A case of syncope and prostration is reported by Dr. E. Wenger, of Gilman, Ill. The amount of morphia used is not stated.
F. Woodhouse Braine, F.R.C.S., etc., publishes the following case:[24] “Mrs. H. C., aged thirty-five, in good health otherwise, had been kept awake seventy-two hours by intense neuralgic pain on left side of head, face and neck, arising from a carious molar tooth on the left side of lower jaw. She was injected with one-third of a grain of acetate of morphia. At 1 A.M., on June 28th last, the morphia, dissolved in about four drops of water, was introduced under the skin of the left arm, just over the insertion of the deltoid. No blood appeared at the puncture. In about fifteen seconds tightness of the chest and difficulty in breathing was complained of, and the patient asked to be raised, saying she felt as if she was dying. Her face and lips now became pale; speech became indistinct (not inaudible); pulse irregular; some spasm of the facial muscles took place, and she fell, to all appearance, dead. Cold water was freely dashed over her face and chest, and as she was unable to swallow, her tongue was rubbed over with sal volatile, and ammonia applied to her nose, artificial respiration being kept up at the same time. During this time her face was blanched, pulse not to be felt, and respiration not to be perceived. Insensibility continued for about three minutes; then, happily, one or two feeble beats of the pulse, and a shallow inspiration or two, showed returning animation. She then became conscious; pulse feeble but regular; respiration slow; fingers remained numb and both thumbs were firmly drawn into the palms of the hands. This passed off in about six minutes, leaving her feeling very ill, but free from the neuralgic pain, which did not return. There was no feeling of nausea, and no attempt at vomiting during any part of the time.”
Mr. Arthur Roberts[25] publishes the following cases:—
“Sir:—The case described by Mr. Braine, in your last week’s journal, of an unusual effect of subcutaneous injection, is what I have seen in two instances, but nothing like to such an alarming extent. One was in a gentleman whom I had injected several times previously, the other in a lady. I have also partly noticed it when I have injected myself. In the first case, a few minutes after the operation, the face became intensely flushed; this was followed by vomiting, and then a dead faint and struggling for breath, the pulse scarcely perceptible. These cases, and the effect on myself, taught me, when injecting a patient for the first time, never to give more than the sixth of a grain—wait a quarter of an hour longer, and then give the remainder of the dose, after ascertaining how the first injection was taking effect. Women, I have found, are generally bad subjects for subcutaneous treatment; for they get frightened and nervous—in fact, one woman told me that though the morphia taken by the skin did her more good than by the mouth, yet she preferred the latter, for the instrument frightened her. I have used my needle over three hundred times, and I have always noticed one fact, that if the wound bleeds after the operation the morphine enters the system much more powerfully and rapidly; and I always know when it is going to bleed, by the operation giving a good deal of pain. When this is the case I withdraw the instrument, to see if the puncture bleeds; if it does, I try a fresh place.”
Bartholow,[26] in his useful and able little work, calls attention to this danger in these words: “In practicing the hypodermic injection it is important to avoid puncturing a vein. Serious depression of the powers of life, fainting and sudden and profound narcotism have been produced by injecting a solution of morphia directly into a vein. Fatal collapse might be induced by injecting air into a large vein, along with the solution.”
Syncope, etc., as we have seen, from this cause, is common; narcotism rare, the drug seeming to exhaust itself in its initial action, or to produce a condition of the system in which narcotism is wholly or partially impossible.
Dr. Corona[27] (Giornale di Medicina Militaire), summing up the results of his experiments on animals, says: “The injection of the two poisons (morphia and atropia) into the veins showed that a much smaller dose was sufficient to produce rapid and grave poisoning, but even then the morphia produced its action instantaneously, and its action always superseded that of atropia.”
J. Pennock Sleightholme, L.R.C.P., Lond.,[28] reports the following case: “A young man of sound constitution and good health, who had never before taken morphia hypodermically, partly as an experiment and partly with the hope of relieving some slight restlessness, injected himself, at about 3 A.M., with one-sixth of a grain of morphia. Immediately after the injection he fell down on the floor in a state of syncope, and had slight convulsive movements on one side of the body; consciousness did not entirely leave him, and after lying still for about ten minutes he was sufficiently recovered to be able to go to the next room and help himself to a couple of glasses of sherry. After this the feeling of faintness gradually passed off, and he slept for about two hours, but on rising, at eight o’clock in the morning, the same feeling of faintness returned, accompanied with great pallor. These symptoms were relieved by a dose of brandy, but did not entirely cease until noon the same day.”
A physician in the South, who is a slave to this habit, writes me: “Several times I have been unfortunate enough to puncture a vein, and to introduce some of the solution directly into it. Immediately I feel a peculiar tingling all over me, from the tips of my fingers to the ends of my toes. The skin of my head feels as if a myriad of pins were penetrating it. This feeling passes off in from three to five seconds. Sometimes it has been followed by a turgescence of the vessels of the brain, causing a great fullness and throbbing, with slight headache following.”
In a most interesting and instructive letter from Dr. Wm. W. Cable, of Pittsburg, Pa., I find the following: “I have spoken of minor accidents which sometimes occurred. In all that I have seen they were caused by the injection of the morphia directly into a vein. A series of phenomena instantly take place. The patient describes the first sensations as the stinging of bees all over the body, with difficulty of respiration, and intense congestion and swelling of the face and body. In one case that I saw the face was so swollen that in five minutes all traces of the natural features were lost. This condition of affairs calls for prompt action. If possible, the patient must be kept in motion and applications of cold water be made to the face and spine. If the patient falls the limbs must be raised, and all methods used to keep the heart acting, for if you can bridge over ten or twelve minutes the patient is safe. To prevent being ‘struck,’ as he calls it, one patient of mine carries a cord, which he throws over the arm, and if an unfavorable symptom occurs, he uses it as a tourniquet, and in a moment the result is apparent in the extravasation of the blood and the morphia from the wounded vessel. This is a safe condition, as afterward no rapid absorption can occur.”