I have seen but two cases that could at all be classed as such. In one there was no fever, and the chill came every morning at daybreak, for three mornings, missed one morning and occurred again the next. It was followed by profuse sweating, that lasted the whole day. In the other case, that of the lady who had used the drug by the mouth for sixteen years, there was fever and some intercostal neuralgia, occurring every other day, for ten days, but not followed by perspiration. A few doses of quinine broke it up. It was for this that I was first called to attend her, her husband believing her to be suffering from malarial fever. In neither of these cases was there any enlargement of the spleen. I then discovered that she was a morphine habituè, much to her chagrin and her husband’s surprise, he never having suspected it. The two following cases are those given as examples by Levenstein:—
CASE I.—INTERMITTENT FEVER IN CONSEQUENCE OF MORBID CRAVING FOR MORPHIA.
M. H., law student, 24 years old, sent to the Institution by Dr. Ewald in 1874, was suffering from acute articular rheumatism when the first injection of morphia was administered. After his recovery, although not compelled to do so through pain, he continued the injections several times in the day, increasing the doses, for the sole reason that he felt elated by them. The principal symptoms that resulted therefrom were loss of appetite, progressive emaciation, loss of strength, and increased perspiration, which frequently caused the patient to become wet all over while in a cold room and quite quiet.
Before his admission into the Maison de Santé he was troubled with feverish attacks, which came on every two or four days, at different times in the day, in the following manner: first there was a chilly feeling for half an hour, followed by heat and profuse sweating. The latter was accompanied by the general symptoms of every feverish attack, enlargement of the spleen also being present.
Present State.—Patient is a tall, muscular man; the examination of the internal organs shows no abnormal condition, excepting an enlarged spleen. Pupils of middle size, equal, reacting well. On December 10, 1875, the afternoon, patient received the last injection of morphia.
December 12. Patient slept in the night. In the course of the day he only feels a little sleepy. The face is red, the skin moist. Toward the evening there is nausea, pressure in the epigastrium, great restlessness, and stomach-ache. Patient moves about in bed, complains of headache, cannot get to sleep. Three relaxed motions.
December 22. Patient has had no sleep during the night, three relaxed motions, vomited once. He complains of giddiness, restlessness and palpitation of the heart. In the morning there is a chill followed by heat and profuse sweating. Vomiting, diarrhœa. Until the afternoon he felt very prostrate and exhausted. Between 3 and 5 P.M. he got up. Soon, however, the symptoms of the morning returned again, and pain in the knees, exhaustion and restlessness compel him to go to bed.
December 23. Has slept from 2 to 5 A.M. with interruptions. Profuse perspiration, nausea, intense craving for morphia, frequent paroxysms of sneezing. The sickness stopped in the course of the day. At 8 P.M. 30 grains of chloral were given.
December 24. Only three hours’ rest. Feels knocked up. One relaxed motion. Much sneezing; craving for morphia. At 9 P.M. 45 grains of chloral were given, but were immediately brought up again.