MORPHINUM.
HEART AND PULSE.
►
Heart’s Action. ►
Palpitations, [40], [66]. ►
Violent throbbing in the heart and carotids, [35]. ► The
beat of the heart could not be felt; with the ear could be indistinctly
heard only at times, [41]. ► Congestions of the head, palpitations of
the heart, with tense pulse; the latter often suddenly disappears and
gives place to a scarcely perceptible, thready, slow, and intermittent
pulse, that marks the beginning of a serious collapse; increased reflex
irritability; the patient has frequent attacks of sneezing and yawning;
he starts up in fright if one approaches him; touch of the skin causes
cramp and twitching, [73]. ► Pulse. [400.]
► Pulse full and slightly accelerated
(after two hours), [23]. ► Pulse strong and frequent, [37]. ► The
pulse in severe cases in small, at times tense or thready. In some cases
oppression of respiration and palpitation are observed, [73]. ► Pulse
strong, rapid, [6b]; (after half
an hour), [6a]. ► Pulse small and rapid, [66], [67].
► Pulse small, contracted, rapid, [18]. ►
Pulse scarcely perceptible, rapid, weak, fluttering, about 140 or 150, [41]. ►
Pulse feverish, [11a]. ► The pulse at first sinks, and then rises
several beats, [44a]. ► Pulse 79 (after twenty minutes), [9]. [410.]
► Pulse ranging from 140 to 160,
extremely non-resistant, feeble, fluttering, [48]. ► Pulse
63 (before taking); 108 (after half an hour), [10]. ► Pulse
66 (before taking); 94 (after twenty minutes), [8]. ► Pulse
rose from 68 to 78 (immediately); to 88 (after one hour), [8b]. ► Pulse
rose from 84 to 94 (after half an hour), [9b].
► Pulse rose from 61 to 86 (after a
few minutes), [11a]. ► Pulse rose from 66 to 82 (after half an
hour); to 90 (after one hour and a half), [10b].
► Pulse 60 (before taking); 80 (after
half an hour), [11b]. ► Pulse 65 (before taking); 68 and
irregular (after twenty-five minutes), [9a].
► Pulse 66 (before taking); 80 (after
half an hour), [8a]. [420.] ►
Pulse 80 (before injections); accelerated 6 beats (three-quarters of an
hour and one hour after 1/15 grain); 80, regular, of good volume and
power (two hours after 1/15 grain); weaker (three-quarters of an hour
after 1/12 grain); feeble, decreased 4 beats (one hour and
three-quarters after 1/12 grain); very small, weak, intermittent,
accelerated 6 beats (three hours and a half after 1/12 grain), [58]. ►
Pulse 74, of fair volume and power (before the experiment); 70, a little
fuller and stronger (two hours after 1/6 grain); accelerated 6 beats,
unchanged in volume and power, intermittent thrice in two minutes
(thirty minutes after 1/4 grain); accelerated 8 beats (three-quarters of
an hour after 1/4 grain); accelerated only 1 beat, of diminished volume
(one hour after 1/4 grain); decreased 8 beats, and of less volume and
power than before the injection (two hours and a quarter after 1/4
grain); accelerated 16 beats (ten minutes after 1/2 grain); accelerated
20 beats, increased in power (half an hour after 1/2 grain); attained
its maximum acceleration of 26 beats, strong and regular, and of good
volume; a pulse indicative of strong stimulation (one hour after 1/2
grain); the maximum acceleration remained unchanged (two hours after 1/2
grain); fallen from 100 to 96, and had nearly returned to its original
volume and power (three hours after 1/2 grain); 94, still a little
fuller and stronger (three hours and a half after 1/2 grain), [53]. ►
Diminished rapidity of the pulse (immediately), [44]. ► Pulse
excessively weak, and rather slow, [20].
► The pulse sinks during the first
hour several beats, [44b]. ► Pulse lowered 4 to 8 beats, but only in
healthy subjects, or those laboring under simple neuralgic complaints
(after half an hour), [46]. ► Pulse about 60 (after four hours), [43]. ►
Normal pulse 60; all day was 49 and 50 (second day), [30]. ► Pulse
65, regular (before taking); 90 (after twenty-five minutes); 80 (after
forty minutes); 62 (after three hours), [3].
► Pulse 75 (before taking); 72 (after
a quarter of an hour); 75 (after three-quarters of an hours); 68 (after
one hour and a half); 66 (after two hours); 70 (after three hours), [7]. [430.]
► Pulse 80 (before the injection);
increased in volume and power, evidently under the influence of strong
stimulation (after one hour); 74, regular, of the same volume and power
as before the injection (after two hours), [56]. ► Pulse
74, regular, good volume and power (before the experiment); reduced 19
beats, being now 55, unchanged in volume and power (after two hours and
a half), [52]. ► Pulse 100 (before the injection);
decreased 4 beats, regular (after one hour); decreased 30 beats, feeble,
and slightly irregular (after two hour), [57].
► Pulse 76 (before the injection);
decreased 16 beats, regular, of unchanged volume and power (after one
hour and a half); decreased 20 beats (after two hours); decreased 22
beats, being now 54, regular, and of good volume and power (after four
hours), [55]. ► Pulse 78 (before the experiments);
decreased 4 beats (fifty minutes after 1/4 grain); decreased 10 beats,
unchanged in volume and power (one hour and a half after 1/4 grain); 60,
decreased 16 beats, of normal volume and power (three hours after 1/4
grain); decreased 4 beats, unchanged in volume and power (one hour and a
quarter after 1/2 grain), [54]. ► Pulse irregular (soon, after fifteen
minutes); afterwards not to be felt, [33].
► Pulse slow, full, intermitting, [6]. ►
Pulse small, contracted, intermitting, [5].
► Pulse hard, [35]. ► Pulse
greatly contracted, [5]. [440.] ►
Pulse exceedingly weak (after eleven hours and a half), [71]. ► Pulse
small, [29]. ►
Pulse very small (after four hours), [36].
► Pulse extremely small
(immediately), [42]. ► Pulse scarcely perceptible, [70]. ►
Very great diminution in the strength of the pulse, and a considerably
reduced arterial tension, [46]. ► The increase or diminution in arterial
tension does not take place in accordance with the quantity injected,
and the largest dose only prolongs the lowering effect, [46]. ►
Tracing almost a straight line, representing the maximum effect on the
arterial tension, which there-after began to increase (half an hour
after 1 centigramme); marked increase in the swell corresponding to the
arterial diastole; but the smaller prominence, caused by dicrotism, is
not yet visible (one hour and ten minutes after 1 centigramme); tracing
returned to normal outline (two hours and ten minutes after 1
centigramme), [46].
NECK AND BACK.
►
Stiff neck (second morning), [43].
► Great pain in the back (after two
hours), [43]. [450.] ►
Pains extending along the spine, [6a].
► Pain and twitchings all down her
spine (after four hours), [43]. ► Weakness of the loins, for several days, [7a].
EXTREMITIES IN GENERAL.
► Objective. ►
Tremor of the hands, [73]. ► Trembling of the limbs, [61]. ►
Trembling of the limbs, and general oppression, [67]. ►
Twitching of the limbs, [1]. ► Her fingers were involuntarily contracted
and extended; she experienced some uneasiness about the elbows and knees
(after third dose); the muscles of the hands and feet became rigidly
contracted; the legs were drawn upon the thighs, and they upon the
abdomen; the arms were alternately flexed, extended, and then contracted
across the thorax (after fourth dose); in fact, the spasmodic action of
all the voluntary muscles was so great as to simulate a genuine case of
traumatic tetanus; alcohol, ammonia, coffee, cold and hot ablutions, and
constant frictions were resorted to with no effect; the spasmodic action
commenced at 2 P.M., and continued till 5.30 P.M., [19]. ► Slight
stiffness or heaviness of the limbs (after one hour), [7]. ► Limbs
paralyzed (after two hours), [23].
[460.] ►
Limbs weak, [6a]. ► Weakness and some trembling of the limbs,
[7a]. ►
Weakness of the joints, [11a]. ► Subjective. ►
Her arms and legs felt as if they were alive, and as if they were going
to jump up (after twenty hours), [43].
► Feeling of great weariness, in the
limbs, with inclination of the right lids to close; great longing for
rest (after one hour), [7a]. ► Abnormal sensations in the extremities
associated with salivation, [73]. ► Heaviness of the limbs, [17]; (after half an hour), [7a]. ► Pains
in the joints, [8b], [66]. ►
Violent pain in the joints, [66].
SUPERIOR EXTREMITIES.
► Stiffness and pain in the arms, after
sleep, [6b]. [470.] ►
Heaviness of arms (after first 1/4 grain), [50]. ► A
peculiar drawing, almost painful sensation in the wrist, [44b]. ►
Trembling of the hands, [63]. ► Hands somewhat tremulous, after sleeping,
[7a]. ►
Slight trembling and unsteadiness of the hands, while writing, [7]. ►
Fingers numb, and both thumbs firmly drawn into the palms of the hands, [33].
INFERIOR EXTREMITIES.
► Gait insecure and tottering, [66]. ►
Gait irregular; staggered like a drunken man (second morning), [50]. ►
Her legs were twitched up, and she begged that they might be held, as
she could not keep them quiet, and said it felt as if there were worms
in them (after four hours), [43]. ► A few twitches of left leg (after one
hour), [60]. [480.] ►
Legs swollen, so that he could not put on boots (second day), [45]. ►
Cramps of the several muscles, [61].
GENERAL SYMPTOMS.
►
Objective. ► Emaciation, [69]. ►
He lost about 15 pounds of body weight, [63].
► General cachexia, [66]. ►
Trembling, [68]. ► Whole body trembles, [66]. ►
Twitching of the muscles, [5], [62], [69].
► Twitching of the muscles of the
face and limbs, at times, [7]. ► Both sides of her mouth were twitching;
the arms were bent and moved backwards and forwards convulsively; the
motions soon ceased but returned (after two hours), [43]. [490.] ► Jerking in the whole body, [68]. ►
Violent jerking in the arms, head, and especially in the face, [3]. ►
Convulsive motions, [2]; (second
day), [23]. ►
Convulsive and tetanic spasms, [25].
► Convulsions, [66]. ►
Convulsions of the extremities and face, with partial opisthotonos;
convulsions renewed by tickling or pressure upon the skin, without any
loss of consciousness, [21]. ► Partial opisthotonos (after two hours), [43]. ►
Eclampsia, [37]. ► Drawing and stiffness of the muscles, [66]. ►
Patient rigid, absolutely immovable; extremities exhibited no
flexibility whatever, and the transient contraction seemed like rigor
mortis; indeed, it was with difficulty that the joints could be moved, [41]. [500.]
► Muscular system very much relaxed
(after four hours), [36]. ► The sensory nerves had almost ceased to
act, and the motor portion was also materially affected by the drug
(after four hours), [36]. ► Phrenic and pneumogastric nerves
considerably narcotized (after four hours), [36]. ► Great
weariness (after thirty-six hours), [23].
► Weakness, [1], [8b], [14], etc. ►
Mental and physical weakness and laxity, [66].
► Weakness of the limbs, small of the
back, neck, and joints (after twenty-five minutes), [9a]. ► Great
weakness, [12]. ► Great weakness of the body, so that he
could with difficulty get into bed, [39].
► Almost unable to walk, for four
hours (after two hours); did not recover from weakness for a week, [57]. [510.]
► Could not get up, in morning
(second day), [45]. ► Prostration, [14], [18],
[66], etc. ►
General prostration, [6]. ► Weakness and general prostration, [6c]. ►
Muscular prostration complete, [48].
► Sudden prostration; she had not
strength to stand up, [49]. ► Fell suddenly to the ground, as if struck
by lightning (after a quarter of an hour), [23]. ►
General weakness and loss of power, [73].
► Some spasms of the facial muscles
took place, and she fell back to all appearance dead; face blanched,
pulse not to be felt, and respiration not to be perceived; insensibility
continued about three minutes), [33].
► Insensible (after nine hours), [24]; (after nine hours and a half), [71]. [520.]
► Collapse; on the second or third
day after the withdrawal of Morphine there occurs in consequence of the
previous slight nutrition diarrhœa, sleeplessness, and yawning, a
condition of weakness in almost all patients, the pulse becomes small,
the face sunken, the patients cannot leave the bed, and have an
expression of complete exhaustion; this simple collapse is not
dangerous; it either disappears as soon as the patient begins to take
regular nourishment or it passes into a more serious from; this latter
commences often with alteration of the voice and articulation; the
patients are hoarse, they stammer or hesitate in speech; the facial
muscles jerk, the tremor of the hands increases; sometimes this serious
collapse appears suddenly, even at a time when the results of
abstinence, as vomiting and diarrhœa, seem to have subsided, and when
it is least expected. Even while the patients are sitting in bed busy
with their surroundings they fall back unconscious, and can at first be
awakened only by most energetic means; the face becomes sunken or
deathly pale, the nose pointed, eyes turned upward and sunken,
respiration difficult, sighing, and slow, pulse perceptible only at the
heart, or the face becomes deeply red, the eyes shining, pulse 44 and
40, and after a transient nausea and a deathly sensation the patient
becomes again unconscious; when raised up the head sinks forward on the
chest. No response can be obtained either by shouting or irritating the
skin; this condition lasting from fifteen minutes to nearly an hour is
repeated three or four times at short intervals in twenty-four hours,
during which the patient remains only partly conscious, or consciousness
returns completely, or the patient may die with symptoms of paralysis of
the brain, [73]. ► She retired at 8 P.M., feeling as she
said “quite drunk;” in about one hour after she was found
perfectly insensible; she was lying upon her back, her eyes open, a
delicate flush in the cheeks, and the lower
extremities paralyzed, very cold, and doughy; the extremities
were violently pinched; pricked with needles, even after consciousness
returned, but with no result; consciousness partly returned in an hour,
when the right arm, and leg were
paralyzed, with violent trembling or shaking; Nux 200 relieved (after a
few doses), [38]. ► The patient was found to be apoplectic,
unconscious, with stertorous respiration and bluish congestion of the
face, [35]. ►
Faintness, nausea, and constant retchings, with alternate flushes of
heat and cold, for five hours (after two hours), [56]. ► Two
attacks of faintness, with dilated pupils (second morning), [8b]. ►
Faint and almost ready to drop (after two hours and eighteen minutes);
recovered in about half an hour after taking a cup of tea, but still
felt poorly and sleepy, [51]. ► So much faintness and nausea as to
confine her to the bed for the remainder of the day, which was for seven
or eight hours (after three hours), [16].
► Dead faint, [70]. ►
Fainted several times, so that she was thought to be dead (after two
hours), [43]. ► When rising suddenly from stool, he
fainted and was soon dead (after three days), [20]. [530.] ► Restlessness, [14], [18],
[62], [66]. ►
General hyperæsthesia, [66]. ► Subjective. ►
Increase of reflex irritability, [66].
► Relex irritability appeared to be
entirely gone; the finger, and subsequently a feather, applied to the
fauces and upper portion of the œsophagus, failed to call forth any
reflex action whatever, [48]. ► (She has comparative, though not
complete, immunity from pain), [72].
► At first, an agreeable sensation, [3]. ►
A sort of pleasant weariness, [60].
► Walked three miles, felt very weak
going along (after two hours and eighteen minutes), [51]. ► Had
felt faint, tremulous, and sick for fifteen minutes (three-quarters of
an hour after 1/12 grain), [58]. ► Heaviness of the whole body, [44b]. [540.]
► An indescribable sensation of
sickness and discomfort, and a condition bordering on delirium, [69]. ►
The nervous system in general is affected; uneasiness, sleeplessness,
hallucinations, alternating moods, hyperæsthesia, neuralgia,
paræsthesia, trembling of the hands, and increased reflex irritability,
and other symptoms of this kind occur, [73].
► Towards 3 o’clock in the afternoon
(after two hours before the usual time for injection), the beneficial
influence of the Morphia has usually given way, not (save exceptionally)
to positive pain, but to the
indescribable sense of depression with Niemeyer’s patients so
graphically represented to him by the phrase “katzenjammer;”
this feeling disappears almost immediately after the injection, [72]. ►
Very ill after the return of sensibility, [33].
► Oppression, [66]. ►
Neuralgia, [62]. ► Neuralgia in various parts of the body,
forehead, occiput, and stomach, [73].
► “Sore all over” (second
morning), [43]. ► Sensation as if the flesh were trembling
on the bones, [49]. ► Crawling and trembling in the tips of the
fingers and in the whole body, [68].
[550.] ►
After the severe symptoms of the period of abstinence have disappeared,
and the patients seem to be convalescent, the whole of the symptoms
suddenly break out again; this renewed outbreak has, however, no further
influence on the course of the case, and generally lasts only one or two
days; in this patient, the relapse was severe, it lasted thirty-six
hours, [62]. ►
Distinct intervals of two or three minutes between the paroxysms of pain
and convulsions, [43].
SKIN.
►
Objective. ► Skin deathly
pale, [29]. ►
The skin lost its elasticity, [69].
► Eruption over the whole body
(second morning), [9a]. ► Eruptions of red pimples, [6b]. ►
Numerous dark bluish spots on the back and thigh, [35]. ►
Eruption over the face and large portion of the body (second day), [9b]. ►
Eruption in the eighth intercostal space, which, except for the absence
of pain, resembled herpes zoster, [61].
► The skin loses its turgescence,
color, and tension. The subcutaneous cellular tissue atrophies (though,
in some cases, especially in women, it contains fat). The face is mostly
pale, ashy gray, seldom deep red, sometimes of a normal color; the
perspiration is usually much more profuse than normal, exanthema is very
seldom observed. Inflammation of the sebaceous glands, zoster, affecting
especially the chin, cheeks, intercostal spaces, occurs from time to
time, disappearing and returning, or in some cases persistent. At the
point of injection of Morphine abscesses form and infiltrate in the
skin, sometimes of a very large size. The patient complains of coldness
or even chilliness, [73]. [560.] ►
Arms and legs covered with red pimples, [6c].
► Subjective. ► Biting in the skin; this biting is
sometimes accompanied by small round elevations, [2]. ►
Crawling, tickling, and itching over the whole body, [68]. ►
Formications, [62]. ► Formication all over (second day), [23]. ►
Itching in the skin, [14], [18], [66];
(after thirty-five minutes), [11];
(after half an hour), [8]. ► Soon wakened by an itching sensation over
the whole body, which induced vigorous and constant scratching; this
sensation was felt in every part of the body, from the crown of the head
to the soles of the feet; head itched as though innumerable insects were
crawling through my hair; face felt as though covered with cobwebs,
which I would try to wipe off; bottom of feet felt as if I had
chilblains; the legs, arms, abdomen, chest, and back, all itched as
though being tickled with feathers, and I was kept busy scratching from
head to feet; this lasted till morning, and I should be afraid to say
how many times I raked over my entire body with my ten finger-nails; I
think that after giving myself a thorough going over, I would drop
asleep, but soon be awakened by the itching, and have to scratch more
vigorously than ever. I expected to find my body covered with blotches,
but my skin was as white and smooth as ever; at intervals all next day
and evening, feel here and there, on body, slight itching; and if I were
on the sand-beach of Carolina would think it suggested fleas, [50]. ►
Constant itching, especially in the face, frequently obliging him to
scratch, [7a]. ► Violent itching over the whole body, in
the evening (first day), [7]. ► Sometimes it produces a troublesome
itching of the skin, which in some cases is universal, but in others
confined to the nose, neck, loins, and inside of the thighs, [15]. [570.]
► Disagreeable itching on the skin,
especially on the anus (after half an hour), [6a]. ►
“Tingling” or prickling sensation in the extremities (soon
after third dose), [19]. ► Tingling in feet (after first 1/4 grain),
[50].
SLEEP AND DREAMS.
►
Sleepiness. ► Yawning, [62], [64].
► Inclination to sleep (after five
minutes), [8]. ► Sleepiness, [9]; (after half an hour), [8]. ►
Occasionally slight excess of sleepiness, making it rather difficult for
the patient to rouse herself in the morning, [72]. ► So
sleepy that it was with much difficulty that I was able to reach my room
and undress (soon after second injection), [50]. ►
Heaviness and sleepiness throughout the day, [59]. ►
Continued heavy and sleepy (after one hour and twenty minutes), [51]. [580.]
► Drowsiness (after fifteen minutes);
since then sleep (after thirty minutes); had continued drowsy and still
remained so (after two hours and eighteen minutes); slept about two
hours (later), [51]. ► Drowsiness (fifteen minutes after 1/15
gr.); felt drowsy and giddy (after one hour); the drowsiness and
giddiness now passed off (two hours after 1/15 gr.); had napped for
twenty minutes (one hour and three-quarters after 1/12 gr.); slept half
an hour more (three hours and a half after 1/12 gr.); drowsiness
continued for a short time, after walking home, [58]. ►
Occasional drowsiness (second day), [30].
► Some drowsiness and giddiness
(fifty minutes after 1/4 gr.); sleepy and light-headed (one hour and a
quarter after 1/4 gr.); dozed and had some sound sleep (from one hour
and a half to three hours after 1/4 gr.); slept soundly for half an
hour, and was now very sleepy and giddy (one hour and a quarter after
1/2 gr.), [54]. ► Drowsiness gone off (after one hour), [57]. ►
Somnolency; he feel asleep and had a short nap (half an hour after 1/6
gr.); somnolency had continued and he still felt a little sleepy (two
hours after 1/6 gr.); great somnolency (fifteen minutes after 1/4 gr.);
somnolency continued (two hours and a quarter after 1/4 gr.); at no time
so great that he could not prevent sleep, and when he gave way to it, he
passed into a gentle slumber from which a slight noise awoke him (after
1/4 gr.); began to feel very sleepy (ten minutes after 1/2 gr.);
unchanged (two hours after 1/2 gr.); less, but continued very sleepy
(three hours after 1/2 gr.); had slept throughout comfortably and a
little more soundly than in ordinary sleep; was not conscious of
dreaming, but muttered a good deal (three hours and a half after 1/2
gr.); a little sleepiness during the next forty-eight hours, [53]. ►
Somnolency and giddiness (after ten minutes); then fell asleep for
three-quarters of an hour; had felt very drowsy and sickish (after two
hours), [56]. ► Great somnolency (after fifteen minutes);
had continued very drowsy, and slept at intervals (after two hours and a
half); walked home, and continued sleepy for two or three hours, [52]. ►
Light slumber, during which he was conscious of jerking in the limbs,
lasting ten minutes (after two hours and a half), [7]. ► He lay
in a half waking, half stupid condition, but with perfect ability to
think of different things, though at the same time he was busy with
confused fantasies; during this slumber the limbs lay as if stiff and
immovable, and could only be moved by great exertion of the will, [7a]. [590.]
► During the first night the patient
slept, and did not wake in the morning, [41].
► Fell asleep (after four hours); his
wife could not succeed in waking him until after five hours more, [24]. ►
Almost constant sleep for five hours and a half (after one hour), in
which he dreamed different things, heard everything that was going on
about him, and was almost always conscious of his condition, [3]. ►
Long, quiet sleep, [6c]. ► Quiet sleep, lasting five hours, after
waking from which he had headache on the right side, [6a]. ► Sound
sleep, lasting five hours, from which he awoke with a dull sensation in
the forehead (after ten hours), [6].
► Deep sleep, at times interrupted by
convulsive cramps, [25]. ► Sleep profound and calm, and with
pleasant dreams, [37]. ► Heavy sleep, with red cheeks, [11a]. ►
Sopor, [18]. ► Sleeplessness. [600.] ►
No disposition to sleep; slept only an hour next night, [43]. ► Most
of the Morphine patients sleep too little, [66]. ► Unable
to sleep till about 2 o’clock in the morning, though the sleep obtained
during the remainder of the night has seemed to refresh me as much as if
I had slept the whole time, [15]. ► Uneasy sleep, with frequent starting up,
lasting six hours, [6]. ► Sleep unsound and frequently interrupted
by lively imagining; became wakeful early in the morning, [30]. ► Fell
into a troubled, delirious sleep, from which she awoke in a few moments,
feeling that she had slept weeks; this kind of sleeping and waking was
repeated all day, [49]. ► Sleeplessness, [14], [62],
[68]. ►
Sleeplessness, followed by sopor, [18].
► Night, restless, [5]; (first night), [11]. ►
Restless sleep, with frequent starting up, [6b]. [610.] ► Sleep restless, with fever and headache,
and itching on the skin (first night), [1b].
► Sleep restless, interrupted;
lasting three hours (after one hour), [11].
► Very restless all night; no sleep, [45]. ►
Dreams. ► Frightful
dreams, [2].® 2000
Article