I should like to see a more extended trial given to applications which keep a wound warm and moist continuously from the time of the operation. I think their use would give satisfactory results. No doubt they are most serviceable remedies throughout various forms of ulceration, and especially so in cases of lupus.
THE HYPODERMIC INJECTION OF MORPHIA IN MENTAL DISEASE: A CLINICAL NOTE.[[7]]
BY C. LOCKHART ROBERTSON, M.D. CANTAB., F.R.C.P.
Medical Superintendent of the Sussex Lunatic Asylum, Hayward’s Heath.
In the first number of the Practitioner, July 1868, Dr. Anstie has published a Paper on “The Hypodermic Injection of Remedies,” in which he truly says, that despite the satisfactory working of the method and of the greatly increased power in handling remedies which it gives us, it is still very much unappreciated. Believing that this remark applies even to the employment of the hypodermic injection of morphia in the treatment of mental disease, I venture on this occasion to lay before the Medico-Psychological Association in the half-hour we devote to Clinical Discussion, a brief outline of three successful cases illustrating the treatment by the hypodermic injection of morphia in recent mania, chronic mania, and melancholia respectively.
In October 1861 Dr. W. C. Mackintosh published a Paper in the Journal of Mental Science on “The Subcutaneous Injection of Morphia in Insanity,” which first drew my attention to this method of treatment. In the Reports of the Somerset Asylum, Dr. Boyd has also recorded his opinion of the value of this treatment in cases of maniacal excitement with sleeplessness, and in that form of destructive mania accompanied with dirty habits.[[8]]
The detail of the hypodermic method of treatment is carefully stated in Dr. Anstie’s Paper, and to this I must refer those who desire farther information regarding it. I use a solution of 6 gr. of the acetate of morphia to the drachm; Dr. Anstie’s strength is 5 gr. I always commence with ♏︎v of the solution (½ gr.), and in only one case out of many hundred hypodermic injections of morphia has any injurious effects followed the remedy thus used.
Case I. Recent Mania.—J. H. W., No. 1,563, female, aged 20, single; domestic servant. Form of disease, acute asthenic mania.
History.—Never had any previous attack. No history of insanity in her family. Has been engaged for some years as a domestic servant. No reason can be given for her illness. It is stated that for the last three or four months she has been strange, and at times depressed, and that about three weeks ago she suddenly became maniacal, and has remained in a state of violent excitement ever since.
Progress.—On admission at Hayward’s Heath, on the 22d of March last, she was in a state of the most intense maniacal excitement, and very incoherent. Physically, she was suffering from marked typhoidal symptoms, her pulse was feeble and very rapid, her skin dry and harsh, her lips and teeth covered with sordes, her tongue coated with a thick creamy fur. She refused all food, and had had no sleep for several nights.