Hypodermic or subcutaneous medication : with special remarks on morphine, atropine, atropo-morphine, and apomorphine, and directions for making their hypodermic solutions : introduction to a discussion in the Section of Pharmacology and Therapeutics at the Annual Meeting of the British Medical Association in Cardiff / by Talfourd Jones.

  • Jones, Talfourd.
Date:
[1885]
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Licence: Public Domain Mark

Credit: Hypodermic or subcutaneous medication : with special remarks on morphine, atropine, atropo-morphine, and apomorphine, and directions for making their hypodermic solutions : introduction to a discussion in the Section of Pharmacology and Therapeutics at the Annual Meeting of the British Medical Association in Cardiff / by Talfourd Jones. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    of atropine, and of atropo-morphine, which have now been described/ and which I have found generally convenient and suitable, will pos- sess in three bottles two solutions of morphine and two of atropine, and in each couple the morphine and the atropine will be of the same strength, and it is, therefore, easy to remember the quantity of alka- loids in them ; for it is only necessary to bear in mind the strength of the atropo-morphine solution, namely, that one minim contains one-twelfth of a grain of morphine, and , JTth of a grain of atropine. This mixed solution, you will note, contains morphine and atropine in the ratio of twenty to one ; and some good observers quote this pro- portion as being the proper one for bringing out the best conjoint re- sults of atropo-morphine. It may not be inappropriate here to state that for many years I have also used this same proportion in all my atropo-morphine sup- positories ; and one of the most generally useful suppositories I know is made for me by Messrs. Battley, with one-quarter grain of acetate of morphine and one-eightieth of a grain of sulphate of atropine, namely, twenty to one. The atropo-morphine solution keeps very well. Here is one made in February of this year : I examined on June 28th the stock-bottle from which it was taken. It was clear, of a pale sherry colour ; and, just as in the accompanying morphine-solution, there was a fraction of a grain of amorphous and crystalline deposit; no trace of mould-fungus. The solution is now clear and pure. Let us now consider the conditions that indicate the use of atropo- morphine in preference to morphine. The conclusions at which I have arrived are these. 1. Fairly small and moderate doses of atropine slightly increase the hypnotic properties of morphine. This is a matter of doubt with many ; some deny that atropine does this, while others even say it very decidedly lessens the hypnotic action. 2. Atropine in medicinal doses increases the anodyne properties of morphine, and this increased anodynia is more marked in local than in distant injections. 3. Atropine in moderate doses counteracts the depressive action of morphine on the heart, and lessens the tendency to sickness, giddiness, and faintness ; and, by its influence on the circulation and on the skin, it also tends to prevent the clammy sweat, the pallor, and the coldness that morphine not unfrequently induces. 4. In small doses it does not influence, to any appreciable degree, the action of morphine on the respiration ; but when given in fair medicinal doses, and, a fortiori, in larger doses, it increases the number of respirations per minute, and augments their depth. Wo may now apply the preceding conclusions to practical medicine. In a weak, a fatty, or a dilated heart, we incur the risk of inducing a syncopal state by hypodermic morphine ; hence it must be used with extreme caution in such conditions, and it is safer to make it a rulo to use not morphine alone, but atropo-morphine in such cases. Of course, there are many cardiac troubles and forms of cardiac dyspnoea in which morphine can be used alone with infinite benefit; and this was pointed out long ago by Allbutt and Ringer; but in the preceding states alluded to, and especially in women, it is better to use atropo- morphine. In hepatic, renal, and intestinal colic, in spasmodic asthma, and in ovarian and uterine neuralgia, and in the painful spasms of tenesmus, atropo-morphine is better than morphine; and similarly, in all these conditions, but especially in the last three, atropo-morphine suppositories are much better than those of morphine.' In most neuralgise, and especially in ophthalmic neuralgia, atropo- morphine is the better remedy. In sciatica, lumbago, brachialgia, and in most forms of myalgia, and in cramp of muscles of the limbs, atropo-morphine is preferable to morphine. In muscular cramps, I have obtained better results when the atropine has been used in greater relative strength than one in twenty.