Codeinum

One of the alkaloids contained in opium ; formula, C]8H21N03.

Preparation, Triturations.

Authorities. 1, provings of. Dr. E. E. Marcy, N. Am. J. of Horn., 5, 413 ; 2, Gregory, proving with Codium nitricum on students, with 0.25 to 0.35 grms., Journ. Pharm., xx, 85 ; 3, Barbier, effects of 0.06 to 0.12 grms., Gaz. Med., 10, 1834; 4, Eobiquet, effects of 0.01 to 0.2 grms., Journ. d. Chim. Med., 9, 96; 5, Schopf, provings with 0.1 grm., on Dwarzak and Heinrich, Lehrb. d. Pharm. ; 6, the same author, provings on Fosse and Krueg ; 7, Dr. A. S. Myrtle, Br. Med. Jour., April, 1874, effects of 4 grains on a man affected by glycosuria; 8, Samuel J. Gee, St. Barth. Hosp. Rep., 1869, effects of Chloro-codeia (formula, ,C,8H,0Clo3) ; 9, Harley, Old Veg. Neurotics, subcutaneous injection of 1, 1-i, and 2 grains, in '" Samuel M. ;" 10, ibid., injection of 1 grain, in John F.

Mind

Emotional. Mental excitement, as after spirituous liquors

Great exhilaration of spirits

Great mental exhilaration, resembling that produced by alcoholic stimulants

Slightly delirious at night

After large doses, gayety, tranquillity, and sleep, accompanied by dreams are usually experienced

Unusual gayety

Felt uncommonly jolly as if up to anything (after half an hour)

Agreeable thoughts and fancies

Depression of spirits, with dull headache

ilO.'] After attenuated doses, depression of spirits, with great desire to sleep, which is accompanied by frightful dreams, and dull headache in the morning on waking

Intellect&l On waking from a Codeine sleep, the intellect is clear, the spirits are elevated, and the countenance is bright and animated

Increased capacity for mental effort

Unusual facility for concentrating the mind upon any topic

After the third attenuation, the mind became inactive and listless, so that the most interesting subjects received no attention

Diminished power of fixing the attention

Inability to perform mental labor

Inability to concentrate the mind

Inability to apply the mind, or to remain quiet in the house

Sluggish association of ideas

In the afternoon and evening the prover is dull, stupid, and quite indisposed to exert himself

Felt very bewildered (after two hours)

Stupor did not easily disappear on waking

Head

Confusion and Vertigo. Confusion of the head

Confusion and heat of the head

Dizziness in the head during the afternoon

Dizziness on blowing the nose

Dizziness on blowing the nose, and bright sparks wherever the prover looks

Felt the room going round with him '(after two hours)

When closing the eyes, objects appear to turn round

General Head. *Dull headache in the morning, which gradually diminishes until noon, when it disappears?.

* Dull headache soon after getting up in the morning, worse on the left side, and lasting about two hours

Dull headache, with dry lips, causing a continual desire to

rll /T -~Stron- Potions in the head and in the carotid arteries

J temples. Sensation of pressure in the temporal and frontal regions,5.-

PnUtng pam in the right temple, in the afternoon

R,.n/wT T- branes,of the lightly injected (after two hours),9.-

Binning sensation in the eyes, worse in the left eye,K-Lids. Aggravate-

a1(cure t n ,ng-°f r»W ***** but followed <™ by

?aS n Fit~* • k;Llerot,c a little injected (after three hours)

Dotation of pup ls,8.-Pupils contracted,9.-Pupils slightly con-

one eU h h o1' ^^^traction of the pupil from one*seventh to

Eyes p. 431

T town. Weakness of vision,5.-Suddenly, his sight failed

un at er two hours)/.-On beginning to write, did not see the letters dis-

tinctly (after two hoin-s),7.-Sparks float before the eyes on stooping

On blowing the nose, bright sparks before the eyes ».

Ears p. 431

Stoppage of the ears

Ringing in the ears

j\OSC Mucous discharge from the nose, with irritation of the Schnei-

derian membrane,1.- Entire loss of smell (after many doses of the 1st

trituration), which continued for three days, and then gradually became re-

wateriagam Patient was unable to distinguish strong musk from

* P^e'~^ Expression of the face animated, rosy and gay or dull and stupid .

Terrified look (after four hours)

Exceedingly pale (after four hours j

Eips dry and parched, causing a constant inclination to moisten them

Mouth p. 431

Anterior part of tongue dry (after three hours)9

Anterior part of tongue and hard palate a little dry (after two hours) 9

Dryness of the mouth, with thirst for beer

Salivation

Knew emet two ladies, recognized their voices, but could not speak to them (after two hours)

Throat p. 431

Strong pulsations in both carotids

Tickling sensation in the throat, in the afternoon and evening

Stomach p. 431

Thirst. Great thirst

Great thirst, with a particular desire for bitter substances

Eructation. Frequent eructations

nausea and Vomiting. Nausea

Nausea and vomiting

Nausea and vomiting (from several doses of 1 grain of the alkaloid)

Feeling a little qualmish (after two hours); nausea continued an hour

Inclination towmti

Felt "sick as death (after four hours)

On attempting to move, began to retch violently (after four hours)

Frequent vomiting

Stomach. *Pain in the stomach

Acute pains in the stomach, with empty eructations (from attenuated doses)

* Violent pain in the stomach

Tenderness in the stomach, with violent pulsations of the heart and carotid arteries

After a dose of 1 to 2 grains, a gentle and agreeable glow is usually experienced in the stomach, followed in some instances by nausea. If these doses be repeated at intervals of four hours, the appetite will become extinct, and not unfrequently vomitings will occur. In an attenuated form, after the closes have been repeated many times, it gives rise to mild pai-oxysms of neuralgic pains in the stomach and bowels

Abdomen p. 432

Uncommon sense of tonicity in the abdomen

Some diminution of the normal peristaltic action

Dull pains throughout the entire abdomen, accompanied by perceptible pulsations, and acceleration of circulation and respiration

Steady dull pains in the transverse colon, relieved by gentle pressure

In the morning, great tenderness of the abdomen, which extends to the epigastrium and to the right and left lung

Extreme tenderness of the lower part of the abdomen in the morning

Stool p. 432

Diarrhoea. Purging in two or three cases

Constipation. Repeated doses of the lower attenuations produce constipation, tenderness of the bowels, especially of the transverse and descending colon, and some flatulence

Urinary Organs p. 432

Bladder. In small and repeated doses, it diminishes the power of retention, and reduces the neck of the bladder to a condition of semi-paralysis

3Lictu ration. Its primary effect is to increase the urinary secretion, and to render it lighter in color; but this is followed by a reaction which reduces it in quantity below the natural standard

In a few instances, it has increased the urinary secretion and rendered it lighter in color

After a prolonged effort, passed nearly 2 ounces of urine ; it is probable that the bladder was not completely emptied (after two hours)

Urine. The urine, previously saccharine (sp. gr. 1038), contained no trace of sugar (sp. gr. 1018)

Sexual Organs p. 432

Increase of sexual power (primary effect) followed by lack of power for several weeks (secondary effects)

Lascivious thoughts, causing frequent erections, day and night

Sexual excitement, during the night, leading to nocturnal pollutions

Respiratory Organs p. 432

Larynx. Tickling in the larynx, which causes a cough

Voice. Voice reduced to a whisper (after four hours)

Congll. *Short and irritating cough, worse during the night

* Troublesome cough, with copious mucous and sometimes purulent expectoration

Morning-cough, with soreness and stitching pains

Respiration, Respiration before expel. 19 ; after two hours and a half 18,9.

Chest p. 432

Fulness and oppression of the chest

Severe pain in the chest and shoulder, on motion

Front. Sore feeling in the sternal region

Sides. Drooping sensation below the left clavicle

Sharp pain in the right lung, on inspiration

Stitching pains in the left lung on breathing

Heart and Pulse p. 432

Precordium, Uneasy feeling about the heart

Drawing pain around the heart, which beats loud and full, causing the prover to feel very uneasy

Fluttering and oppression in the region of the heart, with great desire to walk in the open air

Heart's Action. Painful pulsations of the heart, when attempting to study or to write

Pulse. Accelerated pulse

Acceleration of the pulse fifteen beats

Pulse accelerated eight beats (after one hour), accelerated four beats (after four hours), (after 2 grains, subcutaneously)

Pulse accelerated fifteen beats, fuller and stronger (after one hour)

Diminution of the pulse eighteen beats within four hours

Diminished frequency of the pulse (in the prover), diminished twenty-eight beats during the first four hours

His pulse was 56, the surface was cool, the face pale, the pupils much contracted, the next morning

Before expel., pulse 74 ; after one hour, 68 ; after two hours, 64,9.

Pulse very small and weak

Pulse at wrist scarcely perceptible (after four hours)

Neck and Back p. 433

J¥eck. Convulsions in the muscles of the neck

Convulsive movements of the muscles of the back of the neck

Painful spasmodic twitchings of the muscles of the neck

Neuralgic pains, extending from the occiput down to the back of the neck

Painful pulsations in the left side of the neck

Back, Dorsal. Drawing pain below the scapula on inspiration

Sharp pain below the left scapula on inspiration

Sharp pains extending from the stomach and chest through to the back, between the shoulders, worse on the right side of the vertebral column

Lumbar, Heavy and fatigued feeling in the lumbar muscles

Acute pains in the region of the kidneys

Extremities in General p. 433

Paralytic weakness of the arms and legs

Numbness of the hands and feet ; prickling and numb sensations in various parts of the body

Superior Extremities p. 433

Objective. Convulsions in the muscles of the arms

Spasmodic twitchings in the arms

Involuntary twitching of the muscles of the arm

Subjective, Severe jerking pain in the arm, on attempting to remove a handkerchief from the breast pocket

Ai'm. Feeling as if he had received a blow upon the upper arm

Pulsating pain in the left upper arm

Pain in the right deltoid muscle, lasting only a few minutes

Continued pain in the deltoid muscles

On attempting to dress himself in the morning, the prover experienced a severe pain in the left deltoid muscle, which prevented him from making his toilet ; this pain was not felt when the arm was perfectly at rest

Hands. Numbness of the hands and arms

Inferior Extremities p. 433

Objective, *Involuntary twitchings of the lower limbs

Great weakness of the lower extremities

Subjective. Paralytic sensations in the lower extremities

Knee. Knees give way frequently when walking

Frequent pains in the knees as if sprained, often compelling him to stop abruptly when walking

In the morning, recurrence of the pain in the knee-joint, as if sprained

Sudden pain in the left knee-joint, rendering walking impossible for a few minutes, and then ceasing suddenly

Feet. Numbness of the feet

Painful pulsations in the soles of the feet, worse on resting them against a hard object

Generalities p. 433

Objective, General acceleration of the circulation and respiration

In doses of from % to 2 and 3 grains, it accelerates the circulation and respiration for several hours, followed in all instances by a depressing reaction. In doses of ^th of a grain, no effect has been observed upon the healthy ; but in patients suffering from gastralgia, and neuralgic pains in various parts of the body, we have observed an augmentation of the circulation from much more minute doses than this

When placed in contact with the cellular tissue, it causes inflammation

It excites the muscular structures, giving rise as a primary effect to augmented muscular power, with a tendency to convulsive motions

Trembling of the whole body, appearing after four hours and lasting several hours, until they fell asleep

Convulsive movements of different parts of the body

We have witnessed convulsive motions in the muscles of the chest, neck, arms, and legs, from large and repeated doses. In one case these convulsions were followed by soreness of the parts, and a diminution of muscular power which continued for several weeks

Contact easily excites spasmodic twitchings

If the drug be pushed to a, great extent, reaction takes place, the muscles become enfeebled, and ultimately

Skin p. 433

28 paralysis, especially of the inferior extremities supervenes

Great weakness and lassitude

Exhaustion (after some hours)

State of mixed paralysis and spasm, both tonic and clonic (very large doses)

Great restlessness

Extreme restlessness (larger doses)

Subjective, Morbid sensitiveness of the skin to the touch

Sensation and power of motion impaired

In the first instance, Codeia in doses from to 1 grain, augments nervous sensibility, but there is always a reaction in a few hours, and a corresponding depression is observed, which continues from two to three days

Instead of stupor, sensation of well-being and comfort, the action of the brain not impeded, on waking, after doses

Constant inclination to sit down and close the eyes

Skin p. 434

Objective. Eczema-like eruptions

Subjective. Itching of the skin

Very great itching of the skin

Itching of the skin over the whole body

Itching and heat of the face and head, which gradually extends over the whole body

Itching sensation commencing at the head, and diffusing itself throughout the body

Soreness of the skin after neuralgia

Sensation in the skin of the chest, as if a fly was creeping from one direction to another, not relieved by rubbing or scratching, and lasting about two minutes

Sleep and Dreams p. 434

Sleepiness. Sleepiness

Drowsy feeling

Finally an ability to pass readily into a tranquil, refreshing, and agreeable sleep

Sleep impeded by no heaviness of the head or stupefaction of mind

Somnolency came on in a quarter of an hour ; sleep for half an hour ; and, after three hours, still continued drowsiness (2 grains)

Somnolency in a quarter of an hour ; very drowsy, heavy, gapish, and sleepy (after two hours), (1? grains, subcutaneously)

Somnolency, after one hour ; passed off, after two hours ; followed by a little heaviness (from 1 grain, subcutaneously)

In grain doses of the alkaloid, a calm and refreshing sleep is induced, accompanied by pleasant dreams, and not followed by headache, sleeplessness, disordered stomach, etc.,1.

Sleep very refreshing

Sleeplessness. Much less sleep

Passed a wretched night ; slept none

Doses of the 1st, 2d, and 3d triturations cause a sleep disturbed by unpleasant dreams of dead persons, etc. Secondary effects of small doses are, great drowsiness and listlessness, great drowsiness with inability to sleep, frequent waking from sleep with the covers thrown off, exciting dreams, dreams full of ridiculous fancies

Sleep unrefreshing

Fever p. 434

Chilliness, Surface of body cold and clammy (after four hours)

Heat. General warmth, with itching of the skin, especially between the shoulders (after three hours)

Sensation of agreeable warmth

It sometimes produces a sense of agreeable warmth and itching over the surface of the body. In one instance, this itching persisted for several days. When placed in contact with the skin, it causes a slight inflammation of the part to which it is applied

Genial glow all over (after half an hour)

Accompanying the primary effects of large doses upon the circulation, we usually observe an increased heat or glow, and an itching of the head, face, and body, and a happy exhilaration of spirits. The first influence is felt in the head, which is rapidly diffused from thence to other parts of the system

Heat in the head

Sweat. Sweat in large beads on forehead (after four hours)

Conditions p. 434

Aggravation.

(Morning), On waking, dull headache ; tenderness of abdomen ; cough ; pain in knee-joint.

(Afternoon*), Dizziness; pain in temple; tickling in throat.

(Blowing nose), Dizziness; sparks before eyes.

(When closing eyes), Objects appear to turn round.

(On inspiration), Pam in right lung ; pain below scapula.

(Motion), Pain in chest, etc .

(Besting parts against a hard object), Pain in soles of feet.

Amelioration p. 435

Pain in transverse colon.

Footnotes p. 431

† This pro ver (Hoffmann) had ]or\<r born iifflicted with involuntary twitchings of the left eyelid, recurring frequently through the day, each paroxysm lasting about three minutes, and sometimes relieved by rubbing the part. The aggravation occurred alter the prover had taken several doses daily of the 1st trituration, for a period of several days. From this time the spasmodic action gradually di minished, and ceased entirely at tin: end of about two weeks. Another case of involuntary twitchings of both eyelids, occurring whenever the lad attempted to read or write, was cured in four weeks by the 5th dilution, administered every morning and evening.