Clinical Paper: Cases treated by the hypodermic injection of atropine

Medical Times and Gazette, 17 March, 1860, page 267

[Reproduced in Braithwaite, William: The Retrospect of Medicine, Simpkin, Marshall & Co., 1860, vol. 41, pages 61-63]

CASES TREATED BY THE HYPODERMIC INJECTION OF ATROPINE.

Under the care of Dr. Cowdell, Dorset County Hospital.

The following cases I beg to submit to the notice of the Profession as evidences of the great practical value of the hypodermic injection of atropine in sciatica, lumbago, and, in fact, in all external aches and pains. No claim to originality is made, since it is Dr. Wood’s method, as modified by our French brethren, and reported in the ‘Journal de Medicine et Chirurgie Pratique.’ Dr. Wood’s morphine injection has been practised on several patients without the results now obtained from the use of atropine. The morphine procured sleep in from three to ten minutes, but when the narcotic effect had passed off, the pain returned as bad as before. The atropine causes slight drowsiness, dryness of the throat, and dilatation of the pupil: the only symptom of moment being the disappearance of the pain. The sulphate of atropine being more soluble than the alkaloid itself, is preferred; the strength of the solution is gr. ij. to 3j. of water. The instrument employed is an ordinary naevus injecting syringe, consisting of a graduated tube with screw piston, and a hollow needle which screws on to the tube. The needle is thrust under the skin as near the seat of pain as possible, and from ten to thirty minims of the solution gradually injected. The cases subjoined will show the result: —

Case 1. — S. E., aged 20, a domestic servant, admitted September 29th, 1859, and stated as follows:—“Had an attack of acute rheumatism five months since, was delirious at intervals during three weeks, and, when recovering from the rheumatism, sixteen weeks ago, had an acute pain in the hip, which did not yield to the leeches or blisters which were repeatedly applied.” On admission she was extremely anaemic, and experienced acute pain in the region of the sciatic nerve, increased by pressure. There was no hip affection: contour of hip normal; muscles very flabby; ham-strings contracted; knee bent; and the foot drawn up. She had during the whole time been unable to walk without crutches. Ordered meat diet. Ol. morrhuae and a draught containing iodide of potasium.

30th. Passed last night as usual, without sleep, and in agonies of pain. Injice sol. atropii. sulph. Mxxx. in par dolent.

October 1st. Slept well all night; felt immediate relief after the injection; says she has not had so good a night for sixteen weeks.

4th. Hip is sore, but no pain unless pressed. Repet. inject. horâ somni.

5th. The pain is entirely gone, not even the soreness remaining. Omit. mist. B. Ferri. am. cit. gr. iv. ex aq. ter die.

She was treated for anaemia from this date to November 10th, when the report runs thus :—“November 10th.— Patient has had no pain in the hip since the last injection on October 4th. Two injections only were employed, at an interval of three days, the first of which gave immediate relief, the second removed pain and soreness altogether. Can walk with ease; no pain on pressure over the nerve, and she gains flesh rapidly. Discharged well.”

Case 2. — H. P., aged 26, plasterer, admitted with chronic rheumatism, December 1st, 1859. He was somewhat relieved by the use of guaiacum and iodide of potassium, which was continued until January 12th, 1860, when complaining of an additional pain in the lumbar region which caused him to walk with his hands on his knees, the atropine injection was used.

January 13th. The pain in the back was greatly relieved last night by the injection. Omit. omn. meda. B. Syr. ferri iodid. 3ij. ter die.

15th. Very much better; no pain in back; can walk quite erect; has a pain in the tensor vaginae femoris muscle. Inject. repetatar.

17th. Pain gone from the tensor vaginae femoris muscle, but experiences slight pain in the gracilis and inner hamstrings. Repet. inject.

26th. Feels well and able to work; no pain whatever; says he is cured by the injections. Discharged well.

Case 3.—E.D., aged 50, nurse, admitted January 9th with all the ordinary symptoms of acute sciatica of one day’s standing. She could not stand. Agonizing pain in back and hip, and leg as far as the great toe. Ordered cal. cum opii. and the atropine injection at night.

13th. Found much benefit from the injection last night, leg much better, but still a pain on pressure.

14th. Used injection again last night, and this morning the pain is entirely gone; no pain even on pressure.

19th. She continued improving, and on this day she was discharged well.

The peculiarity in this case is, that she was admitted the morning following the commencement of the attack; and therefore it is worthy of notice that neither abstraction of blood, nor counter-irritation was resorted to, but the injection of atropine only, the effect of which upon the disease is remarkable.

Case 4. — W. S., aged 38, labourer, admitted February 9th, 1860, with sciatica on the right side, which had existed since October, 1859. He walked, or rather limped, into the ward with both hands resting on a stick between his legs, dragging his right leg after him. Pain was increased by pressure over the nerve, from the lower leader of Glutaeus maximus muscle to the popliteal space. Ordered the atropine injection at bed-time, and a mixture of iodide of potassium.

10th. The injection last night removed the pain; only an ache is experienced to-day, instead of the shooting pain of yesterday. Repet. inject. h. s.

11th. Feels no pain or soreness whatever in the hip. Pressure even into the sciatic notch gives no pain, and he can walk with as much freedom and ease as before the attack. He was discharged well on the 16th, seven days after admission.

Case 5. — D. S., aged 56, stone-mason, admitted February 9th, 1860, with sub-acute sciatica of fourteen day’s duration. Walked with difficulty even with the assistance of a stick: could not bear the pressure of a finger over the nerve. He had also bronchitis of the larger tubes, accompanied with profuse expectoration. Ordered the atropine injecton at night, and a squill and henbane mixture for cough.

10th. Cough less troublesome; the injection gave immediate relief; very little pain is now experienced even on pressure over the sciatic nerve, and he can walk without pain, but has a limp. Continue.

12th. Has now no pain in hip even on pressure; walks well and with ease; cough better.

From this day to the 23rd he was treated for his chest affection, being still free from pain in the hip. Discharged well on the 23rd.

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