Dr. Aug. M. Tupper, of Rockport, Mass., published the following interesting case:[15]
“On the morning of the 22d ult. I was called to see Mr. G., who was stopping at one of our hotels. I found a healthy-looking young man, about thirty years old, suffering from lumbago, confined to his bed, and in considerable pain, aggravated very much by movement. Applications of mustard and an anodyne liniment were prescribed. In the evening I called again, and as the relief was slight, decided to inject some morphia directly over the seat of pain, a method I have found very efficacious in similar cases. Accordingly I injected nine drops of a solution of sulphate of morphia, one grain to a drachm of water, into a spot midway between the spine and crest of the ilium. As is my custom, the solution contained one drop of carbolic acid, which I added in order to keep it. In five minutes he expressed himself as feeling relieved, and sat up in bed to show us the improvement. I told him to lie down and keep still awhile, and he did so. We chatted pleasantly for perhaps five minutes longer, when, turning toward his wife, he said, ‘I think I am going to vomit,’ and turned to the side of the bed. I noticed that he looked a little pale, and before Mrs. G., could get the basin, he grew deadly pale, his eyes rolled up in his head so that only the whites were visible, the jaws were clenched, the head was drawn back, and the whole body stiffened, respiration ceasing also. I immediately went to him, dashed cold water in his face, and took the wrist to feel his pulse, which, to my horror, was not to be felt. He was in this state for perhaps a minute. I then raised him up, and looking into his eyes, which were staring wide open, saw that the pupils were widely dilated. Very soon the color began to return to his face, he was drenched with perspiration, and recovered consciousness. I laid him back on the bed, and he looked up, smiled, and said, ‘I’m all right now.’ The pulse was quite full at sixty, but inclined to be irregular. I gave him brandy freely, and he had no further trouble, but the pulse remained at sixty for the next twenty-four hours; he said it was usually about eighty. I cannot verify that, for he left town the following day.
“That was certainly a very unusual effect from such a dose, a little over one-eighth of a grain. The question arose in my mind whether the acid could have had anything to do with it; but I have given the same mixture a great many times without the slightest trouble. I may add that the solution was prepared that morning, and I injected the same dose into the same part of the body, for neuralgia, in a female patient, that very same day, previous to using it on this patient. I should not care to repeat this operation on Mr. G., and advised him never to have it done again. I would also state that it relieved his lumbago, for the next afternoon he was dressed and down at his meals.”
After seeing the report of this case I wrote Dr. Tupper, who has courteously furnished me with the following additional facts: “My patient, I should say, was of a phlegmatic temperament. He had taken no medicines by the mouth before I saw him, nor while under my care. He had never taken any narcotic in his life, he says. The pupils were natural very soon after the effects of the dose ceased. He writes me that his pulse remained at sixty for a week, but that he felt first rate. Pulse rate since then has been seventy-six. It seems to me that it must have been a peculiar susceptibility to this drug in his case, else it would not have had such a lasting effect upon the pulse. I do not think it was due to the mode of administration. He related to me afterward, that a cousin (I think that was the relation) had very peculiar and even dangerous symptoms from a dose of Dover’s powder, some time ago, and that the physician in attendance was detained all night in consequence. This would go to show an idiosyncrasy in the family.”
I think that the doctor is right with reference to idiosyncrasy, but I think, also, that the method of administering the drug had much to do with it. As I have said before, where an idiosyncrasy, be it to narcotism or any other peculiar manifestation, exists, the sudden entrance of the drug into the system is certain to aggravate those symptoms; may, indeed, call forth an idiosyncrasy that the drug given by the stomach would, possibly, never have revealed. The fact that some ten minutes elapsed between the time of the injection and the first appearance of the alarming symptoms seems to preclude the idea of the needle having entered a vein. The symptoms are, however, exactly those that are seen when a vein is punctured. As will be seen from the results of experiments soon to be recorded, and from the conclusions arrived at by the Committee of the Medico-Chirurgical Society[16] of England, five minutes is abundant time for enough of the drug to be absorbed to produce its characteristic, and, therefore, its unusual effects, where idiosyncrasy exists.
Prof. H. C. Wood,[17] states that he has seen deep coma produced in three minutes by a hypodermic injection of morphia. This may have been due to unusual rapidity of absorption from the cellular tissue, or to direct injection into a vein.
Here is a somewhat similar case[18]: A lady, aged twenty-four, who has been a sufferer from neuralgia every day for months, was given a hypodermic injection of one-fourth of a grain of the hydrochlorate of morphia in the subcutaneous tissue of the leg. Alarming syncope and extreme prostration came on within five minutes after the injection was made. The patient was not out of danger for four hours after, and was too ill to leave her bed for two weeks. The neuralgia did not return for some months.
Dr. Francis H. Miller, of East New York, formerly House Surgeon of St. Peter’s Hospital, Brooklyn, writes me: “Several times, when I suppose my fluid entered some small vein, the patients complained of sudden weakness, faintness and dizziness, and almost syncope.”
Dr. Samuel W. Francis, of Newport, R. I., writes me: “I have heard of two or three cases where extreme syncope set in, the patients being restored only with great difficulty.”