Urine.—The specific gravity varied from 1.012 to 1.020. Reduction of oxide of copper was noticed.
CASE II.—INTERMITTENT FEVER IN CONSEQUENCE OF MORBID CRAVING FOR MORPHIA. (IMPOTENCE. DISORDERED SPEECH. ALBUMINURIA.)
Captain B., sent to the Institution by Staff-Surgeon Dr. Peltzer, had been using injections of morphia in consequence of severe pains from a gunshot wound in 1871. For a time his medical attendant diminished the drug, but soon, by the advice of the latter, he purchased a syringe and bought the morphia, first at a chemist’s, and afterward at a shop where they sold chemicals; he injected gradually as much as twenty-four grains per day. Several times his wife tried to stop the injections or at least to diminish the dose, but this was followed by vomiting, diarrhœa and loss of sleep, so that the doctor again recommended its further use.
The principal complaints of the patient, on account of which he, on December 20, 1875, sought admission into the ‘Maison de Santé,’ were: The appetite is bad, the bowels are so much constipated that they are sometimes not relieved for eight days. From time to time patient suffers from disordered micturition, having to strain rather long before the water passes. Very frequently there was congestion to the head, and during sleep quivering of the muscles of the face and extremities. Now and then he suffered from giddiness and headache. He feels unwell, principally in the morning. Impotent for three years. He was obliged to resort to alcoholic beverages as stimulants, but he was no drunkard. From September 12 until the end of October, 1874, the patient had had a shivering lasting two hours daily, followed by half an hour’s heat and two or three hours’ profuse perspiration. Large doses of quinine taken daily for a period of three weeks are said to have cured the fever; it is worthy of notice that the patient stopped the use of the morphia during the latter period of the feverish attacks. Taking to it again, there was the same characteristic attack every week or fortnight at first; gradually, however, the free intervals became shorter, and at the time of his admission into the Institution the intermittent had again returned to the quotidian type. A treatment with large doses of quinine for several months, resorted to by his medical attendant, proved of no avail. Patient is pretty tall; muscles and subcutaneous areolar tissue very well developed. Face red. Eyes bright. Tremor of hands, slight degree of difficulty in speaking. Patient shows great vivacity in talking; his features move quickly; his movements are brisk. The physical examination of the thoracic and abdominal organs shows no abnormal condition, except a considerable enlargement of the spleen.
The morphia was at once withheld.
December 21. Patient had a restless night, feels exhausted and knocked up; yawns, complains of cold, loss of appetite, severe headache on moving the head, and pains in the back; this is followed by nausea and at night by vomiting. Profuse perspiration.
December 22. Patient was very restless in the night; got out of bed, ran about, laid down again, perspired freely, asked for morphia. The abundant perspiration lasted till midday and was accompanied by determination of blood to the head. Patient suffered from giddiness and felt greatly tired. Appetite poor. Frequent retching, but no vomiting.
December 23. Patient has slept little. Three relaxed motions in the morning. Symptoms the same as on the previous day. New symptoms: twitchings in the extremities, excitement, sensitiveness to the light, and epigastric pains. To remove the latter symptom sinapisms to the stomach, hot poultices and cupping (four times) were attended with success. Frequent vomiting.
December 24. Patient has only slept for a few hours. A great deal of sneezing; eight relaxed motions. In the course of the day he felt well.