Some physicians use carbolic acid, some chloral hydrate, some benzoic acid, and some chloroform, as preservative agents. Any of these substances, present in sufficient amount to prevent decomposition and clouding of the solution with minute vegetable growths, are apt to be irritating. In my first work on morphia, a full list of the solutions used in this and other countries will be found.
Erysipelas sometimes results from the subcutaneous use of morphia.
The syringe needles are sometimes broken off in the flesh. This is, however, a rare occurrence.
The method of making an injection, undoubtedly, has something to do with the occurrence of abscess. The usual plan is to pinch up a fold of skin and pushing the needle in quickly, inject the solution slowly, beneath it. Some persons prefer to plunge the needle deep into the muscular tissue. It is claimed for this plan that abscess seldom occurs, and there is certainly less liability of wounding a vein.
The following is taken from my book on “Morphia Hypodermically,” and illustrates very fully another danger sometimes attending the use of the drug in this way:—
Articles have, from time to time, appeared in various medical journals, at home and abroad, detailing certain alarming symptoms following immediately upon the injection, subcutaneously, of moderate doses of morphia. Such accidents have been ascribed by most authors, to the entrance of a needle into a vein, with the consequent sudden passage of the drug into the circulation; by some, to the injection of a bubble of air into the vein; by others, to fright attendant upon the dread of the operation and the prick of the needle; and by still others to the rapid absorption of the remedy when a vein is not punctured. Which of these hypotheses is the correct one it is at present difficult to decide; perhaps each may have proved a factor at certain times or in certain cases. The weight of opinion would seem to favor the idea of sudden entrance of the drug into the circulation by puncture of a vein. By a careful study of some of these cases we may be able to come to a definite conclusion.
Dr. M. E. Woodling, of North Branch, Minn., writes:—“My first case in which the hypodermic injection of morphia was tried, resulted as follows: Patient large, strong and robust-looking man. Complained of pain in the course of the sciatic nerve, and of lumbago. Injection given back of the trochanter major, patient sitting; given slowly. I turned to lay the syringe on the table, when the patient appeared unsteady, straightened rather rapidly and persistently, and slipped from the chair, falling full length, supine, upon the floor, pale and with absent respiration. He was now perfectly limp. No response to shaking or questions. Spoke the word ‘breathe,’ loudly, in his ear. This he obeyed. Repeated this for about a minute, and in another he was able to sit up, but was very sleepy and unsteady, requiring assistance. In about five minutes he was able to stand, and I took him out on the street and walked around with him for an hour. I then took him home, still sleepy, but improving. The next morning he was all right, but the pain was only partially relieved. Other injections were given, with no bad consequences.”
Dr. A. Atkinson, Professor Materia Medica, College of Physicians and Surgeons, Baltimore, in reply to my fifth query, writes: “Never had death to result, and but one accident, and that was apparent suspension of animation for about fifteen minutes, in a young lady, very anæmic, in whose case I injected one-eighth of a grain of the sulphate of morphia (the regular Magendie’s solution) into the rectus muscle of the abdomen, at the repeated and urgent entreaties of the patient, to relieve an obstinate uterine neuralgia. She recovered from the neuralgia and from the effects of the morphia in three-quarters of an hour. I had, a year before, injected one-fourth of a grain into the arm of this same patient, for cardiac neuralgia, with complete relief of the pain in one hour, and with no bad effects.”
Dr. E. Jones, of Cincinnati, has kindly written me and inclosed an article[12] of his, bearing directly upon this subject. In it he says: “Did the needle enter an abdominal vein? Several times. The first time I became somewhat alarmed; the patient at once threw up her arms, complained of suffocation, giddiness, excessive fatigue, a severe tingling sensation following the course of the circulation. The countenance was at first livid, then flushed; the eyes became unusually brilliant; slight muscular twitchings, profuse sweating, with cold extremities, and in a few moments complete relaxation was followed by deep sleep, which lasted only four hours, when she awakened, feeling, as she expressed it, ‘ever so much better.’
“The same accident occurred three times, the symptoms much milder, with the exception of a burning sensation of both eyelids of either eye and both lips, which at one time became painfully intense. The above symptoms were produced by an injection of five grains of sulphate of morphia into an abdominal vein.