A substance obtained from morphine (differing only from morphine in having one less equivalent of water).

Formula

, C17H17

NO2 . (Morphine is C17H19

NO3 .)

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, .

Apomorphinum