Coffeinum

Volume I — Special Symptomatology

Pharmacology. — Caffeine may be obtained by treating grc und coffee with benzine, which dissolves out the caffeine and fixed oils. Distill the benzine solution to dryness, and boil the residue in water, dissolving the caffeine, which, on filtering and concentrating, is deposited.

Caffeine crystalizes in white, silky, long needles, which are slightly flexible and transparent, and have a specific gravity of 1.23. Taste weak, but bitter and unpleasant. It is fusible, volatile and soluble in water, alcohol or ether. The Citrate of Caffeine may be substituted for the pure alkaloid.

Officinal Preparation. — Triturations up to the 3 x ; afterwards, alcoholic dilutions.

Head.

• Congestion of blood to the head, with flushed face and nervous excitement.

• Obstinate sleeplessness, especially in children and nervous

women.

It increases the reflex excitability and may produce tetanus.

[The tetanus is considered by most authors a medullary tetanus, for it is not produced in the leg of a frog if the ischiatic nerves are cut; and it takes place in a limb, the circulation of which has been stopped by a ligature, before the subscutaneous injection of caffeine.

It produces at first an increased frequency of the pulse, but a diminution of its bulk takes place very quickly (one minute after the injection), and sometimes determines the immediate death of the heart.

The increased rapidity of the heart-beats, and the rise of arterial pres. sure observed, may be attributed to a paralysis, more or less complete, of the nerves proceeding from the ganglia to the muscles of the heart.

Three grains did not kill a dog in which artificial respiration was produced. One fourth of a grain killed other dogs in the same condition.] (See " Coffea; " and " Therapeutics" Vol. II.)

Volume II — Special Therapeutics

This substance is the alkaloid of the Coffee bean. It is said that a cup of coffee, forming an infusion of 16.75 grams of dry

coffee, contains about 0.1 to 0.12 gram of Caffein; and an infusion of 5 grams of very good tea contains the same quantity of Caffein. The chemists have decreed Caffein and Thein are identical, but we cannot always accept the dictum of the chemist, for two substances may appear chemically identical, yet may possess different physiological properties.

It was once supposed that Caffein represented the principal qualities of tea, coffee, guarana, and some other substances used as beverages by various nations. But it is doubtful if such is the fact, for they all differ in effect, while the action of the Caffein is uniform. It is probable that coffee contains several other constituents in smaller quantities than Caffein, so that Caffein cannot be made a complete substitute for the “ Coffea” which we have used in practice.

Dr. Aubert (“Pfluger’s Archiv ”), who has studied the effects of this substance on the nerves, muscles, respiratory movements, heart, and circulation, says it increases the reflex excitability and may produce tetanus. He considers this “ a medullary tetanus, for it is produced in the frog if the ischiatic nerves are cut, and it takes place in a limb the circulation in which has been stopped by a ligature before the subcutaneous injection into the skin of the back.”

Caffein has been used in the practice of European and English physicians, and also in this country, much as the Guarana (Paulliana) is now used, namely, for nervous and sick headaches.

Its pathogenetic power of causing excessive reflex excitability accounts for the virtues of Coffea, even in high potencies, in the nervous erethism of children and women, and shows that it may homoeopathically prevent the accession of tetanoid spasms during intestinal irritation, or even the irritation of dentition.

It is therefore an analogue of Hux and Ignatia, but antagonistic to Scutellaria, Cypripedium, Calabar, and the Bromides (also Chloral).

But it has other curative powers which may be utilized. It has been found curative in cardialgia, spasmodic asthma, hemicrania, and nervous palpitations.

Coffee-drinkers are notoriously subject to crampy pains in the stomach, palpitation of the heart, and severe headache. A proof

that tea is not identical with coffee, is the fact that after the suspension of the use of coffee, and a resort to tea as a beverage, these symptoms disappear. Tea symptoms subside after substituting coffee.

I have used Caffein a good deal during the last few years, especially in sleeplessness; nervous agitation after excessive pleasurable emotions ; nervousness in teething children, and in women suffering from uterine diseases.

I usually prescribe the 3* trituration, nor have I ever observed any aggravations from it. On the contrary, it generally relieves, when Scutellaria or Ignatia fails. Sometimes Coffea 200 will act better than Caffein. This is probably due to some idiosyncrasy or extreme susceptibility. One of the pathogenetic symptoms of Caffein is “ flushing of the face.” You will find it palliative of that symptom when occurring in women at the climacteric.

The Bromo-hydrate of Caffein exceeds Caffein in some of its sedative effects on the system. I have been pleased with the effects of the 2X trituration, in sleeplessness, especially when there was frequent and watery urine.

Citrate of Caffein as Diuretic in Cardiac Dropsy. — Professor Gubler called attention some time since to the property of the Citrate or the Bromo-hydrate of caffein, given in doses of four to eight grains, in producing abundant and instantaneous diuresis in cases of cardiac dropsy, either when given hypodermically or by the mouth. Dr. Lewis Shapter (“ Practitioner,” January) adds to this his experience with the Citrate alone. The dose given by Dr. S. has not exceeded three grains in any case, on account of the nausea and vomiting produced by larger amounts. This has been sufhcient, however, to establish copious diuresis as a general thing even in the most advanced stages of cardiac dropsy. In one of Dr. S.’s cases a pill of Citrate of caffein, three grains, was given at night. The urine previously passed had been to the amount of a pint to a pint and a half in twenty-four hours. During the first night after taking the pill, and the next morning, the patient, passed two and half pints of urine. Subsequently Citrate of caffein in threegrain doses was ordered in solution with Glycerin and water, and for six weeks, while this was continued, the amount of urine passed during each twenty-four hours amounted to from two to three pints. Other cases are detailed by Dr. Shapter, in which the Citrate of caffein acted equally well. His observations lead him to the opinion that Citrate of caffein occupies a “ special ” place as a therapeutic agent in cardiac disorder, its position being limited as a cardiac diuretic to advanced cases of cardiac disorders, or such advancing cases of cardiac disorders where muscular embarrassment and neurosal incoordinate cardiac action (the indicators of progressive mural decay) exist. The existence of these symptoms appears clinically to forbid the administration of “tonic” doses of Digitalis so long as an outlet has not been effected from the venous system which shall coincidently, with more powerful cardiac contraction, relieve the stagnating pressure of venous blood on the right side of the heart. Citrate of caffein is (1) a diuretic. (2) It increases the heart’s action, either (a) directly by stimulating the organ itself, or (6) indirectly by means of the arteries, which it also excites to further contraction. After discussing its physiological action at some length, Dr. S. concludes that, whatever may be the true theory of the action of Citrate of caffein, the opinion is forced upon him from observation, that in doses of gr. iii to to gr. vi it is a diuretic and cardiac stimulant of great value in cases of cardiac dropsy, where a dilated, feeble, and irregularly contracting heart, undergoing progressive mural decay, is the main clinical and pathological element to be contended against. — “ Philadelphia Medical Times.”

A recent German writer praises the Bromo-hydrate of caffein in doses of jq- and grain (lx and 2* triturations) in dropsy from heart disease, especially when due to dilatation or failure of the circulation from cardiac debility. It seems to act better than the simple Caffein or the Citrate.