MORPHINUM.
FEVER.
►
Chilliness. ► Skin cool;
the feet warm, [34]. ► Surface rapidly becoming cold (after nine
hours and a half), [71]. ► The skin of the whole body was somewhat
livid, especially the lips and nails, and, with the extremities which
were covered, it was very cold, and covered with cold, clammy
perspiration, [41]. ► Cold and pale, for four hours (after two
hours), [57]. ► Generally cold and tremulous (one hour
and three-quarters after 1/12 gr.), [58].
► Skin icy cold, [29]. [620.] ► Diminished temperature (immediately), [44]. ►
Temperature lowered from a quarter to half a degree (after half an
hour), [46]. ►
Temperature at first falls and afterwards rises, [44a]. ►
Chilliness, [62]. ► Chills creeping over her, especially from
the hips to the knees, and back again to hips, [49]. ►
Violent shudderings, [2]. ► Rigors, [64].
► The warmth of the face diminished,
and it became paler than usual; with general weakness (consequence of
nausea), (after two hours), [7]. ► Extremities cool, [35]. ► Head,
face, and hands cool (two hours and a quarter after 1/4 gr.), [53]. [630.]
► Extremities cold (after fifteen or
twenty minutes), [32]. ► Extremities cold, nails blue (after four
hours), [36]. ► All the extremities and hands cold and
livid, [17]. ►
Hands and feet became cold (after third dose), [19]. ► Lower
extremities cold, [5]. ► Heat. ►
Skin hot and dry, [37]. ► Burning heat of the skin (after half an
hour), [8a]. ►
Temperature rises 2/10° (Centigrade), [44b].
► General diffusion of warmth
throughout the body (one hour after 1/2 gr.), [53]. ►
General increase of warmth, especially in the face (after half an hour),
[7a]. [640.]
► Heat over the whole body, at night,
[18]. ►
Heat and itching over the whole body, [12].
► Alternate flushes of heat and cold,
with nausea, faintness, and constant retchings, for five hours (after
two hours), [56]. ► Fever, [61].
► The intermittent fever of
morphinism, which assumed first a tertian and then a quotidian
character, [61]. ► The intermittent fever of Morphine
intoxication seems to depend upon a peculiar neuropathic predisposition,
since many persons develop no paroxysms of intermittent fever in spite
of large doses and long-continued use of Morphine. No other cause,
however, can be assigned for the development of the intermittent than
the use of the Morphine, for patients are attacked by it who live in
regions free from malaria, and similar symptoms are not observed in
other members of the family who have been living under the same
conditions. Mild and severe forms of the intermittent fever of Morphine
may be distinguished. Both have, in common with malarial fever, beside
the rhythmical type, the fact, first,
that the paroxysms apparently disappear after Chinin., though in spite
of the continued exhibition of the latter, they sooner or later
reappear; second, they are benefited
by change of locality, and are brought on again by any imprudence (a
voyage on the water, errors of diet). The characteristics of
intermittent fever of Morphine, are those of malarial fever, chilliness,
amounting to a shaking chill, headache, oppression, heat, and sweat.
They are distinguished in the fact that after abstinence from Morphine,
the paroxysms of fever, though they had existed for a long time,
disappeared without treatment; in some cases the intermittent fever
appears like a febris arthritica; there occur, at indefinite times,
attacks with chilliness, heat, and sweat. These attacks are repeated
three to six times, at increasing intervals, and then generally no
longer recur. Usually the intermittent of Morphine has a tertian or
sometimes a quotidian type; it is sometimes anticipating, sometimes
postponing; the attacks last from four to ten hours, followed by a
normal condition; the paroxysms are only exceptionally relieved by
withdrawal of Morphine. In such cases the patient complains that, at the
time when the fever usually occurs, he feels uncomfortable, especially
that he is exhausted. With the febrile paroxysms are associated
neuralgia in various nerve-areas, supraorbital, intercostal, and cardiac
pains; the temperature rises in all cases and varies from 38.5° to 40°
(C). The spleen is usually enlarged. After the paroxysm, a sediment is
noticed in the urine. In the more violent from of Morphine intermittent,
delirium occurs during the height of the fever; in this delirium the
patient cannot be kept in bed, and is excited even to raving. Great
exhaustion and prostration follow the fever, and continue into the
apyrexia, [73]. ► Tertian intermittent fever, with delirium
during the paroxysms; this fever was a puzzle to the then physician, as
malarious diseases do not occur in the district, and treatment with
quinine was without effect; it was intermittent fever from morphinism, [62]. ►
The lower extremities had a somewhat higher temperature than the
portions that are usually uncovered, though the temperature of these was
far below the normal, [41]. ► Warmth in the face (after three-quarters
of an hour), [7]. ► Head hotter than usual, [7a]. [650.] ► A little heat and flushing of the face, [55]. ►
Face and head hot and flushed (one hour after 1/2 gr.), [53]. ► Cheeks
hot and flushed; scalp a little less so (half an hour after 1/2 gr.), [53]. ►
Cheeks and forehead hot and flushed, hands hot, “felt hot all
over” (after one hour), [56].
► Sweat. ►
Skin very moist, [48]. ► Sweat, [61].
► Perspiration, [5]. ► General
perspiration, [66]. ► Perspiration over the whole body, with
increased warmth and redness; more frequently in men than in women, [13]. ►
Excessive sweating, [64]. [660.] ►
Copious perspiration, [9]; all
over (after twenty minutes), [8]. ► Profuse sweat, [62], [67];
(second day), [23]. ► General profuse perspiration (after five
minutes), [11]. ► Profuse perspiration, so that he changed
his clothes nineteen times in one night, [4].
► Bathed in perspiration (after two
hours), [43]. ► Exhausting sweat, [69]. ► Cold
sweat, [66]. ►
Broke out into a cold perspiration, on walking three miles (after two
hours and eighteen minutes), [51].
► Cold perspiration over the body
(after fifty minutes), [9]. ► Clammy sweat over the whole body, [17]. [670.]
► Skin dry, itching (first night), [11]. ►
Colliquative sweats, with deep redness of the face, [73]. ► Face
covered with perspiration (after one hour), [8b]. ► Upper
part of the body covered with a viscid perspiration, [15]. ► Cold
sweat on the back (second morning), [8b].
CONDITIONS.
►
Aggravation. ► (Morning), On waking, disappearing on moving
about; head painful. ► (After eating), Heaviness, etc., of head; pain
in stomach. ► (After sleep), Stiffness in arms; hands
tremulous.
SUPPLEMENT: MORPHINUM.
Authorities.
74,
Le Cliniq. (Lond. Med. Gaz., vol. iii, 1829, p. 851), Mr. G. took 24
grains of the Acetate dissolved in 1 ounce distilled water; 75, M. Martin-solon, Bull. de l’Acad. Roy. de
Méd., 1836, and Brit. and For. Med. Rev. (Am. Journ. of Med. Sci., 22,
1838, p. 202), effects of dipping the point of a lancet in an aqueous
solution and inserting beneath the epidermis; [From inoculation of all
common preparations of Opium he saw the same effects, except that the
papillæ sometimes acquired a diameter of an inch and a half, and then
became radiated and diffuse.] 76,
same, effects of the Muriate experienced by Dr. Lafargue, from thirteen
punctures on the front of the forearm; 77,
Blanchard Fosgate, M.D., Amer. Journ. of Med. Sci., New Ser., 1, 1841,
p. 112, for toothache took 1 ounce of a solution containing 1 1/4 grains
of the Sulphate, after taking no food nor drink for eighteen hours; 78, omitted; 79,
Lond. Med. Gaz. (Bost. Med. and Surg. Journ., vol. xxxiii, 1845, p.
128), a young woman, for scirrhus of uterus, vomiting, and pain in the
stomach, applied to the epigastrium, from which the skin had been
removed by a blister, 1/32 grain of the Muriate; the same was repeated
the next morning; 80, Chas. Foulke,
M.D., Amer. Journ. Med. Sci., New Ser., 15, 1848, p. 568, Mrs. R., æt.
sixteen years, eight months pregnant, for labor-pains, took 11 1/2
grains of the Sulphate in three hours; 81,
C. S. S., Bost. Med. and Surg. Journ., 63, 1860, p. 325, a young man
made habitual use of Morphine, generally taking one-fifth of a bottleful
(1-8 ounces) in water; 82, J. S. L.,
ibid., p. 391, Mrs. A. H. S., æt. forty-two years, had taken Morphine
for years; when first seen she was taking from 4 to 6 drachms per week; 83, B. Woodward, M.D., ibid., vol. lxv, p.
157, I took 1/3 grain of the Sulphate at 7, 10, 1, and 4 o’clock. I
repeated this experiment four times, at intervals of five days, with
same effects; afterwards subjected five young men to same experiment,
and with four obtained a very large increase and lower specific gravity
of the urine; with one of them, on two trials, I found no perceptible
increase or diminution of, but a marked lessening of, specific gravity;
I did not obtain same results from Opium itself, but there was no
difference whether the Muriate or Sulphate were used; 84, Wm. Norris, M.D., Amer. Journ. Med. Sci.,
New Ser., 44, 1862, p. 395, a person, æt. nineteen years, took 75
grains of Sulphate in water; 85,
Medical Circular, June 10th, 1863 (Brit. Journ. of Hom., 22, 348),
effects of solution of Mor. mur., taken in the usual doses, but too
frequently, for cold in the chest; 86,
Dr. J. L. Prentiss, Chicago Med. Journ., December, 1866 (Amer. Journ. of
Med. Sci., New Ser., 53, p. 565), a woman was said to have taken 5
grains of Morphia; 87, J. R. Wiest,
M.D., Cincin. Journ. of Med. May, 1867, p. 265, Mr. W., æt. fifty
years, took an unknown number of pills, each containing 1/6 grain of the
Sulphate; 88, Benj. B. Wilson, M.D.,
Med. and Surg. Reporter, vol. xix, 1868, p. 369, a woman who had been
receiving hypodermic injections of 1/4 grain of the Sulphate, now
received a somewhat larger one; 89,
J. J. Lyons, M.D., New Orleans Med. and Sur. Journ., vol. xxii, 1869, p.
292, a girl, æt. five years, took 5 grains of Sulphate to prevent the
return of an intermittent, from which she had been suffering the
previous week; 90, John Sprott,
M.D., ibid., p. 506, for rheumatism, used daily for three years, from 2
to 4 grains of Sulphate; 91, C. H.
Alden, Philad. Med. Times, vol. i, 1871, p. 295, L. R. took by enema
between 12 and 15 grains of Sulphate, dissolved in 2 fluid ounces of
water; 92, W. W. Grisson, M.D., St.
Louis Med. and Surg. Journ., 1872, p. 353, a woman, æt. thirty-one
years, took 6 grains of Morphine; 93,
Geo. Bayles, M.D., Virginia Med. Rec., 1875, p. 188, Mr. S., for
pleuritis of the right side, took within three hours and a half 50
minims of Squibb’s solution of Morphia; 94,
Dr. A. P. Hull, Philad. Med. Times, September, 1876, p. 581, a child,
æt. six weeks, took 1/2 grain of Sulphate; 95,
E. H. Coover, Philad. Med. and Surg. Reporter, vol. xxxvi, 1877, p. 452,
John H., æt. thirty years, for an abscess on the left parotid, took 2
powders, containing probably 2 1/2 grains of Sulphate, at an interval of
twelve hours; 96, S. B. Chase,
ibid., vol. xxxiv, p. 37, a man, æt. thirty-five years, took 6 or 7
grains of Morphia.
MIND.
►
I found her, as she had been for some hours, crazy, with three or four
holding her in bed; during the intervals of slight convulsions she was
in this crazy condition, [80]. ► Subsequent to the commencement of the
nausea, and previous to the exhibition of a gill of cold strong coffee, my mind was depressed,
and considerable anxiety pervaded it, but it was at the same time
restrained to a consideration of the condition of my system, and no
pleasurable sensations had been experienced. The coffee, however, soon
raised this weight of oppression, and, I may add, also the controlling
power of reason, and in their stead, fancy in her wildest range roved on
through scenes of rapture and splendor, which the mind of the patient,
unassisted by such powerful influences, is utterly incapable of
attaining. This delightful revelling of the imagination continued five
or six hours, and during this interval my attendants, who spoke to me
several times, could not determine whether I was asleep or not; neither
can I settle the question myself, for, if asleep, I awoke so easily that
the transition could not be perceived. But I am conscious that this
state of mental delirium ended in a sound sleep, which was succeeded by
a few hours of lassitude, [77]. ► So nervous that the least movement in the
room would make her spring from the bed, [82].
► Sometimes talking in a partially
incoherent, excited manner (after three hours), [91]. ►
Incoherency in speech for three weeks, [79].
[680.] ►
Mind much confused, but when persistently addressed, her attention was
aroused, and she replied, though rather incoherently (after three
hours); mind quite clear (fourth day), [91].
► Lost his recollection (after six or
seven minutes), [74]. ► Stupor, [79].
► Stupor was fast approaching, but
was not complete, occasionally, she would wake and fret (after three
hours), [79]. ► Complete insensibility, [89], [96],
etc. ► Comatose, although by
persistent shaking and loud talking, he could be roused for a brief
period, [87].
HEAD.
►
Dizziness, [79]. ► Slowly rolling her head (after three
hours), [91]. ► Pain in the head, [79]. ► Head
felt very heavy (after three hours), [91].
[690.] ►
Heaviness of the head, [76].
EYE.
►
Eyes sunken in the head, [82]. ► Eyelids half closed; conjunctivæ
injected, pupils contracted to mere points; irides immovable (after
three hours); pupils natural size or nearly so, and the irides movable
(fourth day), [91]. ► Pupil contracted (after three hours), [95], etc. ►
Pupils contracted to a pin’s point, [94],
etc. ► Pupils contracted to a little
more than a pin’s point, [96]. ► Contracted pupil and complete
insensibility, [96]. ► Great contraction of the pupils, almost
perfect blindness, [89]. ► Saw every object double and very
indistinctly (after three hours), [91].
► She saw only one-half of
surrounding objects; for instance, in the case of a person standing
before her, she could see only the right or left half of the body; it
was three weeks before vision was completely restored, [79].
EAR.
[700.]
► Ringing in the ears, [79].
FACE.
►
Suffused and purple countenance, [88].
► Complexion cyanotic, [93]. ►
Countenance of a dark color, [94].
► Face and lips livid, [80]. ►
Constantly rubbing the nose, eyes, and face, [89]. ► Jaws
rigid, [96]. ►
Masseter muscles rigid (after six hours), [86].
MOUTH.
►
Teeth firmly closed (after six hours), [86].
► Tongue dry and cracked in places, [82]. [710.]
► Clamminess of the mouth, [76]. ►
The saliva of the mouth was being churned into a froth, which welled up
and then disappeared at every return and subsidence of the respiratory
movement, [93]. ► Slow of speech, although if sharply
questioned he would answer his name, [84].
► It was with great difficulty that
she could talk so as to be understood, [82].
STOMACH.
►
Thirst, [84]. ► Great nausea and many efforts to vomit
(after five hours), [77]. ► Vomited at intervals (after three hours),
[91]. ►
Vomiting in the evening, [85]. ► The pain in her stomach recurred every
few minutes, and became at times very intense; she made loud cries,
ground her teeth, and threw her arms about violently; she described the
pain as like that of cramp (after six hours); the pain became gradually
less, and was felt more in the region of the umbilicus (after nine
hours), [91]. ► It often produces a painful cramp of the
stomach, and especially is it liable to do so in persons not in the
habit of using it. This effect is readily relieved by a small quantity
of some stimulant, brandy or spirits of camphor being the most
effectual. One-eighth of a grain acts more powerfully on an empty
stomach than half a grain after eating, [90].
URINARY ORGANS.
[720.]
► Pain across the kidneys, followed
by diuresis, [81]. ► Vesical tenesmus, but was unable to pass
urine; about 8 or 10 fluid ounces removed by the catheter (after three
hours); urine removed twice, about 12 fluid ounces each time (second
day); passed urine naturally (third day), [91].
► It acts almost invariably as a
diuretic in from one to two hours, [90].
► Passed 28 ounces of urine, with
specific gravity of 1014, in twenty-four hours (before the experiment);
measured all the urine passed at 9 P.M., and found it to be 48 ounces,
very limpid, specific gravity 1003 (the day of the experiment), [83].
RESPIRATORY ORGANS.
►
When taken in a full dose it changes the voice, producing a temporary
hoarseness, [90]. ► Respiration hurried, [82]. ►
Breathing not more than once in forty-six seconds (after five hours and
a half), [80]. ► The child breathed about once in fifty
seconds for seven hours, [90]. ► Respiration stertorous, 10 to the minute,
[87]. ►
Stertorous breathing, [94]. [730.] ►
Stertorous breathing was strongly marked, in fact, the patient ceased to
breathe, the interval being lengthened out one-fourth of a minute or
nearly so, [88]. ► Breathing was stertorous, irregular, and
very slow, not more than two respirations in a minute, [93]. ►
Respiration stertorous and feeble, so much so that he breathed but four
times a minute (five hours after second dose), [93]. ►
Breathing stertorous; at times arrested for a minute (after six hours), [86]. ►
Breathing peculiar to the last stage of Opium poisoning, [96]. ►
Respiration suspended, [92].
HEART AND PULSE.
►
Circulation full but slow, [77]. ► Strong and frequent pulse, [79]. ► Pulse
130 and feeble, [92]. ► Pulse 120 and of moderate strength, [87]. [740.]
► Pulse 110, [82]. ► Pulse
80, moderately full (after six hours), [86].
► Pulse 80 and soft, [84]. ► Pulse
full and slightly excited (after three hours), [89]. ► Pulse
60 (after three hours), [91]. ► Pulse feeble and irregular (five hours
after second dose), [95]. ► A slow, laboring pulse, [94]. ► The
pulse was intermittent, and so weak as to be almost imperceptible at the
wrists, and there was a fluttering movement observable on both sides of
the neck, [93]. ► Pulseless, [96].
INFERIOR EXTREMITIES.
► Gait staggering, [84]. [750.] ► Lower extremities deficient in
sensibility and lying motionless (after three hours), [91].
GENERALITIES.
►
Very much emaciated, [82]. ► Some half dozen slight convulsions, [80]. ►
Convulsions, [79]. ► Frightful convulsions, [74], [96].
► After half an hour a sensation of
thickening and stiffening of the muscles of the back of the neck, which
soon extended to the flexor muscles of all the limbs, and which
continued until the morbid action was broken in upon. This was not a
condition of rigidity such as obtains in cramps, but subject to
volition, and was rather of that feeling that we imagine would be
experienced in a paroxysm of catalepsy could the patient be made
sensible of the movements of his limbs, [77].
► The child was under the influence
of the Morphia; perfectly limber, for seven hours, [80]. ►
Suddenly collapsed (four hours after second powder), [95]. ►
Considerable degree of prostration and apathy, [77]. ► A few
hours of lassitude, after the sound sleep, [77]. [760.] ► By keeping slightly under its influence,
it is a perfect antidote against taking cold, [90].
SKIN.
►
Livid, [92]. ►
Skin about face, neck, chest, arms, and hands had a cyanotic appearance
(five hours after second dose), [95].
► Skin yellow and shrivelled up, [82]. ►
Finger-nails dark (five hours after second dose), [95]. ► About
a minute and a half after the operation a small pimple, with a diffuse
rosy areola and slightly itching, is observed. In about twenty minutes
the pimple becomes about four lines in diameter and one line in
thickness; it is flattened. Its color is somewhat more than that of the
skin, it is hard, its areola is very red, and about an inch and a half
in diameter; its heat has increased, but the sensation of itching
remains about the same. During the first hour the pimple and its areola
are at their highest degree of development; from this time the
appearances diminish, and at the end of two or three hours the red color
of the skin has entirely disappeared, the pimple has become very flat,
but it does not entirely disappear, until from twelve to twenty-four
hours after the operation. If several punctures are made near each
other, in the same manner, the appearances of the pimples are as above
described, but the areolæ are confluent; the heat and itching are
considerably increased. The appearances, however, disappear in the same
manner as when a single puncture is made, [75].
► Rash beginning on the face spread
itself over the entire body, quickly extending from the face to the
neck, trunk, and lower extremities; so strongly did it resemble measles,
at least in having the crescentic arrangement, that it had been
pronounced such by another medical man; the discontinuance of the cause
was followed by a speedy resolution of the seeming exanthem, and next
day there was little trace of the eruption, [85]. ►
Intolerable itching of the skin (after three hours), [89], [91].
► Itching and pricking of the skin
intolerable, [80]. ► Considerable pricking of the skin, [77].
SLEEP.
[770.]
► Frequent yawnings, [76]. ►
Excessive drowsiness, “falling asleep, even while she was
speaking,” [83]. ► Invincible desire to sleep, [76]. ►
The tendency to sleep increased somewhat for a time, and twice fell
asleep, though constantly talked to, but was soon aroused (after three
hours), [91]. ► Would sleep even when standing up, if
those supporting him did not keep him constantly in motion, [84]. ►
Profoundly asleep, could not be aroused (five hours after second dose), [95]. ►
Profound sleep; if left to herself she quickly fell into a state of
profound stupor, and lost all consciousness, not breathing more than
once in forty-six seconds (after five hours and a half), [90]. ►
Profound somnolence for eighteen hours; partial somnolence between two
hours and a half and three hours and a half, [93].
FEVER.
►
Skin cold (after six hours), [86],
[96]. ►
Skin cool; feet quite cold (after three hours), [91]. [780.] ► Skin pale, rather cool, and bathed with
perspiration, [87]. ► Extremities cold, [92]. ► Hot
and dry skin, [79]. ► Skin warm and moist, [80]. ► If he
deferred the habitual dose beyond a certain number of hours,
perspiration came on, and his system felt relaxed, [81]. ► Body
bathed with cold perspiration (five hours after second dose), [95]. ►
Surface of face, scalp, and hands loaded with large beads of cold
perspiration, which, about the nose and mouth, coalesced and trickled
down upon the bed-linen, [93]. ► Clammy sweat over the whole surface, [82].® 2000
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