ATROPINUM.
FEVER.
► Skin rather cool
than warm on forehead and head, [18]. ► Chilliness and cramp, and tingling of the extremities (after
one hour), [8]. ►
Internal coldness with external burning heat of the whole body; toward 6 P.M., it became so
great that he was apprehensive, and so restless that he could not remain anywhere; he
hurried home expecting misfortune; scarcely had he entered the house when he had to seek the
open air, only to return again to the house; at 7 1/2 P.M., he lay down hoping that the
restlessness would go away by sleep; could not sleep till toward eleven; he tossed about in
bed, with audible and perceptible palpitation and anxiety as great as if he had committed a
great crime, [1]. ►
General diffusion of warmth, [8]. ► Skin hot (after forty-eight hours), [8]. ► The skin is hot and
pungent, face flushed, veins of forehead tinged, and head burning, [11]. [510.] ► Slight elevation of the temperature of the surface, rarely
exceeding 1° and a still slighter and less appreciable rise of the internal temperature of
the body, [8]. ►
Temperature 100° (after twenty-four hours), [18]. ► Temperature 102° (after fourteen hours), [18]. ► Temperature frequently
varied, now glowing heat, now cold over the back (cold predominated), [1]. ► Alternate heat and chill, a
violent tension of the chest, with dyspnœa, and feebleness of the pulse (from tasting
Atropia), [27]. ►
Atropia checks sweating, whether physiological or morbid, [29].
CONDITIONS.
► Aggravation.
► (Morning), Talked
confusedly, etc.; on rising, vertigo; on waking, very dizzy; on waking, sticking in left
temporal region; felt very weak. ► (Night), Immediately upon closing eyes, after retiring, delirium;
agitation, etc.; frequent micturition. ► (Toward 6 P.M.), Internal coldness, etc.; of the whole body. ► (In open air), Very weak.
► (Beer), Caused pain
in stomach. ► (Upon closing eyes),
Mind becomes confused, etc. ► (After
coughing), Burning in throat. ► (After drinking milk), Vomiting. ►
(Every motion), Pains in base of skull, etc. ► (Periodic), Dry cough,
etc. ► (Each pulsation of heart),
Pain in eyes, etc. ► (Rising),
Vertigo, etc. ► (Stepping),
Pains in base of skull, etc. ► (Turning
head quick), Vertigo. ►
(During the vomiting), Pain in umbilical region. ► (On waking), Vertigo,
etc. ► (Walking),
Severe sticking pains; pain in stomach. ► (Drinking warm fluids), Vomiting. ►
Amelioration. ► (Evening),
Pains in head disappear. ► (Towards
morning), Dryness in throat. ► (Toward 11 A.M.), Pains in head. ►
(Going into open air), Confusion in head. ► (After moving about in open air),
Sticking in left temporal region. ► (Sitting), Feels better. ► (Standing), Feels better.
SUPPLEMENT: ATROPINUM.
Authorities.
30, Dr.
Chassaignac (Gaz. des Hôp., January, 1853), Am. Journ. of Med. Sci., vol. lii, p. 540, 3 or
4 drops of a solution made with 5 centigrams of Atropine in 30 grams of water, acidulated
with acetic acid, were dropped into the eye of a man suffering with cataract; 31, Dr. Bethune, Bost. Med. and Surg. Journ., vol. lvi, 1857, p.
201, made three successive applications to the eye, of a solution of 2 grains to the drachm;
32, M. T. Saddler, M.D., Med. Times and Gaz., 1868 (1),
p. 391, a child, aged three months, took a teaspoonful of a mixture containing 1/200 grain
of the sulphate in a fluid drachm, afterwards 6 drops; 33,
Geo. Lawson, Lancet, 1868 (1), 570, effects of the application of the sulphate to the eyes
of two persons; 34, S. R. Percy, M.D., Prize Essay,
1868, p. 15, took 1/10 grain of the sulphate in 1 ounce water; 35,
S. W. Gross, M.D., Am. Journ. of Med. Sci., Oct., 1869, p. 401, Mrs. H., aged forty-three,
took 3 grains of Atropia, death; 36, F. H. Parsons,
M.D., Brit. Med. Journ., 1869 (2), p. 675, a man, aged forty-five years, swallowed less than
2 drachms of a solution of the sulphate; 37, A. W.
Stocks, Brit. Med. Journ., 1870 (1), 489, for an attack of lumbago, made a hypodermic
injection of 6 minims of a solution containing 1 grain alkaloid to 2 drachms water, with
relief, afterwards used the same quantity obtained from a different druggist; 38, Drs. Millick and Kerper, Med. and Surg. Reporter, vol. xxvi,
1872, p. 257, a lady, for rheumatic iritis, took a solution containing about 1 grain
Atropia, and immediately drank hot coffee; 39, S.
Buckley, Pharm. Journ., Third Series, vol. ii, 1872, p. 597, Mr. A. Harris, took some
Atropia in food, death; 40, Roderich Zeiss, Ueber die
Werkung des Atropins auf den Puls., Jena, 1875; 41, Dr.
Hugo Magnus, Zehender’s Klin. Monatsbl., 1876, p. 386, Royal Loud. Oph. Reports, 1877 (Am.
Journ. of Med. Sci., New Series, No. 150, p. 569), effects on the eye; 42, T. E. Murrell, M.D., Phila. Med. and Surg. Rep., Sept., 1876,
p. 269, a man, aged forty years, took a solution of Atropia; 43,
Henry Gibbons, M.D., Pacific Med. and Surg. Journ., 1876, p. 466, a child, aged three years,
took and indefinite quantity of a solution; 44, R. L.
Bowles, M.D., Brit. Med. Journ., 1876 (1), p. 533, dropped 4 drops of a solution of 4 grains
to 1 ounce, into two persons eyes; 45, E. Nettleship,
ibid., p. 444, a woman, aged forty-four years, for iritis, applied a solution of the
sulphate, 4 grains to 1 ounce, several times a day to the eye; 46,
J. Oscroft Tansley, Med. Rec., vol. xii, 1877, p. 334, a young woman, with tinnitus aurium
in one ear, was given a solution of the sulphate, 4 grains to 1 ounce, to be instilled into
the ear daily; 47, same, a woman applied a plaster to
the right side; 48, E. Wilson, Lancet, 1878 (1), 165, a
woman, aged forty-three years, and her daughter, aged thirteen years, drank a lotion
containing 3 grains of the sulphate; 49, A. S. Greenway,
M. B., Brit. Med. Journ., 1878 (2), p. 516, Chas. S., aged forty-five years, took over a
teaspoonful of Atropia; 50, J. C. Mackenzie, M.D.,
Cincin. Lancet and Obs., Feb. 1878, p. 148, A. C. H., aged twenty-six years, took 20 grains
of the sulphate; 51, F. C. Holts, M.D., Chicago Med.
Journ. and Examiner, vol. xxxviii, 1879, p. 43, a man, aged seventy-two years, applied a
solution of Atropia to the eye for several days.►
In twelve days she returned considerably disturbed in
mind, saying she could not see well with the eye upon the same side
as the ear in which the Atropia had been used. It was examined and found to be strongly
under the action of Atropia, the other eye being normal, [46].
► Acute glaucoma; the Atropia was dropped in to
facilitate a proper examination of cataract. The right eye only was affected, though the
drops had been put in both. The patient had been seen on two occasions before the Atropia
was used, and there was no occasion to suspect any glaucomatous condition. The symptoms came
on within a few hours of the drops being used, [41]. ► In one case there was acute conjunctivitis, lasting several
days; in the other, erysipelas of the lids, spreading to the face and head, was excited on
two occasions, a period of six months intervening, [33].
► In four or five days she began to have difficulty in
seeing with her right eye, being the eye upon the same
side of the body to which the plaster had been applied. Upon examination the pupil was seen
to be considerably enlarged, and the eye was undoubtedly strongly under the action of belladonna, the left eye being normal, [47]. [520.] ► Dr. Rothhaupt, aged twenty-five years, whose normal pulse was
60 to 64, at this time 64, injected 0.00025 gram Atropia; pulse gradually fell in five
minutes to 52; during the next twenty minutes it fluctuated between 50 and 60; after
twenty-six minutes it was 48; it slowly but gradually rose, until after an hour it regained
its normal rate, and after an hour and a quarter continued regular at 60. Another man, aged
twenty-five years, with pulse constantly at 68, took 0.0005 gram; after seven minutes pulse
60; after thirty-three minutes 68; thirty-eight minutes 72; sixty-two minutes 78;
seventy-seven minutes 78; where it remained constant. K. R., aged forty-six years, injected
1/2 milligram; pulse rose to a maximum of 70 beats. R. Z., aged twenty-five years, with a
pulse of 60; rose to a maximum of 68. B., aged twenty-five years, pulse 64; rose to a
maximum of 74. O. Z., aged twenty-one yeas, pulse 60; rose to a maximum of 80. The same
prover, K. R.; the pulse fell after ten to twenty minutes 10 beats. R. Z., the same. B.’s
fell 10 beats in one to ten minutes. O. Z.’s fell 6 beats in ten to twenty minutes. Another
series of experiments with 0.00075 gram; pulse 62, fell after twelve minutes to 48; after
thirty-nine minutes it was 78; after forty-nine minutes 86; after which it gradually
returned to the normal. Same man subsequently injected 0.001 gram (or 1 milligram), pulse
60; in seven minutes and three-quarters it fell to 52; after thirty minutes it was 102;
after which it returned to the normal and did not fall below it. Another proving, with 1 1/2
milligram; pulse 68; in twelve minutes 52; in forty minutes 104; after which it gradually
returned. After an injection of 1/4 milligram, the maximum fall of the pulse was reached in
twenty-six minutes, and lasted fifty minutes. After 1/2 milligram the maximum was reached in
sixteen minutes, and lasted forty-one minutes; after 3/4 milligram the maximum fall was
reached in thirteen minutes, and lasted twenty-one minutes. After 1 milligram the maximum
fall was reached in seven minutes and lasted fourteen minutes. After 1/4 milligram there was
no rise in the pulse. After 1/2 milligram the maximum was reached in eight minutes, and it
lasted fourteen minutes. After 3/4 milligram the maximum rise was reached in twenty-six
minutes, and lasted one hundred and nineteen minutes. After 1 milligram the maximum rise was
reached in forty-two minutes, and lasted one hundred and sixty-four minutes, [40]. ► In half an hour vertigo
occurred, with wanderings of vision; In three-quarters of an hour all the symptoms of
poisoning with Belladonna were present, flushed face, enormously dilated pupils, and
incessant hallucinations. The patient drew his coverings over him, and attempted to seize
objects that he saw in the air. On attempting to rise his legs failed under him, and he
could not take two steps without being assisted. His pulse was 120 and full. In the evening
he became more calm, but the bladder was distended, and he was unable to empty it, so that
the catheter had to be used. He lost all recollection of his illness except his delirium and
its accompaniments, [30]. ►
Delirium, uncertainly in his gait, with absence of sleep and difficulty of swallowing. On
the day after but one, he had another attack of delirium, somewhat resembling delirium
tremens, seeing imaginary persons in the room, [31]. ► It had a distinct persistently bitter taste, and produced a
numb sensation upon the tongue, somewhat similar, though less in degree, to that produced by
aconite. In about ten minutes it produced a sense of nausea, which continued to increase
until an effort was made to vomit. Although the effort at vomiting was made several times,
nothing was thrown up. To this intense thirst succeeded, and a frontal headache, which was
lessened by closing the eyes. Next a dryness was felt in the throat, and the tongue and
mouth felt dry and feverish. These symptoms were not relieved, and only mitigated for a
short time, by drinking water. This dryness of the throat increased, and was persistent for
several hours, causing at first almost constant deglutition, and towards the last a strong
effort to avoid deglutition, which had become painful. During the first tow hours the pulse
was less frequent, but afterwards became smaller and more rapid. The eyes soon lost all
control of distance; a printed book held at the usual distance was a perfect blur; held at a
long distance, letters could be distinguished, but the words upon looking at them, soon ran
into confusion. Objects at a distance could be plainly seen, even a little more plainly than
natural (hypertrophia), but near objects, though for a moment distinguished, soon lost their
distinctness. A numb or crawling sensation, a formication, was felt down the back, upon the
arms, and back of the hands. This formication was intense and very unpleasant upon the
palate. Light became unpleasant to the eyes, causing pain deep in the eyeballs. Motion
became unpleasant, and if the feet were lifted in walking, the floor seemed to recede from
them before they again were put down. A sliding of the feet along the floor seemed to be the
only safe way of locomotion. The head began to be dizzy, and for fear of falling it was
necessary to be seated in the easy chair. Thirst at this time was very great, but only
little water could be taken at a time, as the effort of swallowing was unpleasant. A languid
feeling came on, as the semirecumbent position was assumed, and whether sleep, accompanied
with wild dreams, or waking hallucinations followed, it was impossible to tell. Whether the
brain was troubled with hallucinations, or with wild fantastic dreams, they were exactly the
opposite of those produced by Cannabis indica, for all the imaginations and conversations
were of the long past, none of the future. Whether there was total blindness, or merely an
imagination of blindness, could not be remembered; but, if there was blindness to the
external eye, the mind saw all its images with great distinctness, and the impress of them
was left with vividness. There was consciousness of individuality, but the actions were
performed by others, who were embodied spirits of those long since departed. Lengthy
conversations of a most pleasant character were held with Plato, Alcibiades, Aspasia, and
others. How long this state lasted cannot be told; but sound, profound sleep must have
followed, for consciousness to external objects did not return till sixteen hours after
taking the Atropia. Awaking took place suddenly; there was no pain, no headache, nothing
abnormal but a languor and disturbed vision. The bladder had not been emptied during these
sixteen hours, and although a large quantity of water had been drunk, but a moderate
quantity of urine was passed. The vision was not clear for several days, [34]. ► In about twenty minutes
her hands were tremulous and her eyes closed; but she was quiet and became drowsy. In a few
minutes the agitation increased, until it became more violent; she at the same time kicking
out her feet and throwing her arms forward. On attempting to move her to her bed, it was
found that her limbs were powerless, and that she was unable to stand, so that she had to be
carried. Her face was very much flushed. In a few moments a meddlesome and pleasant delirium
set in, in which she picked at her clothes, tried to get out of bed, and imagined she was
sewing, or nursing her child, or engaged in shopping with her sister. These hallucinations
lasted for about ten minutes, when she sighed and yawned repeatedly, and “dropped into
a comfortable sleep;” the interval between the taking of the medicine and the sopor
having been rather more than one hour; after three hours’ unconsciousness, and laboring
under a heavy stupor. The eyes were closed, the pupils dilated, and the muscular system was
greatly relaxed, excepting a condition of trismus, which was well marked, and deglutition
was almost impossible. The respiration was labored and very much like that of an intoxicated
person. The pulse was quite good, but neither it nor the respiration was counted.
Countenance somewhat livid. Lids closed, conjunctivæ slightly injected; eyes had a fixed
and brilliant stare. The tongue, roof of the mouth, and soft palate were glazed and parched,
[35]. ► Pupils
dilated. Excessive dryness of mouth and throat, with a sensation of burning and choking.
Great difficulty in swallowing. Pulse 130. Great dizziness, and a sensation of weight on the
top of the head and over his eyes. Frequent rigors and loss of muscular power, being unable
to walk, or as he expressed it, “to feel his legs.” Very restless and agitated.
Great difficulty in articulation. Micturition accomplished only after some trouble, [36]. ► In less than five
minutes, I became aware that I had an overdose; my heart began to labor heavily, and to my
feelings, roughly, at the rate of about fifty per minute, accompanied by a sore feeling
immediately over the base of the heart. This continued about ten minutes, and was
immediately followed by intense thirst, dryness of the mouth and throat, with great
perversion of sensation, everything tasting intensely acid. The skin of my whole body began
to feel turgid and swollen, and in about an hour and a half was covered with a rash
precisely similar to that of scarlet fever. There was also diplopia; during the evening I
was completely unable to read the newspaper. Next morning there was power to read with one
eye at once; and in the evening the disturbance of vision had entirely gone, as well as all
other signs of the action of the drug, [37]. ► Insensible and comatose. Pupils largely dilated. Face flushed
and swollen, [39]. ►
In a state of intense excitement; skin greatly congested; face, hands, and whole body
swollen and bloated; mind delirious; sensibility suspended; violent clonic spasms at times
of the limbs; pupils dilated to their fullest extent; intense thirst; speech thick and
clogged; tongue and throat swollen (after two hours), [38].
► In one hour, face flushed, full, strong, hard, and
bounding pulse, almost stertorous breathing, with much somnolency, and great impairment of
all the senses. When aroused and raised up he would look wildly around, and when addressed
in a loud voice would mutter some incoherent words. There was great muscular tremor, and
muscular weakness, particularly of the lower extremities, insomuch that he was unable to
stand when aroused, although at the same time he exhibited considerable strength in his
arms. He passed his urine involuntarily, [42]. [530.] ► Delirious, but not
wholly unconscious, starting frequently from a brief period of repose and screaming with
pain or terror, and clutching violently with the hands. The flexor muscles of the
extremities, the upper especially, were principally affected. The muscles of the spine
occasionally contracted so as to jerk the head backwards with electric quickness. Pupils
dilated to the utmost. Pulse 120, and diminished in force. Surface dry and hot, and covered
with a strongly marked scarlatinoid redness (after one hour), [43].
► Giddy and strange feeling in the head so that he could
not see. Throat of a deep red hue, sore and could not swallow. Pupils widely dilated, [44]. ► Dryness of mouth
and throat. Sour taste in mouth. Dryness and burning in the stomach. Repeated vomiting;
partial delirium, [45]. ►
Pupils widely dilated and insensible to light; gait staggering, the patients being unable to
stand alone; there was great thirst, and the elder patient had incontinence of urine. They
both talked and laughed wildly, but answered questions readily. The intellect was confused,
both patients fancying they were still at home, and attempting to arrange furniture, [48]. ► Staggering on
walking. Excessive nervousness. Giddiness. Loss of power over legs. Pulse rapid.
Unconscious. Pulse weak and irregular. Skin dry. Face flushed. Violent delirium. Tongue dry
and brown. Respiration laboring and quick, accompanied by flapping of cheeks. Twitching of
some muscles of arms and legs. Catching at imaginary objects. Chest, râles about base.
Unintelligible talk in sleep. Tympanitis over abdomen. Tenderness over abdomen. Soreness at
pit of stomach. Urine high-colored, turbid, of an amber color; chlorides present; no
albumen; specific gravity 1015. Pain over right side of chest. Cough and expectoration;
sputum rust-colored and scanty. Absolute dulness of chest as far as spine of scapulæ on
right side behind, with tubular breathing and bronchophony. Over left lung, posteriorly,
rough breathing, otherwise breath sounds healthy, [49].
► Dryness of the throat. Confusion of vision. Pupils
largely dilated (after four hours and a half). Slightly delirious, and staggered as if under
the influence of alcohol (after five hours); he seemed to have hallucinations, for
frequently he would put out his hands and attempt to grasp some imaginary object (after five
hours and a half). Drowsy and stupid, but he recognized me and asked me in a sort of maudlin
manner what was the minimum dose, meaning the minimum lethal dose; he could be easily
aroused, and although his answers to questions were given in an indistinct tone they were
quite rational, and some remarks that he made indicated that he appreciated the danger of
his condition (after five hours and a half); the coma steadily increased, and the prospects
seemed almost entirely hopeless; his head hung upon his shoulders in a perfectly limp state;
there was complete unconsciousness, from which he could not be aroused; for about half a
minute respiration ceased, and artificial respiration was resorted to, and cold only be
maintained at eight in a minute (after ten hours). Pulse 140, full and strong (after five
hours and a half); 120, full, but no so forcible as before (after seven hours and a half);
120, less force (after ten hours). Respirations 20, and not in any respect abnormal (after
five hours and a half); about 24 (after seven hours and a half); for about half a minute it
ceased, and artificial respiration was maintained at 8 per minute (after ten hours);
improved (after eleven hours), [50]. ► Delirium, to which was soon added all manner of absurd
hallucinations. Pulse rapid and feeble. Skin flushed and dry. Tongue dry and brown. Great
thirst. Dryness of the throat, [31]. ► In a few minutes the child turned a deep red, like
“scarlet fever,” over its face and the upper half of its body; the perspiration
was checked, and the skin became hot and dry. This continued for five hours (after a
teaspoonful). The same redness appeared, but only lasted for half an hour (after 6 drops), [32].® 2000
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