The newspaper report of the following case has been kindly sent me by F. W. Barkitt, L.R.C.P., etc., Dublin, Ireland. The extract is from the Irish Times newspaper, October 23d, 1870, giving an account of the coroner’s inquest:—
The patient was a governess, single, aged 56, and addicted to the morphine habit, using the drug hypodermically.
Dr. Austin Meldon deposed he was called to see the deceased on the morning of the 16th instant. He found her in the spasm of lockjaw. She was actually in the spasm when he entered the room, her body being bent forward. Witness was of opinion the disease commenced late on Sunday night. From examination and inquiry, witness had made up his mind that the disease was caused by a slight wound, inflicted by the needle of a subcutaneous injection syringe. There were numbers of marks over her body, where she had been in the habit of making these injections. The slight wound to which he had referred was made on the previous Friday. He found she had been in the habit of using these injections for years. That morning she told him she had used twelve grains of morphia in one injection, and showed him the papers which had contained the four powders. That was an enormous quantity, a quarter grain being a full dose. The immense quantity she used that morning showed she had been using it for years. She told him that she was in the habit of using, when affected with neuralgia, twenty grains in twenty-four hours. There was no case on record of so much being used.[39]
Witness asked her why she had adopted that mode of taking morphia. She said, in order to avoid the temptation of taking more of the drug. There was a case of poisoning from morphia in the same way in London, last year, but the quantity was considerably smaller—the dose taken being only one grain four times a day. After witness saw her, he continued the injections during her spasms, and they relieved her pain, but, of course, the doses he gave were very small, and as the suffering became less, so did the quantity in the injection he administered. He would account for the lockjaw which caused her death by the particular puncture in the skin, as a nerve might have been injured by the entrance of the needle. It was a very hazardous thing for an unprofessional person to use one of those needles. He knew of two cases of lockjaw caused by it. In one of these cases, the patient was very nearly poisoned, for he used when he had no pain a dose which had been ordered him by a medical man when he was in great pain.
Witness made a careful post-mortem examination. He had never seen a lady of that age whose organs were in a more healthy condition. The reason she used it, I may say, was to relieve facial neuralgia, in the first instance, and the habit grew on her. I found the surface of the body punctured in innumerable places with the needle. She seemed as if she had been tattooed.
“Coroner. Is there anything else you think it well to tell us? Are you certain she died from traumatic tetanus? ‘I am clearly of that opinion, both from the history and condition of the case.’
“Coroner. There is one point which I would wish to have cleared up. Several medical men have mentioned to me that it is quite possible she might have obtained, either by mistake or otherwise, strychnia in place of morphia. You are satisfied that is not the case? ‘I am perfectly satisfied. I should say that the symptoms of tetanus and strychnine poisoning are the same while the spasms are on. After the spasms pass away, the patient becomes quite well in strychnine poisoning, but the muscles remain contracted in lockjaw.’”
I have written Dr. Meldon, asking for histories of the two cases of tetanus referred to, but as yet have not had a reply. The British Medical Journal, in commenting on this case, says that it has no knowledge of the case referred to by Dr. Meldon as occurring in London, but refers to three cases of death from traumatic tetanus after the hypodermic injection of the sulphate of quinine (Lancet, July 6, 1867), and a case of tetanus after the use of morphia, due, probably, to the use of rusty needles (Lancet, December, 1876, p. 873).