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]

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.

14/23 page 10

dcnscil summary of Brunton's views of its action on the intestines. He says: 1. Small doses increase peristaltic movements. 2 Mode- rate doses arrest them, but the muscular fibres of the intestine retain their irritability. 3. Large doses stop peristalsis, and also paralyse the muscular fibres of the intestine. ' Again, I would have you chiefly to bear in mind that, on unstriped muscular fibre, medicinal doses cause relaxation and muscular quiet- ness, and full doses paralysis. Atropine also checks the secretions of the salivary and sweat-glands, and the secretions of most other glands. It is well to note that atropine is very rapidly eliminated from the system, and chiefly by the urine. Let us, now, consider the medicinal uses of atropine, under four headings. 1. As an Anodyne and Antisjmsmodic.—Its action on sensory nerve- endings and on involuntary muscular fibre teaches us that it possesses anodyne and antispasmodic qualities. Anstie held that belladonna was the best medicine for every kind of pain in the pelvic viscera. He believed it was far inferior to morphia as a speedy and reliable re- liever of neuralgic pain, but, for all forms of pelvic neuralgia, it sur- passed morphia. As a general pain-reliever, no one would think of comparing atro- pine with morphia ; but, in certain painful conditions, its value is beyond question. The chief indication for its hypodermic use is pain- ful muscular spasm ; and, for this purpose, a local injection is better than a distant one. It has been found useful in painful spasms of the intestines, bladder, uterus, urethra, and bile-ducts. Hence its value in spasmodic intestinal colic ; in the passage of gall-stones, or renal calculi ; and in laryngismus stridulus and spasmodic asthma. 2. As an Anhydrotic or Sweat-lcssencr. —Here its use is indisputable. The general hyperidrosis occurring in phthisis, in debility, or in women during the climacteric, is always much relieved by atropine. An. in- jection of isjjth of a grain, or sometimes ,l 3th of a grain, will stop the sweating, and put the patient into a comfortable state. It is similarly useful in salivation, and as a local injection in a painfully distended or inflamed mamma. 3. As a Respiratory and Cardiac Stimulant.—It is useful in de- pressed or paralysed conditions of the centres, regulating the breath- ing and circulation ; and it has been thus used with .advantage in pulmonary congestions, and to counteract heart-failure in syncope, in shock, and in typhus fever. But these stimulating properties are best considered under a fourth heading. - 4. As an Antidote.—It is here that we see its astonishing value, when subcutaneously employed. In the February number of the Practitioner for 1870, Professor Fraser, in discussing atropine as an antidote to physostigma, made the following remark. He said that “no investigation could possibly be undertaken that would more cer- tainly advance the science of therapeutics, increase its resources, and remove irrational scepticism, than that of the antagonism of remedies.” I am a firm believer in the soundness and the wisdom of this opinion. It has been demonstrated by our President that, within certain limits, a very marked antagonism exists between atropine and eserine. Atropine is also antagonistic to morphine and opium, muscarine and poisonous mushrooms, aconite, pilocarpine, chloral-hydrate, quinine, gelsemine, and nitro-glycerine, and perhaps to prussic acid ; but this does not exhaust the list Bartholow says it is antagonistic to tartar emetic and veratrine. Atropine, as a respiratory stimulant, is especially useful as an anti- dote to morphine or opium; but it is also well to bear in mind its addi- tional value as a cardiac stimulant, for, as mentioned by Ringer, patients may die after opium, in a state of collapse, and not from asphyxia, though death, as we know, usually happens from paralysis of respiration. But death, too, may occur after morphine from syncope. To avoid

Licence and re-use

Contents