Cinchoninum sulphuricum

Volume II — Main text

Cinchoninum.-An alkaloid of china, commonly used as a sulphate (C20H24N2O. SH₂O, × 4H2O), in which form it was employed in these provings, &c. I. Provings. after-moderate 1. Mrs. M-, æt. took 48, well, except16th thatinshe e. was 1 gr.subject 1 h. to perspiration profuse exertion, on July after first dose she had eructations, rumbling in abdomen at n. and till next m. The following d. ebullition to and heat of head.- 18th, e., 2 gr. The same symptoms, and also roaring in ears at n., frontal pain pressing down to eyes, aggravated by movement andwhen walking, heat in head, especially around eyes, sleepy feeling in eyes, so that the lids constantly closed.- 19th. Constant heartburn, eructation of air, rumbling in abdomen, tearing in back towards r. shoulder ; pains and tension in nape on moving it, weariness and drowsiness, dreamful sleep at n., and starting up from sleep in affright.- 20th. Quite well ; she was never afterwards troubled with the perspirations. (NOACK'S Proving, Hygea, xvi , 152.) 2. JULIANA PIERTSCH, lady's-maid, suffered for some time from oppression of chest and pressive pain beneath middle of sternum, dyspnea, disposition to shed * " Although Ch. possesses the power to stop the movements of the colourless globules, yet this action perhaps can only be obtained on the slide of the microscope, On injecting into the blood doses which cause the death of the animals, Ch. has no influence on the colourless blood-corpuscles " (GELTOWSKY, Pract., viii, 334). Schwalbe has obtained similar results . + " Drs. Culler and Bradford find that Ch. diminishes the red and increases relatively the quantity of the white corpuscles of the blood " (RINGER).

tears, tendency to constipation.-July 15th, e., I gr. Next m. eructation of air, rumbling in bowels, distension of abdomen, discharge of flatus; feeling of agility of limbs and unusual good health. Afternoon, frontal headache and pressure on eyes ; 2 soft stools; great urging to urinate, ushered in by pain from both sides of abdomen tohypogastrium; passed frequently large quantities of urine,when the pain gradually declined, and at length disappeared. The urine had a copious, white, flaky sediment. -17th, e., 2 gr. Next m. the symptoms were the same as before, except that she felt fatigued and bruised in all her limbs.- 19th. No more symptoms. (Ibid., 154.) 3. WILHELMINE DIETZ, a healthy girl, æt. 19. a. Took on July 24th and 27th , m. , 2 gr.- 24th. Frequent stitches in the sides, first one side, then the other, aggravated by movement. The 2nd, 3rd, and 4th d., the pains went off, but returned on the 5th d. From this d. (28th) the shooting pains extended all along back, but were especially located between scapule. The 1st d. (24th) 2 stools and 3 micturitions; 2nd d., 1 stool, 4 micturitions ; 3rd d., 2 soft stools, 7 micturitions ; 4th d., 4 soft stools, 3 micturitions. From 5th d. had daily 1 stool, 3 and 4 micturitions. Every m. headache all over head, with singing tinnitus aurium, great thirst (especially 6th and 7th d.), heat in mouth, at first anorexia, from 7th d. great appetite, frequent eructation, distended abdomen, great borborygmus, loose fatiguing cough, shaking the head, with pressive pain under sternum (since 5th d.), and hoarseness (since 6th d.), with feeling as if the throat had been burned with hot drinks, and as if something stuck in glottis ; always great heat and perspiration, especially at n.; trembling of limbs and weakness. On 9th d. (Aug. 1) she looked pale and hollow-eyed. b. Aug. 1st, e., 2 gr. The shooting pains, which had ceased for a d., did not return till 5th, but from that to 8th they were present. They seem to come from the back, thence involving hypochondria, relieved by standing and sitting, recurring when lying and coughing; loose cough with mucous expectoration coming from deep down on chest ; hoarseness, which has lasted since the 6th d. of first proving. Loses breath when walking quickly. The heat and burnt feeling of mouth and throat continued.- 7th. Headache involving whole head, brought on by stooping, with stupid feeling.-8th. Headache gone; on looking closely at anything, all becomes black before eyes ; tongue has a thin coating of mucus in its centre ; head always hot and dry ; about noon, pulse 65, small, weak, slow. Menses have come on I week too soon, and are scanty.- roth. Stitches in side occasionally, none yesterday, but instead some frontal headache and stupid feeling. Still loses breath when walking quickly; feeling of heat in mouth, roughness and scrapy feeling in throat ; hoarseness returns when she gets overheated.- 12th. Well. (Ibid. , 155.) 4. WILHELMINE WALTHER, housemaid, æt. 17.-Aug. 7th, 7 p.m., 2 gr.- 8th, m., nausea, lasting all d., retching, eructation of air, flow of saliva, especially a.m., little appetite; p.m., thirst and copious micturition of clear urine ; e., hard, scanty stool. 10 a.m. till noon, rigor, confusion of head, pressure in eyes. 6 p.m. , vertigo. Great weariness in feet all d. 10 p.m., pulse quick, soft.-9th. After a restless n. , broken by frequent waking, in m. soft stool ; a.m., pain in back between shoulders ; pressive pain in scrob. cordis and hepatic region; p.m., nausea, frequent sour eructations, noise in ears ; urine greatly increased.-10th. The 2 first dorsal vertebræ painful when pressed; from m. onwards a tearing and griping pain in 1. side of hypogastrium all d.-11th. The pain in bowels continued; great dryness and roughness in throat. Noon, before dinner, transient nausea and inclination to vomit; p.m., when walking in open air headache with vertigo and great thirst. From this time the symptoms almost ceased, except occasional confusion of head.-22nd. Chilliness as though soused with cold water, headache, backache and bellyache. In m. 2 diarrheic stools.-23rd. Bellyache continues.-24th. Still pain in belly, whirling in head, anorexia, hard, painful stool. In forenoon took 2 gr. P.m., violent frontal pain ; e., chill ; n., restless dreamful sleep. (Ibid., 157.) 5. LAURANTIUS FRITZ, nurse in surgical cases , æt. 25. a. Oct. 20th, 10 p.m., 1 gr.-21st. All d. much thirst, griping in umbilical region and discharge of much fetid flatus; constipation; restless sleep.-22nd, 9 a.m., 4gr. Soon nausea, eructation and discharge offlatus. This continued the next 2 d.-24th, e., 6 gr. Soon nausea and at n. general soreness of body.- 25th. On waking, headache as if the head would burst, especially in occiput, with ringing in ears ; thick yellow fur on root of tongue, with clean moist borders ; hunger without appetite, distension of abdomen after

eating; cutting in upper part ofbelly more towards r. side, lasting all d.; rumbling in bowels, constipation ; increased discharge of urine with burning sensation in urethra; pricking pains in throat when swallowing as with fine needles ; whistling respiration, tightness of chest, feeling as ifthorax were quite hollow ; all d. chilliness and chattering of teeth ; great weariness, so that the feet can hardly be dragged along, making him go to bed in afternoon; the limbs go to sleep in every position. 10 p.m., heat in forehead, speading thence all over head ; profuse sweat and thirst at n., sacral pains ;; soreness of whole body, body, especially of eyes, ears, and genitals. -26th. Yesterday's symptoms continue; especially troublesome were, roaring in ears, thirst, eructation, great exhaustion, trembling of limbs; e., chilliness, dry heat, and at n. sweetish, unhealthy-smelling perspiration; urine deposited white sediment.-28th. The same symptoms having continued on 27th, he had to-day throbbing 1. sided headache, aggravated by stooping, trembling of limbs and great muscular weakness. -29th and 30th. Confusion of head, m., with vertigo, worse on stooping ; great appetite. The last 8 d. the hair fell out much. After 2 d. the headache was not quite gone. b. Nov. 7th, 10 p.m., 12 grs. Immediately great nausea; much thirst and perspiration, and restless sleep at n.-8th. On rising violent frontal headache, spreading to occiput, lasting till noon, then ceasing for 2 h., and returning till bedtime. At same time heat in head, ringing in ears, eructation, loose stool ; noon, slight stitches in chest, more on r. side, into scrob, cordis at front of insertion of diaphragm ; eyes felt deeply sunk; dimness of vision.-9th. Pale, unhealthy complexion ; bluish-grey rings round eyes, frontal headache till e., thirst, exhaustion, drowsiness, trembling, increased secretion of urine ; profuse sweat at n.- 10th. Violent headache.- 11th. Headache, very fetid flatus, rumbling inbowels. No more symptoms except general exhaustion for a long time. (Ibid. , 159.) 6. Dr. OTTO PIPER.-Feb. 7th, 10 p.m., 8 gr. Bitter taste for a few m., followed by a flat, sweetish taste. Then for h. some scraping in larynx.-8th, m ., face round eyes very swollen, felt when opening eyes. P.m., sudden epistaxis while seated, the blood very thin and bright red. The urine passed in m, deposited after 24 h. a slimy sediment of brownish-green colour, and it had a putrid smell. The urine passed during d. was darker, and the sediment was brickdust colour. The urine passed was scantier.-9th. Urine the same as yesterday, only it did not deposit any sediment. The m. urine had a brownish-green colour and a slimy sediment, and from 11th deposited a thin red crust. From 13th the normal state returned. (Ibid., 162.) 7. BIRKNER, medical student, æt. 23, healthy except a disposition to constipation. -February 26th, 8 a.m., 4 gr. Pulse before taking dose 56, 2 h. later 70, after dinner 84 ; 10 p.m.,54; no stool. Passed urine 4 times, twice it had a sediment ; it was acid. to a.m., pressure in gastric region, and also at 7 p.m., but then it was more on 1. side.- 27th, m. , pulse 54, noon 82, e. 60. 10 a.m. , slow stool. Passed urine 4 times, once (m.) with sediment.-28th, 7 a.m., in bed, chilliness, cutting in bowels, discharge of flatus. 8 a.m., copious loose stool. All a.m., cutting and rumbling in bowels ; occasional pulsation in gastric region and chilliness, especially in scrob . cordis. 11 a.m., a second diarrheic stool. Passed urine 5 times, 3 times it showed a sediment. Pulse, m. 56 ; 2 p.m., 75 ; 9 p.m., 64.-March 1st. No stool. Passed urine 5 times, twice with sediment. Pulse, m. 52, noon 78 , e. 54.-2nd. Urine passed 6 times, once with sediment, constipation. Pulse, m. 54, noon 80, e. 62.-3rd., 8 a.m., 8 gr. Pulse, m. 55, later 68, after dinner 88, at 10 p.m., 68 . Soon after taking dose, chilliness, which recurred in forenoon several times. IO a.m. , soft stool; confusion of head with feeling as if brain had increased in size. At same time cutting in bowels, feeling of fulness of abdomen and pain in scrob. cordis, increased by pressure, oppression of chest and rapid breathing. 11 a.m. , head free, but pain returned at 3 p.m., changed into heaviness of head, and was worst in e., when it became pressive pain in occiput and on region of coronal suture. The fulness ofabdomen, the cutting and rumbling in bowels, and the pain in scrob. cordis, lasted all d. Eructations, discharge of flatus. 9 p.m., great heat all over body, with great turgescence ofveins; great weariness made him go early to bed.-4th. Restless sleep atn. 9 a.m., confusion of head, lasting till noon. 4 p.m., constant heat of head with cold extremities, worst at 6 p.m., with general burning heat and dryness of skin. Much flatulence discharged up anddown. 9 p.m., along with heat ofhead, confusion,

pressive pain in head, and a kind of dazedness. No inclination for work, thoughts lost. Pulse, m. 56, noon 80, e. 72. Urine with a sediment.-5th. Restless, bad sleep. On waking, headache, especially in occiput, relieved by rising. ing. Pulse, m. 54, noon 78 , e. 58 , rather irregular. Urine had a sediment only m.-6th. Pulse, m. 54, noon 76, e. 54. Slight sediment in urine.-7th. Pulse, m. 53, noon 72, e. 54. Sediment in urine, m. Stool normal. (Ibid., 162.) 8. R. H. GEYER, medical student, æt. 24. a. April 3rd, 9.30 p.m., 2 gr.-4th , m. , anorexia, full feeling in stomach, eructations with taste of rotten eggs, great exhaustion. After dinner painful full feeling and pressure in stomach for some h. Sleep disturbed by disagreeable dreams.- 5th, 10 a.m., painful stiffness of nape. 10 p.m. , tearing in stomach.-6th. Last n. woke by pains under sternum; the lower part of sternum seemed drawn or pressed inwards.-7th, afternoon,great prostration and languor ; constant pressive pain in sternum . b. April 20th, 9 p.m. , 4 gr. At n. sweat betwixt scapulæ, later itching there.- 21st. Great weariness with much yawning and stretching of limbs. Next n. sweat. -22nd. Much eye-gum had accumulated during n. After dinner great weariness and constant pandiculation; very little appetite, easily satiated.-23rd, m., great weariness ; bruised pain at insertion of deltoids; frequent intolerable twitching and creeping at mouth of anus, removed by scratching; tightness of chest, as though ribs were contracted anteriorly ; stool loose, thin in shape, passes slowly with pressing ; the sphincter ani is very lax as if paralysed; rectum contracted, as shown not only by the thin shape of the excrements, but by a peculiar indescribable sensation during stool.- 24th. Burning in stomach and lower part of œsophagus ; frequent pressure inthe scrob. cordis. - 25th. Continued pain across hypogastrium as from incarcerated flatulence at 10 a.m. Noon, pressure in stomach ; e., bruised feeling in sacrum.- 26th. In m. in bed stitches in cartilages of 1. 5th and 6th ribs for h.; occasionally repeated throbbing pain in r. half of forehead ; great weariness all d.- 27th. Nightmare at n.; soon afterwards lascivious dreams and painful erections. Afternoon, great sexual excitement and erections ; painful tension across chest.-28th. At n. tiresome dreams ; pain in anterior hemispheres of brain as though a net were drawn through the cerebral substance ofthat part ; bruised pain at insertion of deltoids, the shoulders can hardly bear the coat; perspiration on forehead after moderate exercise in cool weather ; involuntary jerking motion of 1. 2nd and 3rd fingers ; in r. hand spasmodic pain here and there, without moving hand or fingers.-29th. Pressive pain on head as though a great weight pressed the parietal bones against brain ; pressive pain in forehead and under sternum.-May 1st. After constipation for several days astool of firm and large fæces ; the sphincter ani very strong, at same time an obtuse cutting pain in anus, and thence forward to navel, as also fine pricks in scrob. cordis. The first d. there was great weariness, which in the first 5 days was intolerable, incessant yawning and stretching ; appetite constantly very bad, often soup alone caused satiety and fulness of stomach ; discharge of wind upwards and downwards. -5th. Peculiar sensitiveness and feeling of tension of scalp, soreness of roots of hair, as though matter were under scalp, chiefly on r. side. June 1st. He still complained ofdrawing in arms and pain in bones of extremities. (Ibid., 167.) 9. Dr. A. NOACK. a. Oct. 22nd, 9 a.m., 4 gr. Taste at first bitter, changing into sweetish, something like alum. Pulse at first 85, after h. 75, at 8 p.m. 65. Forenoon, slight rumbling in bowels from flatulence, painful tension ofgastric region ; nausea for several h. after dinner; 2 p.m., copious stool, at first consistent, afterwards diarrhæic ; great secretion of urine ; e., great lassitude in thighs.-23rd, 5 a.m., pulse 66, 10 a.m. 70, 9 p.m. 60, pulse in m. weak and small.- 24th. In m. in bed cutting in middle ofbelly, later spreading to upper part of belly and lasting 2 h.; thirst all d. Urine copious, very acid, with a glittering scum; pulse small and weak. 10

p.m., urging to stool, and soft stool passed with difficulty. At n. tension of abdomen, cutting-drawing in abdomen and urging to urinate, relieved by passing a large quantity of urine as clear as water.-25th. In m. in bed great exhaustion. Copious secretion of urine, which was quite watery, but soon became turbid and deposited a fine reddish-yellow sediment. No stool.- 26th. Much watery urine ; no stool.- 27th. Copious light yellow urine ; large stool. b. July 16th, 11 p.m., 10 gr. After a quiet, sound, dreamless sleep, lasting longer than usual, felt unrefreshed on waking ; back (especially between scapulæ), ribs, arms and legs as if bruised; slight griping and rumbling in bowels for 1 h.,

abdomen tense, full, heavy; tongue covered with a thin coating of saliva ; taste pappy; hawking of a quantity of very viscid mucus ; chest felt hollow, so that breathing was peculiarly easy; skin dry, its veins prominent. to am., copious stool ofdark greenish-brown colour and ordinary consistence,but of such large size that the anus was painful from its passage; after dinner, feeling of heaviness in abdomen as if a stone lay there, lasted all afternoon. All d. abdomen tense, some very fetid flatus passed. Urine very dark m., less so afternoon, copious, acid. Confusion of head, some frontal headache, especially on r. side, lasting all afternoon. Pulse in m. small, weak and compressible, afternoon larger and undulating; 7 a.m., 66 ; 10 a.m., 86 ; 3 p.m., 75 ; 9 p.m., 75.-18th. Increased secretion of urine, dark coloured. (Ibid., 170.) 10. Rust says it causes heat in epigastrium, quick pulse, slight perspiration. Larger doses cause greater heat of stomach, dryness in mouth and fauces, thirst ; dry tongue, with yellow fur, burning in throat, eructation, flatulence, constipation, warm skin and turbid urine. ( Rust's Mag., xii, H. 3.) 11. BERAUDI says 15 to 20 gr. cause increased saliva, nausea, pains in bowels, sometimes diarrhea, quick pulse, dimness of vision, noise in ears, headache, weight inhead and rush ofblood to head. (Omodei's Annali Univ. di Med., Nov. and Dec., 1829.) 12. BARBIER says 6 to 8 gr. act strongly on intestinal canal, after to 2 h. causing movements, distension of bowels, and throbbing in epigastrium ; the intestines seem to be in parts distended and hardened, there is abnormal contraction of muscular fibres and violent colic ; heat of stomach spreading to abdomen and chest and head, especially severe in throat ; burning thirst; sometimes 2 or 3 hard stools with tenesmus, sometimes constipation, also sickness, and now and then pain and drawing in limbs. (Traité élém. de Mat. Méd., 4th Edit., i, 357.) 13. ELSON made experiments to ascertain effects of sulphate of C. upon healthy pulse. On 1st d. took gr. v every h.; on 2nd d. took gr. x at same intervals ; on 3rd d. gr. xx in like manner. On d. of no medication 6 observations made ; mean pulse 70. On days of medication, there appeared :-1 . (11 doses) 11 observations, mean pulse 761 ; 2. (12 doses) 12 observations, mean pulse 7814; 3. (11 doses) II observations, mean pulse 9416. Thus C. decidedly accelerated pulse. (Am. J. of Med. Sc. , N. S., lii, 97. ) 14. Sulphate of C. applied to the mucous membrane of the mouth produces a sensation of tolerable bitterness, which disappears promptly on rinsing the mouth two or three times; at first the mouth becomes dry, then the secretion of saliva is augmented, but remains viscid and frothy; on increasing the dose, the nasal fossæ participate in this condition, asensation ofwarmth is experienced at the epigastrium, together with a slight tendency to vomit, and an insignificant amount of pain, which may extend over the entire abdomen. Given in powder or dissolved, it is easily absorbed ; from the stomach and intestines it passes promptly into the blood and the secretions. The influence of sulphate of C. upon the circulation is but slightly appreciable in a dose of from grm. 0'10 to 0.25 ; but in doses larger than this, up to 070, the pulse is quickened,the heart palpitates; præcordial pain supervenes, which appears to embrace the entire l. side of the chest; the respiration becomes embarrassed and slowed ; on standing up the legs yield, the arms become heavy, and sometimes syncope ensues; the skin becomes hot, the face animated, the eyes brilliant, heavy anddifficult to open ; sometimes the pupil dilates, at other times contracts. With a dose of 0.70 the head becomes heavy and aching. In this dose the drug produces a special headache, affecting chiefly the anterior parts of the head, accompanied by a very remarkable feeling of compression. Aspecies of transient intoxication ensues. In large doses, humming noises in the ears as with sulphate of quinine, but this phenomenon is less constant ; a desire to sleep, and if sleep comes it is accompanied by strange dreams. In a case observed by M. Grisolle, where the subject had taken grm. 2.50, retention of urine manifested itself, but the pulse remained at 55. (BOUCHARDAT, DeLondre and GIRAULT, L'Annuaire le Thérapeutique, 1856, p. 22.) II. Poisonings.-1. Twelve outoftwenty-three patients (intermittent fever), treated with various doses of C. sulph., have experienced symptoms of uneasiness due to the medicine. One of these is constant headache, occupying frontal region and temples. The patients feel constriction of the whole anterior part of the head,

varying much in intensity, sometimes intolerable. I have never seen the headache extend to or attack only the hind part. Once I observed vertigo and acute pain in the limbs. (MOUTARD- MARTIN , Mém. de l'Acad. Imp. de Méd. , T. xxiv. ) 2. Of 198 patients subjected to administration of sulph. of C., 94 had no trouble, 80 had cephalalgia, 40 buzzing and whistling in ears, 33 vertigo and dizziness, 44 trouble of vision, 46 titubation, 8 epigastralgia, 4 nausea, 8 colic. (Lévy, L'Union Médicale, vi , 163.) III. Experiments on animals.-I. BRIQUET found injection of 2 grm. into jugular of 5 dogs produce in 3 instant death (apparently from weakening of heart) ; in 2 convulsions, passing off in 1, in other becoming more intense, and ending in death trom meningitis (post-mortem examination). (Op. cit..)