“Being unable to see her for a day or two, I requested my friend, Dr. Geo. E. Walton, who had watched the case with a good deal of interest, to call and give her an injection of two grains, when she put both hands to her head and gave a cry of excruciating agony. A sharp pain darted through her head, which lasted ten or fifteen minutes; also complained of an intense itching of nose and lips, finally passing off, leaving no deleterious effects. The same accident occurred to myself, only in a less degree. These injections were also made in the abdomen.”
The patient was a German woman, aged thirty-seven, and weighing about 135 lbs. The case was presumably one of fecal accumulation in the colon, with severe abdominal pains.
Dr. W. A. Neal, of Dayton, Michigan, writes in this connection as follows: “No deaths; the only accidents were where a vein was punctured. This produced dyspnœa, great distress, and was usually followed by a chill and the reaction by fever; but in every instance there has been but one chill, and fever once, lasting three or four hours.”
Edward T. Wilson, M.B., Oxon., F.R.C.P., Lond., who has a valuable and interesting article on the subcutaneous injection of morphine, in the St. George’s Hospital Reports, for 1869, writes me as follows: “Never either death or accident. Nothing beyond a temporary feeling of faintness, and on two occasions a temporary outburst of urticaria, which soon passed away.” I hardly think these phenomena were due to injection into a vein; indeed, the writer does not endeavor to account for them on this ground. They partake more of the nature of rapid absorption with some idiosyncrasy. Dr. E. C. Seguin makes mention, in the New York Medical Record, of a lady thus affected (urticaria) by any preparation of opium taken by the mouth.
Arthur R. Graham, M.D., etc., of Weybridge, England, sends me the following interesting and conclusive case: “No deaths; but one alarming accident worth recording: I had injected a large dose (probably three-quarters of a grain) into the right forearm of a woman whom I was in the habit of injecting daily. Almost immediately she started up, and holding up her left hand and looking at it, exclaimed, ‘O, how funny my fingers feel!’ and fell back in a dead faint, with blanched lips. I immediately bound a tape tightly around the arm, above the puncture, and then gave brandy and asafœtida injections, but she remained unconscious, I think, for more than half an hour. After she was sufficiently recovered to talk rationally I loosened the tape, when she immediately fainted again. Of course, I at once tightened the ligature and kept it so for some hours. The second swoon was less alarming than the first. In the first no pulse could be felt, nor could the heart sounds be heard, excepting with great difficulty. My impression at that time was that, had I not applied the ligature at once I should have had a fatal result to chronicle. It was the impulse of the moment to tie on the tape, and had I had time to reason I should have rejected the idea as an entirely useless one; but in any similar emergency I should now recommend any one to try it.”
Dr. E. Fletcher Ingalls[13], who has devoted much attention to the hypodermic injection of morphia, reports the following case: “I have often used hypodermic injections of morphia, and always with good results, until a few weeks since, when I obtained alarming results from the administration, by this method, of one-fourth of a grain of morphia.
“The patient, in consequence of continuous watching with sick children, had become debilitated, and, as a result, suffered at times from severe pains of a neuralgic character. I was called in the night to see her in one of these attacks. The pain had commenced about twelve hours previously, and with frequent exacerbations, had steadily increased in severity until it had become unbearable.
“I dissolved one-fourth of a grain of morphia in pure water, and administered it under the integument on the outer side of the arm. Within a few seconds the breathing became stertorous, the pulse failed, the lips and countenance became livid, and the eyes were set; respiration ceased, the radial and cardiac pulsations were lost, and the heart sounds could not be distinguished. The woman was to all appearances dead. How long this condition continued I cannot tell; it seemed an age, but was probably only ten or fifteen seconds, for by prompt means I succeeded in resuscitating my patient.
“After a few minutes she expressed herself as much relieved. I remained with her some time, and then left careful directions with the husband in case any other unfavorable symptoms should occur. During the next few hours the patient fainted twice, but she was restored by dashes of cold water in the face.”
Dr. H. L. Harrington, of Little York, Ill., refers me to the report of a case[14] of his, which reads as follows: “Was called a short time since to treat W. S., male, aged sixty-two, for acute dyspepsia (bilious attack) accompanied by very severe pain. Administered hypodermically, in the hypogastric region, morphiæ sulph. 0.02 gram. Before the syringe was emptied alarming syncope supervened, and occurred twice, at intervals of ten or fifteen minutes. Stimulants administered freely, artificial respiration and the use of electricity were successful in reviving the patient. Neither narcotism nor coma were in any degree present. Is it possible to attribute the syncope to the effects of the drug? Not over fifteen seconds were occupied in the operation.” I think this an excellent example of the puncture of a vein with entrance of the drug directly into the circulation.