326 DISEASES OF THE PERIPHERAL NERVES. 



blister was applied, the resulting vesicle was opened, and the desired 

 dose of morphine was sprinkled on the denuded spot, or else the mor- 

 phine was mixed with saliva and inoculated into the skin. The intro- 

 duction of hypodermic injections, instead of these troublesome proce- 

 dures, was a great event, and was regarded as an immense advance in 

 treatment. It was thought that the affected nerves might now be 

 narcotized with facility. The results were perfectly surprising. In 

 numerous cases, instead of writing a prescription of doubtful efficacy, 

 the physician could free the patient from his pain in a few minutes. 

 Moreover, it soon became evident that, not only in neuralgia, but in 

 many other painful diseases also, this effect followed the hypodermic 

 injections of morphine ; and, secondly, that it did not make much dif- 

 ference whether the injection was made at the seat of the pain or at 

 some other point. I know many physicians who never go out to their 

 practice without a Pravads syringe and a solution of morphine in their 

 pocket, and who usually bring the morphine-bottle home empty. It 

 cannot be denied that the hypodermic injection of solution of morphia 

 is sometimes abused. From this abuse we have become acquainted 

 with a form of chronic morphine-poisoning that was previously little 

 attended to. If injections of morphia have been made for some time, 

 and the dose has been increased more and more, independent of the 

 return of the pain, the patients begin to feel an absolute need of the 

 injections. They feel dull, and complain of an undefinable weakness, 

 discomfort, trembling, etc. Some describe their state as resembling 

 that after a debauch. Indeed, the condition before and after the injec- 

 tion often reminds us most strikingly of that of a toper, before and after 

 his first glass of spirits in the morning. But these bad results may be 

 avoided by the careful use of hypodermic injections of morphia. It is 

 doubtful whether they have any local action ; but it is certain that the 

 general effect of the morphine is much more complete and precise, if it 

 be injected under the skin, than if it be administered internally, and 

 we must regard the hypodermic injection of % to % of a grain of mor- 

 phine as an invaluable palliative for neuralgia. Next to the employ- 

 ment of cold and narcotics, come frictions of the skin with veratrine 

 ointment (gr. iv x to fat j), or aconite ointment (gr. j to fat 3 j). 

 After using veratrine ointment, the patients feel a peculiar prickling 

 in the skin, which occasionally benumbs the pain. [A mixture of 

 equal parts of chloral hydrate and camphor forms a clear liquid, 

 which painted on the part relieves pain.] 



We have stated that a third requirement of the indications from 

 the disease is to prevent the conduction of excitement from the irri- 

 tated nerves to the brain. The most effective mode of doing this is 

 by dividing the nerve between the brain and the affected part, or by 



