Apomorphinum hydrochloricum

Volume III — Main text

ApomorpbinUUli prepared from Morphia by treatment with hydrochloric acid under pressure. CjyHijNOj.HCl.

1,11. Prevings and Poisonings. — I. Dr. J. G. Blackley, May a3th, 1869, at 9 p.m., injected i^^x of a 10 per cent. sol. under skin of I. arm, pulse being 72 and temp. 98°. ^^ During the first 2 m. no effects were produced. After about 3 m, pulse began to rise slightly, and respiratioit became slightly accelerated. At end of 4 m. I felt a sudden qualmishness, almost immediately followed by nausea and profuse vomiting. This continued for several m. \ 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 7 or 8 m. from the commencement of the experiment 1 began to feel very faint and was compelled to lie down, and almost immediately on doing so I fainted entirely, and remained in a state of syncope for about 5 m. On awaking from this 1 felt giddy and chilly, and was obliged to take a littjc brandy and water. This was retained, and as I began to feel slightly drowsy I remained lying down for about an h,, during which time I perspired profusely. On rising I still felt slight giddiness, but no inclination to vomit. 1 went to bed, and slept soundly all n., awaking about 8 a.m. in my usual health, slightly pale^ but very hungry."

Pulse at 9.5 had risen to 80, at 9.12 fallen to 65. Temp, at 9.5 was 992', at 9.12, 97'8°. (Brit. Journ, of Hom.^ xxxi, 498.)

1. Same injected into arm of a stout carman, act. 28, having an ulcer on the leg, at S.4 p.m., a solution containing gr. ^^, Pulse was 76, temp. 98*3°. 8.8, felt giddy ; complained of pressure at epigastrium ; pulse 88, weak but regular ; pupils moderately dilated. 8.9, began to vomit slightly. 8.10, vomiting profusely ; this continued for 3 m. 8.13, ceased vomiting; took a drink of water, which came up immediately ; milk was also reiccted in same manner. Pulse 80, weak ; temp. 9H'6 . 8.20, still feels very giddy and looks pale ; pupils dilated. After lying down for \ h. he got up and walked home ; felt no unpleasant after-effects, and at 9 ate a good supper. (Ibid,)

2. a, Oct. 26th, 1873, ^- Lachize injected into my I. arm 3 mlgrm. of A. j pulse was 60, resp. 16, temp. 36'8°, 9-23, pulse 72 ; no other change. 9.25, violent inclination to vomit; feeling of heat all over, but especially in head ; face congested ; pulse 92, rcsp. 20, temp. 36'9°. g.28, pulse 96, resp. 22 ; no other change. 9-30, pulse slightly irregular ; less nausea ; pulse 80, resp. 20. 9.35* pulse still irregular ; nausea ceased ; drowsiness j temp. 368°, resp. 16. 9.40, sleep. 10.15, awoke, feeling well; pulse 63, temp. 368'^, resp. 14. Breakfasted at 11 without feeling anything abnormal.

b, Nov. 6, 6 mlgrm. were injected at 9.40 a.m., pulse 76, resp. 15, temp, 369°. 9. 13, pulse 80. 9.45, violent inclination to vomit ; full regular pulse; pandiculations; pulse 100, resp. 18, temp, as before. 9.48, retching ; pulse 104, resp. 24., both irregular, temp. 368°. 9.50, easy vomiting ; pulse 94, still irregular, resp. 20. 9.53. pulse 96, resp. 21 ; more vomiting. 9.55, vomiting ceased, still some nausea^ pulse 94, resp. 18, both irregular, temp. 367°. 10, quite quiet; drowsy; pulse 76, resp. 12, temp. Tjt>"j°, Quiet sleep for an h. ; on waking, pulse 68, rcsp. 8, temp. 368°. Ate next meal without any uneasiness.

c. Dec. loth, 3 ctgrm. were injected at 2.20 p.m., pulse 66, resp. 14, temp. 36'8°. 2.22, pulse 134, resp. 19; vomiting, without previous nausea, preceded for a m. by sudden sensation of heat, running all over body, and lasting for 3 m. j during it pulse 100 — 102, resp. 20 — 24, temp, normal. 2.26, extreme fatigue ; tried to get up, but cuuld not J pulse 84, resp. 16. 2.27, pulse 78, resp. 15. 2.28, nausea, pulse 96, rcsp. 18. 2.29, several vomitings, violent headache. 2.32, quiet, drowsy; pulse 98, resp, 17, temp, 37°; so much fatigued that eyes closed involuntarily. 2.36, nausea, pulse 104, resp. 16, temp. 37**. 3.38, vomiting, less copious than before; invincible need of repose. Slept in a chair. 4, ached with fatigue ; no other bad feeling j pulse 80, resp. 25, temp. 37*^. (Victor Bourgeois, in Allen's Encyeioptedia^

i. 427O

1. ^ gr. was swallowed by a man in good health. In 20 m. he felt dizzy and depressed, with an uncomfortable sensation in the head, very qualmish, not in the least somnolent ; he then became very pale, and was salivated ; in 25 m. after the dose he vomited freely ; after doing so twice he felt much relieved, drank half a glass of wme, and in { h. regained his usual condition. (Gee, Trans, of Clin, Soc.^ ii, 167.)

p

1. A healthy young man was injected in the arm vrith gr. -^ In about 3 m. he began to feci uncomfortable in his head j in 5 m. he wai much depressed ; in 7 m. he looked very pale and low, his pulse became infrequent and rather weak j he sweated ; in 10 m. from the injection he vomited thrice ^ after a little brandy the vomiting ceased, and he recovered in about { h. [Ibid.)

2. A gentleman who was working with A., and had hi^ hands sometimes wetted with the solutions, frequently vomited 3 or 4 times in the c. ; besides this he was, at times, depress^, uncomforuble in the head, and unfit for work. (Ibid.)

3. Once or twice, when A. has been used as an emetic, there has been an amount of depression both of the circulation and of the general muscular power beyond what could be accounted for by the vomiting. (Ibid.)

4. A man affected with chronic Bright's disease was mjected with gr. -jJjr. In 4 m. he vomited freely. The vomiting continued at intervals for \ h. ; he then passed into a mildly delirious state for \ h., after which he went to sleep for an h. ; when he awoke he felt, according to his own account, better than before the injection. {Ibid.)

5. RiEGEL and Boehm have observed quite commonly giddiness, headache, and a disposition to yawn i also free perspiration and great drowsiness, with apathy. In none uf their experiments was the pupil affected ; the pulse was very generally diminished in force and volume. (H. C. Wood, op, cit.)

6. a. If the dose injected is insufficient to produce vomiting, the patient is observed (5 — 10 m.) to grow pale, and the circulation to slacken. We have seen in such a case a fall of the pulse from 72 to 48. The patient is then attacked with faintness and profuse sweats, the eyes become dim, the strength fails, and the pulse is as feeble as it is slow. These phenomena arc fortunately transient, and the pulse soon rises again ; the other symptoms gradually pass off, and by the end of an h. the relieved patients enjoy a refreshing sleep.

b. When the dose is emetic the results are different. There is no faintness without nausea, ^s in the former case, but, on the contrary, pronounced nausea^ ending after 3 — 5 m. in vomiting. The latter may even supervene primarily. It is rapidly performed, but moderate, and merely empties the stomach, rarely bringing up bile, and never followed by diarrhoea. Each attack of it is brief, and followed by marked quietude, sometimes even a little sleep. (Trousseau eC

PlDOUX, Cp. cit.)

III. txpifimenti on animals. — i. A, injected in large doses into the the lower animals produces grave symptoms referable to the nervous system. Two gr. were injected into a dog ; he vomited, and in 2 or 3 m. 'began to course round the large room in which the experiment was performed in a curiously methodical manner. He recovered completely. Three gr. injected into a car produced more excitement ; her running about was frequently interrupted by high leaping into the air and turning somersaults; her pupils were dilated to the extreme and insensible. Two more gr. produced epileptiform convulsions. Two gr. yet were injected, making 7 in all ; the convulsions were followed by perfect

relaxation, the heart beat pretty forcibly ; she was found dead the following m. All the organs were perfectly natural ; no hypcraemia of any of them. (Gee, lac. cit.)

1. Under skin of abdomen of a large powerful tom-cat injected gr. ^ dissolved in lO dr. of water. This was at 10.20 p.m. Within a few seconds after he began to be excited and to jump about the roots; pupils became very much dilated ; runs wildly round room looking up at walls, 10.25, '■^sp. and pulse very much quickened ; very excited and savage ; highly sensitive to slight noise ; ruus round room and tries to scale wallSj falling backwards on bactc at each attempt. On exami* nation with ophthalmoscope retinal vessels appear much congested. 10.40, injected another ^ gr. Urination \ walks to and fro like a tiger in a cage, constantly looking up at the wall \ pupils dilated to their fullest extent i breathing 92 per m,, laboured j pulse too rapid to be counted. 11, injected another \ gr. \ slightly salivated i tongue protruding ; is very savage if touched \ runs about from side to side, hind legs being slightly dragged ; slight twitchings of head, especially or. hearing any noise \ runs backward. Next m. all symptoms had disappeared save a slight dragging of hinder extremities, which continued for 2 d. (Blackley, lac, cit,)

2. Chouppe divided the two pneumogas tries in a dog, which was then allowed to rest until the vomiting produced by the operation had entirely subsided. He then made a subcutaneous or intravenous injection of apomorphine, tartar emetic, and ipecacuanha. With the two former, vomiting occurred as quickly and as freely as when the nerves were intact; with the third vomiting never occurred. (Gax, Mid. tU Paris, Aug. 1, 1874.)

3. SiEBERT and Moor/, have shown that A. does not affect the blood-pressure, and that the pulse rises when emesis comes on, reaches its maximum during vomiting, and declines in the interval. It causes at first increased rapidity of breathing, afterwards diminishes the force and depth of the movements, and hnally arrests them. This result occurs even when the vagi are divided. It has no appreciable influence on the temperature. As respects its influence on the nervous system, it is at flrsE strongly excitant. Afterwards it causes muscular tremblings, followed by paralysis and convulsions. The muscular irritability is impaired but not destroyed, and the functions of motor and sensory nerves remain intact. (Bartholow, op, cit.)

Volume IV — Supplement

APOMORPHINUM.

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I, II, 11. A patient, zt. 58, took 3). of a 1 per cent. sol. 3 times a day for a week without difficulty, I then increased dose to ij ter die, and patient complained that it gave him sharp pain across forehead and over bridge of nuse, and made him feel so sleepy that he could hardly kkeep eyes open, (Murrett, Brit. Med. Journ., Feb. 28th, 1891.)