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It should be remembered that atropin is not a sleep-producer; it may stimulate the cerebrum. Therefore at night it might well be combined with a possible necessary hypodermic injection of morphin. The question of the advisability of strychnin is a constant subject for discussion. Strychnin is overused in the cases of most patients who are seriously ill.
According to Lewin, Brochin reported a case in which the idiosyncrasy to morphin was so great that 1/25 of a grain of the drug administered hypodermically caused irregularity of the respiration, suspension of the heart-beat, and profound narcosis.
According to the same authority, Wernich has called attention to paresthesia of the sense of taste after the employment of morphin, which, according to his observation, is particularly prone to supervene in patients who are much reduced and in persons otherwise healthy who have suffered from prolonged inanition.
An active purgative should be given at once and in the ordinary case, stimulants are indicated. If marked distress is present, morphin is given and where there is much rise of temperature, cold drinking water is offered in abundance and catharsis is enhanced by enemata. Locally, hot applications are of benefit.
Of striking significance is the fact that morphin alone caused no change in the H-ion concentration, while if administered before the application of a stimulus which by itself produced increased H-ion concentration, the action of that stimulus was neutralized or postponed.
These effects are probably due to a central excitation of a similar nature to that produced by santonin. Persons thus attacked complain, shortly after the injection, of an intensely sour or bitter taste, which for the most part ceases after elimination of the morphin. Von Graefe and Sommerfrodt speak of a spasm of accommodation occurring after ingestion of medicinal doses of morphin.
As the toxins are gradually eliminated from the body the symptoms abate, and if no more are introduced they disappear. Sapræmia in these respects, therefore, is comparable to poisoning by any other form of alkaloid, such as strychnin or morphin.
Yavorski cites a rather remarkable instance of morphin-poisoning with recovery: a female took 30 grains of acetate of morphin, and as it did not act quickly enough she took an additional dose of 1/2 ounce of laudanum. After this she slept a few hours, and awoke complaining of being ill.
It would be wrong to prostrate a patient with frequent saline purgatives, but the bowels must move at least once every other day, generally better daily; and if the case is one of typhoid fever, they should be moved by some carefully selected laxative, and after the bowels have sufficiently moved, the diarrhea should be stopped by 1/10 grain of morphin, and the next day the bowels properly moved again.
Neither had learned the first page in Life's text-book of happiness, and as both, could not have their way at the same time, rifts grew into chasms which widened and deepened. Then the wife sought attentions she did not get at home in social circles and the husband sought comforts his wife and his home did not give, in drink and fast living, later with cocain and morphin.
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