Morphinum - Appendix symptoms - T.F. Allen

APPENDIX

Authorities

1, Sertürner (the discoverer of M.), took 1/2 grain, repeated after half an hour, and again after a quarter of an hour, Annali Univerz. di Med., xxvii (Buchner's Toxicologie, 1827, p. 201); 2, Bally, experimental effect of moderate doses, and also 2 grains of Sulphur ^sulf. or acet., Méd. de l'Acad. Roy. de Méd. a Paris (from Wibmer); 3, Charvet, experiments on himself, with 1 grain of acetate, Wirkung des Op., p. 176 (Wibmer); 4, same, a man aged thirty-six, took 6 grains of acetate at one dose; 5, same, another took 6 grains of the acetate; 6, Chevallier, Rev. Med., 1824, took 1/4 grain of the acetate (Wibmer); 6a, same, took next day, 1/3 grain; 6b, same, took, the following day, 1/2 grain; 6c, same, took, the following day, 1 grain; 7, Wibmer, took 1/4 grain of the acetate, repeated after one hour and a half; 7a, same, took, 1/4 grain of M., repeated after one hour and a half; 8, Beraudi (experiments on several healthy persons, Horn's Archiv, 1829, from Wibmer), a man named Allinio took 1/8 grain of the acetate, pulse before the dose 66; 8a, same man, subsequently took 1/4 grain; 8b, same man, took 1 grain; 9, Beraudi on Crispo, aged twenty-one, effects of 1/6 grain of acetate; 9a, same man, took 1/3 grain; 9b, same man, took 1/2 grain; 10, Beraudi on Rabuni, aged nineteen, effects of 1/8 grain of the acetate; 10a, same, man, effects of 1/4 grain; 10b, same man, 1/2 grain; 11, Beraudi on himself, effects of 1/2 grain of acetate; 11a, same, 2/3 grain; 11b, same, 1 grain; 12, Beraudi on Sella, effects of 1/2 grain of acetate; 13, Bonnet and Trousseau, Bull. Gén. de Thérap., 32 (Wibmer), general effects of the salts; 14, Ronander, Hecker's Annal. de Méd., 1834 (Wibmer), effects of 1/4 to 1 grain of acetate; 15, Tully, Bost. M. and S. J., 1832, effects of 1/4 grain of the sulphate, on himself; 16, same, effects of 1/4 grain of the sulphate for pain in the stomach; 17, Bonjean, a man took 55 grains at once, Schm. Jahrb., 52, 156; 18, Leissier, effects of 33 to 36 grains of acetate, in a man, Journ. de Conn. Méd., 1838 (A. H. Z., 18, 288); 19, Anderson, effects of 1/4 grain of sulphate, repeated in two hours, in a woman suffering from sleeplessness, Am. J. Med. Sc., 1848; 20, Anderson, effects of 2 ounces of a solution of the muriate during thirty-six hours, in a patient suffering from delirium tremens, Month. J. Med. Sc., 1854; 21, Shearman, effects of 3 grains in a woman, Med. Times and Gaz., 1857; 22, Kreisig, effects of a solution in a girl aged sixteen, Inaug. Diss. (S. J., 93, 175); 23, Salviat, effects of 2 grammes, in a man aged thirty, Union Med. d. [left] Gironde, 1859 (from Tardieu, Empoison.); 24, Rodgers, effects of 1 grain in a man, suffering from neuralgia of face (post-mortem showed kidneys diseased), Lancet, 1861; 25, Zepuder, effects of 1/12th grain of the acetate in a child, eleven weeks old, Wien Med. Halle, 1861 (A. H. Z., Mbl., 3, 49); 26 and 27, omitted; 28, Dr. A.M. Cushing, provings, Mass. Hom. Med. Soc. Trans., vol. 3, p. 569, effects of 100 drops of 3d dil., evening first and second days, 1 drachm evening third day, 1 1/2 drachms evening fourth day; 29, Alexander, Wien Med. Presse, 1865 (S. J. 128, p. 294), effects of 1/6 grain, in a child; 30, Am. Hom. Obs., 1864, p. 169, effects of 1 1/2 grain of M., by mistake for quinine, for a slight indigestion; 31, Maschka, fatal effects of large doses, Prag. Vjs., 1867 (A. H. Z., Mbl., 16, p. 57); 32, omitted; 33, Brain, effects of injections of 1/3 grain of acetate, in a woman aged thirty-five, for pain in a tooth, Med. Times and Gaz., 1868; 34, Reyher, poisoning by M., Deutsch Arch. f. Clin. Med., 4, 602; 35, Pfister, effects of a solution, S. J., 15, p. 16; 36, Verdi, effects of 15 grains in a woman, Ohio M. and S. Rep., 3, 156; 37, Cattell, symptoms of muriate, Br. J. of Hom., 11, 337; 38, Goodno, effects of a solution of acetate (3 grains to 1 ounce), teaspoonful doses for dysmenorrhoea, Am. J. H. M. M., 4, 60; 39, Tellar, effects of injection of 1/12th grain, A. H. Z., 83, p. 40; 40, Gross, effects of injections of muriate, in a girl aged twenty, suffering from chronic neuritis, Am. Hom. Obs., 1870, p. 420; 41, Model, effects of twelve doses of 1/4 grain of acetate, for sleeplessness, AErzt. Intell. Bl., 1871 (A. H. Z., Mbl., 25, p. 2); 42, Oliver, effects in one case, Practitioner, 1871, p. 79; 43, Ferris, effects of a solution of muriate, for a cough and diarrhoea, Br. Med. J., 1871; 44, Schroff, Lehrbuch der Pharm., p. 515, general effects of small doses; 44a, same, larger doses, 14 to 36 milligrammes; 44b, same, doses up to 7 centigrammes; 45, Tardieu, poisoning by 2 grammes, Sur. l'Empoison., 1058; 46, Martin, effects of injection of muriate, Gaz. des Hôp., 1874; 47, Transk, effects of 6 or 7 grains of the sulphate on self, and 2 grains to daughter, and 3 grains to another young lady, N. Y. Med. J., 1874; 48, Schweig, effects of 7 grains of sulphate, in a healthy man, N. Y. Med. J., 1874; 49, Dr Helen J. Underwood, effects of as much as could be put on a sixpence, in a girl, threatened with chorea, Med. Invest., 1875, p. 282; 50, C. B. Gatchell, effect of injecting 1/4 grain into his own arm, dose repeated after fifteen minutes, Med. Invest., 1875, p. 244; (51 to 59, Harley's experiments, Old Veg. Neurotics) 51, Michael, aged forty-eight, "strong but disabled by sciatica," effects of injection of 1/4 grain of the acetate; 52, John L., aged fifty-four, with facial neuralgia, effects of 1/6 grain of the acetate; 53, Samuel M., aged forty-nine, with facial neuralgia, effects of injections of 1/6 grain of acetate, afterwards 1/4 grain, and again 1/2 grain; 54, John W., aged thirty-three, with lumbar neuralgia, injected 1/4 grain, and some weeks afterward 1/2 grain; 55, Charles V., aged thirty-two, chronic lumbago, injected 1/4 grain of acetate; 56, Mary B., aged forty-six, lame from sciatica, injected 1/6 grain of the acetate; 57, Mrs. N., aged forty, neuralgia in right shoulder, injected 1/7 grain Morph. acetate; 58, Mrs. E. W., aged thirty-four, four months pregnant, hysterical and neuralgic, effects of 1/15 grain of the acetate, afterward of the 1/12 grain; 59, Miss L., aged thirty-seven, effects of 1/8 grain, on alternate mornings; 60, Berridge, effect of injection of 1/8 grain, N. Am. J., 1872, p. 102; 61, Levinstein, effects of injections of M., 22 to 30 grains daily, for neuralgia, Berl. Kl. Woch., 1877; 62, same, effects on a woman of as much as 15 grains daily, injections for chronic rheumatic symptoms; 63, same, effects in a man, with rheumatism, of 1/2 to 1 gramme injections daily; 64, same, in a man, injections of 1 to 1 1/2 gramme daily (commenced its use in syphilitic "iritis"); 65, Berridge, "a man took Morph. acet. nine days after a proving of Cannabis indica," Hahn. Month., 3, 462; 66, Fiedler, general effects, Schmidt's Jahrb., 172, 236; 67, same, fatal case, after stopping habitual use of M., in a woman; 68, same, effects of stopping habitual use, in a man, thirty-five years old; 69, same, another case reported by Kapf; 70, Roberts, effects of subcutaneous injection, in a man, Med. Times and Gaz., 1868; 71, Anstie, effects of 3 grains injected into rectum of a man, suffering from fistula, Med. Times and Gaz., 1863, p. 134; 72, Anstie, effects of prolonged use of M. in small (1/4 grain daily) doses in a lady, suffering from sciatica, Practitioner, 1871, p. 153; 73, Levinstein, Die Morphium-sucht, eine Monographie, Berlin, 1877, general effects.

The delirium of Morphine intoxication convicts of a series of symptoms that possess nearly all the characteristics of alcoholic delirium. From my observation two forms of Morphine delirium may be distinguished, the acute and chronic. The chronic develops during the course of Morphine intoxication, continues during the period of abstinence, and runs its course without excitement. The acute form appears as a consequence of the withdrawal of the drug, and breaks out with violent symptoms. In the chronic form the depression is variable; most of the patients exhibit a certain joyfulness, only for a short time interrupted by anxiety; in some individuals during the day the mood is depressed, in the evening there is some excitement, and at times illusions of the senses. Trembling of the hands and twitchings of the muscles are constant forms of the disease. In spite of the alternations the patients are perfectly lucid and self-possessed. They are able to ward off for a longer or shorter time their depressed or excited moods, and they can mingle with society. The acute delirium tremens of Morphine develops in the course of six to twelve hours after the withdrawal of the drug. The patients at first become excited and restless; run constantly about the room, weep and cry, and at last become delirious, under the action of painful sensations and hallucinations. The attacks, which last only a few hours, are followed by a quiet stage, during which the patients have hallucinations which involve all the organs of sense except that of taste. They see brilliantly colored birds, hear voices, have a sensation of sitting in wet, and perceive the most various odors. These illusions are associated with a hypochondriac mood; the patient thinks he will die; thinks he has seen his own burial; seems to see persons by him constantly growing larger and larger, etc.; also frequently talks with himself and with absent people. Tremor of the hands increases, and is associated with muscular twitches, nystagmus, and trembling of the whole body. At the commencement of the acute delirium, the voice and speech became changed. This delirium tremens of Morphine must not be confounded with the condition of excitement that occurs during the period of abstinence, especially after the exhibition of Chloralum ^{Chloral hydrate}; if the patient, during the first two to four days of abstinence, is given a dose of 3 or 4 grammes for sleeplessness, the individual is seized a few hours after the dose with a high degree of excitement; he has to rise in bed, leaves it and runs around the room weeping, laughing, singing crying, and knocking against doors and windows, throwing over the furniture, and at last becomes agressive to those about him; he becomes quiet only towards morning, and has a very transient sleep, from which he wakes without remembrance of the occurrences of the night, or he can recall them only with difficulty. The differential diagnosis between the delirium tremens of Morphine and other forms of delirium, is only difficult when the physician is ignorant of the cause, and when the patient is in the later stage of Morphine intoxication (when there is tremor, sleeplessness, some disturbances of speech, restlessness, anxiety, mental illusions), then it is almost identical with chronic alcoholism. Moreover, it is not easy to recognize when the person intoxicated by Morphine has been in the habit of partaking freely of alcoholic drinks, and has communicated only the latter fact to the physician. The acute delirium tremens of Morphine may be distinguished from the acute delirium tremens potatorum, by the following

lst. Delirium potatorum occurs spontaneously, or after tremors, or during the progress of acute diseases; the acute delirium of Morphine occurs only during the partial or total abstinence from Morphine.

2d. In the height of delirium potatorum the delirium mostly disappears, while in the delirium of Morphine it increases.

3d. Alcoholic drinks, which are frequently craved by the patient, mostly aggravate the paroxysm, never arrest or obliterate it. The Morphine patient longs for Morphine, and is for a time quieted by a large dose of it.

4th. Delirium potatorum continues for days or weeks, while the duration of the delirium tremens of Morphine rarely exceeds forty-eight hours.

5th. The delirium potatorum ends in a collapse, which is frequently fatal; in the delirium tremens of Morphine there is no collapse. The delirium of Morphine can scarcely be confounded with that of lead (delirium saturninum), since in the latter the lead line on the gum, extensor paralysis, and the alternating conditions of excitement and stupefaction are sufficiently distinctive.

EYE.

EAR.

SLEEP.

CONDITIONS.

(351 to 353, from Franklin Scott, Inaug. Diss., Philad., 1803, p. 18); 351, gave Mr. J. A., aet. twenty-three years, 40 drops of tincture; 352, I took 2 grains, rubbed down, with a little water; 353, Mrs. H. took 6 drachms of tincture; 354, Dr. Dufresne, Bib. Hom., vol. i, 1833, p. 227; 355, J. B. Biddle, M.D., South. Med. and Surg. Journ., July, 1851, p. 427, a woman took 2 fluid ounces of Laudanum; 356, A. Hadden, M.D., Amer. Med. Times, vol. i, 1860, p. 149, Mary McD., aet. twenty-eight years, took a dose of Laudanum; 357, H. J. Horton, M.D., Med. and Surg. Reporter, vol. xv, 1866, p. 225, Mr. E. H., aet. thirty years, took 3 ounces of Opium; 358, same, ibid., vol. xiv, p. 336, a child, two weeks old, took 6 drops of Laudanum; 359, Henry Gibbons, M.D., Pacific Med. and Surg. Journ., 1868, p. 163, Mrs. --- swallowed a gill of brandy, and immediately after 1/2 an ounce of Laudanum; 360, J. E. O'Brien, M.D., Chicago Med. Journ., vol, xxvi, 1869, p. 720, Emmy C., aet. two years, swallowed 13 pills of gum Opium, each containing about 1/4 grain; 361, F. W. Campbell, M.D., Canada Med. Journ., vol. vi, 1870, p. 62, A. B., aet. thirty-two years, took about 2 ounces of Laudanum; 362, J. B. Chaggon, M.D., ibid., p. 409, Mr. A. G. took same quantity; 363, S. W. Morrison, M.D., Philad. Med. Times, November, 1875, p. 106, a child, aet. four weeks, took an indefinite amount; 364, J. C. Morse, M.D., Pacific Med. and Surg. Journ., 1876, p. 56, a man swallowed between 40 and 70 grains of Opium; 365, omitted; 366, C. H. Morfit, M.D., Phil. Med. and Surg. Rep., 1877 (2), p. 466, poisoning from swallowing 1/2 ounce of Laudanum; 367, Wm. T. Plant, M.D., New York Med. Rec., vol. xii, 1877, p. 717, a man, while intoxicated, took 1 ounce of Laudanum, and died; 368, Dr. Janvrin, Amer. Journ. of Obstet., vol. xi, 1877, p. 780, a child aet. five weeks, took 10 drops of Squibb's liq. Opii. com.; 369, T. G. Nasmyth, M. B., Edinb. Med. Journ., December, 1878, p. 505, a woman swallowed about 12 drachms of Laudanum, and died in thirty-six hours; 370, F. A. Southain, Brit. Med. Journ., 1878 (1), p. 824, a man, aet. thirty-eight years, took a quantity of Laudanum; 371, North Carolina Med. Journ., 1879, p. 65, Bettie R., aet. thirty years, swallowed upwards of 1 1/2 fluid ounces of officinal tincture of Opium; 372, Dr. Miclucho Maclay, Chemist and Druggist (Nature, vol. xix, 1879, p. 492), observations of Dr. Clouth.

Preparation

Morphia, an alkaloid from opium, C17H19NO3

Including the various salts, to which reference is made in the list of authorities.

Preparation, Triturations, or solutions in alcohol.

Supplement

OPIUM.

AUTHORITIES.

EYE.

EAR.

RESPIRATORY ORGANS.

NECK.

EXTREMITIES.

SUPERIOR EXTREMITIES.

SLEEP.

FEVER.