Mrs. Jane G., a patient of Dr. B. Fränkel, of Berlin, 35 years old, eleven years ago, after having been suffering with typhoid fever, was afflicted with an abdominal complaint which caused so much pain that the family doctor had to administer an injection of morphia daily. Ten years ago patient married, and has given birth to two children one five years, the other eight years old now. The confinements were protracted; both children died soon after their birth. During both pregnancies the use of morphia was discontinued by the doctor, the same taking place during several occasional journeys to bathing-places made by the patient because of her complaint. For five years she has injected morphia herself, the largest dose pro die having been eight grains.
While using the drug, a febris intermittens tertiana showed itself, two years ago, lasting, with an interruption of four weeks, until November, 1876. Regularly at 4.30 P.M. she had shiverings, followed by burning heat, and ending in perspiration. The repeated use of quinine, even a change of air and a sojourn in the country, were unable to suppress the fever. Dr. B. Fränkel, who had only for three months attended Mrs. G., and whom she had never told of her custom of using morphia regularly, made the diagnosis of morbid craving for morphia only through considering the intermittent fever. Apart from the latter, the use of the drug had brought on the following symptoms: sleeplessness, headache, principally in the region of the right occipital nerve, parched mouth, loss of appetite, nausea, sickness, constipation, feeling of oppression, mental anxiety, palpitations of the heart. Patient, after having hardly fallen asleep, wakes up with dyspnœa, which increases to actual fits of choking; swimming before the eyes and muscular quivering.
Patient is admitted into the Maison de Santé, and the use of the morphia is stopped forthwith.
October 16. Hardly any sleep during the night; in the morning patient is in a happy temper, makes no complaints. Temperature and pulse normal. In the course of the forenoon there was much perspiration, and patient complained of headache and nausea. Pupils unequal, the left smaller than the right. Pressure on the stomach, shivering, yawning; in the afternoon, there is restlessness, stomach-ache, epigastric pain, oppressiveness, much perspiration, shivering. Poultices were applied to the abdomen. Up to the evening she had altogether vomited twelve times and had one relaxed motion. Pupils unequal, the left wider than the right. The excitement, in consequence of the pain in the stomach, increases hourly. Patient moves about in bed and moans aloud. Frequent spasmodic yawning. At 9 P.M., a bath with cold douche of a quarter of an hour’s duration is given, after which she became quieter for a short time.
October 17. Patient has been sick thirteen times during the night; no sleep; the pains in the abdomen were very severe, having the character of labor pains. Face pale, pulse 64, full, regular. Frequent yawning, burning in the throat, and abdominal pains continue during the whole of the day. Patient looks worn out, is now and then in a half-dozing condition. Left pupil wider than the right. Great prostration, great thirst. In the course of the day vomited nine times, two relaxed motions.
October 18. No sleep during the night, restless; complains of tearing pains in the legs, and excessive pain in the stomach; pulse and respiration normal; vomited four times, one relaxed motion, frequent sneezing during the day; she is very sensible to every kind of noise. Frequent retching; severe vomiting ten times. Left pupil wider than the right. Patient feels cold. In the afternoon at 5 o’clock patient lisps, becomes of a pale, death-like color, is very much oppressed, and loses consciousness; sinks back on to the pillows with closed eyes. Pulse 42, small, irregular. A quarter of a grain of morphia was at once given, and repeated after twenty minutes’ time. Right pupil wider than the left. After a quarter of an hour patient wakes up, says that she had never felt so well before; takes milk with relish without bringing it up again. Pulse 60, strong and powerful. This favorable condition lasts till 9 P.M., when she again has nausea from time to time. At 10 o’clock a bath, with a cold douche, is given.
October 19. Patient has slept only from 10.30 P.M. to 1.30 A.M. At this time retching again occurs, vomiting, prostration, pains in the epigastric region; hallucinations, illusions set in, followed by collapse accompanied by the symptoms already mentioned, and necessitating the immediate injection of half a grain of morphia at 2.20 A.M., followed by a weaker injection of a quarter of a grain of morphia at 4.15 A.M. Afterwards patient again felt quite well. During the forenoon her condition has been good only at times, the principal complaints being great prostration, impossibility to sleep, pains in the stomach, great thirst. Left pupil wider than the right. About 10 A.M. the sickness increased to such an extent that an injection of one-fifth of a grain of morphia had to be administered. Feeling well after it, patient partook of a pint of milk and soup. In the afternoon she had some cocoa, which she has not brought up. Towards the evening she felt oppressed, which, however, subsided after a warm bath, with cold douche. At 9.25 P.M. another injection of a quarter of a grain of morphia had to be given, on account of symptoms of a collapse showing themselves. Only three-quarters of an hour afterwards the good effect was visible.
October 20. Patient has slept altogether for five hours during the night, with many interruptions. During the intervals, besides being restless, there was prostration, craving for morphia, nausea, and frequent vomiting, and pains in the stomach. In the morning sneezing and yawning. During the daytime the condition was comparatively good. Left pupil wider than the right, towards the evening the contrary taking place. At 8.30 P.M. patient had a bath at 31° R. (87.8° F.) of half an hour’s duration, with cold douche.