TWO CASES OF POISONING BY OPIUM SUCCESSFULLY TREATED BY SUBCUTANEOUS INJECTION OF ATROPINE.
By Assistant-Surgeon
Gopai, Chundek IIoy,
South Suburban Charitable Dispensary. In both these cases sufficient opium had been taken to prove and sufficient timo too had elapsed to allow of its being absorbed into the system, as nothing of it was found in the vomitings after the stomachs had been thoroughly washed; as will be observed from the subjoined reports, the symptoms in both the cases were aggravated beforo atropia was tried. In the first case three injections were given, containing each one-sixteenth of a grain of atropia ; and, though the second injection produced some dilation of the pupil, no decided improvement was observed, aud hence it was not sufficient to neutralize the whole of the opium taken. Three-sixteenths of a grain of the salt, however, were alternately found to neutralize about forty grains of opium. In the second case the symptoms were serious, and, considering the tender ago of the patient and the quantity taken, the result was at first doubtful; but in this case one-fiftieth of a grain of the sale saved the life of the patient. Case I.?On the morning of the 27th September 1873, at 9 a.m., I wa3 asked to see a Madrassee lad, aged 14, whose grandmother, perceiving something wrong with him, sent foe me?the father being absent on duty at the time. On repairing to the houso I found the boy sitting on the floor with eyes shut, and apparently drowsy, with the head stooping
fatal,
The boy was sensible, but would not speak. His pulse pretty fair, but the pupils were much contracted, and I thought he might have taken some narcotics, probably opium
down. was or
bhang.
The anxiety of the whole family was very great, not only because the boy was an only son at the timo but been use an elder brother of his, when a little younger than himself, died by poisoning from aconito root accidentally mixed with treacle. The grandmother told mo that the lad had been too eager the two previous nights to seo the tamasha that was thon taking place in tho cantonment during the Daserha festival, but his father would not allow him to go there for fear of exposure. She
therefore suspected that the boy might have taken
some
poison
July 1,
A MIRROR OF HOSPITAL PRACTICE.
1875.]
and, ns the boy was absent from home in the morning till half-past eight, the suspicion seemed to me to be a probable one. A doso of sulphate of zinc and ipecacuanha was given at once, In the meantime, as and I ordered hot water to be ready. there was no vomiting for some time, I tried to excite it by tickling the throat with feathers, and the boy was sufficiently sensible also to put his own fingers into the throat; he was then made to drink warm water freely. The first vomitings were slightly tinged black, but no distinct smell of opium could be detected in them. The lad being coaxed to tell what he had taken, however, confessed at length that he had swallowed opium, and this statement was confirmed by some of his school fellows and playmates, who stated, in my presence, that he had been to an opium shop. On enquiring, it was found that he had purchased two annas worth of opium, which is ordinarily about 45 grains. But the hoy stated that he did not take the whole quantity purchased; he then pointed to the place where he had kept the remaining quantity, which was found to weigh 5 grains, so that he must have taken about 40 grains. Sulphate of zinc was then twice repeated, warm drinking The stomach also was thoroughly washed out "was freely used. by means of the stomach pump, but no trace of any opium could be found. The symptoms were gradually getting worse, and the boy became very sleepy and unable to sit or stand any longerThe drowsiness became deeper and the pupils contracted to a pin's head. The pulse grew small and feeble, and altogether the symptoms became alarming ; by this time the father returned home and the Civil Surgeon was also called in. A solution of atropia (containing -^g grain of the salt in six minims) was then prepared, and six minims of this solution was injected hypodermicallv into the left shoulder, and this was followed by a cold shower bath. The patient was then made to "walk with the aid of two assistants, and was kept awake by oohl water being dashed constantly on his face. No marked improvement was observed for half an hour, when we injected another six minims' solution into the right shoulder. After fifteen minutes we observed slight dilatation of the pupils, but the other symptoms remained the same. After half an hour more we repeated another injection on the neck. The pupils were then observed to dilate more and more till in about an hour they returned to their normal size. The drowsiness, &c., began also grndually to wear off, so that the patient was able to walk unassisted, though in a tottering manner. During this time he vomited several times the concentrated infusion of coffee, which he was made to drink now and then. He then became quite exhausted and wearied, and unable to walk or even stand any longer. He was then engaged in playing chowsut with bis playmates, which gave him sufficient stimulus to keep himself awake the At 5 p.m. he was all right. whole day. ?
Case II.?Mohamed Ebrahim, aged years, was brought into the hospital on the 24th of October 1873 at 10? a.m. with symptoms of poisoning by opium. The mother stated that about 7* a.m., after administering the usual dose of opium to the child (a custom prevalent here amongst the poor) she carelessly left the debia (box) containing the opium on the floor where the child was playing and took to her domestic work. She did not see the child till after 9 a.m., ?when she found it quite drowsy and insensible. It at once struck her that the child must have swallowed opium from the debia, and she found the whole of the opium contained in it was gone. She could not tell the exact quantity the child had taken, but showed a piece of earth of in which was equal to 10 grains of equal some
volume, weight.
opium
tried to make the child vomit, with more or less success, till the symptoms became alarming enough to render it necessary to have recourse to hospital. Symptoms on admission.?The child was insensible and drowsy and fast sleeping on its mother's shoulder; lids drooping; pupils much contracted; extremities cold; pulse very weak; respiration slow, but not stertorous; no sensibility on pinching. A dash of cold water on the face made the child start up and ery, but it soon relapsed into its former state. A five-grain
Various domestic remedies
were
183
dose of sulphate of zinc was given with warm water and the throat tickled with feathers and fingers. The child had a free vomiting of pure water. Another dose of zinc was repeated and warm water forced down the throat. The child vomited three times after this, but no trace of opium could be found in the vomitings. The drowsiness and insensibility were observed gradually to deepen more and more, almost verging to coma. It was not till half an hour after that I received the hypodermic syringe, which had been lent to the Jail Hospital. During this interval, the child was undergoing the treatment just mentioned with cold dashing on the face and pouring of cold water on the head. Five minims of ^n atropia solution, containing one hundredth part of a grain, had also been given by the mouth, but no signs of improvement were observed, except that the child was kept awake by the means resorted to. Six minims of the solution of sulphate of atropia of the above strength were then snbcutaneously injected into the right arm. Five minutes after the pupils were seen dilating. In half an hour more the child began to show signs of improvement .notwithstanding, another injection was made on the other arm. An hour afterwards the child was out of danger; however it remained more or less drowsy the whole day. In the evening it was taken home, and when it was brought again, next morning, the mother stated that it remained well at night and had a sound A dose of castor-oil was ordered to be
sleep. given, and the patient was discharged. Burrisal, 23rd April 1875.
By Assistant-Surgeon
Gopai, Chundek IIoy,
South Suburban Charitable Dispensary. In both these cases sufficient opium had been taken to prove and sufficient timo too had elapsed to allow of its being absorbed into the system, as nothing of it was found in the vomitings after the stomachs had been thoroughly washed; as will be observed from the subjoined reports, the symptoms in both the cases were aggravated beforo atropia was tried. In the first case three injections were given, containing each one-sixteenth of a grain of atropia ; and, though the second injection produced some dilation of the pupil, no decided improvement was observed, aud hence it was not sufficient to neutralize the whole of the opium taken. Three-sixteenths of a grain of the salt, however, were alternately found to neutralize about forty grains of opium. In the second case the symptoms were serious, and, considering the tender ago of the patient and the quantity taken, the result was at first doubtful; but in this case one-fiftieth of a grain of the sale saved the life of the patient. Case I.?On the morning of the 27th September 1873, at 9 a.m., I wa3 asked to see a Madrassee lad, aged 14, whose grandmother, perceiving something wrong with him, sent foe me?the father being absent on duty at the time. On repairing to the houso I found the boy sitting on the floor with eyes shut, and apparently drowsy, with the head stooping
fatal,
The boy was sensible, but would not speak. His pulse pretty fair, but the pupils were much contracted, and I thought he might have taken some narcotics, probably opium
down. was or
bhang.
The anxiety of the whole family was very great, not only because the boy was an only son at the timo but been use an elder brother of his, when a little younger than himself, died by poisoning from aconito root accidentally mixed with treacle. The grandmother told mo that the lad had been too eager the two previous nights to seo the tamasha that was thon taking place in tho cantonment during the Daserha festival, but his father would not allow him to go there for fear of exposure. She
therefore suspected that the boy might have taken
some
poison
July 1,
A MIRROR OF HOSPITAL PRACTICE.
1875.]
and, ns the boy was absent from home in the morning till half-past eight, the suspicion seemed to me to be a probable one. A doso of sulphate of zinc and ipecacuanha was given at once, In the meantime, as and I ordered hot water to be ready. there was no vomiting for some time, I tried to excite it by tickling the throat with feathers, and the boy was sufficiently sensible also to put his own fingers into the throat; he was then made to drink warm water freely. The first vomitings were slightly tinged black, but no distinct smell of opium could be detected in them. The lad being coaxed to tell what he had taken, however, confessed at length that he had swallowed opium, and this statement was confirmed by some of his school fellows and playmates, who stated, in my presence, that he had been to an opium shop. On enquiring, it was found that he had purchased two annas worth of opium, which is ordinarily about 45 grains. But the hoy stated that he did not take the whole quantity purchased; he then pointed to the place where he had kept the remaining quantity, which was found to weigh 5 grains, so that he must have taken about 40 grains. Sulphate of zinc was then twice repeated, warm drinking The stomach also was thoroughly washed out "was freely used. by means of the stomach pump, but no trace of any opium could be found. The symptoms were gradually getting worse, and the boy became very sleepy and unable to sit or stand any longerThe drowsiness became deeper and the pupils contracted to a pin's head. The pulse grew small and feeble, and altogether the symptoms became alarming ; by this time the father returned home and the Civil Surgeon was also called in. A solution of atropia (containing -^g grain of the salt in six minims) was then prepared, and six minims of this solution was injected hypodermicallv into the left shoulder, and this was followed by a cold shower bath. The patient was then made to "walk with the aid of two assistants, and was kept awake by oohl water being dashed constantly on his face. No marked improvement was observed for half an hour, when we injected another six minims' solution into the right shoulder. After fifteen minutes we observed slight dilatation of the pupils, but the other symptoms remained the same. After half an hour more we repeated another injection on the neck. The pupils were then observed to dilate more and more till in about an hour they returned to their normal size. The drowsiness, &c., began also grndually to wear off, so that the patient was able to walk unassisted, though in a tottering manner. During this time he vomited several times the concentrated infusion of coffee, which he was made to drink now and then. He then became quite exhausted and wearied, and unable to walk or even stand any longer. He was then engaged in playing chowsut with bis playmates, which gave him sufficient stimulus to keep himself awake the At 5 p.m. he was all right. whole day. ?
Case II.?Mohamed Ebrahim, aged years, was brought into the hospital on the 24th of October 1873 at 10? a.m. with symptoms of poisoning by opium. The mother stated that about 7* a.m., after administering the usual dose of opium to the child (a custom prevalent here amongst the poor) she carelessly left the debia (box) containing the opium on the floor where the child was playing and took to her domestic work. She did not see the child till after 9 a.m., ?when she found it quite drowsy and insensible. It at once struck her that the child must have swallowed opium from the debia, and she found the whole of the opium contained in it was gone. She could not tell the exact quantity the child had taken, but showed a piece of earth of in which was equal to 10 grains of equal some
volume, weight.
opium
tried to make the child vomit, with more or less success, till the symptoms became alarming enough to render it necessary to have recourse to hospital. Symptoms on admission.?The child was insensible and drowsy and fast sleeping on its mother's shoulder; lids drooping; pupils much contracted; extremities cold; pulse very weak; respiration slow, but not stertorous; no sensibility on pinching. A dash of cold water on the face made the child start up and ery, but it soon relapsed into its former state. A five-grain
Various domestic remedies
were
183
dose of sulphate of zinc was given with warm water and the throat tickled with feathers and fingers. The child had a free vomiting of pure water. Another dose of zinc was repeated and warm water forced down the throat. The child vomited three times after this, but no trace of opium could be found in the vomitings. The drowsiness and insensibility were observed gradually to deepen more and more, almost verging to coma. It was not till half an hour after that I received the hypodermic syringe, which had been lent to the Jail Hospital. During this interval, the child was undergoing the treatment just mentioned with cold dashing on the face and pouring of cold water on the head. Five minims of ^n atropia solution, containing one hundredth part of a grain, had also been given by the mouth, but no signs of improvement were observed, except that the child was kept awake by the means resorted to. Six minims of the solution of sulphate of atropia of the above strength were then snbcutaneously injected into the right arm. Five minutes after the pupils were seen dilating. In half an hour more the child began to show signs of improvement .notwithstanding, another injection was made on the other arm. An hour afterwards the child was out of danger; however it remained more or less drowsy the whole day. In the evening it was taken home, and when it was brought again, next morning, the mother stated that it remained well at night and had a sound A dose of castor-oil was ordered to be
sleep. given, and the patient was discharged. Burrisal, 23rd April 1875.
