S WBC *i l*-'A ** H *4* - ^J * . ri> **Ytit. K At W " x -?f/ --' ifc ' P ed six years ago : since that time her health has been impaired. Five years ago she was attacked with severe pain in the right sciat- ic nerve, starting from the ilium, and shooi> in<»- down the thigh to the knee. Saw her in November, 1859. . Examination reveals tenderness of the whole right hip, and a painful point was felt upon pressure near the posterior superior spinous process of the ilium. Subcutaneous injection was twice prac- tised in her case by me, with good results; the patient being each time relieved for a 86 HYPODERMIC INJECTIONS. considerable period. Under the use of tonics, she continued doing well, and she suffers but seldom from pain in the hip or limb. Case XXIV. — Sciatica of about six months' standing. Mr. E----, aged thirty-six, merchant, of feeble constitution, and troubled with dis- ease of the kidneys, applied to me, suffer- ing from a severe attack of sciatica, which confined him to his bed. Pain is situated at the outer, lower portion of the thigh, and also in the knee. Is very nervous, and can bear pain very ill. Pulse 110, skin hot, appetite poor. Ordered a- brisk cathartic and sedative pill. Towards evening, the pain continuing to be severe, I injected twenty drops of the solution. The operation was painful; no gastric disturbance followed; and, in about three-quarters of an hour after, the patient was asleep. Passed a good night; but, in CASES OF NEURALGIA. 87 the morning, pain returned. Repeated the injection on three successive days; and I had the satisfaction to see my friend com- fortable, and, in a week from the commence- ment of the attack, to see him return to his business. He has had no return of the pain. Case XXV. Mr. R----, mechanic, aged forty-two, has suffered for more than a year from se- vere pain in the course of the right sciatic nerve, beginning about two inches below the hip-joint, and extending down to the knee. Is hardly ever free from pain; and cold and wet weather aggravates it still more. Has used every remedy. After administering a cathartic the day before, I injected twenty-five drops of the solution into the thigh, with good result. The pa- tient was free from pain for several days: and, when he had a renewed attack, I in- jected thirty-five drops, and later forty-five 88 HYPODERMIC INJECTIONS. drops; after which the pain did not return again. No gastric disturbance. Case XXVI. May 7th, 1860,1 saw, in consultation, a gentleman, aged sixty-eight, who has for years been subject at times to severe, per- sistent pain in the left hip and limb, felt only when he attempted to rise from a chajr or sofa, and never causing any trouble when sitting quietly. Complains also of great weakness in the limb. The case pre- sents more the characteristics of confirmed chronic rheumatism, with great loss of strength, than those of sciatica. As ev- ery thing had been tried, it was proposed to essay subcutaneous injection; for which purpose I was called. May 7th. Injected one-eighth of a grain of sulphate of morphia: patient felt some- what drowsy, but declared himself free from pain, and went to sleep. Left him in that condition. CASES OF NEURALGIA. 89 May 8th. Has passed a comfortable night. Can move about with more ease, but still feels an uneasy sensation in the limb. Repeat the injection. May 9th. Reports free from pain. May 10th. Pain returned : injected one- quarter of a grain of morphia. Free from pain for several days. Re- peated the operation once more with bene- fit. Some weeks later, I received a very hand- some note of acknowledgment from this gentleman, in which he expressed his sat- isfaction of the treatment, and the benefit he had derived from it. Case XXVII. Mr. A----, aged about sixty, a retired merchant, of good constitution, slightly nervous temperament, had been confined to bed, by a severe attack of sciatica of the left side, for about three weeks; when I was asked to see him, in consulta- 90 HYPODERMIC INJECTIONS. tion with the attending physician. This was not the first attack. Twice before, he had suffered from the same disease, which then yielded under the use of qui- nia and local remedies, such as cupping, leeches, and the application of morphia to the blistered surface; but this attack seemed to defy all these formerly successful reme- dial agents, and the patient has been more or less in constant pain. Pulse 100, bowels regular, appetite good. August 30//*, 7h, p.m. Injected fifteen drops of Squibb's Liquor Opii Comp. near the great trochanter of the femur, where the patient complained most of pain, shoot- ing from thence down to the knee, and along the outer side of the leg into the foot. 9£, p.m. Called again with the attending physician, and found the patient resting comfortably on the left, or painful side, and free from pain. Nothing further was done. Aug. 31s£, 8, a.m. Patient passed a com- CASES OF NEURALGIA. 91 fortable night: slept without the use of Dover's powder, and complains of but very slight pain. Repeated the injection; omit- ted all medicine. September 1st and 2d. Free from pain, and no injection needed for two days. Sleeps better, and can turn over in bed without much trouble. September 3d Made an attempt to stand, but found it impossible : the weight and motion give pain. Can, however, be placed in one of Eliaer's extension-chairs. Repeat the injection at night. September ith. Rested well: no pain in the thigh, but complains of a constant prickly sensation in the leg and foot. Foot is considerably swollen around the instep and ankle, and quite painful to the touch. Order the application of equal parts of Tinct. iodini comp. and ether sulphur. October 1st. Patient continued steadily to improve from day to day, and is, at the date of this report, able to walk about quite 92 hypodermic injections. freely, though mostly with the aid of his cane. Goes out daily. October 12th. Patient, whilst in the act of stepping into his carriage, slipped, and fell heavily upon the sidewalk, sustaining a severe contusion of the hip. The pain in the course of the sciatic nerve returned with renewed violence. External applica- tions were ordered to the hip, and the injec- tions repeated (fifteen drops) at the most painful point. Passed a comfortable night. Being mostly free from pain during the day, the injection was resorted to for some time late in the evening, always insuring a good night's rest. Recovery was com- plete in a short time. During the cold of the winter, Mr. A. had a renewed slight attack of sciatica, which, however, was promptly checked by a resort to hypodermic injections ; and for the last four months he has been gaining strength, and continues to be perfectly well up to the present. CASES OF NEURALGIA. 93 Two months ago, January, 1865, this pa- tient had a new attack of sciatica, which yielded to three consecutive injections. Is perfectly well again. Case XXVIII. — Eight Sciatica of many years' standing. Injection of Narcotics; Sulphate of Atropia; Tinct. Cantharidis. During the winter of 1861 and spring of 1862,1 was repeatedly called to visit Mr. B----, an old bachelor of about sixty. He left his room but rarely, owing to his inabil- ity to walk any distance on account of sciatica, which was aggravated by exer- cise. His general health was below the average. His negligent and filthy habits of life, however, rendered any disease pos- sible. Medicines were tried unsuccessfully. He therefore desired me to give him the benefit of subcutaneous injection. Opium injections always relieved him for days, and enabled him to walk about; but they were large: often as much as forty drops of 94 HYPODERMIC INJECTIONS. Liquor Opii Comp. were injected at one operation. This may be accounted for, however, in a great measure, by the long standing of the disease, and the insensibility of the nervous system to impressions of any kind, short of pain, brought about by the inveterate habit of the patient of literally eating medicines for years. I sought to establish counter-irritation along the course of the sciatic nerve, from hip to knee-joint; but by the constant use of liniments, which he had been in the habit of applying for years, several times during the clay, by means of a small block of wood, covered with a strap of rough leather, which he rubbed up and down the limb daily for hours, with all the strength he could muster, the skin had been rendered as hard and dry as sole leather, and the strongest counter-irritant left hardly any impressions. I then injected a solution of one-twen- CASES OF NEURALGIA. 95 tieth of a grain of sulphate of atropia. This subdued the pain entirely, but was followed by such unfavorable head-symp- toms, peculiar to the action of atropia, that I desisted from further experiments in that direction. In February of 1862, I ventured to in- ject near the great trochanter twenty-five drops of tinct. cantharidis. The pain that followed the injection was quite severe. The sciatica, however, subsided for the time. In the course of four days, the in- jection was followed by a considerable ab- scess, which, by the aid of poultices, in time discharged a large quantity of pus, and healed kindly. Aside from the soreness, this gave more relief than any thing I tried in this case. The patient left the house several times, and seemed materially improved. In March, he died suddenly of apoplexy. 96 HYPODERMIC INJECTIONS. Case XXIX.—Right Sciatica of several months' standing. Cure by the injection of Sedatives. Dr. D----, of Boston, stout, about forty- five, happy temperament, and otherwise perfectly healthy, had suffered for several months from severe right sciatica, which rendered him lame, and unable to follow his professional duties regularly as surgeon- dentist, when he sent for me, during the last week of June, 1862. He had con- sulted his medical friends, but got no re- lief. When I visited him, June 27th, he was lying on his bed, suffering intensely. The pain started from the hip-joint, and ex- tended down the thigh and leg into the foot. Ten minims, of Liquor Opii Comp. were injected. June 2Sth. Spent a comfortable night; repeated the injection. Cathartic medicine was ordered at the same time. June 30th. Pain returned; when I ap- plied counter-irritation along the course CASES OF NEURALGIA. 97 of the sciatic nerve, from hip to knee. In- jection was renewed. From July 1st to 17th, resorted repeat- edly to the injection: under its use he rap- idly recovered. July 18th, he attended to his professional duties. His strength, which had been greatly reduced, improved under the use of tonics; and from July, 1862, to date, he has had no relapse. Case XXX. — Right Seiatica of several months' standing. Mr. B----, master of one of our public schools, stout, muscular, moderately active. forty years old, suffered like the doctor whose case I stated last, and by whose advice Mr. B. consulted me. Pain runs along the entire right limb, is almost con- stant, and renders walking difficult. The treatment, with but very slight mod- ifications, was the same as in the previous case. Injections relieved the pain entirely, and, with rest and adjuvant treatment, he 7 98 HYPODERMIC INJECTIONS. left his bed at the end of two weeks. He has had no return of the complaint. Case XXXI. —Double Sciatica of several years' standing. Successful treatment by Subcuta- neous Injections. Mr. B----, a manufacturer, from the in- terior of this State, sixty years old, nervo- bilious temperament, and overtasked with business cares, has been subject to attacks of sciatica of both limbs. The pain is, how- « ever, more persistent in the right limb. Is lame, and stoops much. Medicinal treat- ment has given but temporal relief. September 17th, 1863,1 injected ten drops of the solution near the great trochanter of the right thigh, which relieved the pain effectually. Two weeks later, Mr. B. reported that he had been more free from pain during the above period than ever before, but reported also some gastric disturbance after the op- eration. Reduced, consequently, the injec- tion to eight drops, with good result. CASES OF NEURALGIA. 99 Remedies aiming to give tone to the nervous system, as ferri-valereanitis and others of the same class, were directed to be taken. From September 30th to November 20th, I saw this gentleman several times, each time repeating the injection, till, November 20th, it was discontinued. Walking was much improved, lameness mostly gone, and inconvenience from pain very trifling. This patient has not been under treatment since. Case XXXII. — Left Sciatica of two months' standing. Entire relief by Subcutaneous In- jection. Mr. F----had suffered from severe pain extending along the course of the sciatic nerve of the left thigh for eight weeks, when he consulted me, November 3d, 1863. The pain being intense, I injected twice on the day of consultation, and once on the second day. The third day he attended to his business as usual, and had no further need of my services. 100 HYPODERMIC INJECTIONS. Case XXXIII. —Left Sciatica of several months' standing. Complete relief by the operation. In the early part of January, 1864, Mr. II----, residing in Cambridge, aged fifty, of active business habits, and of a nervous temperament, came limping into my office, experiencing evidently great inconvenience at every step. The case proved to be left sciatica of from two to three months' dura- tion, which had defied thus far all treatment. Cause, exposure to cold, almost constant riding in and out of town; great depres- sion and exhaustion of the system. A friend of his recommended him to my care. Ten drops of the usual solution were in- jected near the great trochanter of the left thigh, followed by relief in from five to ten minutes. I also ordered — R Extr. Colchici Fid. (Squibb's), Liquor Opii Comp. " aa 3 iss., Aquae Cinnam., Aquae Gaulther., aa. § iss. Mix. A teaspoonful morning and night. CASES OF NEURALGIA. 101 This was done, as there was an evident predisposition to rheumatism in the patient. Further, I enjoined perfect rest and freedom from all business care for a time. It will be unnecessary to recapitulate here the treat> ment daily pursued. I would state, how- ever, that during the months of January, February, and March, the injection was applied at first three times, and later but twice a week. From the last clay of March, 1864, till the present, there has been no oc- casion for the repetition of the operation. Case XXXIV. — Recent case of Left Sciatica. After exposure to a severe rain-storm for several hours, Mr. D----, a master me- chanic, living in one of the Boston suburbs, was suddenly attacked with excruciating pain, extending from the left hip-joint to the knee, which rendered walking almost impossible. External applications and in- ternal remedies proved of no avail. In this condition he consulted me. 102 HYPODERMIC INJECTIONS. February 20th, I injected ten drops of liquor opii comp. Pain was soon relieved, and motion rendered more easy; but the gastric disturbance was greater than I had yet observed in any case that has come under my observation. Three days later, five drops only were introduced, followed by relief, but giving rise to the same un- pleasant gastric symptoms. A subsequent attempt was attended with similar results. I made no further injections, but insisted upon rest, applied counter-irritants along the course of the nerve, and gave appro- priate remedies. The patient ultimately recovered. The following four cases of Sciatica I commend to the attention of the reader es- pecially, as they were treated by the injec- tion of irritants ; viz., a saturated Solution of Chloride of Sodium and a Solution of Nitrate of Silver} 1 Vide page 10, ante, caput e. " Injections, their Nature, Extent, and Limit." CASES OF NEURALGIA. 103 Case XXXV.— Right Sciatica treated by the injection of a saturated Solution of Chloride of Sodium and a Solution of Nitrate of Silver. Mr. B----, provision-dealer, aged thirty- two, stout and active, of hereditary rheu- matic diathesis, consulted me, November, 1863. For several months he suffered from a dull, heavy, almost constant pain, starting from the lumbar region and the extremity of the coccyx, extending to the hip-joint, and thence along the course of the sciatic nerve to the knee. There had been no lack of liniments and other appli- cations. November lQth, 9 p.m., I injected fifteen drops of liquor opii comp., and found next morning that the patient had spent a com- fortable night. The operation was several times repeated. January 1st, 1864, the pain being still felt, though much modified, — owing, un- doubtedly, greatly to the fact that Mr. B. 104 HYPODERMIC INJECTIONS. was compelled to be about his business,— I determined to inject twenty minims of a saturated solution of chloride of sodium. I perforated the tissues as deep as I thought safe, the object being to bring about an inflammatory action near the seat of pain, and in the immediate vicinity of the nerve. The injection was followed by a slight burning sensation, extending through the whole length of the thigh; but on the third day the point of injection was quite painful, slightly swollen, indicating the for- mation of an abscess. Aside from the in- convenience experienced in walking, the sciatica had disappeared. Poultices were applied; and, four days later, the swelling had subsided, and all uncomfortable sensa- tions ceased. January 28th, the patient was exposed to wet and cold, and had a relapse. I now injected five minims of the solu- tion of nitrate of silver. Result, severe burning pain for about twenty minutes; CASES OF NEURALGIA. 105 but, when that ceased, the sciatica had also departed. On the fifth day, there was a swelling of the size of a small hen's egg; on the eighth, after being poulticed, a small quantity of matter was discharged; and, in the course of a week, the abscess had healed kindly. The amelioration was greater than ever before. Severe weather, wet, and cold, re- mind Mr. B., however, of his old enemy. He requires but seldom medical aid. Case XXXVI.—Right Sciatica of ten weeks' standing. Injection of Nitrate of Silver; Re- covery. Mrs. M----, widow, forty-six years of age, and tolerably good constitution, was exposed to a rain-storm during the first week of March, 1864. The tenth of the same month, she was seized with severe pain in the right hip-joint, shooting from thence down to the knee. Was obliged to take to her bed; and counter-irritation 106 HYPODERMIC INJECTIONS. was applied, besides the use of internal remedies. She improved; but, as soon as she attempted to use the limb, the parox- ysms returned. Saw her for the fir.st time,* March 29th. The pain then extended along the whole course of the sciatic nerve, down to the knee. As to the cause, there was no doubt. Ordered colchicum and opium internally, and spt. terebinth, externally, with friction; absolute rest in bed, and the limb in a straight but somewhat elevated position. April ith. No satisfactory improvement; when I injected ten drops of the nitrate of silver solution, followed immediately by a sensation of severe burning through the whole limb, which, in the course of half an hour, subsided. Swelling and tenderness followed in five days, but no suppuration. Sciatica much relieved. May 11th. Since April 20th, Mrs. M---- has been doing some housework, experien- CASES OF NEURALGIA. 107 cing comparatively little inconvenience till the night of the 10th, when she was over- fatigued. Injected again fifteen drops of the solution, followed by the same symp- toms as before, except somewhat more se- vere ; considerable swelling, tenderness, and slight suppuration. Recovered in eight days. Took tonics and nervines for a considerable time afterward. Recovery complete. I have seen the patient but twice since June, 1864. Case XXXVII. — Recent Right Sciatica. Injec- tion of Solution of Nitrate of Silver. Mr. C----, a cooper by trade, healthy, and of good constitution, aged forty-one, was suddenly attacked, while at work, with excruciating pain, extending from the hip- joint, along the outer border of the thigh and leg, into the foot. For a week, he had no rest neither night or day. In this state he consulted me, February 12th. His pain 108 HYPODERMIC INJECTIONS. was at once relieved by the injection of liquor opii comp. near the foyer of suffer- ing, and he slept all night. The next morning, when pain returned as severe as ever, I injected ten drops of the solution of nitrate of silver into the thigh. The usual phenomena ensued: on the seventh day, slight suppuration was es- tablished, passed off, and on the eleventh day the abscess had healed. The sciatica has troubled him no more since. Case XXXVIII. — Left Sciatica of recent stand- ing. Injection of Solution of Nitrate of Sil- ver. Miss F----, schoolmistress, aged twenty- seven, rather feeble, and nervous tempera- ment, got her feet wet on returning from school, February 11th, 1864. The immedi- ate result was a severe cold, followed, in about five days, by pain shooting from the hip-joint down to the ankle. Is unable to walk or sleep. An injection of liquor opii comp. relieved her temporarily. CASES OF NEURALGIA. 109 Anxious to try the effect of the irritant, I injected ten drops of the solution, followed by a severe sensation of burning for some time. There resulted hardness and swell- ing at the point of operation, with slight suppuration on the ninth day. Relief com- plete. She took iron and alteratives for some time after. No return of the com- plaint. (ff) Crural Neuralgia. Case XXXIX. — Severe Neuralgia of the Right Leg, extending from Knee to Foot; Cure. Mr> F----? merchant, about thirty-five years old, well built, of regular habits, but a bon vivant, consulted me, January, 1865, about severe pains, shooting from the knee, along the outer border of the leg, into the foot. Can assign no cause for the mala- dy. Is subject to varicose veins below the knee. Several moderate injections of liquor opii comp., and the wearing of elastic stock- 110 HYPODERMIC INJECTIONS. ings, gave the desired relief in a short time. Has had no return of the neuralgia since. Case XL.— Neuralgia of both Legs. Relief by Subcutaneous Injection. Mr. G----, of Boston, forty years old, short stature, and nervous temperament, constantly obliged to be on his feet, has been subject to severe attacks of double crural neuralgia for two years. The paroxysms last from five minutes to an hour, or more. Medicines do little good. I made repeated injections of liquor opii comp., ranging from five to twenty drops; till finally, after the lapse of several months, the neuralgia has yielded to the treatment. For the last three months, Mr. G. has been free from pain. CASES OF NEURALGIA. Ill (6.) General Neuralgia. Case XLI. — General Neuralgia, assuming at times the character of Cervico-Oceipital, — Cervico-Brachial,—Intercostal—Mammary, — Abdominal, — Lumbar, and Sciatic Neuralgia, with temporary loss of power of motion. In- jection of Sedatives, Chloride of Sodium, and Nitrate of Silver. The subject of this protean malady is Miss A---- of Boston, twenty-four years of age, sparingly developed, strumous hab- it, and nervous temperament. Called to visit her October 27th, 1863,1 ascertained the following facts: Has been an invalid for years, always feeble, and un- able to endure fatigue. Some five years ago, she was thrown from a carriage, and supposed to have sustained some injury of the spine. Her health began to fail from that time. Shortly after, she was attacked by severe neuralgia of the neck and head, (cervico-occipital), which at times would end in contraction of the muscles of the 112 HYPODERMIC INJECTIONS. neck, drawing the head completely over to the affected side, sometimes the right, sometimes the left side, continuing for two or three days at least in the same position, and rendering any motion painful. In such a condition, I have seen her again and again. At other times, the neuralgia appears in the shoulder and arm, (cervico-brachial), or in the side, breasts, and intercostal spaces, or in the groins, or in the course of the sciatic nerve; in short, everywhere where Nature has laid out her nerve-tracks. Nor is here the measure full. About fall time, all strength seems to leave her limbs; she is unable either to walk or stand for months, — absolutely confined to her room, lifted by a kind and tender sister daily from bed to arm-chair, and vice versa. ■Such was the routine I witnessed from October, 1863, till February, 1864, when the power of motion and sufficient strength had returned to enable her to move about CASES OF NEURALGIA. 113 unassisted. Enjoys better health in the country during the summer months. Good medical advisers have not been wanting. The following is a summary of her con- dition, October 27th, 1863: Reduced in strength; loss of appetite and sleep; consti- pation; catamenia, irregular and scanty; unable to walk or stand; head drawn to the right side of the neck; neuralgia in the neck and shoulder; soreness upon pressure over the sixth and seventh dor- sal vertebrae. My course with this patient was summa- rily, as follows: The neuralgia was treated by subcutaneous injection. I was never disappointed in its effects in her case, how- ever often I had to repeat the operation, as the largest dose she could bear was only five drops of liquor opii comp. As soon as I went beyond the five drops, there ensued, invariably, entire loss of voice for several days. . This phenomenon I witnessed again and again, as I was sometimes obliged to 8 114 HYPODERMIC INJECTIONS. secure the patient's comfort at the expense of temporary aphonia. By a timely ope- ration, the neuralgia and contraction of the muscles of the neck were often arrested, and sometimes cut short at the very begin- ning of the attack. When I arrived too late, and the head was already thrown over to the shoulder, subcutaneous injection at the point of greatest contraction caused the rigid muscles materially to relax; but no sooner had the fire, so to speak, been arrest- ed in one place, than it would assert its supremacy in another. When met with the injection, relief was sure to follow, for a time at least. In the course of a few months, the paroxysms recurred less fre- quently. December Mh, injected below the inferior angle of the right scapula fifteen drops of a saturated solution of chloride of sodium. Severe pain followed for a few minutes; which, however, soon subsided, and with it the neuralgia. CASES OF NEURALGIA. 115 Soreness supervened in four days; but no swelling or further inconvenience was ap- parent. January 2Mh, 1864, the pain being severe in the hips and along the course of the sciatic nerve, I injected ten drops of a solu- tion of nitrate of silver near the great tro- chanter. A queer feeling ensued, as the patient stated. A swelling of the size of a walnut ap- peared the next day, which, on the fifth, broke, and discharged a moderate quantity of pus. The neuralgia was much relieved; and, for some time after, it was unneces- sary to repeat the operation. From February 1st to June 1st, the in- jection was resorted to several times, each time with greater success. It is just for me to state, that this mode of treatment saved my patient many hours of suffering; that her general health was much improved; and that when she left for the country, in June, she could look back with satisfaction 116 HYPODERMIC INJECTIONS. upon the result of the treatment. During the eight months that I applied the injec- tion, Miss A---- never experienced any ill effects from the hypodermic injection of narcotics and irritants, as is often the case when opium is taken into the system for any length of time, nor any bad counter- effects when it was abandoned. It is further my duty to state, that much of the improvement of the case was owing to constitutional treatment, which, from the very first, was brought into play. Seda- tives alone, and combined with tonics, such as the valerianate of iron, of zinc, iron, and quinine, &c, were fully administered. Very liberal diet, and ale and porter, were also given daily. Salt-water baths and friction had, too, their beneficial influence : in short, every agent that could be pressed into ser- vice to contribute towards a favorable re- sult was forced to pay its tribute. I saw Miss A---- some time in Novem- ber, 1864, upon her return from the couu- CASES OF NEURALGIA. 117 try. She looked much improved, walked tolerably well, and stated that her neural- gia tormented her much less than before. I advised a continuance of the use of tonics, and a sedative pill for the night. I have been informed that the young lady is get- ting along well, and has had no occasion, thus far, to resort to hypodermic injection. Case XLII. — General Neuralgia, resulting from carcinomatous Disease. Value of Hypoder- mic Injection. Sept. 10th, 1862, I was called to visit Mrs.----of Boston, thirty-five years of age, who, a few months before, had undergone a severe surgical operation, — removal of the right breast for carcinomatous disease. Shortly after the operation, she was at- tacked with severe right sciatica. About the same time, for the purpose of recuperating her health, she removed, by advice of her physician, into the country; but not im- proving, and rather getting worse, I was called to see her upon her return. 118 HYPODERMIC INJECTIONS. Of nervous temperament, vivid imagina- tion, intelligent, and educated far above the average; complexion sallow, and expression of countenance anxious ; unable to walk across the room without suffering; appetite poor, and bowels irregular, harassed with constant nausea,—such is the general rec- ord of my first visit. It was at once evident that the sciatica was merely another symptom of the origi- nal dreadful disease which had taken pos- session of the frame; and that, at any time, this sciatica might show itself somewhere else, under a different aspect. From September till February Ath, 1863, the day of her death from exhaustion, my fears proved but too true; the neuralgia assuming sometimes the type of facial, occipital, intercostal, abdominal, lumbar, sciatic, and plantar neuralgia. To in- crease the misery, the stomach would retain no medicine; only the simplest CASES OF NEURALGIA. 119 articles of food, and these were digest- ed in small quantities. Treatment.— I relied upon hypodermic injection to relieve the pain, which soon proved the only means by which to give ease and comfort to my patient; but so sensitive was the stomach and nervous system, that four drops of liquor opii comp. entirely relieved the pain, and generally sufficed to insure a good night's rest, whilst five drops would cause nausea and vomiting. For about five months, the injection was daily administered twice, sometimes often- er. In no instance have I seen it produce greater or more gratifying results. Days and nights of suffering were changed into hours of comfort and ease. If the injec- tion was omitted, the distress was great. Although a cure was out of the question, yet the satisfaction my patient felt, when punc- tually, at 8, p.m., I made my appearance, 120 HYPODERMIC INJECTIONS. impressed itself strongly upon my mind. The evening she died, but a few minutes before my arrival, she is reported to have remarked, "In a few minutes the doctor will be here, and the injection will make me comfortable and easy." Hardly had she whispered these words, when the clock struck eight. I entered the room: she took my hand, clasped it firmly, thanked me for my services, and was no more. A good and noble woman had departed this life. I had the satisfaction to have eased her hours of suffering. Case XLin. — General Neuralgia, of several months' standing. Relief by the Injection. Mrs. F---- of Springfield, Illinois, of poor health and feeble constitution, took a cold nine months after confinement. In consequence, she was seized with intercos- tal neuralgia, which in time assumed the facial, lumbar, and sciatic type. At times, all the nerves of her body seemed to ache. CASES OF NEURALGIA. 121 Proper constitutional remedies were pre- scribed, and, in addition, the injection intro- duced into the precordial region and the thigh eight times. Relief was complete after every operation. In five weeks the patient recovered, but continued to take tonics and alteratives for a period of three months. Case XLIV. — General Neuralgia, resulting from too constant application to business. Mr. H----, merchant, aged forty, com- pletely lost his health in consequence of too great and constant application to busi- ness. Besides loss of sleep, appetite, and strength, there existed a great degree of irritability of the nerves, manifesting itself in constant twitching of the muscles, and pain which seemed to wander all over the body at times. My chief reliance in this case was relax- ation from business; proper constitutional treatment, tending to improve the digestive 122 HYPODERMIC INJECTIONS. organs and to give strength; not forgetting sleep. This last desideratum I was able to bring about by the hypodermic injection of fifteen drops of liquor opii comp. for sixteen evenings; after which time, natural sleep supervened, the twitching of the muscles ceased, and recovery took place in a com- paratively short time. 2. GENERAL DISORDERS OF THE NERVOUS SYSTEM. (a.) Paralysis. Case XLV. — Paraplegia, resulting from gunshot wound in the Abdomen, and lodgement of the ball in the lumbar region. Caries of the fourth and fifth Lumbar Vertebrse. Terrible parox- ysms of Cramps in both Legs, continuing for weeks, relieved by the Injection of Narcotics, Atropia, and Strychnine. Partial restoration of the use of the Limbs. Death from Dysen- tery. The history of this case is, I think, so in- teresting and instructive, that professional PARALYSIS. fas readers, above all, will excuse me if I enter fully into its details. Adino Hall, aged twenty-three, private in the 1st Mass. Vol. Infantry, was wounded in one of the battles on the Chickahominy, in June, 1862. The ball entered near the umbilicus, but did not make its exit. Sub- sequent symptoms and observations placed it between the fourth and fifth lumbar ver- tebrae, between which it remained securely embedded. He was taken up exhausted, and in the hospital found to be paralyzed in the lower half of the body, including bladder and rectum. Some time after, he was discharged as incurable, and sent home. Here he was seen by several eminent sur- geons, and urged to enter the hospital, which he declined to do. Late in July, 1862, during a temporary absence of his attending surgeon from town, I was requested to see him during the in- terval ; and afterwards, at the surgeon's re- quest, continued to attend him. 124 HYPODERMIC INJECTIONS. At my first visit he appeared much emaciated, paralyzed in his lower limbs, and without control over his bladder or rectum. In the lumbar region was a suppurating wound, oval, measuring seven and three- fourths inches in transverse diameter, and laying open the space occupied by the fourth and fifth vertebrae. Destructive caries had supervened, and pieces of bone repeatedly were thrown off. I was daily looking for an opportunity to see the mem- brane covering the spinal cord to some extent exposed to view. He would be suddenly seized, every few minutes, with severe cramps, as he called them, starting from the toes, and creeping up the leg to the knee. The paroxysms came without the least warning, and lasted from one to three minutes. Holding and pressing the limb, or rubbing it with great force, would seem to shorten the paroxysm. At such times he would scream so loud as to be heard by his neighbors. Large doses CASES OF PARALYSIS. 125 of opium and other narcotics had lost their effect; his nights were broken, and sleep anxiously looked for. Such was his condition when I was called to see him. During my first visit, he had two attacks of cramp. I injected at once twenty-five drops of liquor opii comp. into the calf of his right leg. He slept five and one-quarter hours, and had no re- currence of the cramps for seven and one- half hours. When I saw him again in the evening of the same day, he felt some pain; but it was less intense than before the op- eration. Injected thirty drops into the left leg. The wound was dressed and poulticed. I ordered for my feeble, emaciated, and suf- fering patient, a liberal allowance of beef- tea, mutton-broth, &c, and a plentiful sup- ply of champagne. Had a good night's rest, is free from pain, and says he is a new being. ■ For two months, August and September, I visited him twice daily, having recourse 126 HYPODERMIC INJECTIONS. to the injection as circumstances required. It never failed to give the desired relief. The wound also progressed favorably. August 26th, a considerable portion of diseased bone was removed by the for- ceps. Gradually three and four days in- tervened between the injections. But the paralysis continued the same. I thought this to be a favorable opportu- nity to try the effect of strychnia on the paralyzed motor nerves. Of a solution of gr. i. to 3 i. of distilled water, I injected ten drops into the wound of the back. In eighteen minutes, this was followed by con- siderable twitching in both limbs; an uncom- fortable sensation, as the patient described it. The injection was daily but gradually in- creased till it reached thirty drops: each time the same phenomena ensued, more or less marked according to the amount in- jected. At times he acquired the power to lift either leg, being able to hold it up with- out assistance for two or three minutes. CASES OF PARALYSIS. 127 Tinct. nucis vomicae was also administered internally. Strength was constantly gained; and December 14th, 1862, the wound in the back had healed, the ball still remaining em- bedded in the body of the vertebrae. He also regained partial control over the blad- der and rectum. For two months, January and February, I continued my experiments with the injec- tion of strychnia. On the 4th of Febru- ary, he managed to get slowly from his bed unassisted, and to stand up; not, how- ever, without the aid of a cane. He man- aged further, unassisted by any person, to descend one flight of stairs into the kitchen, managing to take hold of various objects near by to assist him and to lean against for support. He continued to manage to get about during the spring and summer of 1863. After September, I saw him but seldom. One day he left his daguerro- type at my house. I finally lost sight of him, till in June, 1864, when I was in- 128 HYPODERMIC INJECTIONS. formed that he had suddenly died of dys- entery. I regret very much not to have had an opportunity to make a post-mortem exami- nation, so as to remove the vertebrae with the ball. To recapitulate: This case presents sev- eral remarkable facts: — 1st. The nature and extent of the in- jury in the most vital parts. 2d. The complete and instant paraplegia following the injury. 3d. The extension and serious nature of the wound in the back, involving caries of portions of two lumbar vertebrae. 4th. The decided effect of the injection of narcotics in arresting the cramps, when other remedies had failed. 5th. The signal effect of the injection of a solution of strychnia upon the paralysis, and partial recovery of the use of the limbs. 6th. Death caused by dysentery, and not by the injury sustained. CASES OF PARALYSIS. 129 Case XLVI. — Paraplegia of recent date; super- vening Rheumatism. Injection of a Solution of Sulphate of Strychnia; Recovery. Mr. W---- of East Boston, sailor, aged forty-three, after long exposure to cold and wet, was attacked with rheumatic fever in February, 1864, which confined him to his bed for eight weeks. From that he recov- ered, when he observed that he was grad- ually losing control over his limbs. March 27th, 1864, when I saw him for the first time, he was unable to lift or move either. At times, he had sharp pains in the calfs of the legs. The bladder was also partial- ly affected, bowels constipated, appetite and strength gone. He was directed to take liquor potass. arsenitis, tinct. nucis vomicae, and other appropriate remedies, for some time. Lib- eral diet, friction to the limbs, and the douche bath to the spine, were also ordered. April 2Mh, there was scarcely, if any, improvement in his condition, except that 9 130 HYPODERMIC INJECTIONS. he had more control over the bladder, and had gained some strength. I injected now fifteen drops of a solution of sulphate of strychnia into the calf of the right leg, which operation I repeated seven times in twenty-three days. At the end of that time, he managed to get out of bed with- out assistance, and to walk, when assisted to some degree by a friend, although com- pelled to rest every few minutes. The 2d of June, when I saw him for the last time, he walked tolerably well with the aid of a cane. The friction, douche bath, and alteratives were advised to be continued for a month longer. At last accounts, the patient was well. (b.) Hysteria. Case XLVII. —Hysteria, aggravated by contin- ued Wakefulness. Cure by Hypodermic In- jection. Miss W----, aged eighteen, nervous tem- perament, and very excitable, suffered from HYSTERIA. 131 repeated attacks of hysteria, caused by mental troubles, the nature of which she was unwilling to reveal. When I saw her, she was in tears, and had not slept for forty-eight hours. She could not con- trol her feelings; refused to take medi- cines. Under these circumstances, I in- jected fifteen drops of liquor opii comp. into the left arm, and had the satisfaction to learn the next morning that Miss W---- had slept for several hours, and was more calm. At her request, I repeated the injection the following evening, and subsequently twice more, after which she recovered. (c.) Wakefulness. Case XLVIII. — Wakefulness, cured by Injec- tion of Narcotics. Mr. F----, a merchant, aged fifty-four, in good health, had been so closely confined to his business, which caused him at the 132 HYPODERMIC INJECTIONS. time considerable anxiety, that he was unable to sleep at night, and his friends expressed fears that he might get the brain fever. I saw him in the evening, ,and injected twenty drops of liquor opii comp. into the leg. In half an hour he was asleep. Rested for six and a half hours. I repeated the operation for four successive evenings, each time increasing the dose; and after the fifth operation he slept as well as ever. I sent Mr. F---- into the country to rest from business. (d.) Delirium Tremens. Case XLIX. Mr. B----, aged twenty-six, of small stature, but strong and well-built, a Ger- man mechanic, presented unmistakable symptoms of delirium tremens, when I was sent for to see him, May 12th, 1860. After an attempt to quiet him by means of medicine, which proved futile, I inject- CASES OF DELIRIUM TREMENS. 133 ed three-quarters^ of a grain of morphia into the cellular tissue of the arm. Twenty minutes after the operation, the patient sunk into a slumber, which was not broken for an hour and a half. This was at 11, a.m. At 4, p.m., when I saw him again, he was rather 'noisy, but more easily persuaded to keep quiet than in the morning. I inject- ed again one grain of morphia, and in less than half an hour the patient was asleep. Next morning, May 13th, at 8, a.m., I learned that he had slept well during the night, without hardly ever awakening, and found him calm and cheerful; talked ration- ally, and said he felt weak, but like him- self again. The operation was not repeat- ed, and in five days after he was at work again. Case L. Mr. St.----, German, aged thirty-four, of nervous temperament, addicted to drink- ing:, had suffered from an attack of deh'r- 134 HYPODERMIC INJECTIONS. ium tremens for two days, when I was called to see him. This was the third time he had had the disease. For two days the delirium was on the increase. Persuasion was useless, as I soon saw, to get him to bed: he declared it to be on fire. I at once dissolved one grain of morphia, and injected it into the thigh before he was aware of what was going on. Refused to let me feel his pulse; but, after about fifteen minutes, he complained of fatigue in his limbs, and said they felt as if going to sleep. Without making any resistance, he was laid on his bed, half closed the eye- lids, and dozed away. He made another attempt to get up, but soon sleep overpow- ered him. 6, p.m. Slept for nearly three hours, but is noisy again. Repeat injection. 9, a.m. Find patient calm, but very weak; pulse 108; no appetite. Slept almost the whole forenoon. In the course of a week, this patient re- CASES OF DELIRIUM TREMENS. 135 covered so far as to be out; and in an- other week's time he followed his usual avocation. Case LI. Mr. S----, bar-tender in a large liquor store, came the second time under my care for delirium tremens, in October, 1863. 'Had been restless for two days before I saw him. At this period, he is very noisy; three men can hardly hold him; insists that the house is on fire; but is quiet, docile, when I converse with him. Injected at once forty drops of liquor opii comp. into the arm, to which he raised no objection. He continued to be noisy for half an hour, when he became calm, and fell asleep. At 7, a.m., I repeated the op- eration again; he slept most of the day. Another injection at 10, p.m., after which he slept the whole ensuing night and part of the following day; seemed to be suffi- cient to restore the patient. 136 HYPODERMIC INJECTIONS. Case LII. Mr. H----, aged twenty-seven, gentleman of leisure, had unmistakable symptoms of delirium tremens when I saw him. Had not slept for thirty-six hours. Injected thirty drops of liquor opii comp. Soon he was asleep. Repeated the operation five hours afterwards, and again eleven Tiours later. This patient recovered with- out difficulty. (e.) Tetanus. Case LIII. I had the opportunity in November, 1860, to observe the effects of subcutane- ous injection in a case of traumatic tetanus, which occurred in the practice of another physician, but who requested my assistance in regard to subcutaneous injection, if I thought proper to apply it to the case. Although death followed on the second day after I saw the patient, it is not say- CASES OF TETANUS. 137 ing too much in praise of this therapeutic agent, if I state summarily, that the effect of the operations which I performed upon the patient at different periods during two days was such as to induce me to recom- mend urgently a trial of the same treat- ment in similar cases: To inject a large dose of the narcotic at once, say from thirty to sixty drops of liquor opii comp.; and to repeat the operation frequently, so as to put the patient completely under the effect of the agent. There is in these cases more than an average chance of suc- cess. * Unless I am mistaken, this case was the first of its kind in which hypodermic injec- tion has been brought into requisition in this city, if not on this continent. Case LIV. In another case of • traumatic tetanus which I saw in consultation in a neigh- boring town, though not present until the 138 HYPODERMIC INJECTIONS. last hours before death, I applied the in- jection at once, twenty-five drops of liquor opii comp., in the back, near the spinal col- umn, to the great relief of the poor suf- ferer. Four hours after, the same quantity was injected; and for six and three-quarter hours, till death ensued, the previous agony and distress were changed into comparative calm and ease. If it was for no other reason than to have it in our power to let our patient die free from the really terrible agony of this dreadful disease, hypoder- mic injection ought to take its place in the front rank of therapeutic agents. I trust that the opportunity will be afforded to me yet to apply the injection at the outset of the disease, in order to dispute with death, inch by inch, its hitherto sure victim. RHEUMATISM AND GOUT. 139 3. RHEUMATISM AND GOUT. Drs. Behier and Herard of France, and Dr. Cowdell of England, have reported cases of rheumatism (chiefly muscular) successfully treated by hypodermic injec- tions; but lam not aware (although I have taken much pains to inform myself upon the subject) that any medical writer in this country has reported cases of rheu- matism, both acute and chronic, treated principally by this agent. If I shall suc- ceed in calling the attention of physicians to its applicability in the treatment of these diseases, I have no misgivings about their experience coinciding with mine. . In a case of acute rheumatism (rheu- matic fever), we have two conditions to take into consideration,— one is the pain, seated usually in, around, or near one or several of the large joints; the other is the constitutional disturbance manifested by fever, dry skin, inaction of the bowels, 140 HYPODERMIC INJECTIONS. loss of appetite, &c. The pain I propose to control entirely by hypodermic injec- tions, and not by the internal administra- tion of medicines; the fever, bowels, &c, on the other hand, by medicines with which no narcotics previously given by the stom- ach can interfere. In chronic rheumatism, I rely also much upon the injection; the constitutional treat- ment varying with every case according to circumstances. I select the following cases from my note-book: — Case LV.—Rheumatism of six months' stand- ing, treated by Subcutaneous Injections. Recovery. Mr. S----, a grocer in this city, but re- siding in West Roxbury, aged forty-eight, tall and well-built, but general health much impaired by over-work, consulted me in November, 1863. I learned the following facts: Six months ago, he was attacked by rheumatism, which permanently settled in RHEUxMATISM AND GOUT. 141 the right shoulder-joint, gradually render- ing motion impossible and the arm useless. The elbow, wrist, and finger-joints were en- larged. It was impossible for him to shut the hand or bend the fingers. The mus- cles had wasted away, so that the greatest discrepancy existed between the two arms. The pain in the shoulder-joint was con- stant; he was unable to lie on the right side ; his sleep was broken. He was emaci- ated ; had no appetite; bowels inactive; sub- ject to a bad cough, accompanied by copi- ous expectoration and profuse night-sweats. He received good medical treatment, but had given up in despair, and discontinued for some time the use of medicines. Examination satisfied me that the lungs and heart were sound; that the cough was mostly nervous, and Mr. S. much reduced in strength from constant suffering. Two conditions were, therefore, requisite to rescue him from his perilous condition; namely, to relieve him of pain, and to im- 142 HYPODERMIC INJECTIONS. prove his digestive functions so as to give him strength. I doubted, however, whether the patient would ever recover the full or partial use of the right arm. I injected fifteen drops of liquor opii comp. below the insertion of the right del- toid. In ten minutes the patient was nau- seated, and vomited a large quantity of bile. He then went to sleep. The following night was the first, after the lapse of months, that Mr. S. slept unin- terruptedly, and at times on the right side. He arose much refreshed, — such was his re- port at my next visit. I directed extr. col- ocynth. comp. and hydrarg. chlorid. mite., aa gr. ii., in the form of a pill, to be taken at night, beef-tea and other nourishing food several times during the day, tepid salt- water bath daily, and the cutaneous circu- lation to be stimulated by friction. The injection was repeated every other day dur- ing the month of December, with satisfac- tory results. It was uniformly followed by sleep: the bowels became more regular, and CASE OF RHEUMATISM. 143 appetite improved. The cough diminished as well as the expectoration and night- sweats, without any special treatment in that direction. It is evident these resulted from extreme debility entailed by suffering and loss of sleep. I now directed the joints of the affected arm and hand to be daily painted with tinct. iodini comp., and flex- ion and extension to be practised to a lim- ited degree. Vegetable tonics were admin- istered, and ale and porter with animal food ordered. Strength daily increased, and the pain assumed a milder character. From January 1st to April, 1864,1 saw Mr. S----twice a week, each time repeat- ing the operation. Motion and flexion of the joints of the arm and hand gradually became more easy and less painful. About the middle of March he wrote a letter with- out difficulty, and had strength- enough in the right arm to lift a chair and similar ob- jects. The muscles became, soon also more fully developed. May Oth, Mr. S. called on me for the first 144 HYPODERMIC INJECTIONS. time in the city. The injections are now discontinued, but the tinct. ioclini is still applied, and tonics continued. At this date the cough has disappeared entirely; appe- tite is good, and bowels regular. Begins to look after his business, and bids fair to be as well as ever. July 1st. Patient has steadily improved; can close his hand without effort, and move the arm tolerably well. August 20th. Saw Mr. S. to-day, look- ing well and hearty. He is busy on his farm, takes no medicines, and, with the ex- ception of some stiffness of the shoulder- joint, has nothing to complain of. Case LVI. — Rheumatic Fever, treated princi- pally by the use of Hypodermic Injections. Mr. S----, merchant, residing in one of the suburbs of Boston, about fifty-five, of bilious temperament, rather delicate organ- ization, and enjoying only a moderate degree of good health, was attacked with rheumatic fever, February 11th, 1864, when CASE OF RHEUMATIC FEVER. 145 I was called to see him. In two days the disease had fully developed itself in the large joints of the right side, and, during the succeeding days, invaded also the left. The least touch anywhere caused pain; even the weight of the bed-clothes could not be borne. Pulse from 90 to 110 for several days; tongue coated, bowels irregular. Of nervous temperament, and anxious, my patient was ill prepared to bear pain. The bowels were immediately acted upon, and the pain relieved by an injection of fifteen drops of liquor opii comp. near the knee-joint. This secured a good night, reduced the pulse, and brought about profuse perspira- tion. The pain was kept in check by the operation; the bowels were made to act twice in twenty-four hours for several days. For six weeks I continued to apply the in- jections when necessary. They were dis- continued without any ill effects to the patient, and no relapse followed. 10 146 HYPODERMIC INJECTIONS. Pain was charmed away; sleep at hand when least expected; the stomach contin- ued to receive and digest food; strength was not made subordinate to debilitating measures; convalescence was more rapid than ordinarily. The maximum dose injected in this case was from ten to fifteen drops, repeated once or twice daily. In a few months this pa- tient recovered entirely, and has been in better health since than before *his sick- ness. Case LVII.—Acute Rheumatism, treated by Hy- podermic Injection. Mr. W----of Roxbury, aged thirty-two, strong and robust, a member of the fire- department, whilst on duty got drenched with water, and continued at work for sev- eral hours till relieved; when next day he was seized with severe pain in his knee- joints, which began to swell considerably. There was also high fever. This was the CASE OF ACUTE RHEUMATISM. 147 second attack of rheumatic fever in two years. I injected twenty drops of liquor opii comp. near the right knee-joint; pre- scribed an active cathartic. March 27th, I ascertained that he had slept considerably during the night, and that the pain was much relieved. Fever abated, but still pulse ranges as high as 98. I introduced again fifteen drops with beneficial effect. During nine days of my attendance, I operated seven times. Be- sides the benefit of the injections, cathar- tics and simple food were the only means that were employed during the treatment. He made a rapid recovery. Case LVIII. — Rheumatism, confined to both Legs. Mr. B----, machinist, aged twenty-seven, well developed and otherwise healthy, had an attack of rheumatic fever about two months ago. He feels well, except that the knee and ankle-joints continue swollen, 148 HYPODERMIC INJECTIONS. and are painful when he attempts to move about. I advised the application of tinct. iodini comp. to the joints, and gave five injections in eleven days, from ten to twenty drops each, near the knee and ankle-joints. The pain ceased, and the swelling disappeared gradually. In seventeen days, Mr. B---- was able to move about without much in- convenience. Case LIX. — Rheumatism, treated principally by Hypodermic Injections. Mrs. A----, mother of three children^ and in rather feeble health, had been con- fined to her bed for nine weeks when I saw her in May, 1864. Her complaint was rheu- matism, which had permanently settled in the knee-joints, rendering any motion of the limbs painful. There was also consid- erable swelling around these joints. I ad- ministered colchicum internally, and inject- ed ten drops of liquor opii comp. near CASE OF RHEUMATISM. 149 the left knee-joint. She had a more com- fortable night. The injection was repeated several successive evenings, as at that time the pain was most severe. Each time it gave the desired relief. In seventeen days she had sufficiently recovered to be able to be moved into the country. Mrs. A. has had another attack lately, which yielded, however, to internal remedies and a few injections. Case LX. — Chronic Rheumatic Gout, of several years' standing. Benefited by Hypodermic Injections. Mr. ----, merchant, fifty-four years of age, strong and robust, a high liver, has been subject to attacks of rheumatic gout for twenty years. Generally the parox- ysms, which are very severe and obstinate, follow some imprudence which has been committed in eating or drinking, or both. When I saw him, October 12th, 1864, he was confined to his bed; the left foot much 150 HYPODERMIC INJECTIONS. swollen, inflamed, and exceedingly painful around the ankle and great toe. The treat- ment consisted of cold applications to the foot, and a pill composed of hydrargyri sub- muriat., extr. colchici, pulv. digitalis, pulv. ipecac, and extr. aconit., — a combination which had benefited him before. October 13th, there was no abatement of the pain; when I injected fifteen drops of liquor opii comp. into the left leg, fol- lowed by complete relief in half an hour. October lith, repeated the operation, also the next day, both times with satis- factory results. The inflammation began now to subside considerably. The injec- tion was applied every other evening for a week; at the end of which time the pa- tient left his bed and gradually resumed his duties. No relapse since. ITS ADVANTAGES AND DISADVANTAGES. 151 F. DISADVANTAGES ARISING FROM THIS TREAT- MENT AS COMPARED WITH ITS ADVAN- TAGES. Having presented various cases of dis- ease in order to demonstrate the advanta- ges of hypodermic injections under proper conditions over the administration of med- icines by the stomach, the question may be asked, whether there are not disadvantages inherent in or arising from this therapeutic agent, which renders our reliance on its ad- vantages in practice somewhat doubtful, or counterbalances them altogether. Presuming that the case be a proper one for treatment, and that the requisites for the success of the operation discussed at some length in the preceding pages have not been disregarded, I know of but two 152 HYPODERMIC INJECTIONS. possible disadvantages which may arise; namely: — a. The nausea and vomiting following sometimes the introduction of narcotics by the hypodermic method. b. The possibility of producing local in- flammation and abscess in the part repeat- edly punctured. These are the principal objections urged against hypodermic injections. Time, ex- perience, and observation have proved that the first can be overcome, and that the sec- ond is not an obstacle inherent in the ope- ration, but the result of carelessness on the part of the operator. a, The nausea and vomiting are, with some rare 'exceptions, the constant concomitant of the introduction of a considerable quan- tity of opium in its various forms by the hypodermic method. It follows the ope- ration in from five to thirty minutes. Of- ten it is inconsiderable, amounting to simple nausea and slight head-symptoms, passing ITS ADVANTAGES AND DISADVANTAGES. 153 off in an hour or less ; at other times it is very severe, continuing for hours and days. Bismuth, chloroform, hop-tea, champagne, and like remedies, sometimes afford relief, especially the free administration of cham- pagne ; sometimes all these fail. The injection once administered, though it relieve the original pain, yet, followed by these unpleasant symptoms, is not unfre- quently refused the second time by the pa- tient. As early as May, 1859, in order to over- come this objection, I experimented with tinctura hyoscyami, tinctura cannabis in- dici, and other sedative preparations intro- duced into the subcutaneous cellular tissue. The nausea and vomiting were not attend- ant upon these; but the effect of these agents upon the pain, the principal symp- tom to be removed, was very imperceptible. These experiments proving, therefore, unsatisfactory, I commenced the introduc- tion of narcotics invariably, in the strong 154 HYPODERMIC INJECTIONS. as well as the feeble, with the minimum dose, in order to establish, so to speak, a point of tolerance wherefrom to form cor- rect data. For the sake of uniformity and reliability, I make use of Dr. Squibb's liquor opii compositus, of which one hun- dred drops are equivalent to one grain of sulphate of morphia. In all my experience, I have found but two cases where only four drops could be borne, as five would produce some nausea. Leaving such exceptional cases out of con- sideration, I regard five drops as the mini- mum dose with which to commence. Further, instead of introducing this dose merely beneath the skin, I inject it deep into the muscles, and seek to strike as near as possible, and often directly, at the pain- ful point and near the nerve. In no case thus operated upon have I been disappoint- ed in the result. The agonized sufferer was relieved, if only temporarily, and nau- sea and vomiting avoided. ITS ADVANTAGES AND DISADVANTAGES. 155 It is true, the operation may have to be repeated oftener than where a larger dose has been introduced, as there is a certain ratio between the dose injected and the time of relief; but what patient would not prefer frequent operations to the most dis- agreeable and distressing symptoms of nau- sea and vomiting ? Having then established this point of tolerance, where the stomach can bear the injection, I gradually increase the dose when necessary. I have repeat- edly injected twice on the same day thirty drops without producing the slightest dis- turbance, where, at the commencement, five drops constituted the maximum dose. One other circumstance deserves men- tion. In cases of delirium tremens, no mat- ter how great the dose injected may be, or how often repeated, I have never had to contend with the symptoms of nausea and vomiting; in consequence of which fact, I always deliver the maximum dose dictated by the circumstances of the case. 156 HYPODERMIC INJECTIONS. Injections reduced then to the minimum standard, often repeated if necessary, and introduced deep into the part, I recommend as the best and reliable means to avoid the symptoms of nausea and vomiting. b. The possibility of producing local in- flammation and abscess in the part repeat- edly punctured is alleged as a second objec- tion. Under section u D," page 32, considerable space was devoted to the consideration of the conflicting opinions of Drs. Hunter, Wood, and others, regarding the localiza- tion of the injection at the painful point, the principal one against which, by Dr. Hunter, is, that it is productive of local inflammation and abscess in the part re- peatedly punctured. I refer my readers particularly to that section, as it sets, I think, this objection effectually at rest. Unless my own judgment deceives me, I have never yet seen, in my own practice, a case of local inflammation or abscess pro- ITS ADVANTAGES AND DISADVANTAGES. 157 duced by the injection, unless that object was especially aimed at by the introduction of irritants, such as a solution of chloride of sodium, or nitrate of silver. No physician would undertake to inject again and again at precisely the identical point where he operated before; but, due judgment being exercised, I maintain that any number of injections, say from fifty to one hundred or more, may be introduced within a space of one or two inches' circum- ference, and no ill consequences follow. As the fluid is quickly absorbed, there is no disposition in such a small puncture to in- flame and suppurate. In a case which occurred quite recently, phlegmenous erysipelas followed frequent injections in the thigh; but in that very instance the erysipelas did not begin at or near the point of puncture, but at a distance from it. Moreover, the patient has had the same disease twice before, when no injec- tions were applied. 158 HYPODERMIC INJECTIONS. This is the only case of its kind that has ever come to my knowledge. Local inflam- mation and abscess in the punctured parts are not the consequences of the operation, because they may have happened under certain conditions of the system; but they are abnormal conditions, resulting from a want of care and judgment. If such is not the case, then nothing could be more dan- gerous than the insertion of the needle into the tissues, the danger increasing in the ratio to the depth the fluid is introduced. CONCLUSION.- 159 CONCLUSION. What has been stated in the foregoing pages proves then, satisfactorily,— 1st, That the stomach is by no means the most tapid way of introducing medi- cines into the system. 2d, That the cellular tissue has great power of absorption. 3d, That narcotics, injected either near, at, or remote from the painful point of a nerve, will diminish the sensibility of that nerve, and, in proportion to the amount, depth, and position of the injection, remove the pain entirely or in part. 4th, That what is true in regard to nar- cotics has also been found to be true in re- gard to other classes of remedies, particular- ly in reference to solutions of chloride of sodium, and nitrate of silver. 160 CONCLUSION. 5th, That the effect of narcotics, so ap- plied, is not confined to their local action; but that they reach the brain through the venous circulation, and there produce their remote effects. 6th, That, destitute as we are of any precise experiments as to the applicability of the cellular tissue as a medium for the reception of medicinal agents, the experi- ments made with the syringe show that it seems to offer an excellent surface for the operation of the absorbent action of the venous system. 7th, That the small syringe affords a safe, easy, and almost painless method of exhibi- tion. 8th, That the method now described is demonstrated beyond a doubt to be ex- tensively applicable in the treatment of disease. THE END. w «**%* y a ^.^:t *RV 4 /^C M 4t