12. The injection of atropine before the administration of chloroform to prevent syncope has been given up by surgeons.
13. It has been recommended as an anti dote to barium salts, hydrocyanic acid, nicotine, pilocarpine, and muscarine poisoning. 14. The question of its use as an antidote to opium will be studied in a further communication. Lepine (Sem. Med., Nov. 25, '96; Brit. Med. Jour., Jan. 9, '97).
A case of lobster poisoning simulating poisoning with atropine in one man and two women. Evacuation was induced only after large doses of castor-oil, senna, magnesium sulphate, and several soap enemata. The general toxic symptoms improved under the hypodermic adminis tration of pilocarpine grain), while for the eye symptoms it was found neces sary to employ eserine, 1 to 2 drops of a 5-per-cent. solution twice daily. Fischer (Nouv. Rem., Apr. S, '9S).
Treatment of Atropine Poisoning. If seen early enough, emetics or warm drinks should be administered, followed by the use of the stomach-tube. Tannin and charcoal may be used if a stomach tube is not at hand and absorption has not taken place. Among the antidotes advised are coffee, alcohol, pilocarpine to 1/4 grain), muscarine nitrate to '/„., grain), morphine sulphate to '/, grain), or eserinc to grain). The violent action of the drug should be restrained by the use of the foregoing antidotes given by hypodermic injection, in moderate doses, and repeated at in tervals, as indicated by the condition of the patient and the urgency of the symp toms.
Case illustrating the paralyzing; influ ence of atropine, hut also demonstrating that persistent effort is frequently re warded by recovery in the most serious cases. Begold (Wrateli, No. 4, p. 96, '96).
The antagonism between atropine and morphine is not as pronounced as some investigators claim. Paz in cases of opium-poisoning gives V, to grain of atropine, while Robert recommends grain every half-hour. These doses are far too great and a single dose of only V„ grain should be given. E. F. Bash ford (Archives Inter. de Pharm. et de Therap., vol. viii, p. 311, 1901).
There can be no doubt that atropine may be of value as an antidote in mor phine poisoning, but only before the third stage, and then only when given in small or moderate doses. But even Here its usefulness is practically limited to a possible excitation of the respira tory movements and a stimulation of the circulation, both of which, however, may be fully compensated for in its per nicious effects, chiefly upon general metabolism. Given in large doses dur
ing the second stage, or in moderate to large doses during the third stage, it almost, if not without exception, does harm by intensifying the morphine con dition, prolonging or shortening, but in tensifying. the second stage, or shorten ing the third stage, and hastening the fatal issue. If the second stage is short ened, it is owed to the earlier develop ment of the third stage of the poisoning. This has been personally found to be a uniform result of a large number of ex periments upon dogs, and which is fully supported by the records of other in vestigators. In fact, a dose of morphine that is not lethal may be made so by the synergistic actions of a sublethal dose of atropine. E. T. Beichert (Then Monthly, May, 1901).
Therapeutics. — DISORDERS OF THE EYE.—Atropine is greatly employed in ophthalmological work, not only as a therapeutic agent, but largely in diag nosis, as it dilates the pupil, diminishes intra-ocular pressure, contracts the ar terioles, and acts topically on the senti ent nerves. Atropine is used when we wish to suspend the power of accommo dation in cases of myopia or hyperme tropia to determine the exact error of refraction, and in astigmatism to ascer tain the difference in the meridians. In the examination of cataract (especially in its early stages) the use of atropine is of great value. A wider and better view of the fundus of the eye is also obtained through the pupil dilated by atropine. As a therapeutic means, atropine is in valuable in all superficial inflammatory conditions of the eye in which pain, tenderness, and photophobia are present. Mild solutions (1 or 2 grains to 1 ounce) instilled within the eyelids generally give prompt relief. In strumous corneal ulcers and phlyctenular keratitis (by diminishing photophobia and blepharo spasm and lessening blood-supply) a few drops of a mild solution (1 grain to ounce) two or three times daily will give relief. In syphilitic iritis where poste rior or anterior synechin are a frequent complication, early and constant dila tation of the pupil should be secured through the use of solutions of atropine (2 to 4 grains to 1 ounce). Atropine will relieve the photophobia of acute conjunctivitis and also that of chronic conjunctivitis associated with blepharitis and granular lids, if used in mild solu tion and not too frequently applied.