An interesting and novel series of careful experiments on man and animals, made by Dr. Gaspar Griswold,[34] then house physician in Bellevue Hospital, this city, although not made with that end in view, seem to demonstrate very clearly that a powerful and possibly irritant medicine (aq. ammonia dil.) when injected into a vein in quantity does not produce any untoward symptoms, but, on the contrary, were always found to have the happiest, and sometimes a most marvelous effect.
Another question arises here: Is it possible for such phenomena as have been ascribed to the injection of morphia into a vein to take place without such puncture? I think so. Some of the cases reported would seem to prove it; notably that by Dr. Tupper, where the symptoms did not appear until ten minutes after the injection was made. Every insertion of a hypodermic needle, of necessity, cuts across or opens a number of capillary vessels, to which is undoubtedly due, to a certain extent, the rapidity of absorption when drugs are given in this manner. The Committee of the Medico-Chirurgical Society[35] came to the conclusion, from experiments on men and animals, that absorption of a sufficient amount of the remedy to produce decided symptoms took place in from four to ten minutes.
“Experiments on a healthy man, aged thirty-two. One-sixth of a grain of acetate of morphia was employed:—
| Symptoms. | Skin. | Mouth. | ||
| Absorption | 5 | min. | 110 | min. |
| Pulse increased | 8 | beats. | None. | |
| Pulse lowered | 12 | ” | 10 | beats. |
| Headache | 36 | hours. | 10 | hours. |
| Nausea | 46 | ” | 3 | ” |
| Pulse, its nat. standard | 22 | ” | 8 | ” |
| Incapacity to work | 7 | ” | None. | |
| Total duration of symptoms | 46 | ” | 11 | hours. |
I have found that some drugs, notably jaborandi, when used hypodermically, manifest their peculiar symptoms in so short a time as one minute, no vein of any size being punctured. It is to be supposed that one drug is absorbed from the subcutaneous cellular tissue with about the same rapidity as another, but that each drug manifests its presence in the circulation with a difference in point of time, according to its peculiar action, or to some idiosyncrasy of the patient. Thus, while morphia may be absorbed as rapidly as pilocarpine or jaborandi, it does not, save in certain persons or at certain times, give evidence of its presence by recognizable symptoms so early or so decidedly as the latter, unless the patient manifests some idiosyncrasy.
From this it would appear possible, in certain cases, for a very rapid absorption to take place, and sudden overwhelming of the heart by the drug to occur without the puncture of a vein. As the needle does not go deeper than the subcutaneous cellular tissues, in a large majority of the cases the immediate treatment would be as effective in one case as in the other.
At a recent meeting of the New York Pathological Society,[36] Dr. Amidon presented some microscopic specimens exemplifying the pathology of hypodermic medication. He said that although hypodermic medication had been in vogue twenty-five years, or according to the claims of some, forty years, he was not aware of any accurate investigation of the relations between the hypodermically injected mass and the skin. He had injected Prussian blue (a weak solution) into the skin of moribund subjects, and a portion of skin was excised after death. The hypodermic injection was given in what he considered the best manner, namely, the pinching up a fold of skin and introducing the needle horizontally. The hypodermic injection was found to occupy a space three and a half centimetres in diameter and one millimetre in thickness, tapering in shape. The location of the hypodermic injection varied according to the amount of adipose tissues in the subject. In those who had but little adipose tissue the hypodermic injection remained immediately below the skin, while in those who had much, the injection diffused itself. It would be seen in the specimens presented that the hypodermically injected mass lay close to the arteries and veins; sometimes it completely surrounded an artery or vein. This, together with some other experiments, proved that it was by the blood vessels and not by the lymphatics that absorption took place.
a, Commencement of the Cephalic Vein; b, Main Trunk of the Cephalic Vein; c, Anterior Branch of Basilic Vein; d, Posterior Branch of Basilic Vein; e, Basilic Vein; f, Median Vein; g, Median Basilic Vein; h, Median Cephalic Vein; i, Biceps Muscle; j, Tourniquet.
(Agnew.)