, it is a perfect antidote against taking cold

Skin p. 588

Livid

Skin about face, neck,chest,arms,and hands had a cyanotic appearance (five hours after second dose)

Skin yellow and shrivelled up

Finger-nails dark (five hours after second dose)

About a minute and a half after the operation a small pimple, with a diffuse rosy areola and slight) itching, is observed. In about twenty minutes the pimple becomes about four lines in diameter and one line in thickness ; it is flattened. Its color is somewhat more than that of the skin, it is hard, its areola is very red, and about an inch and a half in diameter; its heat has increased, hut the sensation of itching remains about the same. During the first hour the pimple and its areola are at their highest degree of development; from this time the appearances diminish, and at the end of two or three hours the red color of the skin has entirely disappeared, the pimple has become very flat, but it does not entirely disappear, until from twelve to twenty-four hours after the operation. If several punctures are made near each other, in the same manner, the appearances of the pimples are as above described, but the areolae are confluent; the heat and itching are considerably increased. The appearances, however, disappear in the same manner as when a single puncture is made

Rash beginning on the face spread itself over the entire body, quickly extending from the face to the neck, trunk, and lower extremities; so strongly did it resemble measles, at least in having the crescentic arrangement, that it had been pronounced such by another medical man ; the discontinuance of the cause was followed by a speedy resolution of the seeming exanthem, and next day there was little trace of the eruption

Intolerable itching of the skin (after three hours)

Itching and pricking of the skin intolerable

Considerable pricking of the skin

Sleep p. 589

Frequent yawnings,™

Excessive drowsiness, “falling asleep, even while she was speaking

Invincible desire to sleep

The tendency to sleep increased somewhat for a time, and twice fell asleep, though constantly talked to, but was soon aroused (after three hours)

Would sleep even when standing up, if those supporting him did not keep him constantly in motion

Profoundly asleep, could not be aroused (five hours after second dose)

Profound sleep ; if left to herself she quickly fell into a state of profound stupor, and lost all consciousness, not breathing more than once in forty-six seconds (after five hours and a halt)

Profound somnolence for eighteen hours; partial somnolence between two hours and a half and three hours and a half

Fever p. 589

Skin cold (after six hours)

Skin cool; feet quite cold (after three hours)

Skin pale, rather cool, and bathed with perspiration

Extremities cold

Hot and dry skin

Skin warm and moist

If he deferred the habitual dose beyond a certain number of hours, perspiration came on, and his system felt relaxed

Body bathed with cold perspiration (five hours after second dose),®l

Surface of face, scalp, and hands loaded with large beads of cold [)erspiraiion, which, about the nose and mouth, coalesced and trickled down upon the bed-linen

Clammy sweat over the whole surface