A very important fact is the great tendency to decomposition shown by apomorphine hydrochloride on exposure to moisture or moist air. As it is also affected by light, it should always be kept in amber-colored bottles. Again, it should never be kept in solution, the latter being always made fresh when it is to be used. Serious symptoms have followed neglect to heed this precau tionary measure.
Its purity may be tested by shaking up in a test-tube a 1-per-cent. solution. If the latter turns emerald-green, it should not be employed. (U. S. P.) Physiological Action. — The physio logical action of apomorphine as an emetic may be gathered from its symp tomatology, which is as follows: The administration of grain hypoder mically is followed in scarcely one-half minute by fullness of the head; the pulse is quickened and increased in vol ume; the pupils slowly dilate; the face is flushed. Perspiration soon appears; the respiration become more frequent and the heart-beats more rapid; and before two minutes elapse emesis is pro duced. Then comes the reaction, a gen eral relaxation, lasting about an hour. The eyes are sunken, the pupils are widely dilated, and the face is pallid and drawn. Yawning inaugurates the period of recovery; sleep follows and upon awakening all effects have passed away. (W. D. Carter.) These effects indicate that the physio logical action of apomorphine must be multiple. This has been found to be the case in experiments upon animals. The drug seems first to excite the cere bral centres, then to depress them. The peripheral arteries become prominent and tense, indicating arterial tension, clue to increased rapidity and force of cardiac action.
It is primarily a stimulant and finally a paralyzant. In excessive doses it causes convulsions, but in a manner not yet fully understood.
Therapeutic doses have no appreciable effect aside from acceleration of the pulse rate, the maximum being reached about the time vomiting begins. This is due to stimulation of the accelerator mechan ism. Following vomiting the pulse-rate decreases: the probable result of depres sion of the heart-muscle, since it has been shown that apomorphine is a muscle poison.
The respirations are usually increased, though variably so, after decided doses.
In case of lethal dose respirations cease as a result of paralysis of the controlling centres.
.Apomorphine has very slight, if any, influence upon temperature.
Apomorphine Poisoning.—When poi sonous doses are given to animals, the opposite of the above is the case; de pression of cardiac action first occurs, followed by weakness and rapid pulse.
The drug also acts as a convulsant through its influence upon the spinal cord, the convulsions being accompanied or followed by muscular paralysis. The respiratory centres are also deeply in volved and death occurs from respiratory paralysis.
In the human being toxic doses of apomorphine produce collapse, uncon sciousness, failing circulation and respi ration, and all the symptoms of profound depression of the vital centres. Convul sions usually precede the profound de pression, and vomiting rarely occurs.
Treatment of Poisoning. — The anti dotes are strychnine, chloral, and chloro form. These should be supplemented by the more diffusible stimulants, as ammonia, whisky, coffee, etc., together with external heat.
Therapeutics.—Apomorphine is doubt less the most reliable of our emetics and the one which acts most rapidly, but the effects obtained depend greatly upon the quality of the drug used. Untoward ef fects of various kinds have been reported, including, besides those added to the normal action of apomorphine, marked depression. This latter has occasioned a certain amount of distrust on the part of the profession, which, however, has no reasonable basis, provided a pure drug can be obtained, and proper precautions are taken, the most important of which is to prepare the solution at the very moment it is to be administered.
The value of apomorphine—according to Carmichel, who voices the experience of pediatricians who have used the rem edy extensively—cannot be too highly esteemed as an emetic for children; the average time at which emesis occurs is much less than the period required by the yellow sulphate of mercury. It affords prompt relief in croup and capillary bron chitis without being attended by nausea and violent retching, which makes it a great boon to children.