Codeïnum

One of the alkaloids contained in opium; formula, C18H21

NO3

Preparation , Triturations.

Authorities.

1 , provings of Dr. E. E. Marcy, N. Am. J. of Hom., 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 , Robiquet, effects of 0.01 to 0.2 grms., Journ. d. Chim. Méd., 9, 96; 5 , Schroff, provings with 0.1 grm., on Dwarzak and Heinrich, Lehrb. d. Pharm.; 6 , the same author, provings on Fossek and Krueg; 7 , Dr. A. S. Myrtle, Br. Med. Jour., April, 1874, effects of 4 grains on a man affected by glyscosuria; 8 , Samuel J. Gee, St. Barth. Hosp. Rep., 1869, effects of Chloro-codeia (formula, C18H20

ClNO3 ); 9 , Harley, Old Veg. Neurotics, subcutaneous injection of 1, 1 1/2, and 2 grains, in "Samuel M.;" 10 , ibid., injection of 1 grain, in John F.

MIND

• Emotional.
• Mental excitement, as after spirituous liquors, 2.
• Great exhilaration of spirits, 1.
• Great mental exhilaration, resembling that produced by alcoholic stimulants, 1.
• Slightly delirious at night, 7.
• After large doses, gayety, tranquillity, and sleep, accompanied by dreams are usually experienced, 1.
• Unusual gayety, 1.
• Felt "uncommonly jolly," as if up to anything (after half an hour), 7.
• Agreeable thoughts and fancies, 1.
• Depression of spirits, with dull headache, 1. [10.]
• 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, 1.
• Intellectual.
• On waking from a Codeine sleep, the intellect is clear, the spirits are elevated, and the countenance is bright and animated, 1.
• Increased capacity for mental effort, 1.
• Unusual facility for concentrating the mind upon any topic, 1.
• After the third attenuation, the mind became inactive and listless, so that the most interesting subjects received no attention, 1.
• Diminished power of fixing the attention, 5.
• Inability to perform mental labor, 5.
• Inability to concentrate the mind, 1.
• Inability to apply the mind, or to remain quiet in the house, 1.
• Sluggish association of ideas, 5. [20.]
• In the afternoon and evening the prover is dull, stupid, and quite indisposed to exert himself, 1.
• Felt very bewildered (after two hours), 7.
• Stupor did not easily disappear on waking, 4.

HEAD

• Confusion and Vertigo.
• Confusion of the head, 6.
• Confusion and heat of the head, 5.
• Dizziness in the head during the afternoon, 1.
• Dizziness on blowing the nose, 1.
• Dizziness on blowing the nose, and bright sparks wherever the prover looks, 1.
• Felt the room going round with him (after two hours), 7.
• When closing the eyes, objects appear to turn round, 1.
• General Head. [30.]
• Dull headache in the morning, which gradually diminishes until noon, when it disappears, 1.*
• Dull headache soon after getting up in the morning, worse on the left side, and lasting about two hours, 1.*
• Dull headache, with dry lips, causing a continual desire to moisten them, 1.
• Strong pulsations in the head and in the carotid arteries, 1.
• Temples.
• Sensation of pressure in the temporal and frontal regions, 5.
• Pulsating pain in the right temple, in the afternoon, 1.

EYE

• Membranes of the eyes slightly injected (after two hours), 9.
• Burning sensation in the eyes, worse in the left eye, 1.
• Lids.
• Aggravation of habitual twitching of the left eyelid, but followed in two weeks by a cure, 1 . [This prover (Hoffmann) had long been afflicted 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 after the prover had taken several doses daily of the 1st trituration, for a period of several days. From this time the spasmodic action gradually diminished, and ceased entirely at the 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.]
• Ball.
• Sclerotic a little injected (after three hours), 9.
• Pupil. [40.]
• Dilatation of pupils, 8.
• Pupils contracted, 9.
• Pupils slightly contracted (after four hours), 7.
• Contraction of the pupil from one seventh to one-eighth, 10.
• Vision.
• Weakness of vision, 5.
• Suddenly, his sight failed him (after two hours), 7.
• On beginning to write, did not see the letters distinctly (after two hours), 7.
• Sparks float before the eyes on stooping, 1.
• On blowing the nose, bright sparks before the eyes, 1.

EAR

• Stoppage of the ears, 6. [50.]
• Ringing in the ears, 5.

NOSE

• Mucous discharge from the nose, with irritation of the Schneiderian membrane, 1.
• Entire loss of smell (after many doses of the 1st trituration), which continued for three days, and then gradually became restored again. The patient was unable to distinguish strong musk from water, 1.

FACE

• Expression of the face animated, rosy and gay or dull and stupid, 1.
• Terrified look (after four hours), 7.
• Exceedingly pale (after four hours), 7.
• Lips dry and parched, causing a constant inclination to moisten them, 1.

MOUTH

• 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, 1.
• Salivation, 5, 8.
• Knew he met two ladies, recognized their voices, but could not speak to them (after two hours), 7.

THROAT. [60.]

• Strong pulsations in both carotids, 1.
• Tickling sensation in the throat, in the afternoon and evening, 1.

STOMACH

• Thirst.
• Great thirst, 1.
• Great thirst, with a particular desire for bitter substances, 1.
• Eructation.
• Frequent eructations, 5.
• Nausea and Vomiting.
• Nausea, 2.
• Nausea and vomiting, 4.
• Nausea and vomiting (from several doses of 1 grain of the alkaloid), 1.
• Feeling a little qualmish (after two hours); nausea continued an hour, 9.
• Inclination to vomit, 5, 6. [70.]
• Felt "sick as death" (after four hours), 7.
• On attempting to move, began to retch violently (after four hours), 7.
• Frequent vomiting, 2.
• Stomach.
• Pains in the stomach, 6.*
• Acute pains in the stomach, with empty eructations (from attenuated doses), 1.
• Violent pain in the stomach, 5.*
• Tenderness in the stomach, with violent pulsations of the heart and carotid arteries, 1.
• 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 doses have been repeated many times, it gives rise to mild paroxysms of neuralgic pains in the stomach and bowels, 1.

ABDOMEN

• Uncommon sense of tonicity in the abdomen, 8.
• Some diminution of the normal peristaltic action, 1. [80.]
• Dull pains throughout the entire abdomen, accompanied by perceptible pulsations, and acceleration of circulation and respiration, 1.
• Steady dull pains in the transverse colon, relieved by gentle pressure, 1.
• In the morning, great tenderness of the abdomen, which extends to the epigastrium and to the right and left lung, 1.
• Extreme tenderness of the lower part of the abdomen in the morning, 1.

STOOL

• Diarrhœa.
• Purging in two or three cases, 2.
• Constipation.
• Repeated doses of the lower attenuations produce constipation, tenderness of the bowels, especially of the transverse and descending colon, and some flatulence, 1.

URINARY ORGANS

• 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, 1.
• Micturition.
• 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, 1.
• In a few instances, it has increased the urinary secretion and rendered it lighter in color, 1.
• After a prolonged effort, passed nearly 2 ounces of urine; it is probable that the bladder was not completely emptied (after two hours), 9.
• Urine. [90.]
• The urine, previously saccharine (sp. gr. 1038), contained no trace of sugar (sp. gr. 1018), 7.

SEXUAL ORGANS

• Increase of sexual power (primary effect) followed by lack of power for several weeks (secondary effects), 1.
• Lascivious thoughts, causing frequent erections, day and night, 1.
• Sexual excitement, during the night, leading to nocturnal pollutions, 1.

RESPIRATORY APPARATUS

• Larynx.
• Tickling in the larynx, which causes a cough, 1.
• Voice.
• Voice reduced to a whisper (after four hours), 7.
• Cough.
• *Short and irritating cough, worse during the night, 1.
• *Troublesome cough, with copious mucous and sometimes purulent expectoration, 1.
• Morning cough, with soreness and stitching pains, 1.
• Respiration.
• Respiration before exper. 19; after two hours and a half 18, 9.

CHEST. [100.]

• Fulness and oppression of the chest, 1.
• Severe pain in the chest and shoulder, on motion, 1.
• Front.
• Sore feeling in the sternal region, 1.
• Sides.
• Drooping sensation below the left clavicle, 1.
• Sharp pain in the right lung, on inspiration, 1.
• Stitching pains in the left lung on breathing, 1.

HEART AND PULSE

• Præcordium.
• Uneasy feeling about the heart, 1.
• Drawing pain around the heart, which beats loud and full, causing the prover to feel very uneasy, 1.
• Fluttering and oppression in the region of the heart, with great desire to walk in the open air, 1.
• Heart's Action.
• Painful pulsations of the heart, when attempting to study or to write, 1.
• Pulse. [110.]
• Accelerated pulse, 2.
• Acceleration of the pulse fifteen beats, 10.
• Pulse accelerated eight beats (after one hour), accelerated four beats (after four hours), (after 2 grains, subcutaneously), 9.
• Pulse accelerated fifteen beats, fuller and stronger (after one hour), 9.
• Diminution of the pulse eighteen beats within four hours, 6.
• Diminished frequency of the pulse (in the prover), diminished twenty-eight beats during the first four hours, 5.
• His pulse was 56, the surface was cool, the face pale, the pupils much contracted, the next morning, 7.
• Before exper., pulse 74; after one hour 68; after two hours, 64, 9.
• Pulse very small and weak, 5.
• Pulse at wrist scarcely perceptible (after four hours), 7.

NECK AND BACK

• Neck.
• Convulsions in the muscles of the neck, 1. [120.]
• Convulsive movements of the muscles of the back of the neck, 1.
• Painful spasmodic twitchings of the muscles of the neck, 1.
• Neuralgic pains, extending from the occiput down to the back of the neck, 1.
• Painful pulsations in the left side of the neck, 1.
• Back.
• Dorsal.
• Drawing pain below the scapula on inspiration, 1.
• Sharp pain below the left scapula on inspiration, 1.
• Sharp pains extending from the stomach and chest through to the back, between the shoulders, worse on the right side of the vertebral column, 1.
• Lumbar.
• Heavy and fatigued feeling in the lumbar muscles, 1.
• Acute pains in the region of the kidneys, 1.

EXTREMITIES IN GENERAL

• Paralytic weakness of the arms and legs, 1. [130.]
• Numbness of the hands and feet; prickling and numb sensations in various parts of the body, 1.

SUPERIOR EXTREMITIES

• Objective.
• Convulsions in the muscles of the arms, 1.
• *Spasmodic twitchings in the arms, 1.
• Involuntary twitching of the muscles of the arm, 1.
• Subjective.
• Severe jerking pain in the arm, on attempting to remove a handkerchief from the breast pocket, 1.
• Arm.
• Feeling as if he had received a blow upon the upper arm, 1.
• Pulsating pain in the left upper arm, 1.
• Pain in the right deltoid muscle, lasting only a few minutes, 1.
• Continued pain in the deltoid muscles, 1.
• 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, 1.
• Hands. [140.]
• Numbness of the hands and arms, 1.

INFERIOR EXTREMITIES

• Objective.
• *Involuntary twitchings of the lower limbs, 1.
• Great weakness of the lower extremities, 1.
• Subjective.
• Paralytic sensations in the lower extremities, 1.
• Knee.
• Knees give way frequently when walking, 1.
• Frequent pains in the knees as if sprained, often compelling him to spot abruptly when walking, 1.
• In the morning, recurrence of the pain in the knee-joint, as if sprained, 1.
• Sudden pain in the left knee-joint, rendering walking impossible for a few minutes, and then ceasing suddenly, 1.
• Feet.
• Numbness of the feet, 1.
• Painful pulsations in the soles of the feet, worse on resting them against a hard object, 1.

GENERALITIES

• Objective. [150.]
• General acceleration of the circulation and respiration, 1.
• In doses of from 1/4 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 1/50th 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, 1.
• When placed in contact with the cellular tissue, it causes inflammation, 1.
• It excites the muscular structures, giving rise as a primary effect to augmented muscular power, with a tendency to convulsive motions, 1.
• Trembling of the whole body , appearing after four hours and lasting several hours, until they fell asleep, 5.
• Convulsive movements of different parts of the body, 1.
• 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, 1.
• Contact easily excites spasmodic twitchings, 1.
• If the drug be pushed to a great extent, reaction takes place, the muscles become enfeebled, and ultimately paralysis, especially of the inferior extremities supervenes, 1.
• Great weakness and lassitude, 1. [160.]
• Exhaustion (after some hours), 2.
• State of mixed paralysis and spasms, both tonic and clonic (very large doses), 8.
• Great restlessness, 1.
• Extreme restlessness (larger doses), 8.
• Subjective.
• Morbid sensitiveness of the skin to the touch, 1.
• Sensation and power of motion impaired, 1.
• In the first instance, Codeia in doses from 1/4 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, 1.
• Instead of stupor, sensation of well-being and comfort, the action of the brain not impeded, on waking, after doses, .

SKIN

• Objective.
• Eczema-like eruptions, 1.
• Subjective. [170.]
• Itching of the skin, 3.
• Very great itching of the skin, 1.
• Itching of the skin over the whole body, 2.
• Itching and heat of the face and head, which gradually extends over the whole body, 1.
• Itching sensation commencing at the head, and diffusing itself throughout the body, 1.
• Soreness of the skin after neuralgia, 1.
• 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, 1.

SLEEP AND DREAMS

• Sleepiness.
• Sleepiness, 6.
• Drowsy feeling, 1.
• Finally an ability to pass readily into a tranquil, refreshing, and agreeable sleep, 1. [180.]
• Sleep impeded by no heaviness of the head or stupefaction of mind, 3.
• Somnolency came on in a quarter of an hour; sleep for half an hour; and, after three hours, still continued drowsiness (2 grains), 9.
• Somnolency in a quarter of an hour; very drowsy, heavy, gapish, and sleepy (after two hours), (1/2 grains, subcutaneously), 9.
• Somnolency, after one hour; passed off, after two hours; followed by a little heaviness (from 1 grain, subcutaneously), 9.
• 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, 4.
• Sleeplessness.
• Much less sleep, 2.
• Passed a wretched night; slept none, 7.
• 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, 1.
• Sleep unrefreshing, 4.

FEVER

• Chilliness. [190.]
• Surface of body cold and clammy (after four hours), 7.
• Heat.
• General warmth, with itching of the skin, especially between the shoulders (after three hours), 9.
• Sensation of agreeable warmth, 9.
• 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, 1.
• Genial glow all over (after half an hour), 7.
• 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, 1.
• Heat in the head, 1, 2.
• Sweat.
• Sweat in large beads on forehead (after four hours), 7.

CONDITIONS

• 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 ), Pain in right lung; pain below scapula.
• ( Motion ), Pain in chest, etc.
• ( Resting parts against a hard object ), Pain in soles of feet.
• Amelioration.
• Pain in transverse colon.

SUPPLEMENT: CODEINUM. Authority.

11 , C. Ambrosoli (Gaz. Lombardo, 1875), Brit. and For. Med.-Chir. Rev., 1876, p. 235, poisoning of a child, aged two years.

• Face pale, extremities cold, pulse small, abdomen distended with flatus, eyes glassy and immovable, 11.