feom — The Medical Tribune. Published by Medical Tribune Co., 124 West 47th Street, New York City. Vol. IX. JANUARY 15, 1893. No. 1. ANTIKAMNIA AND CODEIA AS A SUBSTITUTE FOR MORPHINE. We meet with many cases in practice suffering intensely from pain, where from an idiocyncrasy or some other reason it is not advisable to give morphine or opium by the mouth, or morphine hypodermically, but frequently these very cases take kindly to codeine, and when assisted by antikamnia, its action is all that could be desired. In the nocturnal pains of syphilis, in the grinding pains which pre- cede labor, and the uterine contractions which often lead to abortion, in tic-douleureux, brachialgia, cardialgia, gastralgia, hepatalgia, nephralgia and dysmenorrhoea, immediate relief is afforded by the use of this combi- nation, and the relief is not merely temporary and palliative, but in very many cases is curative. Muscular spasm is often controlled by codeine and antikamnia. Its action is of essentially the same character as the morphine action; the same parts of the central nervous system are affected, and in the same way as morphine, but not in the same degree. In pulmonary diseases this combination is worthy of trial. It is a sedative to the respiratory centers in both acute and chronic disorders of the lungs. Cough in the vast majority of cases is promptly and lastingly decreased, and often entirely suppressed. In diseases of the respiratory organs, pain and cough are the symptoms which especially call for some- thing to relieve ; this mixture does the work, and in addition controls the violent movements accompanying the cough, and which are so dis- tressing. On account of the frequency with which pneumonia in late years is accompanied with grippal symptoms, the treatment, to a great extent, has been modified or changed. The essential features in the result de- sired are a diminution of the pain and a lowering of the temperature. Opinions differ as to whether a reduction of the temperature influences the course of the disease, but a concensus of opinion is that antipyretic treatment is distinctly called for in the beginning, and an analgesic at all 42 THE MEDICAL TRIBUNE. times, if needed to assuage suffering. The needs, therefore, are a heart tonic, which is frequently demanded—either strychnia or digitalis will answer. The antipyretic should be antikamnia, and the analgesic is sup. plied by the codeine and antikamnia together. This is given every three or four hours in powders containing 4f grains antikamnia, and £ grain codeine, throughout the period of congestion and consolidation. Where there is great restlessness, this will have a delightful effect. In the neuroses of the respiratory organs, great relief is afforded by the use of this combination. A paroxysm of asthma is often cut short by a full dose; hay-fever or autumnal catarrh is benefited by its use. In the harassing cough of phthisis, or in the pain of pleuritis, in the painful sensations accompanying bronchitis when the tubes are dry and irritable—as they usually are—the blending of codeine and antikamnia will not be found wanting in its action, but will give results that are gratifying to both the patient and the medical attendant. As a producer of sleep it will be found efficacious. This is doubly true when there is great nervous excitement. Muscular and articular rheumatism are decidedly relieved by it. By its anodyne and soporific effect it husbands the patient’s strength, while the disease is being eliminated by suitable remedies. Biliary and nephretic colic are efficiently treated by this combination ; the antikamnia enhances the value of the codeia, and conversely. Many persons, from some inherent weakness, idiocyncrasy if you please, cannot take any of the coal-tar antipyretics alone, on account of the cardiac depression, but can take this combination with great comfort; the codeia acting as a heart stimulant and tonic. Some forms of cephalalgia are controlled and the pain assuaged better by the use of codeia and antikamnia together, than by the use of antikamnia alone. In uraemia, if the patient can swallow, this combination will be of benefit in arresting the muscular spasms by counteracting the effect of the uraemic poison on the nerve centers, and by producing profuse dia- phoresis. In chorea the adminstration of this combination will prevent the jerking, and give the patient rest by producing sleep. In the pains of locomotor ataxia which are usually of a stabbing character, and are most common in the legs, often accompanied by a hot burning feeling, it will give relief. The action of antikamnia is exalted by being combined with codeia, and not only relieves pain, but allays agitation and controls spasm. ANTIKAMNIA AND CODEIA AS A SUBSTITUTE FOR MORPHINE. 43 This combination is the remedy for diabetes. It is not necessary to go into the etiology and symptomatology of saccharine diabetes ; a few points only will be touched upon. There is often a neuritis of certain nerves which in many cases cause a great deal of suffering. Sometimes the neuritis will come on suddenly without seeming cause, and the pain will be almost unbearable. The pain is boring in character, and the parts very sensitive to the touch. After a time the muscles of the region affected become atrophied with loss of motion, particularly if the extremi- ties be the pai'ts involved. The neuritis may be peripheral, and para- phlegia may also be a concomitant. In nearly all cases of neurotic history, there are pains in the extremities, a feeling of formication and sensations of heat at one time, and of cold at another. Particularly is this so in multiple neuritis. The neuralgia which accompanies saccharine diabetes is often of a peculiar nature, and seems to be a special variety. The pain is usually greater, and affects the nerves conjointly in pains. The combination of codeia and antikamnia is superior to any other remedy in diminishing the quantity of sugar in the urine, and also in diminishing the quantity of urine itself in diabetes mellitus. The bulimia and polydipsia are lessened by its use, and probably the changes in the nervous system which accompany or are causative of the disease, are arrested or prevented. It also prevents waste. It acts directly upon the nervous system; it controls restlessness ; it relieves insomnia ; it relieves the distressing nervous symptoms, particularly those which seem to be connected with derangement of the circulation in the extremities. It relieves the craving of the stomach, and lessens the frequency of the calls to urinate. It is not so likely to produce the opium habit; it is less constipating than opium and morphine, and is not apt to disturb digestion. In cases of marked neurotic type, the combi- nation will in its action be eminently satisfactory. Dietetics must be looked after and enforced ; suitable nutrients must be given, and the combination administered in such doses as may seem to be necessary for according to the intensity of the symptoms. This paper is not intended to be a resume of saccharine diabetes and its treatment, but simply to call the attention of the profession to the combination of antikamnia and codeia as a remedial agent in this disease. It is not claimed that the combination will cure diabetes melli- tus, but there will be, in many cases, arrest of the disease, with prolonged periods of good health, and cure in some cases. J. J. Sullivan, M. D. 275 West 38th Street, New York City. From “Notes on New Pharmaceutical Products.” Dr. W. P. Owen, of Devall’s Bluff, Ark., in his official report to the Chairman of the Committee on State Medicine, which was read before the Arkansas Medical Society at its Seventeenth Annual Session, says: “LaGrippe prevailed during the months of November and December in a sporadic form, and usually with con- siderable violence, the nervous system suffering most. The attack was ushered in usually by intense aching of limbs, spine and entire body. Soreness of the flesh, rigors, with considerable pyrexia, the thermometer regis- tering from 102 to 103 degrees for two or three days and then gradually subsiding. Nervousness and general prostration were very prominent symptoms, and in one case a form of insanity developed which lasted several days, but finally succumbed under appropriate treat- ment. In another case the spine became the seat of trouble, and partial pariplegia resulted, which gave some trouble in treatment, but finally resulted in recovery, under the use of counter-irritation and strychnia. Quinine proved injurious in all cases of this disease, while antikamnia with proper attention to hygiene, gave the best results.”