Chininum sulphuricum

Volume I — Appendix

(Chininum Sulphur icum.)

Description. —There are two forms of the sulphate, a neutral and an acid salt.

The neutral salt is produced by neutralizing quinine with a dilute solution of Sulphuric acid, and adding a few drops of an alkali to determine the crystals. It dissolves in about 700 parts cold water, and 30 parts hot water.

The acid salt always separates from a solution of quinine in excess of sulphuric acid. It is much more soluble in water than the neutral sulphate. It will dissolve in 11 parts of water.

Preparations. — Triturations.

Mind.

Feeling of intoxication, though the mental powers are perfect. Awoke at midnight with long-continued cries ; knew that he was crying, but could not help it ; was obliged to get out of bed ; wrapped himself in his clothes and remained sitting; after a few moments he came to himself again, and soon fell asleep. Delirium.

• Despondency.

• As if some evil were impending.

• Feeling of impending evil, in the afternoon.

Head.

Vertigo, with palpitation.

• Whirling in the head like a mill wheel. Rush of blood to the head, towards evening.

Heaviness and confusion of the head continue until going to sleep in the evening.

• Very severe headache, worse towards evening, with violent palpitation of the arteries of the head, as if the head would be

torn asunder, with glowing heat of the face, vertigo, at times

ringing and roaring in the ears. Violent headache in the forenoon, especially in the left side, with

frequent pulsation of the temporal arteries, with excitement

through the whole body. Pain in the forehead and temples appeared towards evening and

gradually increased in intensity, with visible pulsation of

the temporal arteries, heat of the head, and ringing in the

ears.

Violent pains in the left temple ; the pain extends to the eyebrow, and obliges him to lie down, with which he seeks a cool place on the sofa in order to relieve the pain. Meningitis ; symptoms like delirium tremens.

Eye.

With some the eyes become red, and there is swelling of the lids, with the appearance of pimples. Peculiar dryness of the eyes. All day, eyes feel as if they had been in a glare, or as if the atmosphere were too dry, as if parched. * Pain in the left infra-orbital, malar and superior maxillary nerves; aching and boring, worse in cold air, but nearly constant, even involving the eye at times, with tumefaction adjacent to upper molars. Lachrymation in the open air.

• Disk and retina both very ansemic. Disk looks dry, with the vessels smaller than usual.

• Dilatation of the pupil.

• Dimness of vision, as from a net before the eyes, and once as

from a dark fog. More or less complete, or even incurable amaurosis of one or both eyes. Blindness.

• Great sensitiveness of the eye to the light, with lachrymation

in the full glare of light.

• Bright lights and sparks before the eyes.

• Black spot, size of pin's head, about eighteen inches from right

eye, and moving with eye for some weeks. Blackness before the eyes, with pain in the forehead, so violent that the head seemed as though it would burst.

Ear.

Deafness of both ears on account of loud ringing in them. Intolerance of noise.

• Ringing in the ears, especially noticed in the left, seldom in the

right. Frequent transient ringing in the ears. Constant ringing in the ears. Roaring in the ears and head, so that the patient was almost completely deaf.

Nose.

° Hay fever.

Epistaxis, with cerebral congestion ; flushed face.

Face.

Suddenly seized with oedema of the face and limbs, accompanied by an unusual erythematous rash.

• Face flushed and hot.

• Face pale and suffering.

• Aching about left malar bone in the evening.

• While writing, sudden ache above left zygoma, while inclining

head to that side, also at temporal ridge.

• Neuralgia of the supra-orbital branch of the fifth nerve, especially when periodic.

Mouth.

Tongue coated with a thick yellow fur, which cannot be scraped

off, except the tip, which is red. Mouth full of mucus. Great hunger, compelling him to eat. 0 Quinia acts best after the tongue has been cleaned by the use of Mercurius or Euonymin. Dryness of the mouth and fauces. Mouth tastes as if its secretions were unhealthy.

• Articulation seems impaired. Have to repeat words to make

them understood. Disturbance of the organ of speech; occasionally entire loss of voice for a longer or shorter period.

Throat.

Throat feels a little full ; clogging of the upper pharynx by mucus ; slowly detached by repeated swallowing in the afternoon. Constant scraping in the throat, with irritation to cough, and slimy expectoration, difficult to loosen, in afternoon.

Catarrhal secretion descended the pharynx in considerable amounts} again some hawked up the windpipe ; and all the afternoon there remained a tenacious coating of the same on the back of the palate, causing efforts to swallow it.

Stomach.

Ravenous hunger after a hearty meal, becoming a qualmishness

and nausea when continuing a long time. Anorexia, aversion to food.

Thirst, with unusual appetite and sensation of fasting. Thirst,

eructation, and nausea, with great appetite. Eructations and heartburn. Nausea and vomiting during a meal. Frequent vomiting of an insipid taste in the afternoon. Cardialgia.

A feeling as if the stomach were too full, and something had failed to go down and lodged in the chest ; better by eructation, but fulness still felt.

• After eating, pressure in the stomach, followed by cutting in

the upper and middle abdominal region.

• Even slightest food causes pressure in the stomach and a return

of the usual symptoms.

Abdomen.

• Pain in the region of the liver shortly before going to bed.

• Dull, painful sensation in the region of the spleen, disappearing

on pressure. Pressive pain in the region of the spieen.

• Stitches in the left side, below the short ribs. Much distension

of the abdomen, followed by diarrhoea.

Great distension of the abdomen without passage of flatus. Profuse passage of flatus upward and downward.

Colic in the transverse and left colon. Colic immediately after rising, followed by stool, at first mushy, like diarrhoea, with cadaverous odor, with gradual relief of the colic. Rectum.

Increased hemorrhoidal troubles.

Discharge of bright blood from the anus, without previous pain in the back.

Diarrhoea, with violent colic-like pains across the abdomen. Stool at first mushy, then like diarrhoea, preceded by exceeding offensive flatus at 9 a.m.

Stool difficult, faces of ordinary consistence. Obstinate costiveness, with distension of the abdomen.

Urinary Organs.

Urine copious, high-colored and turbid. Secretion of urine increased ; urine deposited a large quantity of orange-colored crystals, shown under the microscope to be right-angled prisms, with rhomboidal fragments. Increased secretion of urine, preceded by distension of the upper and lower abdomen and oppressed respiration. Haemorrhage of the urinary passages. Urine deposited a rose- red sediment, which under the glass showed rhomboidal flat crystals, with here and there double pyramids. These crystals consisted of Urate of ammonia and phosphates and traces of Quinine. Brickdust sediment in the urine. After taking G grammes of Quinia, over 4 grammes were found in the urine within 48 hours.

Sexual Organs.

Decided depression of the sexual sphere during the proving. An emission during the night without waking. Uterine epistaxis.*

• This is neither a haemorrhage nor a menorrhagia but a steady flow, drop by drop, from the uterus.

• Menses too soon and too profuse, or too scanty. 0 Deficient labor pains from exhaustion.

° Irregular menses. (Hale.)

Respiratory Organs. On rising in the morning scraping soreness of larynx and trachea when swallowing, with raising and coughing of considerable mucus, accumulated during the night, relieving the laryngeal scraping by degrees, but causing rawness in bronchi and lungs of left side; later in the day the cough affected rather the fauces, with rending sensation. Hoarseness at 4 p.m., with a deep tone to the voice. Aphonia. The attack of hoarseness, without anginal symptoms, recurred every afternoon for a long time. Cough and tickling in windpipe.

• Respiration increased. Slow and irregular breathing. Respiration slow, interrupted by sighs.

• Oppression of the chest.

Pressive pain in the left half of chest, which was very sensitive to deep inspiration, most sensitive when the left arm was thrown forcibly backward. Sticking in the right half of -the chest, extending up the shoulder ; during the afternoon impeding respiration, relieved by bending the body forward. Stitches in the left side of the chest, preventing deep breathing, continuing uninterruptedly until the next day, and very gradually disappearing.

Heart and Pulse.

Extreme precordial anxiety. Sticking in the region of the apex of the heart, disappearing after a few minutes. Sitting, the heart's action subjectively felt, extending to head. Palpitation of the heart.

Pulse full and rapid.

Action on circulation was constant ; it usually occurred half an hour after taking, and proportionate to the size of the dose, producing slowness of the pulse.

Pulse irregular, weak, and small. When the pulse was at its quickest it became irregular and intermittent.

Back.

• Sensitiveness of the last cervical and first dorsal vertebrce to

pressure.

• The dorsal vertebrae are painful to pressure with the fingers or

on leaning against any hard substance.

• Pain in the first and second dorsal vertebrae on pressure.

• Third dorsal vertebra very painful to touch, with oppression

of the chest; it was not noticed on pressing on the other vertebrae.

Extremities.

• Weakness in the limbs. Great weakness and weariness of

arms and legs.

• Trembling in the extremities; the power of the will over them

seemed very much hampered.

• Hemiplegia. Fingers blue and cold.

General Symptoms.

General excitement of the arterial system, similar to that produced by strong wine. An internal trembling, wherewith the face became pale, with some urging to urinate, followed by pale urine.

Twitchings, in the evening. Convulsions.

• General weakness, especially of the feet, so as to interfere with

walking.

• Collapse, with feeble pulse and colliquative sweats.

Disturbance of nervous system and of the heart's action, producing general prostration and feebleness of cardiac movements.

° Nearly all neuralgic pains when periodical and malarial. Exhaustion as from hunger. Very restless at night.

Excessive great sensitiveness of the body during the proving.

Skin.

Rash all over the body, vivid as scarlatina and attended with intolerable and incessant itching. The rash and irritation were persistent for several days ; and then gradually and slowly subsided, followed by univeral exfoliation of the

cuticle. Scarlatina-like eruption, with extremely violent itching over the whole body, followed by desquamation, lasting fully three months. With some, pimples appear over the whole body, accompanied with an intolerable itching, and which eventually discharge a matter, somewhat thicker than serum, though not exactly of the consistence of pus ; having reached the suppurative stage, the eruption gives place to squamous scabs.

• Skin cold, pale, moist, and shrunken. Sudden, long, pricking stitches, as with needles, in the skin of the chest, back, and thighs, followed by moderate sweat on the chest and back, in the evening, while walking slowly in the open air.

Sleep.

Constant inclination to yawn, with decided weakness. Coma. Sleep very uneasy, interrupted by wonderful dreams; constant tossing about the bed.

• Sweat, especially on the back and neck when sleeping. Frightful dreams, with restless sleep.

Fever.

Decided shaking chill at 3 p.m. ; at 6 J p.m., heat of the face, lasting until 9 p.m., but no sweat followed. Chilliness, with paleness of the face, pain in the forehead and temples, and ringing in the ears at 11 a.m.

The fever shows itself at one time by an effervescence of the blood, causing great pulsation (or "snapping") of the veins, at another by an icy coldness of the whole body, insomuch that it has been compared to the action of an intermittent fever; this fever seems to terminate by a sharp spontaneous accession.

Extremities, hands, feet, chin, and nose cold from noon until evening.

Heat over the whole body, which gradually breaks into sweats. Sweat breaks out over the whole body from time to time, even

during perfect quiet. Sweat during the morning sleep so

profuse that the bed was soaked with it.

Volume II — Special Therapeutics

The salts of Quinia, an alkaloid prepared from the Cinchona (Peruvian bark), called u China ” in our school, are very extensively used, and abused, by all schools of medicine, not excepting the homoeopathic.

Although China is extensively used by our school, and its symptomatology well understood by our physicians, the same cannot be said of Quinine.

Therefore I consider that I am justified in placing it among the new remedies.

If Hahnemann had experimented with the alkaloid instead of the bark, he would have seen more decided febrile effects, and his belief in its power to cause fever, even intermittents, would have been confirmed by more decided results.

I will quote from Stille’s “ Materia Medica ” the following clear and distinct account of the action of Quinine on man :

When Sulphate of quinia is administered to a healthy person, in quantities not exceeding six grains daily, in doses of half a grain or a grain, it produces effects very analogous if not identical with those of the simple bitters. At first

no sensible effects whatever may be experienced, but, after a short time, the appetite is increased, the food appears to be more rapidly digested, the pulse becomes somewhat fuller and stronger, if not accelerated, the temperature of the surface is correspondingly elevated, the processes of sanguification and nutrition are promoted, and other vital functions are moderately stimulated either directly or indirectly. In other words, the medicine operates as a pure tonic, according to the definition of the term given in this work. In irritable states of the digestive organs, or of the system at large, these effects are sometimes exalted, by the free use of the medicine, into a moderately febrile state, with anorexia, gastric oppression, thirst, a furred tongue, accelerated pulse, heat and dryness of the surface, and headache, or other cephalic uneasiness. This condition, however, is probably not the direct result of the action of the medicine upon the system at large, but indirect and symptomatic of some local irritation produced by it, especially in the stomach or other parts of the digestive apparatus. This state of excessive excitement is rarely experienced in health ; because with an increase in the quantity of Quinia administered other effects are developed of a contrary tendency, which overcome its general excitant influence.

Given to the amount of from six to twelve grains daily, in divided doses, or to a less amount in a single dose, Sulphate of quinia evinces a tendency to act specially upon the brain, and often produces very decided effects upon that organ. The quantity, however, necessary to the production of obvious cerebral symptoms varies greatly in different individuals ; some evincing an extraordinary susceptibility to the influence of even small doses, while others scarcely feel the largest quantity above mentioned. The first cerebral phenomenon usually presented is abnormal sounds, such as buzzing, roaring like that of a strong wind or of a cataract, singing, hissing, ringing, etc. Along with this there is generally more or less hardness of hearing, which, indeed, is one of the most characteristic effects of Quinia. Uneasy sensations in the head are also frequent, as of weight, fulness, tension, and sometimes positive pain, though very seldom severe. The circulation is not much affected ; the pulse being sometimes increased, sometimes diminished in frequency, but for the most part little altered.

When, instead of the quantities above mentioned, from twelve to sixty grains or more are given daily, in divided doses, the effect upon the cerebral functions is increased, and a decided sedative influence upon the circulation produced, as evinced by a diminution of the frequency and force of the pulse, proportionate to the amount of the salt used. Along with the abnormal sounds before referred to there is now giddiness or dizziness ; the individual, if erect, often staggers ; occasionally there is irregular muscular movement ; the hardness of hearing is not unfrequently increased to positive deafness, and in a few instances vision is disturbed and blindness induced. At first, if the individual dose is large, there may be flushing of the face, headache, and sometimes epistaxis, indicating decided sanguineous determination to the head, and occasionally, though very rarely, active delirium occurs. In experiments upon dogs, even meningitis has in some relatively few instances been brought on by very large doses. (Briquet, “Traite Therap. du Quinquina,” p. 161.) But these evidences of overexcitement of the brain give way to others indicating a reduction of nervous power, such as diminished hearing and sight, uncontrollable tremblings, depressed spirits, sighing or yawning, and very rarely a kind of mental disorder, compared by Dr. James McCaw, of Virginia, to delirium tremens. (“ Stethoscope,” ii, 666.) In some instances a tendency to drowsiness or stupor is evinced, in others morbid wakefulness, but in the greater number neither the one nor the other. Though the pulse is at first Sometimes temporarily excited by these large doses, probably in sympathy with the excited brain, it in general soon becomes slower, and always feebler. The pulsations of the heart are often reduced ten or twelve in the minute, sometimes as much as twenty or twenty-five, and the whole number in the minute to forty, but seldom if ever lower. In strength the pulse is diminished very nearly in proportion to the dose, as shown by the experiments of Briquet upon dogs, by means of Poiseuille’s haemadynamometer ; and, in extreme cases, it may be so much reduced as no longer to be felt at the wrist. The skin at the same time becomes cool, pale, and moist, and the face pale or livid, and shrunk.

This prostration under the use of Quinia may be carried so far as to constitute real poisoning. Death has often been produced in dogs by excessive doses ; and in one case, cited by M. Guersant, the same result is said to have taken place in the human subject. In this case, M. Bazire, a practitioner of medicine, in an excited state of imagination bordering on insanity, believing himself to be attacked with pernicious fever, took within a short time sixty grams (very nearly two ounces troy) of Sulphate of quinia by the mouth and rectum. Symptoms of great prostration with loss of sight and hearing came on, which he unfortunately ascribed to the pernicous fever, and hoped to counteract by a continuance of these enormous doses. In the course of nine or ten days he took, additionally, five ounces of the salt. Another physician being then called in, found him covered with cold sweat, completely deaf and blind, with difficult and rattling respiration, profound stupor, and an expression of countenance like that of drunkenness. Though partially roused, with much difficulty, so as to give rational answers, he quickly became delirious and died. (“ Diet, de M4d.” 2e ed., xxvi, 570.)

Giacomini, who first called attention to the powerful sedative influence of Quinia, records the case of an individual who took by accident about three drachms of the Sulphate. Extreme prostration came on, with an almost absent pulse, cold skin, slow respiration, feeble voice, and apparently imminent danger of death, which was, however, averted. In these prostrate cases the pupil is often dilated, and there is sometimes coma.

From Wood’s “Materia Medica ” I take the following relating to its

Poisonous Effects. — The earlier historians of Cinchona did not fail to notice that ill-effects occasionally arise from its use, such as gastric derangement, colic, diarrhoea, headache, restlessness, sleeplessness, and deafness ; but these symptoms were always temporary, and seldom reached so high a degree as to excite alarm. But after the discovery of Quinia, which contained in a small bulk the principal powers of the medicine, cases occurred which were distinguished by very alarming symptoms, such as delirium, coma, blindness, deafness, gastralgia, epileptiform convulsions, dyspnoea, aphonia, paralysis, congestion of the lungs, and lisematuria. Trousseau speaks of a young woman who was delirious for a whole day after taking twenty grains of Sulphate of quinia. In another case, that of a male, forty-six grains rendered the patient blind, deaf, and delirious, and so giddy as to be unable to walk. He also vomited continually. A case is reported by Gelinau of a delicate and nervous lady, who, after taking ten grains of Sulphate of quinia on an empty stomach, was attacked in about two hours with violent abdominal pains, rigors, and general prostration with cold sweats. The face was pale, the eyes sunken, the pupils dilated, the teeth clenched, and the limbs stiff ; confused answers were given to questions ; the respiration was calm, the pulse 60. In about an hour the pulse rose to 80, there were ringing and buzzing in the ears, and the catamenia, which were not then due, made their appearance. The next day the patient was as well as usual, except that she suffered from dulness in the head and heaviness of the limbs. Giacomini reports the case of a man of middle age who took by mistake about three drachms of Sulphate of quinia at a single dose. He gradually became giddy and feeble, and then insensible. Nine hours after taking the medicine he lay motionless and pallid, the fingers were bluish and cold, and the whole surface cool, the respiration slow and suspirious, the pulse regular, but slow and hardly perceptible, the pupils widely dilated, the sight and hearing almost extinct, and the voice extremely feeble ; the thirst was great, the tongue pale and moist, and the breath cold. The patient could not leave his bed until the fifth day. A similar case is narrated by Dr. Baldwin, in which sixty-eight grains were taken in the course of about twenty hours. A case is reported of a man who after taking three doses of Sulphate of quinia, each of eight grains, and at intervals of four hours, experienced the usual phenomena of cinchonism, then became drowsy, and afterward, by degrees, hemiplegic He did not recover the use of his limbs. Grsefe, of Berlin, met with two cases of amaurosis which he attributed to Quinia, and Simon several cases of haemoptysis following the administration of this substance to persons affected with intermittent fever.

But the evidences of the poisonous properties of this drug are also furnished by cases in which it proved fatal to life. Four such cases are collected by M. Melier. In one of these the patient was affected with delirium and coma, and died on the second day. Guersant has given an account of a physician and his wife, both of whom were poisoned by this preparation, the former fatally, after taking nearly five ounces of Sulphate of quinia within the space of eight or nine days. The symptoms were such as have been detailed in the case of Giacomini. Dr. Baldwin has reported the case of a child, six years of age, who died from taking eight grains of this salt, in two doses, with an interval of three hours between them, and with symptoms like those already described. Whenever, in such cases, the body has been examined after death, the same lesions have been found as upon dissection of animals destroyed by the same cause, viz., congestion of the lungs and brain, and in some degree also of the stomach.

A fatal effect, it has just been stated, may follow the administration of comparatively small quantities of Quinia. Such doses, when continued, have occasionally produced toxical, but less serious consequences. Dr. Van Buren saw

partial loss of hearing result from taking two-grain doses of Quinia for a period of some weeks, and a case of amblyopia of three weeks’ duration, and quite intractable, follow the use of four-grain doses every four hours for a week.

But in some cases, it should be borne in mind, enormous doses have been taken without fatal or even alarming consequences. In the case of the lady related by Guersant, and referred to above, about six hundred grains were used within the space of a few hours. Banquier states that one of his patients took seventy-two grains of Sulphate of quinia by mistake and without hurt; and Tomasi di Spineto asserts that ninety grains may be given several times a day without danger. “A medical friend in Alabama,” says Dr. Dickson, “assures us that he had administered thirty grains of the solution of Quinine every hour for seventeen successive hours ; and we have heard authentically of a Western physician, who emptied into the stomach of a patient laboring under bilious remittent an ounce bottle of Sulphate of quinine in one night. From thirty to fifty grains are now spoken of as not unfamiliar doses, and even one hundred grains are occasionally given at once, and, we are assured, both with safety and striking success.” Dr. Drake mentions a man at Memphis, Tenn., who took eighty grains of Quinia at a single dose, and another at Montgomery, Ala., who consumed an ounce in the course of three days, and recovered. At Plaquemine, La., an old lady used ten grains every two hours until an ounce had been taken. No bad effects followed. It must not be forgotten that Sulphate of quinia is often largely adulterated.* The fact may help to explain the innocuousness of the medicine in some of the many cases resembling the above, which are said to be of frequent occurrence in the Western and Southern portions of the United States.

You see in these descriptions an excellent picture of the primary and secondary effects of the drug.

At first, from moderate doses, all the normal functions appear to be simply increased. Afterwards, from larger doses, these functions become strikingly abnormal, until the brain and other important organs are congested and inflamed. Death may result from its ultimate primary effects, namely, from meningitis or apoplexy, or from general internal congestion.

If the drug is continued too long, the hyperstimulation and congestion are succeeded by failure of nervous power (secondary), as above delineated.

You will remember that when describing the primary and sec-

• I have seen specimens of Quinine, especially the Quinine supplied to the army during the late war, which contained nearly 70 or 80 per cent, of Salicin ! It was probably a similar spurious substance which was given in massive doses without causing fatal consequences. — IIale.

ondary action of drugs, I mentioned that we may get secondary effects, without the primary , from very large doses.

You see this illustrated in the effects of massive doses of Quinine, which cause extreme prostration, almost absent pulse, cold skin {pale, moist, livid, shrunken), slow respiration, feeble voice, coma, and in many cases collapse unto death. This it causes by its paralyzing action on the nervous centres without previous stimulation.

The homoeopathicity of Quinine to fever is clearly set forth in its primary effects. But I must impress it upon your memory, that the febrile symptoms there described belong to no other class of fevers but the malarial, sometimes called the miasmatic and paludal.

As to the exact nature and origin of the causes of these fevers, the medical world is not unanimous. It is my belief, however, that such fevers have a cryptogamic origin ; that the spores of certain cryptogamic plants, invisible to the naked eye, are absorbed into the system, probably through the respiratory or digestive organs, and are carried into the blood, where they cause by their fermentive (propagative) force, febrile manifestations. I believe with Salisbury, Bartlett, and others, that the prodroma and the febrile paroxysm (chill, fever, sweat) are the efforts of the organism to throw off the accumulated poison. I believe that Quinine destroys the spores of the fungi in the blood, and is also homoeopathic to the symptoms of the fever itself.

I will take up, in regular order, the symptoms of malarial fever, and show the close similarity between such symptoms and those of Quinine poisoning.

(1.) The Prodroma. — It is a singular but well-known fact, that persons under the influence of malaria ( marsh miasm) experience for days, even weeks, previous to the attack an unwonted exhilaration, an exuberance of healthy sensations. The appetite increases, food is intensely enjoyed, the digestion is strong, and the physical strength is actually increased. But right in the height of this apparent excess of health comes, unexpectedly, the chill, often congestive, followed by the other febrile symptoms.

Now, if you will remember the symptoms of Quinine when

given in moderate doses, you will see an excellent picture of this prodromic state. It would seem as if the fermentive force of the poisonous spores in the blood actually stimulated the functions of the body (primarily), until the excessive fermentation ended in the explosive paroxysm.

(2.) The Chill. — An ague chill may be a simple coldness, or coldness with shivering, ora condition of general congestion, known generally by the names of congestive chill, sinking chill, or syncopal chill.

This last condition may occur when the patient believes himself in perfect health, without any unpleasant warnings. It resembles the collapse of cholera in all but the colliquative discharges, and sometimes these are not wanting. It resembles also the poisonous effects of Quinine when taken in massive doses (fifty to two hundred grains). The reaction from this collapse, or from a simple chill, results in a febrile paroxysm (intense heat, congestion, etc.), and is followed by profuse sweat.

In bad cases no reaction occurs, but the victim dies in spite of all efforts at stimulation. Sometimes the sweat is absent after the fever. In such cases no clear apyrexia obtains, but an erethistic fever smoulders until the next attack (one, two, or three days).

In cases of Quinine poisoning we can get all these stages, with more or less intensity, depending on the amount taken into the system, or the constitution of the experimenter.

So in malarial poisoning. The intensity of the fever will depend on the amount of poison in the blood and the strength of the patient’s constitution.

What therapeutical deductions can we make from these facts ? I will try to explain.

Quinine is homoeopathic to a large proportion of miasmatic fevers, especially if they assume a quotidian type. It is also curative in a large proportion of the “ masked agues,” i. e., paroxysmal attacks (generally quotidian), without chill, fever, or sweat, but consisting of neuralgic pains, spasmodic manifestations, dysenteric symptoms, rheumatic pseudo-inflammations, or any other group of symptoms occurring at the same hour every day or two. Sometimes the attacks merely consist of a dull, heavy aching all over, constituting what is known as “dumb ague.”

You will find a pathogenesis of Quinine in the old “Symptomen Codex,” which contains a large number of characteristic Quinine symptoms, and many that are worthless. There is a late proving, very thorough and careful, in the “Amer. Jour. Horn. Mat. Med.” for May, 1875, by Dr. J. C. Morgan.

You will readily understand that if the theory of the cryptogam ic origin of ague be true, the selection of Quinine is not always to be made from the similarity in symptoms. It is true that the ague paroxysm often presents a close similarity, in symptoms, to the symptoms of Quinine. The pathological conditions also are similar. But there are many cases, often a majority, of agues which present a sameness which prevents all attempts at differential diagnosis. They simply have a chill, fever, and sweat, and they “ache all over;” the attacks occur every day, at about the same hour, and that is all there is of it. The chasing after minute symptoms, the aches and pains, the likes and dislikes, the hour of the day, the order of the appearance of the symptoms, etc., are all useless as aids in the successful treatment of the majority of cases of true epidemic malarial ague.

I believe the true method of prescribing Quinine in ague to be in accordance with the law of dose which I have so often explained to this class.

During the prodromic stage, and to persons who must expose themselves to miasmatic influences, the Quinine can be given as a prophylactic. It has been much used in armies encamped or campaigning in malarious districts, also by travellers who are obliged to traverse countries devastated by paludal fevers. It has been found that a few grains a day will prevent the access of the disease. I believe that a few grains of the 3X trituration would act as a preventive, unless we must rely upon the antiseptic action of the drug upon the fermentive process going on in the blood.

During the paroxysm, Quinine should be given in a high trituration or dilution, from the 6th to the 30th, according to the intensity of the fever, congestion, and nervous phenomena.

I know from actual experience that the use of Quinine during

the paroxysm, in this manner, greatly mitigates the symptoms at the time, and I am certain that it requires less of the medicine to be given through the apyrexia.

At one time the allopathists recommended that Quinine be given during the paroxysm, “ in order to more effectually break the fever;” but although they prescribed it in doses of one-twentieth or one-fortieth of a grain every hour, the aggravations were so painful that the practice was abandoned.

I once supposed that the congestive chill, which is often met with in bad cases, corresponded to the secondary effects of this drug. But I am now satisfied that it is an ultimate primary effect. If Quinine is used at all during the chill, it must be used in small doses (one-tenth or one-twentieth of a grain every half hour). But the treatment of such attacks with Quinine is not very successful. I have known doses of all sizes to be given during the collapse without the slightest effect, even when aided by large quantities of brandy and other liquors. I do not believe you will find it the best remedy in this condition. (Amyl nit. is much better.)

The best treatment for the sinking chill, in addition to the use of medicines primarily indicated, namely, Arsenicum, Veratrum, Aconite, etc., is the use of the hot mustard bath. Strip the clothes from your patient, or leave them on if he is very weak, and place him in a bath of hot water (120° to 130°), in which has been dissolved an ounce or two of powdered mustard. Bub the patient well while in the water, and do not take him out until reaction has set in, and the skin is red and warm, and the external bloodvessels filled. If a bath is not obtainable, rub the patient with dry mustard, or cayenne pepper, or any substance which will bring back to the surface the blood which is stagnating in the central organs of the body.

The radical treatment of malarial fever must be applied in the apyrexia. During the intermission, let the type be what it may, intermittent or remittent, give the Quinine, if indicated, in doses graduated to suit the age, sex, constitution, or idiosyncrasy of your patient.

No time should be lost, in cases of malignant malarial fever, after the first paroxysm or congestive chill, in getting the patient under the influence of Quinine.

We now come to the consideration of the doses to be used in the apyrexia.

The symptoms of the apyrexia resemble the secondary symptoms and pathological condition caused by Quinia, namely, great debility, resulting from the primary congestion, fever, and sweat. The nerve-centres are left in a very weak condition, and the normal reflex functions are semi-paralyzed.

In such condition large or appreciable doses are required. Large experience has enabled physicians to decide with great accuracy the quantity necessary to be used to arrest the paroxysms.

Twenty grains of Quinia, in ordinary cases, is the maximum quantity. This will vary from five grains in susceptible persons, with paroxysms of moderate severity, to fifty grains in cases of pernicious congestive fever, when death would probably result if another paroxysm was permitted.

The manner of giving Quinine varies with the whims and experience of the physician. Some prefer to give five or ten grains just after the paroxysm, and the same quantity just before.

In severe cases, where the apyrexia is short, this is a good plan. But in ordinary cases, my experience has taught me that it is best to begin about six hours before the expected paroxysm, and give one or two grains an hour until the chill comes on, or the chill-time is passed. If I were called to a case of malignant congestive ague, and was informed that another paroxysm was expected in an hour or two, I should not hesitate a moment before giving twenty or thirty grains immediately. In no other way can you be sure of warding off the impending paroxysm.

The relations of the dose of Quinine to age I have studied, as in the case of the Bromides. I have ascertained that the proper quantity is about one-tenth of a grain for each year of a child’s age until five years, provided the dose is repeated every hour. If a single dose is to be given, and not repeated, the quantity would rise to one grain. For every five years until the age of twenty, I would double the dose to be given hourly, and quadruple it if only a single dose is to be given, as in desperate cases.

It may be asked, Are there no substitutes for Quinia? There are, but they are not perfect substitutes.

Ague remedies may be divided into two classes, namely, those

which have the power, like Quinia, of poisoning protozoa, infusoria, and cryptogamic fungi, and those which have not this power.

In the first class I shall place Quinine, Gelseminum, Eucalyptus, Nux vomica, Arsenic, and Cedron.

In the latter class I shall place Eupatorium, Cornus, Salicin, Arnica, Natrum mur., and Hydrastis (Berberina).

All these correspond to the periodicity of the ague paroxysm, but there is another class which does not, while they possess the power of the first class of destroying animal or vegetable germs, namely, Carbolic acid, Sulphite of soda, Salicylic acid, and a few other chemical compounds.

The medicines in Class I will always remain the chief remedies for malarial fevers. They will have to be used in more or less appreciable doses. If you have read Hahnemann, you will remember a suggestive observation, that in many cases neither China (attenuated) or any other remedy will prevent the recurrence of fevers due to marsh-miasm. This is true at this day, for many cases cease to be influenced by any remedy, and only a residence in a non-miasmatic district will eradicate the disease. We can do better, however, than could Hahnemann, for we have a larger number to choose from.

The medicines in Class II will not be found useful in epidemic malarial fevers, especially if of the pernicious type. Boastful homoeopathic physicians often claim that they can cure any case of ague with the high potencies of this or the first class. But those who have practiced many years in malarious districts know that such assertions are false. I need only refer you to the writings and experience of such men as Holcombe, Ellis, Douglas, Marcy, Pulte, and hundreds of others in this country; also Hughes, Baehr, Roth, Kafka, and others in England and on the Continent.

I have personally known and been a close observer of the practice of many high dilutionists. Some I believe to be honest, and they thought they cured veritable cases of epidemic ague when the patient had cured or arrested the paroxysms with Quinine, taken sub rosa.

Others I know to be dishonest. They gave attenuated doses as long as they dared to, and then resorted to Quinine, or allowed the patient to pass out of their hands.

I do not deny that agues can be cured by the high potencies, or attenuated medicines. On the contrary, I affirm that such is the case. But we must sharply define the kind of ague cured by appreciable and non-appreciable doses.

If the blood of the patient is saturated with the malarial poison, appreciable quantities of the medicines in Class I or III are required.

If the blood contains only a small quantity, i. e., if the paroxysms are slight, the medicines in Class II will suffice, or the remedies in both classes, in attenuated doses.

There are many cases of chronic or persistent ague, in all its protean forms, which do not depend on the presence of poisonous germs in the blood. These have long ago been cast off by the organism. The ague paroxysm, the periodical attacks of pain, malaise, etc., are kept up from habit. The profound impression made upon the nervous system by the original malady is continually perpetuated by that strange tendency to habit which adheres to animal and vegetable organisms.

In this class of cases many very striking and notable cures are made by the highest dilutions. I have known of, and have myself cured, old, obstinate agues, with Sulphur 30th and 200th, Arnica 6th and 12th, Arsenicum 30th and 1000th, and Natrum mur. 30th and lm.

I have also known similar cases to be cured by other dynamic forces, such as diversion of mind, the influence of hope and joy, the excitement incident to an intended journey, and even a mistake as to the time of day. And such cures are often just as good and veritable as when made with dynamized medicines.

I cannot too strongly condemn the habit common with allopathic, and even with homoeopathic physicians, in malarious districts, of giving Quinine indiscriminately whenever a patient has a chill and fever resembling ague. Unless the physician is absolutely certain that the attack is due to miasmatic poisoning he should wait until the disease shows its true character.

There are certain rules which should be followed in order that the use of Quinine, in appreciable doses, should be attended with safety and success.

The one important rule is that Quinine, in doses below the 3*

should not be given (except in dangerous cases) until the tongue is dean or cleaning, the pulse open and soft, and the skin moist and cool.

If given in other conditions, Quinine does not generally act favorably. It will change an intermittent or remittent into a continued fever; and I have known it to cause a typhoid.

How shall we bring about the condition of tongue and pulse? I answer : By prescribing the specific remedies to remove the functional disturbance of the liver and gastric organs. The proper use of Aconite, Verat. viride, Mercurius, Podophyllin, Leptandrin, Euonymin, and Nux vomica will usually remove the coat on the tongue, and bring about the desired condition of the circulation.

Then you can suspend the use of all other medicines and give Quinine, if Gelseminum, Arsenic, Eucalyptus, or some other remedy will not cure the patient, or if Quinine is the indicated remedy.

Aside from its curative power in the class of diseases I have mentioned, the curative sphere of Quinine is limited. I utterly deny its so-called “ tonic ” power in all cases. It is only when malaria lies at the bottom of the debility that Quinine does any good.

The apparent tonic influence is only a temporary stimulation, which soon leaves the patient weaker than before.

Nor do I believe it is of any value in true pysemic poisoning, with or without fever. Although it is said to destroy bacteria and infusoria, experience has not proven that its value in septic poisoning is in any way superior to other “ tonics,” or equal to the Sulphites, or Carbolates, or Arsenic. The Carbolate and Carbazotate of quinia have been recommended in such cases, and bid fair to prove very efficacious if used with judgment and in proper doses.

The action of Quinine on the ears may be taken advantage of in our practice. It causes, with the fulness, tightness, and congestion to the head, ringing, roaring, and other noises in the ears, sometimes of a distracting nature, and often complete deafness for days and weeks, and sometimes for life.

The aurist will find Quinia more valuable than China in the treatment of congestive and nervous affections of the ear. Many

cases of tinnitis annum cured promptly by the use of Quinia 3* are on record, also many cases of nervous deafness.

Quinia acts on the eyes no less perniciously when given in large doses than on the ears. It causes dimness of sight and temporary blindness. The defect of vision is sometimes limited to one eye or begins in one eye. The pupil of the affected eye is very generally dilated, objects appear double or unnaturally small, and the eye is injected and suffused. In toxic doses it has caused amaurosis , ending in total loss of sight.

It remains for the oculist to study and define the true sphere of action of this medicine in diseases of the eye.

Although Quinia seems homoeopathic to congestive headache, meningitis, and cerebro-spinal congestion and inflammation, it has not been used by our school in those diseases to any extent. I have used the 6th in congestive cephalalgia, when ringing in the ears was present, and it seemed to act favorably. In neuralgic headaches it is more generally useful, and when periodic will cure them promptly.

Ringer says : “It has long been recognized that Quinia has most influence on the supraorbital branch of the fifth nerve. This branch is most often affected with malarial neuralgia ; but even nonperiodic neuralgia of this branch is probably more amenable to Quinine than neuralgia of the other branches of the fifth or other nerves.” In such neuralgias the smallest doses will often promptly cure. The 3X trit. will sometimes make surprising cures.

No drug, with the exception of Mercury, has been so fearfully abused and has worked such injury to the human race.

It has been used without sense or reason in nearly every disease mentioned in the prodigious “Nosology” of Dr. Good.

It is still a pernicious habit, not confined to allopathists, to give Quinine in fever so soon as a remission occurs. It is a habit fraught with the most injurious consequences.

The same may be said of the habit of prescribing it after any disease has run its course, leaving the patient weak. Unless it is specifically indicated in such cases do not give it. The natural recuperative forces of the organism, or a more appropriate remedy, will insure a good convalescence.

Hahnemann, with his deep insight into the curative power of

drugs, gives the following symptom indicating China in debility : The patient sweats profusely, especially on the back and neck, when he sleeps. This is the characteristic indication for Quinia; and when you find this symptom the lowest triturations of this medicine will remove the debility.

Dr. Wood (allopath), in his “Practice of Medicine,” writing of Quinia in rheumatism, curiously gives the same indication. In his “ Materia Medica ” he also says :

In protracted diseases, particularly those of a febrile character, though perhaps sthenic in the beginning, the vital forces are gradually impaired by their overexercise, and a state of debility ensues requiring tonic treatment. Here, too, the preparations of bark are the most efficient. It is highly important to know exactly when the period for this treatment has arrived ; for if prematurely employed it may injuriously aggravate the excitement. I have noticed that the occurrence of nightsweats, under these circumstances, offers one of the best criteria of the new condition. When a patient with a febrile disease, not having been especially affected with diaphoresis, begins to sweat profusely whenever he sleeps, and only then, I consider the symptom as an almost sure sign of debility ; and Quinia, though previously contraindicated, may now be used with safety and advantage.

In debility from loss of the fluids of the body, with this symptom, I prefer the Tincture of china.

In no class of diseases has Quinia done more injury than in those of the lungs. In animals poisoned with Quinia the lungs are found engorged. The functions of the lungs are always embarrassed (in men) from large doses. It is not unusual for persons, under the use of large doses, to complain of tightness and oppression of the chest, while the face is pale, and wears a look of distress. Sometimes, indeed, there is severe dyspnoea, and a sibilant rhonchus is heard in the bronchi.

Imagine, then, what must be the consequences of giving large doses of Quinine during or after pneumonia, and during the various stages of phthisis. I have known pneumonia to be caused by the vicious habit of physicians or laymen giving Quinine after a chill from a common cold, on the supposition that it was an ague.

It is often given for hectic fever. When given during the incipient stage of phthisis, it fixes the hold of that terrible malady

on tha patient, who might otherwise have been cured by appropriate treatment. (Trousseau says the same of Iron.)

Thousands of persons lapse into pulmonary phthisis after protracted agues treated by large doses of Quinine. In many cases the drug (and the physician) is to be blamed.

It was at one time supposed that it was not safe to give Quinine to pregnant women, but no authentic case of miscarriage or premature labor has yet been reported from its use. It was also alleged that it acted during labor as a uterine motor-stimulant. This, too, has been denied. I am of the opinion, however, that in cases of protracted labor, when the pains have become feeble, and a general condition of prostration sets in, with no tendency to convulsions, a few grains of Quinine will revive the failing energies, and aid in bringing the labor to a favorable termination. Several cases under my care, in which it acted well, tend to confirm this recommendation.

Some German physician, believing in the infusorial origin of “ hay fever, ” claims to get good results from throwing a weak solution of Quinine up the nasal passages. This recommendation was largely published in the newspapers and medical journals, but it has utterly failed in my practice, and I have never heard of its proving of any value in the disease as it appears in this country.

Having said all in favor of this powerful drug which I can consistently, I will close by again cautioning you to use it with great care and discrimination.