In order to still further test the matter, he had injected muriate of pilocarpine into the ankle and into the supraclavicular region. The physiological effects of the drug (diaphoresis, salivation, etc.) were produced in both cases in about the same time, varying in different subjects from one and a half to four minutes; there was no appreciable difference. If the absorption had been by means of the lymphatics, the injection in the supraclavicular region would have produced its effects much more rapidly than that injected into the ankle. In one of the slides the section had fortunately been in the line of the puncture of the needle, and showed that considerable injury had been done to the tissues.
I am firmly convinced that no physician should be held free from blame in case of accident where he has not had a ligature or tape loosely encircling the arm above the point of puncture. At the first intimation of danger this should be pulled tight and kept so for several hours, being loosened gradually, thus permitting but a gradual entrance of the drug into the general circulation. With this precaution it will be seldom necessary to treat such alarming symptoms as are here recorded. A tourniquet for this purpose is here shown. It consists of a strap or heavy tape, at one end of which is sewed a “patent buckle,” that will catch and hold at any point. In the absence of this or a skate strap with such a buckle, any cord or tape, so arranged as to be pulled tight at a moment’s warning, may be used. The treatment of such condition when already established, is summed up in one word—stimulation. Whiskey and ammonia hypodermically, cold affusion, electricity, when there is a battery at hand, and hot bottles to the præcordia.
In some instances tetanus has followed the use of rusty needles, in one case resulting in the death of the victim, an habituè.[37]
At Southsea, recently, an inquest was held upon the body of Mrs. Frampton, wife of a lieutenant and adjutant in the Royal Marine Light Infantry.
The husband of deceased deposed that his wife was twenty-five years old, and that in 1871, previous to giving birth to a child, she suffered greatly from sickness. A surgeon, to alleviate this, used morphia by the hypodermic method, always injecting the solution himself. Some time since deceased assured him she had entirely given up the use of morphia.
On the previous Thursday he found the deceased suffering from convulsions. She grew worse and died the following morning. Since her death several bottles had been found in her wardrobe, tied up in a parcel and secreted, together with five or six small cases, each containing a hypodermic syringe.
Mr. Cruise, pharmaceutical chemist, said that at first he refused to serve the solution, but on reference to his junior assistant he was informed that Mrs. Frampton had been frequently supplied with the solution. In August, September and October, he supplied nine bottles each month, the last being on the 30th ult.
Dr. Norman described the state he found deceased in, and stated that when Mr. Norman and Dr. Jackson were called in they discovered on the upper part of both arms a large number of old scars, which they were informed were the result of hypodermic injections five years ago. There were no recent marks about the arms, but upon both thighs there were a large number of similar marks, and also several marks of recent punctures. Around some of these latter there was a redness of the skin in different stages, and one particularly had the appearance of having been made within twenty-four hours. He was of opinion that Mrs. Frampton died from tetanus, caused by the punctures made in the thighs for the purpose of injecting a solution of morphia. He had been shown three syringes, all of which were in a dirty condition, apparently not having been wiped dry after using. The steel needles were in a very rusty state, which would be likely to set up inflammation.
The jury returned a verdict to the effect, “That the deceased died from tetanus, or lockjaw, caused by inflammation arising from punctures made by the deceased herself, for the purpose of subcutaneous injection of a solution of morphia.”[38]