THE 
HYPODERMIC INJECTION 
OF 
MORPHIA. 
ITS 
HISTORY, ADVANTAGES AND DANGERS. 
(Based on thi Experience of 360 Physicians.) 
By H. H. KANE, M. D., 
NEW YORK. 
NEW YORK: 
CHAS. L. BERMINGHAM & CO., 
Medical Publishers, Entered according to Act of Congress, in the year 1880, 
By Dr. H. H. Kane, 
In the office of the Librarian of Congress, at Washington, D. C. 
Electrotyped and Printed 
by the 
NATIONAL PRINTING CO., 
16, 18, 20 AND 22 CHAMBERS STREET, 
NEW YORK. To 
Drs. WILLARD PARKER, 
anV> 
DANIEL M. STIMSON, 
This book is respectfully dedicated, in attestation of their high 
professional attainments, and their great 
kindness to their former pupil. 
The Author. PREFACE. 
A PHYSICIAN of the present day without a hypo- 
dermic syringe in his pocket or close at hand, would 
be looked upon as would have been a physician fifty 
years ago, did he not own and use a lancet. 
There is no proceeding in medicine that has be- 
come so rapidly popular; no method of allaying pain 
so prompt in its action and permanent in its effect; 
no plan of medication that has been so carelessly 
used and thoroughly abused ; and no therapeutic dis- 
covery that has been so great a blessing and so great 
a curse to mankind as the hypodermic injection of 
morphia. 
Much has been written upon the advantages of 
administering the drug in this way—advantages that 
have been proved beyond question—and almost 
nothing upon the dangers, immediate and remote, 
thereon attendant. My attention was first called to 
the latter by the able and interesting article of Dr. 
E. Fletcher Ingals in the Chicago Medical Journal 
and Examiner for May, 1878. This article and the 
knowledge soon afterwards obtained, that many 6 
PREFACE. 
honest, practical and well-educated physicians in 
various parts of the country had entirely abandoned 
the use of the instrument, led me to a careful study 
of the subject, the results of which are here given. 
By personal inquiry, letters, and chiefly by means 
of six questions,* published, through the great kind- 
ness of the editors, in every prominent medical 
journal of Great Britain, France, Germany, and 
America, I have been enabled to gather much valu- 
able and interesting material hitherto unpublished. 
The inquiry thus started has gradually developed 
beyond my expectation, and I find that instead of 
sufficient material to make two or three interesting 
journal articles, as was my original intention, I 
*Dr. H. H. Kane, of New York City, who has for some time past 
been collecting statistics on the hypodermic injection of morphia, 
would consider it a great favor if members of the profession who see 
this and have had experience with the instrument will answer the fol- 
lowing questions : 
1. What is your usual dose ? 
2. Do you use it alone or with atropia ? 
3. What is the largest amount you have ever administered ? 
4. Have you had i inflammation or abscess at the point of- punc- 
ture ? 
5. Have you had any deaths or accidents caused by this instru- 
ment ? 
6. Do you know of any cases of opium habit thus contracted ? 
Where there has been an autopsy (5) please state the fact and the 
results obtained therefrom. All communications will be considered 
strictly confidential, the writer’s name being used only when he gives 
full consent thereto. PREFACE. 
7 
have enough to fill a small book. Indeed, between 
the letters, the results of personal inquiry, and the 
journal and other literature of the subject, I have 
found it difficult to maintain that just medium be- 
tween undue meagreness and needless excess of de- 
tail. I have endeavored, however, to be as brief as 
was compatible with the vitality of the subject. 
The question has been raised as to whether the 
term hypodermic is correct. To settle the matter as 
definitely as possible, I wrote Prof. Lewis R. Packard, 
of Yale College, whose clear and interesting reply I 
give in his own words: 
“Yale College, New Haven, Conn., Jan. 8, 1880. 
“H. H. Kane, M. D. 
“ Dear Sir : Your letter of 26th Dec. has been handed to me on 
my return home. I should say in answer that, according to the 
analogy of other formations in Greek and the actual usage in deriva- 
tive words of this form, hypodermatic was the correct form. The sylla- 
ble mat is a formative element making the word derma, in which the 
final t is regularly dropped, from the root der. 
“ I think there is no analogy by which one could justify, in such a 
case, the dropping of the two letters a and t and retaining of m, un- 
less, possibly, there is one in the Greek word from which patronymic is 
taken. But in the majority of the English words, e. g., dogmatic, 
rheumatic, &c., we see the ordinary Greek usage, and I know of no 
case in Greek to justify hypodermic. 
“ Yours truly, 
“ Lewis R. Packard.” 
As I was not definitely informed of the incorrect- 
ness of the term hypodermic until the first half of the 
work was electrotyped, I have not changed it, and 8 
PREFACE. 
continue its use throughout the work. The neces- 
sary change will be made in the succeeding edition or 
editions. The fact that the term “ hypodermic ” is now 
so firmly established in ordinary usage, is urged by 
Bartholow as a reason for continuing its use. I do 
not at all agree with him. The change can be readily 
made by any intelligent physician without confusion 
or misunderstanding. 
I have to return my hearty thanks to those gentle- 
men of the medical press, both at home and abroad, 
who so courteously published my questions, thus al- 
lowing me to reach members of the profession every- 
where in an effective manner. To their indulgence 
and kind cooperation is due much that is here pre- 
sented. 
I am also deeply indebted to the members of the 
profession who so promptly and fully answered my 
questions; especially to those gentlemen who un- 
reservedly gave me the details of fatal cases. 
I am, furthermore, under obligations to Prof. T. 
Gaillard Thomas for valuable advice and information, 
and to Drs. Willard Parker, Sr., and Willard Parker, 
Jr., for the loan of books and journals. Also to Dr. 
Campbell for assistance at the Library of the Aca- 
demy of Medicine. 
366 Bleecker St., Jan. 26th, 1880. This is to certify that I have compared the letters in Dr. Kane’s 
possession with the proof-sheets of the chapter on “ Deaths,” and 
find the cases there given fully in accordance with the subject matter 
in the letters. T. Gaillard Thomas, 
Jan. 26, 1880. 
294 Fifth Avenue. 
TO THE PROFESSION. 
In order that clearer light may be shed upon 
some important and still unsettled questions, and 
for the purpose of adding to the completeness of 
this work in subsequent editions, the author re- 
quests members of the profession everywhere to 
answer the following questions at once: 
1. In how many cases of delirium-tremens, in what 
doses and with what result have you used mor- 
phia hypodermically ? 
2. Have you used the drug in this manner in acute 
inflammatory affections of the respiratory organs, 
and with what result ? 
3. Have you used it in acute or chronic renal 
disease, and with what result ? 10 
QUESTIONS. 
4- Do you know of any deaths due to the sub- 
cutaneous injection of morphia ? If an autopsy 
was held, please state the result. 
5. Have you had any serious cases of narcotism 
from the use of morphia in this manner ? If so, 
please state the condition of the pupils, number 
of the respirations and pulsations, the amount of 
morphia used, whether there was any known 
organic disease, and whether there was any opium 
idiosyncrasy. 
6. Have you had any cases where the drug was 
thrown directly into the blood ? What were the 
symptoms and what the treatment ? 
7. In what diseases have you used this method of 
administering morphia, and with what results ? 
All communications will be considered strictly 
confidential, the reporter’s name not being used 
when a request to that effect is made. 
Editors of medical* journals, to whom the author 
is already so deeply indebted, are especially requested 
to give insertion to the above questions. CONTENTS. 
DEDICATION, ... 3 
PREFACE, - 5 
TO THE PROFESSION, 9 
CHAPTER I. 
History of the Discovery—The Instrument—Advan- 
tages of the Method—The Doctrine of Locali- 
zation, - 13 
CHAPTER II. 
Inflammation and Abscess—Solutions Used—Method 
of Injecting—Erysipelas—Cysts—Transmission of 
Syphilis and Carcinoma—Conclusions, - - 34 
CHAPTER III. 
The Commencing and the Usual Dose—Idiosyncrasy— 
Narcotism—Elimination of Morphia by the Kid- 
neys—Experiments, ..... 62 
CHAPTER IV. 
Injection into a Vein—Alarming Syncope—Death— 
Rapid Absorption—Tourniquet, - - - 102 12 
CONTENTS. 
CHAPTER V. 
Deaths from Subcutaneous Injection of Morphia, - 142 
CHAPTER VI. 
Treatment of Opium Narcosis—Atropia—Strychnia— 
Ammonia—Coffee—Electricity—Artificial Re s- 
piration—Oxygen—Cold Douche — Flagellation— 
Walking, - - - - - - 192 
CHAPTER VII. 
Convulsive and Tetanizing Action of Morphia on 
Man—Idiopathic Tetanus—Cases of Traumatic Te- 
tanus from Rusty and Unclean Needles, - 227 
CHAPTER VIII. 
Morphia and Atropia—Advantages over Morphia alone 
—When and in What Quantity to Use, - - 24 
CHAPTER IX. 
The Morphia Habit—Its Dangers—Peculiarities and 
Treatment, ------ 267 
CHAPTER X. 
The Subcutaneous Injection of Morphia—Conclusions, 306 
NAMES OF PHYSICIANS, - - - - 328 
INDEX, - 338 CHAPTER I. 
HISTORY OF THE DISCOVERY—THE INSTRUMENT— 
ADVANTAGES OF THE METHOD—THE DOCTRINE 
OF LOCALIZATION. 
The credit of being the discoverer of the subcu- 
taneous method of administering drugs has always 
been awarded to Dr. Alexander Wood, of Edin- 
burgh, who commenced the practice in 1843, 
wrote upon it in 1855.1 Dr. Wood’s priority in 
this matter has been disputed by Rynd, of Dublin, 
and Kurzak, of Vienna. From a study of the facts 
in the case, it seems probable that two at least of 
these gentlemen, Rynd and Wood, made the dis- 
covery at about the same time, and that to neither 
is due the exclusive credit. Drs. Isaac E. Taylor and 
Washington claim2 to have used practically the same 
method in dispensary practice in this city, in 1839. 
They made an incision into the skin and then 
injected the drug into the subcutaneous cellular tis- 
sue with an Anel’s syringe, the nozzle of which was 
1 Edinburgh Medical and Surgical Journal, 1855. 
2 N. Y. Medical Gazette, 1870. 4 
HYPODERMIC INJECTION OF MORPHIA. 
♦ • 
thrust into the cut. These gentlemen do not seem 
ANEI.’S SYRINGE. 
to have fully appreciated the great advantages of 
this method, and Dr. Taylor was somewhat late in 
claiming the honors due to such a discovery. The 
claim made by Dr. Taylor is unquestionably a sound 
and just one, it being supported by the testimony of 
Prof. Lewis A. Sayre and others, who saw these 
gentlemen carrying out the practice daily. Drs. 
Taylor and Washington do not claim to be the first 
to use morphine in this way, their attention having 
been called to it by seeing an extract from some 
provincial French journal recommending it. The 
name and date of the journal has now escaped Dr. 
Taylor’s memory, and Dr. Washington is dead. 
It is interesting to study the successive steps HISTORY OF THE DISCOVERY. 
i5 
through which this matter passed before its truth 
and importance were fully recognized by the profes- 
sion ; and as we look back upon it now, we wonder 
that it was so long delayed, that it halted so long 
upon the threshold. 
As early as 1809, in a little work entitled “Facts 
Establishing the Efficacy of the Opium Friction in 
Spasmodic and Febrile Disease,” its author, Michael 
Ward, Surgeon to the Manchester (Eng.) Infirmary, 
&c., &c., called the attention of the profession to the 
fact that opium by the skin had quite a different 
action from opium by the mouth ; that it produced a 
directly curative effect when thus exhibited, where 
opium by the mouth was of no apparent service. 
He claimed, in fact, the difference in action and the 
advantages that are now conceded to the hypodermic 
method by every educated physician. For instance, at 
pages 16 and 17 he says:1 “ First. That opium, when 
diligently applied externally, so as to be absorbed by 
the lymphatics, has powerful effects in allaying irrita- 
tion, removing spasm and producing sleep. Secondly. 
That it is capable of producing these happy effects 
where the exhibition of it internally had not the same 
salutary operation. Thirdly. This mode of introducing 
it into the system may be resorted to with advantage, 
when it cannot be given internally or when it will 
T. Clifford Allbutt, Practitioner, 1861. 16 
HYPODERMIC INJECTION OF MORPHIA. 
not stay on the stomach. Viewing the subject in 
this light, a wide field seems to lie open for investi- 
gation, which, if cultivated, may possibly lead to 
important improvements in the practice of medicine.” 
Again, he says: “ It may be urged that the modus 
operandi must be the same, whether opium be given 
internally, or applied externally by absorption ; and, 
therefore, as it has not been efficacious when taken 
by the mouth, we cannot expect it to be so when 
applied externally. But experience, the only true 
test by which to try every hypothesis, seems at 
variance with this; at least, the facts contained in 
the cases above recited, militate, as far as their 
authority extends, against the idea of the modus 
operandi being the same; the effects produced be- 
ing so different.” 
I do not wish it understood that I think Michael 
Ward can in any way dispute for the honors of discov- 
ering the subcutaneous method with Taylor, Wash- 
ington, Wood or Rynd, but that, by a much less ex- 
act method, he demonstrated clearly to his own mind 
the important fact that opium possessed higher, more 
rapid, and more certain curative powers when ab- 
sorbed by the skin, and possibly when applied directly 
to the diseased part. He was upon the very edge of 
the discovery ; he stopped short of the more practical 
application of his knowledge. He rubbed the drug HISTORY OF THE DISCOVERY. 
17 
into the skin, Wood incised the skin and then injected 
the drug; as also did Washington and Taylor. I 
only wish to show that his was the first step in the 
right direction, and an important one. In 1837, 
twenty-seven years later, Dr. Washington was in the 
habit of scarifying the skin of the lumbar region and 
rubbing in a solution of morphine in cases of painful 
labor. 
In 1838, one year later, Dr. Richard Rolland1 
(Treatise on Neuralgia) relates the cure of a case 
of neuralgia by inserting re gr. of morphia, in the 
form of a paste, into four punctures made over the 
deltoid of the affected arm. This was one step near- 
er the discovery. One year later (1839) Taylor and 
Washington incised the skin and inserted the drug 
with an Anel’s syringe. In 1843, Wood and Rynd 
almost simultaneously commenced the practice of 
this method, using a syringe made for that special 
purpose. At first, Wood employed the little syringe 
then in use for injecting naevi with a solution of iron, 
the idea of injecting morphine having been suggested 
in this way. Dr. Wood’s syringe-needle was not 
pointed, and had no lateral opening, it being neces- 
sary to incise the skin before introducing it. To Mr. 
Chas. Hunter, of London, is due, however, the high- 
est praise of all. He at once recognized the great 
1 Wilson, “ St. George’s Hospital Reports,” 1869. 18 
HYPODERMIC INJECTION OF MORPHIA. 
importance of the discovery, improved the instru- 
ment, studied the therapeutic part of the subject with 
care and diligence, on both man and animal, and by 
dint of speaking at society meetings, and reading 
and publishing various papers1 upon this subject, 
awakened the interest of the profession at home 
and abroad* in the matter, and placed the practice 
upon an established basis. Hunter’s syringe was a 
decided improvement upon that of Wood. The lat- 
ter was clumsy, inaccurate and without a needle point. 
Hunter added the needle point, lateral opening, and 
made many other small but important improvements. 
It is to be regretted that there should have been any 
hard feelings in this matter between these two dis- 
tinguished gentlemen. Mr. Hunter seems to have 
endeavored to take away some of the credit attach- 
ing to Mr. Wood, by claiming that Wood’s plan was 
only intended for the treatment of disease by locali- 
zation,while his thought and experiment had develop- 
ed the fact that localization was rarely necessary, and 
that other and more important diseases than those 
spoken of by Wood could be successfully treated 
by this instrument. Hunter’s energy and zeal was 
certainly something wonderful. From England the 
practice spread into France and Germany, receiving 
1 Medical Times and Gazette, 1858 and 1859, and June 3, 1865; 
“On Speedy Relief of Pain,” &c., London, 1865, &c., &c., &c. THE INSTRUMENT. 
19 
favorable attention at the hands of Montpellier and 
Behier, of Paris; Scanzoni, of Wurtzburg; Oppolzer, 
of Vienna; Graefe, of Berlin; and Plulenberg, Erlen- 
meyer and Lorent.1 
The first to use the hypodermic syringe proper in 
this country was Dr. Fordyce Barker, of this city, 
who received one from Prof. Simpson, while he was 
visiting in Edinburgh,2 and used it here in May, 1856, 
on his return. Ruppanier did much both by journal 
articles3 and by the publication of a little work upon 
the subject,4 to popularize and extend the practice 
in this country. He used, chiefly, liq. opii seditavus 
(Squibb), 100 drops of which equaled 1 grain of 
morphia. Alexander Wood employed Battley’s so- 
lution, a preparation double the strength of the tinc- 
ture opii. To what extent the use of the syringe has 
become popular in this country we all know; that it 
is equally popular abroad is quite as certain. 
The syringes at present in use in this country are 
all fnodifications of the instrument which Dr. Barker 
brought with him; Messrs. Geo. Tiemann & Co. 
having made the first from this model for Prof. Elliot, 
of this city, he preferring rubber to glass. Various 
1 Bartholow, “Hypodermic Method,” Phila., 1879, pp. 16 and 19. 
2 TV Y. Med. Gazette, April 9, 1870. 
3 Boston Medical and Surgical Journal, April, 5th, 12th and 19th, 
and May 3, i860. 
4 “ Hypodermic Injection,” Boston, 1865. 20 
HYPODERMIC INJECTION OE MORPHIA. 
kinds are made, some very excellent, some very 
poor. They are of silver, composition, hard rubber, 
and glass, or combinations of these. The glass 
cylinder and metal cased instrument, when properly 
made, is probably the best, as it is strong, the fluid 
in the cylinder can be seen, bubbles of air detected, 
and any dirt or crystallized morphia can be seen and 
be readily removed. Furthermore, the purely metal 
instruments are often dented accidentally, thus ren- 
dering the cylinder uneven and interfering with the 
proper working of the piston. In an instrument 
where the glass barrel is well made, the latter is al- 
ways of exactly the same calibre throughout, and if 
properly protected by metal, will not be broken by 
a blow that would dent the metallic instrument. The 
instrument may be graduated on the glass or on the 
piston rod. I prefer the latter. Messrs. Codman & 
Shurtlefif, of Boston, are making a most excellent 
instrument, all metal, so tempered and jointed as to THE INSTRUMENT. 
21 
be perfectly accurate, air-tight, of even calibre, easily 
cleansed, and strong enough to withstand any ordi- 
nary blow without injury. The cuts here given are 
of the instruments made by this firm. 
The leather packing should be of good material 
and be kept moist with a little carbolized oil. Drawing 
water into the syringe and retaining it by means of 
a metal cap screwed over the needle-end, is apt to 
rot the packing and defeat the very end which it is 
intended to accomplish. Some syringes have the 
packing protected on each surface by a thin metal 
plate, which preserves the leather, keeps it well com- 
pressed, and allows of full expulsion of the last drop 
of fluid in the syringe. 
The needles may be of plain steel, be gold-plated, 
or of pure gold. The steel needles, when well 22 
HYPODERMIC INJECTION OF MORPHIA. 
made and properly cared for are, I think, the best. 
Through each needle a fine wire should be pushed 
and left in situ after each time of using. 
Hard rubber syringes are usually poor and inaccu- 
rate. Most glass instruments are, as a rule, readily 
broken. An excellent instrument of this kind is 
made by Gemrig, of Philadelphia. 
M. Damaschino presented to the Societe Medicale 
des Hopitaux de Paris,1 in the name of M. Gabriel 
Bay, medical student, the description of a new hypo- 
dermic syringe, which, it is claimed, will hold enough 
fluid for a number of injections, and thoroughly 
preserve it from contact with the air, and free from 
vegetable growths, decomposition, &c. It is provid- 
ed with valves for determining the direction of the 
fluid, and it is quite a complicated piece of mecha- 
nism. If the solutions or the plain powder, as re- 
commended in chapter II., are used, and reasonable 
care in keeping the instrument and needles clean is 
exercised, there will be no need of using such an ap- 
paratus, it having the disadvantage of getting out of 
order easily, and being hard to keep clean, in time 
defeating the very end which it claims to accomplish. 
1 Gazette des Hopitaux, Oct. 28, 1879. ADVANTAGES OF THE METHOD. 
23 
After each time of using, the syringe, needle still 
on, should" be washed out thoroughly by drawing 
into it and discharging from it several syringefuls of 
clean water. The needle should be removed and 
dried, the wire inserted, and the metal cap screw- 
ed on at the needle-end, thus preventing the entrance 
of dust or dirt. 
THERAPEUTIC APPLICATI ON. 
It seems hardly necessary to say anything in favor 
of the view of a peculiar action of morphia when 
given in this way. Its advantages over morphine 
given by the stomach, as admitted by all writers on 
the subject are these :— 
1st Economy of the drug; less being necessary. 
2d. Greater rapidity of absorption, and conse- 
quently greater rapidity of action, and greater per- 
manence of effect. 
3d. Possibility of giving, when the stomach cannot 
retain the drug, or when swallowing is impossible. 
4th. Less tendency to constipate and none to dis- 
order digestion. 
5th. Greater local action. 
6th. Peculiar curative action in certain diseases 
where morphia by the mouth is of no avail. Anstie, 
speaking of its advantages, says : 1 “ The advantages 
1 Anstie, Practitioner, July, 1868, vol. I., p. 33. •24 
HYPODERMIC INJECTION OF MORPHIA. 
of the hypodermic over the gastric administra- 
tion are these: i. Economy of the drug. 2. En- 
tire abolition of the depressing or irritant effects 
which are locally produced in the alimentary canal 
during the digestion of various remedies. 3. Far 
greater permanence of effect in many cases than can 
be produced by medicine swallowed. 4. Much great- 
er rapidity of action—a quality which makes injected 
remedies of priceless value in certain emergencies. 
One most important conclusion from these facts is 
this: that anodynes or hypnotics ought never to be ad- 
ministered by the mouth in acute diseases attended 
with anorexia. The practical importance of this 
principle is immense. Regular and systematic nu- 
trition is the great necessity and the great difficulty 
in these diseases, and the avoidance of any treatment 
tending to interfere with digestion of simple food is 
a cardinal necessity.” 
There is, undoubtedly, a very decided difference in 
action between equal amounts of a drug acting over 
a long and over a short period of time ; in the one 
it is the gradual charging of the system with the 
drug; in the other the very rapid absorption and the 
sudden intense, almost shock-like action of the medi- 
cament. Herein lies the great danger attending the 
use of morphia in this way, in the case of patients 
who have an opium idiosyncrasy. Does any one LOCALIZA TION. 
25 
question the difference in effect of exposing a per- 
son suddenly to a heat of 210° F. in a close room, 
and of conducting him slowly through a series of 
rooms until finally one, the atmosphere of which is 
raised to 2io° is reached ? In the first instance the 
effects will be distressing, if not fatal; in the second 
agreeable and salutory. This point will be dwelt 
upon a little more fully when we come to consider 
those cases of death due to the hypodermic injection 
of morphine. 
Great diversity of opinion still exists amongst 
medical men as to whether an injection of morphine 
is as effective when made at a distance from the seat 
of pain, as when made directly over it. The latter 
was the belief of Dr. Alexander Wood, and is shared 
by Eulenberg,1 Benier,2 Mitchell, Keene and More- 
house 3 in certain cases, and by many others. 
Mitchell, Keene and Morehouse, after conducting 
a number of experiments on patients suffering from 
neuralgia, sum up their views as follows: 
“ As the opinion of many good observers is quite 
decided as to the fact that the injection gives the 
same relief, whether made near to or remote from the 
seat of pain, we may with reason be asked why we 
1 “ Die Hypodermatische Injection der Arzneimittel, ” Berlin, 1865. 
2 Practitioner, 1868, p. 35. 
3 Am. Journal Med. Sci., July, 1865. 26 
HYPODERMIC INJECTION OF MORPHIA. 
used so many injections in the same limb or neighbor- 
hood. The answer lies in the fact that our patients very 
early, and we ourselves later and more reluctantly, 
reached the conclusion that the point at which the in- 
jection was to be employed was not a matter of in- 
difference. In the milder instances of neuralgia a 
subdermal injection of morphia used anywhere in 
the body did give relief, but in cases of ‘burning 
neuralgia,’ such as we have described in our book on 
nerve wounds, p. 100, et. seq., the nearer we could 
bring the agent to the place where the pain was felt 
the greater was the ease obtained. We are the more 
anxious to insist upon this matter, because we neg- 
lected to make the same comment when detailing our 
mode of treating these lesions in the volume above 
mentioned. The belief thus reached is not altogether 
unphysiological, as we very well know that morphia 
is capable of causing a local paralysis of sensory 
nerves with which it may come in contact.” 
Of the non-believers in the efficacy of “localization,” 
Mr Charles Hunter1 is the most prominent. His 
objections to continued localization are that, First, 
As good an effect can be obtained by distant sub- 
cutaneous injections ; Second, The certainty to pro- 
duce abscess and inflammation both of the skin, cel- 
1 Med. Times and Gazette, 1858-9. LOCALIZA TION. 
27 
iular tissue and nerve-sheaths, if injection into one 
spot is made often; and Third, That if localization was 
necessary in all cases, a large class of neuralgia could 
not be thus treated. Bartholow1 is of the same 
opinion reserving as exceptions “ cases of scia- 
tica and zoster, and in all cases of long standing in 
which the trunk of the nerve has become altered. 
When neuralgic pain is purely local, produced by 
alterations of nerve trunks, as for example, many cases 
of sciatica, the injection of various irritants into the 
vicinity of the diseased nerve will often be followed by 
notable diminution of the pain and sometimes by cure. 
This important fact has been demonstrated by Luton,2 
Bertin3and Ruppaner.4 It is probably in this way 
that local injections sometimes succeed when remote 
injections fail.” Anstie5 believes that local injections 
are no more efficacious than distant ones, except 
in rheumatic troubles and chronic neuralgias where 
there is much inflammatory thickening and adhe- 
sion. 
Chouppe,6 from one thousand experiments on him- 
self, found morphia injected locally to produce anaes- 
1 “The Hypodermic Method,” Phila., 1879, p. 74. 
2 Archives Gen. 3 Ibid. 
4 “ Hypodermic Injections,” 2nd Edition. 
5 Practitioner, July, 1868, p. 36. 
6 Gaz. Med. de Paris, No. 35, 1874. British Aled. youmal, April 
10, 1875. 28 
HYPODERMIC INJECTION OF MORPHIA. 
thetic effects from two to three minutes sooner than 
when injected at a distance from the seat of pain. 
Eulenberg 1 declares in favor of “ localization ” on 
the ground that there is decided decrease of tactile 
sensibility, etc., at the point of injection. 
Aside from its-practical bearings in surgery, the fol- 
lowing by Dr. Geo. A. Foote,3 in his valedictory ad- 
dress as retiring President of the North Carolina Med- 
ical Society, is of interest in this connection: “ In con- 
sulting with my esteemed friend, Dr. T. P. Jerman, I 
aided in the excision of a fibrous tumor weighing about 
one pound. The patient was a colored woman aged 
fifty years. The tumor was situated near the insertion 
of the deltoid muscle of the left arm. As an experi- 
ment, we injected into the fibrous growth half a grain 
of morphia and one thirty-sixth of a grain of atropia. 
After a few seconds, the tumor was extirpated with- 
out the slightest pain,—the patient remarking at the 
close of the operation, that had she not seen us cut- 
ting, she would not have known what was going on. 
The success was quite beyond our expectation. I 
have had but one opportunity of repeating the ex- 
periment. It was in the removal of a small wen un- 
der the right scapula. The result was equally satis- 
factory. In neither of these cases did sleep occur in 
1 “ Die Hypodermatische Injection der Arzneimittel,” Berlin, 1865. 
2 ‘‘ Transactions of the Medical Society of North Carolina,” 1S77. LOCALIZATION. 
29 
several hours. The .reason is obvious. The atropia 
counteracted the cerebral effects of the opiate. It 
had long been a favorite problem with me to discover 
a method of rendering painless the minor operations 
of surgery without employing chloroform or any an- 
aesthetic inhalent; and I am satisfied that the hypo- 
dermic injection of morphia and atropia into wens 
and fibrous growths meets the case and supersedes 
the necessity of employing so powerful and dangerous 
an agent as chloroform. I am not aware that the 
experiment has ever been tried before, and I earn- 
estly invite your attention to the subject,—hoping 
that it may prove as satisfactory in your hands as it 
has been successful in mine.” ! 
As opposed to the groundwork of Eulenberg’s belief 
we have the conclusions of Prof. De Renzi,2 based upon 
many experiments: “First, The cutaneous sensibili- 
ty, measured by Weber’s compasses, is generally in- 
creased rather than diminished, after subcutaneous in- 
jections. Second, Frequently repeating these injections 
1 An interesting question arises here. Was the local anaesthetic 
effect of the morphia and atropia independent of their constitutional 
action ? and was the absence of pain due to the local narcotic effect 
produced on the nerves supplying the part, or was it the result of a 
constitutional impression manifested locally ? Bartholow says both 
tactile sensibility and sensibility to pain are diminished at the site of 
injection. 
2 La Nuova Liguria Medica, Feb. 20, 1873; N. Y. Med. Journal, 
vol. 18, p. 214. 3° 
HYPODERMIC INJECTION OF MORPHIA. 
and each time measuring the sensibility, the latter is, 
after a few days, often found to be augmented in a con- 
siderable degree, and at the termination of the treat- 
ment is much greater than at the commencement.” He 
therefore concludes “ that morphia does not exert 
any direct and local narcotic effect.” 
Mitchell, Keene and Morehouse1 noticed a like 
increase of sensibility in some of the cases under 
their care ; the sensitiveness being very marked. 
Dr. O. J. B. Wolff,2 in cases of mental disease, 
prefers to make the injection in the anterior and lat- 
eral portions of the neck, so as to get close to the 
vaso-motor centre. He claims to get a better physi- 
cal soothing effect than when the injection is made in 
other situations. This he determined by “ actual 
experiment.” 
Those of my correspondents who have expressed 
themselves upon this point, are chiefly against “ lo- 
calization ” as mischievous, and prone to produce 
inflammation if long continued. 
From a consideration of the various arguments pro 
and con, it would seem that “ localization ” is only to 
be had recourse to for a single, or a few injections, 
and chiefly in the cases pointed out by Anstie, Mitch- 
ell, Keene and Morehouse, and Bartholow. The more 
1 Am. Journ. Med. Sci., July, 1865, p. 68. 
2 “Archiv fur Psychiatric,” Practitioner, 1871, vol. VI., p. 374. LOCALIZATION. 
3i 
the complaint, especially neuralgia, has an acute or 
chronic inflammatory process as a factor, the more effi- 
tacious is a local injection. The cases of “ Burning 
Neuralgia ” which have been given by Mitchell, Keene, 
and Morehouse, as especially calling for localization of 
the injection, are traumatic, and essentially inflam- 
matory. Where the disease seems dependent on a 
constitutional cause, the localization of the injection 
does not seem to be called for, distant injection being 
usually efficacious. This will, of course, not hold 
good in all cases. Further, I do not wish it under- 
stood that in many superficial or deep inflammations 
I advocate injection directly into the seat of the mor- 
bid process. When necessary, or desired, the injec- 
tion should be made as close to the seat of this pro- 
cess as is reasonable. Dr. Foote’s experiments are 
certainly worthy of being tried extensively. 
A few words may be said with advantage as to 
where the injection had best be made, when local 
effect is not desired. Any part of the arm or leg 
may be selected, avoiding, of course, those situations 
where there is liability of wounding a vein. The 
parts over bony prominences should be avoided, as 
also parts where the tissues are tense or are rendered 
tense by the movement of the limb. Injections made 
over bony prominences are usually very painful. I 
am accustomed to select the anterior and outer as- 32 
HYPODERMIC INJECTION OF MORPHIA. 
pect of the forearm. It is maintained by some, and 
I have verified the fact in many instances, that injec- 
tions beneath the skin of the back, are more slowly 
absorbed than when given elsewhere. I have also 
found the same to be the case in some individuals, 
with injections made over the recti muscles of the 
abdomen. This rapidity of absorption varies in dif- 
ferent persons, and by injecting plain water, as well 
as medicated solutions into myself and some of my 
patients, I have found absorption from the groin and 
inner side of arm to rank first in point of rapidity; 
forearm next, leg next, abdomen next, and the thick 
tissues of the back last. This is true both as regards 
the time required for the disappearance of the tumor 
formed by the fluid injected and the time when the 
agent employed (Potass. Iodid) made its appearance 
in the saliva. I am at present continuing these ex- 
periments, and hope by verifying in many what I 
have found in a few cases, to establish or destroy the 
correctness of the results already obtained. Limited 
space will not permit my giving these experiments 
in detail now. 
Bartholow 1 says: “ I have not been able to ob- 
serve any difference in the rapidity of effect as influ- 
enced by the site of puncture. If, as sometimes 
happens, the patient prefer injection into the painful 
1 “The Hypodermic Method,” etc., Phila., 1879, p. 33. LOCALIZA TtON. 
33 
part, it will be well to yield to his prejudices, pro- 
vided no contra-indication exists thereto. Eulen- 
berg, on the contrary, found a less rapid effect from 
injections into the back than from those made else- 
where.” CHAPTER II. 
INFLAMMATION AND ABSCESS—SOLUTIONS USED— 
METHOD OF INJECTING ERYSIPELAS—CYSTS— 
TRANSMISSION OF SYPHILIS AND CARCINOMA— 
CONCLUSIONS. 
It is surprising tvhat a difference of experience 
there is amongst some physicians in the matter of ab- 
cess and inflammation following the puncture of the 
hypodermic needle. One gentleman reports that he 
has an abscess “ in about one in every ten punctures,” 
and another “ in a practice of twenty years' in which 
I have used the hypodermic syringe thousands of 
times, I have seldom had inflammation, and never 
abscess.” 
Of the 357 physicians answering my questions, 28 
report abscess as common, 69 as rare, and 213 have 
had none. Thirty-four of the 213 have seen slight 
inflammation follow the puncture in a few cases. This 
yielded readily to cold water dressings or received no 
treatment at all. Thirteen of the 357 have found in- 
flammation to follow very frequently. 
These figures represent from twenty to thirty thou- SOLUTIONS FOR INJECTION. 
35 
sand injections, at the least, many of the gentlemen 
having used the syringe for the past twenty years, 
none having used it less than two or three hundred 
times. The fact that out of this large number of in- 
jections there is so small a showing of abscess and 
inflammation, speaks well for the practice. I could 
not obtain the number of abscesses seen by each re- 
porter, some reporting many (one in ten, &c.), some a 
few, and many saying nothing of the number. In 
this summary arc not included those cases of abscess 
found in the habitues of the syringe, they being due 
in part to the multiple punctures, the low condition of 
the systerrf, impure solutions, dirty syringes, and care- 
less injecting. Cases of this kind are spoken of by 
many of my correspondents, and are mentioned by 
all the prominent writers on this subject. To include 
these in a table such as this, would be manifestly un- 
just. They will be spoken of more fully under the 
head of “The Morphia Habit.” 
Many of the gentlemen who have written me upon 
this subject ascribe the production of abscesses to 
various causes; as impure, decomposed or too acid 
solutions, dirty syringes, rusty or unclean needles, 
liability of the patient to cutaneous inflammation, 
and poor condition of the general health, all of which 
may thus act in different cases. 
As to the solution, very few doubt that when it has 36 
HYPODERMIC INJECTION OE MORPHIA. 
stood for some time, especially in warm weather, and 
has become filled with a minute vegetable growth, and 
decomposition, to a certain extent, has taken place, 
that it may lead to the formation of abscesses. To 
prevent the occurrence of this decomposition and 
growth of fungi, various agents have been employed. 
In a letter to the Cincinnati Lancet and Clinic for 
May 17, 1879, Dr. H. M. Keyes, Assistant Surgeon 
U. S. M. H. Service, writes as follows: 
“ Some years ago, while attached to the Roosevelt 
Hospital, in New York City, and after repeated ex- 
periments with various tests and anti-ferments, I be- 
came convinced of the practicability of making a 
solution of sulphate of morphia of the strength of 
‘ Magendie’s,’ without the aid of acid, except sali- 
cylic, and that not as a solvent but as a preventa- 
tive of decomposition, making a solution that, when 
properly prepared, gave perfect satisfaction after years 
of use, never causing abscesses—as is frequently the 
case when the mineral acids are used—and when car- 
ried in the pocket for months, being in as perfect con- 
dition for use as when freshly prepared. 
“I pulished the formula in The Druggists' Circular, 
of New York, at the time, under my initials (H. M. 
K.); and, as I am satisfied that there are a great 
many physicians in Cincinnati to whom such a solu- 
tion will be a welcome, I send you the formula to pub- SOLUTIONS FOR INJECTION. 
37 
lish, should you so desire. 
“ The following directions, if followed, will give the 
desired result: 
“ 51 Sulphate of Morphia 256 grs. 
Salicylic Acid 8 grs. 
Distilled Water 16 fl. oz. 
“ Heat the water in a porcelain capsule, over a 
spirit lamp, until the boiling point is reached, add the 
powders, stir with a glass rod until the powders are 
dissolved, filter through coarse filtering-paper while 
hot, and keep in a glass-stoppered bottle of green 
glass. 
“Druggists can make it up in this quantity or larger, 
as can apothecaries in hospitals, and be prepared to fur- 
nish it at a moment’s notice. The ‘ liquor morphiae 
sulphatis ’ of the U. S. Dispensatory can be made 
from it by the proper dilution ((3ss. ad f3vijss. water), 
instead of keeping a large quantity of the latter on 
their shelves. 
“ Sulphate of atropia and other alkaloids may be 
added to it at the option of the physician.” 
According to M. Damaschino,1 abscess and in- 
flammation may always be avoided by the use of a 
perfectly clean and pure solution, he asserting at the 
same time, however, that no solution can be kept free 
from vegetable growths and dirt, and undecomposed, 
1 Gazette des ITopitanx. Oct. 28, 1879. 38 
HYPODERMIC INJECTION OF MORPHIA. 
unless in a phial, where it is perfectly protected from 
the air. To accomplish this, he recommends the 
combined phial and syringe of M. Gabriel Bay, to 
which reference has already been made. 
Prof. Roberts Bartholow, 1 prefers the use of a 
simple solution of the sulphate in pure water, as 
follows: 
IJ Morphiae Sulphat. gr. xvi. 
Aq. destil § i. 
Dissolve and filter. 
Dr. Jennie S. Elder, of Canastota, N. Y., writes:— 
“ Solution prepared as follows : 
“ 1J Sol. Morph. Sulph. Magendie 3 i. 
Atropiae Sulph gr. i. 
Acid Benzoic 
Acid Salicylic 
aa a trace.” 
With this she has never had either inflammation 
or abscess. 
Dr. V. S. McNider, of Jackson, Northampton Co., 
N. C., uses : 
1J Morph. Acetat gr. xii. 
Acid Acetic nr. i. 
Glycerin m. v. 
Aq. Pur ss. 
Dr. Thomas McAllister, of Amesbury, Mass., 
1 “ The Hypodermic Method,” Tilda., 1879, pp. 42, 43. SOLUTIONS FOR INJECTION. 
39 
writes; “I have used the following (Middlesex Hos- 
pital) : 
“ fjL Morph. Acetatis gr. x. 
Acid Acetic, m. i vel. ss. 
Aq. Destillat 3 i. 
Misce et ad. 
Liq. Potassae, m. i vel. ss. 
“Am not particular to have it freshly prepared every 
time. Carry it in pocket, and when one lot is gone 
I get another.” 
The English practice seems to be chiefly the use 
of solutions made with acids for solvents of the salts. 
Anstie 1 recommends the use of the acetate, so dis- 
solved. Lawson2 prefers the muriate. His solution 
is so strong that it requires to be heated, being solid 
when cold. 
The committee of the Medico-Chirugical Society 
used the acetate insisting, however, that the acid, 
necessary to dissolve it, should be carefully neutra- 
lized.3 
Dr. Andrew M. T. Rattray, Portobello, Scotland, 
writes: “I adopt Dr. Tanner’s formula—i. e., in 
3 i aq. destillat. I dissolve gr. x of morphia acetatis; 
to dissolve this salt thoroughly add a few drops of 
acetic acid, after which neutralize the fluid by the 
1 Anstie, Practitioner, 1868. 
2 Med. Times and Gazette, 1870. 
3 “Trans. M.-C. Society,” vol. L. 40 
HYPODERMIC INJECTION OE MORPHIA. 
addition of liquor potassae, till a cloud appears; 
finally, one or two drops of acetic acid are added to 
acidulate the solution.” The dose of this is one or 
two drops, to which ten or twelve of water are added 
at the time of using. 
John H. Wraith, M. R. C. S , Eng., L. S. A., Lond., 
&c., says, in this connection: “Yes, (inflammation 
and abscess), when I made the solution with the mu- 
riate of morphia, instead of the acetate, the muriate 
requiring more acid to dissolve it.” 
Edward T. Wilson, M. B., Oxon, F. R. C. P., Lond., 
who has made a thorough and exhaustive study of 
this subject, and whose paper in St. George’s Hos- 
pital Reports 1 will repay careful study, writes me: 
“ I always use atropia. 
“ R Morph. Acetat gr. xii. 
Atropiae Sulph gr. ss. 
Aq. Destillat ss. 
Solve in Aq. Calent. 
“Abscess at point of puncture about twice or three 
times, perhaps, in many thousands of punctures. 
This immunity I attribute to the use of a simple 
watery solution, without the addition of acid ; also 
in part to the weakness of the solution, rendering it 
less suitable.” 
Eulenberg,2 who largely represents the German 
1 “St. George’s Hospital Reports,” for 1869. 
.2 “Die Hypodermische Injection der Arzneimittel,” Berlin, 1865. SOLUTIONS FOR INJECTION. 
41 
practice in this matter prefers a solution of morphia 
hydrochlorat. made with a small quantity of hy- 
drochloric acid. 
Dr. Samuel G. Armor, Prof. Principles and Prac- 
tice of Medicine, at the Long Island College Hos- 
pital, writes me that he usually dilutes Magendie’s 
solution with an equal part of water, for the same 
purpose. 
Dr. Charles E. Blake, of San Francisco, California, 
writes: “ I have for the past year or two added 
about one grain of salicylic acid to the ounce of solu- 
tion, for its preservative effect, as the growth of fungi 
is thereby prevented. Salicylic acid causes a little 
more smarting when the needle is used, but this 
quickly subsides.” 
Dr. O. J. Hallenbeck, of Canandaigua, N. Y., mo- 
difies the usual solution, as follows : 
E Morph. Sulph gr. Ixiv. 
Atropiae Sulph gr. ii ss. 
Acid Salicylic gr. ii. 
Aq. Destillat iv. 
Dr. G. E. Mecuen, 1,083 Tremont street, Boston, 
Mass., uses the following: 
5; Morph. Sulph io grms. 
Atropiae Sulph 009 “ 
Acid Salicylic q. s “ 
Aq. Destil 6.00 “ 
M. Make a solution and filter. 42 
HYPODERMIC INJECTION OF MORPHIA. 
Dr. J. T. Sledge, Middleburg, Warren Co., N. C., 
writes, “ I use the following solution : 
“ Morph. Sulph gr. xvi. 
Atropiae Sulph gr. 
Glycerin 3 i. 
Acid Carbolic gtt. v. 
Aquae 3 vii. 
Misce et filter.” 
Dr. J. B. Cooper, of Cales Station, 111., writes : 
“ Have had a few cases of abscess, but never when 
carbolic acid was added to the solution; say one 
drop to the drachm.” 
Dr. M. A. Wilson, Clin. Asst, to Chair Dis. Child, 
Bellevue Coll., N. Y., writes: “ I have tried the ad- 
ding of a very slight amount of carbolic acid (gtt. ii. 
to sol. 1 i.), chiefly with the view of preserving it, 
but see no advantages therefrom.” 
Dr. Crawcour, 194 Camp street, New Orleans, La., 
writes : “ My solution is filtered, and to every ounce 
I add two drops of chloroform, which prevents the 
formation of fungi.” Dr. Crawcour was one of the 
first to use the hypodermic syringe in this country, 
he using a Pravaz instrument as early as 1857. 
Dr. C. C. Fite, President of the Board of Health, 
Shelbyville, Tenn., writes: “ I dissolve the morphia 
in boiling water and then filter, and in summer add 
a little salicylic acid, which keeps it pure.” 
Dr. Jno. H. Lowman, Prof. Mat. Med., Wooster SOLUTIONS FOR INJECTION. 
43 
University, Cleveland, Ohio, writes me: “I use 
Magendie’s sol. of morphiae sulphas (gr. xvi. f i.) 
Have used sol. bimeconate of morphia—this is more 
antiseptic, and fungi do not form in it as soon. It 
will remain clear longer than any other solution I 
have used." 
Prof. John J» Reese, ol Philadelphia, writes me: 
“ I keep a solution of morphiae sulph. and atropiae 
sulph. on hand ; It requires, however, (as you doubt- 
less have found) to be occasionally filtered.” 
Dr. W. W. Vinnedge, of Lafayette, Indiana, writes: 
“ Yes, recently I have had three abscesses appear at 
the point of puncture. The solution I used was too 
old. The fault was in the fluid, as shown by the 
microscope.” 
Dr. J. Hawtrey Benson, of Dublin, Ireland, has 
seen inflammation in about i or 2 per cent, of cases, 
but never abscess. He uses acetate of morphia, dis- 
solved without the aid of acid. 
James Donaldson, M. D., late of Madras Med. 
Staff, writes : “ No, never, once only after inject- 
ing a solution of the acetate, which turned out to be 
very acid and acrid. There was, for a few seconds, 
sharp pain, and a small mark remained, looking as 
though the skin had been burned. No abscess oc- 
curred, the subject being quite healthy, but I believe 
that such would have occurred in an unhealthy per- 44 
HYPODERMIC INJECTION OF MORPHIA. 
son. The skin looked, for days, as if scorched, and 
a brown mark long remained as if a sore had existed 
there. I threw the solution away, had another very 
carefully made, as nearly neutral as possible, and no 
such unpleasantness nor pain occurred.” 
Reginald E. Thompson, M. D., who was one of 
the committee, and who drew up the report on the 
subject of the hypodermic injection of morphia for 
the Medico-Chirugical Society 1 writes me as follows: 
“ If the solution is not carefully made and neutral, 
irritation may readily be produced, and I have seen 
abscess occur.” 
Dr. J. Charles Adams, of Lake City, Minn., writes: 
“I have used this method since i860 and have had 
abscess but once ; then, too much acid was used in 
the solution.” 
Dr. Wm. W. Cable, of Pittsburgh, Pa., writes me: 
“ I had both inflammation and abscess when I first 
commenced to use the instrument, but soon learned 
that it was caused either by the rust on the needle, 
or when, from age, some chemical change had taken 
place in the solution. Now, when I use only a fresh 
solution and take great care of the instrument, I 
have no trouble with the most sensitive skin. I 
never use a solution kept longer than 24 hours.” 
Dr. O. C. Tobey, of Westfield, 111., in answer to 
1 “ Transact. Med.-Chirug. Society,” vol. L. SOLUTIONS FOR INJECTION- 
45 
the fourth question says : “ Yes. Several years ago 
fifteen abscesses followed as many punctures; thir- 
teen in one man and two in another. I am perfectly 
satisfied that the fault lay in the morphia, for on 
procuring a new phial of the drug, the thing did not 
happen again, although I continued the use of it in 
the one case.” 
Dr. John S. Marshall, Physician to Cleveland 
Asylum for Insane, Newburgh, Ohio, writes: “ In 
adminstering it about 1200 times slight inflammation 
has followed in a number of instances, and suppura- 
tion in about 25. All of these abscesses occurred in 
the course of a month. Doubtless the cause was 
owing to the adulteration of the morphia, atropia, 
or to the water. We afterward attributed it to the 
atropia, as we had no further trouble after purchas- 
ing a new lot of it.” 
Inability to keep the solution free from fungi, and 
the idea that there is less liability to abscess owing 
to the warmth of the preparation, has led many phy- 
sicians to dissolve a powder of morphia of the 
requisite strength just before using. 
Dr. John A. Ritchey, of Oil City, Penn., writes: 
“ I have had scores of abscesses at the point of punc- 
ture, but never one when I dissolved the powders in 
water alone, immediately before using them.” 
Dr. R. Aberdein, of Syracuse, N. Y., says : “ Only 46 
HYPODERMIC INJECTION OF MORPHIA. 
had abscess form in two cases, and then think it was 
because I used Magendie’s solution. I prefer to dis- 
solve it when needed.” 
Dr. Madison Hammel, of Circleville, Ohio, writes: 
“ I have always used the sulphate of morphia. To 
get a quick and good solution I put the dose in a 
teaspoon, add the water from the syringe, according 
to the quantity I intend to use. I warm this over a 
lamp, draw the fluid into the syringe and inject it 
anywhere without fear of abscess.” 
Dr. T. A. Mitchell, of Owensville, Ohio, writes: 
“ Have had neither worth notice since I have been 
preparing solution at the time of use.” 
Prof. Samuel G. Armor writes: “I have always 
been accustomed to dissolve the morphia in a little 
hot water at the time of using, filling the syringe 
full. Or, if I use Magendie’s solution, I dilute it in a 
syringe-full of warm water. I am under the impres- 
sion that by thus diluting it there is less danger of 
abscess.” 
Dr. D. H. Bliss, of Kansas City, Mo., carries 
powders of the sulphate of morphia of definite 
strength with him and dissolves them at the bed- 
side. He has found carbolic acid and other “preser- 
vatives,” when added in sufficient amount to be of 
service, to be very irritating to the tissues. 
Dr. Wm. H. White, of Bloomfield, N. J., writing SOLUTIONS FOR INJECTION, 
47 
on this point, says: “ Often when administering the 
prepared Magendie’s solution which had become a 
little stale. Never since adopting the course of pre- 
paring the solution at the patient’s bedside by dis- 
solving the sulphate of morphia in a silver spoon, 
or a homoeopathic vial by means of heating it over 
a lamp.” 
Dr. J. H. Arton, of Hamilton, Bermuda, pursues 
the same plan. 
Dr. W. W. Cady, of Logansport, Indiana, writes: 
“ In reference to your fourth question I would further 
say that in order to avoid the possibility of abscesses 
and inflammation I do not use a prepared solution, 
but simply carry in my case a number of i grain 
powders. With the aid of a spoon and a syringe, 
and a few minims of water, the required quantity of 
morphia may be easily dissolved and given. You are, 
no doubt, aware how soon a prepared acid solution 
becomes filled with foreign growths, and how the 
« 
morphine itself will manage to crystallize about the 
cork, thus not only rendering the solution unreliable 
but irritating also.” A physician in the South, a 
slave to the habit, writes: “ I have sometimes intro- 
duced morphia in the calf of my leg and in the 
abdominal muscles, but here it always produced 
considerable irritation and soreness. I have found 
morph, acetat. to give more pain than morph, sulph. 48 
HYPODERMIC INJECTION OF MORPHIA. 
The points in which I prefer to introduce the needle 
on account of being less sensitive to the puncture and 
giving less pain and causing less soreness afterwards, 
are, just above the insertion of the deltoid, on the 
outer aspect of the arm and in the bend of the elbow, 
in the angle between the two veins. Near the 
shoulder, on the front of the arm, is another good 
point. I think one good reason why abscess has fol- 
lowed so seldom is because I always use the solution 
warm.” 
Some of the gentlemen from whom I have heard 
claim special advantages from their peculiar methods 
of making the injection, especially claiming immunity 
from abscess, thereby. The majority of the profession 
follow the usual plan of pinching up a fold of skin 
and passing the needle into the subcutaneons tissue; 
the gentlemen here spoken of vary somewhat in their 
manner of introducing the needle. 
Ernest Aylward, L. R. C. P. E., etc., of Leeds, Eng- 
land, writes: “Neither abscess nor inflammation. I 
invariably inject deep into the gluteus muscle when 
I can get the patient to consent to it.” Dr. G. Wm. 
Semple, of Hampton, Va., writes in this connection: 
“ I had inflammation to occur at the point of puncture 
in a case where the insertion was made over the 
right kidney and probably into the fascia lumbalis. 
A small fibroid tumor resulted (1870), it has not in- METHOD OF INJECTING. 
49 
creased in size since six months after injection, and 
gives no inconvenience. I then added a minute 
quantity of carbolic acid to the injections and have 
since had no such accident, though for the last three 
years I have ceased to use carbolic acid and instead 
have plunged the needle deep into the muscular 
structure.” 
Andrew M. T. Rattray, M. D., of Portobello, 
Scotland, writes: “ In this operation, with the left 
hand seize the fleshy part tightly and inject on the 
opposite side—i. e. say over the deltoid where the skin, 
is tight.” Dr. S. R. Skillern, of Philadelphia, Pa., 
writes: “ I would further state that in my experi- 
ence the discomfort following immediately upon the 
use of the instrument and, too, the chances of an ab- 
scess are greater when the injection has been made 
directly under the skin than when it has been put 
deep among the tissues.” Prof. Samuel Logan, of the 
University of La., writes : “ I usually prefer to inject 
deeply into the muscular tissue over the shoulders.” 
He used the loose cellular tissue in one case where it 
was necessary to inject a large quantity at one time. 
Dr. G. L. Dunlap, of Danville, Kentucky, has ob- 
served “that the deeper the needle is plunged into the 
muscular tissue the chances for these indurations to 
form are diminished.” 
Dr. A. Atkinson, of Baltimore, Prof. Mat. Medica 5° 
HYPODERMIC INJECTION OF MORPHIA. 
and Dermatology, Coll. Phys. and Surg., of that 
city, in answering the fourth question, says: “Had 
inflammation and small abscess but once, and then 
because the lady would not allow the instrument 
to go deeper than the skin. When I plunge the 
needle well into the muscular tissue I never see an 
abscess, induration or discoloration.” Dr. George E. 
Jones, of Cincinnati,1 believes that deep injections 
are preferable to subcutaneous ones, both as regards 
painlessness and freedom from abscess. Dr. Q. C. 
Smith, of Cloverdale, Cal., attributes freedom from 
abscess to injecting deep into muscle. Dr. W. O. 
Walker, of Winchester, Ky., believes in making the 
solution at the bed-side and in inserting the needle 
at about an angle of 45 °, entering it from to I 
inch. 
On the other hand, Dr. J. H. Thompson, of 
Goshen, N. Y., writes me in reference to abscess: 
“Yes, in my own case when the muscle was pierced 
by the needle, but not otherwise.” And Dr. E. J. 
Bergen, of Trenton, N. J., writes upon the same sub- 
ject : “ I never have had but one abscess, and that 
when the injection was made deep in the deltoid 
muscle.” Bartholow2 does not seem to favor this 
method except for the use of strychine in paralysis. 
1 Lancet and Clinic, August io, 1878. 
* “ The Hypodermic Method,” Philadelphia, 1879, p. 32. METHOD OF INJECTING. 
5* 
He says : “ It is claimed for this method that it is 
less painful and less liable to be followed by abscess, 
than by injection under the skin, but it is obviously 
improper if any considerable amount of fluid is to 
be injected.” 
Dr. Temuljee Bhicajee Nariman, of Bombay, 
writes that he does “ not like the idea of pinching up 
a fold of skin and putting the needle under it, as we 
are advised by some. I always put my needle bold- 
ly in and let it pierce the subcutaneous tissue. I 
gently disperse the swelling produced by the in- 
jected fluid simply by pressing the surrounding 
parts.” 
Alfred C. Post, M. D., Prof. Emeritus of Clinical 
Surgery in the University Medical College, N. Y., 
writes me: “ I attribute this immunity of my 
patients from local irritation to my manner of giving 
the injections. I raise a fold of skin, pierce it with 
the needle, inject a drop of the fluid, pass the instru- 
ment a short distance, inject another drop, and so on 
to the end. In this way, the liquid is diffused and 
much less violence is inflicted than when the fluid is 
injected in one mass.” 
Dr. Samuel Logan, of New Orleans, Prof, of An- 
atomy and Clin. Surgery in the University of 
Louisiana, follows nearly the same plan as that of 
Post. “To prevent the formation of abscesses,’’ he 52 
HYPODERMIC INJECTION OF MORPHIA. 
writes, “ I am always careful to inject very slowly, 
and to scatter the fluid as I inject, and afterwards by 
a gentle kneading pressure on the parts assist its 
spreading and absorption.” 
Dr. C. A. White, of Danville, Ind., makes the fol- 
lowing statement: “I am quite sure that the in- 
flammations and abscesses are the result, generally, 
of the imperfect introduction of the needle. In some 
cases I think the skin is not even punctured through, 
but that the needle is so inclined as to ‘ split ’ the 
skin, as it were, and the solution is thus forced into a 
sort of cul-de-sac." 
Dr. P. H. Thornton, of Lakeport, Cal., writes:— 
“ I have had three abscesses, all in the same person, 
caused by injecting air, which I believe to be the 
cause of all abscesses, or nearly all. In fact this has 
been my experience in several thousand injections.” 
It seems hardly possible that this could be the case, 
else why are not abscesses common in localized or 
general emphysema of the subcutaneous tissue ? 
Dr. Samuel P. Reed, of Scranton, Penn., says in 
reference to abscess : “ I used to have abscesses fre- 
quently during the first two or three years experi- 
ence, but have not had one for ten years. They can 
always be avoided with a little care (cleanliness and 
dipping the needle in carbolized oil.)” 
Disease and lowered systemic tone are undoubted METHOD OF INJECTIING. 
53 
predisposing causes of abscess following the use of 
the hypodermic needle. Dr. G. S. Dunlap, of Dan- 
ville, Ky., had an abscess follow the injection in a 
case of rachitis. Dr. W. A. Neal, of Dayton, has 
never had abscess occur, save where “ the blood was 
in bad condition.” 
Dr. Samuel E. Wills, of Earlville, Md., writes: 
“ Abscess was the invariable attendant in several at- 
tacks for which hypodermic injections were used.” 
He found in some cases, as did Prof. Logan, of New 
Orleans, in many, that the tendency to inflammation 
and abscess passed away after the first few injections. 
Dr. Alfred Mercer, of Syracuse, N. Y., had an 
abscess form in the case of a drunkard, and Dr. A. B. 
Stuart, of Santa Barbara, Cal., had the same in a 
plethoric patient convalescent from delirium tremens; 
Dr. De Forrest Willard, of Philadelphia, Pa., has 
seen but one, and that in a feeble, nursing woman; 
Dr. J. W. Brome, of Mottville, N. Y., in the case of 
his father, who suffers from erysipelas. 
Dr. G. Wm. Semple, of Hampton, Va., writes me: 
“ As surgeon in charge of prisoners on Belle Isle, 
I had a good many cases of bad ulcers caused by it, 
in scorbutic prisoners, and many more afterwards, 
when in charge of Federal prisoners. Prisoners 
brought in wounded, from the field, in good general 
health, never suffered so. Since the war, I had an 54 
HYPODERMIC INJECTION OF MORPHIA. 
abscess at the point of puncture in a lady who had 
been for some time suffering from a succession of ab- 
scesses.” 
Dr. A. L. Kilpatrick, of Navasota, Texas, had a 
large abscess form after an injection, in the case of a 
“ large and extremely fat negress ” who had conges- 
tion of the stomach, with vomiting and diarrhoea, 
“ the abscess was disposed to spread, was phagadenic, 
and discharged very freely several days a most offen- 
sive matter.” The sore healed in about a month. 
The doctor is inclined to blame the water used as a 
solvent. It was in the month of June. The same 
gentleman reports a case of abscess thus produced in 
a patient who had disease of the liver. The sore re- 
mained open about a week, the inflammatory action 
and the discharge seeming to do the patient good. 
Other cases are reported where the irritation of the 
abscess and the long continued discharge effected a 
permanent cure in obstinate neuralgia; the good re- 
sults being attributed, of course, to the prolonged 
counter-irritation as of an issue. 
Dr. R. W. Miller, of this city (N. Y.), relates two 
cases, one himself, where such abscesses were 4 and 
4y2 months in healing. The last one months) 
was still discharging at the time of writing. 
Dr. T. Gaillard Thomas, Prof. Diseases of Women 
and Children, College of Physicians and Surgeons, GANGRENE. 
55 
New York City, writes: “ In two of my cases, exten- 
sive phlegmonous inflammation has followed punc- 
tures, attended by dangerous sloughing of cutaneous 
and subcutaneous tissues.” 
The first case was that of a very fleshy lady, in the 
anterior aspect of whose thigh the doctor injected ten 
minims of Magendie’s solution. In the afternoon she 
left the city and remained on the cars until she 
reached St. Louis, when she came under the care of 
Dr. Bell, of that city, who afterwards wrote Dr. 
Thomas that there was considerable inflammation at 
the point of puncture, that eventuated in a circular 
patch of gangrene a little larger than a large silver 
dollar. There was no tendency to lateral spreading, 
but the process went on until the muscular tissue was 
reached, when it stopped and the resulting excava- 
tion filled up rapidly with granulations. There re- 
mains a depressed cicatricial looking scar. 
The second case was seen with Drs. J. J. O’Con- 
nel and T. C. Finnell, of this city. The patient was 
a young man very much broken in health owing to 
prolonged dissipation. His skin was covered with 
patches of psoriasis. He was then in a condition of 
delirium tremens. All remedies by the mouth had 
failed, and a hypodermic injection of ten drops of 
Magendie s solution was used as a dernier ressort, the 
patient’s condition being truly deplorable. The result 56 
HYPODERMIC INJECTION OF MORPHIA. 
was intense inflammation extending from the point of 
puncture, over the insertion of the deltoid, to the 
tips of the fingers, resulting in a gangrene that laid 
the muscles and tendons bare. At one time it was 
feared that amputation would have to be performed, 
but the parts healed kindly, though very slowly. 
Cases of fatal pyaemia or septicaemia from inflam- 
mation and abscess at point of puncture are well 
known. 
Erysipelas.—Dr. Samuel Rapp, of Lake City, 
Colorado, reports the following interesting case: 
“ Male. Aet 54. Gun-shot wound of left hand, 
bullet entering palm, passing upwards and outwards, 
making its exit at lower third of forearm, be- 
tween radius and ulna. I gave a hypodermic injec- 
tion of 10 drops of Magendie’s solution in right fore- 
arm, which was followed by erysipelas at the point of 
puncture of needle, and patient succumbed in five 
days, as inflammation could not be controlled by 
tonics and antifebrifuges.” Dr. Kilpatrick, above- 
mentioned, writes me of abscess and gangrene nearly 
requiring amputation of the arm of a white male 
child, aet. 5. The solution injected, however, was 
quinine in an acid solution. 
Dr. F. W. Entrikin, of Findlay, Ohio, writes of a 
case where the needle passed through a vein, causing 
inflammation and suppuration, but with no bad re- ERYSIPELAS. 
57 
suits. The sore healed slowly. He has seen cases 
where there were slight evidences of erysipelas fol- 
lowing puncture. 
Mitchell, Keene and Morehouse1 give the follow- 
ing: “The local annoyances resulting from injections 
so long continued and so numerous were sometimes 
very embarrassing, for though in some men they 
could be used in the same limb, week after week, in 
others the numerous punctures produced a very un- 
pleasant increase of sensitiveness in the part. Such 
an instance may be found at page 15 1, case 31, of 
our treatise on wounds and other injuries of nerves. 
In other persons the injections gave rise to occasional 
abscesses, and in a soldier who was at one and the 
same time the subject of a very painful wound of the 
arm and of a cold abscess on the back, every injec- 
tion gave rise to a large indolent abscess. One in- 
stance of erysipelas following the use of an injection 
was seen by us.” 
CYSTS.—Dr. Willard Parker, Jr., has kindly shown 
me his arm, beneath the skin of which are several 
small cyst-like tumors, the result of hypodermic in- 
jection some five years ago. Since they first ap- 
peared they have remained in the same condition 
and of the same size. The wall of the cyst seems to 
be fibrous, not very closely attached to the adjacent 
1 American Journal Med. Sciences, July, 1865. 58 
HYPODERMIC INJECTION OF MORPHIA. 
tissues, and has a small opening upon the skin into 
which a probe can be readily thrust. They contain 
a small amount of white secretion or matter that does 
not exude unless the sac is probed or violently 
squeezed. They are perfectly painless. The doctor 
tells me that the mere introduction into the skin of a 
clean hypodermic needle would at that time produce 
considerable inflammation, and that the injections 
would cause circumscribed indurations that did not 
disappear for months. He was suffering from acute 
rheumatism at the time the injections were made, and 
was in a very low, anaemic condition. 
I have since seen similar cystic tumors on the body 
of a prominent medical gentleman of this city. They 
were not open, however, and felt like small fibrous 
tumors. It is possible that the fibrous tumor spoken 
of by Dr. G. W. Semple, of Hampton, Va., was of 
this nature. A bistoury plunged into one of these 
bodies gave exit to a thick, whitish matter. 
Carcinoma.—Dr. Samuel W. Francis, of New 
York, writes, that after injecting morphia in the abdo- 
men of a lady suffering from carcinoma of the ovary, 
he used the same needle on himself, and he says: 
“ For several weeks I had a dark, round, lumpy mark 
on my leg.” He recommends the keeping of a special 
needle for such cases. All needles should, at least, 
be cleaned in some disinfecting fluid after use on sy- CARCINOMA AND SYPHILIS. 
59 
philitic and carcinomatous patients, and in all cases of 
infectious disease. 
Accidents.—Dr. E. L. Partridge, of this city, 
tells me of a case where the following accident oc- 
cured to him: “ The patient, a hysterical girl, was 
very violent, and as the doctor thrust the hypodermic 
needle into the cellular tissue, she suddenly pulled 
her arm away and the needle was broken off close 
to the syringe. He at once procured some ether, 
put her fully under it, and attempted to find the 
needle. This was impossible, and he finally gave it 
up. This was some three years ago, and the needle 
has not since been found.” Dr. Temuljee Bhicajee 
Nariman, of Bombay, writes me of a like accident 
which occurred to him. The needle was, however, 
recovered. 
From the foregoing facts I think we are justified 
in drawing the following conclusions : 
1st. That “localization” of the injection is not 
necessary and sometimes mischievous, save in certain 
cases—i. e., burning neuralgia; 1 cases of sciatica 
and zoster, and in all cases of long standing in which 
the sheath or trunk of the nerve has become altered ;2 
rheumatic troubles and chronic neuralgias where there 
1 Mitchell, Keene & Morehouse, Am. Jour. Med. Sei., July, 1865. 
2 Bartholow, “The Hypodermic Method,” Phila., 1879, p. 74. 60 
HYPODERMIC INJECTION OF MORPHIA. 
is much inflammatory thickening and adhesion,1 and 
in mental diseases.2 
2d. That rapidity of absorption varies in different 
individuals and in the same individual at different 
times, and with the place where the injection is made, 
that from the back being the slowest. 
3d. That hypodermic injections .blunt tactile and 
pain sensibility sufficiently to admit of the perform- 
ance of minor surgical operations without the use of 
an anaesthetic.3 
4th. That abscess and inflammation are compara- 
tively rare occurrences. 
5th. That too acid solutions, unclean syringes, rusty 
or dirty needles, Magendie’s solution that has stood 
for some time, especially in warm weather, improper 
modes of injecting and unhealthy conditions of the 
system are liable to cause abscess or inflammation. 
6th. That the sulphate of morphia is the best salt 
to use, being readily soluble in plain water. 
7th. That no solution should be used that is not 
protected by salicylic acid, carbolic acid, or some 
such drug ; the Keyes’ solution being about the best. 
8th. That carrying powders and dissolving at the 
bedside is an excellent plan. 
9th. That “deep injections” are worthy of trial. 
1 Anstie, Practitioner, July, 1868, p. 36. 
2 Dr. Wolff, Practitioner, vol. 6, p. 374. 
3 Foote, “Transactions North Carolina Med. Soc.,” 1877. CONCLUSIONS. 
61 
loth. That serious inflammation, erysipelas, gan- 
grene, and pyaemia may follow the puncture. 
11 th. That abscesses so formed are often very slow 
to heal. 
12th. That needles should be thoroughly cleansed 
after using on syphilitic or carcinomatous patients, 
and patients ill with contagious or infectious disease. 
13th. That small cystic and fibroid tumors may 
result from the inflammation. CHAPTER III. 
THE COMMENCING AND THE USUAL DOSE—IDIO- 
SYNCRASY—NARCOTISM—ELIMINATION OF MOR- 
PHIA BY THE KIDNEYS—EXPERIMENTS. 
The usual dose or amount of morphia given hypo- 
dermically seems to vary greatly with different prac- 
titioners, and to be, to a certain extent, an index to 
their confidence in the safety of the method. The 
figures thus far obtained are as follows:— 
No. of Pliys. 
No. of Pliys. 
Amount. 
Using-. 
Amount. 
Using. 
r 
1 6 
g1* 
2 
rogr---- 
I 
1 
8 
“ 
17 
1 
u 
. . . I 
4 — 4 “ ... 
26 
V 
1 
6 
u 
.....28 
*-i “ ••• 
4 
1 
u 
..12 
A — 4 “ ... 
5 
4 
u ' • 
49 
1 T “ 
8 1 - - - 
- - - . . 4 
a 
u 
IC 
2 1 u 
a 
u 
10 
1 1 “ 
2 
a 
u 
. . . I 
1 1 « 
3 
u 
7. 
1 i “ 
7 
4 
6 2 
i 
— 1 rrr 
I 
i 2 « 
1 
3 0 
fi Ol • • * 
5 
1 
I “ 
I 
A —A “ ... 
4 
J 6 
1 
1 « 
2 
4 — A “ ... 
1 2 
6 * * * 
1 
i “ 
I 
A — 4 “ ... 
4 
I 0 
8 ‘ ■ 
1 “ 
i 9 “ 
I 
1 0 
4 " • ‘ 
1 
1 U 
... I 
Guess at it from 
3 
8 
16 • ’ • 
247 IDIOSYNCRASY. 
63 
The preceding table shows us that, both at home 
and abroad, the amount of morphia given as the 
“usual ” dose is very diverse, and that many physi- 
cians, by administering such doses to strangers or to 
patients with whose idiosyncrasies they are not ac- 
quainted, are treading upon very unsafe ground. I 
shall endeavor to show in this chapter that the greatest 
care is necessary in the matter of giving the first in- 
jection, for dangerous narcotism and possibly death 
have been known to follow the subcutaneous exhibi- 
tion of amounts of morphia less than those recorded 
by many physicians as their customary and com- 
mencing doses. The question of idiosyncrasy is one 
of great importance with reference to the exhibition 
of drugs by the stomach ; much more so with regard 
to hypodermic medication, for rapidity of absorption 
is at its maximum, the narcotic action of the drug, 
when of this class, is trebled, and the systemic im- 
pression is, consequently, more sudden and shock- 
like. Examples of idiosyncrasies regarding both 
food and drugs are sufficiently numerous and well 
authenticated to deserve more attention at the hands 
of the physician than they at present receive, and a 
neglect to study them may possibly explain why so 
many physicians have so firm a belief in the vis medi- 
catrix natures, and so little in the therapeutic action 
of drugs. 64 
HYPODERMIC INJECTION OF MORPHIA. 
Certain drugs like certain diseases, while affecting 
the system generally, affect some one organ, system, 
or part of a system with marked intensity—other 
drugs like other diseases have no manifest action on 
the general system, but a decided action on some 
organ, system or part of a system. Let us suppose 
the drug to be equal to a certain amount of force, as 
the force necessary, for instance, to drive a sharp axe 
through an oaken stick having a diameter of four 
inches; given the same amount of force, the same 
degree of sharpness of the axe, and the same resist- 
ance by the wood, and the effect will always be the 
same. The effect will vary, however, with variations 
in the amount of force employed, the sharpness of 
the axe and the resistance offered by the stick. So 
with the use of drugs; effects will vary with the 
amount of the drug, its kind, and certain peculiari- 
ties, not yet understood, of the organ or system up- 
on which it develops its maximum intensity. Given 
the same quantity of the same drug and the same 
organ, both as regards weight, function, nutrition, 
innervation, surroundings, &c., &c., and the effect 
will always be the same ; let there be any variation, 
hereditary or acquired, in that organ, and the effect 
must of necessity vary. 
In speaking of the difficulties besetting experi- 
ments for determining positively the question of an- IDIOSYNCRASY. 
65 
tagonism between opium and belladonna. Mitchell, 
Keene & Morehouse 1 say : “ If it were clear that 
these two agents acted in some simple, direct way 
upon an economy equally as simple, the problem be- 
fore us would indeed be like the case of acid and 
alkali; and present to us little that was confusing or 
difficult to comprehend. If, on the other hand, each 
of these drugs acted with equality of force but in 
opposite ways upon numerous organs of a complex 
being, the question would even then be simpli- 
fied,” &c. 
I am firmly convinced that no drug known to us 
ever acts in precisely the same manner twice; al- 
though the main features of its action be alike. If 
there are lesser variations, surely there may be major 
ones, dependent in the main upon some hereditary 
peculiarity of the person. This is true of the ner- 
vous system and its parts in particular, and can be 
readily explained, I think, by a study of the nervous 
system and the nervous diseases of the present day, 
as compared with those of one or two centuries ago. 
Dr. Geo. M. Beard,2 than whom there is probably 
no man better able to speak upon this subject, says : 
“ The organization of the average European and 
American of the cultured classes of the present day 
1 American Journal Medical Sciences, July, 1865. 
2 “ Eating and Drinking,” N. Y., 1877, p. 112, and again atp. 104. 66 
HYPODERMIC INJECTION OF MORPHIA. 
is so much finer and so much more sensitive than it 
was one century, or even one quarter of a century, 
ago, that they cannot bear the same medicine, the 
same stimulants or narcotics, or the same ordinary 
food that they could then. What was then appro- 
priate and necessary and right for their coarser or- 
ganizations, is, for the finer organization that has 
developed with the intense brainwork of our time, 
suicidal or cruel. 
“ All the other conditions of race, climate, season, 
age, sex, being the same, or as nearly the same as 
possible, the food varies with the temperament in a 
manner at once striking and mysterious. 
“ In the chapter devoted to the description of the 
leading articles of food, some remarks were made on 
their palatability, digestibility and nutritive value. 
These remarks were of necessity general in their 
character; to all these are individual exceptions. 
There are idiosyncrasies in the matter of diet that 
defy explanation, and probably can be understood 
only when the mystery of life itself is solved. This 
applies not only to positive but to negath e food, and 
to all our principal medicines. 
“ Even quinine has been known in a few instances 
to produce a peculiar and disagreeable eruption on 
the skin. Some cannot bear mutton, others are made 
ill by a pear, or watermelon, or cucumber.” ID JOS YNCRA CY. 
67 
Henry Maudsley,1 in the course of an article “ On 
Opium in the Treatment of Insanity,” says: 
“ There is hardly a disease in which opposite rem- 
edies may not be useful under the different circum- 
stances which are denoted by such words as ‘ dia- 
thesis ’ and ‘ idiosyncrasy; ’ and there can be little 
doubt that future progress in therapeutics will lie in 
directing the means of treatment more definitely to 
the diathesis, and in less random attacks on the par- 
ticular disease, which may have been engrafted on it. 
“ No statesman with a gleam of philosophy in his 
mind would dream of using the same measures for 
the radical cure of rebellion in differently constituted 
States, simply because it was rebellion; he would 
have regard to the fundamental causes of the dis- 
order, to the evils in the political system whence it 
had sprung, and would in each case apply his 
measures differently, adapting them with special 
reference to the particular defects of each constitu- 
tion. On the other hand, a foolish ruler, like an 
ignorant empiric in medicine, would immediately ap- 
ply the same measures to rebellion, under whatever 
conditions it had arisen, because from time immemo- 
rial such measures had been thought good for rebel- 
1 Practitioner, Jan., 1869. 68 
HYPODERMIC INJECTION OF MORPHIA. 
lion. So, he would do no good or would do great 
harm.” 
Many of us have seen or read of cases where the 
most minute doses of mercury caused salivation and 
produced other distressing symptoms ; where inhala- 
tion of a minute quantity of dust arising from ipecac 
powder produced symptoms analagous to those of 
hay fever; where quinine caused a red eruption over 
the entire skin,1 delirium, ha;maturia and sometimes 
syncope; syncope and depression, failing heart 
power, flushing of the surface, and swelling of the 
limbs from ergot; 2 and where there was a peculiar 
susceptibility to the deliriant, throat drying and rash 
producing power of belladonna or atropia. These 
are but few of the many instances that might be 
mentioned. It is a well-known fact, for instance, 
that a dose of cathartic medicine that will produce 
but a slight laxative effect in one person will produce 
hypercatharsis in another, that while tobacco agrees 
well with some persons, it is a decided poison -i to 
others ; that alcohol has different effects on different 
constitutions in health and in disease, &c., &c., &c. 
Is it surprising then that idiosyncrasies exist with 
regard to opium and morphia, both extremely pow- 
1 F. D. Lente, N. Y. Medical Record, Nov. 16, 1878. 
2 Med. and Surg. Reporter, Phila., Nov. 29, 1879, p. 475. 
3 Anstie, “Stimulants and Narcotics,” Phila., 1865, p. 138. IDIOSYNCRASY. 
69 
erful drugs, and that such idiosyncrasy should be 
brought out more fully and more decidedly when its 
narcotic action is trebled and the rapidity of its 
entrance is quintupled;—is sometimes almost instan- 
taneous by the hypodermic method. 
Anstie says1: “It must be allowed that opium is 
a drug, which, more than any other is liable to pro- 
duce varying effects, according to the idiosyncrasy 
of the patient to whom it is administered.” 
It can thus be readily understood why doses that, 
when given by the mouth, or to individuals who are 
not especially susceptible, when administered sub- 
cutaneously, will sometimes produce the most intense 
narcotism; narcotism that may end in death unless 
the proper measures to combat the influence of the 
drug are resorted to at once. Death has been known 
to ensue, even in spite of these measures. 
Anstie2 devotes a chapter to the interesting sub- 
ject of tolerance of large doses of some narcotics 
(notably alcohol and opium) in certain diseased con- 
ditions of the system. 
The matter of idiosyncrasy is not confined to man 
alone. Prof. S. Weir Mitchell3 says : 
“A second series of experiments-were directed 
1 “Stimulants and Narcotics,” Phila., 1865, p. 116, 
2 Ibid, p. 210, &c. 
3 Am. Journal Med. Sciences, Jan., 1870, p. 19. 70 
HYPODERMIC INJECTION OF MORPHIA. 
towards discovering what amount of morphia might 
kill, when used hypodermically. As regards this 
point, I was surprised to find that wide differences 
were visible in different’ pigeons. This was partly 
due to various and easily seen causes, but in part also 
to reasons which probably rest on the idiosyncrasies 
of the birds employed. Thus, pigeons of two or 
three months old were commonly killed by injections 
into the groin of half a grain to one grain, but some- 
times, though rarely, survived two grains. The 
same amounts used under the skin of the back were 
much less fatal. ***** 
The present series of observations, therefore, show a 
singular range of susceptibility, and indicate very 
distinctly that, as regards hypodermic injections, the 
pigeon enjoys no such complete immunity as seems 
to obtain with opium given by the mouth; while, as 
compared to morphia internally administered, the 
hypodermic method is vastly more fatal.” 
In this connection Dr. Corona1 (Giornale di Me- 
dicina Militaire) says : “As regards the toxic dose, 
there was very great variation both as regards the 
age and the race of the animal.” 
Susceptibility to the narcotic action of morphia is 
somewhat more common, but no more peculiar than 
its tetanic, convulsive, nauseant, or deliriant action. 
1 Edin. Med. Joum., Dec. 1876. Practitioner, 1877, p. 132. NARCOTISM. 
7i 
These peculiarities1 also are to be found in animals, 
but oftentimes are the chief action, the narcotic effect 
being reached only by immense doses. These mat- 
ters will be more fully discussed under their proper 
headings. 
An interesting point with reference to the effect of 
altitude on tolerance of drugs is brought out by Dr. 
Samuel Rapp, of Lake City, Colorado, who writes : 
“ I have noticed in practice, in this altitude, which 
is 8,500 feet above the sea-level, that opiates are 
better borne here than at sea-level, and quinine 
cannot be given in such large doses on account of 
its producing headache, ringing in the ears and, at 
times, delirium.” 
NARCOTISM.—Were we able to distinguish by any 
peculiarity those persons who are especially suscep- 
tible to the narcotic action of opium, or its alkaloid, 
morphia, the hypodermic use of these drugs would 
be placed upon a more exact basis, and many phy- 
sicians who are now much prejudiced against their 
use in this manner would regain their confidence, 
and the profession in general be more at ease. 
With this end in view, I have corresponded with 
many of our college professors and gentlemen who 
have had exceptional opportunities for the study of 
the subject, regarding the relative susceptibility of 
1 Mitchell, American Journal Med. Sciences, Jail., 1870, p. 32, 72 
HYPODERMIC INJECTION OF MORPHIA. 
different temperaments, but regret to say that, thus 
far, I have been unable to obtain any reliable facts. 
Prof. S. Weir Mitchell, Roberts Bartholow, H. C. 
Wood and John J. Reese, of Philadelphia; J. C. Shaw, 
J. B. Mattison, and Alexander J. C. Skene, of Brook- 
lyn ; J. S. Jewell, Henry M. Lyman and James H. 
Etheridge, of Chicago ; Richard McSherry and A. At- 
kinson, of Baltimore ; and William A. Hammond, 
Geo. M. Beard, Alfred C. Post, Willard Parker and 
William H. Thompson, of New York, have found no 
one temperament in which there is special suscep- 
tibility to the narcotic action of opium. Definite 
conclusions have .been reached by Prof. Roberts 
Bartholow1 with regard to susceptibility to the 
effects of atropia. He says : “ Children bear a much 
larger proportional amount than adults. Women 
are more susceptible than men. Persons having a 
light complexion are much more easily influenced by 
it than those having a dark complexion. A delicate 
female, having light-blue eyes and flaxen hair, pos- 
sesses, according to my observation, the maximum 
susceptibility.” If this is verified by other observ- 
ers, its value to the profession will be great. Such 
exact observations of drug action on special consti- 
tutions or temperaments have a therapeutic as well 
as a toxicological bearing. If, as is now largely 
x * The Hypodermic Method,” Phila., 1879, p. no. NARCOTISM. 
73 
believed, atropine is in many points a physiological 
antidote to opium, and if atropine is but poorly 
borne by persons of the configuration above de- 
scribed, opium and its alkaloid, morphia, ought to be 
well borne. This is, however, negatived by what 
little clinical evidence we now have on this point; 
children bear opium poorly, as also do women; and, 
according to Maudsley,1 these drugs are borne best 
by persons of melancholic temperament. This is 
explained, possibly, on the hypothesis that a nervous 
system that is especially susceptible to the action of 
one powerful drug will be so to that of another. This 
is, at best, but a theory. Dr. Bartholow undoubt- 
edly takes into consideration the question of idiosyn- 
crasy with reference to the subcutaneous injection of 
morphine, for he says:2 “ The dose of morphia for 
hypodermic use varies from to y of a grain. In 
commencing, it should not exceed one-third of that o>- 
dinarily administered by the mouth. It is prudent, in 
all cases, to test the physiological capabilities of the 
patient by a moderate dose, before resorting to the 
maximum amount. Patients vary in their suscepti- 
bility. Women are, as' a rule, more easily affected 
than men. One twelfth of a grain is a sufficient dose 
for many of the conditions requiring an injection.” 
1 Practitioner, Jan. 1878, p. 5. 
2 “ The Hypodermic Method,” Phila., 1879, p. 44. 74 
HYPODERMIC INJECTION OF MORPHIA. 
Samuel G. Armor, Prof. Theory and Pract. Med., 
Long Island Coll. Hospital, Brooklyn, writes me: 
“ It has been an impression with me that the sanguine 
and mixed temperaments bear opium better than the 
typically billious or melancholic. I have not studied 
my cases, however, with sufficient acccuracy to be 
positive on this point.” 
J. H. Etheridge, Prof. Mat. Med. and Med. Juris- 
prudence in Rush Med. Coll., Chicago, writes me: 
“ I have always noticed that persons affected with 
opiates in a manner not intended, are almost inva- 
riably poor excreters. The emunctories (one or more 
of them), were doing vicarious service—at least my 
observation has usually revealed some such physio- 
logical aberration.” He further questions whether 
a defective nervous system, conjoined with the vices 
of civilization does not produce defectively acting 
excretory organs, and cause an intolerance of the 
drug in question. 
The part that diseased, or hereditarily abnormal 
excretory organs play in producing temporary or per- 
manent idiosyncrasy with reference to certain drugs 
is undoubtedly a large one, and would, in part at 
at least, explain the action of caffeine in opium pois- 
oning. Disease of the kidneys would suggest itself 
as being the most active factor in the matter, for the 
greater part of the morphia taken into the system DISEASED KIDNEYS. 
75 
passes out in the urine. In its favor we certainly 
have the tradition of years; but against it the fact 
that morphia has been used with excellent results in 
chronic Bright’s disease,1 and in heart disease 2 where 
there was undoubted renal complications. Take also 
the use of morphia subcutaneously in puerperal 
convulsions, presumably uraemic, as advocated by 
Loomis,3 and successfully carried out by Fiset,4 
Dain,5 and many others. 
Dr. Samuel W. Francis, of Newport, R. I., writes 
me as follows: “ I have brought a single lady, who 
was suffering from Bright’s disease, out of five several 
convulsions, happening several hours apart, by inject- 
ing 10 minims of Magendie’s solution of morphia, 
when her respirations became as low as three a 
minute; but she came out all right.” 
Whether the convulsions are due in these cases to 
uraemia or to reflex nerve troubles, it matters not, 
for the excreting power of the kidneys is, for the time 
being at least, markedly diminished or altogether 
abolished. 
Take also, delirium tremens, where after an ex- 
1 Potter, Practitioner, vol. 15, p. 142. Roswell Park, Practi- 
tioner, vol. 15, p. 24x. 
2 T. Clifford Allbutt, Practitioner, vol. 3, p. 342. 
3 New York Medical Record, 1873. 
4 Ibid, 1874. 
6 American Journal Medical Sciences, July, 1874. 76 
HYPODERMIC INJECTION OF MORPHIA. 
haustive study of many cases, Dr. Nacke,1 of Dres- 
den, found albumniuria in 82 per cent. True, in the 
majority of the cases this albumniuria passed away 
with the attack of mania, but during its continuance 
the excreting power of the kidneys was decidedly 
interfered with. Yet we find various authors 2 recom- 
mending the use of opium in this affection; some by 
the mouth, some hypodermically. 
Dr. G. Bodington,3 apparently from clinical expe- 
rience alone, advises in favor of opium and against 
the use of the “ modern salts of the drug, they seem- 
ing to be the most dangerous.” 
When I come to speak of death from the subcuta- 
neous injection of morphine, I shall be able to show 
several deaths, in this disease, the unusual effect of 
the morphia being due possibly to the hampered 
renal excretion. 
In favor of the hypothesis that narcotism out of 
proportion to the dose of morphia, is due to defective 
renal excretion, stand the investigations of Chauvet.4 
He has found that the kidneys, when diseased, have 
lost, to a certain extent, their power to eliminate 
1 Philadelphia Med. and Surg. Reporter, Sept. 27, 1879, p. 281. 
2 “Flint’s Theory and Practice of Medicine,” N. Y., 1873, p. 785. 
“ Holmes’ System of Surgery,” Lond., i860, vol. 1, p. 334 ; vol. 3, pp. 
22 and 894. Med. Times and Gazette, 1859, p. 310, and many others. 
3 British Med. Journal, June 9, 1861. A mer. Jour. Med. Sciences, 
Jan. 1862, p. 217. 
4 Klin. Wochenschrift, Berlin, 1878. DISEASED KIDNEYS. 
77 
drugs from the system. He found that in health, 
from one to two-thirds of the sulphate of quinine 
taken by the mouth is carried out through the kid- 
neys, while in interstitial nephritis, only from one- 
tenth to one-fiftieth is thus removed. Two grains of 
potass, iodid. is, in health, eliminated in three days— 
in disease, in from five to twelve days; bromide of 
potassium, in health, by the twentieth day—in dis- 
ease of the kidneys, not under thirty or thirty-five 
days; three grammes of sodce salicylat. in from two 
to three days, in health—in from five to six days in 
disease. From these facts, the author considers him- 
self justified in warning against the use of powerful 
drugs during renal disease, lest they prove fatal. 
M. Tardieu 1 is of the opinion that special physio- 
logical conditions materially influence the elimination 
as well as the absorption of poisons in animals, and that 
variations will of necessity arise from certain individ- 
ual organic conditions, which are by no means readily 
appreciated. 
Anstie2 believes that in dogs most of the morphine 
is eliminated rapidly by the kidneys ; hence the un- 
usually large doses they are able to take without caus- 
ing any ill effects. 
1 Annales d'Hygiene Publique, Oct. 1864 and Jan. 1865. 
* “ Stimulants and Narcotics,” Phila., 1865, p. 200. 78 
HYPODERMIC INJECTION OF MORPHIA. 
To determine this point definitely, the following 
experiments were made: 
I. To a healthy, well-fed dog, weighing fourteen 
pounds, i oz., i y2 grain of the sulphate of morphia 
was given hypodermically. In thirty-five minutes 
the dog became comatose. But after some hours fully 
recovered. 
2. The same animal being under the influence of 
chloroform, the abdomen was opened and both 
ureters were tied about two inches distant from their 
vesical insertion. The exposed parts were sponged 
off carefully and the edges of the wound brought ac- 
curately together. As soon as he had recovered fully 
from the ether, he was given i y, gr. of the sulphate 
of morphia subcutaneously. In exactly eighteen 
minutes after the injection, he became profoundly 
comatose and died in nine honrs and thirty-nine 
minutes. 
3. A black and tan slut, weighing eight pounds, 
was given i gr. of morphia, hypodermically, and 
soon became comatose. At the end of fifty-five min- 
utes, thirty-five minims of Wyeth’s fid. ext. coffee 
was injected subcutaneously. In ten minutes, thirty 
minims more; and in thirty minutes, twenty-five 
minims more. The stupor now began to pass off, 
and after resting quietly for some hours she fully re- 
covered. EXPERIMENTS. 
79 
4- The same slut was put under the influence of 
chloroform several days later, and one kidney was 
removed, and two drachms tinct. cantharides was 
thrown into the remaining kidney with a veterinary 
hypodermic syringe. When recovered from the chlo- 
roform, i gr. of the sulphate of morphia was given 
hypodermically, and stupor was manifest in thirty- 
eight minutes. FI. ext. of coffee was injected in the 
same manner and amount, but the dog succumbed 
rapidly to the morphine. 
5. To a rabbit, weighing lbs., six grains of the 
sulphate of morphia were given hypodermically. The 
animal recovered in four and a half hours. 
6. The same animal died in three hours after 
giving the same amount of morphia, both ureters be- 
ing tied. 
Owing to my giving too large doses in several in- 
stances the animals died, or it was necessary to give 
antidotes, and thus rendered the results of experi- 
ments for this purpose useless or impossible. 
These experiments, though few in number and not 
as carefully observed as I desired, seem to demon- 
strate the fact that in dogs and rabbits, at least, inter- 
ference with the renal function renders doses of mor- 
phine fatal, that would otherwise cause only a stupor 
of some hours duration. These experiments would 
also tend to show that the beneficial action of coffee 80 
HYPODERMIC INJECTION OF MORPHIA. 
in opium poisoning, in part at least, is due to its 
diuretic action. This action is now pretty well 
established. 1 
These experiments need confirmation or contradic- 
tion at the hands of others. 
With these facts before us, I think that we may 
safely decide that idiosyncrasies with regard to 
opium, do exist, and are of two kinds—hereditary and 
acquired. Of the latter I have spoken at some 
length, not because I have any power to settle the 
question, but simply to demonstrate the fact that our 
knowledge upon this point is very slight, and that, at 
best, we are greatly confused. That deficient or 
abolished renal function may lead to unusually forci- 
ble action of morphine is pretty well settled ; that it 
has been given in disease where such renal conditions 
are present and without any perceptible evil effect, 
we also know. The explanation may lie in the fact 
that the evil effects of the drug that would otherwise 
be apparent are used up in combating certain symp- 
toms of the general diseased condition, of which the 
renal trouble is but a part or the cause. 
An interesting case bearing upon this question is 
reported to me by Prof. Wm. T. Lusk, of this city. 
It is that of a lady suffering with chronic parenchy- 
matous nephritis. When first seen by Dr. Lusk and 
1 Prof. Gubler, Le Progres Medical, June 15, 1879. EFFECTS ON RESPIRATION. 
81 
others she was supposed to be at the point of death. 
In using morphia hypodermically to relieve the pain 
of an attendant neuralgia, she contracted the morphia 
habit, and to the surprise of all lived for seven years. 
This is certainly a remarkable case. 
That doses of this drug large enough to produce) 
alarming narcotism and possibly death, in a healthy 
person, are entirely robbed of their narcotic effect 
when given to persons suffering intense pain, is well 
known. The same also of other drugs. To this, 
however, there are some exceptions, of which I shall 
speak more fully very soon. 
Interesting observations on the different action of 
morphia, subcutaneously used, on the respiration in 
health and disease, have been made by M. Latil,1 
who has kindly written me, calling attention to 
articles by Renault,2 Huchard,2 Levy,2 Martin3 and 
Vibert.4 We also have the observations of Mitchell, 
Keene and Morehouse,5 Da Costa,6 Bartholow,7 and 
many others. 
1 “ Des Injections Hypodermiques de Morphine dans les Dyspnees,” 
La France Medical?, No. II, 1879- 
2 L'Union Medicale, 1874- 
3 “ Society de Medicine de Paris,” 1874. 
4 Journal de Therapeutique, 1875. 
6 Am. Jour. Med. Sciences, July, 1865. 
6 Quoted by the above. 
7 “The Hypodermic Method,” &c., p. 46. 82 
HYPODERMIC INJECTION OF MORPHIA. 
CASES of Narcotism.—Anstie1 says, with refer- 
ence to the commencing dose: “ Three minims (or 
x gr.) is an unsafe dose to commence with; dan- 
gerous and even fatal results have been known to fol- 
low its use. It should not be given till smaller doses 
have been tried.” 
Prof. H. C. Wood, of Philadelphia, in answer to 
my questions, kindly writes: “ I saw once nearly 
fatal results from of a grain. Respirations fell 
as low as two a minute. Six or eight hours’ work 
was necessitated to save the patient.” The same 
case is mentioned in his elaborate work on Materia 
Medica.2 
Dr. William H. Ensign, of New York City (214 
West 22d street), spoke to me of the case of a young 
lady whom he saw some years ago in consultation 
with Dr. Daniel Wisall (U. S. A.) in Washington, 
D. C. She was deeply narcotised by a hypodermic 
injection of gr. of the sulphate of morphia, and 
some hours hard work with battery, artificial respira- 
tion and flagellation, and the administration of coffee 
and belladonna were necessary before she was out of 
danger. I wrote Dr. Wisall some time since for full 
particulars as to temperament, idiosyncrasy, disease, 
&c., but, as yet, have received no reply. 
1 Practitioner, July, 1868, p. 38. 
2 “ Materia Medica and Therapeutics,” Phila., 1879, p. 218. CASES OF NARCOTISM. 
83 
Dr. Chas. T. Jewett, of this city, was called upon 
for assistance some years ago, in a case of narcotism 
following the subcutaneous use of the of a 
grain of morphia, followed in an hour by gr. 
more. The injections were given to relieve convul- 
sions (presumably hysterical) in a young lady aged 
about 25. Artificial respiration, electricity and the 
hypodermic use of atropia were necessary before 
she fully recovered. She was of a decidedly nervous 
temperament. At the time of maximum narcotism 
the pupils were contracted to the size of pin’s points 
and the respirations were as low as four per minute. 
Dr. Temuljee Bhicajee Nariman, of Bombay, in 
answer to my fifth question, writes: “ No deaths, 
but I have seen of a grain of morphia injected 
hypodermically producing all the symptoms of 
opium poisoning. It was a case of renal colic in 
a Parsee lady, where, for the relief of pain, morphia 
was injected by her family doctor in my presence. 
The same day the doctor went out to some distant 
town, leaving the case in my hands. I told the 
relations not to disturb her for three or four hours. 
When that time was over, she could not be roused, 
and I was sent for, and with the greatest difficulty 
she was saved. She was perfectly unconscious; 
pupils were contracted to a pin-hole, and there was 
complete suppression of urine. There was no albu-- 84 
HYPODERMIC INJECTION OF MORPHIA. 
men in her urine either before or after the accident.” 
This is one of these cases that show very plainly 
that intense pain is not always a safe guage to the 
amount of morphia to be given. A somewhat similar 
case is related to me by Dr. F. D. Beane, of this city, 
where the narcotic action of morphia would manifest 
itself in spite of the most excrutiating agony (ovarian 
neuralgia), the patient nearly dying, twice, from 
opium poisoning. 
Dr. J. C. Adams, of Lake City, Minnesota, writes 
me the details of the following case: He was called 
at night to see a lady, aged 58, weighing about 200 
pounds, and of the “ lympha-choleric temperament.” 
Her five grown children are all of the lymphatic 
temperament. Her previous illnesses were of the 
kind commonly known as “bilious.” The doctor 
gave her, subcutaneously, % gr. morphiae sulphat. 
to relieve a severe pain to the right of the epigas- 
trium, “due, in all probability, to the passage of a 
gall stone.” Relief was obtained within half an hour. 
Four hours afterward the doctor was sent for, the 
messenger stating, “that she was very stupid and that 
her breathing was slow.” The doctor ordered strong 
coffee, etc., and did not see her until the following 
morning at 8 o’clock, when he learned that she had 
“ slept for short successive periods during the latter 
half of the night, being waked by nurse whenever the CASES OF NARCOTISM. 
*5 
breathing became oppressive.” At the time the doc- 
tor saw her (8 A. M.), the pupils were contracted and 
the breathing abnormally slow. There were no in- 
dications of kidney disease in this case. She had a 
well-marked arcus senilis and occasional palpitation 
of the heart. 
Dr. H. M. Smith, of Vincennes, Indiana, answers 
my fifth question as follows: “No deaths. In one 
case where the puncture was made in the temporal 
region for severe neuralgia of the eye and inflamma- 
tion, the patient became much prostrated and nau- 
seated, and under stimulation did not come out from 
under influence of drug for six hours. The eyes 
were entirely relieved by it.” Dr. Smith does not 
say how much morphine was injected, but we may 
infer that it was less than y gr., as in answer to 
question three he states that he has never exceeded 
this amount, and to question one, that his usual dose 
is from y to gr. 
A gentleman from the south, whose name I am 
not at liberty to use, writes of two cases occurring in 
his practice, as follows: “Case i. White. Mate of 
vessel. Wife on board. About 35 years old. Was 
suffering from the pain following a fall, to relieve 
which sulphate of morphia in powder, not more and 
possibly less than y2 gr., (as much as I had frequently 
used,) was given hypodermically. The soporific 86 
HYPODERMIC INJECTION OF MORPHIA. 
effects were developed slowly, in about 15 or 20 
minutes, longer than usual. I then left, but was 
soon recalled, with the information that the mate was 
in an alarming condition, which I found verified on 
inspection. He was unconscious, respiration slow, 
corners of eyes upturned, with unmistakable symp- 
toms of opium poisoning. He was at once removed 
from a close cabin to the upper deck where there was 
a good breeze blowing, cold water dashed repeatedly 
over body, strong coffee given to drink, flagellation 
with a flat roller used on legs, and he was walked 
about. No atropia was given as his wife objected on 
the ground that it might still further narcotise him. 
After vomiting, he gradually but slowly recovered. 
His wife stated that he had been nearly killed once 
by a dose of laudanum, of which she informed me 
after his recovery. 
“ Case 2. Maj. , white man, about 30 years of 
age ; a young man of intelligence and refinement, 
but unable to control an inordinate appetite for stim- 
ulants. Had had several attacks of “ the horrors,” 
and it was in a threatened attack of one of these, 
and to avoid it, that his life was endangered by mor- 
phia used hypodermically. After the injection of 
y2 gr., Magendie’s sol., (knowing from experience that 
large doses by the mouth were required), he went to 
his bed, and with arms crossed on breast, endeavored CASES OF NARCOTISM. 
87 
to compose himself to sleep. But finding that he 
could not, in about half an hour after repeated calls 
by him for another injection, gr. more of same 
solution was injected. I soon perceived from his re- 
spiration that he was overpowered by the effects of the 
medicine, and that he was in danger. As he kept 
bachelor’s hall, and there was no one with him, I 
summoned assistance, one physician and several un- 
professional persons, who kindly rendered every as- 
sistance. Five drops fl. ex. belladonna was injected 
into muscles of arm, which quickly produced flushing 
of face, and which, with use of a rotary magnetic bat- 
tery, were the principal agents in his recovery, the 
belladonna probably the more important one. After 
using them he recovered very soon, (in about two 
hours from time of the second injection,) his intellect 
perfectly restored upon his emergence from his dan- 
gerous condition. This gentleman not long after- 
ward was found dead in bed one morning; it was 
supposed from the effects of an overdose of chloral 
taken over night.” 
Dr. E. K. Henschel, of New York City, reports 
the following interesting case, by letter : “ Married 
lady, aged 26, weak, nervous and hysterical, to whom 
m. iv. (Magendie’s solution) were given hypodermi- 
cally. In three minutes she was fully narcotized; 
only by great effort could be wakened; even walking, 88 
HYPODERMIC INJECTION OF MORPHIA. 
ice water, pure black coffee, etc., all had but slight 
effect. After 4hours she was allowed to sleep 
one quarter of an hour; after six hours, allowed to 
sleep undisturbed. The amount given was rather less 
than four drops.” The probability is that, in this 
case, the morphia entered a vein. 
The committee of the Medico-Chirugical Society 
reports1 the case of a woman, aged 70, in whose in- 
fra-orbital region of morphia was injected hypo- 
dermically with the result of producing narcotism, 
which was, however, fully recovered from. 
Also the case of a woman, aged 45, in whom 
of morphia in the left temporal region produced the 
same results. 
Dr. Roswell Park, Assistant to Chair of Anatomy, 
Chicago Med. Coll., writes as follows : “ A man of 
52 years, who had been a hard drinker and a laborer, 
came into Mercy Hospital, in 1876, to be operated 
on for what was supposed by his physician (sic), to 
be cancer of both testicles, but which proved to be 
double hydrocele. The sacs were tapped and a seton 
put in each. This was followed by violent reaction, 
erysipelas, etc. Tr. ferri chlorid. was given in large 
doses and with benefit, until one afternoon he was 
seized with the most violent colic I ever saw, the in- 
testines coiling up and relaxing again, so as to pre- 
1 “ Medico-Chirugical Transactions,” vol. 50. CASES OF NARCOTISM. 
89 
sent tumors of considerable size, visible under the 
abdominal walls. Morph, sulph., % gr., was given 
hypodermically. He soon experienced relief, and 
not long after fell into a rather alarming condition of 
typical opium poisoning, from which he was aroused, 
however, in three or four hours.” 
“ In another case, I produced still more alarming 
symptoms in a young woman seized with violent and 
uncontrollable mania. Repeated injections, at inter- 
vals of one hour were given. She had had a total 
of f- gr. of morphiae sulph. and 14 grains of chloral 
hydrat. Three-quarters of an hour after the last in- 
jection, I was hurriedly summoned, to find her gasp- 
ing for breath, face and lips livid, etc. Active treat- 
ment saved her, and she finally went to the insane 
asylum.” 
In the report1 of the committee of the Medico- 
Chirugical Society on morphia, a case of mania is 
related in which gr. of morphia hypodermically 
used, caused narcotism that lasted for four days, the 
patient finally recovering. Another case of the same 
disease is reported, where gr. thus given was fol- 
lowed by narcotism, ending in death. A case of 
mania is reported to me by letter by Robert Park, of 
Glasgow, Scotland, where he gave, hypodermically, 20 
grains of morphia at a single and, I believe, the first 
1 “ Medico-Chirugical Transactions,” vol. 50. 90 
HYPODERMIC INJECTION OF MORPHIA. 
dose, without the production of any narcotism what- 
ever. This gentleman is in the habit of giving very 
large doses, gauging the amount of the drug by the 
amount of the pain present. Although this practice 
has, thus far, proved perfectly safe in his hands, I 
should hardly care to try it. 
The use of morphia by the mouth and subcutane- 
ously, in mania, is highly spoken of by many au- 
thorities.1 
Dr. Reginald E. Thompson, of London, England, 
1 O. J. B. Wolff, “ Archiv fur Psychiatric,” Practitioner, 1877, p. 374. 
“Annalesde la Societe de Medecin de Gand,” Practitioner, July, 
1868, p. 322. 
W. C. McIntosh, yournal of Mental Sciences, October, 1861. 
Boyd, in 19th and 20th Annual Reports of the Somerset Asylum, 
England. 
C. Lockhart Robertson, Practitioner, May, 1869. 
Maudsley, Practitioner, Jan. 1878. 
Bartholow, “ The Hypodermic Method,” Phila., 1879, p. 56, quot- 
ing also : 
Krafft-Ebing, Bulletin General de Therapeutique, Jan. 30, 1870, p. 
474- 
Maudsley, “Reynold’s system of Medicine,” vol. 2, p. 60. 
Reissner, Bulletin General de Therapeutique, Jan. 30, 1870, p. 89. 
Hunter, “On the Speedy Relief of Pain,” &c., p. 16. 
Lorent, “Die Hypodermatischenlnjectionen nach ClinischenErfah- 
rungen,” Leipzig, 1865, p. 16. 
Erlenmeyer, “ Die Subcutanen Injectionen der Arzneimittel ” Neu- 
wied und Leipzig, 1866. Dritte Auflage, p. 28. 
Eulenberg, “Die Hypodermatische Injection der Arzneimittel,” &c., 
Berlin, 1867, p. 154. 
These, to show the high authority advocating this form of treatment 
in mental disease, proving possibly that the narcotism was due to 
idiosyncracy, hereditary or acquired, and having no direct connection 
with the disease itself. CASES OF NARCOTISM. 
91 
who has been identified with this subject for years, 
having drawn up the report of the Medico-Chirugical 
Society’s committee on the hypodermic injection of 
morphine, writes me in answer to my 3d question: 
“ One grain of morphiae acetat. is the largest dose 
I ever gave (in a case of severe delirium tremens 
which had resisted previous smaller doses). . I don’t 
think I should care to repeat the experiment as the 
effects were alarming, but the case rapidly recovered 
after these passed off.” 
In the report 1 of the committee of the Medico- 
Chirugical Society, a case of delirium tremens is 
narrated where 1 grain of morphia subcutaneously 
(smaller doses, gr., having failed on the preceding 
night) produced profound narcotism, the respiration 
being greatly lowered. At one time death was mo- 
mentarily expected. 
Dr. L. D. Knott, of Bradfordsville, Ky., writes me: 
“ I have had no deaths, but have seen alarming 
symptoms from it.” I have written the doctor for 
fuller particulars, but have thus far received no reply. 
Dr. M. E. Woodling, of North Branch, Minn., 
writes of two cases. The first was probably one of 
injection into a vein, and will be given under that 
heading. The other case is as follows: “ A case of 
acute double pleuro-pneumonitis attended with much 
1 “ Medico-Chirugical Transactions,” vol. 50. 92 
HYPODERMIC INJECTION OF MORPHIA. 
pain. I twice attempted to relieve it by the hypo- 
dermic injection of gr. morphiae sulphat., but the 
pulsations and respirations would become feeble and 
irregular, necessitating its discontinuance before any 
impression was made on the pain.” This case, with 
the next and some others that I shall give, seem to 
bear out the statements of Fothergill,1 that morphia 
is a dangerous drug to use in cases of embarassed 
breathing, due to organic lesion. Against his asser- 
tions, however, stand the observation of M. Latil2 
and others. 
Dr. G. H. Lathrop has very kindly furnished me 
with the full details of the following interesting case: 
Some three years before the date of writing, he was 
called to see Mrs. M , aged 40, of nervous tem- 
perament and usually in good general health. Occa- 
sionally suffers from neuralgic headache. The doctor 
found her with acute pleurisy, the pain being very 
severe. He gave a very small quantity (amount not 
stated) of morphia hypodermically. Patient com- 
plained of being faint and looked very pale. In five 
minutes she was free from pain and made a rapid 
recovery. Some two years after, morphia was given 
by the mouth in large doses, to relieve the pain of 
1 “ Antagonism of Therapeutic Agents,” Phila. 1878, pp. 55 11. 
2 “Des Injections Hypodermiques de Morphine dans les Dysp- 
nees,” La France Medicale, No. 11, 1879. CASES OF NARCOTISM. 
93 
neuralgic headache, and without any ill effects. In 
1878, the same lady had another severe attack of 
acute pleurisy. As the stomach was very irritable, 
the doctor again resorted to the use of morphia hy- 
podermically. “ Within one minute after injecting 
the morphia, the patient lost all color in face and lips 
and was completely prostrated. , She was all the 
time conscious but unable to articulate. Breathing, 
slow and irregular. No pulse at the wrist for several 
minutes. Examination of the heart failed to dis- 
cover the first sound, showing that it was affected in 
systole. With the appropriate remedies she rallied 
from this apparently dying condition and made a 
slow recovery. . I am sure that if I had given this 
lady y gr., or even any larger than y of a grain, 
hypodermically, she would have died.” The doctor 
explains the ill effects of the drug on the ground 
“ that the relief from pain was so sudden, with proba- 
bly an effect so instantaneous on the cardiac nerves 
proper, would produce the collapse of the patient.” 
I am inclined to believe that, in the last instance, 
at least, the injection was made directly into a vein, 
and that the case belongs more properly under the 
head of syncope. 
It is possible that the symptoms may be explained 
on the ground that they were due to the operation of 
inserting the needle, the patient being evidently 94 
HYPODERMIC INJECTION OF MORPHIA. 
very nervous. I give it here, however, to act as a 
companion to the last case and possibly add weight 
to the views of Fothergill. Brown-Sequard,1 quoted 
by Dr. H. L. Harrington,2 relates a case where a pa- 
tient, who was to be bled, fainted at the first prick of 
the lancet. “ The heart ceased to beat and the limbs 
seemed to be dead. The patient was called to life with 
the greatest difficulty. Death would have occurred if 
the most energetic means had not been employed 
immediately.” Brown-Sequard’s paper in the Ar- 
chives de Physiologic3 will also repay careful study 
in this connection. The experience of most of my 
correspondents is in direct opposition to such views, 
as also are the observations of Dr. Edward Smith4 
and others, already quoted. 
J. C. Murphy, L. R. C. P. & S., E., &c., of Dublin, 
writes me : “ I have found gr. the average dose. 
Some were very tolerant of the drug while others 
showed great susceptibility to its action. Two ex- 
amples of the latter: Case 1.—An old lady who 
was suffering from acute (rheumatic) pain at inser- 
tion of the deltoid, I administered j4> gr. without 
atropine. It was followed by headache, furred 
tongue, thirst and partial stupor. Case 2.—To re- 
1 Chicago Med. yournal and Examiner, May, 1878, p. 452. 
2 Ibid, July, 1878. 
3 Boston Med. and Surg. yournal, Dec 30, 1869 
4 London Lancet, Jan. 26, 1856. CASES OF NARCOTISM. 
95 
lieve the pain of pleuritis. It was administered to 
keep the patient in hand, the agony being very great. 
I gave y2 gr. on this occasion. It acted as an over- 
dose and I had difficulty in arousing the patient. She 
subsequently died of double pleuro-pneumonia.” 
Dr. Murphy is of the opinion that atropine in 
small doses, with the morphine, modifies the more 
unpleasant effects of the latter, and lessens the danger 
of stupor. This is quite in accord with the conclu- 
sions of Bartholow1 and of Mitchell, Keene, and 
Morehouse2 so far, at least, as stupor is concerned. 
“ Medical Student ” 3 in his strictures on a case of 
opium poisoning seems to misunderstand Dr. Bar- 
tholow in this connection. 
Dr. Sami. W. Francis, knows of two cases of deep 
narcotism from the use of morphia hypodermically, 
but can give me no details, as the cases occurred in 
the practice of others. 
•Dr. B. H. Detwiler writes me : “ No deaths. On 
one occasion I repeated the injection and came near 
narcotising the patient. Used aromatic spirits of 
ammonia hypodermically in half drachm doses with 
signal benefit.” Dr. Detwiler does not say how 
much morphia was given at each injection, but states 
1 ei Hypodermic Method,” Phila., 1879, pp. 44, 129, 130, and 135. 
2 American Journal Med. Sciences, July, 1865. 
3 North Carolina Med. Journal, Sept., 1879, p. 170. 96 
HYPODERMIC INJECTION OF MORPHIA. 
in reply to my first question that his usual dose is 
from to gr. I have written to the doctor ask- 
ing full particulars, but have, as yet, received no re- 
ply. 
Dr. Geo. A. Foote, of Warrenton, N. C., late 
President of the Medical Society of that State, and 
who has an able and interesting article on the subject 
of hypodermic medication in the Society’s Transac- 
tions for 1877, writes me in reply to questions: 
“ Never had any deaths or accidents. In one case I 
reduced the respirations to 4 per minute. The patient 
rallied kindly under the hypodermic use of whiskey 
and strong coffee.” 
Dr. Robert McNutt, of Rocheport, Mo., writes me: 
“ I gave at one time a grain of the acetate in a case 
of intractable gastralgia from the long and excessive 
use of tobacco, and had some alarming symptoms 
which by the use of strong coffee passed off in eight 
hours.” 
Dr. C. S. Pixley, of Elkhart, Indiana, reports to me 
a case of intense narcotism in a robust farmer, aged 
55, who was suffering excruciating pain due to the 
passing of a gall stone. The doctor gave y2 gr. sub- 
cutaneously, followed in half an hour by the same 
amount. The patient was eased and had no un- 
pleasant symptoms. This was in October. The fol- 
lowing June, the patient had another attack, and Dr. CASES OF NARCOTISM. 
97 
Pixley, knowing the amount the man had taken be- 
fore, gave him 1 grain hypodermically. Very deep 
narcotism soon followed. Artificial respiration was 
kept up steadily from 1 A. M. to 7 A. M., other 
means being used also, and the patient was at last 
pronounced out of danger, he remaining unconscious 
for 24 hours. The doctor explains the narcotism 
here shown, in this way: “The reason of this con- 
duct was, that during the past 10 months patient 
had had no attacks, (passage of gall stones) and con- 
sequently had no treatment and the tolerance of the 
drug, established when I last saw him, was gone.” 
The patient had in former attacks been in the hands 
of an old physician, who had procured relief of pain 
only by giving very large doses of morphine, chloral, 
etc., by the mouth. The patient was permanently 
cured by the last injection; at least he has had no 
attacks since.” 
This case and that by Dr. McNutt illustrates forci- 
bly the danger of using large doses. One grain, 
thus given, is a dangerous dose even when there is 
no idiosyncrasy. 
At a meeting of the Suffolk District Med. Society 
of Boston,1 Dr. Fifield said “ that he had seen very 
nearly fatal results from gr. to gr. (of morphia 
used hypodermically), notably in one case at the City 
1 Boston Med. and Surg. youmal, Nov., 1876. 98 
HYPODERMIC INJECTION OF MORPHIA. 
Hospital, where the battery had to be applied all 
night to keep the patient alive.” 
Dr. E. Fletcher Ingals, to whom belongs the credit 
of first making an effort to collect facts upon this 
subject and get at the truth in the matter, writes in 
the Chicago Medical Journal and Examiner,l giving 
the results of fifty-five replies to circulars containing 
questions as to death, syncope, usual dose, etc. That 
part of his article relating to death will be fully no- 
ticed hereafter. With reference to narcotism, one of 
his correspondents writes : “I am chary of the use 
of the syringe; using it when demanded—dose, 
yi gr. Largest dose ever ventured on was gr., in 
violent colic. The patient was asleep in one minute 
and did not awake for 16 hours. No bad results.” 
It would be interesting to learn whether this sud- 
den effect was not due to the entrance of the drug 
directly into a vein. 
Another writes him : “ I have seen unexpectedly 
severe effects on several occasions. I do not give 
morphia in that way when I can give it by the sto- 
mach. The cases that I speak of were simply severe 
ordinary effects of the medicine.” 
And another: “ In one case the patient slept 24 
hours. The dose was only of a grain.” 
Dr. Richard McSherry, Prof. Theory and Practice 
i May, 1878. CASES OF NARCOTISM. 
99 
of Med. in the University of Maryland, Baltimore, 
writes me: “Have seen narcotism, somewhat alarm- 
ing, upon repetition of full doses but 
never a fatal result.” 
And again: “ I send answers above to your ques- 
tions, which are upon a matter of great importance. 
I certainly meet with subjects from time to time who 
bear opium very ill, or not at all. In some instances 
there is no means of knowing their susceptibilities be- 
fore the experimentum crncis. Some subjects bear it 
very badly in some conditions, or at certain times; 
and the same people bear it well enough when changes 
occur with the progress of years, or under some alter- 
ed conditions sometimes appreciable, at other times 
inappreciable.” 
Dr. E. Wenger,1 of Gilman, 111., vouches for the 
following case: “An old gentleman was suffering with 
rheumatism ; he was attended by a promising young 
physician who had gained some notoriety by the use 
of the hypodermic syringe. He injected morphine 
on this occasion, and in a few minutes became alarm- 
ed at the condition of his patient. He at once sent 
for another physician, who, on his arrival, learned 
the conditions of things. Noble-hearted man that 
he was, to save the young man’s reputation, he pro- 
nounced it a case of apoplexy. By prompt and 
1 Chicago Medical Journal and Examiner, Aug. 1877. 100 
HYPODERMIC INJECTION OF MORPHIA. 
persevering treatment, he succeeded in saving the 
old man’s life. He then advised the young man in 
a friendly way, to be a little cautious how he used 
the squirt in the future.” 
These cases of narcotism from doses of morphia 
that are not considered at all large by many of my 
correspondents and various writers upon this subject, 
are not all that are recorded, and certainly not all that 
have occurred Their number* is sufficient, however, 
to bear out the truth of the statement made in the 
early part of this chapter, that the commencing dose 
of this drug should be a very small one, thus testing 
the idiosyncrasy of the patient, and that the amount 
should be very gradually increased, if an increase is 
necessary. This caution has been urged by many 
authors, notably Anstie, Harley, Maudsley and Bar- 
tholow, and has been systematically disregarded by 
the bulk of the profession, to the end of throwing 
discredit upon, and creating distrust of a method, 
that in proper cases and properly used, has proved 
itself of the utmost value. 
It is worthy of note that in these cases the morphia 
was used alone, in spite of the fact that atropia in 
small doses is thought by many authors to permit of 
larger doses of morphia being used with safety. (See 
chapter on Atropia and Morphia). CASES OF NARCOTISM. 
IOI 
I consider it highly probable, furthermore, that 
the use of morphia, even in moderate doses, in cer- 
tain diseases, to be spoken of more fully in the chap- 
ter on death, is extremely hazardous. These are 
delirium tremens, acute mania, that class of acute 
pulmonary affections where the tendency is to death 
by the lungs, and in some forms of acute and chronic 
nephritis. CHAPTER IV. 
INJECTION INTO A VEIN—ALARMING SYNCOPE— 
DEATH—RAPID ABSORPTION—TOURNIQUET. 
Articles have from time to time appeared in 
various medical journals, at home and abroad, de- 
tailing certain alarming symptoms following imme- 
mediately upon the injection, subcutaneously, of 
moderate doses of morphia. Such accidents have 
been ascribed by most authors to the entrance of the 
needle into a vein, with the consequent sudden 
passage of the drug into the circulation; by some to 
the injection of a bubble of air into a vein ; by others 
to fright attendant upon the dread of the operation 
and the prick of the needle ; and by still others to the 
rapid absorption of the remedy when a vein is not 
punctured. Which of these hypotheses is the cor- 
rect one it is at present difficult to decide; per- 
haps each may have proved a factor at certain times 
or in certain cases. The weight of opinion would 
seem to favor the idea of sudden entrance of the 
drug into the circulation by puncture of a vein. 
By a careful study of some of these cases we may 
be able to come to a definite conclusion. CASES OF SYNCOPE. 
103 
Dr. M. E. Woodling, of North Branch, Minn., 
writes, in answer to my fifth query: “No deaths. 
My first case in which the hypodermic injection of 
morphia was tried resulted as follows: Patient large, 
strong and robust-looking man. Complained of pain 
in the course of the sciatic nerve, and of lumbago. 
Injection given back of the trochanter major, patient 
sitting; given slowly. I turned to lay the syringe 
on the table, when the patient appeared unsteady, 
straightened rather rapidly and persistently, and 
slipped from the chair, falling full length, supine, 
upon the floor, pale and with absent respiration. He 
was now perfectly limp. No response to shaking or 
questions. Spoke the word ‘ breathe ’ loudly in his 
ear. This he obeyed. Repeated this for about a 
minute, and in another he was able to sit up, but was 
very sleepy and unsteady, requiring assistance. In 
about five minutes he was able to stand, and I took 
him out on the street and walked around with him 
for an hour. I then took him home, still sleepy, but 
improving. The next morning he was all right, but 
the pain was only partially relieved. Other injec- 
tions were given with no bad consequences.” 
Dr. A. Atkinson, Prof. Materia Medica, Coll. Phy- 
sicians and Surgeons, Baltimore, in reply to my fifth 
query, writes: “ Never had death to result, and but 104 
HYPODERMIC INJECTION OF MORPHIA. 
one accident, and that was apparent suspension of 
animation for about fifteen minutes in a young lady, 
very anaemic, in whose case I injected gr. of 
the sulphate of morphia (the regular Magendie’s 
solution) into the rectus muscle of the abdomen, at 
the repeated and urgent entreaties of the patient, to 
relieve an obstinate uterine neuralgia. She recovered 
from the neuralgia and from the effects of the mor- 
phia in three-quarters of an hour. I had, a year 
before, injected gr. into the arm of this same 
patient for cardiac neuralgia, with complete relief of 
the pain in one hour, and with no bad effects.” 
Dr. Geo. E. Jones, of Cincinnati, has kindly writ- 
ten me and inclosed an article1 of his, bearing directly 
upon this subject. In it he says: “ Did the needle 
enter an abdominal vein ? Several times. The first 
time I became somewhat alarmed; the patient at 
once threw up her arms, complained of suffocation, 
giddiness, excessive fatigue, a severe tingling sensa- 
tion following the course of the circulation. The 
countenance was at first livid, then flushed; the eyes 
became unusually brilliant; slight muscular twitch- 
ings, profuse sweating, with cold extremities, and in 
a few moments complete relaxation was followed by 
1 “Some Observations on the Deep Injection of Morphia,” Cin- 
cinnati Lancet and Clinic, Aug. io, 1878. CASES OF SYNCOPE. 
I°S 
deep sleep, which lasted only four hours, when she 
awakened, feeling, as she expressed it, ‘ ever so much 
better.’ 
“The same accident occurred three times, the 
symptoms much milder, with the exception of a burn- 
ing sensation of both eyelids of either eye and both 
lips, which at one time became painfully intense. 
The above symptoms were produced by an injection 
of five grains of sulphate of morphia into an abdom- 
inal vein. 
“ Being unable to see her for a day or two, I re- 
quested my friend, Dr. Geo. E. Walton, who had 
watched the case with a good deal of interest, to call 
and give her an injection of two grains, when she put 
both hands to her head and gave a cry of excru- 
ciating agony. A sharp pain darted through her head, 
which lasted ten or fifteen minutes; also complained 
of an intense itching of nose and lips, finally passing 
off, leaving no deleterious effects. The same acci- 
dent occurred to myself, only in a less degree. 
These injections were also made in the abdomen.” 
The patient was a German woman, aged 37, and 
weighing about 135 lbs. The case was presumably 
one of faecal accumulation in the colon, with severe 
abdominal pains. 
Dr. W. A. Neal, of Dayton, Michigan, writes in 
this connection, as follows: “ No deaths; the only 106 
HYPODERMIC INJECTION OF MORPHIA. 
accidents were where a vein was punctured. This 
produced dyspnoea, great distress, and was usually 
followed by a chill and the reaction by fever; but in 
every instance there has been but one chill, and fever 
once lasting three or four hours.” 
Edward T. Wilson, M. B. Oxon, F. R. C. P., Lond., 
who has a valuable and interesting article on the 
subcutaneous injection of morphine in the St. 
George’s Hospital Reports for 1869, writes me as 
follows: “ Never either death or accident. Noth- 
ing beyond a temporary feeling of faintness, and on 
two occasions a temporary outburst of urticaria, 
which soon passed away.” I hardly think these 
phenomena were due to injection into a vein, the 
writer not endeavoring to account for them on this 
ground. They partake more of the nature of rapid 
absorption with some idiosyncrasy. Dr. E. C. 
Seguin makes mention in the New York Medical Re- 
cord of a lady thus affected (urticaria) by any pre- 
paration of opium taken by the mouth. 
Arthur R. Graham, M. D., etc., of Weybridge, 
England, sends me the following interesting and con- 
clusive case: “ No deaths, but one alarming acci- 
dent worth recording—I had injected a large dose 
(probably gr.) into the right forearm of a woman 
whom I was in the habit of injecting daily. Almost CASES OF SYNCOPE. 
107 
immediately she started up, and holding up her left 
hand and looking at it, exclaimed ‘ Oh ! how funny 
my fingers feel! ’ and fell back in a dead faint, with 
blanched lips. I immediately bound a tape tightly 
around the arm, above the puncture, and then gave 
brandy and asafoetida injections, but she remained 
unconscious, I think, for more than half an hour. 
After she was sufficiently recovered to talk rationally 
I loosened the tape, when she immediately fainted 
again. Of course I at once tightened the ligature 
and kept it so for some hours. The second swoon 
was less alarming than the first. In the first, no 
pulse could be felt, nor could the heart sounds be 
heard excepting with great difficulty. My impres- 
sion at the time was that, had I not applied the liga- 
ture at once, I should have had a fatal result to 
chronicle. It was the impulse of the moment to tie 
on the tape, and had I had time to reason I should 
have rejected the idea as an entirely useless one; but 
in any similar emergency I should now recommend 
any one to try it.” 
Dr. E. Fletcher Ingals, 1 who has devoted much 
attention to the hypodermic injection of morphia, 
reports the following case: “ I have often used hy- 
1 Chicago Med. Journal and Examiner, Aug., 1877. io8 
HYPODERMIC INJECTION &E MORPHIA. 
podermic injections of morphia, and always with good 
results, until a few weeks since, when I obtained 
alarming results from the administration by this 
method of one-fourth of a grain of morphia. 
“ The patient, in consequence of continuous watch- 
ing with sick children, had become debilitated, and, 
as a result, suffered at times from severe pains of a 
neuralgic character. I was called in the night to see 
her in one of these attacks. The pain had com- 
menced about twelve hours previously, and with 
frequent exacerbations, had steadily increased in se- 
verity until it had become unbearable. 
“ I dissolved one-fourth of a grain of morpkia in 
pure water, and administered it under the integu- 
ments on the outer side of the arm. Within a few 
seconds the breathing become stertorous, the pulse 
failed, the lips and countenance became livid, and the 
eyes were set; respiration ceased, the radial and 
cardiac pulsations were lost, and the heart sounds 
could not be distinguished. The woman was to all 
appearances dead. How long this condition con- 
tinued I cannot teli; it seemed an age, but was prob- 
ably only ten or fifteen seconds, for by prompt 
means I succeeded in resuscitating my patient. 
“After a few minutes she expressed herself as mud 
relieved. I remained with her some time, and then CASES OF SYNCOPE. 
109 
left careful directions with the husband in case any 
other unfavorable symptoms should occur. During 
the next few hours the patient fainted twice, but she 
was restored by dashes of cold water in the face.” 
Dr. H. L. Harrington, of Little York, 111., refers 
me to the report of a case1 of his, which reads as fol- 
lows : “ Was called a short time since to treat W. 
S , male, aged 62, for acute dyspepsia (bilious 
attack) accompanied by very severe pain. Admin- 
istered hypodermically, in the hypogastric region, 
morphiae sulph. 0.02 gram. Before the syringe was 
emptied alarming syncope supervened, and occurred 
twice, at intervals of ten or fifteen minutes. Stimu- 
lants administered freely, artificial respiration and the 
use of electricity were successful in reviving the 
patient. Neither narcotism nor coma were in any 
degree present. Is it possible to attribute the syn- 
cope to the effects of the drug ? Not over fifteen 
seconds were occupied in the operation.” I think 
this an excellent example of the puncture of a vein 
with entrance of the drug directly into the circulation. 
Dr. Aug. M. Tupper, of Rockport, Mass., pub- 
lishes the following interesting case:2 
“ On the morning of the 22d ult. I was called to 
1Chicago Med. Journal and Examiner, April, 1879. 
2 Boston Medical and Surgical Journal, Oct. 30, 1879. no 
HYPODERMIC INJECTION OF MORPHIA. 
see Mr. G., who was stopping at one of our hotels. 
I found a healthy-looking young man, about thirty 
years old, suffering from lumbago, confined to his 
bed, and in considerable pain, aggravated very much 
by movement. Applications of mustard and an ano- 
dyne liniment were prescribed. In the evening I 
called again, and as the relief was slight, decided to 
inject some morphia directly over the seat of pain, a 
method I have found very efficacious in similar cases. 
Accordingly I injected nine drops of a solution of 
sulphate of morphia, one grain to a drachm of water, 
into a spot midway between the spine and crest of 
the ilium. As is my custom, the solution contained 
one drop of carbolic acid, which I added in order to 
keep it. In five minutes he expressed himself as feel- 
ing relieved, and sat up in bed to show us the im- 
provement. I told him to lie down and keep still 
awhile, and he did so. We chatted pleasantly for 
perhaps five minutes longer, when, turning towards 
his wife, he said, ‘ I think I am going to vomit,’ and 
turned to the side of the bed. I noticed that he 
looked a little pale, and before Mrs. G. could get the 
basin he grew deadly pale, his eyes rolled up in his 
head so that only the whites were visible, the jaws 
were clenched, the head was drawn back, and the 
whole body stiffened, respiration ceasing also. I im- 
mediately went to him, dashed cold water in his face, CASES OF SYNCOPE. 
Ill 
and took the wrist to feel his pulse, which, to my 
horror, was not to be felt. He was in this state for 
perhaps a minute. I then raised him up, and look- 
ing into his eyes, which were staring wide open, saw 
that the pupils were widely dilated. Very soon the 
color began to return to his face, he was drenched 
with perspiration, and recovered consciousness. I 
laid him back on the bed, and he looked up, smiled, 
and said, ‘I’m all right now.’ The pulse was quite 
full at sixty, but inclined to be irregular. I gave him 
brandy freely, and he had no further trouble, but the 
pulse remained at sixty for the next twenty-four 
hours; he said it was usually about eighty. I cannot 
verify that, for he left town the following day. 
“That was certainly a very unusual effect from 
such a dose, a little over one-eighth of a grain. The 
question arose in my mind whether the acid could 
have had anything to do with it; but I have given the 
same mixture a great many times without the 
slightest trouble. I may add that the solution was 
prepared that morning, anji I injected the same dose 
into the same part of the body, for neuralgia, in a 
female patient that very same day, previous to using 
it on this patient. I should not care to repeat this 
operation on Mr. G., and advised him never to have 
it done again. I would also state that it relieved his 112 
HYPODERMIC INJECTION OF MORPHIA. 
lumbago, for the next afternoon he was dressed and 
down at his meals.” 
After seeing the report of this case I wrote Dr. 
Tupper, who has courteously furnished me with the 
following additional facts: “ My patient, I should 
say, was of a phlegmatic temperament. He had 
taken no medicines by the mouth before I saw him, 
nor while under my care. He had never taken any 
narcotic in his life, he says. The pupils were natural 
very soon after the effects of the dose ceased. He 
writes me that his pulse remained at sixty for a 
week, but that he felt first rate. Pulse rate since 
then has been seventy-six. It seems to me that it 
must have been a peculiar susceptibility to the drug 
in his case, else it would not have had such a lasting 
effect upon the pulse. I do not think it was due to 
the mode of administration. He related to me after- 
wards that a cousin (I think that was the relation) 
had very peculiar and even dangerous symptoms 
from a dose of Dover’s powder, some time ago, and 
that the physician in attendance was detained all 
night in consequence. This would go to show an 
idiosyncrasy in the family.” 
I think that the doctor is right with reference to 
idiosyncrasy, but I think, also, that the method of 
administering the drug had much to do with it. As 
I have said before, where an idiosyncrasy, be it to CASES OF SYNCOPE. 
113 
narcotism or any other peculiar manifestation, exists, 
the sudden entrance of the drug into the system is 
certain to aggravate those symptoms; may, indeed, 
call forth an idiosyncrasy that the drug given by the 
stomach would, possibly, never have revealed. The 
fact that some ten minutes elapsed between the time 
of the injection and the first appearance of the 
alarming symptoms seems to preclude the idea of the 
needle having entered a vein. The symptoms are, 
however, exactly those that are seen when a vein is 
punctured. As will be seen from the results of ex- 
periments soon to be recorded, and from the conclu- 
sioris arrived at by the Committee of the Medico- 
Chirugical Society1 of England, five minutes is 
abundant time for enough of the drug to be ab- 
sorbed to produce its characteristic, and, therefore, 
its unusual effects, where idiosyncrasy exists. 
Prof. H. C. Wood 2 states that he has seen deep 
coma produced in three minutes by a hypodermic 
injection of morphia. This may have been due to un- 
usual rapidity of absorption from the cellular tissue, 
or to direct injection into a vein. 
Here is a somewhat similar case :3 A lady, aged 24, 
who had been a sufferer from neuralgia every day 
for months, was given a hypodermic injection of 
1 “ Medico-Chirurg. Society Trans.,” vol. L. 
2 “Materia Medica and Therapeutics,” Phila., 1877, p. 205. 
3 “ Medico-Chirurgical Transactions,” vol. 50. 114 
HYPODERMIC INJECTION OF MORPHIA. 
gr. of the hydrochlorate of morphia in the sub- 
cutaneous tissue of the leg. Alarming syncope and 
extreme prostration came on within five minutes 
after the injection was made. The patient was not 
out of danger for four hours after, and was too ill to 
leave her bed for two weeks. The neuralgia did not 
return for some months.” 
Dr. Francis H. Miller, of East New York, formerly 
House Surgeon of St. Peter’s Hospital, Brooklyn, 
writes me: “ Several times, when, I suppose, my 
fluid entered some small vein, the patients com- 
plained of sudden weakness, faintness and dizziness, 
and almost syncope.” 
Dr. Samuel W. Francis, of Newport, R. I., writes 
me: “ I have heard of two or three cases where ex- 
treme syncope set in, the patients being restored 
only with great difficulty.” 
Dr. J. S. Jewell, Professor of Nervous and Mental 
Diseases, Chicago Medical College, writes me: “ I 
have never had any serious consequences follow 
morphia injection, but have seen temporary un- 
pleasant symptoms (vaso-motor disturbances), vertigo, 
mental confusion, &c., a few times.” 
Dr. Geo. R. Fowler,1 of Brooklyn, states that he 
has twice had alarming symptoms from puncturing 
a vein. He believes that this may be avoided by 
1 N. Y. Medical Record, Aug. 15th, 1874. CASES OF SYNCOPE. 
115 
making the skin of the part to be punctured, tense, 
and introducing the needle at a right angle with the 
axis of the limb. 
Prof. Nussbaum,1 of Munich, has published an 
interesting account of an accident that happened 
to himself. He had made use of the hypodermic 
method of giving morphine to himself, as often as 
2,000 times; using sometimes as much as 5 grains 
of morphia at an injection. One day he accidentally 
injected 2 gr. of the acetate of morphia into a vein 
and did not recover from the dangerous effects for 
two hours. He has seen the same symptoms, in a 
less degree, In two of his patients. He advises slow 
injecting, and withdrawal of the piston if a vein is 
punctured. 
The following interesting remarks are clipped from 
an English journal2 and bear directly on the question 
in hand : 
“‘Observer’ remarks that ‘Spectator,’ in the 
Journal of April 12th, very accurately described what 
always happens when a vein has been pierced and 
morphia injected into it, although he might have 
added (as no doubt it occurred) that the person in- 
jected also experienced a strong taste of morphia; 
and probably, also, an unusually large quantity of 
1 Med. Times and Gazette, Sept. 23, 1865. 
* British Medical Journal, May, 1879. 116 
HYPODERMIC INJECTION OF MORPHIA. 
blood flowed from the puncture. It is a very serious 
accident to inject morphia into a vein, but it need 
never happen, if the operator, thrusting the instru- 
ment under the skin, will draw up the piston, when, 
if the point be in a vein, blood will be drawn into 
the syringe. ‘ Observer ’ knows a gentleman who 
for years has been in the habit of injecting himself 
with morphia three and four times a day, to whom 
the accident has frequently occurred, accompanied 
by the symptoms described by ‘ Spectator.’ He is 
very alarmed at the time, and is afterwards careful to 
draw up his piston, but in three or four months he 
begins to be less cautious, until he gets another 
reminder. As to the necessity of drawing up the 
piston, there cannot be two opinions; for besides 
the-symptoms certain to follow the introduction of 
morphia directly into a vein, there is the danger 
of air entering as well, should care not be taken to 
prevent it. ‘ Observer ’ has known an habitual 
morphia-taker by injection to contract albuminaria. 
The albumen would greatly diminish on the daily 
quantity of the injection being lessened, and entirely 
disappear in forty-eight hours when the morphia was 
wholly discontinued. 
“ ‘ Injector ’ was, until very lately, for nearly two 
years, one of the victims of morphia, and during 
that time he five times thoroughly, and twice par- CASES OF SYNCOPE. 
117 
tially, experienced more or less of the horrible 
symptoms sketched by ‘ Spectator ’ in the Journal 
of April 12th. The sensations were as follows : i. A 
dull gnawing pain in some decayed teeth, accom- 
panied by a metallic taste in the mouth ; 2. A prick- 
ling and tingling of the forehead and cheeks, some- 
what like prickly-heat; but this soon increased, 
spreading to the ears, neck, arms, and chest (but 
not below the waist, although the morphia was in- 
jected into the calf of the leg). This pain soon be- 
came almost unbearable, but it was entirely eclipsed 
by what ‘ Spectator ’ calls ‘ throbbing,’ but which 
‘Injector’ says would be better represented by 
imagining twenty blacksmiths confined in his head, 
with each an India-rubber-headed sledge-hammer, 
and each trying to make the best of his way out. 
Imagine, at the same time, that you are suffering 
from the first-mentioned broiled feeling; that your 
skin feels as if about to burst; your eyes as if al- 
ready started from their sockets; your lips as if 
they did not belong to you—then you may have 
a faint idea of what ‘ Spectator ’ wishes to describe, 
and what I, who have five times felt it, yet feel 
powerless to lay before you as I ought.’.’ He had 
always thought that this condition was caused by, i. 
Too rapid injection ; 2. Too much at once ; 3. The 
solution being too strong; and, 4. By its being in- 118 
HYPODERMIC INJECTION OF MORPHIA. 
jected directly into a tolerably large vein. When the 
symptoms have occurred, he has always noticed that 
injection has taken place at one of two spots—prob- 
ably into the same vein each time in each leg—one 
on each leg. Again, it only occurred when he had 
to inject a large quantity in a short time ; and he 
always used a very strong solution of acetate of 
morphia (forty grains to the half-ounce of water). He 
advises that, when one feels any of the symptoms 
coming, he should walk about as rapidly as he can. 
He has relieved his worst attacks in this way, and 
has warded off others by violent exercise in his room 
as soon as he felt the pain in his teeth, or the 
metallic taste of the “ prickly-heat.” He thinks 
that corroboration of his belief as to the cause of 
the symptoms is afforded by Dr. Pepper’s description 
of the results of injecting milk into the veins of 
anaemic patients. 
The case referred to by “ Observer ” reads as fol- 
lows :x “ Scarcely has the fluid left the syringe when 
the most intense feeling of irritation and prickling is 
felt in the skin, spreading from the puncture rapidly 
all over the body. At the same time the skin be- 
comes suffused with a bright blush. The heart’s 
action then becomes greatly quickened, and there is 
a throbbing, rushing feeling through the head. The 
1 British Medical Journal, April 12, 1879. CASES OF SYNCOPE. 
ii9 
hands are somewhat swollen and the lips get a glazed 
appearance. In one case that I had, the patient be- 
came suddenly unconscious, as if knocked down by 
the sudden shock; and in all the cases where these 
symptoms have appeared the general disturbance 
has been very great and the attack of a severe 
character. The symptoms generally subside gradually, 
leaving behind great pain in the head.” 
This gentleman gives these as the main symptoms 
of several such accidents that have occurred in his 
practice, and characterizes their occurrence as some- 
thing novel and important. 
Dr. J. A. Houtz,1 of Logansville, Penn., who is a 
staunch advocate of the hypodermic method, says: 
‘•The greatest danger is in injecting into a vein suf- 
ficiently large to carry the whole dose at once into 
the circulation. That can be avoided by selecting 
a place where the large veins are least numerous, and 
by injecting, say a third of a dose and then waiting 
eight or ten seconds, when, if in a vein, the symp- 
toms will show themselves. The first symptoms 
are a feeling of great fullness of the head and in- 
tense flushing of the face, coming on within a few 
seconds after the operation. Such, at least, was the 
case in a patient of mine.” 
A case of syncope and prostration is reported by 
1 Philadelphia Med. and Surg. Reporter, Oct. iS, 1879. 120 
HYPODERMIC INJECTION OF MORPHIA. 
Dr. E. Wenger, of Gilman, 111. The amount of 
morphia used is not stated. 
F. Woodhouse Braine, F. R. C. S., &c., publishes 
the following case:1 “Mrs. H. C., aged thirty-five, in 
good health otherwise, had been kept awake seventy- 
two hours by intense neuralgic pain on left side of 
head, face and neck, arising from a carious molar 
tooth on left side of lower jaw. She was injected 
with morph, acetat. gr. At 1 A. M. on June 28 
last, the morphia, dissolved in about four drops of 
water, was introduced under the skin of the left arm, 
just over the insertion of the deltoid. No blood 
appeared at the puncture. In about fifteen seconds, 
tightness of the chest and difficulty in breathing was 
complained of, and the patient asked to be raised, 
saying she felt as if she was dying. Her face and 
lips now became pale ; speech became indistinct (not 
inaudible); pulse irregular; some spasm of the facial 
muscles took place, and she fell, to all appearance, 
dead. Cold water was freely dashed over her face 
and chest, and as she was unable to swallow, her 
tongue was rubbed over with sal volatile, and am- 
monia applied to her nose, artificial respiration 
being kept up at the same time. During this time 
her face was blanched, pulse not to be felt, and res- 
piration not to be perceived. Insensibility continued 
1 Med. Times and Gazette, Jan. 4, 1868, p. 8, CASTS OF SYNCOPE. 
121 
for about three minutes; then, happily, one or two 
feeble beats of the pulse, and a shallow inspiration or 
two, showed returning animation. She then became 
conscious; pulse feeble but regular; respiration 
slow; fingers remained numbed, and both thumbs 
were firmly drawn into the palms of the hands. 
This passed off in about six minutes, leaving her feel- 
ing very ill, but free from the neuralgic pain, which 
did not return. There was no feeling of nausea, 
and no attempt at vomiting during any part of the 
time.” 
Mr. Arthur Roberts1 publishes the following cases: 
“Sir:—fhe case described by Mr. Braine, in your 
last week’s journal, of an unusual effect of sub- 
cutaneous injection is what I have seen in two in- 
stances, but nothing like to such an alarming extent. 
One was in a gentleman whom I had injected several 
times previously, the other in a lady. I have also 
partly noticed it when I have injected myself. In 
the first case, a few minutes after the operation, the 
face became intensely flushed; this was followed by 
vomiting, and then a dead faint and struggling for 
breath, the pulse scarcely perceptible. These cases, 
and the effect on myself, taught me, when injecting a 
patient for the first time, never to give more than the 
sixth of a grain—wait a quarter of an hour longer, 
1 Medical Times and Gazette, Jan. n, 1868, p. 53. 122 
HYPODERMIC INJECTION OF MORPHIA. 
and then give the remainder of the dose, after ascer- 
taining how the first injection was taking effect. 
Women, I have found, are generally bad subjects for 
subcutaneous treatment; for they get frightened and 
nervous—in fact, one woman told me that though 
the morphia taken by the skin did her more good 
than by the mouth, yet she preferred the latter, for 
the instrument frightened her. I have used my 
needle over 300 times, and I have always noticed 
one fact—that if the wound bleeds after the opera- 
tion the morphine enters the system much more 
powerfully and rapidly; and I always know when it 
is going to bleed, by the operation giving a good 
deal of pain. When this is the case I withdraw the 
instrument, to see if the puncture bleeds; if it does, 
I try a fresh place.” 
Bartholow,1 in his useful and able little work, calls 
attention to this danger in these words: “ In prac- 
tising the hypodermic injection it is important to 
avoid puncturing a vein. Serious depression of the 
powers of life, fainting and sudden and profound 
narcotism have been produced by injecting a solu- 
tion of morphia directly into a vein. Fatal collapse 
might be induced by injecting air into a large vein, 
along with the solution.” 
Syncope, &c., as we have seen, from this cause, is 
1 “The Hypodermic Method,” Phila., 1879, p. 32. CASES OF SYNCOPE. 
123 
common; narcotism rare, the drug seeming to ex- 
haust itself in its initial action, or to produce a con- 
dition of the system in which narcotism is wholly or 
partially impossible. 
Dr. Corona1 (Giornale di Medicina Militaire), 
summing up the results of his experiments on ani- 
mals, says: “The injection of the two poisons 
(morphia and atropia) into the veins showed that a 
much smaller dose was sufficient to produce rapid 
and grave poisoning, but, even then, the morphia 
produced its action instantaneously, and its action 
always superseded that of atropia.” 
J. Pennock Sleightholme,2 L. R. C. P., Lond., re- 
ports the following case : “ A young man of sound 
constitution and good health, who had never before 
taken morphia hypodermically, partly as an experi- 
ment and partly with the hope of relieving some 
slight restlessness, injected himself at about 3 A. M. 
with yi gr. of morphia. Immediately after the in- 
jection he fell down on the floor in a state of syn- 
cope, and had slight convulsive movements on one 
side of the body; consciousness did not entirely 
leave him, and after lying still for about ten minutes 
he was sufficiently recovered to be able to go to the 
next room and help himself to a couple of glasses of 
1 (Edin. Med. Journal, Dec., 1876.) Practitioner, 1877, p. 132. 
2 Practitioner, July, 1871, p. 25. 124 
HYPODERMIC INJECTION OF MORPHIA. 
sherry. After this the feeling of faintness gradually 
passed off, and he slept for about two hours, but on 
rising at eight o’clock in the morning the same feel- 
ing of faintness returned, accompanied with great 
pallor. These symptoms were relieved by a dose of 
brandy, but did not entirely cease until noon the 
same day.” 
A physician in the South, who is a slave to this 
habit, writes me: “ Several times I have been un- 
fortunate enough to puncture a vein, and to introduce 
some of the solution directly into it. Immediately 
I feel a peculiar tingling all over me from the tips of 
my fingers to the ends of my toes. The skin of my 
head feels as if a myriad of pins were penetrating it. 
This feeling passes off in from 3 to 5 seconds. Some- 
times it has been followed by a turgescence of the 
vessels of the brain, causing a great fullness and 
throbbing, with slight headache following.” 
In a most interesting and instructive letter from 
Dr. Wm. W. Cable, of Pittsburgh, Pa., I find the fol- 
lowing : “ I have spoken of minor accidents which 
sometimes occurred. In all that I have seen they 
were caused by the injection of the morphia directly 
into a vein. A series of phenomena instantly take 
place. The patient describes the first sensations as 
the stinging of bees all over the body, with difficulty 
of respiration, and intense congestion and swelling of CASES OF SYNCOPE. 
125 
the face and body. In one case that I saw the face 
was so swollen that in five minutes all traces of the 
natural features were lost. This condition of affairs 
calls for prompt action. If possible, the patient must 
be kept in motion, and applications of cold water be 
made to the face and spine. If the patient falls the 
limbs must be raised, and all methods used to keep 
the heart acting, for if you can bridge over 10 or 12 
minutes, the patient is safe. To prevent being 
‘ struck,’ as he calls it, one patient of mine carries a 
cord which he throws over the arm, and if an un- 
favorable symptom occurs, he uses it as a tourniquet, 
and in a moment the result is apparent in the extra- 
vasation of the blood and the morphia from the 
wounded vessel. This is a safe condition, as after- 
ward no rapid absorption can occur.” 
This is a companion case to that reported by 
Graham, and the ligation of the limb proved to be of 
great practical importance. 
An interesting series of experiments, bearing 
directly upon the use of the ligature in such cases, 
were made by Mr. Georges1 at the Paris Society of 
Practical Medicine, some of which were conducted for 
this gentleman by M. Claude Bernard. These experi- 
ments consisted in “ injecting poisonous substances 
into the cellular tissue, with the view of showing 
1 Medical Times and Gazette, June 14, 1865, p. 42. 126 
HYPODERMIC INJECTION OF MORPHIA. 
the far greater safety and certainty of the hypoder- 
mic method as a means of administering, medicinally, 
highly-poisonous substances. He injected quan- 
tities of codeine, atropine, and especially strychnine, 
which would surely cause death in the absence of 
precautions for preventing the too rapid introduction 
of the poisons. These injections were practised 
without danger in the dog’s paw, the passage of the 
poison into the veins being checked by the forcible 
application of a ligature around the paw. To render 
the experiment still more striking, he resolved to em- 
ploy injections of the most dangerous of poisons— 
curare—and M. Claude Bernard conducted them for 
him. A solution containing about five centigrammes 
of curare, sufficient to kill more than fifty dogs of 
the size of the one operated upon, was injected into 
the paw, and in 20 minutes the animal fell on its side. 
The paw was now firmly tied, and at the end of about 
20 minutes the animal arose. Whenever the ligature 
was loosened he again fell down, sometimes at the end 
of ten minutes, and sometimes in a shorter period,x 
and in this way it became possible to dose with com- 
plete certainty, according to the effect desired to be 
produced, the quantity of poison to be absorbed. 
The next day the dog was found on his three paws, 
only suffering from the swelling caused in the fourth 
1 Italics mine. CASES OF SYNCOPE. 
127 
by the injections. The ligature was removed and he 
was soon all right.” 
“ The same experiment performed on another dog 
was followed by the same results, the animal being 
caused to fall or rise at the end of five, ten, or fifteen 
minutes, accordingly as the paw was tied or untied. 
This dog, however, next morning, on the removal of 
the ligature, fell down again, all the poison not having 
had time to become eliminated by the urine, so that 
it was necessary to reapply the ligature. M. Georges 
points out the superiority of the endermic method, 
when we have to administer powerful substances, as 
we may apportion the dose with an exactitude, ac- 
cording to the tolerance of the disease, and idiosyn- 
crasy of the patient, quite unattainable when admin- 
istered internally.” 
Dr. Alonzo Clark, Professor of Theory and Practice 
of Medicine and Clinical Medicine in the College 
of Physicians and Surgeons, New York, kindly gives 
me the details of the following case: There was 
brought into Bellevue Hospital, some years ago, dur- 
ing his term of service, a young woman, aged about 
25, suffering from trismus. The jaws were so firmly 
locked that it was necessary to break out a tooth in 
order to administer food and medicine. All ordinary 
medicine failing, on the evening of the second day, 
the house physician determined to treat the case with 128 
HYPODERMIC INJECTION OF MORPHIA. 
hypodermic injections of morphia. He gave three 
injections’ of fifteen minims of Magendie’s solution, 
with two hours’ interval between the doses, and find- 
ing that no effects of the morphia were apparent at 
2 A. M., he gave an injection of twenty minims. 
When he returned to the ward at 4 A. M. the patient 
was dead. The nurse on being questioned stated 
that the patient was “ asleep ” before the doctor left 
the ward. The arm in which the puncture had been 
made was examined by Dr. Clark and others, and 
over the point of the last puncture a little discolora- 
tion, as from extravasated blood, was apparent, and 
which, on careful dissection, was found to mark the 
track of the needle, which had opened directly into a 
vein. 
In this case the patient probably died almost im- 
mediately, the action of the morphia being shock-like, 
and its effect the more intense as i gr. had 
already entered the system by the skin. 
Prof. Wm. T. Lusk, of this city, writes me of a 
case of syncope following immediately upon the injec- 
tion. No blood appeared at the point of puncture. 
Another case of death from injection into a vein 
is reported to me by Prof. Willard Parker. An in- 
jection of morphia, to relieve the severe pain of neu- 
ralgia, was made into the temporal region of an ap- 
parently healthy young man. Death was almost CASES OF SYNCOPE. 
129 
immediate. The case was in the hands of a physician 
in Connecticut. I have repeatedly written, asking 
for full particulars, but cannot get them. It is a , 
strange fact that all the cases where injection into the/ 
temporal or infra-orbital region is mentioned by 
respondents and by some authors, it has been at- 
tended by either intense narcotism or death. (See 
p. 88.) This is, of course, not a uniform occurrence, 
but it has happened sufficiently often to call our at- 
tention to it, and urge caution in its use in this situa- 
tion. 
In this connection, and in point of history, the 
following quaintly worded extract from a diary, 
which appears in Pepy s Journal1 of May 16, 1664, 
is of interest: “ With Mr. Pierce, the surgeon, to see 
the experiment of killing a dog by letting opium into 
its hind leg. lie and Dr. Clark did fail mightily 
in hitting the vein, and in effect did not do the busi- 
ness after many trials; but with the little they got in, 
the dog did presently fall asleep and so lay till we 
cut him up.” 
The different effects produced by the same acci- 
dent on different persons seems to be due to some 
peculiarity of constitution with reference to mor- 
phine. The drug is thrown so rapidly into the 
circulation that it carries everything before it, seem- 
1 E. P. Wilson, “ St. George’s Hospital Reports,” 1869. I3° 
HYPODERMIC INJECTION OF MORPHIA. 
ing to instantly overwhelm the vital powers. The 
brunt of its action seems to be exerted on the heart, 
and the key to proper treatment is thereby afforded. 
To whatever cause due, the effect is essentially the 
same, the difference being only one of degree. 
That syncope and vaso-motor disturbances are ever 
due to the injection of air into a vein with the 
solution, I very much doubt. In tliejfirst place, the 
morphia itself is quite sufficient tc£ produce the 
symptoms, and in the second place, not more than a 
bubble of air is ever left, by carelessness, in a 
syringe, and this is not sufficient these 
symptoms. To settle this matter, I -purposely in- 
jected into the median cephalic vein of my own arm 
twice as much air as this with a solution of warm 
water, and without any bad effects ; fact, no effect 
whatever. My arm, above the point of puncture, 
was protected by a ligature that could have been 
drawn tight at a moment’s notice had there been 
any untoward symptoms. The following day I in- 
jected the j-g of a grain of the sulphate of morphia 
into another vein, with the effect of producing sudden 
dizziness, a feeling as if the head would burst, prick- 
ling and tingling of the nose, suffusion of the face 
and eyeballs, dilatation of the pupils, faintness and 
nausea. The pulse was first greatly accelerated, and 
then fell to about 65, and remained so all that day. CASES OF SYNCOPE. 
131 
My pulse in health is 74. This was done at 10:30 
A. M., and I did not fully recover until about 3 P. 
M. It may be well to state that morphia, either by 
the mouth or skin, always has a very unpleasant 
effect on me, while opium has not. Instead of 
causing sleep and soothing irritation, the former 
makes me nervous, “ twitchy ” and somewhat light- 
headed. In both cases the needle entered the vein, as 
it was made prominent by the ligature, and blood 
appeared at the point of puncture. As soon as the 
injection wras made the ligature was loosened, I being 
ready to pull it tight at a moment’s notice. 
M. Calvet,1 presents a physiological research of 
the action of morphine upon the various functions of 
the organism. A clinical study of morphine as a 
therapeutical agent, especially in the relations of acute 
to chronic morphinism. In the first, he observes 
that both intra-venous as well as subcutaneous injec- 
tion of the hydrochlorate of morphine accelerates 
respiratory movements, succeeded by a period of 
retardation, and produces sometimes a momentary 
arrest or respiratory syncope. The same relative 
effects occur with the cardiac movements; at first 
accelerated, followed by retarded pulsations; some- 
times even by cardiac syncope. During this time 
animal heat exhibits analogous phenomena, namely, 
the elevated is followed by lowered temperature. In 
1 “ Th£se <le Paris,’’ AT. V. Med. Journal, Sept., 1877. 132 
HYPODERMIC INJECTION OE MORPHIA. 
fact, the absorption of morphine, whether by intra- 
venous or subcutaneous injection, produces a very 
marked influence upon the reflex actions. In certain 
cases the period of exaltation does not occur, but 
the temperature becomes lowered, and the respiratory 
and cardiac movements are slower. Though he has 
not finally completed his researches, M. Calvet ad- 
vances the opinion, “ that the above phenomena are 
the dispnoea, dizziness, &c., sometimes seen during 
the operation of intra-venous injection of milk.” A 
study of these cases 1 (milk injections) shows us that 
these phenomena rarely, if ever, present themselves 
until a large bulk of fluid (from 2 to 6 oz.) has been 
added to the blood. 
An interesting and novel series of careful experi- 
ments on man and animals, made by Dr. Gaspar 
Griswold,2 then house physician in Bellevue Hospital, 
this city, although not made with that end in view, 
seem to demonstrate very clearly that a powerful and 
possibly irritant medicine (aq. ammonia dil.) when 
injected into a vein in quantity does not produce any 
untoward symptoms, but on the contrary were al- 
ways found to have the happiest, and sometimes a 
most marvelous effect. 
1 Pepper, JV. Y. Med. Record, Nov. 16, 1878. H. H. Smith, Ibid. 
Joseph. H. Howe, Ibid, Dec. 7, 1878 and Jan. 4, 1879. J. S. Prout, 
Ibid, May II, 1878. 
2 “ The Intra-venous Injection of Ammonia,” N. Y. Med. Record, 
[une, 1879. CASES OF syncope. 
133 
Is it possible for such phemomena as have been 
ascribed to the injection of morphia into a vein to 
take place without such puncture ? I think so. 
Some of the cases reported would seem to prove it; 
notably that by Dr. Tupper, where the symptoms did 
not appear until ten minutes after the injection was 
made. Every insertion of a hypodermic needle, of 
necessity, cuts across or opens a certain number of 
capillary vessels, to which is undoubtedly due, to a 
certain extent, the rapidity of absorption when drugs 
are given in this manner. The Committe of the 
Medico-Chirurgical Society 1 came to the conclusion, 
from experiments on men and animals, that absorp- 
tion of a sufficient amount of the remedy to produce 
decided symptoms took place in from 4 to 10 min- 
utes. 
“ Experiments on a healthy man, aged 32. Morph, 
acet. gr. was employed : 
Symptoms. Skin. Mouth. 
Absorption 5 min. no min. 
Pulse increased 8 beats. None. 
Pulse lowered 12 “ 10 beats. 
Headache 36 hours. 10 hours. 
Nausea 46 “ 3 “ 
Pulse, its nat. standard....... 22 a 8 “ 
Incapacity to work 6 “ None. 
Total duration of symptoms..46 “ 11 hours.” 
1 “ Medico-Chirurg. Transactions,” vol. L., p. 570. f34 
HYPODERMIC INJECTION- OF MORPHIA. 
I have found that some drugs, notably jaborandi, 
when used hypodermically, manifest their peculiar 
symptoms in so short a time as one minute, no vein 
of any size being punctured. It is to be supposed 
that one drug is absorbed from the subcutaneous 
celluar tissue with about the same rapidity as another, 
but that each drug manifests its presence in the circu- 
lation with a difference in point of time according to 
its peculiar action, or to some idiosyncrasy of the 
patient. Thus, while morphia may be absorbed as 
rapidly as pilocarpine or jaborandi, it does not, save 
in certain persons or at certain times, give evidence 
of its presence by recognizable symptoms so early or 
so decidedly as the latter. 
From this it would appear possible, in certain cases, 
for a very rapid absorption to take place, and sud- 
den overwhelming of the heart by the drug to 
occur without the puncture of a vein. As the needle 
does not go deeper than the subcutaneous cellular tis- 
sues, in a large majority of the cases, the immediate 
treatment would be as effective in one case as in the 
other. At a recent meeting of the New York Patho- 
logical Society,1 Dr. Amidon presented some micro- 
scopic specimens exemplifying the pathology of hypo- 
dermic medication. He said that although hypoderm- 
ic medication had been in vogue twenty-five years, or, 
1 New York Medical Gazette, Jan. 10, 1880. CASES OF SYNCOPE. 
135 
according to the claims of some, forty years, he was 
not aware of any accurate investigation of the rela- 
tions between the hypodermically injected mass and 
the skin. He had injected Prussian blue (a weak 
solution) into the skin of moribund subjects, and a 
portion of skin was excised after death. The hypo- 
dermic injection was given in what he considered the 
best manner, namely, the pinching up a fold of skin 
and introducing the needle horizontally. The hypo- 
dermic injection was found to occupy a space three 
and a half centimetres in diameter and one millimetre 
in thickness, tapering in shape. The location of the 
hypodermic injection varied according to the amount 
of adipose tissues in the subject. In those who had 
but little adipose tissue the hypodermic injection re- 
mained immediately below the skin, while in those who 
had much, the injection diffused itself. It would be 
seen in the specimens presented that the hypodermic- 
ally injected mass lay close to the arteries and veins: 
sometimes it completely surrounded an artery or 
vein. This, together with some other experiments, 
proved that it was by the blood-vessels and not by the 
lymphatics that absorption took place. In order still 
further to test the matter, he had injected muriate of 
pilocarpine into the ankle and into the supraclavicular 
region, the physiological effects of the drug (diaphor- 
esis, salivation, &c.,) were produced in both cases in 136 
HYPODERMIC INJECTION OF'MORPHIA. 
about the same time, varying in different subjects from 
one and a half to four minutes; there was no appre- 
ciable difference, If the absorption 
had been by means of the lympha- 
tics, the injection in the supraclavi- 
cular region would have produced 
its effects much more rapidly than 
that injected into the ankle. In one 
of the slides the section had fortun- 
ately been in the line of the punc- 
ture of the needle and showed that 
considerable injury had been done 
to the tissues. I am firmly convinc- 
ed that no physician should be held 
free from blame in case of accident 
where he has not had a ligature or. 
tape loosely encirclingthe arm above 
the point of puncture. At the first 
intimation of danger this should be 
pulled tight and kept so for several 
hours, being loosened gradually, 
thus permitting but a gradual en- 
trance of the drug into the general 
circulation. With this precaution, 
it will be seldom necessary to treat 
such alarming symptoms as are here recorded. A tour- 
niquet for this purpose is here shown. It consists of a 
(Agnew.) 
a, Commencement of the Ce- 
phalic Vein; bx Main Trunk of 
the Cephalic Vein ; c, Anterior 
Branch of Basilic Vein ; d, Pos- 
terior Branch of the Basilic Vein; 
e. Basilic Vein ; f. Median Vein: 
g, Median Basilic Vein ; h. Me- 
dian Cephalic Vein ; z, Biceps 
Muscle; j\ Tourniquet. CASES OF SYNCOPE. 
137 
strap or heavy tape, at one end of which is sewed a 
“ patent buckle ” that will catch and hold at any point. 
In the absence of this or a skate strap with such a 
buckle, any cord or tape, so arranged as to be pulled 
tight at a moment’s warning, may be used. The treat- 
ment of such condition when already established, is 
summed up in the one word—stimulation. Whiskey 
and ammonia hypodermically, cold affusion, electrici- 
ty, when there is a battery at hand, and hot bottles to 
the precordia. The intra-venous injection of ammonia 
as successfully used by Dr. Griswold in several in- 
stances when the patient was moribund (phthisis, as- 
cites, etc., etc.) might be tried with advantage. Re- 
garding the strength of the solution, he says1 : “For 
this purpose I used the ordinary aqua ammonia (con- 
taining ten per cent, of ammonia gas), diluting it with 
an equal bulk of water.” He thus describes his method: 
“ Selecting a prominent superficial vein in the radial 
region, I exposed it by an incision through the skin. 
I then injected slowly into it a drachm of ammonia 
solution, taking care that the point of the hypoder- 
mic needle was free in the lumen of the vessel. This 
done, I placed my hand over the patient’s heart and 
waited. In fifteen seconds I felt a marked increase 
in the force of the pulsations. In about two minutes 
there was a strong pulse of a hundred, which was 
1 N. Y. Medical Record, June 7, 1879. 138 
HYPODERMIC INJECTION OF MORPHIA. 
plainly perceptible at the wrist. A minute later the 
patient sighed deeply; the color came back to her lips; 
her eyes moved and began to show signs of returning 
intelligence, etc.” This patient fully recovered, and 
with no after-trouble from the injection. This was a 
case of syncope following thoracentesis; the woman 
failing to respond to 15 or 20 3ss. doses of whiskey 
given hypodermically. 
In giving atropine with the morphine, hypoder- 
mically, care should be taken that no more atropine 
than is absolutely necessary be given, lest dangerous 
syncope result.1 
Dr. E. M. Nelson, of St. Louis, has kindly sent 
me the following history of a case illustrating this 
danger: The patient, a large, fleshy, apparently 
healthy woman, is one of those upon whom Dr. 
Thomas Wood, of Cincinnati, successfully performed 
ablation of the uterus. In spite of some years’ ab- 
sence of this organ, she was decidedly hysterical. 
The doctor was called to see her on account of a very 
severe pain, “most keen at a point below the border 
of the ribs on the left side and in the supra-pubic 
region.’’ (In her case the lower part of the abdom- 
inal walls did not close after the operation, done 5 
years before, and there is a hernia in the median 
line a short distance above the pubes. This is re- 
tained by an abdominal supporter when she is up.) 
1 Bartholow, “The Hypodermic Method,” &c.,pp. 110-117 inclusive. CASES OF SYNCOPE. 
139 
At this visit the doctor gave her io gtt. of a solu- 
tion of which this amount represented, morphiae 
sulph. gr. yi, atropiae sulph. gr. “I had on the 
preceding days given injections of gr. morphia 
and of atropia, repeating the dose in half an hour, 
and had then gained only partial relief. This morning 
the patient demanded that I should give her a larger 
dose, so as to afford relief. I gave at the first in- 
jection 30 gtt., equal to morphiae sulph. gr. ss., atro- 
piae sulph. gr. J-2' In half an hour there was no 
relief and no symptom of the action of the remedies, 
and I administered 20 gtt. more, equal in all to 
f gr* morphia and 9-6 gr. atropia. She experienced 
decided relief in a few minutes after the last injec- 
tion, and I soon left. I returned about four hours later, 
and found that she had experienced quite alarming 
symptoms, commencing about half an hour after I 
left. She had fainted and seemed very much pros- 
trated, thought she was going to die, &c. They sent 
for me, but I was out, and when I did see her all 
these symptoms had disappeared. I attributed the 
symptoms to hysteria, and in the evening, finding 
that she was suffering intense pain again, I gave her, 
in the course of an hour, about the same doses that 
I had given her in the morning. (I am not sure as 
to the exact quantity.) It seemed to have the de- 
sired effect in relieving pain, and I left her, expect- 140 
HYPODERMIC INJECTION OF MORPHIA. 
ing that she would have a good night’s rest. I gave 
the injection just as I had done in the morning : 30 
gtt. first, and then, after waiting half an hour, and 
the pain continuing, giving a second dose somewhat 
less than the first. In less than an hour I was called 
back to see the patient again, the messenger re- 
porting that she was dying. I found her in a con- 
dition that was sufficiently alarming. She would 
gasp for breath, call for the windows to be opened, 
and the pulse would fail, and sometimes entirely 
disappear, and respiration become very imperfect. 
Then, under the stimulus of ammonia to the nostrils 
and friction to the extremities, she would revive; 
the pulse regain its tone, and the respiration become 
normal. She would doze off, and I would begin to 
congratulate myself that the trouble was over, and 
that I might leave the patient, when the same symp- 
toms would recur, and this again and again until 
daylight. The intervals of ease would become 
longer, and finally there was a cessation of the re- 
currence of syncope. The last article used in the 
way of treatment for this condition was iced cham- 
pagne, and this seemed to be of advantage. I was 
convinced by the occurrence of similar phenomena 
that the symptoms of syncope were the effect of the 
atropinized solution, and afterwards, in treating that 
patient, when I desired to give large doses of mor- CASES OF SYNCOPE. 
141 
phine, as was necessary at times, in order to relieve 
pain, I used a solution without the atropia. She 
took, last summer, within an hour and a half, by the 
mouth gr., and hypodermically i|- gr. of morphia, 
with no ill effects at all.” Dr. Nelson mentions as a 
peculiarity of this patient that she has a very sensitive 
stomach ; “ more sensitive to the reflex influence of 
odors than any other I ever had to deal with.” 
Dr. E. Wenger, of Gilman, 111., sends me the 
following: “ A young man, aged 26, called to see 
a doctor, an old acquaintance, about 6 o’clock P. 
M., and while there complained of a pain in his side. 
The doctor told him he could relieve him in a few 
minutes by injecting a little morphia and atropia 
under the skin, to which he assented. After about 
ten minutes he left the office, feeling no change in 
the pain rfor effect of the medicine. On reaching 
the pavement he became suddenly blind and fear- 
fully sick. He was taken into a drug-store near by, 
and for three hours his life was almost despaired of. 
He says the prostration and sickness he suffered is 
indescribable. The pupils were very much dilated. 
What quantity was used I do not know.” 
Geo. Oliver,1 M. B., believes that all danger of 
wounding a vein is done away with by inserting the 
needle perpendicular to the surface and passing 
it well in. 
1 Practitioner, vol. 4, p. 80. CHAPTER V. 
DEATHS FROM THE SUBCUTANEOUS INJECTION 
OF MORPHIA. 
So widespread has the practice of giving morphia 
hypodermically become, and in so many serious 
conditions and diseases is it employed* that it is not 
surprising that the method has been charged with 
causing death, where a fatal result would as certainly 
have followed had the drug never been thus ex- 
hibited. Aside from such cases, however, there 
seem to be fair grounds for the belief that in some 
instances death was unquestionably due to the drug 
given in this way. The mere fact that such charges 
have been made against a proceeding at once so 
common and so valuable, demands a thorough and 
dispassionate analysis of the various cases of this 
kind, in order that, if possible, the question may be 
settled beyond a peradventure. 
I shall first give the cases in their original fullness 
or meagreness of detail, and discuss them after- 
wards, premising their relation with the statement 
that no reasonable effort has been spared to obtain CASES OF DEATH. 
M3 
information in every important particular; and 
that where such completeness is not found it is due 
either to carelessness or to unwillingness of the 
physician to answer. 
Case i.—Dr. Jno. H. Lawman, Prof. Mat. 
Medica in Wooster University, Cleveland, Ohio, 
writes me: “The case of death was as follows: 
Man, aged 40; health generally good; no known 
organic disease; I had often seen and examined the 
case; no idiosyncrasies in medicine. He was lame 
from a gun-shot wound of the knee. He became in- 
temperate while living in Kansas, and had mania-a- 
potn. Returned to Cleveland and drank very little 
for twelve months; for past three months immoder- 
ately, though never known to be narcotized with 
alcohol. He was of a bilious (?) temperament. He 
occasionally bled freely on slight provocation, e. g., 
pulling a tooth. Had had severe epistaxis three or 
four times. Perhaps he might be said to have 
haematophilia. On the occasion of last sickness he 
had severe epistaxis, stopped with ice and pressure 
on facial arteries. Reappeared next day; was stop- 
ped again. Reappeared the following night; stopped 
again; appeared next day, and bled profusely. 
Left post, and ant. nares plugged. Patient was 
weak, but picked up soon under milk. He obtained 
and drank considerable whiskey—amount not known. 144 
HYPODERMIC INJECTION OF MORPHIA. 
Plugs removed at the end of forty-eight hours, and 
nares syringed with antiseptic and astringent lotions, 
and then mania appeared. It consisted mainly 
in visions and insomnia; no violence. Bromides, 
chloral and asafoetida were used, but without any 
decided effects. When consultant advised morphiae 
sulph. hypodermically, I urged him to take the case, 
as I did not wish to assume the responsibility under 
morphine treatment; but he urged my remaining, 
and I unwisely did so, witli the understanding that 
his was the directing treatment. After the second 
injection there was no change in the patient. After 
the third injection, possibly -f gr. in all, patient 
became a trifle more quiet. Pupils were unchanged. 
I left, with strict orders to call me if anything un- 
usual appeared. Time, 11 P. M. Was called at 
12:45, with the statement that the patient was dead. 
I questioned attendants, and found that the patient 
suddenly became very quiet, laid down and breathed 
hard, and died in from 30 to 45 minutes after lying 
down. Previously he had been constantly walking 
and talking. Pupils semi-contracted after death; 
skin pale. Could not get satisfactory information of 
details from attendants. 
“ I have observed other cases, where opium under 
above-described conditions acted adversely. One 
case of mania-a-potu, where in addition there was CASES OF DEATH, 
145 
bronchial catarrh; no excessive secretion. The 
symptoms followed a second hypodermic injection 
of the sulphate of morphia. I cannot recall the 
amount and have no record of it. The respirations 
diminished gradually and cyanosis developed. Arti- 
ficial respiration and flagellation averted too pro- 
found coma. The bromide and chloral treatment 
was being used in this case also. 
“ I felt a little uncertain about the amount of 
morphia used in the case of death, but on referring 
to records I find : 1st injection, 7 P. M., ■§■ gr.; 2d at 
9 p- M., % gr. ; 3d at 11 P. M., \ gr.” 
CASE 2.—Dr. Lyman M. Willard sends me the 
particulars of the following case : “ The man was of 
good build; about 25 years old; general health 
good, when himself. The latter months of his life were 
pretty well occupied in drinking whiskey, he being 
under the care of a medical friend of mine at the time 
of his death for delirium-tremens. After pretty thor- 
ough treatment with potass, bromide and chloral by 
my friend, I was called in, and found him very rest- 
less, sleepless, and much inclined to ‘ rat-catching,’ 
and decidedly adverse to keeping his clothes on. Was 
perfectly docile, however, when spoken to sharply. 
Got him to take some good soup, and then gave him 
hypodermic injection of -§- gr. of morphia, he not 
having had a dose of anything for some six hours 146 
HYPODERMIC INJECTION OF MORPHIA. 
previously. Called again, with my friend, in four 
hours, I think, and found him in bed, as we left him ; 
a little quieter than when first seen, still not inclined 
to sleep. On consultation we concluded to repeat in- 
jection, which we did. Remained with him for x/2 
hour, when, on his getting quieter, we left him in care 
of his brother, who slept in bed close to him, and who 
reported at inquest that his brother turned several 
times in the night, but seemed to sleep quietly most 
of the time, snoring once in a while when on his back, 
and seemed asleep when he arose in the morning to 
get the patient his breakfast. The brother, however, 
noticed the patient lying with his neck uncomfortably 
across his arm, but did not disturb him or touch him. 
In about one hour the brother came up again and 
noticed him lying as before, and on attempting to 
arouse him, found him dead. 
“ At post-mortem the lungs were congested, brain 
not so; stomach somewhat congested; liver small 
and tawny in color, significant of cirrhosis. Kidneys 
somewhat enlarged, otherwise healthy. 
“As to ‘pupils and pulse, &c., &c., &c.,’they 
were not observed, of course, during the night. We 
last saw him at 8 P. M. He turned in bed at 3 A. M., 
and was dead at seven, sure, and probably at six, when 
his brother first arose. I remember that the pulsations 
were over 100 at 4 P. M. The respiration was not so CASES OF DEA TH. 
H7 
as to particularly attract attention when seen last by 
us. He evidently died from the excessive use of poor 
whiskey, as the coroner concluded on medical evi- 
dence. The man was of the nervous temperament.” 
CASE 3.—From a physician of prominence in 
London, England, I receive the following: “ Largest 
dose, y2 grain, repeated in about five hours, for deli- 
rium-tremens. Patient died of opium-poisoning. He 
was an old man.” 
Case 4.—The following from a medical gentle- 
man in this city, who does not wish his name used: 
“ But one death, and that in a case of delirium-trem- 
ens, where -g- gr. was employed hypodermically in 
combination with 9-6 gr. atropine, and repeated in 
two hours’ time, as the patient was still violent. He 
had already taken large doses of bromide of potassium 
and chloral. He died five hours afterthe last injection, 
of undoubted opium-poisoning. For two hours after 
the last injection 11:30 P. M., he was awake and rest- 
less, and twice threatened the attendant’s life if he did 
not remove a dog (imaginary) from under the sofa. 
Suddenly the patient became quiet, turned upon his 
back, and the attendant believed that he was asleep, 
but failing to arouse him to administer some beef 
essence, became alarmed, and sent for me. When I 
arrived I found him deeply narcotized, pupils con- 
tracted to pin-holes, pulse slow (do not remember to I4S 
HYPODERMIC INJECTION OF MORPHIA. 
have counted it), and respirations at about 4 per 
minute. Gave 54, grain atropiae sulph. hypodermi- 
cally, used the battery, cold affusions and coffee, but 
to no good end, the patient dying at about half-past 
four in the morning.” 
In answer to a series of questions addressed to him, 
the doctor replied: “ There was no autopsy; the 
pupils just before death were contracted in spite of 
the atropia given — natural a few moments after 
death: He was 36 years old, and free from renal 
and cardiac disease.” 
Case 5.—Dr. E. Fletcher Ingals,1 amongst six 
other cases of death collected by him from physi- 
cians, reports this one: “ I was called to see Mr. B., 
who lived seven miles away, at 8 P. M., and found 
him suffering from myalgia of the muscles of the 
back. I at once administered of a grain of the 
sulphate of atropia hypodermically. After waiting 
till dryness of the throat and other constitutional 
symptoms showed themselves, and finding no relief, 
I gave him of a gr. of morphia by the mouth? In 
f- of an hour from the time I gave him the morphia 
the man was still groaning with pain, and then I gave j 
gr. of morphia hypodermically, which soon quieted the 
patient. Not suspecting any unpleasant effects from 
1 Chicago Med. Journal and Examiner, May, 1878. 
2 Italics mine. CASES OF DEATH. 
149 
the medicine, I took my departure. In a couple of 
hours I was sent for to see the man, who, the mes- 
senger stated, ‘was in a deep stupor.’ Upon my 
arrival, I found Drs. L. and J., who lived only three 
miles distant. The patient’s breathing was stertor- 
ous, and there was complete narcotism. Dr. J. 
stated that the pupils were not contracted when he 
arrived. He had given atropia hypodermically, and 
was using electricity. The latter was kept up, as well 
as artificial respiration, until the patient died, which 
was about 12 hours after the morphine was given. I 
have given morphia hypodermically a great many 
times, and repeated \ gr. doses as often as every 20 
minutes, blit never before saw any such effect as was 
produced in this case.” In a letter to me, this gen- 
tleman writes: “My case referred to was a man 
of about 45 years of age, very intemperatep and I 
fully believe that an intemperate man is more suscep- 
tible to the influence of morphia." 
CASE 6.—A physician from the West writes: “ I 
commenced the use of hypodermics in i860, and 
have used them extensively since, with but one se- 
vere accident; in the case of an old Irish woman 
with asthma. I asked them particularly, before ad- 
ministering the medicine, whether she had taken 
anything or not. They said not. I gave her -g- 
1 Italics mine. *5° 
HYPODERMIC INJECTION OF MORPHIA. 
gr. morphine and atropine hypodermically, and 
shortly after discovered that they had given her 30 
drops of tr. opii. by the mouth a few minutes 
before. She died on time.” 
CASE 7.—Another physician in one of our large 
Western cities writes: “ In regard to the hypoder- 
mic use of morphia, I desire to supplement my 
former communication with this opinion—That I 
believe that nearly, if not all, fatal accidents from 
the hypodermic use of morphia are due to the fact 
that morphia has been previously administered by 
the mouth with no effect, and then a resort to the 
use of the syringe has so tranquilized the nerves that 
a cumulative action has been set up. I know of a 
case where a man was poisoned and died of just such 
treatment. Therefore I say, use only one method at 
a time.” In reply to special inquiries from me, the 
same gentleman writes : “ I had nothing to do with 
the case, and only know of it by hearsay and cir- 
cumstantial evidence.” The patient was a young 
man of about 22 years, tall, slim, and with a family 
history of insanity; of a nervous temperament. He 
was generally healthy, well-educated, and moved in 
the upper walks of life. Was of irreproachable hab- 
its. The patient was suffering from cholera-morbus. 
The quantity of the drug was guessed at when given 
by the mouth, three doses of morphia of -g- gr. each, CASES OF DEATH. 
151 
at intervals of y hour. There being no relief to 
symptoms, he then injected subcutaneously, gr., 
2 doses, 20 minutes apart. He soon fell asleep never 
to awake, in spite of the best skill of several eminent 
physicians who were called in consultation. He 
lived about 18 hours after the time of the last injec- 
tion. Previous to giving the morphine, the family 
entreated the doctor not to give it, as none of the 
fa7nily could take it with safety. “ The general 
opinion is, that the doctor in the first place gave 
more than he says or thinks he did. That it re- 
mained dormant in the stomach, only to be absorbed 
as the nervous forces were quieted by morphine, 
hypodermically, and then a cumulative action on a 
patient morbidly sensitive to opium resulted.” 
Case 8.—Alfred C. Post, Prof. Emeritus Clin. 
Surgery and Pres, of the Faculty of the University 
of the City of New York, Medical Department, 
writes me as follows : “ According to my recollec- 
tions, I have had but one case in which there was 
reason to believe that death resulted from the hypo- 
dermic injection. The patient was a gentleman 
about 70, suffering from a painful affection of the 
rectum. I injected 10 minims of morphia solution 
without relief of pain and without narcotism. Two 
hours after, I repeated the same dose. The pupils 
became contracted, the respirations very slow, and 152 
HYPODERMIC INJECTION OF MORPHIA. 
full narcotism occurred, unrelieved by the antidotes 
which were employed, and terminating fatally within 
a few hours. There was reason to believe that the 
patient was urmmic.” 
CASE 9.—Dr. J. M. Snook, of Kalamazoo, has 
kindly written out the following case in full for me : 
“ My patient was a man of fifty-two or fifty-four 
years of age, of Irish birth, bilious temperament, 
common school education, and engaged as baggage- 
master at the railroad depot. His health for several 
years had been poor, more particularly since five 
years previous, when he had an attack which his wife 
thought was very much like this last one, save the 
stupor, though he was inclined to sleep very heavily, 
and was attended at the time by five doctors. So 
far I have been unable to learn the precise nature of 
the attack, further than that they called it a bilious 
attack. He had at that time some urinary trouble, 
but what, I am unable to learn. 
“For about three weeks previous to this last attack 
he had been feeling poorly, and had complained of 
pain in the bowels and had a poor appetite. At 
noon of the day that he was taken, he walked home 
with much effort, and back to the depot, but ate 
nothing. He continued to grow worse until about 
5 r. M, when he was seized with a severe chill and 
pains in the stomach and bowels. I saw him at CASES OF DEATH. 
i53 
about eight o’clock and found him suffering ex- 
tremely from pains, and gave him the hypodermic 
injection gr.), as stated, which quieted the pain 
within an half hour, when I left him feeling quite 
comfortable. About nine o’clock of the following 
morning they called me again, saying the pains were 
returning. I found him suffering not nearly so much 
as on the evening previous, but as it seemed to be 
increasing, gave him a small injection, I should judge 
about the one-sixth part of a grain, which soon com- 
menced to produce its effect, and I left him, probably 
within fifteen minutes, after giving the injection. In 
about one hour they sent in haste to say that they 
could not rouse him, and he seemed to be sleeping 
too soundly. I saw him immediately, and found him 
breathing rather heavily—respirations sixteen to the 
minute, pulse about one hundred, pupil somewhat 
contracted. Upon raising him to a sitting position 
he would open his eyes and ask to be left alone. 
Six-drop doses of fluid extract of belladonna re- 
peated twice within thirty minutes expanded the 
pupils to more than the ordinary size a trifle. There 
had been no urine passed since the night previous, 
so I attempted to use the catheter, but found the 
meatus so small that it had to be slit up before it 
could be done, and then obtained about two ounces 
of urine—non-albuminous. Gave strong enemas, 154 
HYPODERMIC INJECTION OF MORPHIA. 
with no response from the bowels. The pupils con- 
tinued dilated until after death. The respiration 
continued about sixteen until between three and 
four o’clock, when they were fourteen, and continued 
so until near death, which took place at half-past 
seven in the evening—a little over ten hours after 
giving the last injection. The face was not livid. I 
did not notice any discoloration of the body after 
death.” 
I think the consulting physician excluded opium 
narcosis from the general condition of the patient 
and the history of his case prior to this illness, as 
he concluded that his illness of five years previous, 
very likely, was the cause of the continued poor 
health and the prime cause of the present attack, 
though that, of course, was an opinion only, as the 
history of the first was not satisfactory, and nothing 
could be verified by autopsy. 
Case io.—Dr. C. C. Lee, of this city, whose able 
article on the antagonism of opium and the my- 
driatics may be found in the Am. Journal Med. 
Sciences, Jan., 1862, writes me as follows: “I have 
seen one death following hypodermic injection—in a 
case of broncho-pneumonia in an old man, who died 
within a few hours, comatose, with symptoms of pul- 
monary hyperaemia.” 
Case ii.—Dr. A. P. Brown, of Jefferson, Texas, CASES OF DEATH. 
155 
writes: “ Probably one death.” To a request for full 
particulars, the doctor writes that he took no notes 
of the case, and the particulars have slipped his 
mind. 
CASES 12, 13, 14, 15.—A physician in Indiana 
writes, in his second letter : “ I did not intend to 
convey to your mind the impression that I knew of 
four deaths, beyond a doubt, due to morphia used 
hypodermically, but that other medical men shared 
with me that belief. I cannot go to Dr. X., ancf say 
to him, ‘ I think you did so and so with your hypo- 
dermic syringe.’ All I can testify to is this : I am 
credibly informed that three of the four, after the use 
of an unknown quantity, (they made up the solution 
at the bed-side, guessing at the amount of morphia), 
hypodermically; the patients went to sleep, and 
were never aroused. In two of the cases the remedy 
was used in what is known as ‘bilious colic;’ in one, 
in diarrhoea. In the other, I have been unable to 
form an opinion. No post-mortem, except in one, 
wherein were found biliary calculi. No consultations 
were had, and, as I said before, I felt delicate about 
quizzing the attendant, especially as we were not on 
good terms. Please do not think I came to this 
opinion on that account. The fourth one happened 
to a good friend of mine, and still I did not like to 
approach him on the subject. Death occurred in 156 
HYPODERMIC INJECTION OF MORPHIA. 
from three to eight hours in three cases. Cannot 
say as regards the second one. I am well aware that 
this information is valueless for statistics, because 
death from the syringe cannot be proven beyond a 
doubt. But I shall always think that in this vicinity 
four deaths have arisen from the careless use of the 
syringe.” 
Cases 16, 17.—Dr. E. Wenger, of Gilman, 111., 
who is much opposed to the use of the instrument, 
reports, through Dr. E. F. Ingals,1 the following 
cases: “ Case 1.—I was called to see a woman in her 
fifth confinement. On my arrival, found her in con- 
vulsions. Another physician had been called, who 
arrived in a few moments. I at once suggested 
bleeding. The doctor had just bought a hypodermic 
syringe (the first 1 had ever seen), and suggested the 
injection of morphine, to which I assented. The 
effects of the convulsion, or the injected morphine, 
brought on a heavy stupor, with slow, stertorous 
breathing, from which she could not be aroused. I 
delivered her with the forceps. She slept on until 
she breathed her last. Case 3.—Mrs. W., aged about 
56, had pain in one of her shoulders; in the morning 
she called the family physician, a man of knowledge 
and experience. He injected morphine into the arm, 
and relieved her in a few minutes; in the evening he 
1 Chicago Med. Journal and Examiner, Aug., 1877, CASES OF DEATH. 
157 
called again, and found his patient well, but thought, 
to secure a good night’s rest, it would be well to in- 
ject a little more morphine, which he did, and in 
thirty minutes his patient was a corpse. The feel- 
ings of the doctor can be better imagined than ex- 
pressed.” 
I give here Dr. Wenger’s reply to my letter, ask- 
ing for further details of these cases: 
“ I am sorry that I cannot give you some more 
useful information concerning the cases referred to. 
There was no autopsy held in Cases i and 3. The 
general physical condition of these persons was 
good; both stout and healthy women, living on 
farms in the country. There was no examination of 
the urine of either. In Case 1 there was as much as 
one grain morphia used, though not all given at 
once (dissolved in water). I never learned what 
quantity was given in the other cases. I was present 
at the death of Case 1. The symptoms were similar 
to apoplexy—unconsciousness—slow, heavy breath- 
ing, and full pulse ; rate per minute I do not recol- 
lect ; died about ten hours after the injection; was 
not present with the other cases, but, from what I 
could learn, were similar; do not know the condition 
of pupil at and just after death; no examination of 
urine after death. I wish to say here that country 
physicians have very limited means indeed for chem- 158 
HYPODERMIC INJECTION OF MORPHIA. 
ical analysis, and what is more, it is rarely possible 
to get the consent of families to post-mortem ex- 
aminations.” 
The doctor says, further: “ I met Dr. Alexander, 
of Broadway, Rockingham Co., Virginia, in Wash- 
ington, D. C., last summer, and asked him if he had 
ever seen or heard of any accidents from the hypo- 
dermic injection of morphia. He told me that there 
had been two deaths in his vicinity.” I wrote Dr. 
Alexander, at Dr. Wenger’s suggestion, and received 
the answer that Dr. Wenger was mistaken, he (Dr. 
A.) having never seen or heard of a case of death 
from morphia used hypodermically, but had spoken 
of some deaths caused by chloral. 
Cases 18, 19, 20, 21, 22 and 23.—Dr. E. Fletcher 
Ingals,1 of Chicago, to whose article I have already 
referred several times, sent out some eighty circulars 
to prominent medical men of the Northwest, em- 
bodying a series of questions relative to the occur- 
rence of death, accident, etc., from the use of mor- 
phia, hypodermically. He received fifty-five replies, 
that yielded seven cases of death, one of which is 
already given on page 148 of this chapter. Of the 
other cases, he says: “ In two of the seven fatal cases 
reported, the amount of morphia administered was 
1 “ Chicago Med. Jour, and ExaminerMay, 1878. CASES OF DEATH. 
159 
not ascertained, though it was believed not to have 
exceeded the ordinary dose. In other cases the 
doses and the condition of patient were given, but I 
am not at liberty to report the cases fully. However, 
as my information was derived from men of large 
experience and recognized ability, I can vouch for its 
accuracy. The names of my correspondents are 
withheld for obvious reasons. 
“ One reports two deaths, one of which was caused 
by the subcutaneous injection of y of a grain of 
morphia, combined with of a grain of atropia. 
“ Another reports two deaths; one from two doses 
of morphia, of a grain each, with an interval of 
four hours between the first and second doses. In 
this instance the morphine was given to relieve in- 
tense pain attending invagination of the intestines. 
Death from narcotism ensued six hours after the 
second dose. The other death reported by the phy- 
sician resulted from y of a grain given in a case 
of sciatica. The patient died comatose within five 
hours. 
“ Another reports death caused by two doses of 
y grain each; the first given internally} 
“ The sixth case was that of a patient upon whom 
ovariotomy had been performed. Shortly after thq 
operation this patient was given, subcutaneously, io 
1 Italics mine. 160 
HYPODERMIC INJECTION OF MORPHIA. 
minims of a saturated solution of morphia, which 
amount was repeated five hours later, on account of 
pain. In fifteen or twenty minutes the latter dose 
was followed by profound narcotism, and within two 
hours death ensued, notwithstanding persistent use 
of the most approved treatment. In this case the 
exact dose was not known, but considering the ready 
solubility of morphia, it probably equalled, and may 
have exceeded, 1 y2 grains. The physician who gave 
me the notes of this case found that 10 minims of 
water at 6o° Fahrenheit would dissolve 6% grains.” 
CASE 24.—“ In Washington City a death has re- 
cently occurred from an apparently small dose of 
morphine, hypodermically given. Patient had pneu- 
monia and his cough became distressing. His 
physician had given him during the day, Dover’s 
powders without effect. At 9 o’clock in the evening 
he gave a third of a grain of morphia hypoder- 
mically. He had attended the patient frequently 
before, and had never discovered that opiates by 
the mouth or under the skin had any unusual effect 
upon him. After the physician left, the family of 
the patient became alarmed at the symptoms and 
sent for him to return. Not finding him, another 
physician was summoned, and discovering opium 
poisoning, applied electricity, etc. The regular me- 
dical attendant reached the bedside of his patient CASES OF DEATH. 
i6i 
only to see him die a short time afterwards. The 
patient and physicians were among the best people of 
Washington, and the affair caused much distress. 
The newspaper reports show very manly conduct 
on the part of the physician who administered the 
fatal dose. He did not attempt in the slightest to 
shirk writing in the certificate that the immediate 
cause of death, was an overdose of opium. 
“ The opiate treatment of pneumonia is the one 
perhaps most in vogue, having the high sanction of 
Flint. Hypodermic medication also has a host of 
followers, and among many careful men in the pro- 
fession, although it is somewhat singular that a 
fatal issue should have been reached in the case 
narrated. One-third of a grain of morphine under 
the skin is a full dose, but one far from being con- 
sidered a dangerous one, especially when admin- 
istered in a case where it was known from previous 
experience that no idiosyncrasy against opiates 
existed, and where the distressing symptoms de- 
manded quick relief. The second physician called, 
when interviewed by a newspaper reporter, said that 
one-eighth to one-fourth of a grain of morphine 
were the ordinary hypodermic doses, and that in the 
present instance death was no doubt due to the 
over-powerful action of the narcotic on nervous 
centers already weakened by lack of aerated blood. 162 
HYPODERMIC INJECTION OF MORPHIA. 
Possibly in the present case the cumulative effect of 
the previous doses of the Dover powder may have 
lent its aid to the result.”1 
The seventh case I have given at p. 148. 
Case 25.—Dr. J. G. Stokes, of Grayville, 111., 
writes me: “ I had one patient with syphilitic 
laryngitis. I was called to see him in his last 
hours, and he begged for ease and sleep, and I gave 
him grain of morphia over the deltoid muscle. 
He fell asleep in from 5 to 8 minutes, and died in 
three or four hours, never having been aroused. 
Hence I concluded that he would have lived 12 to 
24 hours longer without the morphia. This is the 
only case that I have met where I thought life 
was shortened by its use.” 
CASE 26.—Dr. N. S. Read, of Chandlerville, 111., 
sends me the following: “ The case I mentioned as 
being narcotized with Y gr. of morphia was a man 
who had been intemperate for years; age 35, height, 
5 feet 8 inches. He had, for the last three or four 
years, drank, on an average, 1 Y* pints of whiskey 
per day ; eat but little, and was very much emaciated, 
weighing about 92 pounds. He had been confined 
to his bed for some three or four weeks, and was suf- 
fering from pain in the stomach and lungs. There 
was very little, if any elimination from the kidneys. 
1 Louisville Med. News, Feb. 23, 1878. CASES OF DEATH. 
163 
The urine had a specific gravity of 1.003. I concen- 
trated a portion, over one-half, but found no crystals 
of urea upon adding nitric acid. He was expector- 
ating a white, tenacious matter, which I think was 
excrementitious. The pulse was no and small. I 
was called in to give relief from pain in the stomach 
and lungs. I gave him gr. of the sulphate of 
morphia at 10 r. M. Called the next morning to see 
him. He had slept all night; was breathing regu- 
larly, pulse 110; temperature ioo°; pupil con- 
tracted. Continued in that condition 36 hours, 
when the respiration became slower (14), and grad- 
ually sank until he died, 48 hours after taking the 
morphine. How much the morphine had to do with 
his death I am unable to say. The friends had been 
looking for him to die a week before.” 
In answer to another letter, the Doctor writes me: 
“ There was hepatization of one lung. No softening 
or ulceration. No albumen in the urine. Very 
little urine secreted.” 
Case 27.—A physician of this city reports 
the following case: “I was called to see a 
married gentleman, aged about 38, fair build 
and nervous temperament. He was suffering 
from violent pain over upper part of abdomen, 
coming on in spasms every two or three min- 
utes, and apparently accompanied by contraction 164 
HYPODERMIC INJECTION OF MORPHIA. 
of the diaphragm. His wife stated that he had been 
subject to these attacks for the past io years, different 
physicians ascribing the seizure to different causes, 
but all treating it alike—with morphine. He had, 
she said, been given as high as 20 minims of Magen- 
die’s solution every half hour until relieved; relief 
being usually obtained in about 1 ]/2 or 2 hours, at 
the most. The man was apparently suffering intense 
agony, and begged for a hypodermic injection of 
morphia, as he could retain nothing on the stomach. 
At 8 P. M. I gave him 10 minims of Magendie’s so- 
lution subcutaneously, and repeated this at 9 and 11 
P. M., as he was still suffering seemingly as intensely 
as when I first saw him. Returning at 1 A. M., and 
finding him still in great pain, I gave a final injection 
of five minims. He soon expressed himself as feel- 
ing easier, and after a time fell into an easy sleep. 
I then went home, thankful that I had relieved such 
intense suffering. At 6:30 A. M. I was hurriedly 
summoned to the patient’s house by the intelligence 
that he was dead. On arriving I found him so, 
having been dead probably a half or three quarters 
of an hour. The pupils were natural. 
“ Autopsy revealed deep congestion of the lungs. 
All the other organs normal. Brain not examined.” 
Here is the death of an apparently healthy man 
from the hypodermic injection of 1 yi gr. of morphia CASES OF DEATH. 
165 
given in % gr. doses, at intervals of one and two 
hours ; pain unabated in severity, and the time 
covered by injections, five hours. There was no his- 
tory of idiosyncrasy; on the contrary, a history of 
tolerance for large doses. 
The wife, who should have sat up with the patient, 
having seen him in these attacks before and having 
seen more morphia used, went to bed and to sleep in 
the full belief that on rising she would find her hus- 
band in his usual health. Owing to the frequency of 
these attacks, once in every two or three weeks, he 
had become something of an invalid. 
Case 28.—Dr. W. H. Haynes, of this city, 
writes me as follows: “ I have given as much 
as fifteen minims to start with in severe, pain- 
ful and uraemic cases, and in a hospital case 
of abdominal aneurism which had ruptured, where 
the bone was gone and the aneurism pressed 
directly on the membranes of the cord and 
the nerves, causing intense agony. I gave as much 
as twenty-five minims in less than a half hour, to his 
relief, though he died with symptoms of opium- 
poisoning 4 hours after, yet the autopsy showed that 
he was doomed any hour.” 1 
CASE 29.—Dr. Garland2 recited the case of a 
1 Full report in Hospital Gazette, Aug., 1877. 
2 “Meeting of Suffolk District Medical Society,” Boston Med. 
and Surg. Journal, 1871, p. 150. 166 
HYPODERMIC INJECTION OF MORPHIA. 
married lady, 40 years old, healthy, but delicate and 
sensitive, and the mother of two children. In July 
she was taken sick with vomiting and purging. 
From the onset she had' a small quick pulse, rest- 
lessness and constant nausea. Dr. Garland gave her 
y gr. subcutaneously. She died 15 hours after the 
injection, in spite of all measures employed.” 
Cases 30 and 31.—In the Report1 of the Com- 
mittee of the Medico-Chirurgical Society two deaths 
(one in a case of mania) from the subcutaneous in- 
jection of morphia are given. 
Cases 32 and 33.—The case reported by Dr. 
Alonzo Clark and that reported by Willard Parker in 
the chapter on Syncope, &c. 
Cases 34 and 35.—A gentleman of excellent at- 
tainments and sound judgment reports to me the 
following cases, which he saw only in consultation. 
He does not wish his name to appear in connection 
with them, lest it should cause hard feeling between 
the physician who had the cases and himself. Both 
cases, strangely enough, occurred in the practice of 
the same man. 
The first was that of a man aged 40, who was 
suffering from severe abdominal pain. The physician 
in attendance claims to have given two x/2 gr. doses 
of morphia subcutaneously, with an interval of about 
1 “ Medico-Chirurgical Transactions,” vol. 50. CASES OF DEATH. 
167 
two hours between the doses. The consultant says: 
“ The patient was moribund when I was called to 
him some hours afterward, but I know nothing more 
of the history of the case, and can only surmise 
that he must have had either larger or more frequent 
doses than was stated.” The doctor does not place 
much reliance on the statements of the gentleman in 
attendance. 
The second case was that of an old lady, aged 
about 70, much enfeebled by an attack of dysentery. 
For some days she had been treated by opium by 
the mouth and by rectal suppositories of the same, 
without apparent toxic effect. The physician in 
attendance finding that the tenesmus was very se- 
vere, decided to give morphia hypodermically. He 
says that he gave gr. in this way. No opium 
had been taken otherwise that day. When seen by 
the consultant the patient was deeply comatose, with 
pin-hole pupils, infrequent breathing, &c., &c. “ I 
injected gr. of atropine and repeated the dose 
after fifteen minutes, using, meanwhile, mild flagella- 
tion and other customary means. 
“ After the second dose the pupils slightly relaxed 
and the patient seemed to be rallying; so, having 
another important case on hand, I departed, leaving 
the atropine solution for my colleague to use again 
if needed, and urging him to see that the patient 168 
HYPODERMIC INJECTION OF MORPHIA. 
was kept awake and supplied with strong coffee. 
As I learned afterward, however, he left the matter 
to the family attendants and went home ; the patient 
relapsed into coma and died about six the following 
morning. 
“ As you see, I have really no scientific data about 
either of the cases. In the latter I used small tenta- 
tive doses of atropine to correspond with the alleged 
smallness of the dose of morphia; but if the usual 
antidotal rule be correct, the fact that the pupils only 
began to relax after gr., and subsequently recon- 
tracted, would indicate that she must in some way 
have had over a grain of morphia, at the least com- 
putation.” 
Case 36.—Dr. J. J. Henna, of this city, writes me 
of one case of death, from morphia thus used, but 
gives no particulars, as the case occurred in the prac- 
tice of another physician, and Dr. Henna did not see 
the patient until after death. Such a case, of course, 
cannot be used for statistical purposes. 
A prominent specialist of this city has told me of 
several cases of patients who had left this city, where 
they were under his care, and in good general health, 
and soon after reaching home died, having been a 
few hours before injected with morphine. The cases 
were always reported to this gentleman as death CASES OF DEATH. 
169 
from some acute disease. In one instance in partic- 
ular the death was attributed to acute diabetes ! 
Here, then, are the records of 36 cases of death, 
all of which are ascribed with more or less justness 
to the hypodermic injection of morphia. How 
many of these patients were really thus killed, or 
rather in how many of these cases we have sufficient 
evidence to warrant us in ascribing death to this 
cause, it is not easy to say. Let us see. In case 
No. 1, reported by Prof. Jno. H. Lowman, of Cleve- 
land, death was undoubtedly due to the injection, 
I heartily endorse Dr. Lowman’s opinion that the 
use of the hypodermic syringe in that case was 
uncalled for and extremely hazardous. It is possible 
that death might have occured had the morphia not 
been used, for the man was in a very low condition 
from the loss of blood and other causes, but every- 
thing seems to point to the conclusion that the hy- 
podermic injections were weighty factors in its 
causation, and teaches us most certainly that the use 
of the drug in this manner in such cases is extremely 
hazardous. Dr. Lowman, from a large experience 
with patients suffering from alcoholic excesses, had 
learned that such cases do not bear the subcutan- 
eous injection of morphia well. It is to be regretted 
that an autopsy was not held, as then, probably, the 
question would have been settled beyond a perad- 
venture. 170 
HYPODERMIC INJECTION OF MORPHIA. 
Maudsley,1 quoted by Bartholow,2 very justly says : 
“ In former times—indeed a very few years since— 
the notion universally prevailed that the delirious 
symptoms were owing to the exhaustion which was 
chiefly kept up by want of sleep; and consequently, 
that the production of continuous sleep for several 
hours was the sole and all-important means of cure. 
It was therefore the custom to ply the patients with 
larger and larger successive doses of opium, with the 
view of drowning the delirium in narcotic stupor. 
Great mischief arose from this widespread belief and 
practice. In the first place, it has often happened 
that the patient, without sleeping at all, has passed 
first into a condition of coma-vigil, next of stertorous 
breathing, and at last sunk, fairly poisoned with 
opium. 
Bartholow 3 then says : “ I quote these strong but 
just expressions to warn my readers against the abuse 
of the hypodermic injection of morphia in the treat- 
ment of delirium-tremens. 
“ The following are the indications for the use of 
this method in this disease: 
“ The condition of ‘ horrors’ or wakefulness preced- 
ing delirium. 
1 “ Reynolds’ System of Medicine,” vol. 2, pp. 88, 89. 
2 “The Hypodermic Method,” &c., p. 59. 
3 Op. cit., pp. 59, 60. CASES OF DEATH. 
171 
“ Excessive and uncontrollable vomiting of food, 
drink and medicine. 
“ Mild cases in which there is little tendency to de- 
pression of the vital forces, in which the assimilation 
of food proceeds satisfactorily. 
“ It is contra-indicated in severe and protracted 
cases, with great depression of the vital forces, and 
non-assimilation of food. 
“In cases where serious organic lesions of liver or 
kidneys have occurred. 
“ In cases in which the delirium-tremens is consec- 
utive to traumatic or other serious lesion of brain.” 
Anstie says : “ It has happened to me, as I doubt 
not it has to others, to see patients suffering from 
delirium-tremens who had been injudiciously pressed 
with large doses of opium, because smaller doses 
failed to produce sleep, die from collapse almost as 
suddenly as if they had been shot, or had swallowed 
a large dose of prussic acid, most obviously from the 
effects of the medicine.” 1 
Dr. Geo. Johnson expressed a like opinion to Dr. 
Anstie. 
I have already referred to some apparently conflict- 
ing testimony on this point. I then gave the opinion 
of Bodington in favor of opium, rather than “ the 
modern salts of the drug, they seeming to be the most 
1 “ Stimulants and Narcotics,” London, 1865, p. 158. 172 
HYPODERMIC INJECTION OF MORPHIA. 
dangerousof Nacke, who found temporary albu- 
minuria in 82 per cent, of the cases of delirium-tre- 
mens observed by him. 
Austin Flint1 says: “ Opium given in large and 
enormous doses, as was formerly the practice, was 
conclusively shown by Ware to be pernicious. Sleep 
is the desired object, but narcosis is not a substitute 
therefor. It is hazardous to induce the latter. But 
an opiate, in small or moderate doses, is often useful. 
A quarter of a grain of the sulphate of morphia every 
five or six hours, or an equivalent of codeia or some 
other preparation, is the safe limitation as regards 
dose and intervals.” 
Victims of the alcoholic habit must sooner or later 
become afflicted with hepatic and renal cirrhosis, in 
which condition there is of necessity imperfect nutri- 
tion and defective elimination of both food and tissue 
detritus. The nervous system is shattered by both 
mal-nutrition and chronic alcoholic poisoning. Is it 
surprising, then, that such a system is especially sus- 
ceptible to the sudden shock-like action of a drug so 
powerful as morphia; rendered trebly so by its exhi- 
bition by the hypodermic method ? It would seem 
that the tolerance established by one poison (alcohol) 
may be sufficient to withstand the initial dose of mor- 
1 “Clinical Medicine,” 1879. CASES OF DEATH. 
173 
phia, but that point being reached, or the limit of 
renal elimination being found, morphia exerts its 
baneful influence, and in a manner somewhat differ- 
ent from the narcotism of the average case. In this 
connection the cases of narcotism in alcoholic sub- 
jects, found at pages 88 and 91 are of interest, especi- 
ally that of nearly fatal narcotism recorded by the 
Medico-Chirurgical Society’s committee. 
Case 2, by Dr. Lyman M. Willard, is of a like 
character, although here there is possibly more room 
for doubt that death was thus caused than in Case i. 
The verdict of the coroner’s jury seems to have been 
based on the supposition that a man who turns in 
bed several times in the night, who seems to sleep 
quietly, snoring once in a while when on his back, and 
where there was found no congestion of the brain, 
but congestion of the stomach and liver, and a tawny 
color and diminution in size of the latter, significant 
of cirrhosis, with kidneys somewhat enlarged, could 
not have died of morphia narcosis. No mention 
is made of the condition of the lungs, a very 
important point in this connection, I think. It seems 
hardly possible to my mind that a young man of 
good build and fair general health could, as drinking 
goes, produce cirrhosis of the liver and diffuse ne- 
phritis in a few months of debauchery. The doctor 
states that the kidneys were somewhat enlarged; 174 
HYPODERMIC INJECTION OF MORPHIA. 
otherwise healthy. In case of palpable enlargement, 
a careful microscopical examination of these organs 
would be necessary to decide their freedom from 
disease. The man does not seem to have died of 
starvation. The fact that no congestion of the brain 
was found at the autopsy is the strongest argument 
against the idea that the man’s death was caused by 
the morphia, for if enough of the drug was given to 
cause death by respiratory failure, there should have 
been congestion of the brain and its membranes, 
marked retardation of breathing, mechanically1 con- 
gesting the cerebrum and its membranes. There is 
but one idea to be advanced in explanation, and that 
is the fact that death may have been caused by 
gradual failure of respiration and death by the heart, 
as has been known to occur in these cases. 
Anstie says:2 “ If these (small stimulant doses) 
failed, however, larger doses of the same remedies 
were tried, but rarely, I believe, with beneficial re- 
sult. The narcotism thus induced was unnecessary, 
and not unfrequently fatal; its depressing influence 
being excited, not gradually and by slow degrees, 
but suddenly and powerfully, depressing the heart’s 
power in so rapid a manner as to cause collapse and 
death.” 
1 Hammond, “ Sleep and its Derangements,” Phila., 1869. 
* “Stimulants and Narcotics,” Phila., 1865. CASES OF DEATH. 
175 
If death occurred in this case in this way there 
would be no trouble in understanding why there was 
no congestion of the brain and its membranes, and 
why the prominent symptoms of opium-poisoning 
were not present. As the case stands, I think there 
is reasonable doubt as to whether the death was 
caused by morphia. The brother’s testimony should 
not, however, be taken without question. It would 
be natural for him to excuse any supposed neglect 
on his part by such a statement as he there made. 
An interesting question, suggested by the history 
of this and the other cases of delirium-tremens here 
reported, is as to how far the effect of depresso-mo- 
tors (the bromide of potassium and chloral), pre- 
viously or simultaneously given in large doses, may 
render the exhibition of opium or morphine danger- 
ous in certain conditions of the system. These drugs 
have a direct depressant action on the heart,1 and 
the latter (chloral) on the respiratory centres.2 So, 
1 In speaking of the treatment of strychnia-poisoning, Wood says 
(page 292) : “ It is obvious that the use of aconite or tobacco, in large 
doses, is accompanied with grave danger, on account of their influence 
upon the heart, and we have in bromide of potassium a substance 
devoid of any such objection,” etc. This is a somewhat strange asser- 
tion in connection with the records of experiments at page 309, where 
ii is said: “ It is well established that large toxic doses of the bromide 
exert a direct paralyzing action on the heart, lessening both the force 
and frequency of the beat, and finally causing diastoltic arrest.”—“Ma- 
teria-Medica and Therapeutics.” 
2 Wood, “ Materia-Medica and Therapeutics,” Phila., 1877, pp. 
309, 320. 176 
HYPODERMIC INJECTION OF MORPHIA. 
also, has morphine in large doses. According to 
general experience in the use of drugs of one class, 
smaller doses of each, in combination, act fully as well 
and with as much power as larger doses of any one 
of them. Hence, it may be possible that the depres- 
sant action of morphia in these cases (mania and 
delirium-tremens) is due to the previous or simul- 
taneous exhibition of chloral and the bromides in 
large quantity. Moreover, in both of these affections 
there has been little or no food taken, and that irregu- 
larly, and in delirium-tremens there is usually some 
organic disease of the liver or kidneys, and some- 
times of the brain, heart or lungs. 
There must, however, be present the condition of 
system that obtains in these diseases, for if we may 
judge from the few cases recorded, morphia in more 
than the ordinary amount, hypodermically, acts in 
an antagonistic manner to at least one drug that in 
large doses is a profound depressor of the action of 
the heart and lungs, death taking place in the 
majority of instances from failure of respiration.1 I 
refer to aconite. The following case by Dr. F. H. 
O’Brien,2 of this city, will illustrate what I mean: 
“ The patient, Miss M , aged twenty-four, un- 
1 Fothergill, “Antagonism of Therapeutic Agents,” &c., p. 43; 
Wood, op. cit., p. 170. 
2 N. Y. Medical Record, Feb. 8, 1878. CASES OF DEATH. 
177 
married, took through mistake half a drachm of the 
tinct. aconiti rad., which was followed in twenty or 
thirty minutes by a sense of warmth in the stomach, 
nausea, and oppression of breathing. Shortly after 
this, followed numbness, tingling, and slight muscular 
weakness. She did not attribute her feelings to the 
drug, and in one hour from the time it was taken 
(4.30 P. M.) the dose was repeated. She started 
soon afterwards to walk a distance of two miles, 
and did not complain until about half way. On 
reaching her destination she began to stagger, and 
was soon completely prostrated. Her voice became 
very weak, and she complained of cephalalgia and 
lancinating pain in different portions of the body, 
but particularly in the joints. I was sent for, and 
arrived at 6.40 P. M. Learning that the patient had 
taken a poisonous dose of aconite, I administered 
the usual emetic, which was swallowed with great 
difficulty. I sent for Dr. Wm. H. Studley, who 
quickly arrived. I found the patient in the follow- 
ing condition: Axillary T. 9 P. 32, R. 10. 
Pupils dilated, extremities cold, loss of conscious- 
ness, extreme pallor of face with expression of great 
suffering, and there was a twitching of the mouth 
and eyelids. Emesis was produced. The stomach 
contained a considerable amount of fluid, which had 
an odor of alcohol. The retching continued, and 178 
HYPODERMIC INJECTION OF MORPHIA. 
her condition each moment grew worse, the pulse 
becoming frequent and irregular, and respiration 
more difficult. By consent of Dr. S., I injected, hy- 
podermically, fifteen minims Magendie’s sol., just 
after which (not exceeding one minute) the symp- 
toms became more alarming still, she having a 
slight convulsion. There was a spasmodic contrac- 
tion of the laryngeal muscles, respiration ceased, and 
the pulse was imperceptible. Dr. S. did not ob- 
serve me inject the morphia, and remarked that if I 
had not already done so it was useless to inject it. 
“ She was a dying woman ; respiration had ceased, 
the feeblest pulsation could not be detected, the 
body was cold to the touch, and we had every 
evidence of impending dissolution. We had lost 
all hope in the case, but were endeavoring to detect 
a feeble impulse of the heart, when suddenly and to 
our surprise the pulse sprang up about the rate of 
forty per minute. The laryngeal muscles were re- 
laxed and respiration began. Very soon the cheeks 
were flushed, and heat returned gradually to the ex- 
tremities. 
“ The thermometer was again placed in the axilla, 
and registered The retching continued, and 
in half an hour the pallor returned, there was gen- 
eral muscular tremor, and the pulse became fre- 
quent and irregular, as before. Ten minims Ma- CASES OF DEATH. 
179 
gendie’s sol. was injected, and an enema containing 
twenty grains carbonate of ammonia and one ounce 
of brandy. She soon rallied as before, this time 
recovering consciousness, and complained of cephal- 
algia, burning sensation in the stomach, and severe 
pain in different parts of the body. At ten o’clock 
P. M. I injected ten minims more Magendie’s sol., 
which seemed to quiet her, and at twelve o’clock she 
was asleep. The bladder had been evacuated four 
times since eight o’clock. 15 th, 6 A. M.—T. 990, 
P. 80. Has vomited only after the enemas, which 
were repeated at intervals of two hours. She com- 
plains of great muscular soreness, and movement 
of the body is painful. She is very weak, her grasp 
being scarcely perceptible. Champagne and mucil- 
aginous drinks were given, and the enemas con- 
tinued, but at longer intervals.” 
This patient fully recovered. A similar case is 
reported1 by Prof. Alonzo Clark, of this city, in 
which the direct stimulant action of morphia was 
quite as decided and much more rapid. 
Dr. Wm. H. Haynes, of this city, writes me of a 
.similar case, where morphia hypodermically used 
acted with celerity and marked benefit. 
The fact that one decided respiratory depressant 
1 N. V. Medical Record, Jan. 3, 1880. 180 
HYPODERMIC INJECTION OF MORPHIA. 
should, in large doses, act as a cardiac and respira- 
tory stimulant, in cases of poisoning from a drug 
that kills by paralyzing the respiratory centres, is very 
hard to understand in the light of our present knowl- 
edge, and teaches us the importance of placing more 
dependence upon clinical than upon theoretical medi- 
cine. 
Of Case 3 I have no particulars, but the reporter 
seems to entertain no doubts as to the cause of death. 
The dose, y gr., seems rather large (the more so as 
the man was old, and as it was repeated in five 
hours’ time). Anstie, in his paper on alcoholism,1 
gives gr. as the maximum dose, and ro to y as 
the usual amount. 
Case 4, reported by a physician of this city, who 
does not wish his name to appear, is one of the same 
nature as Case 2. There is no doubt but that this 
man died of morphia-poisoning, an autopsy only being 
needed to settle the matter beyond question. Here 
the doses were small, -g- gr., repeated in two hours’ 
time, and it is interesting to notice that the patient 
remained awake and talkative for two hours after the 
last injection; that he had previously had large doses 
of chloral and the bromide of potassium, and that his 
last sleep was not marked by stertorous breathing, 
although the respirations were as low as four per min- 
1 “ Reynolds’ System of Med.,” vol. 2. CASES OF DEATH. 
181 
ute ; that just after death the pupils were of natural 
size, and that the man who was young (36) was free 
from cardiac or renal disease. 
With reference to this condition of the pupils it is 
worthy of notice that Wood states 1 that the pupils 
in opium narcosis are contracted, or, as death ap- 
proaches, are widely dilated, and that inequality of the 
pupils may sometimes occur. 
In Case 5, there seems a reasonable probability that 
death was thus caused, although it seems strange that 
such a result should ensue from gr. morphia by 
the mouth, and gr. subcutaneously, when the pa- 
tient had, previous to the injection, received 6—0 of 
a grain of the sulphate of atropia, and further injec- 
tions of the same by another physician, after narcot- 
ism appeared. I think the case must be thrown out 
of our list, as it is not known how much atropia was 
given in all,2 and as no autopsy was held ; the more 
1 “ Mat. Med. and Therapeutics,” Phila., 1877, pp. 205, 214. 
2 In the North Carolina Medical Journal for April, 1879, a case 
appears where a woman was deeply narcoticed by l/2 gr. morph, 
sulph., given hypodermically, for the relief of epileptiform convulsions 
occurring about the time of the menstrual flow. Atropia sulph. was 
used hypodermically, as follows:—3 p. M., ,/<, gr. ; 4 p. m., gr.; 5 
p- M-* h gr-j at 6 P. M., % gr.—]/2 gr. in all, in a period of 3 hours, 
According to the best knowledge on the subject, 1 gr. of morphia is 
antidoted by gr. of atropia (Bartholow and others). Here enough 
atropia was given to antidote 12 grains of morphia, and the symptoms 
point plainly to death from atropine-poisoning. An interesting article 
relative to this case may be found in the same journal, for September, 
1879. 182 
HYPODERMIC INJECTION OF MORPHIA. 
so as the man had been very intemperate for some 
time. The possibility of erroneously ascribing death 
to morphia is shown by the following cases: 
Dr. Fifield,1 after narrating some cases of nearly 
fatal narcotism resulting from the subcutaneous 
use of from *4 to gr. of morphia, told of a 
case of labor where death was attributed to the 
hypodermic injection of gr. of the sulphate of mor- 
phia. The autopsy revealed rupture of a branch of 
of the cceliac artery. Had no autopsy been held in 
this instance, death would undoubtedly have been 
laid at the door of the hypodermic injection, and 
with a show of reason. 
A case of like nature is that occurring in the prac- 
tice of Prof. Roberts Bartholow, where death from 
gr. of morphia was claimed, when in reality it was 
due to oedema of the glottis. 
Case 7, may be taken as an example of that class 
of cases where the drug by the mouth alone would 
kill, if given in fair doses, there being decided idio- 
syncrasy in all members of the family. The case 
further illustrates the danger, pointed out by several 
of my correspondents, of giving morphia hypo- 
dermically after it has been given by the mouth. 
The same danger is illustrated in Case 5. If the 
1 “ Proceedings of Suffolk District Medical Society,” Boston Medical 
a fid Surgical Journal, Nov., 1876. CASES OF DEATH. 
183 
physician who attended the case is believed, the 
patient died of morphia-poisoning, and from small 
doses. If the reporter, the consulting physicians, 
and the father are believed, morphia was given by 
the mouth in inexact doses, the amount of which 
was guessed at, and will consequently never be 
known. With this conflicting testimony, and in 
the absence of an autopsy, I think the case should 
be classed as doubtful so far as the statistics of death 
from small doses, with reasonable intervals, are con- 
cerned. By it, however, the lesson of the existence 
of such a thing as idiosyncrasy and the danger 
attending the exhibition of this drug in these cases, 
and the danger of morphia by the skin after morphia 
by the mouth, is forcibly illustrated. 
Case 6, further shows the danger of the subcu- 
taneous use of morphia after giving opium by the 
mouth. 
In Case 8, reported by Prof. Alfred C. Post, of this 
city, there is a reasonable probability that death was 
due to the morphia, the renal trouble, if present, un- 
doubtedly predisposing to narcotism by reason of 
imperfect elimination. Cases of renal disease where 
this method of using morphia has been attended 
only by excellent results are detailed at page 74, as 
also some experiments performed by myself with 
the view of throwing some light upon this subject. 184 
HYPODERMIC INJECTION OF MORPHIA. 
In Case 9, reported by Dr. Snook, of Kalamazoo, 
Mich., there seems a reasonable probability that 
death was caused by morphia; but without an 
autopsy one could not be certain of it. Take the 
following case as a further illustration of the error it 
is easy to fall into in this matter: 
Dr. R. H. Sabin, of West Troy, N. Y., has very 
kindly written out this case for me in full: “ Capt. 
R. R—, the patient spoken of in my previous com- 
munication, was a very active business man. Two 
years previous to his death he complained to me of a 
distress after eating. I gave him some medicine 
which relieved him. Something like a year after, he 
complained to me that after eating he would have a 
pain in the stomach, would have to stop for a few 
moments, and then the pain would pass off. He 
could not, during the last year, walk up a hill with- 
out stopping to rest. He often left his house in the 
evening to call on me, with the intention of consult- 
ing me in regard to it; would sit all evening talking 
of everything else, and go away without saying any- 
thing about it. The day of his death he went to 
church in the morning, where he was taken with pain 
about the heart, so severe that he left the house, went 
home, applied mustard to the chest, and sent for me. 
When I saw him he was suffering severely. I used 
chloroform by inhalation, and the pain soon changed CASES OF DEATH. 
185 
to the left shoulder, and was described by him as 
being most excruciating. Fearing that irritation in 
the stomach might be causing the pain, I gave an 
emetic of mustard and ipecac. He soon vomited, 
but the pain was not relieved. I then gave y gr. 
morphia, and continued external applications. As 
this did not relieve the pain, I got my syringe and 
gave y gr. morphia under the skin over the shoul- 
der, where he complained of the severe pain. About 
two hours from the time he was first taken he began 
to get easier, though he was not entirely relieved, 
but so much better that he dropped into a quiet 
sleep. In ten or fifteen minutes he awoke and said 
he was much better, though in some pain. He slept 
again, and I left him in the care of his wife and 
neighbors. About three-quarters of an hour passed, 
his wife speaking to him every few minutes, he 
showing by his answers that he was perfectly rational. 
About 4 P. M. his wife noticed a change in him. 
I was sent for—arrived soon after, but found him 
dead.” 
“ Post-Mortem.—Body well nourished ; right lung 
slightly congested, and with adhesions between 
pleural surfaces. The coronary arteries were ossi- 
fied, the one going to the left side being entirely 
obliterated. The walls of the left ventricle were 
very thin and softened. The autopsy was made by 186 
HYPODERMIC INJECTION OF MORPHIA. 
Drs. Hun and Hails, of Albany, and Dr. McLean, 
of Troy, in the presence of several other medical 
gentlemen. These gentlemen considered the death 
due to angina pectoris, and believed that the mor- 
phia had nothing to do with it. There was nothing 
abnormal about the kidneys or stomach.” 
In Case io, reported by Dr. C. Carroll Lee, of 
this city, death from morphia seems to be unques- 
tioned, and the doctor is an excellent observer, whose 
opinion is worthy of full credit. This case, like those 
reported at page 92, would seem to be in accordance 
with the views of Fothergill, stated at the same page. 
Of Case 11, we have no particulars. 
Of Cases 12, 13, 14, and 15, the evidence is not 
sufficient to warrant us in saying that death was due 
to morphia, hypodermically used. It is probable, 
however, that one at least of these four deaths was 
thus caused. 
Cases 16 and 17, reported by Dr. E. Wenger, of 
Gilman, 111., are hardly worthy of a place here, 
owing to the fact that the details are very meagre ; 
there was no autopsy; and in case 16, the disease itself 
seems to have been sufficient to cause death. Had 
this patient died and no morphine been given, I 
think no question would have been raised as to the 
cause of death. Such cases are dying every day, 
in precisely the same manner, and without the use of CASES OF DEATH. 
187 
morphine; indeed, many cases of cure are reported 
by this very plan of medication in this disease. In 
Case 17, reported by the same gentleman, the death 
was almost too rapid (30 minutes) for it to be caused 
by morphia. The meagre detail points as much to 
disease of the heart as to death from opium narcosis. 
I think there is no question as to the honesty of the 
belief entertained by Dr. Wenger as to the cause of 
death, but I think he comes to this conclusion on 
rather meagre grounds. The case may have ap- 
peared sufficiently conclusive to the doctor who saw 
it, but it seems as though so important a matter 
would have sufficiently impressed itself upon his 
mind to enable him to state the grounds of his 
belief; the more so, as the subject of death from the 
hypodermic injection of morphia was a new and 
startling thing at that time. Furthermore, in Case 1, 
as much as one grain of morphia was used, a fact 
not stated in the Journal article, and in his, Case 3, 
the amount of morphia used is not known, and as 
the patient died within 30 minutes, something un- 
usual (as puncturing a vein) must have occurred, if 
the fatal result was due to the morphia. 
Cases 18, 19, 20, 21, 22 and 23, reported by Dr. 
E. F. Ingals, are worthy of consideration only from 
the fact that Dr. Ingals vouches for the truth of the 
reports. The reports themselves are anything but 188 
HYPODERMIC INJECTION OF MORPHIA. 
satisfactory. The doctor might have given some im- 
portant part of the case histories, and certainly the 
doses used, without in any way compromising the 
gentlemen who reported the cases. The opinions of 
any one man, though he be honest and thoroughly 
educated, as is Dr. Ingals, are of necessity warped by 
a certain amount of bias, and error in reasoning upon 
such cases will oftentimes creep in. 
Hence, the opinions of one man upon so important 
a question as this are by no means conclusive, and 
only of value'inasmuch as they awaken other men to 
a study of the subject and excite discussion in which 
truth may at last be reached. It is heartily to be 
wished that the doctor had given fuller information 
than he has done. One of the cases, in this gentle- 
man’s interesting article, illustrates the danger of giv- 
ing morphia hypodermically after giving it by the 
mouth. 
In the case of the patient upon whom ovariotomy 
was performed, the amount of morphia was exces- 
sive and it is not surprising that death ensued. 
In Case 25, death was probably due to the morphia, 
and was, perhaps, a mercy to the patient. 
In Case 26, it is probable that the morphia had 
little, if anything, to do with the patient’s death ; al- 
though in such a condition of kidneys (probably renal CASES OF DEATH. 
189 
cirrhosis) the elimination of morphia would be very- 
slow and narcotism very likely to result from a small 
dose. 
In Case 24, there is reason to believe that death 
was due to the injection of morphia, and very for- 
cibly illustrates the possible danger (borne out by 
other cases) of giving morphia hypodermically after 
administering opium or morphia by the mouth, and 
of using it in those diseases where the tendency is to 
death by the lungs, the blood being already in a 
poorly aerated condition. 
In Case 27, we can say as positively as anything 
can be said in medicine, that death was due to the 
morphia, although given in but small doses (the 
patient being accustomed to larger amounts, if the 
wife’s statements are to be believed), and at reason- 
able intervals. 
It has often been asserted that narcotics are harm- 
less so long as intense pain is present, their whole 
force being expended in relieving the pain. This 
may be true in the majority of instances, but in some 
cases it is not so. Witness this case and some others 
reported under the heads of narcotism and of 
death. 
In Case 28, the dose was excessive. The case was 
one, however, where euthanasia was possibly justi- 
fiable. 190 
HYPODERMIC INJECTION OF MORPHIA. 
In Case 29, there is reasonable grounds for believ- 
ing that death was due to the morphia injected, al- 
though in small amount. 
Although Cases 30 and 31 are lacking in detail, it is 
to be supposed that the eminent gentlemen compos- 
ing the Committee of the Medico-Chirugical Society 
would fully assure themselves of the truth of the 
matter before announcing these facts. 
In Case 32, death was in all likelihood due to the 
injection, and to the fact that it was made directly 
into a vein. It is quite supposable that a patient 
suffering from trismus should die in a hospital ward 
without attracting the particular attention of the 
nurse. This and the one reported by Dr. Parker 
are the only cases of death that I know of from injec- 
tion of this drug into a vein. The demonstration of 
the fact was made with Dr. Clark’s usual accuracy. 
The treatment of tetanus and trismus by large 
doses of morphia bears the stamp of authority. This 
is one of the diseases where large doses of the drug 
are sometimes used with marked benefit, narcotism 
rarely showing itself. 
In Cases 33 and 34, there is no absolute proof of 
death from morphia, as the reporter himself admits. 
In Case 34, the woman’s age, her great prostration, 
and the fact that the pupils did not respond to the at- 
ropia, would throw much doubt upon the matter. The CASES OF DEA 77/. 
191 
question here arises as to whether it is a safe proceed- 
ing to give as much atropia as was here given when 
the action of the heart must have been very weak. 
The other cases are, of course, doubtful, but the 
probability is that in at least one of them death was 
due to the morphia used. Acute diabetes is a some- 
what novel affection. CHAPTER VI. 
TREATMENT OF OPIUM NARCOSIS — ATROPIA — 
STRYCHNIA — AMMONIA — COFFEE — ELECTRI- 
CITY — ARTIFICIAL RESPIRATION — OXYGEN 
COLD DOUCHE — FLAGELLATION — WALKING. 
So much has been done in the matter of experi- 
ment upon both men and animals, to determine the 
antagonism of atropia and morphia (opium and 
belladonna), and so many cases have been given in 
its support, that the treatment of opium or morphine 
narcosis seems to many a very simple matter. 
However numerous and complete these experiments 
may have been, and however many cases have re- 
sponded to this form of treatment, the fact still stands 
that not a few victims of opium-poisoning die in spite 
of the careful and conscientious carrying out of the 
treatment in every detail. Such cases, though possibly 
proving themselves the exception to the rule, teach 
us that full reliance cannot be placed on one measure 
alone. A person who has taken a fatal dose of 
morphia may have had the effects of that drug TREATMENT or morphia narcosis. 
193 
thoroughly antidoted by the action of atropine, and 
yet die from some cause other than the imme- 
diate effects of the drug. Indeed, there is reason to 
believe that in some cases the patient is actually 
killed by the antidote.1 It will be well, then, to 
consider atropine as a valuable agent in saving life 
jeopardized by poisonous doses of morphine, and to 
study all those agents the sum of whose actions 
combat as nearly as possible the fatal tendencies of 
opium or morphia. The tendency to death in poison- 
ing by opium or its alkaloid, morphia, is by failure of 
respiration. Hence those means that combat this 
tendency are the most valuable. We may arrange 
all the agents necessary to use as follows: 
Atropia, 
Strychnia, 
Ammonia. 
To Aid or Estab- 
lish Respiration, 
Artificial respira- 
tion, 
Sylvester’s me- 
| thod (modified), 
Electricity. 
Oxygen. 
Ammonia, 
Whiskey, 
Caffeine or coffee. 
Subcutaneous in- 
injection, 
To Stimulate the 
Heart, 
Intravenous in- 
jection, 
Ammonia. 
Enemas, 
Hot water, 
Whiskey, 
Ammonia. 
1 North Carolina Medical Journal, April, 1879. i94 
HYPODERMIC INJECTION OF MORPHIA. 
Cold douche and warm douche, alter- 
nately, 
Hot irons to epigastrium, 
Flagellation, 
Walking. 
To Produce Gener- 
al Stimulation, 
To Counteract So- 
porific Effects, 
Caffeine, 
Ammonia, 
Cold douche. 
To Produce Diuresis.. Caffeine. (?) 
Only those measures that are of service in poisoning 
by morphia hypodermically will be discussed here. 
In reality, the only difference in treatment of nar- 
cosis, resulting from morphine by the skin and 
opium or morphine by the mouth, is, that, in the 
latter case, the stomach-pump or emetics are to be 
used in addition to the other means, of which I 
shall now speak. 
Atropia—Belladonna.—The question as to 
whether belladonna is a physiological antidote to 
opium has long been a debated point, the discussion 
extensive and the writings voluminous. The feeling 
at the present day, amongst those who review the 
history of the question fully, fairly and dispassion- 
ately, seems to be that these two drugs are mutually 
antidotal in certain particulars only, and that the 
benefits to be derived from the employment of 
belladonna in opium-poisoning are confined to the TREA TALENT OF MORPHIA NARCOSIS. 
195 
very limited area of direct stimulant effect on the 
respiratory centres. As favoring the view that 
these two drugs and their alkaloids are mutually 
antidotal in man, we have the experiments and 
conclusions of Mitchell, Keene and Morehouse,1 
Bennet,2 Bartholow,3 Fothergill,4 the statistical and 
other papers of Norris,5 Lee,c Oliver,7 and Smith,8 
and many cases 9 of poisoning where such antidotal 
action is fairly well proven. 
1 American Journal Med. Sciences, July, 1865. 
2 British Medical Journal, 1874, p. 547. 
3“The Hypodermic Method,” &c., Philadelphia, 1878. 
4 Am. Journ. Med. Sci., October, 1862. 
5 Ibid, Jan., 1862. 
6 Thesis, Ibid, July, 1876. 
7 Phila. Med. and Surg. Reporter, Nov., 1874. 
8 “Antagonism of Therapeutic Agents,” Phila., 1878. 
9 S. Wordsworth Poole, Practitioner, vol. 13, p. 251. D. B. Wil- 
son, Philadelphia Med. and Surg. Reporter, Nov. 17, 1878. H. 
Wardner, Medical Examiner, Feb. 15, 1874. Antonio di Bernardo, 
Gazette Hebdomadaire, No. 8. J. F. Prentiss, Chicago. Med. Journal, 
Dec. 1866. Motherwell, (Australian Med. Journal, Oct. 1861), 
Med. Times and Gazette, Jan., 1862. Thos. Anderson, (Monthly 
Journal Medical Sciences, April, 1854J, Am. Journal Med. Sciences, 
July, 1854. Johnson, London Med. Record, April 9, 1873; 300 cases 
in China treated with atropia with success, the best results being ob- 
tained in the severe cases; also quoted in “ Ringers’ Handbook,” N. 
Y., 1875, p. 50. M. S. Buttles, N. Y. Medical Record, Aug., 1868. 
H. S. Downs (11 cases), quoted by J. P. McGee, Am. Journal Med. 
Sciences, July, 1869. D. S. Bucklin, N. Y. Medical Journal, vol. 20, 
p. 165. Radcliffe (London Lancet), Practitioner, July, 1868, p. 247. 
Practitioner, vol. 4, p. 59. Ulrich, Medical Summary, Nov., 1879. 
C. H. Lewis, Detroit Lancet, Nov., 1879. Greenway, British Medical 
Journal, Oct. 5, 1878. Black, Canada Medical Record, Dec., 1879; 
and many others. 196 
HYPODERMIC INJECTION OF MORPHIA. 
Dr. Alfred Ludlow Carroll, of New Brighton,' 
Staten Island, writes me as follows: 
“ As to the antidotal action • of atropia—still dis- 
puted by Harley and some others—I have quite re- 
cently had another instance, in the person of a 
gentleman who took nearly an ounce of laudanum 
with suicidal intent. I saw him about an hour 
afterwards, when, of course, most of the drug must 
have been absorbed ; and narcosis was already com- 
mencing. I gave him an emetic of turpeth min- 
eral, followed by warm mustard-water, as a prelimi- 
nary measure; and, as soon as I could procure the 
solution, injected N grain of atropia, the effect of 
which upon the pupils was marked within ten 
minutes. With constant exercise and a repetition of 
the atropia two hours later, he made an excellent 
recovery.” 
Prof. John J. Reese thinks that the weight of evi- 
dence is in favor of the mutually antidotal powers of 
these two drugs, as concluded from a study of clinical 
cases. He seems to think the results of experiments 
on animals far from satisfactory in establishing the 
question of antagonism. In a recent letter the 
doctor tells me that he has since seen no reasons 
for changing his opinions as thus stated. 
1 American Journal Medical Sciences, April, 1871, p. 380. TREATMENT OF MORPHIA NARCOSIS. 
197 
Dr. John Harley 1 does not believe that there is 
sufficient antagonism between these drugs to be of 
material service in cases of poisoning. He further- 
more believes that, when given together, the atropia 
intensifies the hypnotic action of opium, he having 
proved this to his own satisfaction on the human 
subject. This seems to be in accordance with the 
views of Bartholow 2 and Miller,3 and the facts pre- 
sented by some of the cases reported to me. 
Anstie does not believe that these two drugs are 
mutually antidotal. He says : “ It may be possible 
that in poisoning with one narcotic, a different nar- 
cotic, in doses so small as to have only a stimulant 
action, might prove beneficial, as is clearly the case 
with small doses of tea or coffee in poisoning with 
alcohol. But, that the general poisonous action of one 
narcotic can remedy the general poisonous action of 
another, appears extremely improbable, and should be 
rejected until there is some better evidence of it than 
we at present possess.” 
Dr. A. Falck, a reference to whose article is to be 
found in Schmidt's Jahrbiicher, calls attention to 
the fact that the so-called antagonism of opium and 
1 “ Gulstonian Lect.,” British Medical Journal, April, 1878, and 
“ The Old Vegetable Neurotics.” 
2 “ Materia Medica,” pp. 368-9. 
3 British Medical Journal, Nov. 17, 1877. 
4 “ Stimulants and Narcotics,” Phila., 1865, p. 207. 198 
HYPODERMIC INJECTION OF MORPHIA. 
belladonna was noticed by Albinus and others, as 
early as 1570. He (Falck) does not believe that these 
drugs are antidotal in the true sense of the term, as 
will be seen from the following : “ Atropin and phy- 
sostigmin ; strychnin and chloral hydrate; chloral 
hydrate and atropin; morphine and atropin, are all 
respectively antidotal in a pharmacological sense, 
but not in a physiological one. That is, the one 
will diminish the symptoms caused by the other, but 
will not produce contrary physiological effects.” 1 
Dr. Corona,2 from a series of very full, careful and 
varied experiments on animals, comes to the follow- 
ing conclusions : “ That a partial physiological antag- 
onism between atropia and morphia may be recog- 
nized, but that the theory of a mutual therapeutic 
antagonism cannot be accepted. Morphia is available 
as an antidote in poisoning by atropia, but poisoning 
by the former drug may not be combated by the 
latter.” 
Brown Sequard3 affirms his disbelief in their mutual 
antagonism, basing his opinions upon experiments 
made on animqls. 
With reference to the value of experiments on ani- 
mals with the view of obtaining reliable facts relating 
1 Philadelphia Medical and Surgical Reporter, Dec. 13, 1879. 
2 ( Giornale di Medicina Militaite) Practitioner, vol. 18, p. 132. 
3 Journal de la Physiol., Oct. i860, p. 726. TREATMENT OF MORPHIA NARCOSIS. 
199 
to the use of these drugs in man, the protest of Mit- 
chell, Keene, and Morehouse 1 is of interest: 
“ And here it is not unfit that we should criticise 
the loose way in which therapeutic inferences have 
been drawn from experiments On animals, where, of 
necessity, poisonous doses have been used and their 
effects studied. Most of the symptoms which ensue 
when a dose of any ordinary narcotic has been 
taken are so completely subjective that we can learn 
their existence only by the statements of the person 
who feels them. Even when these drugs are given 
in poisonous doses to animals, it does not follow that 
the resultant symptoms will, either in degree or in 
kind, correspond accurately to those which occur 
under like circumstances in man. Dr. Anstie, in his 
recent work on Stimulants and Narcotics, has very 
well illustrated this proposition. We ourselves have 
seen a dog recover after the subcuticular injection of 
twenty-fivegrains of atropia thrown, in divided doses, 
into various parts within a few minutes. 
“ The temptation to study poisons in cold-blooded 
creatures is always very great, because in these ani- 
mals certain facilities for toxicological study are pre- 
sented which do not elsewhere exist. But, as might 
be expected, analogies fail us more and more as we 
1 Atn. Journal Med. Sciences, July, 1865. 200 
HYPODERMIC INJECTION OF MORPHIA. 
pursue our researches upon creatures remote from 
man. No more striking example of this is to be 
met with than one of us, Dr. Mitchell, has recorded 
in the Journalde la Physiologic, for Jan., 1862, where 
the author details at length a series of experiments 
upon snapping-turtles which he attempted to poison 
with woorara. 
“ In this paper it is shown that while only 9-6 of 
a grain is required per pound of the animal to des- 
troy a rabbit within a few minutes, the snapping- 
turtle is poisoned with difficulty, and not surely, by 
Y of a grain for each pound of its weight. 
“ It would be easy to extend these examples and 
to show, not that we should cease to use animals for 
the study of poisons, but that in order to appreciate 
properly any toxic agent, we must follow its effects 
through a wide range of created existence from 
vegetable to man, and that its therapeutic uses are 
to be learned only from its influence upon the being 
to whom, finally, it is to be of medicinal value.” 
Prof. H. C. Wood, of Philadelphia, whose powers 
of observation and analysis are of the highest order, 
says: “When the subject in hand is looked at from 
its clinical aspect, the conclusions of Dr. Bennet are 
confirmed. To tabulate and discuss the cases of 
opium or belladonna poisoning, in which the counter- 
narcotic had been used, would require very many TREATMENT OF MORPHIA NARCOSIS. 
201 
pages, and I, therefore, can only state my opinion 
that these records establish the therapeutic value of 
atropia in opium-poisoning; but this does not indi- 
cate, much less prove, complete antagonism between 
the two drugs. No one would question the value of 
alcohol in certain stages or conditions of opium- 
poisoning, and yet no one would claim that opium 
and alcohol are in any sense antagonistic. In opium- 
poisoning death occurs chiefly through failure of the 
respiration. Atropia is the only known drug which 
exerts a decidedly stimulating effect upon the respir- 
atory centres. It is evident that in advanced stages 
of opium-poisoning this property renders atropia an 
invaluable remedy. In protracted opium narcosis 
the cardiac and vaso-motor actions of atropia are of 
service; but it should never be forgotten that the 
main influence for good is upon the respiratory cen- 
tres. The first improvement from atropia in these 
cases is, usually, increased frequency of respiration; 
and as the breathing becomes less embarrassed the 
other symptoms ameliorate, largely because of the 
increased aeration of the blood.”1 
Fothergill2 adds two drugs to the list of direct 
respiratory stimulants: “There can exist no longer 
any doubt that we possess in atropia, in strychnia 
1 “ Materia-Medica and Therapeutics,” Phila., 1877, pp. 250-1. 
2 “Antagonism of Therapeutic Agents,” Phila., 1878, p. 109. 202 
HYPODERMIC INJECTION OF MORPHIA. 
and in ammonia most powerful means for acting 
upon the respiratory centres when these are being 
paralyzed by toxic agents.” 
A strong point in favor of the hypothesis of the 
mutual antagonism of these two remedies is the fact, 
if it can be well proven, that atropia exercises a 
directly controlling and curative effect on some of 
the unusual manifestations of morphia (convulsions, 
tetanus, etc.) where its beneficial effect could in no 
way be referred to its stimulant action on the respir- 
atory centres (see p. 231). I think that we must con- 
clude from what we at present know that we are not 
justified in simply giving atropia in every case of 
opium narcosis to which we are called, with the 
expectation that atropia alone will do the entire work 
without aid, even if they are mutually antagonistic. 
There are other measures nearly, if not quite, as im- 
portant, and should a patient die without their use, 
the physician must, of necessity, feel that there are 
fair grounds for the belief that death was due to his 
culpable neglect. 
It has been experimentally and clinically demon- 
strated that about Lr-5 gr. of atropia should be exhibited 
for every grain of morphia taken, and vice versa. This 
is, of course, not exact, the amount necessary in each 
case being decidedly modified by special idiosyncrasy 
and diseased condition, both as regards opium and TREATMENT OF MORPHIA NARCOSIS. 
203 
belladonna. The physician must decide alone from 
the condition of the pulse and respiration. 
If the respirations, after one or two repetitions ot 
fractions of a proportionate dose, increase in frequency 
and the pupils commence to dilate, the hand should 
be stayed and other measures employed to still fur- 
ther better the patient’s condition. Too much atro- 
pia may prove decidedly injurious, and, as a rule, the 
physician who puts implicit confidence in the antag- 
onizing power of atropia, in the excitement of the 
hour, is very apt to overstep the bounds of safety. 
One such case has already been cited. 
On this point Bartholow1 says: “It cannot be 
too strongly insisted on, in this connection, that bel- 
ladonna in too large quantity, or too long in action, 
exhausts the irritability of the unstriped muscular 
fibre, and thus induces the very state which its ad- 
ministration was intended to relieve. The state of 
the pupil, the action of the heart, and the condition 
of the reflex movements are the guides to the ad- 
ministration of belladonna in cases of opium narcosis. 
The smallest quantity of belladonna which will dilate 
the pupil, raise the tension of the arterial system, 
deepen the respiration, and re-establish the reflex 
excitability, should be used. The author has a strong 
conviction, arising from some painful personal expe- 
“ Materia-Medica,” pp. 368-9. 204 
HYPODERMIC INJECTION OF MORPHIA. 
rience, that it is a fatal error to attempt to restore a 
patient in opium narcosis to complete consciousness 
by repeated doses of belladonna. The action of these 
agents, combined, is to produce profound sopor, and 
this is not a condition of danger so long as the pulse, 
respiration, and reflex movements, are in good condi- 
tion. To substitute belladonna narcosis for opium 
narcosis is only increasing the hazard under which 
the patient is already struggling.” 
Prof. H. C. Wood 1 likewise deems this a matter 
of considerable moment, as is here shown : “ It is a 
matter of the gravest practical importance to decide 
when, how, and in what quantities, the mydriatic 
should be employed. The exhibition of belladonna 
should, I think, commence as soon as there is decided 
failure of the respiration. The stomach is so para- 
lyzed in the narcosis that it is uncertain how fast ab- 
sorption will take place in the viscus; and the drug 
should always be given hypodermically, in the form 
of the alkaloid, if possible. The first injection of 
atropia should be of such size that it could not pos- 
sibly do harm, and fa of a grain is, in most in- 
stances, a fair commencing dose. Very generally 
several repetitions of this are necessary, and the 
delicate practical point is to decide how often these 
repetitions shall be indulged in. 
1 “ Materia-Medica and Therapeutics,” &c., p. 251. TREATMENT OF MORPHIA NARCOSIS. 
205 
“ I think that very frequently too much atropia is 
given, and believe that often a great deal of firm- 
ness is required in these cases not to use it too freely, 
especially since reliance is generally placed upon the 
pupils as a guide. They are, however, a very un- 
safe guide, as is apparent when it is remembered that 
whilst opium contracts them by influencing the nerve 
centres, atropia probaby dilates them by acting on 
the peripheral nerves. It must not be forgotten that 
in doses of sufficient magnitude atropia paralyzes the 
nerve trunks, and may thus increase the danger. A 
cardinal principle should, therefore, be to give no 
more of the mydriatic than is absolutely necessary. 
One-fortieth or one-sixtieth of a grain may be in- 
jected every fifteen, twenty, or thirty minutes, as the 
urgency of the symptoms may demand. The judg- 
ment should be formed from a bird’s-eye view of the 
whole case, fresh atropia not being given so long as 
the respiration and other symptoms are undergoing 
amelioration, but the dose being renewed so soon as 
any tendency to relapse is manifested. Thus, if, un- 
der the influence of atropia, in a case the respirations 
had risen from four to eight per minute, I would not 
use the counter-poison again until there was mani- 
fested a tendency for the respirations to grow less 
frequent or unless, for a long period, there had been 
no improvement.” I quote Dr. Wood at this length 206 
HYPODERMIC INJECTION OF MORPHIA. 
because he so aptly expresses in a manner that can- 
not be improved upon what I deem safe and sensible 
practice. 
STRYCHNIA.—Fothergill1 asserts that strychnia 
has a decided power over respiration, acting here, as 
elsewhere in the body, as a tonic. If this be true, 
and there seems very little reason to doubt it, then, in 
opium poisoning where there is decided embarrass- 
ment of respiration, we have in strychnia a valuable 
respiratory stimulant. Dr. Geo. A. Foote2 gives the 
following testimony in support of this view: "The 
antagonism of opium to strychnia is worthy of 
special attention. Dr. A. S. Jones, an intelligent phy- 
scian of Warren County, administered, by mistake, 
three grains of strychnia to a valuable pointer dog. 
Soon its characteristic effects, pain and convulsions, 
followed. In order to relieve the suffering and, if 
possible, to save the life of the animal, he injected 
six grains of morphia within two hours after discover- 
ing his mistake. The recovery was perfect, and the 
dog enjoyed forty-eight hours of profound and de- 
lightful repose. Being desirous of testing, for my- 
self, this antagonism, I made two similar experi- 
ments—giving one and three-fourth grains of 
strychnia to one dog, and two and a half to another. 
1 “Antagonism of Therapeutic Agents,” Phila., 1878, pp. 107, 117. 
2 “ Transactions of the Med. Society of the State of North Caro- 
lina,” 1877, p. 69. TREATMENT OF MORPHIA NARCOSIS. 
207 
The toxical effects were soon manifested, both ani- 
mals exhibiting signs of extreme suffering. I then 
injected one grain of morphia every half hour into 
each of my canine patients, until four grains had 
been used to counteract the smaller dose of strychnia, 
and six grains to counteract the larger dose. The 
spasms yielded readily, the pain abated, and both 
dogs recovered, after having slept about two days. 
I related the above experiments to my friend Dr. L. 
J. Picot, a member of this Society, who soon had an 
opportunity to test the treatment in the case of 
a gentleman who, with supposed suicidal intent, had 
taken strychnia in quantity sufficient to produce ap- 
palling convulsions. He successfully met the emer- 
gencies of the occasion by the hypodermic use of 
five grains of morphia in divided doses at short in- 
tervals. The case was reported to this Society (see 
Proceedings, 1875). Prof. John J. Reese denies the 
antagonism of these agents (see American Journal 
of Medical Sciences, 1871, April number). He 
administered to a dog hypodermically one grain of 
sulphate of morphia, and after waiting ten minutes he 
injected half a grain of strychnia. The animal 
died in twenty-one minutes. Now I think that Dr. 
Reese’s failure was due to the small quantity of 
morphia used. Strychnia has acquired a reputation 
as a poison scarcely inferior to that of prussic acid; 208 
HYPODERMIC INJECTION OF MORPHIA. 
and yet, if I do not greatly err, we have in the hy- 
podermic use of morphia a potent instrumentality 
for counteracting its fatal effects. 
“ And here let me mention a case reported by Dr. 
Charles Duffy, of Newburn, N. C. He says : * I 
have recently had a brilliant recovery from poisoning. 
The patient had taken three grains of morphia and 
one hundred and sixty of chloral. I injected hypo- 
dermically, one-twelfth of a grain of strychnia. In 
less than fifteen minutes a slight tonic spasm ensued. 
The patient, who but a few moments before could 
not be aroused by shaking, flagellating, &c., now, as 
if by magic, became semi-conscious—the dusky hue 
giving place to the natural color—like a cloud to a 
ray of sunshine.’ ” 
It would be well to use it and atropia together, 
keeping them in solution, or, what is much more 
convenient for carrying in small compass, in powder. 
The following formula would give the required 
strength in a few drops ready for subcutaneous in- 
jection. 
R Strychnige Sulphatis gr. i. 
Atropiae Sulphatis gr. ii. 
Aquae Destil ii. 
M. Ten minims gives *m> gr. strychnia and 43 gr. at- 
ropia. TREATMENT OF MORPHIA NARCOSIS. 
209 
Or with caffeine : 
IjL Strychniae Sulphatis gr. i. 
Atropiae Sulphatis gr. ii. 
Caffeinae Citratis gr. 96. 
Aquae Destillat 1 ii. 
M. The same strength as the above with the addition 
of 1 grain of caffein to every 10 minims of so- 
lution. 
Or when in powders : 
5-- Strychnise Sulphatis gr. 
Atropiae Sulphatis gr. i. 
Caffeinae Citratis gr. 48. 
M. Fiat chart, no. 48. 
Each powder contains A gr. strychnia, A gr. 
atropia, and 1 gr. caffein. 
It would not be advisable to commence with more 
than 9i) gr. of styrchnia hypodermically, nor should 
the total amount employed exceed 0 gr., although 
more than this has been used. If this fails to give 
relief, by assisting respiration, it will be both useless 
and hazardous to venture upon larger doses. Toxic 
doses of this drug would still further embarrass respi- 
ration and increase the patient’s danger. The mini- 
mum fatal dose recorded is “ something under half a 
grain.’’1 
1 H. C. Wood, op. cit., p. 292. 210 
HYPODERMIC INJECTION OF MORPHIA. 
Artificial Respiration.—The methods of pro- 
ducing artificial respiration may be divided into me- 
chanical and electrical. Of the former there are 
several excellent plans now in use, the best of which, 
probably, is a modification of the Sylvester method. 
It it the more advantageous as it can be performed 
with the patient in the sitting posture. It has been 
employed with success by Dr. H. P. Campbell1 in a 
case of this kind, and is described as follows :— 
“ The patient was supported in the sitting posture, 
by an assistant kneeling on the bed at his back and 
holding his head erect between his hands; two other 
assistants, standing on each side of the patient, now 
took charge of an arm each, holding the limb firmly 
at the elbow and upper part of the forearm ; the 
tongue was now pressed down by the handle of a 
spoon, or the fingers introduced into the mouth; 
the assistants having charge of the arms were now 
directed to elevate these limbs simultaneously, carrying 
them above the head at an angle of about forty-five 
degrees, and dragging upon them so as to slightly lift 
the patient; the arms were then depressed and 
brought down close against the sides of the thorax 
so as to compress the chest. 
“ The effect of these movements was the following: 
1 Monograph, “ Caffein as an Antidote in the Poisonous Narcotism 
of Opium,” Augusta, Ga., i860. TREATMENT OF MORPHIA NARCOSIS. 
211 
At each attempt at lifting the body by the arms in 
this way, forcible traction outwards was made on the 
walls of the chest, through the pectorales major and 
minor muscles, the serrati and parts of the two latis- 
simi dorsi muscles—giving rise to expansion of the 
walls of the thorax ; the air was thus caused to enter 
forcibly into the lungs, and thus inspiration was com- 
pleted. The arms were then brought steadily down 
and pressed against the sides of the thorax and 
abdomen—compressing them and expelling the air 
forcibly from the lungs and effecting expiration. 
“Under the use of the artificial respiration, the ap- 
pearance of the patient was much improved. The 
color was restored to the face, the lips became red- 
der, and the countenance more natural, though the 
relaxation of the muscular system was by no means 
lessened ; if the head was left unsupported for an 
instant, it fell forward as suddenly and forcibly as 
that of a dead man. The artificial movements were 
continued for more than an hour, and though the 
color of the patient was improved and the heart’s 
action became normal, still, when they were omitted, 
there was found no improvement in the natural res- 
pirations, these being still but four in a minute, as 
before artificial respiration was applied.” 
A little atropia given hypodermically would prob- 
ably have made the effects of artificial respiration 212 
HYPODERMIC INJECTION OF MORPHIA. 
more apparent and permanent. Even without it 
this patient, after a time, began occasionally to take 
a natural inspiration, until, finally, breathing was nor- 
mal. As in cases of asphyxia from drowning, arti- 
ficial respiration should be kept up for a long time. 
It is an interesting fact in this case that as soon as 
the patient was allowed to resume the prone position 
all efforts at natural respiration ceased. 
Electricity is another important measure at our 
command with which to establish or assist respira- 
tion. In the Annales d'Electricity are recorded 
four cases of opium-poisoning, in which, after all 
other means had failed, electricity proved successful. 
No mention is made of belladonna in these cases. 
One pole was placed at the back of the neck and the 
other at the perineum. 
In Dr. Trask’s case,3 already referred to, where 
five grains of morphia were taken by the mouth by 
mistake, and where x-6 gr. atropia sulph. was used 
hypodermically, electricity was also employed, and 
with signal benefit. An electrode over the phrenics 
on each side of the neck gave the best results. 
In the case reported by Dr. C. T. Jewett, of this 
city, excellent results were had from one pole at 
the back of the neck and the other over the pit of 
1 Boston Med. and Surgical Journal, 1868, p. 208. 
* New Yotk Med. Journal, vol. 20, p. 165. TREATMENT OF MORPHIA NARCOSIS. 
213 
the stomach; breaking the current as often as was 
necessary. 
Dr. Geo. M. Schweig1 relates a case of poisoning 
from seven grains of morphia (Magendie’s solution). 
He first injected 2\ and then 0 gr. sulphate of 
atropia hypodermically. Slight dilatation of pupils; 
no effect on opium narcosis. Electricity was then 
tried. The poles were placed over the phrenic 
nerves, causing inspiration; diaphragm was allowed 
to relax by breaking current as soon as inspiration 
was complete. None of the other respiratory mus- 
cles would respond to a very strong current. The 
patient finally recovered. 
More atropia might have been used in this case 
with advantage. It is not surprising that the small 
amount employed did not materially affect the narco- 
sis. About of a grain should have been used. 
Care should be taken not to use too strong a cur- 
rent, or to use it too long. As the breathing im- 
proves, gradually diminish the force of the battery. 
So familiar is the profession with the use of the 
battery in these cases that it does not seem necessary 
to go into details. 
Inhalation of Oxygen.—Prof. H. C. Wood,2 
from whose very able work I have already so largely 
1 N. Y. Med. Journal, vol. 19, p. 278. 
* Op. cit., p. 251. 214 
HYPODERMIC INJECTION OF MORPHIA. 
quoted, writes as follows: “The double nature of 
profound opium narcosis must not be lost sight of: 
the blood is saturated with carbonic acid almost to 
the dead-line, and much of the unconsciousness, much 
of the failing circulation, much even of the embar- 
rassed respiration, is due to the presence of this gas. 
As soon as the system is in a measure relieved of 
this load it begins to rebound; emetics act, con- 
sciousness returns to some extent, the circulation 
frees itself, and the road leading towards health is 
entered upon.” 
Improvement of the respiratory function by med- 
ical and mechanical means, tends to better this con- 
dition, which may, however, be further relieved by 
the inhalation of oxygen. Not only is the patient 
suffering from an excess of carbonic acid, but also 
from a lack of oxygen. 
John Ellis Blake 1 used inhalation of oxygen with 
excellent success in a case of poisoning by aconite, 
other measures being also employed. This treat- 
ment was suggested by Dr. T. G. Thomas, who had 
employed it successfully in the cyanosis of croup, 
pneumonia, etc. Dr. Blake’s method is as follows: 
“ A small rubber tube being connected directly with 
the copper reservoir, the other end, terminated by a 
Small nozzle, was inserted in one nostril, leaving the 
1 N, Y, Med. Journal, vol. 21, p, 361. TREATMENT OF MORPHIA NARCOSIS. 
215 
other free to admit common air. A small jet of gas 
being now permitted to escape, on closing the gal- 
vanic circuit the lungs were filled with this highly 
oxygenated air. Keeping up artificial respiration, 
with this new, powerful agent to help, good effects 
were soon seen in the lessening of the lividity of the 
face and lips, and a less corpse-like look generally. 
The amount of oxygen used in this case was four 
hundred gallons.” The patient’s condition just pre- 
vious to the use of the oxygen was as follows: u The 
body was becoming quite cold, no higher tempera- 
ture being observed at this time in the mouth than 
95°-96° F.; cyanosis marked, not only the face being 
darkly blue, but the same color being observable 
under the nails. The following interesting article 1 
by Dr. Charles B. Ball, Surgeon to the Blaenavon 
Iron Works, Pontypool, bears directly upon this 
matter: 
“ On January 16th, 1877, I attended a family who 
were found insensible in bed that morning. I found 
a man aged 55, his wife aged 48, and daughter aged 
16, in one bed, in a very small room, quite insensible. 
There were the remains of a large fire in the grate, 
the chimney of which was imperfect. Upon admit- 
ting plenty of air and using the usual restoratives, the 
1 (British Med. Journal, April 20, 1878, p. 562) Braithwaite's Re- 
trospect', Jan. 1879, p. 218. 216 
HYPODERMIC INJECTION OF MORPHIA. 
woman became sufficiently conscious to say that she 
remembered being up at 2 A. M., when she experi- 
enced considerable difficulty in breathing, and a se- 
vere headache; after which she remembered nothing 
further till she was restored to consciousness. The 
man became semi-conscious, but the girl remained 
perfectly insensible. I had her, therefore, removed 
to another and well-ventilated room, where artificial 
respiration was resorted to. She now had violent 
tetanoid convulsions, at intervals of a few minutes. 
The muscles of the face were, however, exempt from 
the general spasm. The pupils of the eyes were of 
average diameter, but dilated in bright light and 
contracted when the light was removed. This phe- 
nomenon was also noted in the man’s case. 
“ During the day, the man and woman progressed 
favorably, but the girl became much worse, the 
convulsions appearing at longer intervals and the 
intervening coma being more profound. The treat- 
ment now adopted in her case was the application 
of a blister to the back of the neck, stimulating ene- 
mata, and the hypodermic injection of pure ether. 
None of these measures had the desired effect, and 
at ten o’clock that night she was apparently dying. 
The convulsions had entirely subsided. The pulse 
at the wrist could not be felt, and the respirations 
were few and shallow. Through the kindness of TREATMENT OF MORPHIA NARCOSIS. 
217 
Mr. P. C. Gilchrist, F. C. S., I now obtained a large 
supply of pure oxygen, which, by a little arrange- 
ment of an ether-inhaler, I was enabled to give her 
to breathe in any degree of dilution required. At 
first equal parts of air and oxygen were given, but 
afterwards the proportion of oxygen was increased. 
It produced a rapid and most marked effect; the 
pulse soon became perceptible and quickly increased 
in force. After the inhalation of about four gallons 
of gas, it was discontinued, respiration and circula- 
tion having been well revived. During the inhala- 
tion the convulsions recurred, having been absent 
for several hours. Although not sensible during 
the night, she was decidedly better, being able to 
swallow fluid nourishment, and the convulsions 
gradually subsiding. She did not recover con- 
sciousness till the morning of the 18th, being forty- 
eight hours from the time I first saw her. 
“The different degrees in which the persons suf- 
fered, although exposed to the same poison, appear 
to be worthy of note. The intensity of the girl’s 
symptoms is, I think, accounted for by the fact that 
she suffers from phthisis, and has therefore a smaller 
available lung surface. As the woman got up to 
walk about the room during the night, she for 
the' time respired a higher, and therefore purer, 
atmosphere; and this may account for the fact that 218 
HYPODERMIC INJECTION OF MORPHIA. 
her symptoms were the lightest of the three. The 
action of the pupils with regard to light, noticed in 
two of the cases, was remarkable and very apparent. 
Although the inhalation of oxygen has been recog- 
nized in medicine since the time of Sir H. Davy, 
yet its use among the generality of practitioners is 
not frequent, and the above case was the first time 
I have ever used it. Its action impressed me great- 
ly; for I have never witnessed a life so certainly 
saved by any other therapeutic agent. One great 
objection to its more general use has been the diffi- 
culty of obtaining the gas readily in a state of 
purity and in a portable form. This has now been 
obviated; and I have here a copper flask, into 
which fifteen gallons of pure oxygen have been 
compressed. I obtained it from Messrs. Barth, of 
26 Duke street, Bloomsbury, and it appears to be 
very convenient for medical purposes, being easily 
carried about, as its weight is only five pounds three 
ounces when full; the diminution in weight will tell, 
roughly, the amount of gas used.” 
It would be an excellent idea if some of the in- 
strument or large retail drug houses in the various 
cities would keep fifteen or twenty gallon reservoirs 
of this gas on hand. Indeed, as poisoning by opium 
is so common, it would be a good plan for at least 
one drug-store in every town to keep one of these 
reservoirs in stock. TREATMENT OF MORPHIA NARCOSIS. 
219 
The Heart.—It is often necessary to support the 
action of the heart during opium narcosis. This is 
best done by hypodermic injections of whiskey and 
ammonia. Of the latter the aromatic spirits may be 
used or the aq. ammonia diluted with equal parts of 
water. About half a drachm of each should be used, 
and repeated as often as is necessary, the pulse being 
the guide. Hot enemas of whiskey may also be 
tried. If the heart fails to respond to these, the in- 
tra-venous injection of ammonia after the Griswold 
plan (see p. 132) should be resorted to. 
Ammonia, aside from its stimulant action upon the 
heart and arteries, is a powerful respiratory stimulant, 
acting probably directly upon the respiratory centres 
in the medulla. 1 
Caffeine maybe used, also, with a view to stimulating 
the heart’s action. It will be spoken of more fully 
in the next section. 
Flagellation, walking the patient about, the cold 
douche and hot applications to the epigastrium are 
too familiar to need explanation. 
Subcutaneous Injection of Caffeine.—The 
experiments of Dr. J. Hughes Bennet2 have proved 
caffeine to be, within certain limits, antagonistic to 
opium or morphia. This action is probably a double 
1 H. C. Wood, Op. cit., pp. 109, no. 
2 British Med. Journal, 1874. 220 
HYPODERMIC INJECTION OF MORPHIA. 
one—as a cerebral stimulant and as a cardiac 
stimulant. I say within certain limits, for Dr. 
Hughes found that the lives of the animals 
experimented on were saved by caffeine when 
a certain amount of morphia had been given, and 
that when that amount was exceeded caffein was 
powerless to save. 
The question was raised not long since by Prof. 
Montrose A. Pallen,1 of this city, his views being 
based on the treatment of cases of opium-poisoning 
by the fluid ext. of coffee, whether the beneficial 
results obtained in such cases were not due to 
the diuretic powers of coffee or caffeine. The fluid 
ext. of coffee which the doctor employed was had 
of Wyeth & Co.,2 of Philadelphia, and was for the 
purpose of acting as an eliminator of the urates in 
gout. He says: “ It certainly possesses valuable 
properties in the treatment of chronic gout as a 
renal depurant. Can it act thus to remove the 
poison of opium and the tissue detritus caused 
therefrom ? ” 
Prof. Gubler3 asserts that caffeine, theine, men- 
1 N. Y. Med. Record, Dec. 21, 1878. 
2 This firm has kindly furnished me with a sample of the same, 
which is a powerful and elegant preparation, and worthy of trial, as 
much of the caffeine of the shops is said to be adulterated, and conse- 
quently unreliable. It is of the strength of a grain to the drop. 
3 Le Progres Medical, June 15, 1879. TREATMENT OF MORPHIA JVARCOS/S. 
221 
theine, &c., are excellent diureties and well worthy of 
trial. I give here his formula: 
Caffeine gr. vii. ss. 
Syr. Menthae 3 i* 
Aq ii ss. 
M. Dose 1 ss. to 3 i-, repeated if necessary. 
“ Prof. Sewell, of Quebec (British Med. Journal),1 
reports the case of a lady who had taken, for the re- 
lief of pain, three drachms of Battley’s liquor opii. 
sedativus every three hours till sleep was produced 
—altogether she had taken about three ounces and a 
half of the solution. When seen by Dr. Sewell, at 
11 P. M., she was totally unconscious, with pin-hole 
pupils, an imperceptible pulse, and, what seems al- 
most incredible, only three respirations in two min- 
utes. A strong infusion of green tea was prepared 
without delay, and half a pint of it was injected into 
the rectum, where it was retained for half an hour. 
This was repeated at intervals till 4 A. M., when the 
patient had so far recovered as to be able to speak, 
and at 8 A. M. she was pronounced out of danger. 
Even then, however, her sight had not recovered; 
she asked the attendant to light the gas, although the 
sun was shining brightly into the room.” 
Dr. Lewis Shapter 2 reports four cases of the suc- 
1 N. Y. Med. Record, July 20, 1878. 
* {Bos ton Med. and Surg. Journal) Monthly Review, &c., Oct. 1879. 222 
HYPODERMIC INJECTION OF MORPHIA. 
cessful use of this remedy in the dropsy of advanced 
cardiac disease, when in some instances digitalis had 
failed to give relief. The amount of urine was 
trebled. We can readily explain this on the knowl- 
edge that caffeine is a decided cardiac stimulant. 
Clinical experience confirms what experiments on 
animals have taught us with reference to the beneficial 
action of coffee or caffeine in opium-poisoning. Dr. 
W. W. Cochrane, of Atchison, Kansas, reports two 
cases as follows: 
“Mrs. R , aged 25 had taken three pow- 
ders, each supposed to contain grain morphia, 
for colic. Had taken the last powder three hours 
previous to my arrival, and had been insensible for 
two hours; the most strenuous efforts failed to arouse 
her. Breathing almost imperceptible, pulse feeble, 
intermittent, pupils contracted, insensible to light. 
Gave her hypodermically thirty drops of strong 
coffee, repeated in fifteen minutes, and again in 
fifteen minutes, when she soon opened her eyes and 
was sensible. Directed her to drink coffee and be 
kept warm; she begged hard to be permitted to 
sleep. Recovered kindly. 
“2. C. H. S., aged 55, had taken opium for sev- 
eral years, until the habit had increased up to twelve 
grains a day. Had taken in the last month four 
drachms of morphia and four ounces of chloral for TREATMENT OF MORPHIA NARCOSIS. 
223 
rheumatism. He was found on the floor and sup- 
posed to be dead. He had taken within four hours 
five grains of morphia and one hundred and fifty- 
grains chloral hyd. No efforts aroused him. Head 
and extremities cold, pulse feeble and irregular, 
pupils contracted, insensible to light; breathing 
would cease for seconds, when artificial respiration 
restored it. Gave him, per forearm, twenty drops 
strong coffee, repeated in ten minutes, and again in 
fifteen, when in twenty minutes more he became 
sensible and recovered.” 1 
Dr. Seneker2 reports a case of rapid recovery in 
morphine-poisoning, after injecting 3 grains of caffeine 
subcutaneously within ten minutes. 
Dr. H. F. Campbell3 relates an interesting case of 
opium-poisoning, where over half an ounce of lauda- 
num was taken. The patient recovered, treated 
only by artificial respiration and large doses of coffee 
and caffeine by the mouth and rectum—twenty grains 
by the latter. As a result, there was extreme rest- 
lessness, as soon as stupor had passed off, and great 
nervous excitement, some of the symptoms being 
somewhat analagous to those of an over-dose of 
strychnia. The same gentleman reports another 
L Michigan Med. News, 1879, p. 249. 
2 Si. Louis Med. Journal. 
3 Monograph, “ Caffeine as an Antidote in the Poisonous Narcotism 
of Opium,” Augusta, Ga., i860. 224 
HYPODERMIC INJECTION OF MORPHIA. 
case 1 where the patient had taken 3 oz. of laudanum 
15 hours before being seen. Caffeine was used as 
in case just reported, but the patient died from a 
“ collection of mucus in the lungs.” 
Probably the best way in which to give coffee in 
these cases is by the hypodermic method, caffeine or 
Wyeth’s fluid extract of Java coffee being used, the 
former in 1 gr. doses, every half hour, until some 
change in the strength of the pulse and conscious- 
ness somewhat returns; the latter in 30 drop doses 
in the same manner. The drug should not be 
pushed too far, as it may then act as a depressant 
The indications just given will be the best guide. 
Veratrum Viride.—Attention has been called 
to the supposed antidotal action of veratrum viride 
over opium, by a writer whose name and the name 
of the journal in which he wrote have now escaped 
my mind, also by Dr. James C. Gardner, of Mitchell, 
Indiana, who writes as follows: 
“ My attention was first called to the antagonism 
between opium and veratrum viride when treating a 
case of peritonitis. I gave opium and veratrum com- 
bined ; the opium was intended to relieve the pain 
and restlessness ; the veratrum to reduce the action 
of the heart and arteries. My prescription was pulv. 
opium, gr. ii to gr. iij, Norwood’s tincture veratrum 
1 Southe?n Med. and Surg. Journal, August, i860. TREATMENT OF MORPHIA NARCOSIS. 
2=5 
viride, gtts. v. My patient was relieved, but did not 
sleep. I next treated a case of typho-malarial fever 
in which delirium and restlessness were prominent 
symptoms. I gave sul. morphine, followed by the 
happiest effect in procuring sleep, rest and quietude 
for four or five hours, when my patient awoke, hav- 
ing a very dry mouth; pulse full and numbered about 
eighty-five. Patient restive, I concluded to add five 
gtts. of Norwood’s tincture to the next dose of sul. 
morphine, and give every fourth hour until the pa- 
tient rested and slept well. . After the third dose was 
given I found my patient resting well, but had not 
slept since commencing the use of the veratrum viride. 
I then directed the veratrum to be omitted and the 
morphine to be continued. One dose of the morphine 
was sufficient to procure a good, refreshing sleep. In 
a few days after I had noticed this effect, I thought 
this must certainly be attributed to the veratrum 
viride. I was called to see a child, aged 15 months,who 
had swallowed about a half grain of sul. morphine left 
by a physician for a lady who had been in the habit 
of taking morphine. She had mixed the morphine in 
a little water and left it standing in a glass on a chair, 
to step into an adjoining room, when the child drank 
the poison. I saw the child in about an hour and a 
half after it had drank the solution. The little fellow 
was comatose ; I could hardly arouse him enough to 226 
HYPODERMIC INJECTION OF MORPHIA. 
get him to swallow the medicine. I gave him gtts. x. 
of Norwood’s tincture of veratrum viride. In about 
thirty minutes he vomited, his eyes opened, he 
looked around, then looked up in my face and smiled. 
His improvement continued from this, so that he re- 
quired no further aid.” 1 
Further testimony and experiments are needed to 
settle this question. It is worthy of attention from 
the fact that veratrum is of the same class as aconite, 
and morphia has been found to act almost magically 
in aconite-poisoning, as pointed out by Prof. Alonzo 
Clark2 and Drs. O’Brien 3 and Haynes (see p 176). 
1 St. Louis Med. and Surgical Journal, Dec., 1879. 
* Al. Y. Medical Record, Jan. 3, 1880. 
3 N. Y. Med. Record, Feb. 8, 1879. CHAPTER VII. 
CONVULSIVE AND TETANIZING ACTION OF MOR- 
PHIA ON MAN.—IDIOPATHIC TETANUS.—CASES 
OF TRAUMATIC TETANUS FROM RUSTY AND UN- 
CLEAN NEEDLES. 
THERE are some peculiar effects of morphia on the 
human system that are of interest by reason of their 
variety and the possible light that they shed upon the 
antagonistic action of morphia and atropia. They 
are few in number, but well authenticated, and are 
in strict accordance with our knowledge of the ac- 
tion of the drugs on the lower animals. Such facts 
might, with some show of justice, be urged in favor 
of a belief in the doctrine of evolution, showing as 
they do how closely and inseperably man and ani- 
mal are linked, and how a certain trait or idiosyn- 
crasy that marks all the members of one class is 
perpetuated in an occasional member of another 
class. 
A word here with reference to the antagonistic 
action of morphia and atropia, in the light of 
these peculiar manifestations. If it can be proven 228 
HYPODERMIC INJECTION OF MORPHIA. 
conclusively that atropia has specific power to con- 
trol the convulsive and other unusual actions of 
morphia in man, then we must admit that its bene- 
ficial action in opium and morphia poisoning is due 
to direct antidotal power, and not to its stimulant 
action on respiration only. 
Dr. S. Weir Mitchell makes the following state- 
ment d “ Pigeons, and probably other birds, seem to 
possess the same peculiarity which causes certain men 
to exhibit, under opiates, only excitement of the mo- 
tor ganglia, emesis and a restlessness which, with fuller 
doses, might possibly eventuate in convulsions—a 
rare incident of opium-poisoning, which, however, 
occurred early in a case which I have elsewhere re- 
ported.” Not finding a record of this case in any 
works or journals to which I had access, I wrote Dr. 
Mitchell upon the subject, and received the following 
reply: “I am, unfortunately, unable to recall the 
name of the journal in which it was published, but 
I send you, briefly, my recollections of the case: A 
gentleman had taken an overdose of morphia some 
four hours before I was called to see him. He ex- 
hibited marked symptoms of opium-poisoning, and 
during my visit had several convulsions, from mild 
to severe. In one hour I administered f gr. atropia 
1 Amer. Journal Med. Sciences, Jan. 1870. CONVULSIONS AND TETANUS. 
229 
and was fortunately able, soon after, to see him 
gradually recover.” 
It is a well-known fact that as we descend in the 
scale of animal life, we get very different effects 
from the same drug. The more simple or imperfect 
the structure of the brain, the more certain is mor- 
phia to excite reflex irritability. In the frog we 
have distinct tetanic spasms. Upon this may be 
explained the fact that in children convulsions are 
not uncommon in opium-poisoning; also that in 
persons of “ nervous temperament” opium and its 
alkaloid, morphia, are prone to produce excitement, 
nervousness, sometimes delirium, and occasionally 
tetanic spasm. Such effects have been known to 
occur in the adult,1 though more common in chil- 
dren after poisonous doses of this drug. It has 
been found that morphia is more apt to produce 
these results than is opium.2 
Charvct,3 quoted by Pareira,4 made a very ex- 
tensive series of experiments with reference to the 
effects of opium on different animals, by which the 
conclusion is reached that “ the effects of opium on 
the animal kingdom have a relation to the degree of 
development and influence of the nervous system. 
1 “ Christison on Poison,” &c., p. 707. 
* Christison, op. cit., 725 “Taylor, on Poisons,” &c., p. 615. 
3 “ De 1’Action Comp. del’Opium,” Paris, 1826. 
4 “ Materia-Medica,” I,ond., 1853, p 2108. 230 
HYPODERMIC INJECTION OF MORPHIA. 
A glance at this interesting series of phenomena, 
called forth by opium in different classes of animals, 
gives us all its usual and unusual effects on man. 
Convulsions in fishes, amphials and reptiles, stupor 
in birds, tetanus in frogs, &c., &c. Different effects, 
are produced also on different races of men,1 vary- 
ing with their mental and moral peculiarities. 
M. Waldemar Baxt,2 of St. Petersburg, after a series 
of extended experiments with the various opium 
alkaloids, comes to the conclusion, amongst many 
others, that: “ i. The whole group of opium alka- 
loids taken together constitute a series of agents 
with two specially characteristic actions—narcotic and 
tetanically convulsive. 2. Each individual alkaloid 
possesses one or the other of these characteristic 
effects exclusively, or else a blending of the two 
opposed actions, in consequence of which the one or 
the other becomes prominent, while the other is 
more feebly pronounced. 3. The first place, as a 
pure narcotic, must be given to papaverine. It is 
followed by morphia narceia, codeia, &c., with con- 
stant diminution of the narcotic character of the 
influence and continually increasing convulsive ten- 
1 Pareira, op. cit., p. 2109. Editorial, London Med. Examiner, 
July 5, 1877. 
2(“ Archiv fur Anat. und Physiol., Reichert und Dubois-Reymond,” 
No. 2, 1869; Practitioner, Sept., 1869) Am. youmal Meet. Sciences, 
October, 1869. CONVULSIONS AND TETANUS. 
231 
dencies, which in the bain reach the level of complete 
tetanus, indistinguishable from that produced by 
strychnia, except by the size of the dose required. 
Dr. Samuel P. Reed, to whose interesting letter I 
have referred several times, relates the following case, 
which was probably one of those rare and peculiar 
manifestations of morphia: “ Two hours after I had 
used this injection in a case of torticollis in a young 
lady, alarming symptoms of strychnia-poisoning 
showed themselves, lasting about hour. I could 
never account for them.” Dr. Reed’s solution and 
method of making the injection will be referred to a 
few pages further on (p. 250). 
Dr. Courtenay,1 of Jamaica, relates the following 
interesting case: 
“ A male coolie, under treatment for lumbago, in 
in the Lucea Parochial Hospital, Jamaica, was ordered 
a hypodermic injection of one-sixth of a grain of 
morphia, the injection to be repeated every night. 
This treatment was continued for three nights, and 
on the morning following the third use of the injec- 
tion the patient complained of feeling unwell at 
breakfast, and retired to bed at 9.10 A. M., where he 
was seized with convulsions of a tetanic nature. His 
symptoms were the following: he was quite in- 
1 (British Med. Journal, Oct., 1879) Boston Med. and Surg. Jour- 
nal, Nov. 13, 1879, p. 711. 232 
HYPODERMIC INJECTION OF MORPHIA. 
sensible, his eyes were widely opened and staring, 
the pupils slightly contracted, teeth clenched, face 
flushed, nostrils dilated, and breathing hurried. 
There was spasmodic contraction of the muscles of 
the upper extremity; the temperature was increased; 
the heart’s action regular, though weak. This attack 
lasted for ten minutes, when consciousness returned; 
but on attempting to speak he was seized again, and 
the convulsions returned at gradually increasing 
intervals, until they finally left him at twelve, noon. 
tl The treatment immediately adopted in this case 
was the administration of doses of ten drops of the 
tincture of belladonna every hour, with coffee and 
brandy, and the application of the extract of bella- 
donna down the course of the spine. This treatment 
was continued for a few hours, and, all urgent symp- 
toms having yielded to it, the belladonna was given 
in diminished doses of five drops every four hours, 
and continued for the two following days. At the 
end of that time, no recurrence of the convulsions 
having taken place, the ordinary treatment for lum- 
bago was recommended, of course with the omission 
of the morphia injection.” 
Phillips,1 speaking of the action of opium in poison- 
ous doses, gives the following : “ The course of events 
differs considerably in young children, especially in 
1 “ Materia-Medica and Therapeutics,” N. Y., I879, p. 65, TRAUMATIC TETANUS. 
233 
young infants. Here there is a more rapid passage 
into profound stupor; but what is especially charac- 
teristic is the much greater frequency with which 
convulsions occur. The convulsive movements vary 
from mete twichings of the facial muscles to ryth- 
mical startings of the limbs ; to severe clonic convul- 
sions, which may be hemiplegic or may affect both 
sides of the body alike, and even to tetanic spasms. 
I have seen three adults thrown into a state of appar- 
ently complete tetanic rigidity of the whole body, 
the mouth open and squared, all the facial muscles 
highly tetanized, the spine strongly curved, resem- 
bling the shape of a well-drawn bow; and this state 
of opisthotonos continue in each case, without any 
abatement, from twelve to forty-five hours, and then 
only become relaxed to become rigid again for a 
longer or shorter time, according as the effect of 
the opium was kept up.” 
Anstie 1 refers to a case of poisoning by 3 grains 
of morphia injected into the rectum, where the 
pupils were strongly contracted, the breathing was 
rapid 2 at first, and delirium and incomplete coma3 
were present. 
Traumatic Tetanus from Puncture of the 
1 Op. cit., p. 208. 
2 A not uncommon occurrence in men and in animals, according 
to Anstie, when the drug enters the system rapidly. 
3 Italics mine. 234 
HYPODERMIC INJECTION OF MORPHIA. 
Hypodermic Needle. —Tetanus, due to the punc- 
ture of the hypodermic needle, is not a common oc- 
currence, in which event the records of the following 
cases may prove of interest: 
“ At Southsea, recently, an inquest was held upon 
the body of Mrs. Frampton, wife of a lieutenant and 
adjutant in the Royal Marine Light Infantry. 
“ Deceased s husband deposed that his wife was 25 
years old, and that in 1871, previous to giving birth 
to a child, she suffered greatly from sickness. A 
surgeon, to alleviate this, used morphia by the hypo- 
dermic method, always injecting the solution him- 
self. Some time since, deceased assured him she had 
entirely given up the use of morphia. 
“On the previous Thursday he found the deceased 
suffering from convulsions. She grew worse and 
died the following morning. Since her death several 
bottles had been found in her wardrobe, tied up in a 
parcel and secreted, together with five or six small 
cases, each containing a hypodermic syringe. 
“ Mr. Cruise, pharmaceutical chemist, said that at 
first he refused to serve the solution, but on reference 
to his junior assistant he was informed that Mrs. 
Frampton had been frequently supplied with the 
solution. In August, September, and October, he 
supplied nine bottles each month, the last being on 
the 30th ult. TRAUMATIC TETANUS. 
235 
“Dr. Norman described the state he found deceased 
in, and stated that when Mr. Norman and Dr. Jack- 
son were called in they discovered on the upper part 
of both arms a large number of old scars, which 
they were informed were the result of hypodermic 
injections five years ago. There were no recent 
marks about the arms, but upon both thighs there 
were a large number of similar marks, and also 
several marks of recent punctures. Around some of 
these latter there was a redness of the skin in differ- 
ent stages, and one particularly had the appearance 
of having been made within twenty-four hours. He 
was of opinion that Mrs. Frampton died from te- 
tanus, caused by the punctures made in the thighs 
for the purpose of injecting solution of morphia. 
He had been shown three syringes, all of which 
were in a dirty condition, apparently not having 
been wiped dry after using. The steel needles were 
in a very rusty state, which would be likely to set up 
inflammation. ' 
“The jury returned a verdict to the effect, ‘That 
the deceased died from tetanus, or lock-jaw, caused 
by inflammation arising from punctures made by the 
deceased herself, for the purpose of subcutaneous 
injection of solution of morphia.’ ’’1 
in this connection the following from Bartholow,2 
1 Medical Press and Circular, Nov. 29, 1876. 
c ii The Hypodermic Method,” etc., pp. 96, 97, 236 
HYPODERMIC INJECTION OF MORPHIA. 
who refers to cases of abscess, traumatic fever, etc., 
by Calvet, and death by Dujardin-Beaumetz, fol- 
lowing the puncture, is of interest: “ One of the 
most inveterate subjects I have ever encountered 
was a man living in the wilds of Texas, who used 
a glass hypodermic syringe that had been broken 
many times, and mended with successive deposits of 
sealing-wax, until only the rusty old needle remained 
in view.” And yet no tetanus ! 
The newspaper report of the following case has 
been kindly sent me by F. W. Barkitt, L. R. C. P., 
&c., Dublin, Ireland. The extract is from the Irish 
Times newspaper, Oct. 23, 1879, 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 hypo- 
dermically. 
“ 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 lock-jaw. 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 TRAUMATIC TETANUS. 
237 
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 injec- 
tions 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.1 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 mor- 
phia 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 wit- 
ness 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 lock-jaw 
1 In my chapter on * ‘The Morphia-Habit ” I shall show that much 
larger amounts have been used and for long periods. 238 
HYPODERMIC INJECTION OF MORPHIA. 
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 lock-jaw 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 in- 
stance, and the habit grew on her. I found the sur- 
face of the body punctured In innumerable places 
with the needle. She seemed as if she had been 
tatooed. 
“ 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 men- 
tioned to me that it is quite possible she might have 
obtained, either by mistake or otherwise, strychnine 
in place of morphia. You are satisfied that is not 
the case ? ‘ I am perfectly satisfied. I should say that TRAUMATIC TETANUS. 
239 
the symptoms 9f tetanus and strychnine are the 
same while the spasms are on. After the spasms 
pass away the patient becomes quite well in strych- 
nine, but the muscles remain contracted in lock-jaw.’ ” 
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 Med. Journal,1 in 
commenting on this case, says that it has no knowl- 
edge of the case referred to by Dr. Meldon as oc- 
curring 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 case2 of tetanus after the use of morphia, due 
probably to the use of rusty needles (Lancet, Dec., 
1876, p. 873). 
Referring to this case, Dr. J. O’Flanagan, of Dur- 
ham, writing to the Medical Press and Circular, 
which also contained a report of this case, says: 
“ Sir:—I think the above title of the case reported 
in your last issue does not accurately express the 
nature and cause of the malady from which the 
patient died. I am of opinion that the neuralgia 
caused the tetanus, and that the morphia injections, 
so largely used, ‘ staved off’ for a considerable time 
the ‘ evil day ’ from the poor patient, who finally 
1 Hospital Gazette, Dec. 6, 1879. 
2 See page 234. 240 
HYPODERMIC INJECTION OF MORPHIA. 
gave in to the blood disorder, and the tetanus there- 
from. I am led to believe this from my remembrance 
of a case of trismus in a young woman (rheumatic) 
which I treated successfully, five years ago, with 
hydrate of chloral, Fleming’s tincture of aconite and 
bromide of potassium, and with chloroform inhala- 
tions. At the time I did not deem the case of suffi- 
cient importance to publish; but, having very recent- 
ly succeeded in saving a bad case of traumatic tetanus 
in an interesting little girl of nine years old by the 
same means, I intend shortly to collect my notes of 
the first case, and to publish both cases together, 
with your permission, in the columns of the Medical 
Press.” 1 
I think that very few will agree with Dr. O’Flana- 
gan in his view of the case. 
Dr. A. Ady, of West Liberty, Iowa, reports the 
following case: “On the 19th of this month I in- 
jected fifteen grains of bromide of quinia, dissolved 
in thirty minims of dilute alcohol, into the cellular 
tissue above the crest of the left ilium of a man aged 
sixty-two years, for an intractable periodic neuralgia 
in that position. The neuralgia was relieved, but 
there was more than ordinary inflammation at the 
site of injection, followed by a forming slough. It 
gave him considerable pain on the 21st and 22d, 
1 Hospital Gazette, Dec. 6, 1879, TRAUMATIC TETANUS. 
241 
when morphia was ordered sufficient to relieve him. 
During the 23d and 24th he was reasonably comfort- 
able, and sat up most of the afternoon, Sunday, en- 
tertaining company. Upon retiring, at iop. M., he 
was seized with tetanus, and died in twenty-three 
hours. I have been intimate with him for twenty-six 
years, and, with the exception of occasional attacks 
of this neuralgia, he has enjoyed uninterrupted 
health.” 1 
Prof. A. Liautard, of the American Veterinary 
College, this city, writes me the details of the follow- 
ing case of tetanus in a horse : 
“Dear Doctor:—I enclose the history of the 
case of traumatic tetanus I wrote to you about, as 
I see it printed in the American Veterinary Review. 
Tetanus is not an uncommon disease amongst horses, 
and, of course, is more commonly traumatic. 
“Gray gelding, 7 years old, which suffered one 
night with spasmodic colic and was treated by hy- 
podermic injections of morphine and atropine in 
three places on one side of the neck; these were fol- 
lowed by small abscesses, which, being opened, heal- 
ed rapidly. Four days after he was found with his 
jaws closed tight, the membrana nictitans protruding 
over the eye, the muscles of the body contracted ; in 
a word, presented all the symptoms of tetanus. The 
lN. Y. Med. Record, Dec. 14, 1878. 242 
HYPODERMIC INJECTION OF MORPHIA. 
treatment consisted in the administration of bromide 
of potassium every four hours in 4 ounce doses with 
chloral hydrat. per rectum. He was destroyed four 
days later.” 
Dr. Ross1 reports a case of traumatic tetanus fol- 
lowing lancet-puncture for vaccination in a child: 
“ Edward K., three and a half years old, of healthy 
German parentage, never sick since a mild attack of 
scarlatina in early infancy, was visited at 8 o’clock 
p. M., June 5th, 1879, and found to be suffering with 
tetanus, from which he died before 8 A. M. the follow- 
ing morning. He had no evidence of having, either 
recently or remotely, received an injury of any sort 
—no wound by puncture, laceration, or incision at 
any time since birth, with the exception to be men- 
tioned. It was only during the early part of the 
day that his family noticed a peculiar expression 
about his face, and an occasional elevation of his 
arms and shoulders, which culminated at dinner in 
such a pronounced convulsion that he fell from his 
chair to the floor. Quickly following this fall he had 
two spasms of such severity as to necessitate the 
calling of a physician. When I reached the house 
the ‘sardonic grin’ was pronounced, and jaws 
tightly locked, several spasms occurring during my 
brief visit. As the night advanced they recurred 
1 (Southern Clinic) Nashville Journ. Med. and Surg., Dec., 1879. TRAUMATIC TETANUS. 
243 
with rapidly increasing frequency, and only ended 
with his death. Three weeks previous to his attack, 
he had been vaccinated by a German midwife, the 
virus inserted in two points on the left arm. Upon 
one of these sites, a normal looking, almost dry crust 
appeared, and at the other a highly inflamed ulcer, 
from which the crust had evidently been forcibly 
torn. To my mind, this furnished a satisfying cause 
for the disease.” 
I give this case only for its rarity and its bearing 
on the subject of tetanus from the iuflammation fol- 
lowing slight puncture. 
The lesson to be learned from these cases is that 
the syringe and needles should be kept scrupulously 
clean, being cleansed both before and after each 
time of using, by drawing warm water into the 
syringe and forcing it through the needle. If the 
water be slightly carbolized it will be an advantage. 
The “ rimmers ” figured by Dr. Bartholow in the 
frontispiece of his little work 1 are not necessary un- 
less the needle is left uncleaned, in which case it is 
better to throw it away and use a new one. 
1 “ The Hypodermic Method,” &c. CHAPTER VIII. 
MORPHIA AND ATROPIA. 
Is there any decided advantage in using the sul- 
phate of atropia with the sulphate of morphia for 
purposes of subcutaneous injection ? Some authors 
and some of my correspondents seem to believe that 
there is, and assign to atropia various important 
modifying actions which it will be well to study in 
detail. I shall here give a table showing how many 
of those answering my second question do and do 
not use atropia : 
Always 46 
Occasionally .... 48 
With Atropia 
Asthma, 
Neuralgia, 
Idiosyncrasy. 
I n special cases.. 16 
Without Atropia 
no 
. 210 
32° 
It will be seen from these figures that but a few 
over one-sixth of the entire number answering this 
question use atropia invariably; about the same MORPHIA AND ATROPIA. 
245 
proportion use it occasionally; about one-nineteenth 
of the number use it only in special cases; and over 
two-thirds do not use it at all. Some of those who 
never use it have not done so simply because they were 
used to and satisfied with the plain morphia solution, 
while others, after trying it, gave it up, either finding 
the atropia of no particular advantage or the mor- 
phia alone more satisfactory. 
That the effects of these two drugs when used to- 
gether are different from the effects of either used 
alone, is clearly demonstrated by Bartholow, 1 who 
has studied their physiological action, alone and to- 
gether, upon the human adult. 
He found that the effect of the morphia was modi- 
fied, as follows: 
On the Nervous System— 
1. Atropia in small doses increases the hypnotic 
power of morphia. 
2. Atropia in sufficiently large doses counteracts 
the hypnotic properties of morphia, and if in excess 
causes phantasms, illusions, &c. 
3. It increases the pain-quelling power of morphia. 
4. It does not affect the disorders of motility and 
vertigo, sometimes produced by morphia. 
5. In cases of poisoning these drugs are mutually 
antidotal. 
1 “ The Hypodermic Method,” &c., pp. 130, 131, 132, &c. 246 
HYPODERMIC INJECTION OF MORPHIA. 
6. It dilates or holds normal the pupil, which would 
otherwise contract under morphia. 
7. It prevents or modifies the arterial tension 
produced by morphia. 
Circulation and Respiration— 
8. It prevents depression of heart-power produced 
by morphia. 
9. It counteracts the fall of temperature produced 
by full doses of morphia. 
10. In small doses, it adds to the power of mor- 
pliia to reduce the number of respirations. 
11. It prevents that fall in the number of pulsa- 
tions which has been found to result from a moderate 
dose of morphia. 
The Digestive Apparatus— 
12. It increases the dryness of the larynx, mouth, 
See., produced by morphia. 
13. The constipation from morphia is prevented, 
and relaxation of the bowels often occurs. This 
seems to be due to increased peristaltic action. 
14. The dyspeptic troubles sometimes occasioned 
by morphia are abated, bnt not prevented. 
15. Nausea and prostration from morphia are 
often lessened or prevented by it. 
Genito- Urinary Organs— 
16. Atropia upholds the functional activity of the 
kidneys, which is decidedly lessened by morphia. MORPHIA AND ATROPIA. 
247 
17. Atropia prevents the diaphoretic action of 
morphia. 
18. The dysuria of morphia is not relieved by 
atropia, both having the same effect on the bladder, 
though in a different way. 
From a study of these results of Dr. Bartholow’s 
careful and painstaking experiments and observa- 
tions, of which this summary is a necessarily imper- 
fect representation, we are naturally led to conclude 
that atropia should be of much service, when given 
with morphia, both in health and disease. It re- 
quires, however, careful discrimination as to when to 
give it and when to withhold it. 
For example, where it is necessary to give mor- 
phia in large doses in cardiac disease, or in diseases 
where the tendency is to death by failure of heart- 
power, it will always be advisable to use the two 
drugs together, using just enough of the atropia 
to combat the action of morphia on the heart, 
and slightly stimulate it. It is well settled, however, 
by numerous observations that in shock and various 
conditions where there is decided failure of heart- 
power, morphia in small doses is a special cardiac 
stimulant. 
In case we wish to increase the pain-quelling 
power of morphia, and at the same time get an 
hypnotic effect, a small amount of atropia — say 248 
HYPODERMIC INJECTION OF MORPHIA. 
gi*.—should be added to each dose of morphia. 
If it is desired to obtain relief from pain, and yet 
have no soporific effect, the amount of atropia 
should be increased, so that its action on the cere- 
brum shall slightly outbalance that of the morphia. 
Dr. Bartholow’s statement that atropia and mor- 
phia decrease the number of respirations more than 
morphia alone, he modifies by offering the following 
as an explanation : “ When Dr. De Courcey received 
the morphia alone, he experienced much less sopo- 
rific effect than when both agents were injected to- 
gether; and to this quiescent state of the cerebral 
functions is to be attributed the slower respiratory 
movements.” I think that this is the true explanation, 
and it is borne out by the mass of evidence showing 
that atropia exercises a direct stimulant power over 
the respiratory centres. Were this not so, it would 
be extremely hazardous to use these two drugs in 
that class of diseases where the tendency is to death 
from failure of respiration. 
The cases of narcotism, syncope and death, 
already related, where morphine was given hy- 
podermically in acute pulmonary disease, offer a fair 
probability that the use of this drug in this class of 
diseases is of itself dangerous, the drug acting in the 
same direction as the disease. If this is not merely 
coincidence, and it is certainly borne out by a study MORPHIA AND ATROPIA. 
249 
of the physiological action of morphia, then where, 
from great pain, it is absolutely necessary to resort 
to its use, sufficient atropia should be given at the 
same time to overbalance its soporific and respiratory 
depressant action and to directly stimulate the respi- 
ratory centres. 
Of course, in diseases such as acute pleurisy, with 
but little effusion and agonizing pain, to which the 
.existing dyspnoea may be referred, a sufficient amount 
of morphia to banish the pain will lessen the frequency 
and increase the depth of the respirations. 
It must be borne in mind in this connection that 
individuals vary greatly in their susceptibility to atro- 
pia, and that one or two injections must be made before 
an exact knowledge of the case can be had. A patient 
of mine, a lady suffering from the passage of a gall- 
stone, was twice troubled with illusions and phan- 
tasms from the use of £-0 gr. of atropia in combina- 
tion with y2 gr. morphia. According to the expe- 
rience derived from the average case, this lady should 
have borne a much larger amount of atropia, and 
its unpleasant effects on the cerebrum have been coun- 
teracted by the morphia. For this reason I should 
advise that the two drugs be kept in separate bottles 
or powders, so that the dose of either may be varied 
at pleasure. 
With reference to the increased power of morphia 250 
HYPODERMIC INJECTION OF MORPHIA. 
and atropia over morphia alone, to relieve pain, there 
is some diversity of opinion. The combination of the 
two drugs has been highly lauded in all forms of pel- 
vic pain, notably that of a neuralgic character. Prof. T. 
Gaillard Thomas, of this city, in conversation with the 
author, a few days since, said that he had never found 
atropia to add to the pain-relieving power of morphia 
either in pelvic or other pains. To this he made the 
exception in favor of dysmenorrhoea, but held that 
atropia was of service then only by virtue of its being 
a drug that was itself capable of giving great relief 
in that affection. He had formerly used the two drugs 
together in all cases, but had of late years employed 
morphia alone, finding it to act quite as well as when 
atropia was combined with it. The opinion of Dr. 
Thomas, especially with reference to pelvic pains, is 
of unusual interest, as his opportunities for observing 
and treating this class of affections have probably 
been greater than those of any other man in this 
country. 
Dr. Samuel P. Reed, of Scranton, Pa., writes: 
“ The advantages of combining the atropia with the 
morphia are that it increases the anodyne and relax- 
ing influence and lessens its narcotic effect. I have 
had old rheumatic cases send for me to give them 
‘a shot’ (as they called it), and said ‘that mine 
was stronger than anybody else’s.’ ” The doctor’s MORPHIA AND ATROPIA. 
251 
manner of making his solution is somewhat peculiar 
and the solution is so strong that it would be hardly 
safe to trust it in the hands of any but a very careful 
man. 
He says: “ I keep on hand, in a glass-stoppered 
phial, a solution of atropia sulph., gr. to aq. 
destillat, 1\. Of the latter, I pour into a teaspoon 
about 9 minims, (the quantity my syringe is marked 
for), and saturate it with morphia sulph. (at least 
gr. i.) I then inject into the areolar or muscu- 
lar tissue one or two minims, wait a minute or two, 
and continue to inject 1 minim at a time every two or 
three minutes, without removing the syringe,until the 
desired effect is produced.” This solution, so far as 
the morphia is concerned, is a very strong one, and, 
in the light of the facts presented in the chapter on 
narcotism and death, I should not advise its trial. 
It seems hardly possible that the efficacy of the 
doctor’s injection can depend on the presence of 
atropia in the solution, for by his own showing there 
would be but the gr. of this drug used if the 
whole of the 9 minims was injected; and that would 
represent gr. i. of morphia, a very heavy dose. Fur- 
thermore, in using so little of the atropia the doctor 
loses the power with which atropia is credited by 
some (Bartholow, Fothergill; see p. 259) of rendering 
large doses of morphia safer, 252 
HYPODERMIC INJECTION OF MORPHIA. 
Dr. Julio J. Lamadrid, of Brooklyn, N. Y., writes 
me: “ Another reason why I prefer to use these two 
agents together is that the pain-relieving power of 
morphia is greatly increased by atropia.” 
Dr. J. Howard Morgan, of New York City, writes 
as follows: “ I very frequently use it with atropia 
sulph., especially where I wish to prolong the pain- 
quelling effects of the remedy, and also where I 
wish to avoid nausea or other unpleasant effects of 
the drug in susceptible patients. This last object is 
often not attained fully, but the prolongation of the 
pain-controlling influence has often been quite note- 
worthy. I remember a case of a man who suffered 
much from acute rheumatism who was relieved by 
a hypodermic injection of atropia alone for about 
three hours, and then by one of morphia alone for 
four or five hours, but on combining morphia and 
atropia in one injection (the dose of each being 
a little less than when given alone), the pain was 
relieved nearly twenty-four hours. This observation 
was several times repeated on him, and uniformly 
with the same result.” 
Dr. A. B. Stuart, of Santa Barbara, California, 
writes: “ Use it alone when the pain is the result 
of or accompanied by inflammation; in other cases, 
such as neuralgia, with atropia.” MORPHIA AND ATROPIA. 
253 
Anstie1 is of the opinion that atropia itself pos- 
sesses the power to relieve the pain of neuralgia and 
sometimes cure the disease, the cure, when resulting, 
being usually permanent. He admits, however, that 
its pain-relieving power is much inferior to that of 
morphia, except in all pelvic neuralgias. He has 
also found it of the greatest service in neuralgia of 
the eye, when there is inflammatory trouble, with 
the danger of destruction of this organ. If it acts 
so well alone in these cases, it should have some 
beneficial effects when combined with morphia. 
Mitchell,2 on the contrary, found that atropia, even 
in large doses, utterly failed to give any relief to 
neuralgic pain. He recommends the combination of 
the morphia and atropia for the purpose of having 
the atropia combat the propensity to sleep caused 
by the morphia. It was found to do this very satis- 
factorily. This conclusion is based on the large 
series of experiments made on the human subject 
by this gentleman and Drs. Keene and Morehouse.* 
Of course these gentlemen say nothing regarding the 
use of atropine alone, or the two drugs together, in 
the pelvic troubles of females, as their experiments 
were carried on exclusively upon men—soldiers 
wounded in war. 
1 u Neuralgia and its Counterfeits,” London, 1871, p. 189. 
2 “ Injuries of Nerves,” Phila., 1872, p. 271. 
3 Am. Journal Med. Sciences, July, 1865. 254 
HYPODERMIC INJECTION OF MORPHIA, 
Bartholow1 says: “Whenever the hypodermic 
injection of morphia is proper and necessary, atropia 
should be combined with it, unless contra-indicated;” 
and again:2 “The pain-relieving power of morphia 
is increased by atropia.” 
Dr. Samuel Logan, Prof. Anatomy and Clin. 
Surgery in University of Louisiana, New Orleans, 
writes me that he prefers the combination of mor- 
phia and atropia for severe neuralgia. 
As a Preventer of Nausea and Prostra- 
tion.—Here, as upon the preceding questions, opin- 
ions are decidedly at variance. Mitchell, Keene and 
Morehouse say: “ Like others, we have met with 
other inconveniences attendant upon this mode 
of employing morphia. In rare cases it always 
caused distressing sick-stomach, but as the pain for 
which we used it was oftentimes agonizing, the 
patient usually preferred to endure the sick-stomach 
rather than fail of the delightful relief he obtained 
from the injection. In these instances it was com- 
monly observed that the morphia ceased, after a 
time, to produce either nausea or emesis.” And 
again: 
“ Morphia was very apt to cause nausea when 
1 “The Hypodermic Method,” &c., p. 134. 
* “ Ibid," p. 130. 
3 Am. Journal Med. Sciences, July, 1.865, p. 68. MORPHIA AND ATROPIA, 
255 
injected subcutaneously. In some men it never 
failed thus to affect them, when to such persons 
we gave the two drugs in equivalent doses—that 
is to say, doses which controlled the pupil, and 
perhaps after a time dilated it—we still found that 
nausea occurred as when only morphia had been em- 
ployed. Here again the antagonism fails.” 
Ringer1 is of the opinion that these unpleasant 
manifestations of morphia are often counteracted by 
adding belladonna to the morphia, in the proportion 
of one of the former to twenty of the latter. 
Dr. J. C. Lyman, of San Rafael, Cal., writes upon 
this point as follows: “ I find the addition of 
atropia a preventive of nausea, and do not recall ever 
having a patient who was nauseated by an injection 
of morphia and atropia, whereas, before I used the 
atropia, nausea was quite common.” Dr. Julio J. 
Lamadrid, of Brooklyn, N. Y., believes that atropia 
prevents or modifies the nauseant effect of morphia 
hypodermically used. Dr. G. Wm. Semple, of 
Hampton, Va., formerly used atropia for this pur- 
pose, but now finds that from 3 ss. to 3 i of diluted 
hydrobromic acid, by the mouth, “ is a certain pre- 
ventive of that very grave inconvenience.” 
The observations of Dr. J. M. Dacosta2 are of in- 
1 “ Handbook of Therapeutics,” N. Y., 1875, p. 520. 
2 Am. Journal of the Med, Sciences. April, 1870, and April, 1871. 256 
HYPODERMIC INJECTION OF MORPHIA. 
terest in this connection. He speaks very highly of 
the use of the bromide of potassium to prevent the 
nausea and vomiting following the use of morphia, 
and to which some persons are peculiarly liable. 
He found that the nausea of opium was more readily 
controlled than that of morphia. 
Dr. J. Y. Dale gives a case in practice where the 
bromide acted with remarkable effect—the nausea 
having been great and persistent. According to An- 
stie,1 the nausea and vomiting resulting from narcotic 
drugs is due to “ narcotic depression ” of the nervous 
centres. In cases where atropine acts so well in 
preventing or allaying this difficulty he believes it to 
be by stimulation of these depressed centres and by 
reason of its power to check excessive gastric secre- 
tion, a property possessed by most narcotics when 
given in small doses. 
That this nausea and prostration may be so severe 
as to cause alarm is shown by the following case, 
reported to me by Dr. H. M. Smith, of Vincennes, 
Indiana: “ In one case, where the puncture was 
made in the temporal region for severe neuralgia 
and inflammation of the eye, the patient became 
much prostrated and nauseated, and under stimula- 
tion did not come out from under influence for six 
hours.” 
1 “Stimulants and Narcotics,” Lond., 1865, p 225. MORPHIA AND ATROPIA. 
257 
These cases are as much to be referred to idio- 
syncrasy as is narcotism, &c., the brain being the 
organ most readily affected in one case, the stomach 
in another, the muscular system in another, and so 
on, according to hereditary or acquired peculiarity. 
Dr. J. Charles Adams, of Lake City, Minn., ex- 
presses himself as follows: “ I incline to the 
opinion, based on my own observation, that when 
very severe pain is instantly relieved there is more 
nausea than when the pain is gradually mitigated.” 
Dr. Samuel W. Francis, of Newport, writes : “ I 
do think that atropia aids in preventing nausea, &c., 
but have not felt the need of it in my practice.” 
Professor Jno. W. Lowman, of Wooster Univer- 
sity, Cleveland, Ohio, says: “Usually alone; with 
atropia when morphia is not tolerated or when too 
great physical depression results. Also, in asthma 
and diseases of like nature. I always give morphia 
alone when the patient exhibits great force or 
power.” 
Dr. P. H. Thornton, of Lakeport, Cal., writes: 
“ If an idiosyncrasy for morphia exists, I combine 
it with atropia; if not, I use it alone.” 
Bartholow 1 says, in this connection : “ The sick- 
ness and nausea, and the not uncommon great 
depression of the vital powers, caused by morphia 
1 “The Hypodermic Method,” &c., p. 133. 258 
HYPODERMIC INJECTION OF MORPHIA. 
are opposed by atropia. The after-stomachal effects 
of morphia—indigestion, loss of appetite, a pasty 
tongue—are much diminished by atropia, but not 
absolutely prevented.” As atropia produces the 
same digestive troubles as morphia, he recommends 
its use in small doses,—as morphia gr., atropia 
tjo gr- 
Dr. Montrose A. Pallen,1 of this city, has found 
atropia to mitigate the nausea and vomiting of mor- 
phia. He recites a case, however, where it failed to 
do this, though given in large amount (jq gr.). 
Dr. E. T. Wilson 2 found that in some patients who 
were nauseated by morphia given by the skin, if the 
first few drops were injected slozvly, no such trouble 
occurred, but if injected rapidly, nausea showed 
itself at once. Indeed, he found that where the first 
few drops were slowly introduced, the remainder of 
the fluid could be rapidly injected without causing 
any disturbance. 
William T. Lusk, Prof. Obstetrics, Diseases of 
Women and Children, &c., Bellevue Hosp. Med. 
Coll., writes as follows : “ I use it without atropia. 
(Morphia makes me very sick always. I was ad- 
vised to take it once for a cold, and combined it with 
atropia. The combination made me feel worse than 
usual).” 
1 AT. Y. Medical Record, Dec. 21, 1878. 
2 “ St. George’s Hospital Reports,” 1869. MORPHIA AND ATROPIA. 
259 
Lessens Tendency to Produce Headache 
and Digestive Troubles.—As we have already 
seen, morphia given subcutaneously is less apt to dis- 
order digestion than when given by the stomach.1 
Thefe are some cases, however, where morphia, hy- 
podermically, does produce these troubles, and in which 
atropia lessens this tendency. A number of my 
correspondents testify to its efficacy in this respect. 
Rendering Large Subcutaneous Doses of 
Morphia Safer.—Dr. Alfred Ludlow Carroll, of 
New Brighton, Staten Island, writes me: “I have 
the fullest faith in the efficacy of morphine in dimin- 
ishing the narcotic and augmenting the anodyne in- 
fluence of morphia. In a tolerably wide experience 
I have invariably found that a much smaller dose of 
morphia would relieve neuralgia when combined 
with atropia then when given alone, and for some 
years past I have always employed the combination.” 
J. C. Murphy, L. R. C. P. & S., E., etc., of Dub- 
lin, writes me: “ I have used the solution with atro- 
pine, which seems, (along with counteracting its 
unpleasant effects), to moderate its soporific power.” 
He relates a case where the lady was most intolerant 
of erven the smallest doses by the mouth, and where 
he was able to give it, in combination with atropia, 
1 Anstie, Practitioner, July, 1868, p. 33. 260 
HYPODERMIC INJECTION OF MORPHIA. 
in large doses by the skin, without any unpleasant 
effects whatever. 
Dr. Julio J. Lamadrid, of Brooklyn, believes that 
by combining atropia with morphia much larger 
doses of the latter can be given than would be safe 
otherwise. Bartholow 1 says, speaking of the hypo- 
dermic use of morphia in asthma: “ Ordinarily I 
combine atropia with the morphia, in order to give 
large doses with safety; for in this disease, as in 
many other neuroses, the maximum doses are often 
required to accomplish relief.” And again:2 “Atro- 
pia in small doses—9-6 of a grain—increases the 
hynotic power of morphia; but if the quantity of 
atropia be sufficient, it overpowers the effects of 
morphia on the cerebrum, causing wakefulness or 
disturbed sleep, phantasms and illusions.” This is 
quite in accord with the conclusions of Mitchell, 
Keene and Morehouse,3 but opposed to those of 
Corona.4 
Fothergill5 is of the same mind, for he says: 
“ There seems every reason to believe that bella- 
donna may be usefully combined with opium or mor- 
1 “The Hypodermic Method,” etc., p. 76. 
2 Ibid, p. 130. 
3 Am. Journal Med. Sciences, July, 1865. 
4 ( Giomale di Medicina Militaire, quoted by Edinburgh Med. Jour- 
nal,Dec. 1876.) Practitioner, 1877, p. 132. 
5 “Antagonism of Therapeutic Agents,” Phila., 1878, p. 62. MORPHIA AND ATROPIA. 
261 
phia in those cases where it becomes imperative to 
give very large doses of these agents, such doses in- 
deed as may threaten the respiration or circulation. 
Belladonna will maintain the action of the centres 
under huge doses of morphia, without interfering 
materially with the effect upon the cerebro-spinal 
centres.” 
The following case seems somewhat strange in the 
light of these facts; illustrating, however, the ad * 
vantages of giving atropia for the purpose of getting 
increased power. 
“ A lady suffering from cancer of the womb had 
had as much as 2 grs. and £ of morphia injected 
hypodermically at once to relieve the paroxysms of 
pain. This dose did not produce sleep for an hour 
or more, and then only of a dozing character and 
easily interrupted. As the disease had not advanced 
far, I was anxious to husband the morphia as much 
as possible. Believing that belladonna or atropia 
increases the effect of opium, I gave yo of a gr. of 
atropia with morphia, with such good results that after 
a few trials I found that f of a gr. of morphia, when 
combined with jq of a gr. of a atropia, was enough 
to relieve the pain as effectually as the 2 grs.and £ of 
morphia had done alone, and produced sound sleep 
at once. 
“ On one occasion, a dose of yy gr. of atropia and 262 
HYPODERMIC INJECTION OF MORPHIA. 
of a gr. of morphia had failed to relieve an unsusu- 
ally severe attack of pain. After 4 hours, the pa- 
tient’s son, who had previously given the injection un- 
der my direction, on his own responsibility repeated 
the dose, not unnaturally supposing that as 2f grs. 
of morphia had been given at once, several times 
before, i of a gr. might be repeated after an interval 
of 4 hours. On visiting her soon afterwards, I was 
cautioned not to disturb her ; but, being anxious to 
see the effects of the second dose, I examined her a 
little more attentively than usual, and found the sup- 
posed sleep was really profound coma. The pupils, 
moderately dilated, were insensible to light. The 
respirations were shallow, and continually interrupted 
by an alarming pause. The eye-lids when opened 
remained so. No shaking or pinching produced any 
effect. Although vomiting was a prominent symptom 
with her, neither finger nor feather, tickling the fauces 
produced any movement. The sole reflex action 
that I could excite was a slight quiver of the right 
eyelid when cold water was thrown on the face and 
chest, but the respiration was not altered by it. 
Ammonia to the nostrils also failed to cause move- 
ment. The pulse was soft, regular and 116. Fre- 
quent cold affusion to the face and chest, with mus- 
tard poultices to the calves of the legs and the nape 
of the neck, were applied at intervals for an hour MORPHIA AND ATROPIA. 
263 
before the patient could be roused. As far as this one 
case goes, nothing can be more conclusive, I think, 
than that atropia intensifies rather than counteracts 
the sedative effects of morphia.” 1 
The Case (No. 5, Chap, v) where death- resulted 
from morphine in spite of the exhibition of at- 
ropia before the latter was given, and during the nar- 
cosis also, seems to be inexplicable. 
If it can be settled beyond question that atropia 
possesses this power, then we have in it a most im- 
portant safeguard ; one that will permit of the giving 
with safety not only the ordinary dose, which, as has 
been shown, may often produce serious and even fatal 
narcotism, but of giving very large doses, such as are 
sometimes required. . As these large doses are, how- 
ever, usually exhibited during intense pain, we 
should expect the pain itself to use up much of the 
evil effects of the drug, and lessen its danger ; and as 
the gentlemen who claim increased safety from the 
addition of atropia also claim increased pain-reliev- 
ing power, by the same measures, smaller rather than 
larger doses would consequently meet the indica- 
tions, and not call for the safety action of atropia. 
Indeed this matter is still far from being proved, 
the chief argument in its favor being obtained from 
J. N. Miller, British Medical Journal, Nov. 17, 1877, 264 
HYPODERMIC INJECTION OF MORPHIA. 
a priori reasoning from the physiological antagonism 
of the two drugs. A careful series of experiments 
should be made upon both man and animals for the 
purpose of determining this point definitely. Until 
such experiments, carried on with the utmost care 
and for this purpose alone, are made, a positive opin- 
ion on this point should not be given, much less act- 
ed upon. Those experiments already made are not 
sufficiently conclusive to warrant a final opinion, the 
more so as they have been chiefly done upon animals. 
(1) That’atropia is considered of service by some 
in increasing the pain-quelling powers of morphia; 
by others that it exercises no influence whatever in 
this direction. 
(2) That by some it is considered a perfect and 
by others a partial preventer of the nausea and pros- 
tration sometimes following the use of morphia Hy- 
podermically ; by still others as of no value what- 
ever. 
(3) That the nausea and prostration of morphia 
subcutaneously is best controlled by the simultane- 
ous exhibition of the bromides or hydro-bromic acid 
by the mouth. 
(4) That atropia in small amount increases the 
hypnotic power of morphia. 
(5) That atropia is considered by some to render 
We are to conclude, then : MORPHIA AND ATROPIA. 
265 
doses of morphia, that would otherwise be dangerous, 
safe. 
(6) That the constipation resulting from the use 
of morphia hypodermically may be combated by 
small doses of atropia. 
(7) That atropia is considered by some to prolong 
as well as increase the pain-relieving power of mor- 
phia. 
A study of these final conclusions and others, 
given a few pages back, teaches us that there is con- 
siderable room for exact clinical inquiry as to the 
advantages of combining the two drugs for hypo- 
dermic use; that if the propositions offered by the 
gentlemen who have studied the action of these 
drugs separately, and when given together, are cor- 
rect that such combination is of use therapeutically 
only, for the purpose of combating pain, and in 
some few special diseases, for as regards the majority 
of bodily functions, these agents antagonize each 
other and render any other than their anodyne ac- 
tion nil. 
In painful affections of the abdomnial organs, where 
it is desired to relieve this pain by a remedy or 
remedies that do not constipate, then atropia and 
morphia are invaluable. Also in those cases of en- 
euresis where an irritable condition of the bladder 
predominates; in fact in all forms of incontinence of 266 
HYPODERMIC INJECTION OF MORPHIA. 
urine of the hypersesthetic type.1 In such cases, 
however, the drugs given by the rectum are quite as 
effective, if not more so, than when given subcuta- 
neously. This is especially true in the nocturnal 
eneuresis of children ; the use of morphia in any way 
being dangerous, and the puncture of the hypoder- 
mic needle producing sufficient fright to cause 
syncope and convulsions. Painful personal experi- 
ence has taught me this, I having had a case where 
I used this instrument, the child nearly dying of 
fright. . 
I think upon the whole that the double solution 
(morphia and atropia) is being used too much, and 
with but little sensble discrimination. Even though 
atropia may do no harm when thus used, still it is 
foolish to employ it when there is no necessity for it. 
Every physician should study his cases carefully, and 
where the one or the other solution is called for give 
it, but he should not, as a mere matter of routine, 
give atropia every time that he gives morphia (by 
the skin). Certainly not until the safeguard action 
of atropia is settled. As the evidence stands now, 
the atropia and morphia solution is safer to use be- 
cause the atropia adds to the anodyne powers of the 
morphia, and hence it is necessary to use less of the 
latter drug. 
1 Skene, “ Disease of the Bladder and Urethra in Women,” N. 
Y., 1878, p. 80. CHAPTER IX. 
THE MORPHIA HABIT—ITS DANGERS—PECULIARI- 
TIES AND TREATMENT. 
It is not my intention to go at all extensively into 
the subject of the morphia habit; first, because I do 
not consider myself at liberty to devote to it the 
space necessary for its full and comprehensive discus- 
sion ; and second, because those better qualified to 
do so have already expressed their views upon the 
subject. Edward Levenstein,1 Medical Director of 
the Maison de Sante, Schoreberg, Berlin, has studied 
this subject at great length, supplementing the results 
of his observations on a large number of the slaves 
of habit, by numerous experiments on animals. 
His work, an English translation of which has 
just been published, will well repay perusal. Calvet 2 
has also studied the subject upon animals. N 
The dangers of contracting this habit from the hy- 
podermic use of morphia was recognized3 in the 
very infancy of the practice, but was scoffed at or 
1 “ Die Morphiumsucht,” Berlin, 1877. 
2 (“Th&se de Paris”), At. Y. Medical Journal, Sept. 1877. 
3 Anstie, Practitioner, i860. 268 
HYPODERMIC INJECTION OF MORPHIA. 
disregarded until a few years ago, when the profes- 
sion in Germany, England and America awoke, al- 
most simultaneously, to a knowledge of the fact that 
the habit had become alarmingly common, and that 
it had been contracted, in the majority of instances, 
through the carelessness of the physician, who had 
taught either the patient or his friends how to use 
the instrument. 
Some of my correspondents, men of ability and in 
large practice, express themselves as very skeptical 
of the truth of the statement that the morphia habit 
has ever been formed by the use of the drug hypo- 
dermically. Testimony from all parts of the civ- 
ilized world settles this matter beyond question. 
Bartholow, from whose excellent little work I have 
so often quoted, says :1 
“ The introduction of the hypodermic syringe has 
placed in the hands of man a means of intoxica- 
tion more seductive than any which has heretofore 
contributed to his craving for narcotic stimulation. 
So common now are the instances of its habitual use, 
and so enslaving is the habit when indulged in by 
this mode, that a lover of his kind must regard the 
future of society with no little apprehension. It 
may well be questioned whether the world has been 
i'he gainer or the loser by the discovery of subcu- 
1 “The Hypodermic Method,” &c., p. 90. THE MORPHIA HABIT. 
269 
taneous medication. For, every remote village has 
its slave, and not unfrequently several, to the hypo- 
dermic syringe, and in the larger cities men in busi- 
ness and in the professions, women condemned to a 
life of constant invalidism, and ladies immersed in the 
gayeties of social life, are alike bound to a habit 
which they loathe, but whose bonds they are power- 
less to break. Lamentable examples are daily en- 
countered, of men and women, regardful only of 
the morphia and indifferent to all the 
duties and obligations of life, reduced to a state of 
mental and moral weakness most pitiful to behold. 
“Usually the habit is formed in consequence of 
the legitimate use of the hypodermic syringe in the 
treatment of disease. Employed in chronic painful 
maladies for a long period, it is discovered, when an 
attempt is made to discontinue the injections, that 
the patient cannot or will not bear the disagreeable, 
even painful, sensations which now occur. More 
frequently, when the injections are to be used for a 
long time, the patient is unwisely intrusted with 
the instrument, and taught all the mysteries of the 
solutions and the mode of administration.” 
In reply to my 6th question, Prof. T. Gaillard 
Thomas, of this city, unreservedly expresses himself 
as follows : “Yes, of a large number of such, several 
of whom are now under observation. Indeed, I look 270 
HYPODERMIC INJECTION OE MORPHIA. 
upon the frequency of these cases as a great and grow- 
ing evil. I never, now, under any circumstances, teach 
the patient to use the syringe upon him or herself. In 
my own experience, two deaths have occurred from 
the prolonged and excessive use of this method of 
administering morphine, it being continued as a vice 
for years.” 
The same opinions are expressed in an editorial in 
the London Medical Examiner, July 5, 1877,1 the 
writer instancing many cases where morphia is given 
unnecessarily, thus leading to the habit, when other 
drugs fully able to accomplish the desired therapeutic 
end are neglected. 
Levenstein 3 recognizes the dangers of thus con- 
tracting this terrible habit and forcibly depicts its 
horrors. 
Anstie 3 thinks that there is “ far less tendency with 
hypodermic than with gastric medication to rapid 
and large increase of the dose, when morphia is used 
for a long time,” and that there is less mental, mus- 
cular, nervous and gastric derangement, less interfer- 
ence with the powers of life, when the habit is thus 
contracted and carried out, it being thus a smaller 
1 N.Y. Medical Journal, Sept, 1877. 
2 Review of “Die Morphiumsucht,” Berlin, 1877, Edinburgh Med. 
Journal, August, 1878, p. 160. 
3 Practitioner, July, 1868. THE MORPHIA HABIT. 
271 
evil than the old form of excess by the mouth.1 That 
this may be the case in certain individuals there is no 
doubt, but that it is so in the majority of instances is 
decidedly negatived by the reports which I have re- 
ceived from all parts of the country, and from gentle- 
men who devote their attention exclusively to this 
subject. 
Dr. Joseph Parrish, so well known in this connec- 
tion, writes me that there are exceptional instances 
where not only does morphia, thus taken several times 
daily for years, not lessen the vital powers, but seems 
to be positively beneficial. 
Dr. Golding Bird2 relates the case of a lady, 
probably hysterical, who, for the relief of acute 
paroxysmal pain in the loins, took morphine. She 
had been taking it for seven years. For the past two 
years had increased the dose to io grs. t.i.d. There 
were no obvious ill effects ; functions were properly 
carried on, appetite good, and there was no known 
organic disease. 
The morphia was taken by the mouth. This case 
is given simply to illustrate the fact stated that mor- 
phia taken for a long period seems to be of positive 
benefit, or to do no apparent injury in certain cases, 
which are, however, but rarely met with. 
1 Practitioner, vol. 6, p. 149. 
2 Boston Medical and Surgical Journal, 1842, p. 355. 272 
HYPODERMIC INJECTION OF MORPHIA. 
Dr. J. B. Mattison,1 of Brooklyn, a well known 
specialist in this line, has had a number of cases of 
this kind under his care, and is of the opinion that 
persons of the decidedly nervous temperament are 
those most likely, indeed almost certain, to drift into 
this habit if the injections are continued for a month 
or more by the physician, especially if it is necessary 
to use the drug in large doses. 
In support of this is the careful research of Dr. 
Geo. M. Beard,2 of this city, who shows how readily 
persons suffering from neurasthenia take to the use of 
stimulants and narcotics and push them to excess. 
These facts, taken in connection with like views ex- 
pressed by many of my correspondents, teach us to 
be specially guarded in the continued use of this 
drug in persons of this class. It seems to be more 
dangerous in those instances where full narcotic doses 
are‘required in order to relieve the pain of neuralgia, 
&c., to which this class of persons are especially 
liable. Persons addicted to the excessive use of al- 
cohol sometimes replace it with opium or morphine, 
and carry the latter to the same excess as the 
former. 
P'rom those of my correspondents answering the 
6th question I have gathered the foil wing: 
1 Interview. 
2Quarterly Journal of Inebriety, Sept., 1879. THE MORPHIA HABIT. 
273 
131 physicians report 184 cases of the opium-habit 
thus contracted, and, 
197 physicians have never seen or heard of a case 
of this kind. 
All of those gentlemen reporting indefinitely as 
“ many cases,” “ have often seen it,” “ a not uncom- 
mon sequel,” “ know of a number,” etc., I have 
credited with three cases, and I have thus, in all like- 
lihood, reported less than have been actually seen. 
Charlatans in various parts of the country are 
reaping a rich harvest from the victims of this habit. 
From correspondence with several of these I find 
that the majority of their victims formed the habit 
through the use of this instrument for disease, 
chiefly neuralgia. These quacks are utterly without 
conscience, without a jot or tittle of honesty or 
honor, and go on bleeding their patients pecuni- 
ary from day to day, while deluding them with 
lying assertions and holding out false hopes. An 
analysis of their so-called perfect substitutes for 
morphia, by Dr. J. B. Mattison, of Brooklyn, showed 
them to consist of morphia in large amount; some- 
times, morphia and atropia. 
Anstie 1 is of the opinion that there is a decided 
difference, dependent on the manner in which the 
drug is given. Witness the following: 
1Practitioner, vol. 6, p. 149. 2 74 
HYPODERMIC INJECTION OE MORPHIA. 
“ That there is a special state of chronic narcotism 
induced by the continued repetition of large hypo- 
dermic doses of morphia is a fact familiar to many 
physicians. It differs strikingly from that which 
results from the persistent abuse of opium or mor- 
phia taken by the mouth, in the slighter effects which 
it produces on consciousness, and especially in the 
fact that it usually scarcely impairs, if indeed it does 
not decidedly increase, the activity of appetite and 
digestion; hence it is far more consistent with the 
active performance of the duties of life, and with the 
maintenance of general bodily nutrition ; and, so far, 
it must be considered as a much smaller evil than 
the constitutional habit induced by the old-fashioned 
forms of opium excess. But it is quite as fatally ef- 
fective as the latter in weaving a chain of habit from 
which the patient can either not escape at all or can 
do so only by great efforts, involving the prolonged 
endurance of great distress. It is certain, then, that 
the physician can only be justified by very special 
circumstances in allowing such a condition to be set 
up in any patient under his charge.” 
This is not at all in accordance with the experience 
of Bartholow, Mattison and Levenstein. At the time 
in which Dr. Anstie wrote the habit was not so com- 
mon and much smaller doses were used then, than 
are employed by the slaves of the habit at the pres- THE MORPHIA HABIT. 
275 
ent day. The amount of the drug at present used 
in this way is positively astonishing. 
In the case of the governess who died of tetanus 
following the puncture of a hypodermic needle (see 
p. 237), the statement is made by Dr. Meldon, that on 
some days the patient used as high as 20 grs. subcu- 
taneously in the 24 hours ; and that this is the largest 
amount on record. The doctor is mistaken in this. 
Dr. Bartholow1 knows of cases where 20, 40 and 60 
grains were used daily by habitues; and Dr. Robert 
Park, of Glasgow, Scotland, writes me of a case of 
acute mania in a woman, where one scruple of morphia 
was given, hypodermically, at a single dose, she being 
a non-habitue. 
Dr. J. C. How writes me that he has seen patients 
who were in the habit of taking (hypodermically) 
from 2 to 18 grains in the course of the day. 
Dr. Samuel Logan, Prof. Anatomy and Clin. 
Surgery in the University of Louisiana, writes me 
of the following case, which is of interest both from 
the large amount employed and the ease with which 
the morphia was diminished in amount and finally 
stopped altogether: 
“ The largest amount I have ever reached was in a 
case of excessive and prolonged suffering from an hepa- 
tic abscess, in which, after giving it daily in gradually 
“The Hypodermic Method,” &c., p. 91 276 
HYPODERMIC INJECTION OF MORPHIA. 
increasing doses for eighteen months, the amount of 
twenty-five grains morning and night was reached and 
continued for ten months. At the end of this time, 
I began to decrease the dose very gradually without 
the knowledge of the patient; and at the end of an- 
other year I had ceased giving anything but water. 
For three months I continued to give her water alone, 
for the purpose of deceiving her. During all this 
time the hepatic abscess was discharging through 
the right lung; and it continues to do so, at intervals, 
still. My first visit was paid Feb. 4, 1875. In this 
case the morphine seemed to act as a substitute for 
food, for the stomach was in such an irritable condi- 
tion that it would retain nothing for weeks at a time. 
She was sustained also—perhaps chiefly—by nutri- 
tive enemata. The latter are even now continued, the 
stomach being still unable to retain but a very small 
amount of anything whatever, leading me to believe 
that it must be bound down by adhesions. To me 
the chief interest of this case centers around the fact 
that it demonstrates the possibility of relieving the 
patient from the ‘ opium habit’ by the gradual 
method. This can be better done when the agent is 
given, at each dose, by the physician himself. I never 
teach my patients how to use the instrument, except 
in necessarily fatal cases. Nor can you trust the rela- 
tives or the nurses in this matter. They will yield THE MORPHIA HABIT. 
277 
to the importunities of the patient. I adopted the 
plan of surreptitiously adding a syringe-full of water 
to the phial containing the morphine mixture, as I 
was washing out my instrument after using it each 
time. Not even the mother of the party discovered 
what I was doing till I informed her some six months 
after I had begun the reduction of the dose.” 
This case and those to follow demonstrate very 
clearly that with a reasonable amount of care on the 
part of the physician, there is but little fear that this 
habit will be contracted. It is in those cases where 
the physician lets the control of the instrument go 
out of his hands or where he needlessly uses it, or 
uses it in unnecessarily large doses, that there is dan- 
ger of contracting the habit. 
Dr. Richard J. Noble, of Selma, N. C., writes me: 
“ On one patient I have used the hypodermic syringe 
between 2,500 and 3,000 times in a period of 
eighteen months, and so far see no signs of the 
opium habit.” 
Dr. A. W. Carson, writing me, refers to a case 
where 60 grains of morphia were used, hypodermi- 
cally, in the 24 hours. No details are given, and I 
have, as yet, received no answer to a letter request- 
ing full information. 
Prof. H. C. Wood, of Phila., writes me of two cases, 
in one of which the habit was readily broken off. In 278 
HYPODERMIC INJECTION OF MORPHIA. 
the other, it was doubtful whether the habit was con- 
tracted by taking morphia by the syringe, or by the 
mouth. 
Dr. Wm. H. Vail, of Cornwall-on-Hudson, N. Y., 
sends me the history of the following case : 
“In August, 1874, I was called to see a stranger— 
a lady—who said she was suffering from one of her 
usual severe attacks of neuralgia, and that her phy- 
sician always used large doses of morphia hypoder- 
mically, so I gave her ]/2 a grain in that way (I then 
carried the grain powders). In the evening, as she 
said she was no better, I gave her of a grain. 
Next morning, I gave her a grain at her solicitation 
for a larger dose. To make a long story short, I saw 
her twice a day for some time—every visit she wanted 
a larger dose. I soon decided she was an opium- 
eater. But in order to see how much she could bear, 
I increased the dose more or less every visit (gener- 
ally ]/2 a grain) till I reached the dose of 8 grains of 
morphia hypodermically at one time.” 
Dr. E. W. Drake, of Middleboro, Mass., writes me 
of two cases of the habit thus formed, both parties 
committing suicide because they were unable to 
break their terrible bonds. 
Dr. F. C. Remondino, Health Officer of San 
Diego, Cal., writes me of a case of morphia habit THE MORPHIA HABIT 
279 
from the use of the syringe. The patient used from 
8 to io gr. per day, increasing to 24 gr. during a 
severe fit of illness. There is no hope of recovery, 
as the man is thoroughly broken down. This patient 
has but seldom had abscess. He plunges the needle 
directly into the muscular tissue of the arm or leg. 
Dr. W. McKenna, of Carrickmacross, Ireland, 
writes me that in a case of aneurism, in which there 
was great pain, he used morphia and atropia twice a 
day for twenty-one weeks, and found that he “ did 
not have to increase the dose even to the end.” It 
may be possible that when atropia is used, increase 
in the amount of morphia necessary to control pain 
is not required. If there is any probability of this, it 
is certainly worthy of extended trial to determine the 
point positively, for then not only would the danger 
of contracting the morphia habit be less, but a clue 
to its proper treatment be reached. 
T. Carter Wigg, M. D., L. R. C. P., M. R. C S., L. 
S A., of Derby, England, writes me as follows: “ I am 
of opinion that for all practical purposes to 2 
grains is the dose which gives the full therapeutic 
value. I have not found larger doses (in cases where 
the use of morphia has been continued for some 
time) produce greater or more lasting effect. I have 
generally found the effect of a dose of morphia, 
hypodermically administered, to last not more than 280 
HYPODERMIC INJECTION OF MORPHIA. 
from 18 to 20 hours, however large the dose may 
have been. I have been enabled in one case, where 
I used it for nine consecutive months, in doses of 1 y2 
grains, by occasionally reducing the dose when the 
pain was less severe, to thoroughly relieve the patient 
with the full dose of 1 grains. I have found one 
grain every 12 hours produce better results than even 
as much as 3 or 4 grains once in 24 hours. I will 
never permit or advise a patient to administer mor- 
phia to himself.” 
Dr. W. F. McAllister, of the Quarantine Office, 
San Francisco, sends me the details of the following 
case, where an extraordinary amount of morphine 
was taken at the dose, and in the 24 hours : 
“ A physician who resided in this city contracted 
dysentery while in Shanghai, China, in the summer 
of 1873. Morphia was used hypodermically, and he 
drifted into the habit of using the drug in this way 
himself; the habit resulting in his death in 1878. I 
was called to see him professionally in Feb., 1875. 
He was at that time residing at Hong Kong, China. 
He was consuming each day seventy-two grains of 
the sulphate of morphia, taken in three doses, 24 gr. 
to the dose. This he continued to do until the day 
of his death. 
“ In another case, equally as interesting, a surgeon 
in the United States navy contracted the habit while THE MORPHIA HABIT. 
281 
in Tokio, Japan. He used the drug by hypodermic 
injection. He was suffering at the time with 
secondary syphilis. There was hardly a portion of 
his body free from puncture-points and hundreds of 
abscesses had followed at the point of puncture. He 
subsequently returned to California and died in the 
insane asylum. This patient used twelve grains at a 
dose.” 
The first case is certainly a very remarkable one. 
The second less so, for scarring of the entire body in 
these patients is common, and the dose is not very 
large. 
In this connection I am reminded of the fact that 
physicians themselves are often slaves to this habit. 
I know of two such instances myself and have heard 
of many others from my correspondents in various 
parts of this country; none from abroad. 
Dr. Wm, W. -Cable, of Pittsburgh, writes me: 
“ Yes, a great many of these cases. All these per- 
sons who use opium hypodermically, contracted the 
habit by using the drug for relief of pain caused by 
accident or disease. Among the diseases for which 
it had been used in these cases I can enumerate, 
facial neuralgia, acute rheumatism, sciatica, dissec- 
tion wounds, simple cholera, ileo-colitis, and diarrhoea. 
Many of these patients having provided themselves 
with a syringe take it as regularly as the drinker does 282 
HYPODERMIC INJECTION OF MORPHIA. 
his ‘ nip,’ and in quantities that would astound the 
uninitiated; one professional man taking 32 grains a 
day without apparent injury. The only fatal cases 
that have come under my observation were persons 
who administered the fatal doses themselves (two of 
the four fatal cases were doctors). In all, the deaths 
were sudden and unseen by medical men, and in none 
was any analysis made of the solution used, nor any 
post-mortem examination of the bodies held.” 
The two fatal cases spoken of by Prof. T. G. Thomas, 
of this city, were both in young persons, and the 
death was due to extreme exhaustion, dependent on 
imperfect nutrition and a gradual depression of the 
nervous and circulatory systems. 
Dr. William Commons, of Union City, Indiana, 
answers my sixth question as follows: “Yes; one 
case—a married woman of good condition in life, 
twenty-six years old, and when in good health 
weighing from ninety-five to one hundred pounds. 
Had not menstruated for four months, and had been 
treated for obstinate vomiting, which for two months 
had been controlled by hypodermic injections of 
morphia. When I saw her she was receiving injec- 
ions of twenty minims of Magendie’s solution of 
morphia four to eight times in the twenty-four hours. 
Did not interfere with injections, and gave nourish- 
ment per rectum. At the post-mortem, ten days THE MORPHIA HABIT. 
283 
later, the body was emaciated, weight about fifty 
pounds; complexion like a mixture of Java coffee 
and milk; stomach a bag of gas, with the mucous 
coat peeling off under the finger; liver atrophied; 
uterus containing a two months’ foetus, which, with 
all the internal organs, had a color like a mixture of 
black coffee and cream.” 
The doctor is inclined to the opinion that death 
was due to the morphia habit, but the amount used 
was so small and the time so short that I think it 
more likely that the vomiting produced extreme ex- 
haustion, with, possibly, some gastritis, and that the 
patient died more from innutrition and exhaustion 
than from the morphia habit. 
Dr. J. C. Howe, of Haverhill, Mass., writes me: 
“ It has been my fortune, since my return from the 
army in 1866, to be brought in contact with numer- 
ous slaves to the ‘ opium habit.’ I think the use of 
the syringe is much preferred by habitues to its ad- 
ministration by the mouth; in quite a number of cases 
it had never been used save by injection. I have no 
doubt that the quickness of effect and, it may, be the 
slight stimulus of the prick is the cause of this 
preference. 
“ I have had under my care patients using from 2 
to 18 grs. daily, in from I to 4 injections. 
“ In two cases—one male, one female—small super- 284 
HYPODERMIC INJECTION OF MORPHIA. 
ficial abscesses followed about one-fourth of the injec- 
tions. In both these cases the point of insertion was 
the arm, mostly the upper arm. 
“ In three cases, all males, who inserted the point 
in the thigh and buttock, there have been seven deep- 
seated abscesses, slow in their course, with extremely 
offensive contents. I think I have found the habit 
more easily broken up by those who have used the 
syringe, though I have not usually found the cure 
difficult in either case where I could get entire con- 
trol of the patient. Except in victims of the habit, 
I now rarely use the syringe unless the exigencies of 
the case seem especially to require it.” 
The infrequency of abscess amongst some of those 
who use the syringe for years is a matter of surprise, 
they making from 2 to 35 punctures a day. Thus, 
one gentleman, a physician of ability, who has been 
a slave to the habit for the past six years, writes me 
that in all that time he has had but two abscesses, 
and attributes these to the employment of an impure 
solutiou. This freedom from abscess must be attri- 
buted to cleanliness of the instrument, dissolving the 
the powder at the moment of use, and injecting it 
while warm. As a rule, the more concentrated the 
solution the more liability there is to abscess. The 
majority of these habitues, according to my corres- 
pondents, make the injection deep into the muscular THE MORPHIA HABIT. 
285 
tissue, and to that attribute immunity from pain, in- 
flammation and abscess. Those persons, of whom 
instances have already been given, who seem to 
maintain an excellent physical condition, although 
using morphia in this way several times daily, rarely 
have abscess. Those, on the contrary, whose health 
is broken, either from the practice or from some 
chronic disease, are prone to have abscess follow 
nearly every puncture. This is especially true of 
syphilitics. 
In some of these persons the condition of the body 
is terrible. Abscesses are to be seen in every stage, 
from those just forming to those just healing or 
healed; large and small cicatrices, reddened, bluish, 
hardened or doughy lumps; ecchymoses; patches 
of gangrene of various sizes cover the body every- 
where, “ leaving ” as some of my correspondents 
express it, “hardly a spot of healthy skin, large 
enough to be covered by a dime.” 
The cut at p. 287 represents one of the male nurses 
at Bellevue Hospital, who contracted the habit by 
stealing the house physician’s syringe to give himself 
an occasional injection. The effect was so pleasing 
that he continued the practice and finally died. The 
wood cut here given represents the condition of his 
body a short time before death. 
Abscesses thus produced are usually deep and 286 
HYPODERMIC INJECTION OF MORPHIA. 
continue to discharge for months, thus further de- 
pressing the system. In some persons abscesses are 
common at first, the skin being very irritable, but 
after a time they cease to occur, until the systemic 
tone is severely depressed, and the tissues are suffer- 
ing from innutrition, when they are very frequent 
and often accompanied by circumscribed patches of 
gangrene. 
In all these cases constitutional is much more im- 
portant than local treatment, although the latter 
should not be neglected. Nitrate of silver, when the 
granulations are exuberant, and Balsam Peru when 
sluggish, also strapping, are of service. 
Prof. Willard Parker has seen peculiar conditions 
of the skin result from the habitual use of the 
syringe. In one case keloid prominences showed 
themselves, and in the other there was a condition of 
the leg closely resembling elephantiasis. 
Dujardin-Beaumetz1 relates a case of death, and 
Calvel,2 (both quoted by Bartholow3) “ has collected 
many cases of abscess, traumatic fever and other 
accidents produced by hypodermic injection of mor- 
phia, but, rightly enough, refers them to the causes 
above mentioned—the state of the needle, improperly 
1 Bulletin Generate de, Therapeutique, Jan., 1879. 
2 “ Th6se de Paris.” 
3 Op. cit., p. 96. THE MORPHIA HABIT 
287 288 
HYPODERMIC INJECTION OF MORPHIA. 
prepared solutions, and to the cachexia induced by 
the morphia habit.” 
I have already referred to two cases of death from 
traumatic tetanus, produced by the use of rusty or 
unclean hypodermic needles. That tetanus may re- 
sult from a severe local inflammation, vaccination 
pustule, and from the hypodermic use of quinia, has 
also been shown. 
Treatment.—The treatment of the morphia 
habit is of three kinds: sudden deprivation, gradual 
deprivation, and substitution. The former is the 
plan of Levenstein,1 who has treated many cases in 
this way and with excellent success, so far as ac- 
complishing a cure is concerned. It is necessary, 
however, that the patient be fully under the physi- 
cian’s control, the best place being an asylum. This 
plan has two decided objections: if the patients 
have been using the drug for a long time or in large 
quantities, their sufferings are agonizing, and there 
is decided danger of serious and even fatal collapse. 
This has been pointed out by Bartholow,2 who has 
had a very unpleasant experience of the kind, and 
also by Levinstein; but the latter claims that it can 
always be obviated by careful watching and prompt 
treatment, which consists in the injection of a small 
1 “ Die Morphiumsucht,” Berlin, 1877. 
2 “The Hypodermic Method,” &c., p. 90, THE MORPHIA HABIT. 
28g 
quantity of morphia, say ]/2 gr. repeated, within a 
few minutes, if the pulse and general condition do 
not improve. He remarks that the morphia given 
for this purpose does not prolong the time of the 
severe symptoms of abstinence. In addition to this, 
other means are to be used. “ At the same time 
the patient is to be kept awake by counter-irritation, 
smelling-salts, cold compression on the head, drop- 
ping ether on the skull, by talking loud to him and 
shaking him; and such stimulants as liquor am- 
moniae, champagne, port-wine, brandy, hot coffee or 
tea with rum, are to be given internally.” 
The same author graphically describes the symp- 
toms of total abstinence from morphia, as follows: 
“ Only a few hours have passed since using the last 
injection of morphia, and already the feeling of com- 
fort brought on by the action of the drug is passing 
off. The patient is overcome by a feeling of un- 
easiness and listlessness; the feeling of self-con- 
sciousness and self-possession is gone, and is re- 
placed by extreme despondency; a slight cough 
gradually brings on dyspnoea, which is increased by 
want of sleep and by hallucinations. The vaso-mo- 
tor system shows its weakness by abundant perspi- 
ration, by the dark color of the face, which replaces 
the pale condition apparent during the first few days. 
Flow of blood to the head and palpitation of the 290 
HYPODERMIC INJECTION OF MORPHIA. 
heart, with a hard pulse, soon show themselves. The 
latter symptom often disappears suddenly, and is re- 
placed by a slow, regular, thread-like pulse, which is 
the sign of the beginning of a severe collapse. The 
reflex irritability increases; the patients begin to 
sneeze, and have paroxysms of yawning; they start 
if any one approaches them; touching their skin 
causes cramping movements or convulsions; the 
trembling of the hands, if not already evident, now 
becomes distinctly perceptible. The power of 
speech is disordered ; lisping and stammering take 
place. Diplopia and disorders of the power of ac- 
commodation, frequently accompanied by increased 
secretion of the lachrymal glands, show themselves. 
The patients are overcome by a feeling of weakness 
and total want of energy, and are thus compelled to 
lie in bed. Neuralgic affections of various parts of 
the body, pain in the front and back of the head, 
cardialgia, abnormal sensations in the legs, associ- 
ated with salivation, coryza, nausea, vomiting, and 
diarrhoea, tend to bring them into a desperate condi- 
tion. Some persons will bear up with fortitude 
under all these trials; they will quietly remain in 
bed and endure the unavoidable suffering, hardly 
uttering a complaint. Of the others, although the 
great minority of them sleep and doze during this 
trying time, some can find rest nowhere; they THE MORPHIA HABIT. 
291 
jump out of bed, run about the room in a state of 
fear, crying and shrieking; gradually they become 
calmer, although occasionally their excitement in- 
creases. A state of frenzy, brought on by hallucin- 
ations and illusions of all the senses, at last causes a 
morbid condition to which I have given the name of 
delirium-tremens, resulting from morbid craving for 
morphia, it being similar to that caused by alcohol. 
Some of- the patients, however, will be found walk- 
ing about in deep despair, hoping to find an oppor- 
tunity of freeing themselves from their wretched 
condition.” Many cases illustrating the different 
phases of this state are then given by this author. 
Here is further evidence in favor of the plan of 
treatment by sudden deprivation of the drug:— 
“Dr. Osgood [Quart. Jour. Inebriety, June, 1879) 
has, in a hospital, during the past two years, 
treated 800 cases of opium inebriety. His plan, 
in general, is: (1) The absolute and total discon- 
tinuance of the use of opium from the begin- 
ning of treatment. (2) A trusty attendant to be 
with the patient day and night for the first three 
days. (3) Chloral hydrate for the first three nights 
if required. (4) Good food, milk, raw eggs, brandy 
(in some cases), chicken broth. (The above to be 
taken in small quantities). (5) In diarrhoea, give 
two-drachm doses of a mixture of equal parts of 292 
HYPODERMIC INJECTION OF MORPHIA. 
tincture catechu and tincture of ginger. (6) Vomit- 
ing will frequently yield to bismuth in fifteen-grain 
doses; and in some cases a single dose of calomel 
has acted like a charm. Ice is of advantage in some 
cases. (7) Throughout- the entire treatment it 
should be remembered that the patient is below par, 
and requires tonics. Quinine and tincture of iron 
have a prominent place in our list. (8) The patient 
should expect to suffer more or less for the first 
three days, and should make himself a prisoner for 
that time. By the fourth day there is usually 
marked improvement. (9) Usually by the sixth 
day all desire for opium is gone. The patient then 
requires a change of air and surroundings, and 
tonics for a few weeks. Out of one hundred cases 
thus treated there was but one death, and that 
from apoplexy.” 1 
Dr. Bartholow2 recommends gradual diminution 
of the morphia and gradual increase of atropia in the 
solution used, at the same time paying marked atten- 
tion to the condition of the general system, using 
general and special tonics, good food, nutritive 
enemata when necessary, compelling exercise, and 
procuring sleep when absent or disturbed, by means 
of appropriate measures. 
1 (Detroit Lancet) Canada Lancet, Dec. I, 1877. 
2 Op. cit., p. 102, et. seq. THE MORPHIA HABIT. 
293 
Dr. J. B. Mattison,1 of Brooklyn, who has done 
some excellent work in this special field, quotes Dr. 
Parrish 2 as a firm believer in the plan of cure by 
gradual diminution, and gives the following amongst 
other deductions: 
“ ‘ To relieve the symptoms it is desirable to avoid 
the shock, as it is desirable to avoid it in surgical 
operations. 
“ ‘ For this purpose, the practitioner should immedi- 
ately reduce the accustomed supply to the minimum 
dose, which will meet this condition. 
“ ‘ When the minimum is reached, the suffering of 
the patient begins, and then the practice should be 
to give tone to the nervous system, as the opium 
stimulus is withdrawn. The reduction should be in 
minute quantities and the tonic doses full and persis- 
tent. 
“‘The moral sentiment, the confidence and cour- 
age of the patient, should at all times be kept up to 
the attainable degree. 
Such a course will almost always secure the de- 
sired result.’ 
“The above we believe to be the plan of treatment 
best adapted to a large majority of cases. True, we 
cannot support it from personal experience, by refer- 
1 Southern Med. Record, Dec., 1874. 
2 Med. and Surg. Reporter, Nov. 15 and 22, 1873. 294 
HYPODERMIC INJECTION OF MORPHIA. 
ence to a single case so managed ; but it appeals 
itself (in our judgment) most strongjy to ‘ common 
sense,’' which is better than any theory, and, besides, 
has the indorsement of those whose successful experi- 
ence entitles them to the very highest respect and 
belief. 
“From a superficial view, a plan of treatment di- 
rectly the reverse of what we advocate answered a 
perfect purpose in the case under consideration, and, 
seemingly, our practice was rather inconsistent with 
our precept. Granted; but there werh some unusual 
circumstances in this instance, which, fully explained, 
will make it far from inexplicable why we succeeded 
so well, notwithstanding a complete and immediate 
withdrawal of the accustomed stimulus.” 
The plan which Dr. Mattison is now pursuing 
seems to possess all the advantages of the several 
plans heretofore in use, and but few of their disad- 
vantages. The patients being under his immediate 
supervision, he puts them at once upon full doses ot 
the bromides, sixty grains three times a day, and 
rapidly increases the amount of these as he 
lessens the amount of morphia, timing it so 
that when reflex irritability from deprivation of mor 
phia is present in maximum intensity, the bromides 
are being given in doses sufficiently large to control 
it. With this he also uses other means, as tonics, THE MORPHIA HABIT. 
295 
baths, &c. The doctor’s views may be found ex- 
pressed in his own excellent manner in the Qiiarterly 
Journal of hiebriety. 
Dr. S. F. McFarland,1 of Oxford, N. Y., believes 
that these cases are best relieved by “ large reduc- 
tions at rather long intervals, allowing time for the 
system to rally between each, and the patient to re- 
tain his self-control.” 
In connection with the possibility of entirely sub- 
stituting water for morphia when there is danger of 
the habit being formed, the following cases, which Dr. 
R. J. Kinkead, Prof, of Obstet. Med., Queens College, 
Galway, sends me, are of interest: “ Fearing that the 
habit might be contracted by a patient to whom I 
had constantly to administer morphia hypodermi- 
cally, I determined to substitute water in its place— 
I had never heard of this being done at the time—and 
I was greatly surprised to find that, whereas, when the 
morphia was injected, I had time to wash out the 
syringe and put it up in the case and bid my patient 
good night, when the water was injected, she 
fell asleep almost immediately. It never failed to 
have this effect, and it did not cause a sensation of 
cutaneous irritation, which usually followed next day 
when the morphia had been injected. 
“ But more marked than all was the effect produced 
1 “ Trans. N. Y. State Med. Society,” 1877. 296 
HYPODERMIC INJECTION OF MORPHIA. 
on another case. Having to accompany a patient on 
a long railway journey, and finding that the jolting of 
the train occasioned great agony, I injected grain 
of morphia. In a short time it produced its effect, but 
all through the stupor, the motion of the train was 
felt, and occasionally the patient would spring up into 
a sitting posture. The eyes would open, pupils enor- 
mously dilating, consciousness would return, pupils 
contract, and, with a groan of pain, the patient would 
sink down to doze off and go through the same per- 
formance again in a short time. In about 2 hours this 
effect of the morphia wore off, and pain being severe, 
I was entreated to give another injection. This 
time I injected water. The patient immediately fell 
into a sound sleep. Slept without disturbance for the 
remainder of the journey, did not perfectly wake up 
when moved from train to a carriage, and slept 
quietly in it whilst being driven to the house. On 
other occasions, I have found the same effect follow.” 
Dr. E. L. Betterly, of Wilkesbarre, writes me that he 
has succeeded in deceiving his patient in like manner. 
There are advertising charlatans in various parts of 
the country who pretend to break up this habit in 
from 8 to 20 days by means of the hypodermic use 
of a perfect substitute for morphia. Some of these 
solutions have been analyzed and found to contain 
morphia—some morphia and atropia. THE MORPHIA HABIT. 
297 
Dr. W. C. Blalock 1 recommends hydrocyanic acid 
as an efficient substitute for opium and morphia, in 
the treatment of the opium habit. He has found 
“ no patient who could not quit morphia while under 
the influence of the acid.” It acts pleasantly, with- 
out depressing after-effects. His formula reads : 
Ijf Acidi hydrocyanici dil gtt. xlviij; 
Syrup. Simp ; 
Aquae §j. 
M. Sig: a teaspoonful at 7 a. m., 12 m.? and 8 p. m. 
Dr. William F. Hutchinson relates the following 
interesting case2 of cure by electricity : “ About the 
first of January of the present year, I was requested 
by Dr. O. C. Wiggin, of this city, to see with him 
a lady supposed to be suffering with cerebral con- 
gestion in an advanced stage. 
A visit to Mrs. S. revealed the following history: 
“Age 39; married; one child, aged six; and has had 
one miscarriage. Weight, about 150 pounds; and 
general appearance of contour and skin good. Pa- 
tient kept up a low moaning, answering most of 
my questions intelligently, then relapsing into a 
semi-unconscious condition. Pulse 100, compress- 
ible. Temperature 990; no loss of control of evacu- 
ations ; conjunctivae congested and pupils contracted 
1 {Atlantic Med. Journal) Physicians' Monitor, 1878, vol. 4, No. 8. 
2 (iV. K Record,) Southern Med. Record, Sept, 20, 1879. 298 
HYPODERMIC INJECTION OF MORPHIA. 
closely; perspiration starts upon the smallest exer- 
tion, which also causes pain in abdomen and excites 
vomiting, which has lately become persistent, ac- 
companied with intense thirst. Hands and feet cold, 
with shrivelled palms and plantar surfaces. No dif- 
ference in temperature of head and axilla. 
“ Ophtalmoscopic examination gave retinal and 
/\ 
choroidal congestion, with venous enlargement, slight 
optic neuritis, and choked disk. 
“There was constant pain, and sense of fullness 
in frontal region. 
“ The only family history that could be obtained 
bearing upon the case was the death of one sister, a 
year ago, from acute brain inflammation, the re- 
mainder of the immediate family being still living 
and in good health ; and the present condition ap- 
peared to be the culmination of six years of almost 
constant pain and general nerve exhaustion, follow- 
ing the birth of the child, aggravated by a subse- 
quent miscarriage. 
“ At this visit no suspicion was entertained by me 
of any opium habit, and the case was diagnosed as 
passive cerebral congestion, dependent upon general 
neurasthenia. 
“ The next day Dr. Wiggin called and gave me 
the following additional items, which at once placed 
the case in its proper light and gave the key to THE MORPHIA HABIT. 
299 
many of the symptoms before cited. After her 
confinement, which was a long and painful one, she 
suffered severly from wandering pains in back and 
hips, for which her attending physician at the time 
ordered tincture of opium applied externally, giving 
at the same time ten drops by the mouth, and the 
ground was broken for the building of the habit. 
The dose steadily increased until she came under the 
charge of Dr. Wiggin, some six months previous to 
my seeing her, when she was taking four ounces of 
laudnanum daily, internally, besides continuing ex- 
ternal applications as before. Attempts were made 
to stop the pernicious habit, but it was too late for 
wise counsel to avail, and the usual cunning of 
opium-eaters procured for her the drug in spite of 
every effort of both husband and physician. 
“All forms of concurrent medication had been 
faithfully tried, but nothing was of use except the 
opium, to which it became absolutely necessary to 
resort occassionally, as, without it, the poor lady 
would arouse the neighborhood with agonizing 
screams and cries. 
“At this juncture, as a forlorn hope, it was de- 
cided to essay galvanism, hoping that its great vital- 
izing power might aid in restoring tone to the 
exhausted nerve-centres. At my suggestion, Collis 
Brown’s chlorodyne was given in place of laudanum, 300 
HYPODERMIC INJECTION OF MORPHIA. 
and produced the same effect with an ounce per 
diem that the four ounces of the former had done. 
“ Central galvanism was applied with a twenty- 
four cell Bartlett battery, using six cells from the 
cilio spinal centre to the forehead with a downward 
current; then from the cervical vertebrae to the 
solar plexus with an ascending current, each lasting 
six minutes, or until the skin was thoroughly red- 
dened under the negative carbon point. For the 
first few days applications were made morning and 
night. In a week the vomiting had ceased and con- 
sciousness returned, and the evening sitting was 
omitted. After a month the dose of anodyne was 
gradually decreased, but with every diminution the 
nausea returned, and nothing but a return to the old 
dose would avail. But her condition was very 
much improved. She slept better, the eyes were 
normal as to color, and the palms were no longer 
dry. At the close of the second month she was 
able to sit up, and the dose of anodyne was steadily 
cut down without the patient’s knowledge, by adding 
to the chlorodyne a sufficient quantity of flavored 
treacle to replace each dose taken, until at that time 
an ounce would last three days. 
“ Her general Condition was greatly improved, 
and she began to take interest in her surroundings. 
In two months more she commenced to go out, and THE MORPHIA HABIT. 
3°i 
came to my office for treatment when I changed the 
current to the Siemens and Halske cabinet cell, 
which, with its low tension and perfect capability of 
control, I regard as the ideal battery for central 
galvanism. There was no further trouble, and to- 
day, June 21st, the lady is quite well, attending to 
all her household duties, not having tasted opium in 
any form for seven weeks, and expressing un- 
bounded delight at being free from the terrible habit 
which had so long been her master. 
“ The ratio?iale of the action of galvanism in this 
case is difficult to understand. When the circuit 
was closed over the superior cervical sympathetic 
ganglion, Dr. Wiggin and myself distinctly observed 
a sudden wavelike contraction of the distended ret- 
inal veins, which resumed their size in a few mo- 
ments after the stimulus was removed. But, after 
some weeks’ treatment, these veins became normal, 
and the intraocular congestion had disappeared pari 
passu with the cerebral symptom, and having re- 
peatedly witnessed the same phenomenon in other 
cases, I am led to believe that the galvanic current 
has a direct tonic influence upon the vaso-motor 
system, which accounts for the occasional surprising 
results obtained in cases of cerebral congestion. 
With the advent of increased nerve circulation, came 
an absolute horror for the drug, and it is not easy to 302 
HYPODERMIC INJECTION OF MORPHIA. 
know to what to attribute the increase of strength 
of will up to the point of totally dispensing with it 
of her own accord, unless it be to some change in 
mental power, due to increased nerve tone, the 
direct result of what I have before termed the vital- 
izing power of the galvanic current. Faradism was 
not at any time employed. 
“ Dr. Wiggin gives full credit to the special treat- 
ment for the cure of the case.” 
The most important point for the physician to keep 
in mind is that, in the majority of cases, formation of 
the habit from the use of the hypodermic syringe is 
his own fault. When care and discretion are exer- 
cised the rule will be for the patient to recover with- 
out any desire to continue the use of the drug. To 
attain this end the following precautions are neces- 
sary. 
i. The drug in any form or in any manner should 
never be used in cases where the patients are of de- 
cidedly nervous temperament or when they are in a 
condition of neurasthenia, so long as some other drug 
can be found to accomplish the same end, even though 
relief be a little less rapid. 
2. In any case the drug should be used only in 
quantity just sufficient to obtain relief. It is surpris- 
ing in how many cases decided relief from pain will 
result from the subcutaneous injection of morphia in THE MORPHIA HABIT. 
303 
very small doses (o to yi gr.), especially if the 
puncture be made deep into the muscular structure 
of the part. 
3. The earliest opportunity for decreasing the 
amount of the drug should be carefully watched for 
and the necessary gradual decrease in the strength of 
the solution be made. 
4. Where morphia is to be used for any length of 
time, atropia should be combined with each dose of 
it, in small amount (from 9*0 to gr.), as Bartho- 
low is of the opinion that the danger of contracting 
the habit is thus lessened. 
5. The patient should be kept in utter ignorance of 
what the solution contains, and of its strength. Un- 
der 710 co7iditions whatever should the patient, his 
friends or attenda7its he instructed in the use of the 
syringe. 
If these rules are followed, the matter will be en- 
tirely in the hands of the physician, and the number 
of the slaves to this habit will be materially dimin- 
ished, for in the majority of cases there will be no 
desire to have the injections continued. 
Some patients, tasting the sweets of full doses of 
morphia, will undoubtedly keep the matter in mind, 
however careful the physician may be, and, unbe- 
known to her most intimate friends, procure a syringe 
and use it, as is instanced by the following from Dr. 304 
HYPODERMIC INJECTION OF MORPHIA. 
William Edward Vermilye, of Pittsfield, Mass.: 
uYes; have heard of several, and have had one in- 
stance in my own practice. Three years ago I at- 
tended a lady with acute rheumatism and gave her 
several gr.) injections at bed-time. Unknown to 
her husband or to any one else she procured a 
syringe, morphia in grain powders, and is now a 
confirmed opium-user.” 
The cases reported by Dr. Samuel Logan and 
many others, and those that I give here, evidence the 
fact that so long as the instrument is in the hands 
of the physician, the amount, even though large, may 
be gradually lessened, and the patient be brought to a 
favorable close of the illness with no morphia desire 
remaining. 
Dr. J. Northrop Smith, of Hickory Grove, Ga., 
writes me as follows in answer to my sixth question: 
“ I know of but one case, and that of only two years’ 
standing. He was so completely under the influence 
of the morphia that I have known him to take 6 or 8 
grains every twenty-four hours. He has been under 
my treatment now for some time, and I have gradu- 
ally reduced the quantity to I grain in the twenty- 
four hours.” 
Dr. William Judkins, of Cincinnati, gives me the 
brief notes of a somewhat similar case : 
“ The patient was a confirmed opium-eater. When THE MORPHIA HABIT. 
3°5 
she first came under treatment, gr. I had no more 
effect than half that dose; so the syringe was full 
of water, she was satisfied. Gradually reduced 
amount without her knowledge, giving internally 
tonics, &c. Marked improvement took place, and 
after three months’ treatment, the last of which water 
alone was used hypodermically, discharged her 
cured. 
Prof. William A. Hammond, who, by the way, has 
never known of a case of morphia habit contracted 
from the use of the syringe, writes me of a case of 
chronic spasm of the sterno-mastoid muscle, where 
he “ carried the quantity of morphia up to twelve 
grains, with the result of curing the disease.” There 
seems to have been no difficulty in reducing the 
amount and finally discontinuing its use. CHAPTER X. 
THE SUBCUTANEOUS INJECTION OF MORPHIA — 
CONCLUSIONS. 
A STUDY of the opinions and cases that I have 
collected and presented in the preceding chapters, 
furnishes abundant food for thought; the more so, as 
nearly every physician in the world is using a hypo- 
dermic syringe with more or less frequency. Many 
are unquestionably using this instrument too often ; 
are using it in cases where the same, or other reme- 
dies, by the mouth, would be equally efficacious, and 
certainly safer. Far be it from me to condemn the 
use of an instrument the employment of which has 
brought both temporary and permanent relief, some- 
times cure, to thousands suffering the most intense 
agony. Its value in cases especially suited to it cannot 
be over-estimated ; its use in cases unsuited to it, or 
where other means would answer as well, cannot be 
too strongly and heartily condemned. Death, syn- 
cope, alarming narcotism and, perhaps more impor- 
tant than all, that living death—the morphia habit CONCLUSIONS. 
307 
—bids us choose our cases well, and continue its use 
for only so long a time as is absolutely necessary. 
It would seem from a study of the cases related un- 
der the latter head, and from many of the interesting 
letters for which I cannot find space, and therefore 
give at second-hand, that so long as the drug is used 
carefully, and with discrimination, by the physician, 
the morphia habit is little apt to result, and that it 
may be broken off when once formed, although the 
amount of morphia used is large. But nevertheless, 
even when these results are attained, persons, es- 
pecially those of the neurasthenic type, will often 
procure a hypodermic syringe surreptitiously and 
continue, commence or re-commence the practice 
anew. For this the physician is certainly not to 
blame, but the fact still stands, and the question 
arises whether relief by other means, though less 
prompt and less permanent, would not have been 
preferable to the deplorable mental, moral and physi- 
cal condition that almost uniformly obtains when the 
habit is once established. 
When Wood first gave his idea to the world, and 
when that idea was practically developed and ex- 
tended in point of applicability by Hunter and 
others, it was thought to be glory enough to have 
found a weapon sufficiently powerful to cope with 
severe and obstinate neuralgia and diseases that 308 
HYPODERMIC INJECTION OF MORPHIA. 
would not yield to other treatment. To-day, as 
seen from its journal literature, the subcutaneous 
method of giving morphine has become almost uni- 
versal, and it is employed for complaints of the most 
trivial character. Aside from the immediate and 
remote danger of thus needlessly extending this 
practice, there itf another reason why this instrument 
should not be so commonly employed—there is apt 
to be slurring of diagnosis and a blind treatment of 
the most prominent symptom. This is especially 
the case with the younger members of the profession. 
Having relieved the pain, they fail to study the minor 
symptoms, to look at patient’s family and personal 
history, to be observing of skin and tongue and 
pulse. It may be urged that the patient often re- 
covers without any other treatment. True! But 
many do not, and the lack of study of every point 
in the successful cases bears its fruit of slovenly 
diagnosis and unscientific treatment in many suc- 
ceeding cases. 
I have not thought proper to devote space, in the 
present edition of this work, to a special discussion 
of the affections in which the hypodermic injection 
of morphia has proved especially advantageous. 
I shall simply content myself at present with giv- 
ing a list of these diseases, some of which have been 
spoken of in the preceding chapters, and with the CONCLUSIONS. 
3° 9 
statement that the most marked curative effects have 
followed, especially in epilepsy, idiopathic tetanus 
and neuralgia. These diseases are : 
Anemia, Cerebral. 
Angina Pectoris. 
Asthma. [The morphia cigarettes of Reginald Thompson are better. ] 
Blepharospasm. 
Bronchitis. [With hacking cough and with excessive secretion.] 
Cholera. [Dr. T. Y. Johnston, of Sarnia, Ontario, Canada, relates 
the following: “i grain by actual weight in 3ss. tepid H20—in 
collapse of ‘ Canadian cholera ’ constant vomiting—involuntary 
discharges every io minutes—extreme case—caused by drinking 
impure water in haying-field, in large quantity—hot day—hap- 
piest results.”] 
Cholera Morbus. [Many of my correspondents testify to its very 
rapid and powerful curative action in this affection.] 
Cholera Infantum. [In minute doses.] 
Carcinoma. 
Cystitis. [Morphia by suppository is preferable.] 
Continued Fevers. [Small stimulant doses, and with small doses 
of antimony to control delirium. ] 
Convulsions, Hysterical. [Lauded highly also by some in in- 
fantile convulsions, when given in small doses. ] 
Cardiac Diseases. [Small stimulant doses; also for the trouble- 
some cough of attendant bronchitis. ] 
Chorea. [Rarely curative. Produces much-needed sleep and mod- 
difies severity of symptoms. One case of cure reported from in- 
jections of j*o gr. morphia and Ji2 zinci sulph. ] 
Delirium-Tremens. (Vigilans.) [A dangerous remedy.] 
Dyspnoea. [Of great service oftentimes, whether the affection is due 
to mechanical or other causes. ] 
Dislocations. [Often removes pain and relaxes muscles, thus allow- 
ing easy replacement. ] 
Diabetes. [Sometimes, though rarely, curative.] 
Dyspepsia, Nervous. [Often a marked benefit, but should be used 
with the greatest care lest morphia habit be formed. ] 
Diarrhoea. [Other means quite as effective and less dangerous.] 
Emphysema. 
Epilepsy. [Often curative. Best in non-traumatic and minor cases. 3IQ 
HYPODERMIC INJECTION OF MORPHIA. 
Dr. J.A.Gamage reports the following, Feb. 28, 1873: “Mrs. H. 
2371 Tulip St. Age 66 years. Widow for 24 years. Blonde. 
Above the average height} weight 136 lbs.; always enjoyed 
good health with exception of the frequent epileptic attacks. 
Catamenia regular and normal; no dysmenorrhoea or uterine 
trouble. One child, female, aged 30 years. Troubled since 
1853; first attack occurring without any apparent cause; al- 
ways suddenly, with but one manifestation of its approach—i.e., 
copious and frequent micturition, occurring shortly before an 
attack. No giddiness, deafness, dimness of sight, sounds 
in the ears, sparks of light before the eyes; but marked dis- 
tention of the veins of the head and neck, trembling of the 
extremities, wandering, confused state of the mind, with 
entire loss of the power of distinct articulation, occur im- 
mediately before the epileptic attack. 
‘ ‘The most severe seizures are preceded by painful sensations, 
particularly spasmodic pains in the stomach. The convulsive 
action of the muscles was not confined to any particular part, 
but more active about the face. Always of the clonic kind; the 
thumbs always firmly pressed in upon the palms of the hands. 
The face always livid, with a turgid state of the veins of the 
head and neck; respiration laborious and always sonorous, 
varying with the severity of the attack. 
“ These spasmodic symptoms always abate abruptly. 
“ In no attack has either urine or faeces passed otf involun- 
tarily. 
“The shortest duration of the paroxysms, twenty minutes; 
the longest, nine hours. 
“ Never more than one paroxysm has occured at onetime 
or on the same day; but occur regularly—monthly in winter, 
semi-monthly in summer. 
“ The mental powers have gradually been failing, till (at this 
time, almost total imbecility now exists. 
“ I am indebted to her daughter for the greater part of this 
history of her mother’s case; also, the fact that she has been 
under medical treatment for years, here and there, hospitals, 
dispensaries, and private physicians, regular and others, em- 
bracing all pathies. 
“Concluded (as an experiment) to attempt the prevention of 
future occurrences, by administering hypodermically £ gr. mor- 
phia sulph. thrice daily for one month; daily for three months; CONCLUSIONS. 
311 
thrice weekly for three months ; weekly for one year, and semi- 
monthly for one year—then discontinued treatment. During 
this time no other medicine was given for the malady under 
consideration, and no attack has ever occurred from that day to 
this time of writing.” 
Dr. Charles Bain, of Murphysborough, 111., another, as fol- 
lows : “ The case in which I used such a large dose of morphia 
and atropia was one of epilepsy, which had resisted all treat- 
ment for seven years. At the time that I began the treatment 
of the case the spasms had become so severe that they had 
paralyzed one side of the patient, and the interval between 
the spasms was only five minutes, and the patient had not been 
able to eat or drink for forty-eight hours. I began the treatment 
by using one grain of morphia and one-fiftieth of a grain of 
atropia every 6 hours, and in five days the spasms had ceased 
entirely. Now, for the first time in the history of the case, neu- 
ralgic pains set up, of the severest grade, all over her system. 
I had then to increase the atropia and use the syringe three 
times a day to keep the patient quiet, and finally I had to in- 
crease the atropia to one-sixteenth*of a grain, and use it only 
twice a day. I used the above dose of morphia and atropia 
twice a day for some two months, and the pains began to sub- 
side, and I would only use it at night or bed-time, to give rest 
for the night. I used it at night only for some thirty or forty 
days, and then only every other night, as the pains kept gradu- 
ally giving away and finally not more than one time in a week. 
I treated the case from first to last, about six months, with the 
hypodermic syringe and nothing else. At the end of this time 
all pains ceased. It has been now three years since the patient 
has had any symptoms of epilepsy or any pain.”] 
Gastric Catarrh. 
Gastric Ulcer. 
Hepatic Colic (Gall-stones). 
Hepatic Cancer. 
Hepatic Abscess. 
Insomnia. [Often succeeds where opium or morphia by the mouth 
fail. ] 
Incontinence of Urine. 
Itching (pruritus Vulvse). 
Laryngismus Stridulus. [Bartholow.—But a minute quantity of 
morphia to be used.] 312 
HYPODERMIC INJECTION OF MORPHIA. 
Lead Colic. 
Lumbago. [Inject directly into the muscle; gr. a sufficient 
amount. ] 
Malaria and Malarial Neuroses. [Spoken of in the highest 
terms by some of my correspondents.] 
Mania and Insanity. 
Meningitis, Cerebro-Spinal. 
Muscular Spasm. [See Hammond’s case, p. 305.] 
Neuralgia. [Pver one half the slaves to the habit contracted it in 
being treated for this disease. Under no circumstances let the 
patient buy or use the syringe himself. ] 
Nymphomania. 
Ovarian Neuralgia. 
Pleuritis. 
Pneumonitis. [See pp. 91, 92.] 
Pericarditis. 
Peritonitis. 
Polyuria. [Other remedies act quite as well.] 
Renal Colic. [Often the only manner in which morphia can be 
given with relief to life intense pain. The injection should be 
made directly into the lumbar muscles. ] 
Rheumatism. 
Shock. [ In small stimulant doses, frequently repeated. ] 
Spinal Irritation. 
Sprains. 
Tetanus. [Acts better in idiopathic than in traumatic form.] 
Uraemia. 
Vaginismus. [Rectal or vaginal suppositories better.] 
Vomiting of Pregnancy. [Often of great service. ] 
As already shown (in Chapter I), morphia, when 
given hypodermically, acts differently, in some re- 
spects, from morphia when given by the mouth. 
These differences are not so important, however, as 
to warrant us in the indiscriminate use of the drug in 
this manner. It is only fitted for cases where it is 
desired to obtain: CONCLUSIONS. 
313 
(a.) Rapidity of action. 
(b.) Increased force of action. 
(c.) Direct benefit from localization. 
(d.) A minimum effect on the functions of the 
alimentary canal. 
These four propositions really cover the whole field 
of the usefulness of morphia in certain diseases, and 
explain the difference in action. The action of a 
drug when given by any way other than the stomach 
is no way different save in rapidity of action, increase 
of force, absence of local action on the stomach and 
presence of local action on the absorbing surface. 
Such difference is, of course, very important in cer- 
tain diseases, and as such is worthy of careful con- 
sideration, but the attempt, made by some, to ascribe 
the curative effects of the drug thus given to a mys- 
terious something, in no way explanable, is foolish. 
Difference of effect from varying degrees of force is 
aptly illustrated by the difference between an easy 
blow upon a “ rice-grain tumor ” of the wrist joint, 
and a forcible blow—the one makes little or no 
impression, the other ruptures the sack and cures the 
disease—of difference in rapidity, by the example of 
the hot air bath given at pp. 24, 25. 
The same knowledge that leads us to a proper un- 
derstanding of the therapeutic action of the drug 
thus given, also points out very forcibly the danger 3H 
HYPODERMIC INJECTION OF MORPHIA. 
of using it hypodermically in certain persons and in 
certain diseases. 
Those cases where death has been attributed to 
this method of exhibiting morphine furnish a very 
instructive chapter. In some instances the fatal re- 
sult was undoubtedly wrongly, although honestly at- 
tributed to this cause. So complex a piece of 
mechanism is this body of o’urs; so many diseases, so 
many taints and impressions, hereditary and acquired, 
are working in us from year to year; so much have 
our physical and social surroundings to do with the 
state of our health ; so many processes are going on 
within us, of which we have but the faintest inkling 
of their how or why, that it becomes us ill to say 
positively, especially in the absence of a knowledge 
of all the facts in the case, and frequently without the 
light shed by an autopsy, that death was due to this 
or that cause alone. The same facts admonish us 
that routine practice and favorite prescriptions are a 
snare and a delusion ; that we need more exact knowl- 
edge and less taking things for granted ; that patients 
must be treated individually and not as a class, and 
that shouldering a disease with a name and then 
smothering its outcry—pain—under a heavy dose of 
morphine, is not the chief aim and end of all medi- 
cine, and is but superficial and unscientific practice. 
The patient’s physical and mental peculiarities must CONCLUSIONS. 
3*5 
oftentimes be understood, or a cure, unless by a happy 
accident, is not possible. 
I do not forget that in many cases diseased action 
may be set up and continued by the pain of some 
other diseased action, or the disease itself be aggre- 
vated by the continuance of this its most apparent 
and most distressing symptom. In such cases mor- 
phia or its like are of great benefit, and should be 
given by the skin when they cannot be taken by the 
mouth or rectum, and not otherwise. In any case 
the patient should not know what he is taking, and 
the drug should only be continued as long as is ab- 
solutely necessary If necessary the drug should be 
called by some other name. 
Many of these cases of death, however, are as 
well established as it is possible to establish any- 
thing of this kind. Furthermore, it must be borne 
in mind that the cases thus recorded are but a per- 
centage, possibly a small one of the cases where 
death has actually occurred from the use of the drug 
in this way There is a natural delicacy about ex- 
posing one’s blunders to the world, especially blunders 
that have compromised the life or caused the death 
of a human being Crimes these will be considered, 
however much the physician may offer in their extenu- 
ation, and however great a part may have been 
played by the idiosyncrasy of the patient. The dose 316 
HYPODERMIC INJECTION OF MORPHIA. 
may have been small, the patient apparently in a pre- 
carious condition of health, and death occur. Think- 
ing men would not blame, yet moral cowardice on 
the part of the physician far outbalances the honor 
attaching to the sacrifice of personal feelings for the 
good of the profession or the public. 
In support of this, I may say that I know of cases 
other than those here reported, where death was at- 
tributed to the hypodermic use of morphia, and yet 
the physicians will not even allow the histories or the 
main facts of the cases to be used anonymously. 
Still, with this knowledge of the possibility of 
death from small doses, and the fact that death 
has occurred in many instances, it must be remem- 
bered that the practice yielding this number covers a 
very extensive ground both as regards time and 
the number of injections—forty years and fully 
thirty thousand injections, at the lowest estimate (the 
latter applying only to the practice of my 360 corre- 
spondents). If the practice, when legitimately 
pursued, can be made, by a little care and the study 
of idiosyncrasy, to yield few or no deaths and acci- 
dents, and but few cases of the morphine habit, such 
care and study will have been well repaid. Mean- 
time a physician, who from a neglect of these precau- 
tions loses the life of one or more of his patients, 
should be held responsible, provided it has been in CONCLUSIONS. 
3J7 
his power to acquaint himself with the facts in the 
case. 
Three very plain lessons are taught us, I think, by 
the cases here recorded : First, that the use of mor- 
phia in large doses by the mouth, and especially in 
small or large amounts by the skin, is a very hazar- 
dous proceeding in delirium-tremens and, possibly, 
in acute mania. Second, that the use of the drug in 
this way, if given at all, should be given with the 
greatest care in those diseases in which there is a 
tendency to death by the lungs, and where the blood 
is but poorly aerated. Third, that the hypodermic 
injection of morphia in chronic organic disease of 
the kidneys, especially that form known as “cir- 
rhosed” or “ granular contracting” kidney, may be 
followed by fatal results. 
At the same time, it must be remembered that in 
these very diseases morphia, in large doses to 3 
grains), has been repeatedly given by the hypoder- 
mic method and not only without producing fatal or 
serious but, on the contrary, very beneficial results. 
Robert Park, Med. Officer for 3d and 4th Districts 
of City Parish, Glasgow, Scotland, writes me of the 
following case: “ Mrs. Sarah Walker, prostitute, 
aged 36, admitted into Chatham Workhouse, Oct. 8, 
1869, under my care. Insane; suffering from gay 
delirium, and very violent. Usual narcotism ob- 3i8 
HYPODERMIC INJECTION OF MORPHIA. 
served after morphia given per orem, did not follow. 
Sleep not obtained for many hours, but delirium 
moderated and controlled. Seen on the day follow- 
ing the injection (one scruple having been given), by 
Dr. Hutchins, F. R. C. S., of Chatham. Solution 
used contained i gr. in 12 minims and 3 ii were 
injected. She was sent to Baring Lunatic Asylum, 
Kent.” 
Dr. Wm. M. Baird, of Washington, N. J., writes 
as follows: “15 minims at 9 A. M.; 30 minims at 
9.30 A. M.; 30 minims at 10 A. M.; and 3i at 10.30 
A. M., and failed to get effects then, and ceased. This 
was in a case of sleeplessness from excessive drink.” 
Others of my correspondents report like cases. Here 
grains was administered subcutaneously within 
a period of one hour and a half. Hardly a safe 
proceeding in the light of cases already recorded 
and the fact that Ware found that more persons died 
under the opiate than under any other treatment. 
There necessarily enters into this, as into every 
problem of like nature, the element of possible 
error, due in part to coincidence, in part to our 
inability to judge fully, from lack of knowledge or 
opportunity. For instance, Dr. B. may be firmly 
convinced that Mr. C. died from the effects of a 
hypodermic injection of morphia, given to him while 
he was suffering an attack of delirium-tremens. A11 CONCLUSIONS. 
319 
autopsy is not made, either from objections offered 
by the man’s friends or from carelessness, perhaps 
fear, on the part of the physician. Dr. B. will con- 
sequently always believe that death was due to the 
drug, when, possibly, if an autopsy had been held, 
sufficient cause might have been found to utterly 
refbte the idea. 
If ours was a profession the members of which 
were prone to vent petty spites and secretly cast 
discredit upon one another, Dr. B. might, perhaps, 
in the absence of a post-mortem examination, be still 
more firmly convinced of the truth of his opinion, if 
the death occurred in the practice of his rival, Dr. S. 
This, however, is merely a supposition, and a very 
unchristian-like one at that. 
Further observation and clinical experience may 
prove that I am in error on these points, but until 
such evidence is presented we have sufficient 
grounds for avoiding the use of the drug by this 
method, or using it with the utmost care and in 
minute doses; in these complaints. 
An important point, in treating any person with 
whose peculiarities we are not acquainted, is to ascer- 
tain whether any idiosyncrasy with reference to 
opium or morphia, exists, and to use a very small 
commencing dose, increasing it afterwards as the 
exigencies of the case may require. 320 
HYPODERMIC INJECTION OF MORPHIA. 
Many physicians are daily using quantities of mor- 
phine, at a single dose, that have been known to 
kill in some cases. Others are using amounts that 
are not only much larger than this, but extremely 
dangerous and, in my opinion, uncalled for save in 
very rare cases, much smaller doses accomplishing 
all that is to be desired. These gentlemen urge that 
they have been giving the drug in these amounts for 
years past and have had neither accident nor death. 
This is no proof that such doses are not dangerous. 
Many men can say the same with regard to chloroform; 
still no one doubts that death has been produced 
by that agent in cases when a fatal result was least 
expected and in the hands of gentlemen who had 
taken every precaution and were fully competent to 
administer it. 
Take the following extracts from a letter that I 
received from a prominent medical men in Scotland, 
as an example: “ Usual dose varies much, as e. g., 
from yi to i grain at first injection, and from to 3 
grams for subsequent injections. Physiological and 
therapeutical effects relied upon as guides. I never 
predetermine my dose now, but inject slowly a dose 
as nearly as possible proportionate to intensity and 
quantity of pain to be relieved ; or, otherwise, rela- 
tively to constitution or idiosyncrasy of individual.” 
Again he says: “ From 2 to 3 grains a very frequent CONCLUSIONS. 
321 
dose, and perhaps (roughly speaking) xyi grains 
might be set as an average in my practice.” Still 
this gentleman has never seen death or accident re- 
sult. He has been very fortunate. 
Every blessing of the extent that this method 
of administering morphine has been to suffering 
humanity must needs have its draw-backs, and con- 
sequently he who avails himself of its advantages 
should be prepared, at a moment’s notice, to combat 
its evil effects and successfully treat the accidents that 
may occur. 
I venture to say that many of the deaths here 
recorded would not have occured if the agents 
necessary to use and the knowledge of just how to 
use them had been in readiness. To this end every 
physician should carry with him, in the same case 
with the morphine (so that when he takes the one he 
is obliged to take the others) the proper drugs to use 
in case syncope or narcotism result. It has, I think, 
been demonstrated with sufficient fullness, that atropia 
alone should not be fully depended upon in combat- 
ing the narcotic effects of opium or morphine. 
By having these drugs, the names and amounts of 
which should be plainly printed upon each paper, in 
the form of powders, they can be carried in small 
compass—in the case containing the syringe. They 
are as follows: 322 
HYPODERMIC INJECTION OF MORPHIA. 
6 i gr. Atropine powders. 
3 gr. Strychnine powders. 
6 2 gr. Citrate of Caffeine powders. 
6 i gr. Carbonate of Ammonia powders. 
Or in solutions: 
Magendie's solution of Morphia — 3 ii. 
Solution Atropiae Sulph. (gr. y to 3 i) — 3 ii. (m. v. 
= A sr-) 
Solution Strychnia Sulph. (gr. y2 to 3 i) — 3 ii. (m. 
v. = 27 gr0 
Solution Caffeinae Citrat. (gr. xii to 3 i) — 3 ii. (m. v. 
= gr- i-) _ 
Aq. Ammonia (io per cent, gas) to be diluted with 
equal parts of water — 3 ii. vel. § ss. 
or, if preferred, the compound powders or solutions 
given at p. 209 may be used. 
Where the physician does not object to carrying a 
little larger case, the solutions may be carried in 1 ss. 
bottles, which will need refilling less frequently, and 
not necessitate the use of such concentrated solutions. 
Indeed, all the drugs used by the hypodermic method 
can be packed in a small compass. 
By this arrangement the physician has at hand the 
means for combating any dangers that may arise. 
This is of especial importance in country practice, 
where it is often several miles to the nearest drug- 
store. These remedies are needed at once; the bat- 
tery and oxygen can be sent for. Cold water for CONCLUSIONS. 
323 
douching purposes, and wet towels for flagellation are 
always to be had. 
The tourniquet (described at p. 136) for ligature of 
the limb in case of syncope, should be in the case or 
in the physician’s pocket. In its absence any strong 
piece of cord or linen will answer the purpose. I 
must again insist that it is never safe to give a hypo- 
dermic injection of morphine or of any other powerful 
drug without a cord or tourniquet hanging loosely 
on the limb, ready for immediate use, in case of 
necessity. It will, probably, not be necessary to 
tighten it in one out of a thousand injections, but that 
once may prove fatal if the appliance is not at hand. 
The method of injecting is a matter of no small 
importance, both as regards the frequency of inflam- 
mation and abscess and the liability to wound a vein, 
with the resulting unpleasant and sometimes danger- 
ous symptoms. Many of my correspondents favor 
the deep injection, while some few believe it improper. 
In this connection I give an extact from the letter of 
Dr. Stephen B. Hamlett, of Waco, Texas, it having 
reached me too late for insertion in its proper place: 
“ Morphia to have its full effect and to act 
promptly when injected under the skin, should be 
thoroughly dissolved, and the solution made warm be- 
fore using. 
“ I have frequently observed that when persons, es- 324 
HYPODERMIC INJECTION OF MORPHIA. 
pecially those unaccustomed to resorting to this 
means of relief, roughly punch the needle into the 
tissues, they not only cause great pain to the 
patient, but, by the imperfect manner in which the 
medicine is applied, they greatly modify the good 
that would otherwise result from its use. My opinion 
is that the medicine acts much more promptly when 
placed well into the subcutaneous cellular tissue, after 
having been prepared as above suggested, for I have 
frequently observed that when placed into the mus- 
cular tissue, as is often the case, its effects are quite 
slowly developed and altogether unsatisfactory. 
“Caution should at all times be observed in giving 
morphia in this manner, when it has been recently 
administered per orem without relief. For I have 
noticed, at times, the prompt relief apparently given 
to all the functions by the use of a hypodermic injec- 
tion of morphia, and have been led to believe that 
absorption even, under certain circumstances, may be 
materially aided. In this manner we are liable to get 
the cumulative effect of the drug, and narcotism re- 
sults. 
“ I would advise caution, also, in the use of any 
anodyne or anesthetic immediately before resorting 
to the hypodermic use of morphia.” 
Slowness of effect, in many cases, is to be desired, 
and if injection into muscle gives this result, then it CONCLUSIONS. 
325 
should be followed in all cases save those where a 
sudden and shock-like or very rapid action is required. 
Deep injections, are, I believe, worthy of a more ex- 
tended trial than they have thus far had. 
Prof. Wm. H. Draper, of this city, in conversation 
with the author a few days since, dwelt forcibly upon 
the relation existing between rough and careless in- 
jecting and the occurrence of inflammation and ab- 
scess. He never makes the puncture in the forearm, 
but selects the parts on the front of the arm, about 
the shoulder, and the abdomen, owing to the small 
number of veins and the abundance and depth of the 
cellular tissue, permitting free movement of the skin. 
His method is as follows: He pinches up a longitu- 
dinal fold of skin, and inclining the syringe at about 
an angle of 45°, enters the needle at a right angle to 
the long axis of the limb ; the danger of puncturing a 
vein being, therefore, at a minimum. The needle 
working freely in the subcutaneous cellular tissue, he 
injects slowly. Although having used the syringe for 
many years and in a large number of cases, he has 
never entered a vein or had an accident. In support 
of his views, he cited the case of a young lady, suf- 
fering intensely from spinal irritation, where he gave 
an injection twice or three times a day for over two 
years without the occurrence of a single abscess. As 
the case improved he gradually diminished the num- 326 
HYPODERMIC INJECTION OF MORPHIA. 
ber of injections, and finally ceased to give them. 
To-day, her skin does not bear a mark to show the 
place where the injections were made, and there is no 
thickening of the subcutaneous cellular tissue. 
The doctor is firmly of the opinion that had this 
young lady been allowed to use the syringe, she 
would have become a slave to the habit. He never 
permits a patient or his friends to use the instru- 
ment. 
I give here the following from Dr. A. G. Emory, 
of Opelika, Alabama, which was unfortunately over- 
looked. It belongs in the chapter on INJECTION 
INTO A VEIN : 
“ I remember three cases in which there were very 
distressing symptoms, chiefly nausea and vomiting, 
which continued for several hours ; in one case at least 
IO hours. The first time I had the trouble was in an 
unmarried lady of about 25 years and hysterical. 
Morphine was used to prevent, if possible, the return 
of certain nervous symptoms which came on every 
forenoon. The dose was small—exact amount not 
remembered—and was injected under skin of arm. 
I remember that the puncture bled, and my opinion 
is the needle entered a vein, for she complained al- 
most instantly of a dizziness and nausea, and very 
soon she began to perspire quite freely and was very 
restless and pale. I never repeated morphine in her CONCLUSIONS. 
327 
case. In one of the other two cases there is an 
idiosyncrasy, as opium in all methods of administra- 
tion produces nausea and vomiting.” 
Finally, let it be distinctly understood that I con- 
sider the hypodermic use of morphia a very decided 
therapeutic advance, and of incalculable benefit in 
allaying pain, and curing disease in cases where other 
modes of treatment utterly fail. In calling attention 
to the dangers sometimes attending the use of the 
drug in this way, I do it not from a one-sided view 
of the question, not with a desire to condemn it, 
simply to point out what may occur, endeavor to 
show how best to avoid it, and, if possible, restrict its 
use to those cases in which it is proper. NAMES OF THE.PHYSICIANS 
Who have kindly favored the author with their opinions 
upoti the hypodermic injection of morphia. 
Alexander, Dr. L. G., Hopkinsville, Ken. 
Alexander, Dr. J. A., Broadway, Va. 
Atkinson, Dr. A., Prof. Mat. Med. College Phys. and 
Surg., Baltimore, Md. 
Ady, Dr. A., West Liberty, Iowa. 
Armor, Dr. Samuel G., Prof. Theory and Prac. of Med., 
L. I. Coll. Hosp., Brooklyn, N. Y. 
Aberdien, Dr. R., Syracuse, N. Y. 
Adams, Dr. J. Chas., Lake City, Minn. 
Ayers, Dr. Benj., Brooklyn, N. Y. 
Arton, Dr. J. H., Hamilton, Bermuda. 
Abbott, Dr. S. W., Wakefield, Mass. 
Aylward, Ernest, L. R. C. P. E., &c., Barnoldswich, 
Leeds, Eng. 
Beane, Dr. F. D., New York, N. Y. 
Betterly, Dr. E. L., Wilkesbarre, Penn. 
Blake, Dr. Chas. E., San Francisco, Cal. 
Bartholow, Dr. Roberts, Prof. Mat. Med. and Thera., 
Jefferson Med. Coll., Philadelphia, Penn. 
Brome, Dr. J. W., Mottville, N. Y. 
Bayley, Dr. N. B., Brewsters, N. Y. 
Brown, Dr. C. W. M., Elmira, N. Y. 
Buckham, T. R., M. C. S. and Pa., Canada, Flint, Mich. 
Benson, J. Hawtrey, Dublin, Ireland. 
Brown, Dr. A. P., Jefferson, Texas. 
Barkitt, F. W., L. R. C. P. & S., Dublin, Ireland. 329 
Baker, Dr. H. H., Cleveland, O. 
Bergen, Dr. E. J., Trenton, N. J. 
Bliss, Dr. D. H., Kansas City, Mo. 
Brush, Dr. E. C., Dem. Anat., Starling Med. Coll., Col- 
umbus, O. 
Beard, Dr. Geo. M., New York, N. Y. 
Bell, Dr. A. W., Moodus, Conn. 
Barron, G. B., M. D., &c., Southport, Liverpool, Lan- 
cashire, Eng. 
Baldwin, Dr. J. F., Ed. of Ohio Med. Recorder, Columbus, 
Ohio. 
Biggs, Dr. M. S., London, Eng. 
Babcock, Dr. Jas. L., Albany, N. Y. 
Baker, Dr. F. J., Youngstown, N. Y. 
Baird, Dr. Jas. B., Sec. Med. Association Georgia, At- 
lanta, Ga. 
Butterfield, Dr. S. A., Indianapolis, Ind. 
Blanchard, Dr. Henry, Boston, Mass. 
Baird, Dr. Wm. M., Washington, N. J. 
Bain, Dr. Chas., Murphysboro, 111. 
Barker, Fordyce, M. D., L.L. D., Prof. Midwifery and 
Dis. Women, Bell. Hospital Med. College, New 
York, N. Y. 
Carpenter, Dr. A. M., Prof. Prin. and Prac. Medicine, 
College Phys. and Surg., Keokuk, Iowa. 
Coover, Dr. E. H., Harrisburg, Penn. 
Commons, Dr. Wm. W., Union City, Ind. 
Cooper, Dr. J. B., Coles Station, 111. 
Cleveland, Dr. J. L., Cincinnati, Ohio. 
Crofford, Dr. T. C., Coffeeville, Miss. 
Clopton, Dr. A. G., Scotsboro, Ala. 
Cady, Dr. N. W., Logansport, Ind. 
Cutter, Dr. J. C. (Harv.), Consulting Phys. to Kaitakushi 
(Colon. Dept.), Sappow, Hakkaido, Japan. 
Clark, Dr. W. R. S., Bluffton, Ind. 
Carson, Dr. A. W., Dover, Kan. 330 
Crawford, Dr. R. O., Lu Verne, Minn. 
Crewitt, Dr. J. A., Robertsdale, Pa. 
Chadwick, Dr. Alex., Heywood, near Manchester, Eng. 
Caldwell, Dr. S. W., Trenton, Tenn. 
Crawcour, Dr. N., New Orleans, La. 
Carroll, Dr. A. L., New Brighton, S. I. 
Clark, Dr. D. S., Rockford, 111. 
Congdon, Dr. C., Randalia, Iowa. 
Dillman, Dr. M. S., Yellow Springs, Ohio. 
Drake, Dr. E. W., Middleborough, Mass. 
Dawson, Dr. W. W., Prof. Prin. and Prac. of Surgery, in 
Med. Coll, of Ohio, Cincinnati, Ohio. 
Donaldson, Dr. James, London, Eng. 
Davis, Dr. J. C., Denver, Colorado. 
Dunlap, Dr. C. O., McArthur, Ohio. 
Dixon, Dr. J. N., Springfield, 111. 
Draper, Dr. Wm. H., Clin. Prof. Dis. of Skin, Coll. Phys. 
and Surg., New York. 
Donaldson, Dr. H. C., Morrison, 111. 
Dunlap, Dr. G. T., Danville, Ken. 
Dunlap, Dr. R..W., Danville, Ken. 
Daniels, Dr. H. H., Breedsville, Mich. 
Drake, Dr. C. H., White Haven, Penn. 
Detwiler, Dr. B. H., Williamsport, Penn. 
Davis, Dr. G. W., Chico, Cal. 
Davis, Dr. Thos. A., Verbena, Ala. 
Ewell, Dr. Jesse, Jr., Hickory Grove, Va. 
Easley, Dr. E. P., New Albany, Ind. 
Eads, Dr. B. F., Marshall, Texas. 
Etheridge, Dr. Jas. H., Prof. Mat. Med. and Med. Juris., 
Rush. Med. College, Chicago, 111. 
Entrikin, Dr. F. W., Findley, Ohio. 
Edmunds, Dr. W., London, Eng. 
Emory, Dr. A. G., Opelika, Ala. 33i 
Egerton, Dr. J. C., Hendersonville, N. C. 
Elder, Dr. Jennie S., Canastota, N. Y. 
Elmer, Dr. H. W., Brigeton, N. J. 
Elderdice, Dr. R. B., McKnightstown, Penn. 
Foote, Dr. Geo. A., Warrenton, N. C. 
Fowler, Dr. R., Elmo, Texas. 
Fowler, J., Surg. to Hosp. and General Dispensary, Wake- 
field, England. 
Fite, Dr. C. C., Pres. Board of Health, Shelbyville, Tenn. 
Fitch, Dr. Wm. H., Rockford, 111. 
Fowler, Dr. E. P., New York, N. Y. 
Fort, Dr. C. H., Tuskegee, Ala. 
Francis, Dr. Samuel W., Newport, R. 1. 
Florentine, Dr. F. B., Saginaw City, Mich. 
Gray, Dr. A. W., Chicago, 111. 
Graham, Dr. Arthur R., Holmwood, Weybridge, Eng. 
Groesbeck, Dr., Chicago, 111. 
Gunn, Dr. Jno. G.. Noxapater, Miss. 
Gamage, Dr. T. A., Philadelphia, Penn. 
Hammel, Dr. Madison, Circleville, Ohio. 
How, Dr. J. C., Haverhill, Mass. 
Harris, Wm. T., M. C. P. & S. Ont., Brantford, Ont. 
Hunt, Dr. C. H., Stanwood, Iowa. 
Henschel, Dr. E. K., New York, N. Y. 
Henderschott, Dr. L. W., Mill Shoals, 111. 
Hamlett, Dr. S. B., Waco, Texas. 
Harrington, Dr. H. L., Little York, 111. 
Haynes, Dr. W. H., New York, N. Y. 
Holly, Dr. F. M., Greenwich, Conn. 
Hines, Dr. W. Frank, Chestertown, Md. 
Hallenbeck, Dr. O. J., Canandaigua, N. Y. 
Hughson, Dr. Jno. S., Sumter, S. C. 
Hoover, Dr. C., McCombs City, Miss. 
Hendren, Dr. Geo. M. Nicholasville, Ky. 
Holt, Dr. Benj. L., Penn Yan, New York. 332 
Hachenberg, Dr. G. P., U. S. Exam. Surgeon, Austin, 
Texas. 
Henning, Dr. J. A., Red Key, Ind. 
Hauxhurst, Dr. D. C., Battle Creek, Mich. 
Hammond, Dr. Wm. A., Prof. Dis. of Mind and Nervous 
Sys., University Medical Coll. New York, N. Y. 
Holton, Dr. H. D., Brattleboro, Vt. 
Henna, Dr. J. J., New York, N. Y. 
Ingles, Dr. J. A., Morea, 111. 
Jones, Dr. Geo. E., Cincinnati, Ohio. 
Johnson, Dr. T. G., Sarnia, Ontario, Canada. 
Johnson, Dr. Horner, Oberlin, Ohio. 
Jewett, Dr. Chas. T., New York, N. Y. 
Jewett, Dr. Chas., Brooklyn, N. Y. 
Judkins, Dr. Wm., Cincinnati, Ohio. 
Jewell, Dr. J. S., Prof. Nervous and Mental Dis., Chicago 
Med. Coll., Chicago, 111. 
Kilpatrick, Dr. A. R., Navasota, Texas. 
Kinkead, Dr. R. J., Prof. Obstetrical Med., Queens Coll., 
Galway, Ireland. 
Kent, Dr. J. S., St. Louis, Mo. 
Knott, Dr. L. D., Bradfordsville, Ken. 
King, Dr. E. W., Galena, Ind. 
Kittson, E. Graves, L. R. C. P , Lond., Hamilton, On- 
tario, Canada. 
Liautard, A., M. D., V. S., New York, N. Y. 
Lee, Dr. Chas. C., New York, N. Y 
Logan, Dr. Samuel, Prof. Anat. and Clin. Surg., University 
of Louisiana, New Orleans, La. 
Lathrop, Dr. G. H., Wurtsborough, N. Y. 
Lamadrid, Dr. Julio J., Brooklyn, N. Y. 
Lyman, Dr. J. C., San Raphael, Cal. 
Lawson, Dr. W. T., Danville, Ind. 
Lallerstedt, Dr. T. L., Panola, Ga. 
Lyman, Dr. H. M., Prof. Phys. and Dis. Nervous Sys, 
Rush Med. College, Chicago, 111. 333 
Lisscomb, Dr. Thos., Shelbyville, Tenn. 
Leisenring, Dr. P. S., Sec. Board of Health, Omaha, Neb. 
Lowman, Dr. John H., Prof. Mat. Med. Wooster, Uni- 
versity, Cleveland, Ohio. 
Lyman, Dr. Albert B., Baltimore, Md. 
Latil, M., Paris, France. 
Lusk, Dr. Wm. T., Prof. Obstet. and Dis. Women and 
Children and Clin. Midwifery, Bell. Hospital Med. 
Coll., New York. 
Mitchell, Dr. E., Lancaster, New Hampshire. 
McIntyre, Dr. B. C., New York, N. Y. 
Mosser, Dr. M. B., Mechanicsburg, Pa. 
McAllister, Dr. W. F., Quarantine Officer, San Francisco, 
Cal. 
McKenna, Dr. W., Carrickmacross, County Monaghan, 
Ireland. 
Mulheron, Dr. E., Binghampton, New York. 
Miller, Dr. F. H., East New York, N. Y. 
Muller, Dr. R. W., New York, N. Y. 
McNutt, Dr. Robert, Rochefort, Mo. 
McSherry, Dr. Richard, Prof. Theory and Practice Med., 
University of Maryland. Baltimore, Md. 
Miller, Dr. C. B., Lawrenceburg, Ind. 
McCleary, Dr. J. D., Indianola, Iowa. 
Morgan, Dr. J. Howard, New York, N. Y. 
Mitchell, Dr. S. Weir, Philadelphia, Pa. 
McDuffie, Dr. W. C., Fayetteville, N. C. 
Mather, Dr. W. H., Suffield, Conn. 
Mitchell, Dr. T. A., Owensville, Ohio. 
McCombs, Dr. G. M., St. Lawrence, N. Y. 
McBride, Dr. T. H., Joliet, 111. 
Murphy, J. S., L. R. C. P. & S. D., &c., Dublin, Ireland. 
Marshall, Dr. John S., Phys. to Cleveland Asylum for the 
Insane, Newburgh, Ohio. 
McAllister, Dr. Thos. S., Amesbury, Mass. 
Mercer, Dr. Alfred, Syracuse, New York. 334 
Moore, Dr. R. L., Spring Valley, Minn. 
Melmick, Dr. J., Harrisburg, Ohio. 
Mecuen, Dr. G. E., Boston, Mass. 
Mattison, Dr. J. B., Brooklyn, N. Y. 
Monday, Dr. W. H., Terrell, Texas. 
McNider, Dr. V. S., Jackson, N. C. 
Noble, Dr. Richard J., Selma, N. C. 
Neal, Dr. W. A., Dayton, Mich. 
Nelson, Dr. E. M., St. Louis, Mo. 
Nariman, Dr. Temuljee Bhicajee, Fort Cowasjee, Patell 
Street, No. 41, Bombay. 
O’Connell, Dr. P., Chicago, 111. 
O’Brien, Dr. M. W., Barnesville, Ohio. 
Orr, Dr. Oscar, Hickory Ridge, 111. 
Partridge, Dr. E. L., New York, N. Y. 
Parker, Dr. Willard, Jr., New York, N. Y. 
Pixley, Dr. C. S., Elkhart, Ind. 
Priestly, Dr. Jas. T., Des Moines, Iowa. 
Page, Dr. J. N., Marshfield, Ind. 
Parrish, Dr. Wm. G., New York, N. Y. 
Park, Dr. Roswell, Denr. and Ass’t to Chair of Anat., 
Chicago Med. College, Chicago 111. 
Post, Dr. Alfred C., Prof. Emeritus, Clin. Surg., President 
of Faculty University Med. Coll, New York. 
Piffard, Dr. H. G., New York, N. Y. 
Powell, Dr. J. Z., Logansport, Ind. 
Phelps, Dr. R. H. Littleton, Mass. 
Pike, Dr. Chas. C., Peabody, Mass. 
Pace, Dr. J. M., Dallas, Texas. 
Parrish, Dr. J. S., Glasgow, Junct., Ken. 
Parcels, Dr. W. H., Lewiston, Pa.. 
Peck, Dr. O. W., Oneonta, N. Y. 
Park, Robert, Med. Officer for 3d and 4th Dists. of City 
Parish, Glasgow, Scotland. 
Parrish, Dr. Joseph, Burlington, N. J. 335 
Purple, Dr. S. S., New York, N. Y. 
Remondino, Dr. P. C., Health Officer, San Diego, Cal. 
Read, Dr. N. S., Chandlerville, 111. 
Reese, Dr. J. J., Prof. Med. Jurisprudence and Toxicology, 
University Pennsylvania, Philadelphia, Pa. 
Reeves, Dr. W. W., Wills Point, Texas. 
Rattray, Andrew M. S., Portobello, Scotland. 
Reed, Dr. Samuel P., Scranton, Penn. 
Rapp, Dr. Samuel, Lake City, Colorado. 
Ritchey, Dr. J. A., Oil City, Penn. 
Robbins, Dr. M. M., Aurora, 111. 
Rariden, Dr. Samuel R., Bedford, 111.. 
Snook, Dr. J. M., Kalamazoo, Mich. 
Stedman, Dr. R., Colesburg, Iowa. 
Soulages, C. C., D. M. P., New York, N. Y. 
Sabin, Dr. R. H., West Troy, N. Y. 
Sharer, Dr. W. F., Rockfield, Ind. 
Smith, Dr. J. Northrop, Hickory Grove, Ga. 
Stuart, Dr. A. B., Santa Barbara, Cal. 
Smith, Dr. H. M., Vincennes, Ind. 
Sutton, Dr. R. E., Rome, New York. 
Skillern, Dr. S. R., Philadelphia, Penn. 
Sledge, Dr. J. T., Middleburg, N. C. 
Smith, Dr. A. C., Newcastle, Province New Brunswick, 
Can. 
Snowden, Dr. T. Gustine, Franklin, Penn. 
Smith, Dr. G. M., North Lewisburg, Ohio. 
Shaw, Dr. J. C., Pres. N. Y. Neurological Society, New 
York, N. Y. 
Squier, Dr. John B., Sulphur Springs, Ohio. 
Skene, William, M. D., F. F. P. S. G., L. R. C. S. E., &c., 
Dewsbury, Yorkshire, Eng. 
Smith, Dr. Quintius C., Cloverdale Cal. 
Schellenberger, Dr. J. R., Philadelphia, Penn. 
Schooler, Dr. Lewis, Nevada, Iowa. 336 
Shaw, Dr. Fausse Pointe, Iberia Pa., La. 
Stokes, Dr. J. G., Grayville, 111. 
Sefton, Dr. W. Edgar, Sladesville, N. C. 
Semple, Dr. G. Wm., Hampton, Va. 
Thompson, Dr. F. D., Sherman, Texas. 
Thomas, Dr. Charles H., Philadelphia, Penn. 
Traver, Dr. W. H., Providence, R. I. 
Traver, Dr. L., Providence, R. I. 
Taylor, Dr. D. B., Millburn, 111. 
Thompson, Dr. J. H., Goshen, New York. 
Thomas, Dr. T. Gaillard, Prof. Gynaecology, Coll. Phys. 
and Surg. New York, N. Y. 
Thorn, Dr. Samuel S., Toledo, Ohio. 
Taliaferro, Dr. Frank, Richmond, Va. 
Tobey, Dr. O. C , Westfield, 111. 
Thornton, Dr. P. H., Lakeport, Cal. 
Trow, Dr. Wm. M., Easthampton, Mass. 
Thompson, Dr. Wm. H., New Haven, Conn. 
Thompson, Reginald E., South Kensington, London, 
England. 
Tupper, Dr. A. M., Rockport, Mass. 
Trueheart, Dr. P. R., Sterling, Kansas. 
Taylor, Dr. Isaac E., Emeritus Prof. Obstet. and Dis. of 
Women and Pres. Faculty Bell. Hosp. Med. Col. 
Upham, Dr. W. R., Yonkers, New York. 
Vandersloot, Dr. F. W., York, Penn. 
Vail, Dr. W. H., Cornwall-on-Hudson, New York. 
Vinnedge, Dr. W. W., LaFayette, Ind. 
Vermilye, Dr. Wm. Edward, Pittsfield, Mass. 
Wilson, Dr. C. L., Atlanta, Ga. 
Walton, Dr. J. E., Chicago, 111. 
Wheeler, Dr. H. M., Northfield, Minn. 
Westcott, Dr. N. S., New York, N. Y. 
Woodling, Dr. M. E., North Branch, Minn. 337 
Wood, Dr. H. C., Prof. Mat. Med. and Thera., and Clin. 
Prof. Diseases Nervous Sys., Med. Department, Univ. 
of Penn. 
Weist, Dr. J. R., Richmond, Ind. 
Wigg, T. Carter, L. R. C. P., M. R. C. S., L. S. A., Derby, 
Eng. 
Willard, Dr. Lyman M., Saratoga Springs, New York. 
Wenger, Dr. E. Gilman, 111. 
White, Dr. C. A., Danville, Ind. 
Walker, Dr. W. O., Winchester, Ky. 
Willard, Dr. DeForest, Philadelphia, Penn. 
Wharton, Dr. H., Farmer City, 111. 
Wilson, Edward T., M. B., Oxon, F. R. C. P. Lond. 
Westal., Cheltenham, Eng. 
Wraith, John H., M. R. C. S. Eng., L. S. A. Lond., Lan- 
cashire, Eng. 
Wilson, Dr. M. A., Clin. Asst, to Chair, Dis. Children, 
Bell. Hosp. Med. Col., Phys. to Dispensary Depart., 
N. Y. Foundling Asylum, New York, N. Y. 
White, Dr. Wm. H., Bloomfield, N. Y. 
Wills, Dr. Samuel E., Earlsville, Md. 
Walker, Dr. J. S., Greenville, Miss. 
Woodward, Dr. Wm., Pres. Med. Soc., Co. of Chemung, 
Big Flats, N. Y. 
Yeamans, Dr. J. B., Glasgow, Mo. 
Names given 284 
Names withheld 80 
Forgot to sign name 2 
Too late for classification 13 
Total 379 
THE END. INDEX. 
A 
Aberdein, Dr. R., solution preferred by, 45. 
Abscess, 34-62. 
Causes of, 34-35. 
From low condition of the system, 53. 
In morphia habitues, 284. 
Accelerated breathing in morphia poisoning, Anstie on, 233. 
Aconite, antidoted by morphia, cases, 176. 
Action of morphia. 
On respiration in disease, 81. 
“ “ in health, 248. 
On animals, 229-231. 
Acute pulmonary disease, morphia and atropia in, 248. 
Adams, Dr. J. Charles, excess of acid in solution, 44. 
Case of narcotism, 84. 
Observations of, 257. 
Ady, Dr. A., case of tetanus from hypodermic injection of quinine, 240. 
Alcoholism, predisposing to abscess from puncture of hypodermic 
needle, 53. 
Altitude, effect of on drug action, 71. 
Amidon, Dr., experiments of, 135. 
Ammonia, intra-venous injection of, 132. 
As a heart stimulant in morphia-narcosis, 219. 
Anaemia, cerebral, 309. 
Anel’s syringe, 14. 
Angina pectoris, 309. 
Animals, action of morphia on, 229-231. 
Anstie, on the advantages of the hypodermic method, 23, 24. 
On localization, 30. INDEX. 
339 
Anstie, on opium idiosyncrasy, 69. 
Elimination of morphia by kidneys, 77. 
On collapse in delirium-tremens after subcutaneous injection of 
morphia, 171. 
On narcotism in delirium-tremens, 174. 
On accelerated breathing, delirium and incomplete coma in 
morphia poisoning, 233. 
Pain relieving power of atropia, 253. 
On the morphia habit, 270-273. 
Antagonism of morphia and atropia, 194. 
Antidotes that should be carried, 322. 
Armor, Prof. Samuel G., solutions used by, 41-46. 
Temperaments specially susceptible to morphia, 74. 
Arton, Dr. J. H., manner of preparing solution, 47. 
Atkinson, Prof, A., method of injecting, 49. 
Temperaments peculiarly susceptible to morphia, 72. 
Case of syncope, 103. 
Atropia, variations in susceptibility to, 72, 249. 
As a preventer of the nausea of morphia, 245. 
As a preventer of the digestive troubles caused by morphia, 259. 
As rendering large doses of morphia safer, 259. 
Atropia and morphia, 244-267. 
Effects on different organs, 245. 
In pelvic pain, 250. 
Author, experiments of, 76, 130. 
Aylward, Dr. Ernest L., method of injecting, 48. 
B 
Bain, Dr. Charles, case of epilepsy, cure, 311. 
Baird, Dr. Wm. M., large doses of morphia, 317. 
Ball, Dr. Charles B., cases of carbonic acid poisoning treated by in- 
halation of oxygen, 215. 
Barker, Prof. Fordyce, early use of syringe, 19. 
Barkitt, Dr. F. W., 236. 
Bartholow, Prof. Roberts, on localization, 27, 30. 
On differences in rapidity of absorption according to site of 
injection, 32. 
Solution recommended by, 38. 
Deep injections, 50. 340 
INDEX. 
Bartholow, Prof. Roberts, on susceptibility to atropia, 72. 
On susceptibility to morphia, 72. 
The commencing dose, 73. 
Injections into veins, 122. 
When to give morphia in delirium-tremens, 170. 
Interesting case by, 235. 
Observations on morphia and atropia, 245, 248, 254, 257, 260. 
Observations on the rapid spread of the morphia habit, 268. 
Dangers of sudden deprivation in treatment of morphia habit, 
288. 
Treatment of morphia habit, 292. 
Baxt, M. Waldemar, action of morphia, 230. 
Bay, Dr. Gabriel, syringe invented by, 22, 38. 
Beane, Dr. F D , pain vs. narcotism, 84. 
Beard, Dr. George M., idiosyncrasies, 65. 
Temperaments, 72. 
Tendency of neurasthenics to push use of stimulants to ex- 
cess, 272. 
Behier, on localization, 25. 
Belladonna treatment of morphia habit, 292. 
Bennet, Dr. J. Hughes, experiments on antagonism of morphia and 
caffeine, 219. 
Benson, Dr. J. Hawtrey, solution used by, 43. 
Bergen, Dr. E. J., deep injections, 50. 
Bertin, on localization, 27. 
Betterly, Dr. E. L., hypodermic injection of water, 296. 
Bird, Dr. Golding, case by, 271. 
Blake, Dr. John Ellis, solution used by, 41. 
Treatment of aconite poisoning by inhalation of oxygen, 214. 
Blalock, Dr. W. C., treatment of the morphia habit, 297. 
Blepharospasm, 309. 
Bliss, Dr. D. H., manner of preparing solution, 46. 
Bodington on morphia in delirium-tremens, 76. 
Braine, F. Woodhouse, injection into a vein, 120. 
Broken needles, 59. 
Brome, Dr. J. W., abscess, 53. 
Bromide of potassium, 175. 
Treatment of morphia habit, 294. 
Bronchitis, 309. 
Brown, Dr. A. P., case of death, 154. 
Brown-Sequard, case of syncope from prick of lancet, 94. INDEX. 
341 
C 
Cable, Dr. Wm. W., on fresh solutions, 44. 
On injection into veins, 124. 
Deaths of morphia habitues, 281. 
Cady, Dr. W. W., method of preparing solution, 47. 
Caffeine as a heart stimulant in morphia narcosis, 219. 
As a diuretic, 220. 
Calvet, experiments of, 131, 267. 
Calvel, abscess, traumatic fever, &c., from puncture of hypodermic 
needle, 287. 
Campbell, Dr. H. F., coffee and caffeine in morphia narcosis, 223. 
Carcinoma, use of special needle for, 58. 
Cardiac disease, 309. 
Morphia and atropia for, 247. 
Carroll, Dr. Alfred Ludlow, on atropia and morphia, 259. 
Carson, Dr. A. W., large doses, 277. 
Causes of abscess in morphia habitues, 284. 
Cerebral anaemia, 309. 
Cerebro-spinal meningitis, 312. 
Chawvet, experiments of, 76-77. 
Chloral hydrate, danger of giving before morphia, 175. 
Cholera, 309. 
Cholera morbus, 309. 
Cholera infantum, 309. 
Chorea, 309. 
Chouppe, experiments of, 27. 
Circulation, effects of morphia and atropia on, 246. 
Claims of Taylor, Washington, Wood, Rynd, Kurzak, 14. 
Clark, Prof. Alonzo, injection into a vein with fatal results, 127. 
Aconite antidoted by morphia, 176. 
Cochrane, Dr. W. W., coffee in morphia narcosis, cases, 222. 
Commons, Dr. W., case of death attributed to morphia habit, 282. 
Continued fevers, 309. 
Convulsions from morphia, 227. 
Case by S. Weir Mitchell, 228. 
Convulsions, hysterical, 309. 
Cooper, Dr. J. B., solution used by, 42. 
Corona, Dr., idiosyncracy in animals, 70. 
Injection into veins, 123. 
Courtenay, Dr., case of tetanus from morphia, 231. 342 
INDEX,. 
Crawcour, Dr. N., solution used by, 42. 
Cysts following hypodermic injections, 57. 
Cystitis, 309. 
D 
Da Costa, Prof. J. M., the bromides for the nausea of morphia, 255. 
Dale, Dr. J. T., bromides in nausea of morphia, 255. 
Damaschino, abscess and inflammation from impure solutions, 37. 
Danger of using morphia by skin after using it by the mouth, 183, 
324- 
Death from injection into a vein, 127-128. 
Death from subcutaneous injection of morphia, 142, 314. 
De Courcey, Dr., experiments of Bartholow on, 248. 
Deep muscular injections, 49-50. 
Deepened respiration from decrease of pain, 249. 
Delirium-tremens, morphia in, 76, 91, 143, 150, 162, 170, 172, 309. 
Deprivation, sudden, in treatment of morphia habit, 288. 
Gradual, in treatment of morphia habit, 288. 
De Renzi, Prof., experiments of, 29. 
Detwiler, Dr. B. H., cases of narcotism, 95. 
Diabetes, 309. 
Diarrhoea, 309. 
Diathesis, Maudsley on, 67. 
Different actions of morphia when slowly and rapidly absorbed, 24. 
Digestive tract, effect of morphia and atropia on, 246. 
Diseases predisposing to abscess, 53. 
For which morphia has been used hypodermically, 309. 
Dislocations, 309. 
Dissolving powders at bed-side, 45-46. 
Donaldson, Dr. James, solution used by, 43. 
Drake, Dr. E. W., suicide of morphia habitues, 278. 
Draper, Prof. Wm. H., method of injecting, 325. 
Dujardin-Beaumetz, on abscess and traumatic fever from puncture of 
hypodermic needle, 287. 
Dunlap, Dr. G. L., method of injecting, 49. 
Abscess in rachitic patient, 53. 
Dyspepsia, nervous, 309. 
Dyspnoea, 309. INDEX. 
343 
E 
Effect of morphia and atropia on the nervous system, 245. 
On the digestive apparatus, 246. 
On the genito-urinary organs, 246. 
On circulation and respiration, 246, 248. 
In cardiac disease, 247. 
Elder, Dr. Jennie S., solution used by, 38. 
Electricity in morphia narcosis 212. 
Elephantiasis, condition of limb resembling, from punctures of hypo- 
dermic needle, 287. 
Elimination of morphia by the kidneys, 76, 77. 
Emory, Dr. A. G., cases by, 326. 
Emphysema, 309. 
Entrikin, Dr. F. W., case by, 56. 
Ensign, Dr. Wm. H., case of narcotism, 82. 
Epilepsy, cases of cure by morphia, 309. 
Erysipelas following puncture of hypodermic needle, 56. 
Etheridge, Prof. James H., on temperaments, 72-74. 
Eulenberg on localization, 25-28. 
Solution preferred by, 40. 
Experiments regarding rapidity of absorption, 32, 133. 
On elimination of morphia in dogs, 78. 
Of Dr. Amidon, 135. 
F 
Fibroid tumors from puncture of hypodermic needle, 48. 
Fifield, Dr., case of narcotism, 97. 
Fite, Dr. C. C., solution used by, 42. 
Flint, Prof. Austin, opium treatment of delirium-tremens, 172. 
Fluid extract of colfee in morphia narcosis, 220. 
Foote, Dr. Geo. A., on local anaesthetic effect of morphia, 28. 
Case of narcotism, 96. 
Fothergill, atropia as lessening danger from morphia, 260. 
Strychnia as a respiratory stimulant, 206. 
Dangers of morphia in some forms of pulmonary disease, 92. 
Fowler, Dr. Geo. R., cases of syncope, 114. 
Francis, Dr. Samuel W., hypodermic injections in carcinomatous sub- 
jects, 58. 
Morphia in chronic Bright’s disease, 75, 344 
INDEY, 
Francis, Dr. Samuel W., cases of narcotism, 95. 
Syncope, 114. 
Atropia as a preventer of the nausea of morphia, 257. 
c 
Gamage, Dr. J. A., cases of epilepsy cured by this method, 310. 
Gangrene following the hypodermic injection of morphia, 54, 55. 
Gardner, Dr. James C., veratrum viride in opium narcosis, 224. 
Garland, Dr., case of death, 165. 
Gastric catarrh, 311. 
Gastric ulcer, 311. 
Genito-urinary organs, effect of morphia and atropia on, 246. 
Georges, experiments of, 125. 
Gradual deprivation in the treatment of morphia habit, 288. 
Graham, Dr. Arthur, case of syncope, 106. 
Griswold, Dr. Gaspar, intravenous injection of ammonia, 132-137. 
Gubler, Prof., caffeine as a diuretic, 220. 
II 
Hallenbeck, Dr. O. J., solution used by, 41. 
Hamlett, Dr. Stephen, experience of, 323. 
Hammel, Dr. Madison, method of preparing solution, 46. 
Hammond, Prof. Wm. A-, temperaments susceptible to morphia, 72- 
Case by, 305. 
Harrington, Dr. H. L., case of syncope, 109. 
Haynes, Dr. W. H., case of death, 165. 
Case of aconite poisoning treated by morphia, 179- 
Heart, the, in morphia narcosis, 219. 
Action of caffeine on, 219. 
Tendency to death by morphia and atropia, 247. 
Henna, Dr. J. J., case of death by, 168. 
Henschel, Dr. E. K., case of narcotism by, 87. 
Hepatic colic, 309. 
Cancer, 311. 
Ulcer, 311. 
Abscess, 311. 
History of the discovery, 13-20. 
Horse, traumatic tetanus in, from hypodermic injection, 241. INDEX. 
345 
Houtz, Dr. J. A., injection into a vein, 119. 
How to avoid formation of morphia habit, 302-306. 
How, Dr. J. C., on the morphia habit, 275. 
Cases by, 283. 
Hunter, Mr. Charles, labors of, in introducing the method, 17, 18. 
On localization, 26. 
Hutchinson, Dr. Wm. F., treatment of opium habit by galvanism, 297. 
Hydrocyanic acid treatment of morphia habit, 297. 
Hypodermic syringe, first use of, 13. 
Syringes, 19-23. 
Syringe, Bay’s, 22. 
Hypodermic injection of whiskey in morphia narcosis, 219. 
Of caffeine, 219. 
Hysterical convulsions, 309. 
I 
Idiopathic tetanus from morphia; cases by Reed, Phillips, and Cour- 
tenay, 23 x, 232. 
Idiosyncrasy, 63, 80, 319. 
Inflammation and abscess, 34-62. 
Ingals, Dr. E. Fletcher, cases of narcotism, 98. 
Cases of syncope, 107. 
Cases of death, 148, 158. 
Injection into a vein, 102. 
Insanity, 312. 
Insomnia, 311. 
Intemperance, abscesses in, 53. 
Intra-venous injection of ammonia, 132, 137. 
Itching, 311. 
J 
Jewell, Prof, J. S., temperaments peculiarly susceptible to narcotic 
action of morphia, 72. 
Vaso-motor disturbances from hypodermic injections, 114. 
Jewett, Dr., C. T.,. case of narcotism, 83, 212. 
Jones, Dr. Geo. E., method of injecting, 50. 
Case of syncope, 104. 
Judkins, Dr. Wm., case by, 304. 346 
INDEX. 
Keloid condition of skin from puncture of hypodermic needle, 287. 
Keyes, Dr. H. M., solution recommended by, 36. 
Kidneys, elimination of morphia by the, 761 77• 
Kilpatrick, Dr. A. L., abscess, 53. 
Cases by, 56. 
Kinkead, Prof. R. J., hypodermic injection of water, 295. 
Knott, Dr. L. D., observations of, 91. 
Kurzak, claims for, 13. 
K 
JL 
Lamadrid, Dr. Julio J., advantages of combining atropia with mor- 
phia, 252. 
Atropia as a preventer of nausea of morphia, 255. 
Atropia rendering morphia safer, 260. 
Laryngismus stridulus, 311. 
Lathrop, Dr, G. H., case of narcotism, 92. 
Lawson, solution used by, 39. 
Lead colic, 312. 
Lee, Dr. C. Carroll, case of death by, 154. 
Levenstein on the morphia habit, 267, 270. 
Treatment of the habit by sudden deprivation, 288. 
Liautard, Prof. A., case of traumatic tetanus in a horse from puncture 
of hypodermic needle, 241. 
Ligation of limb to delay absorption, 106, 125. 
Local anaesthetic effect of morphia, 28. 
Localization, 25-33. 
Logan, Prof. Samuel, method of injecting, 49-51. 
Morphia and atropia, 254. 
Case by, 275. 
Loomis, Prof. A. L., treatment of puerperal eclampsia, 75. 
Lowman, Prof. Jno. H., solution used by, 42. 
Case of death, 143, 171. 
When to use atropia, 257. 
Lumbago, 312. 
Lusk, Prof. Wm. T., morphia in Bright’s disease, 80. 
Case of syncope, 128. 
Morphia and atropia, 255. INDEX. 
347 
Luton, on localization, 27. 
Lyman, Prof. PI. M., temperament susceptible to morphia, 72. 
Lyman, Dr. J. C., atropia as a preventer of the nausea of morphia, 
255. 
Malaria and malarial neuroses, 312. 
Mania, 90, 166, 312. 
Marshall, Dr. John S., impure atropia as a cause of abscess, 45. 
Mattison, Dr. J. B., temperaments peculiarly susceptible to morphia, 72. 
On the ease with which the morphia habit may be formed, 272. 
Treatment of the morphia habit, 294. 
Maudsley, on diathesis as a modifier of treatment, 67. 
Morphine in delirium-tremens, 170. 
McAllister, Dr. Thos., solution used by, 38. 
McAllister, Dr. W. F., cases of morphia habit, 280. 
McFarland, Dr. S. F., treatment of the morphia habit, 295. 
McKenna, Dr. W., case by, 279. 
McNider, Dr. V. S., solution used by, 38. 
McNutt, Dr. Robert, case of narcotism, 96. 
McSherry, Prof. Richard, narcotism, 99. 
Temperaments peculiarly susceptible to morphia, 72. 
Mecuen, Dr. G. E., solution used by, 41. 
Medico-Chirurgical Society’s report; cases of narcotism and death, 88, 
89, 91, 166. 
Meldon, Dr. Austen, case of traumatic tetanus from puncture of hypo- 
dermic needle, 236, 275. 
Meningitis, cerebro-spinal, 312. 
Mental disease, localization of injection in, 30. 
Mercer, Dr. Alfred, abscess in a drunkard, 53. 
Method of injecting, 48. 
Miller, Dr. Francis H., injection into vein, 114. 
Miller, Dr. J. N., case by, 261. 
Mitchell, Keene and Morehouse on localization, 25, 30. 
On increase of dermal sensibility, 30. 
Inflammation following injection, 57. 
On the nausea of morphia, 254. 
Mitchell, Dr. T. A., on the use of fresh solutions, 46. 
Mitchell, Dr, S. Weir, on idiosyncrasy in animals, 69. 
in 348 
INDEX. 
Mitchell, Dr. S. Weir, susceptibility of different temperaments to nar- 
cotic action of morphia, 72. 
Action of opium on lower animals, 228. 
Case of convulsions from morphia, 229. 
Pain relieving power of atropia, 253. 
Morgan, Dr. J. Howard, atropia aud morphia, 252. 
Morphia in puerperal convulsions, 75- 
In Renal disease, 75, 80. 
In Delirium-tremens, 76,91, 143, 150, 169, 170, 172. 
In Mania, 90, 166. 
In Acute respiratory diseases, 93, 94. 
In Shock, 247. 
Death from subcutaneous injection of, 122, 128, 142. 
Death from injection into vein, 127, 128. 
Dangers of, after chloral and the bromides, 175. 
Narcosis, treatment of, 213. 
Causing convulsions, 227. 
Causing tetanus, 227, 231. 
Action of on animals, 228-230. 
Habit, the, 267. 
Morphia and atropia, 244-267. 
In pelvic pain, 250. 
Muller, Dr. R. W., cases of abscess, 54. 
Murphy, Dr. J. C., cases by, 94. 
Morphia and atropia, 259. 
Muscular spasm cured by hypodermic injection, 305. 
w 
Nacke, on albuminuria of delirium-tremens, oo. 
Narcotism, tases of, 82-102, 
Treatment of, 192. 
Nariman, Dr. Temuljee Bhicajee, method of injecting, 51. 
Cases by, 59, 83. 
Nausea of morphia, atropia to prevent, 254. 
Neal, Dr. W. A., abscess, 53. 
Case of injection into vein, 105 
Needles, breaking of, case, 59. 
Rusty, producing tetanus, 233. 
Nelson, Dr. E. M., peculiar action of atropia, 138. INDEX. 
349 
Nervous system, effect of morphia and atropia on, 245. 
Neuralgia, 28, 312. 
Norman, Dr., traumatic tetanus from rusty hypodermic needle, 235. 
Nussbaum, Prof., injection into a vein, 115. 
Nymphomania, 312. 
o 
O’Brien, Dr. F. H., case of aconite poisoning treated by morphia, 176. 
O’Flanigan, Dr. J., remarks on case of traumatic tetanus, 239. 
Oliver, Dr. George, cautions of, 141. 
Opium friction, 15, 16. 
Osgood, Dr., treatment of opium habit, 291. 
Ovarian neuralgia, 312. 
Oxygen, inhalation of in morphia narcosis, 213. 
Pain relieving power of morphia increased by atropia, 250. 
As a preventor of narcotism, 81. 
Pallen, Prof, Montrose A., morphia and atropia, 258. 
Coffee as a diuretic in morphia narcosis, 220. 
Park, Dr. Roswell, cases of narcotism, 89. 
Park, Dr. Robert, large dose in mania, 89, 317. 
Parker, Dr. Willard, Jr., case of, 57. 
Parker, Prof. Willard, on temperaments, 72. 
Case of death from injection into a vein, 128. 
Condition of skin resembling keloid and elephantiasis from 
punctures of needle, 287. 
Parrish, Dr. Joseph, on peculiarities of the morphia habit, 271. 
On the treatment of the morphia habit, 271. 
Partridge, Dr. E. L., case by, 59. 
Pelvic pain, atropia and morphia in, 250. 
Pepy’s Journal, extract from, 129. 
Pericarditis, 312. 
Peritonitis, 312. 
Phillips, tetanus from morphia, 233. 
Pixley, Dr. C. S., case of narcotism, 96. 
Pleurisy, morphia in, 249, 312. 
Pneumonia, 312. 
p 350 
INDEX. 
Poor health, predisposing to abscess, 53. 
Post, Prof. Alfred C., method of injecting, 51. 
Temperaments, 71. 
Case of death, 151. 
Pruritus vulvse, 312. 
Puncture of needle producing tetanus, 236. 
Quinine, tetanus from hypodermic injection of, 240, 
4 
R 
Rachitis, abscess in, 53. 
Rapid relief to pain a bar to careful diagnosis, 308 
Rapidity of absorption, 32, 133, 134. 
Rapp, Dr. Samuel, case by, 56. 
Altitude as modifying action of drugs, 71. 
Rattray, Dr. Andrew M. T., solution used by, 39. 
Method of injecting, 49. 
Read, Dr. N. S., case of death, 162. 
Reed, Dr. Samuel P., avoidance of abscess, 52. 
Case of tetanus from morphia, 231. 
Morphia and atropia, 250. 
Reese, Prof. John J., solution used by, 43. 
Temperaments peculiarly susceptible to narcotic action of mor- 
phia, 72. 
Remondino, Dr. P. C., case of morphia habit, 278. 
Renal disease, morphia in, 75. 
Renal colic, 312. 
Respiration, action of morphia on, in disease, 81. 
Action of morphia and atropia on, 246-248. 
Rheumatism, 312. 
Ringer, belladonna for the nausea of opium, 255. 
Ritchey, Dr. John A., method of dissolving morphia, 45. 
Roberts, Mr. Arthur, case of syncope, 121. 
Rolland, Dr. Richard, method of inserting morphia, 17. 
Ross, Dr., tetanus following vaccination, 242. 
Ruppaner, work by, 19. 
On localization, 27. ■ INDEX. 
351 
Rusty and unclean needles producing tetanus, 233. 
Rynd, of Dublin, claims of, 13. 
s 
Schweig, Dr. Geo. M., morphia narcosis treated by electricity, 213. 
Semple, Dr. G. Wm., fibroid growth at point of puncture, 48, 58. 
Abscesses in broken constitutions, 53. 
Hydrobromic acid preventing the nausea of morphia, 255. 
Seneker, Dr., caffeine in morphia narcosis, 223. 
Sewell, Prof., cases of opium poisoning treated by coffee, 221. 
Shapter, Dr. Lewis, caffeine in cardiac dropsy, 221. 
Shaw, Dr. J. C., temperament peculiarly susceptible to narcotic action 
of morphia, 72* 
Shock, morphia for, 312. 
Morphia and atropia for, 247. 
Skillern, Dr. S. R., method of injecting, 49. 
Sledge, Dr. J. T., solution used by, 42. 
Sleightholme, J. Pennock, injection into a vein, 123. 
Smith, Dr. H. M., case of narcotism, 85. 
Case of extreme prostration from morphia, 256. 
Smith, Dr. Edward, 94. 
Smith, Dr. Q. C., deep muscular injections, 50. 
Smith, Dr. J. Northrop, case by, 304. 
Snook, Dr. J. M., case of death, 152. 
Solution, impure, causing abscess, 35-40- 
Solution used by Wood, 19. 
“ Ruppaner, 19. 
“ Keyes, 36. 
“ Bartholow, 38. 
“ Elder, 38. 
“ McNider. 38. 
“ McAllister, 38. 
“ Lawson, 39. 
“ the English, 39. 
“ Rattray, 39. 
“ Wraith, 40. 
“ Wilson (E. T.), 40. 
“ Eulenberg, 40. 
“ Armor, 41. 352 
INDEX. 
Solution used by Blake, 41. 
“ Hallenbeck, 41. 
“ Mecuen, 41. 
“ Sledge, 42. 
“ Cooper, 42. 
“ Wilson (M. A.), 42. 
“ Crawcour, 42. 
“ Fite, 42. 
“ Lowman, 42, 
“ Reese, 43. 
“ Vinnedge, 43. 
“ Benson, 43. 
“ Donaldson, 43. 
“ Thompson, 44. 
“ Adams, 44. 
“ Cable, 44. 
Spinal irritation, 312. 
Sprains, 312, 
Statistics of morphia habit, 272. 
Sterno-mastoid, spasm of, cured by subcutaneous injection of mor- 
phia, 305. 
Stokes, Dr. J. G., case of death, 162. 
Strychnia in morphia narcosis, 206. 
Stuart, Dr. A. B., abscess, 53. 
Morphia and atropia, 252. 
Sudden deprivation in treatment of morphia habit, 288. 
Susceptibility to morphia, 72. 
To atropia, 249. 
Syncope from injection into vein, 102. 
Syphilitic patients, special needle for, 58, 61. 
Syringes, hypodermic, 19-23. 
T 
Table of usual dose, 62. 
Tardieu on the elimination of poisons, 77. 
Taylor, Dr. Isaac E., claims of, 13. 
Temperaments, 72. 
Tetanus from morphia, 227. 
Cases by Reed, Phillips and Courtenay, 231, 232. INDEX 
35.3 
Tetanus, morphia treatment in, 312. 
Therapeutic application, 23. 
The morphia habit, 267. 
Thomas, Prof. T. Gaillard, gangrene following an injection of mor- 
phia, 54, 55. 
Inhalation of oxygen, 214. 
Atropia and morphia in pelvic pain, 250. 
Death from continued use of morphia, 282. 
Thompson, Dr. Reginald E., solution used by, 44. 
Morphia in delirium-tremens, 90. 
Thompson, Dr J. H., deep injections, 50. 
Thornton, Dr. P. II., cause of abscesses, 52. 
When to use atropia, 257. 
Tobey, Dr O C., impure morphia as a cause of abscess, 44. 
Tourniquet, 106, 107, 125, 136, 323. 
Trask, Dr., case of, 212. 
Treatment of abscesses in morphia habitues, 286. 
Of morphia habit, 287. 
Traumatic tetanus from hypodermic injection, 233. 
Tupper, Dr. Aug. M., case of syncope, 109. 
u 
Uraemia, 75, 312. 
Usual dose, 62. 
V 
Vaccination, tetanus following, 242. 
Vaginismus, 312. 
Vail, Dr. Wm., case by, 278 
Vein, injection into, 102. 
Death from, 127, 128. 
Veratrum viridein opium poisoning, 224. 
Vinnedge, Dr. W. W., solution used by, 43. 
Vomiting of pregnancy, 312. 
W 
Ward, Michael, on “ opium friction,” 15, 16 354 
INDEX. 
Washington, Dr., claims of, 13. 
Walker, Dr. W. 0., method of injecting, 50. 
Wenger, Dr. E., cases by, 99, 120, 141, 155. 
Whiskey, hypodermic injection of, 219. 
White, Dr. C. A., method of injecting, 52. 
White, Dr. Wm. H., manner of making solution, 46. 
Wigg, Dr. T. Carter, on continued use of morphia, 279. 
Willard, Dr. Lyman M., case by, 145, 173. 
Willard, Dr. De Forest, abscess, 53. 
Wills, Dr. Samuel E., abscess, 53. 
Wilson, Dr. E. T., solution used by, 40. 
Cases by, 106. 
Manner of injecting, 258. 
Wilson, Dr. M. A., solution used by, 42. 
Wolff, Dr. O. J. B., localization in mental disease, 30. 
Wood, Dr. Alexander, claims of, 13. 
On localization, 25. 
Wood, Prof. II. C., temperament, 72. 
Case of narcotism, 82. 
Rapid absorption of morphia, 113. 
Pathology of morphia narcosis, 213. 
Cases of morphia habit, 227. 
How to give atropia in morphia poisoning, 204. 
Woodling, Dr. M. E., case of narcotism, 91. 
Case of syncope, 103. 
Wraith, Dr. John H., solution used by, 40. 
Wyeth’s fluid extract of coffee, 220. ESTABLISHED 1876. 
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