Cinchona is certainly a wonderful drug, wonderful in the many varieties of its species, wonderful in its composition and wonderful in its effects. It also has an historical value to homeopathists as being the drug which led Hahnemann to the discovery of THE law of cure, and enabled him to establish homeopathy as a fixed science. It is not a little singular that the natives of Peru, especially in the early days, would not permit the Cinchona tree to be touched, as they believed it to be poisonous and under the charge of special gods. They were therefore not a little astonished when Europeans became engaged in the occupation of stripping the bark from the trees and exporting it to Europe. The Cinchona industry has now grown to such an enormous extent as to demand certain restrictions in its gathering and exportation lest the species become extinct. New trees are being continually planted, so that there is no danger of extermination of the drug.
There are several varieties of the Cinchona bark of which, however, I can mention but three, namely, the pale bark, the Calisaya or yellow bark and lastly the red bark, or Cinchona rubra. There are some thirty or forty other species known.
A physician in the West, the value of whose experiments I am in clined to doubt, claims to have discovered in Cinchona rubra a certain specific against intemperance, or the thirst for liquor. He gives the bark in appreciable doses and claims that in a time varying from one to four weeks it will cure the most confirmed inebriate of his pernicious appetite.
. In publishing the accounts of his observations in the journals, he says that he was led to his discovery on treating an " old sot" who had never'known a sober day until he had chills and fever, which was cured by red bark.
Cinchona contains, as you will notice by this schedule on the board, quite a number of alkaloids or active principles:
Cinchonine, C20H21N2O. Cinchonidine. Quinine, C20H24N2O2. Quinidine.
Quinamine, C20H26N2O2. Quinic acid. Cincho-tannic acid.
Besides these there are many others. They differ from each other in chemical composition only in the amounts of carbon, hydrogen, nitrogen and oxygen they contain.
It now remains for us to study the general effects of Cinchona before we proceed with our consideration of its symptomatology.
It has been determined that a solution of Quinine of one part to ten thousand acts destructively on infusoria. Thus it will destroy the poisons that propagate many of the contagious" diseases, as puerperal fever, scarlatina, etc. The use you may make of this property is this: When going from one case of puerperal disease to another, you may bathe your hair and whiskers in a solution of Quinine in bay-rum. This will destroy all danger of carrying contagion and will not prove a source of annoyance to yourselves. On the contrary, it will aid the growth of the hair and beard.
Quinine also has a destructive effect on amoeboid motion, which form of motion has been observed in the white corpuscles of the blood, or leucocytes. This is one reason why allopathic physicians have used it to prevent inflammation. Quinine also retards change of tissue. That is one explanation of its tonic effect. You will see that this property of retarding waste is still more marked in COFFEA.
Quinine also acts upon the heart substance, weakening that structure. Thus there is impaired circulation.
Another effect of Quinine when experimented with by subcutaneous injections is that large quantities destroy the ozonizing powers of the blood.
It also tends to act on the spleen, producing congestion, inflammation and enlargement of that viscus.
There is still one other property 6f Quinine which it may be well to remember, and that is its power of abolishing reflex action when taken in large quantities.
Now let me give you the symptoms of cinchonism, that is, the symptoms which follow the excessive use of Cinchona. You will find quite prominent among all the other symptoms an increase of appetite from stimulation of digestion. Soon nausea and vomiting show themselves and even diarrhoea may be added to the gastric disturbances. Then the head becomes affected. There is a peculiar sensitiveness to external impressions, to noises, to bright lights or to anything that is apt to render the patient irritable. There is experienced a peculiar form of headache, which is characterized by dull aching and at other times by throbbing in the head. There are well-marked ringing or roaring sounds in the ears, a very characteristic effect of Cinchona. Vertigo still further complicates the case. If the use of the drug is still persisted in, deafness follows.
In other cases there appears a sort of Cinchona intoxication which is not unlike that produced by alcohol. This is followed by delirium, dilated pupils, then complete stupor with difficult respiration and finally convulsions, these convulsions arising from anaemia of the nerve centres and not from congestion as is the case with Belladonna. In extreme cases, collapse and death from paralysis of the heart end the patient's life. These, then, are the general effects of Cinchona, when that drug is given persistently in increasing doses and at short intervals. They may vary in severity from a simple ringing in the ears to all the symptoms of complete poisoning.
Hahnemann has taught us that the anaemia which the Cinchona causes renders it useful only when debility or anaemia comes from loss of fluids. In the allopathic school it is used in all forms of debility, given either alone Or in combination with iron or sherry wine. But, as I have said before, we have learned from Hahnemann that it is only useful in the anaemia which results from, loss of fluids. Hence, we may use it for the results of haemorrhage, whether it be from the mouth, lungs, or uterus. You may use it when long-lasting diarrhoea has exhausted the patient. It may even be used when the condition has proceeded further than a simple debility, and that horrible disease known as hydrocephaloid has developed.
In such cases, when Cinchona is the remedy, the child has these symptoms: After violent or long-lasting cholera infantum, it becomes drowsy, the pupils may be quite large, the breathing is very rapid and superficia); the diarrhoea may have ceased, or the movements may be involuntary; the surface of the body is rather cool, especially the prominent features about the face; thus, the ears, nose, and chin are cold. In just such cases as this, Cinchona will, if there is any vitality remaining, restore the patient to health.
If it should fail, you may still fall back on CALCAREA PHOSPHORICA, a similar but more deeply-acting drug.
In applying Cinchona to the debility resulting from sexual excesses, remember that it is only curative for the debility resulting from the excessive loss of semen. If there are constitutional troubles ft is worse than useless.
Now let us pause and study the relation which Cinchona bears to other drugs applicable to debilitated and anaemic conditions.
FEFFUM is indicated in pure anaemia, with an appearance of plethora.
ARSENICUM is the remedy for debility resulting from overtaxing of the muscular tissues, such as follows prolonged exertion, climbing mountains, etc.
PHOSPHORUS is preferably indicated in prostration which is very sudden in its onset, when the nervous system is exhausted. Hence, we may sometimes have to use this drug in quite a variety of diseases, in scarlatina, in measles, in diphtheria, and, in fact, in any disease in which the nervous system seems to have sustained a sudden shock or blow. This is not a Cinchona case, remember.
PHOSPHORIC ACID is somewhat different from Phosphorus again. It is to be thought of in debility of nervous origin, when it is not connected with any pain except, perhaps, a simple burning in the spine or in the limbs. The mind is rather apathetic, and the patient is inclined to be drowsy and sleepy. The characteristic of this sleepiness is that he is easily aroused from it and is wide awake.
ZINCUM is good when the brain becomes affected in the course of nervous diseases, scarlatina, or summer complaint of infants. Especially is it useful in scarlatina when the child has not sufficient strength to develop an eruption.
You may use Cinchona for haemorrhages, and here you can scarcely do without the drug. The haemorrhage may come from any orifice of the body; the blood is apt to be dark and clotted; the flow is so profuse as to have almost produced exsanguification of the body; there is coldness of the face, in fact, of the whole body, and the features are collapsed; there is gasping for breath; the patient demands to be fanned. Now, this fanning is desired, not for the purpose of cooling the patient, but is called for because of the instinctive demand for more oxygen, which the fanning produces by changing the strata of air inhaled. Cinchona is frequently called for in ante- and post-partum haemorrhages; in such cases you do not give it in a single dose, but repeatedly at short intervals until the consequences of the haemorrhage have been removed.
There is another condition in which I would recommend Cinchona, and that is, when retained placenta is attended by haemorrhage. PULSATILLA does no good. I know that it has been recommended in these cases to take away the after-birth by manual interference, but it has been my practice to administer Cinchona until the tonicity of the uterus is restored and then remove the placenta.
The nearest remedy to Cinchona in these symptoms is IPECACUANHA, which is useful when there is profuse bright red flow of blood, usually accompanied by nausea, and sometimes by very hard, labored breathing.
Sometimes there is coldness of the surface of the skin, which is covered with cold sweat. It is one of our best remedies in the haemoptysis of incipient phthisis.
BELLADONNA is useful when the haemorrhage is of bright blood, coagulating rapidly, and feeling hot to the parts over which it flows.
TRILLIUM controls haemorrhage when the flow is either bright red or dark, and occurs in women who flood after every labor.
MILLEFOLIUM is suited for a profuse, bright red flow; it is much like Aconite, but it lacks the restlessness and anxiety of that remedy.
SABINA is to be used when the flow is bright red, and is attended with pain extending from the pubes through to the sacrum.
CARBO VEGETABILIS is to be given when there is a continuous passive haemorrhage. The patient wants to be fanned. The skin is cool and bluish, and the pulse rapid and weak.
SECALE is said to be best adapted to thin scrawny women. The flow of blood is passive; it is attended with tingling in the limbs. Although the surface of the body is cold, the patient persistently expresses her desire to be uncovered.
ERIGERON is said to be useful in profuse haemorrhage similar to that of Sabina, but associated with irritation of the bladder and rectum.
HAMAMELIS is suited to passive venous haemorrhages, especially jvhen the part from which the flow of blood proceeds feels sore and bruised.
ACALYPHA INDICA is useful in haemoptysis after fits of dry coughing.
You may also compare LEDUM, VINCA MINOR, and CINNAMOMUM.
After reaction has been established after haemorrhage, you may still give Cinchona if there is headache with violent throbbing of the carotid arteries. This is not a Belladonna symptom. It is here an indication of anaemia, whereas under Belladonna this symptom is indicative of hyperaemia.
You may have to use Cinchona to cure asthenopia, but only when it occurs as the result of haemorrhage or loss of fluids. An examination with the ophthalmoscope shows the disk to be pale and anaemic. The pupils are apt to be dilated; the eyes ache on attempting to use them, as in reading or writing, and objects blur.
We now come to the study of the action of Cinchona on the digestive organs. It is very useful for dyspepsia, occurring especially after loss of fluids. Digestion is so weak that the stomach cannot tolerate any food at all. Should the patient's supper come to him later than usual, he is sure to suffer in consequence. The stomach is distended with flatus but fetching relieves only momentarily. The least food or drink taken
increases this symptom, so that he feels full after taking but a small quantity, as though he had eaten an enormous meal. He complains often after eating of a sensation as of a lump in mid-sternum, as though food were lying there. This is situated higher up than is the "hard-boiled egg" sensation of ABIES NIGRA. PULSATILLA also has the same sensation in the same locality.
You may also use Cinchona in the gastric troubles of children who are continually asking for dainties. Substantial kinds of food they will not touch. On awaking in the morning they are cross and irritable. They have a bad taste in the mouth and a white-coated tongue.
Cinchona is useful in some diseases of the bowels, especially when associated with marked tympany. The abdomen is enormously distended ; when you percuss it, it gives forth a sound almost like that from striking the tense head of a drum. It is particularly when this tympany occurs early in the disease that Cinchona does good; then this symptom shows early debility. Later in the course of the disease, when it results from decomposition, Cinchona is less valuable, and you must resort to such remedies as TEREBINTHINA, COLCHICUM, etc.
The diarrhoea of Cinchona is very characteristic. The stool is lienteric in character. It is either worse at night or after eating. This is attended with rapid exhaustion and emaciation. In appearance, the stools may be yellow, watery, or brown, and very offensive. Cinchona is one of our best, remedies for diarrhoea occurring in hot weather after eating fruits.
The nearest allies to the drug here are FERRUM, ARSENICUM, PHOSPHORIC ACID, OLEANDER, IRIS VERSICOLOR, and PODOPHYLLUM.
ARSENICUM and FERRUM both have profuse lienteric diarrhoea, coming on during or after eating.
PHOSPHORIC ACID differs from Cinchona in that, while the stools are frequent and copious, they are not attended with much debility.
IRIS VERSICOLOR is indicated in summer diarrhoea. The stools are copious and are associated with vomiting. The patient is worse at about two Or three o'clock in the morning. It differs from VERATRUM ALBUM in the absence of coldness.
PODOPHYLLUM is to be used for profuse gushing diarrhoea, coming on in the morning, or more during the day than at night. The stools may contain undigested food and often, in children, deposit a mealy sediment.
The OLEANDER diarrhoea is also lienteric. The patient passes in his stool the food which he had eaten the day before.
Cinchona, as you all know, is a valuable remedy in the treatment of chills and fever, particularly for that form of intermittent fever which arises from marsh miasm. It is useful either in fevers of the tertian or of the quartan type. The chill and heat are usually unaccompanied by thirst, but there is thirst either before or after the. chill. During the chill the patient sits as near as possible to the fire or wraps himself up warmly in blankets; but the WARMTH THUS OBTAINED DOES HIM NO GOOD. The chill is followed by long-lasting heat, during which the patient desires to uncover. He is then usually without thirst. His face is fiery red, and he is often delirious. The sweat which follows is profuse and debilitating. The apyrexia is by no means free from symptoms. The face is sallow, dingy-yellow, from bilious complications, the spleen is enlarged, and there are aching sore feeling in the splenic region, and total loss of appetite or canine hunger. The feet become oedematous often from disturbance in the composition of the blood, but mostly from interference in the hepatic and splenic circulations. Sleep is greatly disturbed, and the patient, so soon as he closes his eyes, sees figures, etc., before him.
The SULPHATE OF QUININE has these same symptoms, with this in addition, the chills recur with clock-like regularity. But both drugs may be indicated in an anteponing type of fever. Cinchona and its preparations have been so much abused in the treatment of intermittent fever that it is necessary to carefully differentiate them from their concordant remedies.
First of all CORNUS FLORIDA. This has sleepiness long before the chill; the patient feels chilly, but is warm to the touch; the heat is associated with drowsiness, and is followed by profuse sweat.
MENYANTHES is excellent when the chill predominates, with icy coldness of the tips of the fingers; in fact, all peripheral parts of the body get cold.
In CAPSICUM the chill begins in the back, with thirst. The patient feels better from heat applied to the back and from wrapping up, just as under Ignatia.
EUPATORIUM PERFOLIATUM is useful when the chill comes in the morning, or in the morning of one day and the afternoon of the next; but usually, however, at nine o'clock in the morning. The chill is often preceded by thirst and bitter vomiting. The drinking of water makes the patient chilly. The fever is usually followed by very slight sweat.
LACHESIS may be used after the abuse of Quinine, when the chills return in the spring.
EUCALYPTUS is a remedy which has been highly recommended in malarial fevers, but I must say to you that I know little or nothing about it.
IPECACUANHA is useful in intermittent fever when the type has been spoiled by Quinine. You can obtain no clearly defined picture of the case. Everything is confused. Ipecacuanha seems to have the property of developing the symptoms and of curing the case, or it provides you with sufficient data to enable you to select the appropriate remedy. The characteristic symptom of Ipecacuanha during the paroxysm is short chill, followed by long fever. Usually we find gastric symptoms, with a preponderance of nausea. Another remedy which maybe utilized for the removal of the bad effects of Quinine is ARSENICUM. It is called for when the paroxysms occur more or less periodically. Thirst is great. The spleen is swollen. Dropsical symptoms appear. Paroxysms of neuralgia appear in the face, and recur quite regularly. Arsenicum may be indicated when almost any form of disease assumes the malarial type. In these cases you will find the ordinary remedies of no value whatever.
Still another remedy in severe cases is CARBO VEG. This is especially of service after the abuse of Quinine, when there is thirst during the chill; when the body is icy-cold, and especially is this coldness noticed from the knees down; and when there is lack of reaction. You will be surprised to see how nicely an apparently hopeless case will rally under one or the other of these remedies.
There is a constitution developed by the marsh miasm for which it is necessary to use deeply acting remedies. Foremost among these stands ARANEA DIADEMA. This drug is suited to persons who may not have any distinct type of fever, but who suffer at every cold or damp change in the weather. The symptoms seem to be ill-defined. At one time they feel dyspeptic, at another they ache all over; but in all cases the constitutional taint is at the bottom of the whole trouble. Aranea diadema will so change the type of constitution that the patient will escape any further injury when exposed to dampness.
In some cases you will have to use FERRUM as an antidote to Quinine, especially when we have the masked anaemia peculiar to this drug. The face is easily flushed, and the bloodvessels throb. The spleen is enlarged, and dropsical symptoms are manifested mostly about the feet.
Cinchona, to return to that drug, is. also of essential service in the treatment of hectic types of fever, such types of fever as indicate a long-lasting suppurative process. The surgeon is called upon to employ this drug very frequently when, after emptying an abscess, symptoms of hectic fever develop. The cheeks are red. The patient is excessively nervous, the nervous irritability being greatly disproportionate to the patient's strength. He is so greatly prostrated by the fever that he can scarcely raise his head. Diarrhoea adds to his weakness. Copious night-sweats also exhaust him. Along with Cinchona in this connection, you must place in your mind its analogues, which are chiefly ARSENICUM and CARBO VEG. You will often meet with a severe case in which Cinchona runs its course, and no longer produces improvement. You will then have to select Arsenicum or Carbo veg., according to the symptoms of the case.
CARBO VEG., as well as Cinchona, is to be remembered as a remedy to prevent collapse, which follows the opening of a cold abscess, such as occurs in spinal caries. The symptoms of the two remedies are almost identical, and your choice between them may be difficult unless you find other symptoms in the case pointing distinctly to one or the other drug.
Another form of suppurative trouble in which you may use Cinchona, is in suppuration of the lungs, particularly in drunkards, when the trouble is associated with hectic fever.
You may also be called upon to use Cinchona in disorganized states, either of the external tissues or of the lung substance; in the case of the latter being indicated by the hectic symptoms and by the foetid breath. Here Cinchona vies with ARSENICUM, SECALE, and LACHESIS.
Do not confound the fcetid breath just mentioned with that arising from certain forms of bronchitis, in which the sputum is retained a long time and undergoes decomposition in the lungs. While the patient is breathing quietly you can notice no extraordinary odor. As soon as he gives a deep cough the breath becomes horribly offensive. This kind of cough calls for CAPSICUM, and, perhaps next in importance, for SANGUINARIA CANADENSIS.
You will find Cinchona often indicated in inflammatory rheumatism, not in the beginning of the disease, but later when the fever has become intermittent in its. character. The joints still remain swollen. The characteristic pains in these cases are jerking and pressing. The patient will not permit you to approach, crying out with pain if you touch the affected parts, so exquisitely sensitive is the surface.
Cinchona is also a neuralgic remedy. It is especially suited to neuralgia of the infraorbital nerve on either side when the symptoms are typical in their return, and when the slightest touch or draught of cold air makes the patient worse. If the neuralgia is of malarial origin Cinchona is increasingly indicated.
You may here compare CEDRON, which is applicable to malarial neuralgia, usually supraorbital, when the attacks return with clock-like regularity.
In jaundice you should use Cinchona when the surface of the body and the sclerotica are yellowish. The liver is swollen and sensitive to the touch, and there is a feeling in the right hypochondrium as of subcutaneous ulceration. The stools are whitish, and are accompanied by foetid flatus, or else there is diarrhoea. It is especially indicated in jaundice arising from sexual excesses, from loss of animal fluids, from abuse of alcohol, and from gastro-duodenal catarrh.
The antidotes to Cinchona are ARSENICUM, IPECAC., CARBO VEG., LACHESIS, PULSATILLA, FERRUM, and VERATRUM ALBUM. The indications for most of these have already been given you.