anomalies and curiosities of medicine-第125部分

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ar　to　the　ancient　physicians；　and；　according　to　Lewin；　Tralles　reports　an　observation　with　reference　to　this　in　a　man；　and　says　regarding　it　in　rather　unclassical　Latin：　　〃　。　。　。　per　multos　dies　ponderosissimum　caput　circumgestasse。〃　Convulsions　are　said　to　be　observed　after　medicinal　doses　of　opium。　Albers　states　that　twitching　in　the　tendons　tremors　of　the　hands；　and　even　paralysis；　have　been　noticed　after　the　ingestion　of　opium　in　even　ordinary　doses。　The　〃pruritus　opii；〃　so　familiar　to　physicians；　is　spoken　of　in　the　older　writings。　Dioscorides；　Paulus　Aegineta；　and　nearly　all　the　writers　of　the　last　century　describe　this　symptom　as　an　annoying　and　unbearable　affection。　In　some　instances　the　ingestion　of　opium　provokes　an　eruption　in　the　form　of　small；　isolated　red　spots；　which；　in　their　general　character；　resemble　roseola。　Rieken　remarks　that　when　these　spots　spread　over　all　the　body　they　present　a　scarlatiniform　appearance；　and　he　adds　that　even　the　mucous　membranes　of　the　mouth　and　throat　may　be　attacked　with　erethematous　inflammation。　Behrend　observed　an　opium　exanthem；　which　was　attended　by　intolerable　itching；　after　the　exhibition　of　a　quarter　of　a　grain。　It　was　seen　on　the　chest；　on　the　inner　surfaces　of　the　arms；　on　the　flexor　surfaces　of　the　forearms　and　wrists；　on　the　thighs；　and　posterior　and　inner　surfaces　of　the　legs；　terminating　at　the　ankles　in　a　stripe…like　discoloration　about　the　breadth　of　three　fingers。　It　consisted　of　closely　disposed　papules　of　the　size　of　a　pin…head；　and　several　days　after　the　disappearance　of　the　eruption　a　fine；　bran…like　desquamation　of　the　epidermis　ensued。　Brand　has　also　seen　an　eruption　on　the　trunk　and　flexor　surfaces；　accompanied　with　fever；　from　the　ingestion　of　opium。　Billroth　mentions　the　case　of　a　lady　in　whom　appeared　a　feeling　of　anxiety；　nausea；　and　vomiting　after　ingestion　of　a　small　fraction　of　a　grain　of　opium；　she　would　rather　endure　her　intense　pain　than　suffer　the　untoward　action　of　the　drug。　According　to　Lewin；　Brochin　reported　a　case　in　which　the　idiosyncrasy　to　morphin　was　so　great　that　1/25　of　a　grain　of　the　drug　administered　hypodermically　caused　irregularity　of　the　respiration；　suspension　of　the　heart…beat；　and　profound　narcosis。　According　to　the　same　authority；　Wernich　has　called　attention　to　paresthesia　of　the　sense　of　taste　after　the　employment　of　morphin；　which；　according　to　his　observation；　is　particularly　prone　to　supervene　in　patients　who　are　much　reduced　and　in　persons　otherwise　healthy　who　have　suffered　from　prolonged　inanition。　These　effects　are　probably　due　to　a　central　excitation　of　a　similar　nature　to　that　produced　by　santonin。　Persons　thus　attacked　complain；　shortly　after　the　injection；　of　an　intensely　sour　or　bitter　taste；　which　for　the　most　part　ceases　after　elimination　of　the　morphin。　Von　Graefe　and　Sommerfrodt　speak　of　a　spasm　of　accommodation　occurring　after　ingestion　of　medicinal　doses　of　morphin。　There　are　several　cases　on　record　in　which　death　has　been　produced　in　an　adult　by　the　use　of　1/2　to　1/6　grain　of　morphin。　According　to　Wood；　the　maximum　doses　from　which　recovery　has　occurred　without　emesis　are　55　grains　of　solid　opium；　and　six　ounces　of　laudanum。　According　to　the　same　authority；　in　1854　there　was　a　case　in　which　a　babe　one　day　old　was　killed　by　one　minim　of　laudanum；　and　in　another　case　a　few　drops　of　paregoric　proved　fatal　to　a　child　of　nine　months。　Doubtful　instances　of　death　from　opium　are　given；　one　in　an　adult　female　after　30　grains　of　Dover's　powder　given　in　divided　doses；　and　another　after　a　dose　of　1/4　grain　of　morphin。　Yavorski　cites　a　rather　remarkable　instance　of　morphin…poisoning　with　recovery：　a　female　took　30　grains　of　acetate　of　morphin；　and　as　it　did　not　act　quickly　enough　she　took　an　additional　dose　of　1/2　ounce　of　laudanum。　After　this　she　slept　a　few　hours；　and　awoke　complaining　of　being　ill。　Yavorski　saw　her　about　an　hour　later；　and　by　producing　emesis；　and　giving　coffee；　atropin；　and　tincture　of　musk；　he　saved　her　life。　Pyle　describes　a　pugilist　of　twenty…two　who；　in　a　fit　of　despondency　after　a　debauch　（in　which　he　had　taken　repeated　doses　of　morphin　sulphate）；　took　with　suicidal　intent　three　teaspoonfuls　of　morphin；　after　rigorous　treatment　he　revived　and　was　discharged　on　the　next　day　perfectly　well。　Potassium　permanganate　was　used　in　this　case。　Chaffee　speaks　of　recovery　after　the　ingestion　of　18　grains　of　morphin　without　vomiting。

In　chronic　opium　eating　the　amount　of　this　drug　which　can　be　ingested　with　safety　assumes　astounding　proportions。　In　his　〃Confessions〃　De　Quincey　remarks：　〃Strange　as　it　may　sound；　I　had　a　little　before　this　time　descended　suddenly　and　without　considerable　effort　from　320　grains　of　opium　（8000　drops　of　laudanum）　per　day　to　40　grains；　or　1/8　part。　Instantaneously；　and　as　if　by　magic；　the　cloud　of　profoundest　melancholy　which　rested　on　my　brain；　like　some　black　vapors　that　I　have　seen　roll　away　from　the　summits　of　the　mountains；　drew　off　in　one　day；passed　off　with　its　murky　banners　as　simultaneously　as　a　ship　that　has　been　stranded　and　is　floated　off　by　a　spring…tide

　　　　　'That　moveth　altogether　if　it　move　at　all。'

Now；　then；　I　was　again　happy；　I　took　only　a　thousand　drops　of　Laudanum　per　day；　and　what　was　that？　A　latter　spring　had　come　to　close　up　the　season　of　youth；　my　brain　performed　its　functions　as　healthily　as　ever　before；　I　read　Kant　again；　and　again　I　understood　him；　or　fancied　that　I　did。〃　There　have　been　many　authors　who；　in　condemning　De　Quincey　for　unjustly　throwing　about　the　opium　habit　a　halo　of　literary　beauty　which　has　tempted　many　to　destruction；　absolutely　deny　the　truth　of　his　statements。　No　one　has　any　stable　reason　on　which　to　found　denial　of　De　Quincey's　statements　as　to　the　magnitude　of　the　doses　he　was　able　to　take；　and　his　frankness　and　truthfulness　is　equal　to　that　of　any　of　his　detractors。　William　Rosse　Cobbe；　in　a　volume　entitled　〃Dr。　Judas；　or　Portrayal　of　the　Opium　Habit；〃　gives　with　great　frankness　of　confession　and　considerable　purity　of　diction　a　record　of　his　own　experiences　with　the　drug。　One　entire　chapter　of　Mr。　Cobb's　book　and　several　portions　of　other　chapters　are　devoted　to　showing　that　De　Quincey　was　wrong　in　some　of　his　statements；　but　notwithstanding　his　criticism　of　De　Quincey；　Mr。　Cobbe　seems　to　have　experienced　the　same　adventures　in　his　dreams；　showing；　after　all；　that　De　Quincey　knew　the　effects　of　opium　even　if　he　seemed　to　idealize　it。　According　to　Mr。　Cobbe；　there　are　in　the　United　States　upward　of　two　millions　of　victims　of　enslaving　drugs　entirely　exclusive　of　alcohol。　Cobbe　mentions　several　instances　in　which　De　Quincey's　dose　of　320　grains　of　opium　daily　has　been　surpassed。　One　man；　a　resident　of　Southern　Illinois；　consumed　1072　grains　a　day；　another　in　the　same　State　contented　himself　with　1685　grains　daily；　and　still　another　is　given　whose　daily　consumption　amounted　to　2345　grains　per　day。　In　all　cases　of　laudanum…takers　it　is　probable　that　analysis　of　the　commercial　laudanum　taken　would　show　the　amount　of　opium　to　be　greatly　below　that　of　the　official　proportion；　and　little　faith　can　be　put　in　the　records　of　large　amounts　of　opium　taken　when　the　deduction　has　been　made　from　the　laudanum　used。　Dealers　soon　begin　to　know　opium　victims；　and　find　them　ready　dupes　for　adulteration。　According　to　Lewin；　Samter　mentions　a　case　of　morphin…habit　which　was　continued　for　three　years；　during　which；　in　a　period　of　about　three；　hundred　and　twenty…three　days；　upward　of　2　1/2　ounces　of　morphin　was　taken　daily。　According　to　the　same　authority；　Eder　reports　still　larger　doses。　In　the　case　observed　by　him　the　patient　took　laudanum　for　six　years　in　increasing　doses　up　to　one　ounce　per　day；　for　eighteen　months；　pure　opium；　commencing　with　15　grains　and　increasing　to　2　1/4　drams　daily；　and　for　eighteen　months　morphin；　in　commencing　quantities　of　six　grains；　which　were　later　increased　to　40　grains　a　day。　When　deprived　of　their　accustomed　dose　of　morphin　the　sufferings　which　these　patients　experience　are　terrific；　and　they　pursue　all　sorts　of　deceptions　to　enable　them　to　get　their　enslaving　drug。　Patients　have　been　known　to　conceal　tubes　in　their　mouths；　and　even　swallow　them；　and　the　authors　know　of　a　fatal　instance　in　which　a　tube　of　hypodermic　tablets　of　the　drug　was　found　concealed　in　the　rectum。

The　administration　of　such　an　inert　substance　as　the　infusion　of　orange…peel　has　been　sufficient　to　invariably　produce　nervous　excitement　in　a　patient　afflicted　with　carcinoma。

Sonnenschein　refers　to　a　case　of　an　infant　of　five　weeks　who　died　from　the　effects　of　one　phosphorous　match　head　containing　only　1/100　grain　of　phosphorus。　There　are　certain　people　who　by　reason　of　a　special　susceptibility　cannot　tolerate　phosphorus；　and　the　exhibition　of　it　causes　in　them　nausea；　oppression；　and　a　feeling　of　pain　in　the　epigastric　region；　tormina　and　tenesmus；　accompanied　with　diarrhea；　and　in　rare　cases　jaundice；　sometimes　lasting　several　months。　In　such　persons　1/30　grain　is　capable　of　causing　the　foregoing　symptoms。　In　1882　a　man　was　admitted　to　Guy's　Hospital；　London；　after　he　had　taken　half　of　a　sixpenny　pot　of　phosphorous　paste　in　whiskey；　and　was　subsequently　discharged　completely　recovered。

A　peculiar　feature　of　phosphorus…poisoning　is　necrosis　of　the　jaw。　This　affection　was　first　noticed　in　1838；　soon　after　the　introduction　of　the　manufacture　of　phosphorous　matches。　In　late　years；　owing　to　the　introduction　of　precautions　in　their　manufacture；　the　disease　has　become　much　less　common。　The　tipping　of　the　match　sticks　is　accomplished　by　dipping　their　ends　in　a　warm　solution　of　a　composition　of　phosphorus；　chlorate　of　potassium；　with　particles　of　ground　flint　to　assist　friction；　some　coloring　agent；　and　Irish　glue。　From　the　contents　of　the　dipping…pans　fumes　constantly　arise　into　the　faces　of　the　workmen　and　dippers；　and　in　cutting　the　sticks　and　packing　the　matches　the　hands　are　constantly　in　contact　with　phosphorus。　The　region　chiefly　affected　in　this　poisoning　is　the　jaw…bone；　but　the　inflammation　may　spread　to　the　adjoining　bones　and　involve　the　vomer；　the　zygoma；　the　body　of　the　spheroid　bone；　and　the　basilar　process　of　the　occipital　bone。　It　is　supposed　that　conditions　in　which　the　periosteum　is　exposed　are　favorable　to　the　progress　of　the　diseas