A BRIEF SUMMARY 
OF 
HYPODERMIC MEDICATION. 
WITH COMPLIMENTS 
SHARP &°F DOHME, 
BALTIMORE. ■ 
BRIEF SUMMARY 
OF 
HYPODERMIC MEDICATION, 
COMPILED FOR THE CONVENIENCE 
OF THE 
MEDICAL PRACTITIONER, 
AND ISSUED BV 
SHARP & DOHME, 
BALTIMORE. 
1887. The recent introduction of soluble hypodermic tab- 
lets, enabling the physician to make an instant solution 
of a medicinal agent for injection, instead of the bulky 
solutions, which can be kept unchanged but for a few 
days, and the improvements in syringes (see plates and 
description on page 19), have obviated many of the ob- 
jections to hypodermic medication, and have rendered 
its practice more sure and easy. 
With the view of bringing these facts to the notice of 
the medical profession, and for their convenient refer- 
ence in emergencies, we have carefully compiled the 
following “ brief summary ” from the most recent and 
reliable sources. 
This summary is necessarily succinct, and should be 
regarded more in the light of a suggestion and reminder 
than as an elaborate treatise. We have not only men- 
tioned the remedies which can be furnished in tablet 
form, but also those liquids which have been used hypo- 
dermically. 
We hope it will be found convenient for the pockei 
and prove of substantial service to the busy practitioner, 
which will be sufficient apology for its publication. 
SHARP & DOHME. 
Baltimore, April, 1887. 
Copyrighted, 1887. A BRIEF SUMMARY OF HYPODERMIC MEDI- 
CATION, AND ITS ADVANTAGES. 
Hypodermic medication has been used now for about 
twenty-five years—a period sufficient to thoroughly test 
its value and uses, and to bring the performance of it to 
a high state of efficiency and accuracy. The following 
very brief and condensed account is offered in the hope 
that it will be found of use to the busy practitioner, and 
may prove suggestive in some emergency when time 
does not allow the consultation of some more elaborate 
treatise. To those who desire more fully to enter into 
this subject, the full and comprehensive work of Prof. 
Roberts Bartholow, 4th edit. 1882, will give informa- 
tion up to that date. 
The advantages of administering remedies by this 
method are : 1st. A more prompt and speedy effect is 
produced; indeed, the effects of active remedies thrown 
into the connective tissue under the skin are perceived 
almost instantaneously. 2d. The results are more per- 
manent and curative. In the case of neuralgia, for 
example, remedies are often given without effect, and 
for some time, when their hypodermic use has promptly 
wrought a cure. A very simple explanation of this is 
found in the fact that many remedies themselves undergo changes when brought in contact with the gastric juice, 
and even if not altered, their absorption is necessarily 
slow; consequently they do not make that forcible 
impression which is made when they are given hypo- 
dermically. 3d. Gastric disturbances are avoided. 
Kennedies do not interfere with a digestion often already 
enfeebled. 4th, and finally, remedies can be adminis- 
tered to persons unable or unwilling to swallow—as 
in the case of unconsciousness from narcotic poisons, 
persons with suicidal intent, or the mentally deranged. 
Various objections have been made to this method; 
but when these are examined they will be found to 
depend on imperfect instruments, badly prepared medi- 
cinal agents, or an improper introduction of the medicinal 
agent. 1st. The instrument should be kept clean and 
in good working order; the needle-points sharp and 
free from rust. 2d. The solution for injection should 
be freshly prepared, and of medicinal agents of un- 
doubted purity and strength. 3d. The injection must 
be made under the skin into the connective tissue. A 
failure to observe one or all of these conditions may 
involve the formation of abscesses, or even serious 
systemic effects. Dangerous results have followed 
the injection of some powerful remedy into a vein, but 
a little care on the part of the operator will avoid any 
such accident. 
The instrument itself has been made of various 
materials and modified in many ways since its first use. 
There is no one substance presenting all the qualities 
needed to form an ideally perfect hypodermic syringe; 
the one combining most of these qualities is glass, and its single disadvantage of fragility has been successfully 
overcome by enclosing the glass barrel in a bi-fenes- 
trated cylinder of metal. An instrument thus made 
has the advantage of not being acted upon by any 
agents likely to be used subcutaneously; of being 
transparent to allow of the inspection of its contents, 
and of being easily kept clean. The needles should be 
of finely tempered steel, with needle-point and sharp 
cutting edges, so as readily to pierce the integument 
without any bruising. Care should be taken that they 
are kept free from rust and that the entire syringe is 
regularly cleansed after use and before being placed in 
its case. This can be done by drawing in and forcing 
out several times a little clean water; unscrewing the 
needle and carefully wiping the point dry between the 
fingers; the small quantity of sebaceous matter from 
the skin being sufficient to prevent it from rusting. A 
fine wire should then be inserted to keep the tube of 
the needle open. Very great improvements have lately 
been added in furnishing what are called wings to the 
syringe, giving a firm hold and complete control of the 
instrument; and in making the lower cap movable, 
exposing the whole calibre of the barrel and allowing 
the introduction of a tablet, thus making a solution in 
the syringe. 
The operation of injection is a very simple one. The 
place chosen for its performance is usually the outer side 
of the arm, but any convenient place will answer. Some 
authorities prefer injecting at or near the seat of pain. 
Inflamed tissues and bony prominences should be 
avoided. The place being determined, a fold of loose skin is pinched up between the thumb and finger of the 
left hand. The syringe being charged, the needle is 
thrust in promptly, penetrating the skin. This will be 
recognized by the cessation of resistance, and the point 
of the needle will now move freety in the connective 
tissue. The needle should pass in an inch or more. 
The piston is now slowly pushed home ; the needle is 
then withdrawn and pressure with the point of a finger 
should be made for a few moments, to prevent the escape 
of the fluid. In cases of paralysis, some inject directly 
into a muscle. Prof. Bartholow, “Hypodermatic 
Medication,” p. 44, says: “In practising the hypo- 
dermatic injection, it is important to avoid puncturing 
a vein. Serious depression of the powers of life, faint- 
ing, and sudden and profound narcotism, have been 
produced by injecting a solution of morphia directly 
into a vein. Fatal collapse might be induced by in- 
jecting air into a large vein along with the solution.” 
This latter may be avoided by driving all the air out of 
the syringe, after charging it, by holding the syringe 
with the needle-point up and gently pushing the piston 
until a drop of fluid exudes. 
The active agent to be injected subcutaneously should 
be in perfect solution. The solution itself should be 
neutral (i. e. neither acid nor alkaline), clear and free 
from foreign matter, and not too concentrated. The 
difficulty of fulfilling these conditions has in the past 
very materially hindered the more general use of this 
method of treatment. But comparatively a very few 
years ago many of the alkaloids were to be had only as 
bases, and were more or less insoluble without the addition of some acid, and the slightest excess of the 
latter caused intense local irritation. When this had 
been overcome, after a clear, neutral solution had been 
made, it was found impossible to preserve it in this state 
for even a short time. It was found that even after a 
few days a solution of morphine which had been care- 
fully filtered and was perfectly clear had become cloudy. 
This was owing to the growth of a microscopic organism, 
the Penicilium; and experience proved that this not 
only grew at the expense of the alkaloid, thus weak- 
ening the strength of the solution, but that it proved 
also to be a local irritant when injected into the tissues, 
resulting frequently in abscess. From time to time 
various means were devised to obviate this difficulty, 
but none proved effectual until the soluble hypodermic 
tablets were made. These, when properly prepared, 
solve the problem most satisfactorily. They should be 
quickly and entirely soluble, perfectly neutral, and the 
excipient combined with the alkaloid should be bland 
and unirritating. Made in this manner they are a great 
boon to the profession, since they reduce the dose to a 
mathematical accuracy, which was formerly very often 
a matter of conjecture, when a solution had to be carried 
about. The alkaloid is effectually preserved in the 
tablet from deterioration, and the latter presents an 
accurate and definite dose, of which a solution can be 
made fresh, and almost instantaneously, when needed. 
Their portability and compactness are not the least 
among their good qualities. The practitioner can now 
go armed with a dozen hypodermic remedies, which will 
not deterioriate by keeping, and which do not occupy any more space than formerly the vial containing a 
solution of morphine alone did. 
Prof. Bartholow, p. 59, says : “A * hypodermic tab- 
let’ .... is conveniently carried, and, as regards 
liability to accident, is much superior to any permanent 
solution. Since I have adopted the method of extem- 
poraneous solutions, I have not had occur the hard 
nodules and the points of suppuration and sloughing 
which were not infrequent when permanent solutions 
were employed.” 
Remedies used hypodermically are much more 
active than when given by the mouth. 
The general rule is to give one-tliird less than given 
by the mouth to produce the same impression. As 
some persons exhibit peculiar susceptibilities to certain 
remedies, it would be well to inject a small dose tenta- 
tively where the idiosyncrasy of the patient is not 
known. 
Apomorphine used hypodermically is indispensable 
as an emetic in cases of narcotic poisoning. It acts 
freely when all emetics given by the mouth fail. It 
has also been used in capillary bronchitis to free the 
tubes of secretion, and in croup to dislodge the false 
membrane. 
Amyl nitrite is usually best given by inhalation, 
but where respiration is about ceasing, as in cases of 
angina pectoris, chloroform narcosis, surgical shock, 
cholera asphyxia, etc., etc., it may prove of immense 
utility when injected hypodermically. Arsenic has been successfully used in chorea, lym- 
phadenoma, enlarged spleen and in splenic leucocythemia. 
Excellent results have also been obtained in chronic 
skin diseases, as psoriasis and eczema. The best form 
is sodium arseniate, which is less likely to produce the 
toxic effects of arsenic than any other, and is less irritant 
locally. 
Atropine is principally used in combination with 
morphine, and as its physiological antagonist. It has 
been used to advantage by hypodermic injection in 
acute rheumatism near the painful joint, in epilepsy, 
and asthma with marked results. Seasicbiess and vomit- 
ing of pregnancy are relieved by it; the algid state of 
cholera; diseases of the bladder. Atropine is also 
the antagonist to pilocarpine, muscarine and eserine, 
and may be used to combat the toxic effects of these, 
as well as of morphine or opium. In treating a case of 
poisoning by atropine, it should be remembered that its 
effects on the economy last longer than those of mor- 
phine, so that, in giving the latter as an antidote, it 
may be necessary to repeat the dose of morphine. 
Caffeine has been used in neuralgia, hysterical head- 
ache and migraine. Dr. Anstie relieved by it the in- 
somnia attendant upon chronic alcoholism without 
delirium. It has also been used with success against 
opium narcosis. 
Carbolic acid used hypodermically as a 2 per cent, 
solution, has produced excellent results in erysipelas, 
and in other diseases supposed to depend on morbific ferments. It has also been used in pleuro-pneumonia, 
in synovitis, white swelling, adenoma, bubo, fibroma, etc. 
It has afforded great relief in acute rheumatism, in 
chronic rheumatism, myalgia, superficial neuralgia, etc. 
Chloral hydrate causes much local irritation and 
pain when injected under the skin—so much so that its 
use is restricted to cases in which the stomach cannot 
bear the remedy, or where the patient is unable or un- 
willing to swallow. It has proved useful in poisoning 
by strychnine, uncontrollable vomiting, obstinate hiccough, 
in violent cholera morbus, and in true cholera. In the 
latter Prof. Bartholow had the best results from its use. 
It has also proved beneficial in asthma and other 
neuroses of the chest, but care must be exercised lest a 
fatal result is produced by paralysis of a weak heart. 
Chloroform is not adapted for ordinary hypodermic 
use, but has been used with great success in many cases 
of obstinate neuralgia, sciatica, etc., by a deep injection, 
by Prof. Bartholow. For details, see his work on 
“ Hypodermatic Medication,” fourth edition, 1882, p. 
288, etc. 
Cocaine is principally used subcutaneously for pro- 
ducing local anaesthesia in minor surgical operations, 
etc. For this purpose it is injected into the areolar 
tissue as near to the seat of operation as possible. 
Also injected into the gum for drawing teeth. 
Recently Bignon found that animals poisoned by 
strychnine can be saved by the hypodermic injection of 
cocaine pushed to the point of delirium, and the effect maintained for some time. He found they could be 
saved by this means even after the occurrence of tetanic 
spasms. See Medical News, December 25th, 1886. 
Codeine may be used hypodermically as a substitute 
for morphine, but has no advantages except where a 
special hypnotic action is desired, as in mania, hypo- 
chondria, and delirium tremens. It has proved of great 
use in diabetes. 
Conine has been used in asthma, emphysema, angina 
pectoris, tetanus, and in acute mania. 
Curarine or Woorarine has been used in tetanus 
with some success. It has also been used in epilepsy 
and in hydrophobia with reported success. 
Duboisine may be substituted for atropine in all 
diseases where the latter is now used. Prof. Bartliolow 
is of opinion that it is to be preferred to atropine, and 
gives it as his experience that it is much more effective 
in psychical disorders. 
Ergotin hypodermically is available for hemorrhages 
in general; especially useful in haemoptysis, subinvolu- 
tion of the uterus, chronic metritis, intramural fibroids, 
polypi and hydatid mole of uterus, hypertrophied pros- 
tate, varicocele, aneurism, varicose veins, enlarged spleen, 
leukaemia, exophthalmic goitre, acute affections of the 
meninges of the brain and spinal cord, cerebrospinal 
meningitis, congestive form of migraine and headache, 
sunstroke, tic douloureux, hcmicrania, and sometimes in 
sciatica. Eseriue or Physostiginine lias been of great utility 
in tetanus, the proportion of recoveries to deaths being 
one-half. It should be given hypodermically and in 
quantities sufficient to keep the spasms in check, and 
sufficient nourishment must be given. It has also been 
used in hydrophobia, in bronchitis, pulmonary congestion 
and pneumonia. 
Ether may he employed subcutaneously with great 
advantage in cases of sudden depression of the powers 
of life, as in the bites of venomous snakes, surgical shock, 
Asiatic cholera, the passage of biliary or renal calculi; 
in the action of arterial sedatives, as aconite, veratrum 
viride, etc. Also in cardiac failure from hemorrhage. 
It has proved of great benefit in cases of severe 
adynamic pneumonia, and in variola. It should never 
be used in the chloroform narcosis. Whiskey or brandy 
may be used hypodermically in cases of sudden depres- 
sion of the powers of life, but not in the chloroform 
narcosis. They are more likely to be conveniently at 
hand in sudden emergencies than ether, but are more 
apt to be followed by local inflammation and abscess. 
Hydrocyanic acid maybe given subcutaneously with 
advantage in mental disorders, gastralgia, nausea and 
vomiting. 
Hyoscine is derived from the decomposition of Hos- 
cyamine and is said to possess the sedative and hyp- 
notic properties of Hyoscyamine in a much higher 
degree, and may be used in its stead. Hyoscyamine is of high value in mental disorders, 
paralysis agitans, chorea, mercurial trembling, senile 
trembling, spasmodic cough, laryngismus, hiccough. 
Mercury, in the form of corrosive chloride, by the 
hypodermic method is used in syphilis, and with the 
greatest advantage ; also in some forms of chronic skin 
diseases. Corrosive chloride of mercury generally causes 
some pain when used subcutaneously, but with a solution 
not too concentrated, with a clean syringe and sharp-cut- 
ting needle without rust, there is no danger of an abscess. 
Morphine alone or combined with Atropine has 
proved useful in diseases of the brain and nervous 
system, delirium tremens, cerebro-spinal meningitis, sun- 
stroke, hysteria, epilepsy, eclampsia, uraemic convulsions, 
chorea, tetanus, hydrophobia, muscular cramp and spasm, 
neuralgia. Also in asthma, emphysema, hiccough, acute 
inflammatory affections of the respiratory organs, angina 
pectoris, dyspepsia, schirrus, cholera, vomiting of preg- 
nancy, colic, peritonitis, affections of the bladder and 
urethra, after-pains in childbirth, the nocturnal pains in 
acute rheumatism and tertiary syphilis; in certain sur- 
gical diseases, especially fractures and dislocations, 
strangulated hernia; as an aid to chloroform narcosis, 
and in poisoning by belladonna or atropine, by gel- 
semium, and by veratrum viride. 
As Morphine is by far the most frequently used 
subcutaneously of the alkaloids, and its range of use- 
fulness is very large, it is well to bear in mind that 
a larger dose can be given combined with atropine, since the latter is a powerful excitant of the centre 
of respiration, which is depressed by large doses of 
morphine, and a fatal issue may result in consequence 
of paralysis of this centre. The desirable effects of 
morphine are increased by the addition of atropine, 
while the toxic effects are counteracted. 
Should toxic symptoms be induced by the use of 
morphine, they should be met with a subcutaneous 
injection of atropine. The head of the patient should 
be low, all restrictions to free respiration removed, 
ammonia placed to the nostrils. Subsequently caffeine 
may be given hypodermically. Artificial respiration 
and the faradic current to the muscles of the chest may 
be used. The injection of ammonia into the veins, and 
the inhalation of amyl nitrite or its injection subcuta- 
neously, have proved of benefit. 
Nicotine has been successful in tetanus. About one 
half the traumatic cases treated with it recover. The 
officinal wine of tobacco may be substituted for the 
alkaloid. 
Pilocarpine has been advantageously used in mumps 
and acute affections of the parotid, submaxillary and 
sublingual glands, acute tonsilitis. Has afforded relief 
in the metastasis of mumps, obstinate hiccough, hoarse- 
ness, bronchitis, bronchorrhcea, asthma, emphysema, car- 
diac dropsy, dropsy of acute albuminuria, eclampsia, 
effusion into cavities. To cut short an ague chill. 
It may be administered either as nitrate or muriate. Quinine has been used subcutaneously with great 
advantage in pernicious fever, in malarial fevers at- 
tended with gastric irritation, in chronic malarial poi- 
soning, to abort recent malarial fevers; combined with 
a small dose of morphine it has proved very useful 
in typhoid fever. It lias also been used very suc- 
cessfully in India in the treatment of sunstroke. 
Finally, some cases of neuralgia have been cured by its 
means. The form best adapted to hypodermic use is 
the quinina bi-muriatica carbamidata, which produces 
no local irritation. 
Strychnine injected under the skin has proved 
highly beneficial in the treatment of paralysis, especially 
in hemiplegia, paraplegia, infantile paralysis, local 
paralysis, progressive muscular atrophy, progressive loco- 
motor ataxia, facial paralysis, gastralgia, cardiac neu- 
ralgia, amaurosis, amblyopia. In the misty vision 
produced by the abusive use of tobacco, strychnine has 
been found to be of the greatest advantage in restoring 
strength to the optic nerve. 
Dr. Echeverria remarks: “ The effects of strychnia 
are widely different when administered hypodermically 
or by the mouth. A smaller dose exhibited hypo- 
dermically may be capable of regenerating at once the 
lost muscular power.” SHARP & DOHME’S 
SOLUBLE 
HYPODERMIC TABLETS. 
Perfectly and quickly soluble. 
Always ready for Instant use. 
Never cause local irritation. 
These tablets are confidently offered to the medical pro- 
fession as combining every possible merit. 
They can be perfectly and quickly dissolved when dropped 
into a little water in the barrel of our Improved Hypodermic 
Syringe (see page 19) and shaken. 
They are accurate in dose, and retain their activity and 
strength for any length of time. 
They may also be given by the mouth. 
SOLUBLE HYPODERMIC TABLETS. 
Per 
Bottle 
IOO 
Tab’s 
Per 
Bottle 
20 
Tab’s 
APOMORPHINE MURIATE 
$ 80 
20 
“ “ 
I-li g-r 
1 00 
25 
“ 4k 
1-8 gr 
1 20 
35 
ATROPINE SULPHATE 
40 
15 
“ 
40 
15 
fcfc “ 
55 
17 
CAFFEINE SO DIO-BENZOATE .... 
1-2 gr 
90 
25 
“ “ 
1 10 
30 
COCAINE IIY D ROCII LOR ATI] 
1-25 gr 
70 
20 
" “ 
1-10 gr 
90 
25 
“ “ 
1-8 gr 
90 
25 
tfc fck 
1-1 gr 
1 50 
35 
*k kk 
1-2 gr 
2 40 
60 SOLUBLE HYPODERMIC TABLETS. 
Per 
Bottle 
IOO 
Tab’s 
Per 
Bottle 
20 
Tab’s 
CODEINE SULPHATE 
...1-8 gr 
$ 70 
20 
“ kk 
1 00 
35 
CONINE HYDHOBHOMATE 
70 
20 
DUBOISINE SULPHATE 
.1-100 gr 
70 
20 
U k* 
1 00 
25 
EKGOTIN. 
70 
20 
ESEKINE SULPHATE 
. 1-100 gr 
1 00 
25 
44 44 
1 10 
30 
HYOSCYAMINE SULPHATE 
. 1-100 gr 
1 20 
35 
HYOSCINE HYDROBROMATE 
.1-100 gr 
2 00 
50 
MERCURY CORROSIVE CHLORIDE.... 
40 
15 
44 “ 4< 
40 
15 
MORPHINE SULPHATE 
50 
15 
kk kk 
55 
17 
44 4‘ 
60 
18 
“ kk 
.. 1-3 gr 
00 
25 
44 4k 
...l-2gr 
1 10 
30 
MORPHINE AND ATROPINE No. I. 
j Morphine.. 1-8 gr 1 
16 
| Atropine.. .1-200 gr j ' 
MORPHINE AND ATROPINE No. II. 
j Morphine....1-6 gr (_ 
I Atropine.. .1-180 gr j 
MORPHINE AND ATROPINE No. III. 
j Morphine... 1-4 gr} 
(Atropine .1-150 gr j 
MORPHINE AND ATROPINE No. IV. 
J Morphine....i-4gr ( 
1 Atropine - - .1-100 gr f 
PILOCARPINE MURIATE 
. 1-20 gr 
90 
25 
kk kk 
1 20 
35 
“ 
• • ■ 1-3 gr 
3 00 
65 
PILOCARPINE NITRATE 
90 
25 
44 “ 
... 1-8 gr 
1 20 
35 
44 44 
3 00 
65 
QUININE BIMURIATE CARBAM 
1 gr 
1 10 
25 
*k kk ‘k 
2 10 
45 
44 44 44 
3 10 
65 
SODIUM ARSENI ATE 
. .1-30 gr 
40 
15 
STRYCHNINE SULPHATE 
40 
15 
“ “ . . 
.1-120 gr 
40 
15 
44 44 
. 1-100 gr 
40 
15 
40 
15 
Tablets Can be Sent by Mail if Desired. LATEST IMPROVED 
HYPODERMIC SYRINGE, 
MANUFACTURED EXPRESSLY FOR 
SHARP & DOHME. 
This syringe is represented by Fig. 3. The very impor- 
tant improvements consist of the movable cap a, which opens 
the entire calibre of the barrel and allows the easy introduc- 
tion of our soluble tablets, and a solution for immediate use 
is readily made by adding 10 m. water. Then the solid and 
securely fastened wing-plate affords a firm hold and perfect 
command of the syringe. 
They are packed either in an oblong leather-covered case 
(Fig. 1) 3 inches long, If inches wide, containing, besides 
the syringe, two bottles of our soluble tablets ; or in a flat 
nickel-plated metal case (Fig. 2) 3f inches long by If 
inches wide, containing one bottle of tablets besides the 
syringe. They are all of the best materials and most 
accurately made. 
A SYRINGE 
packed in either style of case as described above will 
be sent by mail on receipt of 
$2.50. Fig. 3. 
Fig. 1. 
Fig. 2.