APOMORPHINUM.
A substance obtained from morphine (differing only from morphine in
having one less equivalent of water). Formula, C17H17NO2. (Morphine is C17H19NO3.)
Authority.
J. B. Victor Victor Bourgeois, de L’Apomorphine, un
nouvel émétique, monograph, Paris, 1874.
CASE I.
Injection of three
milligrammes of Apomorphine; no result. ►
October 26, 9.20 A.M. M. Lachize injected into the outer portion of my left arm three
milligrammes of Apomorphine. I placed a thermometer in the axilla. ►
9.20. Pulse 60, respiration 16, thermometer 36.8°. ►
9.23. No especial sensation; pulse 72, thermometer 36.8°, respiration 16. ► 9.25. *Violent inclination to vomit;
feeling of heat all over, but especially in the head; face congested; pulse 92, thermometer
36.9°, respiration 20. ► 9.28 No change; pulse 96,
thermometer 36.9°, respiration 22. ► 9.30. Pulse
slightly irregular; less nausea; pulse 80, thermometer 36.9°, respiration 20. ► 9.33. Pulse 84, thermometer 36.9°, respiration 20. ► 9.35. Pulse still irregular; nausea entirely ceased; no
particular symptom; drowsiness; respiration calm and regular; pulse 80, thermometer 36.8°,
respiration 16. ► 9.40. Sleep. ►
10.15. Awoke; no more nausea; no headache; no fatigue; pulse 64, thermometer 36.8°;
respiration 14; breakfasted at 11 o’clock without feeling anything abnormal.
CASE II.
Injection of six
milligrammes Apomorphine; vomiting. ► November
6. M. Lachize made another injection of six milligrammes Apomorphine into the lower and
outer portion of the left arm, and conducted subsequent observations as carefully as before.
► 9.40 A.M. Pulse 76, thermometer 36.9°, respiration 15.
► 9.43. Pulse 80, thermometer 36.9°, respiration 15. ► 9.45. Violent inclination to vomit;
full, regular pulse; pandiculations; pulse 100, thermometer 36.9°, respiration 18. ► 9.48. Retching; pulse and breathing irregular; pulse 104,
thermometer 36.8°, respiration 24. ► 9.50. Easy vomiting; same irregular pulse; pulse 94, thermometer
36.8°, respiration 20. ► 9.53. Pulse 96, thermometer
36.8°, respiration 21; more vomiting; condition the same. ►
9.55. Vomiting ceased; still some nausea; continued irregularity of pulse and respiration;
pulse 94, thermometer 36.7°, respiration 18. ► 10
o’clock, quite; drowsiness; pulse 76, thermometer 36.7°, respiration 12; quiet sleep for
one hour; on awaking, pulse 68, thermometer 36.8°, respiration 8; ate my next meal without
any uneasiness. ► Next day, and several times afterward,
I took a subcutaneous injection of one centigramme Apomorphine; it caused no pain, and no
local symptoms; the resulting phenomena were the same as before, only after injecting ten or
twelve milligrammes the vomiting came on in four or five minutes; it was more violent.
CASE III.
Encouraged by the experiments upon animals, I took
an injection Dec. 10, 1873, of three centigrammes Apomorphine, in presence of Drs. Zuber and
Grandjax, on the outer portion of the right arm, the left arm being bandaged. ► 2.20 P.M. Pulse 66, thermometer 36.8°, respiration 14. ► 2.22. Pulse 104, thermometer 36.8°, respiration 19; vomiting, without previous nausea, took place two minutes after
the injection; sudden sensation of heat running all over the body, and lasting about a
minute, followed by vomiting; this vomiting lasted three minutes; during this time, pulse
100 to 102, thermometer 36.8°, respiration 20 to 24. ►
2.26. Extreme fatigue; tried to get up, but could not; pulse 84, thermometer 36.8°,
respiration 16. ► 2.27. No change; pulse 78, thermometer
36.8°, respiration 15. ► 2.28. Nausea; pulse 96,
thermometer 36.8°, respiration 18. ► 2.29. Some attacks
of vomiting; violent headache. ► 2.32. Quiet; drowsiness;
pulse 98, thermometer 37°, respiration 17. ► 2.33. Pulse
98, thermometer 37°, respiration 17; so much fatigued that the eyes closed involuntarily. ► 2.36. Nausea; pulse 104, thermometer 37, respiration 16. ► 2.38. Less copious vomiting than before; invincible need of
repose. ► 2.40. Slept in a chair. ►
4 o’clock. Ached with fatigue; no other bad feeling; no headache; pulse 80, thermometer
37°, respiration 15; at dinner, less appetite than usual. The symptoms observed in these
cases resemble those which follow the use of all emetics in nauseating doses; there was an
unpleasant feeling at the præcordia; congestion of the face and headache; then the
conjunctiva became injected; there was copious salivation, and after a certain interval a
sense of considerable fatigue. After emetics the symptoms were the same, but more intense.
The stage of nausea, in my own case, was always very brief, yet recognizable. The others, to
whom the drug was administered, had, in general, the same symptoms. Dr. Zuber, aide-major at
Val-de-grace, after two subcutaneous injections, felt each time an intense headache; he was
dizzy, and his limbs much fatigued. The feeling of weakness was very well marked in one of
our friends, an exceedingly robust individual, aged 30; a copious sweat covered his face,
which was pale instead of florid as usual; after each of several trials he had a violent
attack of dyspnœa, perhaps due to a long-established organic affection of the heart.
Complete recovery generally took place in an hour or two after the injection; usually, also,
the vomiting was succeeded by invincible drowsiness.
CASE IV.
Injection of one centigramme
Apomorphine. Vomiting in ten minutes. ► Man,
72 years old, entered the Rotschild Hospital December 24; he had long labored under chronic
bronchial catarrh, with pulmonary emphysema; at present there is considerable dyspnœa and
difficult expectoration; the patient is obliged to sleep sitting up. The Apomorphine was
prescribed with the view of affording relief by removing the violent contractions of the
diaphragm and thoracic walls, and promoting discharge from the lungs; at 11 o’clock he
received an injection of one centigramme Chlorohydrate of Apomorphine into the arm at its
dorsal aspect. Solution fresh, limpid, colorless; pulse 80, respiration 28; (the temperature
was not taken, our previous observations having convinced us of the uselessness of doing
so). ► 11.5. Pulse 92, respiration 28; patient made no
complaint; yawning. ► 11.10. Pulse 108, rather irregular;
respiration 32; the patient, without previous nausea, was attacked by vomiting, which lasted
about two minutes; it consisted of mucus, and was quite scanty; no facial congestion; no
sweat. ► 11.13. Pulse 70, respiration 24. ► 11.15. Pulse 88, respiration 24; renewed but ineffectual
efforts to vomit. ► 11.20. Pulse 76, respiration 20; the
patient complained of great fatigue; he breathed more easily, and said he felt quite sleepy;
in a few minutes he sank back on his pillow and went to sleep; while asleep, 11.45, pulse
76, regular; respiration 18 to 20. ► 1 o’clock. The
patient is awake, pulse and respiration the same. Having so far confirmed the beneficial
effects of the medicine, we intended to administer it again next day, increasing the dose to
fifteen milligrammes, but the patient seemed so much depressed that we thought it best not
to risk the experiment; the injection caused no pain, and no subsequent irritation.
CASE V.
Injection of one centigramme
Apomorphine; vomiting in six minutes. ► Young
man, aged 24, under treatment for a febrile, gastric difficulty, which had lasted three
days; robust constitution; general health excellent; tongue thickly coated; headache; no
diarrhœa; no gurgling, or abdominal tenderness. ► 10.20
A.M. One centigramme Apomorphine injected into left arm; same solution as in preceding case;
pulse 92, respiration 14, morning temperature 38.2°). ►
10.22 Pulse 108, respiration 15. ► 10.25. Pulse 120,
small, regular; respiration 15; nausea; face congested and moist; hiccough. ► 10.26. Pulse 120, respiration 20; copious, slimy vomiting now
set in and lasted one and a half minutes. ► 10.28. Pulse
88, respiration 15; the patient was quiet for three or four minutes; he complained of
weakness; then nausea returned; the hiccough ceased. ►
10.32. Pulse 104, respiration 22; renewed vomiting, almost as copious as at first, but more
painful; it lasted two or three minutes. ► 10.38. A third
vomiting; scanty; patient’s face covered with sweat; much prostrated, and complains of great
fatigue; after this he lies quiet, and soon falls asleep. ►
10.40. Pulse 84, strong and regular; respiration 10. ► 1
o’clock. Patient awake; no further effects from the medicine; says he feels much relieved;
his headache, he asserts, has quite ceased; pulse 96, thermometer 38.6°), respiration 14.
No local symptom. Next morning, patient much the same; fever less; scarcely any headache;
tongue still coated; some diarrhœic stools in the evening are rather attributable to his
complaint than to the Apomorphine.
CASE VI.
Woman with gastric trouble.
1st. Dose of fifteen milligrammes given by the mouth; no effect. 2d. Administration of two
centigrammes; vomiting in eight minutes. ►
Woman, aged 23 years; has a child three years old; sound constitution; usual health good; a
patient since the day before we saw her at 9 A.M.; the tongue is thickly coated, and shows
the marks of the teeth; intense headache; blue circles around eyes; skin hot and moist;
constipation for three days; pulse 100, thermometer 38.6°, respiration 16. ► At 9.30 we gave her fifteen milligrammes of Chlorohydrate of
Apomorphine in thirty grammes of water (an extemporaneous preparation). ► 9.35. Pulse 108, respiration 16. ►
9.40. Pulse 116, respiration 16; some nausea. ► 9.45. No
change. ► 9.50. Pulse 108, respiration 14 to 16; nausea
ceased. ► 10 o’clock. Pulse 100, respiration 14. From
this time patient felt as before; no inclination to vomit. The medicine seemed without
effect. ► Next day, no change; fever quite considerable;
evening temperature 39.2°, morning temperature 38.4°; no stool; tongue coated; inclination
to vomit. ► 9 A.M. Pulse 96, respiration 14; twenty
milligrammes Apomorphine taken by the mouth; same preparation as yesterday. ► 9.5. Pulse 112, respiration 16; nausea. ►
9.8. Pulse 120, respiration 22; copious bilious vomiting. ►
9.10. Pulse 92, quiet; respiration 20. ► 9.15. Renewed
vomiting, less copious than at first. ► 9.20. Pulse 92,
quiet; respiration 16. ► 9.30. Quite quiet, but no sleep;
patient feels relieved; headache, which before the first vomiting was most intense, has now
almost entirely ceased. ► 11 o’clock. Pulse 92,
thermometer 38.6°, respiration 14; no movement of the bowels during the day; at night one
very difficult stool. ► Next morning, although the tongue
was less coated and the headache better, a saline purgative was prescribed. Perhaps we
should have obtained better results from a dose of three centigrammes Apomorphine.
CASE VII.
(Communicated by Dr. Zuber.) ► Hæmoptysis from tubercle. Injection of three centigrammes
Apomorphine; copious vomiting in four minutes. ►
Leon S., second-class trooper in the second regiment of artillery, 23 years old, of mean
appearance, was attacked, on the 22d December last, with a troublesome hæmoptysis. When I
saw him it had lasted four hours; the blood raised was bright red, frothy, almost pure, and
quite abundant (four hundred or five hundred grammes); cold fomentations had been applied to
his chest, and he had taken two tablespoonfuls of salt; pulse frequent, 104. It was
necessary to arrest the bleeding as soon as possible. I thought of resorting to the use of
emetics, so highly recommended in such cases, and I selected Apomorphine, whose properties
as a speedy emetic made it particularly applicable. ► At
5 P.M. I injected under the skin quite a large dose of Apomorphine, three centigrammes of
slightly altered solution (colored light-green); the patient went on coughing, and at each
paroxysm he brought up blood having the same appearance as before. ►
5.4. Abundant vomiting of food, without previous nausea; this lasted about two minutes; then
came a period of quiet, when the cough no longer racked the patient; in half an hour the
vomiting ceased; the patient was extremely feeble, but the means employed appeared to have
done good service; he coughed only at long intervals, and the expectorated blood became less
and less. ► Next day, there was hardly a trace of blood
in the sputa; hæmoptysis was probably owing to a tuberculous induration at the apex of the
right lung; no local effect.
CASE VIII.
(Communicated by Dr. Zuber.) Angina tonsillaris. Injection of two centigrammes Apomorphine; vomiting in
three or four minutes. ► M. T., sculptor; sick
for three or four days with acute tonsillitis; he was very subject to angina. At Rome, where
he was an art student, he had several attacks, one of which, of a phlegmonous nature, caused
him much suffering. Moreover, during a residence in the Campagna, he contracted an obstinate
intermittent, which still lingered, and imparted to the fever accompanying his angina a
decidedly remittent type; the tonsils are entirely swollen, they greatly impede respiration,
and deglutition is almost impossible. I made two free incisions into each tonsil, with a
view of depleting them; and, at last, to aid this effect, I thought of administering
Apomorphine, since it was exceedingly, difficult of the patient to get down a dose of
emetic. I injected, accordingly, two centigrammes of a recent solution; nausea came on in
three minutes, followed by vomiting, which the condition of the pharynx rendered very
difficult and painful. The vomitings, which were quite frequent, ceased in half an hour. As
I anticipated, the muscular contractions strongly favored the escape of blood from the
engorged tonsils, through the previous scarifications, and the patient soon felt
comparatively easy. I prescribed emollient gargles, and a draught containing seventy-five
centigrammes of quinine. ► Next day, there was
considerable improvement; fever less intense; the tonsils though still much enlarged, now
allowed air and warm drinks to pass easily. M. T. considered himself cured, and could not
sufficiently praise the new emetic. “At Rome,” he said, “they vomited me a
great deal, for they used to precede quinine by an emetic, but the effect was never so
speedy. Here the business is over before ordinary emetics would begin to operate.”
SUPPLEMENT: APOMORPHINUM.
Authorities. 2
, J. G. Blackley, M. B., Brit. Journ. of Hom.,
1873, p. 497, injected 10 minims of 10 per cent. solution under the skin of the left arm; 3, Same, injected 1/20 grain Hydrochlorate of apormorph., under
the skin of the arm of William J., aged twenty-eight years; 4,
Dr. Jurasz Deutsche Arch. für. Klin. Med., 1875, p. 52; 5,
M. Chouppe, Gaz. Hebdom., Dec. 1874 (Lond. Med. Rev., vol. iii, p. 57), general effects; 6, Dr. Brochin, Gaz des Hôp., Jan. 16th (ibid., p. 58), effects
of the hydrochlorate.►
Pulse 76; temperature 98.3° (normal; feels giddy;
complains of pressure at epigastrium; pulse 88, weak, but regular; pupils moderately dilated
(in four minutes); began to vomit slightly (in five minutes); vomiting profusely, this
continued for three minutes (in six minutes); ceased vomiting took a drink of water, which
came up immediately; milk was rejected in like manner; pulse 80, weak; temperature 98.6°
(in nine minutes); still feels very giddy, and looks pale; pupils dilated (in sixteen
minutes), [3]. ►
Pulse 72 (before experiment); 80 (in five minutes); 65 (in twelve minutes); 70 (second day),
[2]. [10.] ► Temperatue 98° (before experiment); 99.2° (in five
minutes); 99.2° (in twelve minutes); 97.8°. (second day), [2].
► After three minutes the pulse began to rise slightly,
and the respirations became slightly accelerated. At the end of four minutes I felt a sudden
qualmishness, which was almost immediately followed by nausea and profuse vomiting. This
continued for several minutes, and was followed as soon as the contents of the stomach had
been evacuated by severe retching. On taking a draught of water with a little brandy in it
this was immediately rejected, and on drinking cold water this too returned at once. No
bile, however came up in the vomited matters. At the end of seven or eight minutes from the
commencement of the experiment I began to feel very faint and was compelled to lie down, and
almost on doing so fainted entirely, and remained in a state of syncope for about five
minutes. On awaking from this I felt giddy and chilly, and was obliged to take a little
brandy and water. This was retained, and as I began to feel slightly drowsy, I remained
lying for the space of about one hour, during which time I perspired profusely. On rising I
still felt slight giddiness, but no inclination to vomit. I went to bed and slept soundly
all night, awaking about 8 A.M., in my usual health, slightly pale, but very hungry, [2]. ► In two to seven
minutes after the injection of a solution of 1 milligram under the skin the symptoms begin,
usually with dulness of the head, sometimes described as a headache, sometimes as a simple
heaviness or vertigo, often associated with roaring in the ears and feeling of heat. At
times the patient is suddenly attacked by a feeling of anxiety in the præcordial region, or
by pressure in the chest. With the reaction there is generally an inclination to sleep,
prostration, and loss of strength, and in a few cases nausea and retching, beginning without
warning. The relaxation during the prodromal state is at times very great, reminding one of
collapse, frequently associated with profuse perspiration, salivation, and paleness,
especially of the face. The vomiting comes on in from four to twenty-six minutes after the
injection, usually in ten to fifteen minutes after a dose of 5 milligrams. Vomiting is very
easy, without effort, or after the stomach has been emptied very difficult, and associated
with eructations and retching. The vomiting will occur once or be repeated two to eight
times, with greater or less intensity. Between the acts of vomiting the patient is usually
quiet, feels very weak, yawns or perspires very freely. Sleepiness is frequently noted. The
nausea continues, frequently associated with retching or eructations, and only ceases when
there is no more to vomit. Between the acts of vomiting there is very great prostration and
apathy. The whole stage of vomiting varies according to the frequency of the act and the
length of intervals between the acts, lasting from one to fifty minutes. After the cessation
of vomiting the symptoms gradually disappear; restoration is slow, the patient feels
nauseated for some time, and weak and sleepy, [4]. ► It appears from many experiments that Apomorphia produces
vomiting by what channel so ever it reaches the organism, but that its effects are more
prompt and more certain when it is introduced directly into the blood by intravenous or
subcutaneous injection. If given by the mouth, the dose must be increased, and the effects
are less certain. During the two or three minutes immediately following the injection, the
patient does not feel anything. Soon a sensation of weight at the stomach, followed by a
slight pain in the head, comes on. Then salivation becomes copious, the body is covered with
perspiration one or two efforts at vomiting without any result occur, and at the third, or
more rarely the fourth effort, the patient vomits three or four times successfully; then
comes a period of calm. The vomitings return after an interruption of five or six minutes,
followed by another interval of calm, and the same scene is repeated five or six different
times, to terminate definitely at the end of about half an hour, and to give place to a very
quiet sleep, lasting from an hour to an hour, [5]. ► A woman, forty years of age, complained a gastric troubles
without fever. After some days she was attacked by sore throat and complete anorexia. The
tonsils were red and swollen and the tongue very much furred. A hypodermic injection of
three or four milligrams of Hydrochlorate of apomorphia was administered to her in the
sternal region. The pulse was full, and marked 100 beats. In four minutes the patient felt
slight uneasiness and a little vertigo she said she felt her head turning round and becoming
stupid. She turned pale, became insensible, her pulse became extremely weak, intermittent,
and then imperceptible; the pupils were dilated, and the respiration seemed to be entirely
suspended. Slight tonic convulsions showed themselves in the left corner of the mouth and in
the left cheek. The patient became inert and did not answer to the questions put to her.
After sprinkling with cold water, inhalations of ammonia, frictions, mustard poultices,
etc., she recovered consciousness in three minutes and vomited twice, after which she again
fainted, became extremely pallid, and the pupils were alternately dilated and contracted;
these symptoms were afterwards repeated, [6].® 2000
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