Injuries of nerves and their consequences - Reflex Sympathetic ...

TREATMENT. 271
patient who receives a half-grain or more of morphia
may become presently free from pain, and yet walk about
with little or no desire to sleep. The ability to lessen
pain is not therefore of necessity connected with the sleepcompelling
potency. Where, however, the latter is inconveniently
felt, and w^e desire the former only, it is possible
to attain the end in view by using with the morphia
a certain share of atropia. Thus, if we inject half a grain
of sulphate of morphia, and with it the thirtieth of a
grain of sulphate of atropia, the anaesthetic force of the
morphia will rest unaltered, but the tendency to sleep
will be greatly diminished. The views here set forth
were reached after long and careful experiments on large
numbers of men,* and seem to justify the practice of using
atropia and morphia together.
As regards the place of injection, I agree with most
observers that it is generally of little moment, the effect
being the same whether it be thrown into the atfected
limb or into a remote part. The single exception to this
I shall presently — mention.
Manipulation. I have elsewhere spoken of the use of
massage in restoring the nutrition and motions of a limb.
It is only of late that I have sought to control pain and
alter the nutritive state of a diseased nerve trunk by this
means. A case of contusion of the ulnar nerve became
subject to intense neuralgia, the nerve being hardened
and enlarged, owing, probabl}^ to subacute neuritis. It
was very tender, and no application of electricity
was
borne with any patience. The pain was relieved by
hypodermic injections, but after using many remedies,
* Antagonism of Atropia and Morphia, etc., S. Weir Mitchell, W. W.
Keen, and G. R. Morehouse, Am. Joiirn. Med. Sci., July, 1865. These researches
led us to the conclusion that the two drugs are mutually antagonistic
thrnuL^h a part only of their range of symptoms, even agreeing
as to some of their modes of activity.