Three cases, including a personal one, in which death followed the administra tion of morphine after chloroform anaes thesia. Lauwers (Jour. de Chin, March April, 1001).
Treatment of Acute Poisoning by first indication is to empty and wash out the stomach. Emetics may be used, but large doses will be required. The stomach-siphon is preferable if it can be used. By means of it antidotes can be introduced into the stomach as soon as it is washed out. Since opium is eliminated into the stomach from the blood-vessels and then reabsorbed by it, frequent lavage of the stomach is ad vised. Tannic acid and permanganate of potash are chemical antidotes to opium, and a solution of one of these may be placed within the stomach by means of the stomach-siphon. Perman ganate of potash, if given while the poi son still remains in the stomach, will de compose the morphine. A quantity of the permanganate at least equal to the amount of morphine swallowed should be administered, well diluted with water, as recommended by William Moor, of New York, who first suggested this valu able antidote. Many instances of success with this remedy have been reported.
One grain of morphine is decomposed by exactly 1 grain of permanganate of potassium. This should be the basis of the permanganate treatment of opium poisoning. No matter how much time has elapsed since the taking of the poison, a sufficient quantity of the anti dote should be given per os (well di luted), or, if the patient he unable to swallow, the permanganate solution can easily be administered through the nose by means of a catheter, piece of rubber tubing, and a funnel. Hypodermically, a 1 to 15 solution can be used. The moth's operandi of hypodermic injections of permanganate of potassium, in cases of morphine poisoning, is explained by the fact that the permanganate instan t taneously selects morphine from among albuminous bodies. William Moor (Med. Rec., Feb. 17, '94).
Potassium permanganate given by the mouth directly after poisoning is 'a valu able, but not perfect, antidote to the morphine salts: an antidote, however, which should not be relied upon to the exclusion of mechanical or medicinal measures for emptying the stomach.
H. C. Wood (Univ. Med. Meg., Aug., '94).
Case of a child, aged 18 months, poisoned by 2 morphine pills, grain each. About I grain of potassium per manganate was given at once, no other agent, not even an emetic being resorted to. A second grain was given and the little patient put to bed. During the night the child had some delirium of a wild nature and had little sleep, but next day appeared none the worse for its overdose of morphine. H. B. Tingley (Med. Rec., Nov. 3, '94).
Thirty-five cases of opium poisoning in which potassium permanganate has proved its great value.
The physician should at once adminis ter a sufficient quantity of the perman ganate on reaching the bedside, while in ambulance cases the surgeon should first administer the potash salt before con ' veying the patient to the hospital, other wise the jolting of the vehicle promotes the absorption of the poison. William Moor (Med. Rec., Mar. 2, '95).
Case in which the permanganate was used successfully by hypodermic injec tion, 3 grains being given in that way every hour until 12 grains had been given. Hayes (N. Y. Med. Rec., May 25, '95).
Treatment of opium poisoning by per .
manganate of potassium employed in 19 cases, the following solutions being used No. 1 solution:— Potass. permang., 10 grains. Acid. sulph. dil., 2 drachms. Aq., 1 pint.
As this does not keep well, the sul phuric acid has to be kept separately, and the quantities in the stock mixtures are so arranged that 2 drachms of the permanganate and 2 drachms of the sul phuric acid in the concentrated solution, added to a pint of water, provide the proper amount for use.
No. 2 solution:— Potass. permang., 2 grains. Aq., 1 pint.
This is also kept in a concentrated stock mixture. The following instruc tions are carried out regarding the use of the stock solutions: 1. The stomach is to be washed out twice with plain water, washings being kept for chemical examination.