Dr. J. S. Jewell, Professor of Nervous and Mental Diseases, Chicago Medical College, writes me: “I have never had any serious consequences follow morphia injection, but have seen temporary unpleasant symptoms (vaso-motor disturbances), vertigo, mental confusion, etc., a few times.”
Dr. Geo. R. Fowler,[19] of Brooklyn, states that he has twice had alarming symptoms from puncturing a vein. He believes that this may be avoided by making the skin of the part to be punctured tense, and introducing the needle at a right angle to the axis of the limb.
Prof. Nussbaum,[20] of Munich, has published an interesting account of an accident that happened to himself. He had made use of the hypodermic method of giving morphine to himself, as often as 2000 times, using sometimes as much as five grains of morphia at an injection. One day he accidentally injected two grains of the acetate of morphia into a vein, and did not recover from the dangerous effects for two hours. He has seen the same symptoms, in a less degree, in two of his patients. He advises slow injecting, and withdrawal of the piston if a vein is punctured.
The following interesting remarks are clipped from an English journal,[21] and bear directly on the question in hand:—
“‘Observer’ remarks that ‘Spectator,’ in the Journal, of April 12th, very accurately described what always happened when a vein has been pierced and morphia injected into it, although he might have added (as no doubt it occurred) that the person injected also experienced a strong taste of morphia; and probably, also, an unusually large quantity of blood flowed from the puncture. It is a very serious accident to inject morphia into a vein, but it need never happen, if the operator, thrusting the instrument under the skin, will draw up the piston, when, if the point be in a vein, blood will be drawn into the syringe. ‘Observer’ knows a gentleman who for years has been in the habit of injecting himself with morphia, three and four times a day, to whom the accident has frequently occurred, accompanied by the symptoms described by ‘Spectator.’ He is much alarmed at the time, and is afterward careful to draw up his piston, but in three or four months he begins to be less cautious, until he gets another reminder. As to the necessity of drawing up the piston, there cannot be two opinions; for besides the symptoms certain to follow the introduction of morphia directly into a vein, there is the danger of air entering as well, should care not be taken to prevent it. ‘Observer’ has known an habitual morphia taker by injection to contract albuminuria. The albumen would greatly diminish on the daily quantity of the injection being lessened, and entirely disappear in forty-eight hours, when the morphia was wholly discontinued.
“‘Injector’ was, until very lately, for nearly two years, one of the victims of morphia, and during that time he five times thoroughly, and twice partially, experienced more or less of the horrible symptoms sketched by ‘Spectator’ in the Journal of April 12th. The sensations were as follows: 1. A dull, gnawing pain in some decayed teeth, accompanied by a metallic taste in the mouth. 2. A pricking and tingling of the forehead and cheeks, somewhat like prickly heat; but this soon increased, spreading to the ears, neck, arms and chest (but not below the waist, although the morphia was injected into the calf of the leg). This pain soon became almost unbearable, but it was entirely eclipsed by what ‘Spectator’ calls ‘throbbing,’ but which ‘Injector’ says would be better represented by imagining twenty blacksmiths confined in his head, with each an India-rubber-headed sledge hammer, and each trying to make the best of his way out. Imagine, at the same time, that you are suffering from the first mentioned broiled feeling; that your skin feels as if about to burst; your eyes as if already started from their sockets; your lips as if they did not belong to you—then you may have a faint idea of what ‘Spectator’ wishes to describe, and what I, who have five times felt it, yet feel powerless to lay before you as I ought.” He had always thought that this condition was caused by: 1, too rapid injection; 2, too much at once; 3, the solution being too strong; and 4, by its being injected directly into a tolerably large vein. When the symptoms have occurred, he has always noticed that injection has taken place at one of two spots—probably into the same vein each time in each leg—one on each leg. Again, it only occurred when he had to inject a large quantity in a short time; and he always used a very strong solution of acetate of morphia (forty grains to the half-ounce of water). He advises that when one feels any of the symptoms coming, he should walk about as rapidly as he can. He has relieved his worst attacks in this way, and has warded off others by violent exercise in his room, as soon as he felt the pain in his teeth, or the metallic taste or the “prickly heat.” He thinks that corroboration of his belief as to the cause of the symptoms is afforded by Dr. Pepper’s description of the results of injecting milk into the veins of anæmic patients.
The case referred to by ‘Observer’ reads as follows:[22] “Scarcely has the fluid left the syringe when the most intense feeling of irritation and pricking is felt in the skin, spreading from the puncture rapidly all over the body. At the same time the skin becomes suffused with a bright blush. The heart’s action then becomes greatly quickened, and there is a throbbing, rushing feeling through the head. The hands are somewhat swollen and the lips get a glazed appearance. In one case that I had, the patient became suddenly unconscious, as if knocked down by the sudden shock; and in all the cases where these symptoms have appeared the general disturbance has been very great and the attack of a severe character. The symptoms generally subside gradually, leaving behind great pain in the head.”
This gentleman gives these as the main symptoms of several such accidents that have occurred in his practice, and characterizes their occurrence as something novel and important.
Dr. J. A. Houtz,[23] of Logansville, Pa., who is a staunch advocate of the hypodermic method, says: “The greatest danger is in injecting into a vein sufficiently large to carry the whole dose at once into the circulation. That can be avoided by selecting a place where the large veins are least numerous, and by injecting, say a third of a dose, and then waiting eight or ten seconds, when, if in a vein, the symptoms will show themselves. The first symptoms are a feeling of great fullness of the head and intense flushing of the face, coming on within a few seconds after the operation. Such, at least, was the case in a patient of mine.”