While I am constantly talking about the action of single remedies, I have frequently occasion to use combinations. If I have any favorite prescription, it is the one I shall probably publish at least every year that I continue to conduct this journal, because of the smoothness with which it controls general discomfort, distress, and the milder forms of pain without exhibiting the characteristic unpleasant physiological action of any of its constituents.
Dr. Abbott's hyoscine, morphine, and cactin compound, has because of its efficiency as a pain controller, come into sharp popularity. This combination of mine, which I have used for twenty-five years, is made of morphine, hyoscyamus and a stimulant which may be selected according to the condition of the patient. It may be cactus for the heart, xanthoxylum or strychnin for the nervous system, and capsicum as a local stimulant for the stomach.
As this is to be given by the stomach and as morphin does not act properly in the presence of an acid, I always add an alkaline nerve sedative to it. The following is the most common form with me, as meeting most frequently the indications:
|Morphine sulphate||grains 1|
|Strontium bromid||drams 1.5|
|Hyoscyamus sp.||drops 10|
|Tincture of capsicum||drops 10|
|Syrup of orange||ounce 1|
Mix. Sig.: Take a teaspoonful every ten, twenty or thirty minutes until an effect is produced, and then every hour or two as needed.
There seems to be a peculiar efficiency in this combination, that I have never been able to obtain from any other combination of the constituents or in fact from any single remedy, or combination of remedies.
Many patients have an idiosyncrasy, which is opposed to morphin in any dose. At other times, certain conditions of the nervous system or of the stomach cause unpleasant effects to occur from the action of morphin. I have never known a patient to show the least unpleasant results from this combination. It is accepted by the most sensitive stomach.
If there is any one form of pain for which I have found it of superior advantage, it is after surgical operations. In these cases where the patient is exceedingly weak and the circulation is feeble, and vomiting from the anesthetic is almost uncontrollable, the general distress of the patient for the first twenty-four or thirty-six hours is sometimes difficult to describe.
When I have been able to obtain the consent of the surgeon at such a time, I have given this combination with impunity, and have invariably had the blessings of the patient afterwards. It seldom fails to control
the irritability of the stomach, produces quiet and refreshing sleep, and relieves entirely the general distress. We should have some single remedy that would accomplish all these results in a desirable manner, but unfortunately we have not.
This combination, a few drops at a dose, or more according to the age of the child, may be used in many disorders of childhood especially as stated in surgical cases, where distress is constant. In acute disease we are usually able to treat the symptoms specifically, and overcome the pain and distress by single remedies, but in surgical conditions we are sometimes at a loss to meet these conditions. I am confident that others will find this combination as satisfactory as I have found it.
Ellingwood's Therapeutist, Vol. 2, 1908, was edited by Finley Ellingwood M.D.