Apomorphini hydrochloridum

 A substance obtained from morphine (differing only from morphine in having one less equivalent of water).
 Formula, с17H17NO2.
 (Morphine is с17H19NO3).

 Cases.
 Case I.
 Injection of three milligrammes of Apomorphine; no result.
 October 26, 9.20 p.m M. Lachize injected into the outer portion of my left arm three milligrammes of Apomorphine.
 I placed a thermometer in the axilla.
 9.20.
 Pulse 60, respiration 16, thermometer 36.8 0.
 9.23.
 No especial sensation; pulse 72, thermometer 36.8 0, respiration 16.
 9.25.
 Violent inclination to vomit; felling of heat all over, but especially in the head; face congested; pulse 92, thermometer 36.9 0, respiration 20. 9.28.
 No change; pulse 96, thermometer 36.9, respiration 22-9.30. Pulse slightly irregular; less nausea pulse 80, thermometer 36.9 0, respiration 20.
 9.33.
 Pulse 84, thermometer 36.9 0, respiration 20.
 9.35.
 Pulse still irregular; nausea entirely ceased; no particular symptom; drowsiness; respiration calm and regular; pulse 80.
 Thermometer 36.8 0, respiration 16.
 9.40.
 Case II.
 Injection of six milligrammes Apomorphine; vomiting.
 November 6.
 M. Lachize made another injection of six milligrammes Apomorphine into the lower and outer portion of the left arm, and conducted subsequent observations as carefully as before.
 9.40 p.m Pulse 76, thermometer 36.9 0, respiration 15.
 9.43.
 Pulse 80, thermometer 36.9 0, respiration 15.
 9.45.
 Violent inclination to vomit; full, regular pulse; pandiculation; pulse 100, thermometer 36.9 0, respiration 18.
 9.48.
 Retching; pulse and breathing irregular; pulse 104, thermometer 36.8 0, respiration 24.
 9.50.
 Easy vomiting; same irregular pulse’ 94, thermometer 36.8 0, respiration 20.
 9.53.
 Pulse 96, thermometer 36.8 0, respiration 21; more vomiting; condition the same.
 9.55.
 Vomiting ceased; still some nausea; continued irregularity of pulse and respiration; pulse 94, thermometer 36.7 0, respiration 18.
 10 o’clock.
 Quiet quiet; drowsiness; pulse 76, thermometer 36.7 0, respiration 12; quiet sleep for one hour; on awaking, pulse 68, thermometer 36.8 0, respiration 8; ate my next meal without any uneasiness.
 Next day, and several times afterward, I took a subcutaneous injection of one centigram Apomorphine; it caused to pain, and no local symptoms; the resulting phenomena were the same as before, only after injecting ten or twelve milligrammes the vomiting came on in four or five minutes; it was more violent.
 Case III.
 Encouraged by the experiments upon animals, I took an injection Dec. 10, 1873, of three centigrams Apomorphine, in presence of Drs. Zuber and Grandjax, in the outer portion of the right arm, the left arm being bandaged.
 2.20.
 Pulse 66, thermometer 36.8 0, respiration 14.
 2.22.
 Pulse 104, thermometer 36.8 0, respiration 19; vomiting, without previous nauseam took place two minutes after the injection; sudden sensation of heat running all over the body, and lasting about a minute, followed by vomiting; this vomiting lasted three minutes; during this time, pulse 100 to 102, thermometer 36.8 0, respiration 20 to 24.
 2.26.
 Extreme fatigue;tried to get up, but could not; pulse 84, thermometer 36.8 0, respiration 16.
 2.27.
 No change; pulse 78, thermometer 36.8 0, respiration 15.
 2.28.
 Nausea; pulse 96, thermometer 36.8 0, respiration 18.
 2.29.
 Some attacks of vomiting; violent headache.
 2. 32.
 Quiet; drowsiness; pulse 98, thermometer 37 0, respiration.
 17.
 2.33.
 Pulse 98, thermometer 37 0, respiration 17; so much fatigued that the eyes closed involuntarily.
 2.36.
 Nausea; pulse 104, thermometer 37 0, respiration 16.
 2.38.
 Less copious vomiting than before; invincible need of repose.
 2.40.
 Slept in a chair.
 4 o’clock.
 Ached with fatigue; no other bad feeling; no headache; pulse 80, thermometer 37 0, respiration 15; at dinner, less appetite than usual.
 The symptoms observed in these cases resemble those which follow the use of all emetics in nauseating doses; there was an unpleasant feeling at the precordial; congestion of the face and headache; then the conjunctiva became injected; there was copious salivation, and after a certain interval a sense of considerable fatigue.
 After emetics the symptoms were the same, but more intense.
 The stage of nausea, in my own case, was always very brief, yet recognizable.
 The others, to whom the drug was administered, had, in general, the same symptoms.
 Doctor Zuber, aide-major at Val-de-Grace, after two subcutaneous injections, felt each time an intense headache; he was dizzy, and limbs much fatigued.
 The feeling of weakness was very well marked in one of our friends, an exceedingly robust individual, aged 30; a copious sweat covered his face, which was pale instead of florid as usual; after as usual; after each of several trials he had a violent attack of dyspnoea, perhaps due to a long-established organic affection of the heart.
 Complete recovery generally took place in an hour two after the injection; usually, also, the vomiting was succeeded by invincible drowsiness.
 Case IV.
 Injection of one centigram Apomorphine.
 Vomiting in ten minutes.
 Man, 72 years old, entered the Roth’s child Hospital December 24; he had long labored under chronic bronchial catarrh, with pulmonary emphysema; at present there is considerable dyspnoea and difficult expectoration; the patient is obliged to sleep sitting up.
 The Apomorphine was prescribed with the view of affording relief by removing the violent contractions of the diaphragm and thoracic walls, and promoting discharge from the lungs; at 11 0’clock he received an injection of one centigram сhlorohydrate of Apomorphine into the arm at its dorsal aspect.
 Solution fresh, Limpid, colorless; pulse 80, respiration 28 (the temperature was not taken, our previous observations having, convinced us of the uselessness of doing so).
 Pulse 92, regular; respiration 28; patient made no complaint; yawning.
 11.10.
 Pulse 108, rather irregular; respiration 32; the patient, without previous nausea, was attacked by vomiting, which lasted about two minutes; it consisted of mucus, and was quite scanty; no facial congestion; no sweat.
 11.13.
 Pulse 70, respiration 24.
 11.15. Pulse 88, respiration 24; renewed but ineffectual efforts to vomit.
 11.20.
 Pulse 76, respiration 20; the patient complained of great fatigue; he breathed more easily, and said he felt quite sleepy; in a few minutes he sank back on his pillow and went to sleep; while asleep, 11.45, pulse 76, regular; respiration 18 to 20.
 1 o’clock.
 The patient is awake; pulse and respiration the same.
 Having so far confirmed the beneficial effects of the medicine, we intended to administer it again next day, increasing the dose to fifteen milligrammes, but the patient seemed so much depressed that we thought it best not to risk the experiment; the injection caused no pain, and no subsequent irritation.
 Case V.
 Injection of one centigram Apomorphine; vomiting in six minutes, Young man, aged 24, under treatment for a febrile, gastric difficulty, which had lasted three days; robust constitution; general health excellent; tongue thickly coated; headache; no diarrhoea; no gurgling, or abdominal tenderness.
 10.20 p.m One centigram Apomorphine injected into left arm; same solution as in preceding case; pulse 92, respiration 14, morning temperature 38.2.
 10.22.
 Pulse 108, respiration 15.
 10.25. Pulse 120, small, regular; respiration 15; nausea; face congested and moist; hiccough.
 10.26.
 Pulse 120, respiration 20; copious, slimy vomiting now set in and lasted one and a half minutes.
 10.28.
 Pulse 88, respiration 15; the patient was quiet for three or four minutes; he complained of weakness; then nausea returned; the hiccough ceased.
 10.32.
 Pulse 104, respiration 22; renewed vomiting, almost as copious as at first, but more painful; it lasted two or three minutes.-10.38.
 A third vomiting; scanty; patient’s face covered with sweat; much prostrated, and complains of great fatigue; after this he lies quiet, and soon falls asleep.
 10.40.
 Pulse 84, strong and regular; respiration 10.
 Patient awake; no further effects from the medicine; says he feels much relieved; his headache, he asserts, has quite ceased; pulse 96, thermometer 38 0, respiration 14.
 No local symptom.
 Next morning patient much the same; fever less; scarcely any headache; tongue still coated; some diarrhoeic stools in evening are rather attributable to his complaint than to the complaint than to the Apomorphine.
 Case VI.
 Woman with gastric trouble.
 1st. Dose of fifteen milligrammes given by the mouth; no effect.
 2d. Administration of two centigrams; vomiting in eight minutes.
 Women, aged 23 years; has a child three years old; sound constitution; usual health good; a patient since the day before.
 We saw her at 9 p.m; the tongue is thickly coated, and shows the marks of the teeth; intense headache; blue circles around eyes; skin hot and moist; constipation for three days; pulse 100, thermometer 38.6 0, respiration 16.
 At 9.30 we have gave her fifteen milligrams of сhlorohydrate of Apomorphine in thirty grams of water (an extemporaneous). 9.35.
 Pulse 108, respiration 16.
 Pulse 116, respiration 16; some nausea.
 9.50.-9.50. Pulse 108, respiration 14 to 16; nausea ceased.
 Pulse 100, respiration 14.
 From this time patient felt as before; no inclination to vomit.
 The medicine seemed without effect.
 Next day, no change; fever quite considerable; evening temperature 39.2 0, morning temperature 38.4 0; no stool; tongue coated; inclination to vomit. 9 p.m.
 Pulse 96, respiration 14; twenty milligrammes Apomorphine taken by the mouth; same preparation as yesterday.
 9.5.
 Pulse 112, respiration 16; nausea.
 9.8 Pulse 120, respiration 22; copious bilious vomiting.
 9.10.
 Pulse 92, quiet; respiration 20.
 9.15.
 Renewed vomiting, less copious than at first.
 9.20, quiet; respiration 16.
 9.30.
 Quite, but no sleep; patient feels relieved; headache, which before the first vomiting was most intense, has now almost entirely ceased.
 11 o’clock.
 Pulse 92, thermometer 38.6 0, respiration 14; no movement of the bowels during the day; at night one very difficult stool.
 Next morning, although the tongue was less coated and the headache better, a saline purgative was prescribed. Perhaps we should have obtained better results from a dose of three centigrams Apomorphine.
 Case VII.
 (Communicated by Doctor Zuber). Hemoptysis from tubercle.
 Injection of three centigrams Apomorphine; copious vomiting in four minutes.
 Leon S., second-class trooper in the second regiment of artillery, 23 years old, of mean appearance, was attacked, on the 22d December last, with a troublesome hemoptysis.
 When I saw him it had lasted four hours; the blood raised was bright red, frothy, almost pure, and quite abundant (four hundred or five hundred grams); cold fomentations had been applied to his chest, and he had taken two tablespoonfuls of salt; pulse frequent, 104.
 It was necessary to arrest the bleeding as soon as possible.
 I thought of resorting to the use of emetics, so highly recommended in such cases, and I selected Apomorphine, whose properties as a speedy emetic made it particularly applicable.
 At 5 I injected under the skin quite a large dose of Apomorphine, three centigrams of slightly altered solution (colored light-green); the patient went on coughing, and at each paroxysm he brought up blood having the same appearance as before.
 5.4.
 Abundant vomiting of food, without previous nausea; this lasted about two minutes; then came a period of quiet, when cough no longer racked the patient; in half an hour the vomiting ceased; the patient was extremely feeble, but the means employed appeared to have done good service; he coughed only at long intervals, and the expectorated blood become less and less.
 Next day, there was hardly a trace of blood in the sputa; haemoptysis was probably owing to a tuberculous induration at the apex of the right lung; no local effect.
 Case VIII.
 (Communicated by Doctor Zuber). Angina tonsillaris.
 Injection of two centigrams Apomorphine; vomiting in three or four minutes.
 M. T., sculptor; sick for three or four days with acute tonsillitis; he was very subject to angina.
 At Rome, where he was an art student, he had several attacks, one of which, of a phlegmonous nature, caused him much suffering.
 Moreover, during a residence in the сampagna, he contracted an obstinate intermittent, which still lingered, and imparted to the fever accompanying his angina a decidedly remittent type; the tonsils are entirely swollen, they greatly impede respiration, and deglutition is almost impossible.
 I made two free incisions into each tonsil, with a view of depleting them; and, at last, to aid this effect, I thought of administering Apomorphine, since it was exceedingly difficult for the patient to get down a dose of emetic.
 I injected, accordingly, two centigrams of a recent solution; nausea came on in three minutes, followed by vomiting, which the conditions of the pharynx rendered very difficult and painful.
 The vomitings, which were quite frequent, ceased in half an hour.
 As I anticipated, the muscular contractions strongly favored the escape of blood from the engorged tonsils, through the previous scarifications, and the patient soon felt comparatively easy.
 I prescribed emollient gargles, and a draught containing seventy-five centigrams of quinine.
 Next day, there was considerable improvement; fever less intense; the tonsils, though still much enlarged, now allowed air and warm drinks to pass easily.
 M. T. considered himself cured, and could not sufficiently praise the new emetic.
  At Rome, he said, they vomited me a great deal, for they used to precede quinine by an emetic, but the effect was never so speedy.
 Here the business is over before ordinary emetics would begin to operate .

 Sleep.
 10.15.
 Awoke; no more nausea; no headache; no fatigue pulse 64, thermometer 36.8 0, respiration 14; breakfasted at 11 o’clock without feeling anything abnormal.

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• 22% — Narcissus pseudonarcissus
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