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]
Catalogue details

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.

    20/23 (page 16)
    the sulphate have been gaining ground. In Germany, the hydro- chlorate is still in pretty general use. I cannot help thinking that vomiting has been more associated with the hydrochlorate than with the other morphine salts. If so, it may possibly be due to the gradual formation of apomorphine in old solu- tions of the hydrochlorate. Those of you possessing old solutions of the hydrochlorate had better test them for apomorphine; and, meanwhile, I would recom- mend those who now use the hydrochlorate to give it up in favour of the acetate, which, without any doubt, is the very best morphine-salt we can use for hypodermic purposes. Gentlemen, I thank you for the patience with which you have listened to my address. I have endeavoured to lay before you the chief points of interest in connection with the four most important of our hypodermic remedies. I have made no attempt to enumerate all the painful troubles and complaints for which hypodermic injections of morphia can be used ; but I trust I have succeeded in making clearer, than has hitherto been done, how and when morphine by itself, or atropine by itself, and atro- pine and morphine combined, can most advantageously be employed in the lessening of pain and the curing of disease. You will probably agree with me that in many, if not in most cases, a local injection is better than a distant ono ; and I trust that the solutions which have been handed round to you, have made it very evident that there is no difficulty in making and keeping some hypo- dermic solutions. But I shall have failed in one of the chief objects of this address, if I have not succeeded in convincing you that there is need for increased caution in the administration of hypodermic injec- tions, and need for greater judgment, care, and nicety in deciding upon the proper dosage for each individual patient. Dr. Spender (Bath), after thanking Dr. Jones for his exhaustive paper, alluded to the extreme desirability of letting the initial dose be very small, such as one-tenth of a grain for an adult man, -and one- twelfth of a grain for an adult woman. Unless this precaution were observed, a misfortune, he said, would surely happen sooner or later. Moreover, an accident of this kind was ruinous in its consequences to a country practitioner ; it was worse than a chloroform-accident, be- cause there several persons shared the responsibility. It was, in Dr. Spender’s opinion, always well to tell the patient, when administering morphine for the first time, not to expect much effect from the first dose. Should any effect be apparent, the patient had an unexpected pleasure, and the medical man was saved from the risk of untoward symptoms or a possible mishap. A long time since he bad read of strong black coffee as being an excellent remedy to have by one when administering morphine ; and now he always took care to have some strong hot coffee at hand whenever he had reason to think a mishap possible. The worst of these accidents was, he said, that they might happen with all the organs apparently in perfect condition, and with the individual in the best of health ; and, therefore, they were apt to come without the slightest warning, and quite unexpectedly. Dr. Sheen (Cardiff) said it was probably only too true that morphine was often given in doses far too large, and sometimes, possibly, with fatal results. There could be no doubt that morphine, when injected subcutaneously, was absorbed into the system, and did not act simply locally. He was glad to hear what Dr. Jones had said as to the greater stability of the stronger solutions ; his own was 1 in 6. Mr. Hancocke Wathen (Clifton) dwelt on the need for increased caution in the use of injections. He related circumstances in which morphine had been employed with culpable negligence. The President (Professor Fraser) expressed the thanks of the meet- ing to Dr. Talfourd Jones, and regretted that time would not admit of a further and fuller discussion of so important a subject.