T.H. Wardleworth
1839 The Lancet  
5 powdered hydrochlorate of morphia was sprinkled over a blistered surface, the influence of the narcoticwas felt in the head in less than a minute. He might here enumerate the symptom hich indicated the general influence of the narcotic, thus applied, upon the cerebro-spinal centres ; but he preferred leaving these to the details of the cases, illustrative of the practice, which he had selected to lay before the students. He might, however, mention, that when the nerves were topically
more » ... as in neuralgia, the general symptoms scarcely ever displayed themelves. Such was the physiological action of narcotics applied to the denuded surface of the body, which had hitherto been recorded; but there was another action produced by at least one of these, namely, hydrochlorate of morphia, which had not, to his knowledge, been previously observed, and to which much of the advantages derived from its application, in a therapeutical point of view, was to be attributed. He referred to the production of a papular eruption, terminating in pustules, which spread from the immediate vicinity of the part in which the hydrochlorate was applied, all over the body; and it was more or less attended with oedema. In some instances the swelling, when the blistered surface was in the vicinity of the head, had been so considerable as to close the eyes, in a manner similar to that which occurs in erysipelas of the head. It had also been attended with some degree of fever; and in a few instances delirium had displayed itself when the eruption had reached its acme. It seemed to operate as a most powerful and efficient counter-irritant, without, apparently, interfering with the narcotic influence of the hydrochlorate. The eruption was a pustular one, and he had observed that the relief was most obvious as soon as the pustules were fairly formed ; indeed, so striking had been the beneficial influence of this eruption, that he was inclined to accord with the remark of Dr. Jenner, that " every pimple with a vesiculated head had an errand to perform for the benefit of the constitution." He had selected the preceding cases from a great number. The first three were intended to illustrate the local influence of the endermic application of the salts of morphia ; the other two, their general influence. His object in bringing forward these cases was, to direct attention to the enderii)ic practice which promised many advantages; and which only required to be investigated to gain the support of British practitioners. The cases which I have published, and which are now before the public, tend to show, in a remarkable manner, the powerful effects of the ergot of rye ; for, in Mrs. R.'s case,* after all other means had failed, the ergot at once produced pains of a more truly uterine character than had previously existed, evidenced by a further protrusion of the membranes, the os uteri becoming shorter, and gradually dilating, all of which went on progressively until the process of labour was completed; showing, in this case, the effects of the ergot in producing dilatation of the mouth of the womb, a property imputed to it by Chevreuil, who has reported sixteen cases, in which the ergot seemed to soften and dilate the os uteri. The following case, which I was called upon to attend, on the 4th of July, 1838, at four, A.M., is one in which the ergot had a most decided effect upon the os uteri. Mrs. K-, act. 28, a stout and healthy woman, in labour of her second child; on examination I found the os uteri dilated to the size of a crown-piece, thick, and unyielding ; on inquiry I found that my patient had had pains for more than two days, and which had returned at irregular intervals during that time. Her pulse being full and strong, I bled her to 3xx., which was followed by considerable relief. After waiting some time, and the pain not return. ing, I left her, and desired to be sent for on the least return of pain. About six, P.M., same day, I was again sent for ; on examination I found the membranes protruding beyond the os uteri, which was much in the same state as described at my last visit, from the restless condition of my patient, and her friends, who, in fact, desired me to give her some " coflee.'t From a knowledge of its efficiency in similar cases, I at once acceded to their solicitations, and I accordingly gave Mrs. K-3j. of the ergot, and in ten minutes the pains became more frequent, the mouth of the womb softer, and more dilated ; for, in ha)f-nn-" Vide LANCET, No. 8, vol. i., 1838-9. ! t As the ergot is called in this neighbourhood.
doi:10.1016/s0140-6736(01)19011-2 fatcat:drtk25oy65ambpjs6ophe2ue64