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MORPHIA IN INFANCY AND EARLY CHILDHOOD
355 much longer intervals, did not show the presence of that where chloroform
or
ethyl-chloride
is
omin- the danger of syncope at onset is reduced.
employed
The pretended medication is given by hypodermic injection, and the to become graver as age advanced. A psychoneurotic dosage is as follows: a solution is employed which congroup had to be carefully evaluated. The cases showed tains 10 mg. of morphine and 0-5 mg. of scopolamine the appearance of a depressive with a previous history per c.cm. At 12 years, the whole dose is injected; of anxiety neurosis or, less frequently, obsessional under 10 years, three-quarters ; under 6 years, a half ; features. The prognosis was regarded as being grave under 4 years, a third ; and under 2 years, a and depended on the amount of subjective as against quarter. With this dosage it was hardly ever found objective depression. The former was the greater, and necessary to administer morphia again during the the less objective the depression the worse the prog- night following operation. The conclusion is drawn nosis. Such cases generally showed poor integration that it is time to reconsider the usual teaching of the personality and were seldom genuinely reactive. with regard to the use of morphia in early childhood, The psychoneurotic group demonstrated neuropathic which is perhaps more a matter of tradition than of and psychopathic features in earlier life. A group of established fact. depressives with aversion. These demonstrated a reversal of the passive unworthy attitude of the FLACCID PARALYSIS FROM A STREPTOCOCCAL INFECTION depressive and showed a hostile averse critical attitude together with the more typical depressive features. BuBiED in the archives of medicine are many The personality was notably rigid and the prognosis records of affecting the nervous system Mention was made of reactive which have epidemics was most serious. been localised to districts or institutions. depressions in elderly people where, in the absence of Most of them have passed without a cause being ominous personality features, the prognosis was much found, but Rosenow3 has lately described one better than the age would indicate. in which careful bacteriological and experimental The whole question of prognosis was, said Dr. was made. The outbreak was in a college. Harrowes, bound up with a consideration of the per- investigation The onset of illness was sudden, the students being ,sonality assets of the individual and the extent to ill during the night with sore-throat, pains in which the effect was bound to any specific topic. the extremities, headache, and diarrhcea accompanied Most ominous in the personality were rigidity, obstinby vomiting. Several of them developed a flaccid acy, materialism, timidity. He gave an account of of groups of muscles, limited to one or research into the r6le of the vaso-regulative system, paralysis other of the limbs, to the head and neck, or to the mentioning the work, among others, of Potzl, trunk; two died of paralysis of the respiratory Eppinger, Hess, and Backlin. All the depressive cases muscles. Not only those with frank paralysis, but injected with adrenaline by Dr. Harrowes showed a many abortive cases had a high cellular content, up vagotonic response. The normal elevation of blood- to 900 cells per c.mm., chiefly polymorphonuclear, in pressure on emotion was then investigated by causing the cerebro-spinal fluid. A green-producing pleoemotional responses psychologically while the blood morphic streptococcus was isolated from the cerebropressure was being taken. It was found that, in cases fluid and from the nasopharynx of many of spinal where clinically the prognosis was good along the the patients. This streptococcus was also found in lines indicated, the blood pressure rose on emotion ’, the milk obtained direct from the udders of the dairy being evoked. This formed an interesting confirma- cows supplying the college. It was not possible to tion of clinical examination, and Dr. Harrowes cultivate it after adequate pasteurisation, and it was suggested that further study of this feature in con- observed that on such measures being adopted the junction with the vagotonia of depressives might lead subsided. Intracerebral injection of the to some useful generalisation which would operate as epidemic coccus led to the production of a flaccid paralysis in a prognostic formula. rabbits-animals notorious for spontaneous infections of the nervous system. MORPHIA IN INFANCY AND EARLY CHILDHOOD The resemblance of this epidemic to acute anterior OWING to its depressant effect on the respiratory lies only in the similarity of the symppoliomyelitis centre, there is a very general fear of administering toms. The work of E. Weston Hurst and others morphia to infants and young children; likewise has already shown that infantile paralysis is a virus scopolamine-morphine narcosis has been blamed for infection transmissible to monkeys and unassociated increasing the foetal death-rate, although it is now a streptococcus. conceded that morphia can safely be given to the mother up to four hours before the time of delivery. THOSE WHO CATCH COLD Some authorities, however, consider that the dangers I THERE have always been two schools of thought of morphia during the first years have become someabout the best way of preventing colds-the pre. thing of a bogy, and L. E. Holt and J. Howlandhave cautionary and the defiant. There are those who stated that opium is quite as valuable a drug in the windows their with sealed, and those who fling sleep treatment of disease at this life-period as at any who never venture out in winter, them those open ; ’other, provided that appropriate doses are given. and those who take strenuous regular exercise in all P.-F. Armand-Delille2 now goes further than this, and Of second weathers. late the group has been in the strongly advocates the routine use of morphia or ascendant, but it no encouragement certainly scopolamine-morphine narcosis as a preparation for from the latest statistical gets from Johns researches surgical anaesthesia in children over one year of age. 4 He bases his advocacy both on animal experiment Hopkins University. William M. Gafafer deals with of the attacks disease upper respiratory reported and on a series of over 800 children in whom it has been employed without ill-effect. He claims that in during 35 weeks (October to May, 1930) by 341 this way anaesthesia is begun and consciousness people, of whom the large majority were university - retained with much less distress to the patient, and students. Ofthethese, 277 were accustomed to sleep winter with wide-open windows, throughout
regarded equivalents. Hypochondriasis ous in recurrent cases, the prognosis of which was
as
____
taken
____
with
1 Diseases of Infancy and Childhood, 2
New York and London,1926.
Bull. de 1’Acad. de Méd., 1932, cvii., 890.
____
3
Jour. Infect. Dis., June, 1932, p. 377. 4 Amer. Jour. Hyg., July, 1932, p. 224.
or
ethyl-chloride
is
omin- the danger of syncope at onset is reduced.
employed
The pretended medication is given by hypodermic injection, and the to become graver as age advanced. A psychoneurotic dosage is as follows: a solution is employed which congroup had to be carefully evaluated. The cases showed tains 10 mg. of morphine and 0-5 mg. of scopolamine the appearance of a depressive with a previous history per c.cm. At 12 years, the whole dose is injected; of anxiety neurosis or, less frequently, obsessional under 10 years, three-quarters ; under 6 years, a half ; features. The prognosis was regarded as being grave under 4 years, a third ; and under 2 years, a and depended on the amount of subjective as against quarter. With this dosage it was hardly ever found objective depression. The former was the greater, and necessary to administer morphia again during the the less objective the depression the worse the prog- night following operation. The conclusion is drawn nosis. Such cases generally showed poor integration that it is time to reconsider the usual teaching of the personality and were seldom genuinely reactive. with regard to the use of morphia in early childhood, The psychoneurotic group demonstrated neuropathic which is perhaps more a matter of tradition than of and psychopathic features in earlier life. A group of established fact. depressives with aversion. These demonstrated a reversal of the passive unworthy attitude of the FLACCID PARALYSIS FROM A STREPTOCOCCAL INFECTION depressive and showed a hostile averse critical attitude together with the more typical depressive features. BuBiED in the archives of medicine are many The personality was notably rigid and the prognosis records of affecting the nervous system Mention was made of reactive which have epidemics was most serious. been localised to districts or institutions. depressions in elderly people where, in the absence of Most of them have passed without a cause being ominous personality features, the prognosis was much found, but Rosenow3 has lately described one better than the age would indicate. in which careful bacteriological and experimental The whole question of prognosis was, said Dr. was made. The outbreak was in a college. Harrowes, bound up with a consideration of the per- investigation The onset of illness was sudden, the students being ,sonality assets of the individual and the extent to ill during the night with sore-throat, pains in which the effect was bound to any specific topic. the extremities, headache, and diarrhcea accompanied Most ominous in the personality were rigidity, obstinby vomiting. Several of them developed a flaccid acy, materialism, timidity. He gave an account of of groups of muscles, limited to one or research into the r6le of the vaso-regulative system, paralysis other of the limbs, to the head and neck, or to the mentioning the work, among others, of Potzl, trunk; two died of paralysis of the respiratory Eppinger, Hess, and Backlin. All the depressive cases muscles. Not only those with frank paralysis, but injected with adrenaline by Dr. Harrowes showed a many abortive cases had a high cellular content, up vagotonic response. The normal elevation of blood- to 900 cells per c.mm., chiefly polymorphonuclear, in pressure on emotion was then investigated by causing the cerebro-spinal fluid. A green-producing pleoemotional responses psychologically while the blood morphic streptococcus was isolated from the cerebropressure was being taken. It was found that, in cases fluid and from the nasopharynx of many of spinal where clinically the prognosis was good along the the patients. This streptococcus was also found in lines indicated, the blood pressure rose on emotion ’, the milk obtained direct from the udders of the dairy being evoked. This formed an interesting confirma- cows supplying the college. It was not possible to tion of clinical examination, and Dr. Harrowes cultivate it after adequate pasteurisation, and it was suggested that further study of this feature in con- observed that on such measures being adopted the junction with the vagotonia of depressives might lead subsided. Intracerebral injection of the to some useful generalisation which would operate as epidemic coccus led to the production of a flaccid paralysis in a prognostic formula. rabbits-animals notorious for spontaneous infections of the nervous system. MORPHIA IN INFANCY AND EARLY CHILDHOOD The resemblance of this epidemic to acute anterior OWING to its depressant effect on the respiratory lies only in the similarity of the symppoliomyelitis centre, there is a very general fear of administering toms. The work of E. Weston Hurst and others morphia to infants and young children; likewise has already shown that infantile paralysis is a virus scopolamine-morphine narcosis has been blamed for infection transmissible to monkeys and unassociated increasing the foetal death-rate, although it is now a streptococcus. conceded that morphia can safely be given to the mother up to four hours before the time of delivery. THOSE WHO CATCH COLD Some authorities, however, consider that the dangers I THERE have always been two schools of thought of morphia during the first years have become someabout the best way of preventing colds-the pre. thing of a bogy, and L. E. Holt and J. Howlandhave cautionary and the defiant. There are those who stated that opium is quite as valuable a drug in the windows their with sealed, and those who fling sleep treatment of disease at this life-period as at any who never venture out in winter, them those open ; ’other, provided that appropriate doses are given. and those who take strenuous regular exercise in all P.-F. Armand-Delille2 now goes further than this, and Of second weathers. late the group has been in the strongly advocates the routine use of morphia or ascendant, but it no encouragement certainly scopolamine-morphine narcosis as a preparation for from the latest statistical gets from Johns researches surgical anaesthesia in children over one year of age. 4 He bases his advocacy both on animal experiment Hopkins University. William M. Gafafer deals with of the attacks disease upper respiratory reported and on a series of over 800 children in whom it has been employed without ill-effect. He claims that in during 35 weeks (October to May, 1930) by 341 this way anaesthesia is begun and consciousness people, of whom the large majority were university - retained with much less distress to the patient, and students. Ofthethese, 277 were accustomed to sleep winter with wide-open windows, throughout
regarded equivalents. Hypochondriasis ous in recurrent cases, the prognosis of which was
as
____
taken
____
with
1 Diseases of Infancy and Childhood, 2
New York and London,1926.
Bull. de 1’Acad. de Méd., 1932, cvii., 890.
____
3
Jour. Infect. Dis., June, 1932, p. 377. 4 Amer. Jour. Hyg., July, 1932, p. 224.