THE PREVENTION OF MORPHINISM. A THERAPEUTIC REVOLUTION : CODEINE AND NARCEINE, vice MORPHINE. BY J. B. MATTISON, M. D. MEDICAL DIRECTOR, BROOKLYN HOME FOR HABITUES, BROOKLYN. Member American Medical Association; American Association for the Cure of Inebriety; New York Academy of Medicine; Medico-Legal Society; New York Neurological Society; Medical Society, of the County of Kings. Read before the American Medical Association, Washington, May 6, 1891. Reprint from "Dietetic Gazette'' September, i8qi. THE PREVENTION OF MORPHINISM. A Therapeutic Revolution: Codeine and Narceine, vice Morphine. BY J. B. MATTISON, M.D. Medical Director, Brooklyn Home For Habitues, Brooklyn. Member American Medical Association; Ameri- can Association for the Cure of Inebriety; New York Academy of Medicine; Medico- Legal Society; New York Neurological Society; Medical Society of The County of Kings. Read before the American Medical Association, Washington, May 6, 1891. The prevention of disease ranks higher than its cure, and he who essays the role of benefac- tor along this line, deserves well of his fellows, be results success or reverse. I shall presume to make effort at filling that role to-day; shall try to command your attention by enlisting in- 1 terest in what promises to remove, very largely, a stigma that has rested long and weightily on the healing art, and by wiping out this blot on the scutcheon, secure favor by virtue of not only an advance so decided as to mark a new era in therapeutics, but, above all, by les- sening in large degree the main factor in a disease that spares neither sex. state nor con- dition and which, sad to say, claims for its victims more of our confreres than the world will ever know. Pain and insomnia, with the use and abuse of morphia for their relief, are the leading twin causes of the morphine disease. Quite apart, however, is a peculiar power, per se, in this drug that makes it, so often, a bane after blessing-a snareful influence than which a stronger, save one, does not exist, and which carries with it, too often, degradation and death. It goes then, without saying, that if one can offer that which will bring ease, and win the "sweet restorer" without this harm- ful sequence, he will entitle himself to the plaudit of profession and public, by averting a danger that threatens the well-being of the per- son and society at large. Such, in much measure, I think we have in codeine and nar- ceine. The former has long been used, to a minor extent, the latter is rare. Opinion has 2 varied as to their value, but my experience with each, in a field special, unique, and to some ex- tent unequaled, has brought with it a belief in their virtue along painful, insomnic lines, and a confidence so pronounced that I bespeak for them your careful, practical consideration. I am not willing to say there can be no Codeinism or Narceinism, despite the statement of Fischer that "tolerance and habituation analagous to morphine, are not caused by codeine," but I do assert that the snaring, seductive power of codeine is vastly less than that of morphia and that this one negative power for harm alone should secure for it a larger share of professional confidence and field for remedial work than it has hitherto had. Nor am I ready to say that codeine has a value, aside from its anodyne, equal to morphia in inflammatory conditions, nor that it has like power as a stimulant. To neither of these does my argument apply, but solely to its use in painful, agrypnic conditions, apart from tem- perature rise or cardiac decline. Codeine was discovered in 1832, by Robiquet, who wrote in its favor, and two years later, Barbier and Bertha, after a series of careful experiments, claimed its special tendency towards the sympathetic system. These reports were confirmed but, like some other valuable 3 drugs, digitalis, for instance, the merits of codeine were for many years in abeyance, and only within the last half decade has it come well to the front with a claim for doing good work too strong to be disregarded. Foreign physicians, especially on the conti- nent, have always led in the use of codeine, but the time is quite here for us to follow their good example, and I cannot now do better than to commend to your careful reading a valuable paper by Lauder Brunton, in the British Medi- cal Journal, June 9, 1888. Dr. Brunton lauds it highly, declaring he is satisfied that, to use his exact language: "it has a powerful action in allaying abdominal pain." He cites various painful conditions in which it has served him and his colleagues well, and closing his paper remarks that he "thinksit not improbable that codeine, which has almost fallen into disuse as an anodyne, will again come into vogue." I endorse every word of Dr. Brunton's, and venture the belief that we are on the eve of a larger use of codeine, in pain and insom- nia, than the American profession has yet known. I will not weary you with stating the various morbid conditions that codiene will control. Its province is more or less relief of any and every pain, but it is specially adapted, by virtue 4 of its non-tolerant power, to neuralgic disorders which stand so largely and so closely in genetic relation to the abuse of morphine ; and, in gen- eral, to any and all long-continued pain. Even in incurably painful conditions it is often better than morphia, bringing ease without the unpleasant gastric and other sequlse of the latter drug. * The hypnotic action of codiene is also dis- tinct and decided, and may be quite apart from any analgesic need. It is a reliable soporific, though sometimes acting more slowly, yet, without the dullness or headache often sequel- ing morphine. A great gain in using codiene vice morphine as an anodyne and hypnotic is that it lacks that inexplicable influence of the latter-before not- ed-in making itself felt, apart from relief of pain, and so creating a morbid condition, a so- called "craving," that will not be denied. I confess to you, gentlemen, that though I have been studying opium and opium habitues for more than twenty years, I do not fully un- derstand it, but am more and more impressed by this peculiar power with every case that comes under my care. Another point in favor of codiene is the non- need of increasing the dose on long usage. The reverse so often obtains with morphia that 5 it marks one of the distressing features attending habitual use ; growing by what it feeds on, it steadily adds to the hapless lot of those who from force of conditions beyond control, find themselves compelled to mind an imperious power they are helpless to resist. To get good results from codiene it is essen- tial to have it pure. Such is supplied by Merck, of Darmstadt and NewYork. The sulphate and phosphate-the first by mouth, and the other for subcutaneous use-are the most eligible. The latter is freely soluble-more so than morphia, my usual solution being six grains to the drachm. It should be freshly made ; bitter almond water tends to preserve it; I have never noted local harm. The dose required is larger than morphia. Fischer says triple; Bartholow four times. Fischer has written more largely of codeine-de- tailing several years experience-than any other foreign physician, and to him is mainly due my extensive use of the drug. I commend to you his papers in the German medical press of 1888. An initial dose of one-half grain by mouth, or one-quarter to one-half grain by skin is safe, and may be repeated and increased as required. Narceine, though so little used, is a soporific 6 of value. It is not an anodyne. Failure will result if pain be present. The dose should be double that of morphia. The hydrochlor^te -Merck-admits of hypodermic use. Gentlemen, you have my paper. It is a plea for less morphine-more codiene. The usually accepted statement that its anodyne and hyp- notic action is weak and uncertain, is wrong. It has a constant and well marked effect as an analgesic and soporific, without unpleasant secondary symptoms-nausea, headache, and general malaise so common with morphia. I urge you to use it, and especially do I commend it to the junior members of the profession, who too often are enthused with that modern mis- chief-maker, hypodermic morphia, and have not yet gained the wisdom given their fathers, whose experience has led them to discard-in- creasingly often, I am glad to say-a power so potent for ill. I speak feelingly on this subject, gentlemen, for my professional work for many years has brought me in daily contact with those-mostly our own guild-whose lives have been blighted by morphia. The easing of pain ranks next to the saving of life, and when in doing such noble work, we do it without entailing a bondage binding, it may be, for life, the millenium will be nearer than now. 7 THE BROOKLYN HOME FOR HABITUES. OPIUM, CHLORAL, COCAINE. wWiT'W^. j ENLARGED BUILDING. DR. J. B. MATTISON, MEDICAL DIRECTOR, 165 EROOKLTIT A.VEKVE, Between Park and Prospect Places, Brooklyn, THIS HOME, the only one of its kind in the World, offers to either sex a remedial retreat where they may secure release from the enslaving power of narcotics. LOCATION. Delightfully located, mid charming surroundings, in the Eden part of suburban Brooklyn, It combines the comfort and attractions of a city and country home. EQUIPMENT. Steam and water heat, ga» and electric light, solarium, gymnasium, bil- liard room, Turkish and Russian baths, and every appliance which practice has proved of value in the treatment of this disease. TREATMENT. The treatment is original, humane, and effective-Mattison method- presenting the most advanced scientific and common-sense plan. The first stage effects, in proper cases, complete narcotic quitting in ten or twelve days-avoiding the painful ordeal of abrupt disuse, or the tiresome delay of prolonged decrease-and, meantime, by a special employment of bromide of sodium, secures a sedation which counteracts and controls in large degree, the nervous derangement incident to entire withdrawal. The second stage includes sedatives and stimulants-hot baths, electricity, coca, quinine, can- nabis, and such other measures as the conditions of each case may seem to demand. The third stage comprises tonics, soporifics, and full feeding-an essentially roborant regime. DURATION. The usual length of treatment, in simple cases, males, is four weeks. COST. Rates range from $10 to $50 per week according to size and location of apartment-four weeks payment in advance. One-quarter of the Home is free to worthy applicants too poor to pay, whose character and poverty can be vouched for by two reputable medical men. SUCCESS. There are two essentials for success-an earnest desire to recover, and freedom from organic disease. Granting these, patient can be cured. The number of cases is limited, and each case receives the personal, professional care of the Medical Director. Alcoholics are not received, except those who also use opium, chloral or cocaine. ADVANTAGES. Attractive apartments, liberal cuisine, desirable privacy, cheerful society and exclusive professional attention, based on nineteen years' experience in the study of this disease. DIRECTORS. Dr. Chas. Cuthbert Hall, Pastor First Pres. Church, Brooklyn. Dr. R. R. Meredith, Pastor Tompkins Ave. Cong. Church, Brooklyn. Dr. J. O. Wilson. Pastor Simpson M. E. Church, Brooklyn. Dr. Chas. H. Hall, Rector Holy Trinity Church, Brooklyn. Alex. J C. Skene, M. D., Prof. Gynaecology, Long Island College Hospital, Brooklyn. John A. McCorkle, M. D., Prof. Practice of Medicine, Long Island College Hospital, Brooklyn. Lewis S. Pilcher, M. D., Prof. Surgery, New York Post-Graduate School, Brooklyn. Arthur Mathewson, M. D., Prof. Eye and Ear, Long Island College Hospi- tal, Brooklyn John C. Shaw, M. D., Prof. Nervous Diseases, Long Island College Hospi- tal, Brooklyn. T. Caillard Thomas, M. D.. New York. Edw. G. Janeway, M. D., New York. Allen McLane Hamilton, M. D., New York. Geo. F. Shrady, M. D., New York. Mr. Chas. R. Miller, Editor N. Y. Times, New York. Hon. Amos G. Hull, Ex-Pres. Soc. Med. Jurisprudence, New York. Rev. J. N. Hallock, Editor Christian at Work, New York. Gen. C, T. Christensen, Brooklyn. CONSULTANTS. Dr. SKENE, Dr. McCORKLE, Dr. PILCHER, Dr. MATHEWSON, Dr. SHAW. THE MATTISON PRIZE. OPIUM ADDICTION AS RELATED TO RENAL DISEASE. A PRIZE OF FOUR HUNDRED DOLLARS. With the object of advancing scientific study and settling a now mooted question, Dr. J. B. Mattison, of the Brooklyn Home for Habituds, offers a prize of $400 for the best paper on " Opium Addiction as Related to Renal Disease," based upon these queries :• Will the habitual use of opium, in any form, produce organic renal disease ? If so, what lesion is most likely? What is the rationale ? The contest is to be open for two years from Dec. I, 1890, to either sex, and any school or language. The prize paper is to belong to the American Association for the Cure of Inebriety, and be published in a New York medi- cal journal, Brooklyn Medical Journal and Journal of Inebriety. Other papers presented are to be published in some leading medical journal, as their authors may select. All Papers are to be in possession of the Chairman of Award Committee, on or before January 1, 1893 The Committee of Award will consist of Dr. Alfred L. Loomis, Pres. N. Y. Acad, of Medicine, Chairman; Drs. IL F. Formad, Phila.; Ezra H. Wilson, Brooklyn ; Geo. F. Shrady, and Jos. H. Raymond, editor Brooklyn Med. Journal.