China officinalis

Volume II — Main text

CHINA .

Cinchona Calisaya, Wedd. Peruvian bark. Nat. Ord., Rubiacea. I. Provings.-I . HAHNEMANN, Fragmenta de Viribus. Contains 122 symptoms from self, and 99 from authors . 2. IBID., Mat. Med. Pura, vol. iii of original, vol. i of translation . Contains 427 symptoms from self, 575 from 21 fellow-observers, and 141 from authors. 3. IBID. " I took, by way of experiment, for several d. ziv or good bark twice a d. My feet, finger-ends, &c., first became cold, and I felt tired and sleepy, then my heart began to beat, and my pulse became hard and quick ; I got an insufferable feeling of uneasiness, a trembling (but without rigor), a weariness in all my limbs ; then a beating in my head, redness of the cheeks, thirst,-in short, all the old symptoms with which I was familiar in ague appeared one after another, yet without any actual chill or rigor. In brief, even those particularly characteristic symptoms which I was wont to observe in agues-obtuseness of the senses, kind of rigidity in limbs, but especially that numb disagreeable feeling which seems to have its seat in the periosteum of all the bones of the body-all put in an appearance. This paroxysm lasted each time 2 or 3 h., and came on afresh whenever I repeated the dose, but not otherwise. I left off, and was quite well." (Note to transl. of CULLEN'S Mat. Med., ii, 108. 1790.) 4. JÖRG instituted provings with a tinct. of I part to 6, and with powdered (yellow) bark. a. ENDERS, Nov. 21st, 1821 , took 18 dr. of tinct. in 3j of water. Soon after nauseous taste had subsided, agreeable warmth from stomach to navel. 22nd.-36 dr. in zij . On 23rd, two stools, contrary to custom. 24th.-At 9 a.m., 70 dr. in zij . Feeling of warmth in abdomen ; very good appetite ; 3 stools, of which last was pappy. 25th .-At 9 a.m. , 120 dr. in a tumblerful. Nausea and unpleasant taste. At I p.m., soon after dinner, considerable palpitation, increased by movement, lessened by quiet, continuing till 7. Feeling nervous and anxious, went to bed as early as 8.15, soon fell asleep, but awoke frequently. 26th.-Awakened at 3 a.m. by considerable palpitation, * See note on preceding page .

not lessened by any change of posture, but increased by lying on 1. side ; pulse small. At 4 this subsided, and he fell asleep again. At 9 it returned with diminished force, but increased with motion of body. Towards e. perfectly well again ; bowels not moved till next d. (JÖRG, Kritische Hefte, 1823, H. 2.) 5. HACKER, æt. 20. Nov. 21st.-Took 18 dr. of tinct. in 3j of water ; inclination to vomit, nausea, eructations, flatulent discharges. 22nd.-36 dr. in zij ; same results only. 24th.-70 dr. in zij . Less appetite, more frequent eructations, discharges of very fœtid flatus, less nausea, but more turgor of cutaneous veins. 25th.-120 dr. in a tumbler ; same effects, with thinner stools and painful sensations in his hæmorrhoids ; on each of the 4 succeeding n. not inconsiderable emission ; greater prominence of cutaneous veins. (Ibid.) 6. FRAUTHMANN, æt. 23. 21st.-18 dr. in 3j at 9 a.m. Continued bitter eructations till mid-day ; agreeable warmth in abdomen ; rumblings and rattlings in intestines ; urine somewhat darker ; no evacuation for 2 d. 22nd.-36 dr. in zij . Same effects ; belly much swollen for a short time till eructations occurred. 24th.-70 dr. in Zij . In 1 h. nausea, constant eructations, bitter slimy taste, watering of mouth ; scanty and dark-coloured urine. Dec. 3rd.-140 dr.; besides effect of former doses, no appetite all d. ( Ibid. ) 7. MEURER, æt 27. a. Dec. 9th. At 9 a.m., took zij of powder stirred up with Zij of water. Directly after, tasteless eructations till towards e. At I sharp pains in abdomen for 8 m.; from 2 violent flatulence. At 5 same dose, followed by eructations as before ; unquiet sleep, interrupted by erections. 10th .-No eructations, but more flatus than usual ; n. as last. Appetite throughout rather increased. b. 18th.-Took 3j of tinct. in Zvj of water at 9 a.m., and repeated dose at 10.30. At 5 and 9 p.m. took zij. No immediate effects save eructations, and the elevation induced by the alcohol. Very sound sleep, only twice awakened by thirst and two calls to urine (unusual) . 19th.-Head somewhat affected ; throughout d., during digestion, colicky pains ; two pappy stools. No further symptoms. ( Ibid.) 8. STEINBACH, æt. 23. a. Dec. 9th . At 9 a.m., took powder as 7 a, repeating at 5 p.m. Nothing noticed save eructations, and a rather harder stool. Costiveness continued during 10th and 11th . b. Dec. 18th.-Took tinct. as 7b. After each dose slightly intoxicated, excited, and cheerful ; appetite very good. In e., feeling lively, lay on sofa and smoked. At 11.15, quite unexpectedly, slight vomiting, chiefly of sour-tasting water, smelling of tinct. Slept for some h., waking frequently, as after unusual alcoholic potations during d. 19th.-Head still somewhat affected. Nothing more or further. (Ibid.) 9. KLEMM, æt. 34, took same doses as 7 and 8. Nothing after powder save costiveness, and nothing whatever (he being used to spirits) after tinct. (Ibid.) 10. GÜNTZ , æt. 21 , took same. After 1st dose or powder nausea and weight at stomach ; after 2nd some spasm there. Two stools next m.; for 5 d. after rather costive. Tinct. produced nothing but slight intoxication. ( Ibid.) 11. WALTL took daily zij of powder. Nothing noticed till 4th

and 5th d., when unusual appetite came on, so that he ate twice as much as usual ; at same time motions were easier. Then took 3ss or tinct. daily. Appetite continued the same ; but he felt no other unusual symptoms. (A. h. Z., xx, 367.) 12. PIPER took an injection containing 3j of powder. In 5 m. nausea and hot rising from stomach ; soon after, taste of bark quite sensible all over mouth ; some confusion of head with tensive pain in forehead and orbits ; movement of eyes painful, with feeling of mechanical hindrance ; nausea, and such active disturbance in abdomen that he was obliged to eject clyster in 10 m. Evacuation delayed by tenesmus ; pain in head suddenly ceased, and patient saw closet (in which a candle was burning) all in dazzling sulphur-yellow light, a few m. later glittering with rosy light. On returning to sitting-room illusion passed off, and did not recur. Pain in eyes and nausea in slighter degree till he fell asleep. No further symptoms. ( Ibid., xix, 202.) 13. Woman took 10 dr. of tinct. Sleeplessness entire n.; rightsided face-ache ; profuse perspiration, with feverish heat ; dreadful feeling of excitement ; face flushed and swollen ; needle-like pains in 1. face, chest and hand. (ROBINSON, B. J. ofH. , xxv, 323.) 14. Young woman took 3 dr. 3 times a d. After 3 d. cold colicky cramp in bowels, followed by slight diarrhea. (Ibid.) 15. JOHN M. WALKER tested effects on pulse. a. Pulse 66. After taking I gr. ofred bark, it rose between 10 and 70 m. to 72, and became full and tense, gradually declining to normal during 35 m. more. At height of action there was slight headache. b. Pulse 64. After 12 gr. of resin rose during corresponding time to 73, falling in 25 m. Face flushed at acme of effect. Pulse noted as " full" only. c. Pulse 66. After 12 gr. of extr. fell in first 5 m. to 60, but was full and strong ; then rose during 40 m. more to 72, full and tense ; falling during 40 m. more. d. Pulse 72. After 12 gr. of gum, similar change in quality, and rise (45-55 m.) to 82. After 75 m. was still 75 . e. Pulse 72. After 2 oz. of decoction, in 5 m. became 62 and soft, became gradually quicker and fuller, till in 75-90 m. it was 77, tense, with flushed face. After 100 m. 66 and full . f. Pulse 64. After 2 oz. of infusion, gradual rise, with increase of fulness and tension, to 76 (60-80 m.) ; fall occupied 20 m. more. (ALLEN'S Encyclopædia, x, 460.) 16. If a man in perfect health takes a small or moderate dose of bark, no obvious effects are produced, or perhaps a little thirst, with some slight disorder of stomach ; or a temporary excitement of appetite may be brought on . Ifthe dose be increased, the alimentary canal becomes disordered (indicated by nausea, vomiting, loss of appetite, thirst, and constipation, or even purging) ; a febrile state of the system is set up (manifested by excitement of the vascular system, and dry tongue) ; and the cerebro-spinal system becomes disordered, as is shown by the throbbing headache and giddiness. The disturbance of the functions of the stomach is produced not only when the bark is

given in the more nauseating form of powder, but also in the form of infusion, decoction, or tincture. (PEREIRA, op. cit.) II. Poisonings.-1 . a. There are two diseases which the manufacture of quinine from bark induces in the workmen. The first is the so-called " quinine fever," to which those only are subject who work in the mill, and are much exposed to the bark-dust. This manifests itself in chill and heat, like an intermittent. But according to all our experience it always comes to an end with one violent fit, without the use of any medicine whatsoever ; and it is remarkable that the workmen who have once got over this single fit can ever after expose themselves with impunity to the dust ; only a few, however, incur the risk, the greater part preferring to give up the employment. This fever attacks all the workmen, with very few exceptions, who inhale much of the dust. b. The second disease is an eruption from which many suffer during the early period of their service, who are occupied with the further elaboration of the medicine. In some cases this eruption spreads all over the body, so that they have to leave off work, whereupon rapid improvement occurs ; but as soon as they resume work the eruption reappears, and then nothing remains for them but to leave off their employment altogether. In a few this eruption was very serious, and the sexual organs were swollen. As a rule, however, the affair is trifling, and disappears entirely after some time, so that ultimately the work can be done without inconvenience. The eruption shows itself in every operation of the manufacture, with the exception of the grinding, the inhaling of the dust being never followed by it but always by the fever. c. Our men have never suffered from the diarrhea which other manufacturers, especially in Paris, have observed among their people. (GARMS, Eröffnung eines neuen Weges zur sichern Indic. der Arzn., 1853, p. 407. ) 2. A healthy man drank a considerable quantity of a strong decoction of China. There occurred headache, vertigo, chilliness, restlessness , indescribable anxiety, trembling, staggering gait, cold sweat, palpitation of heart, intermittent pulse. After enduring this for several h. he was relieved by drinking hot tea, which caused diaphoresis and diuresis, but the same symptoms occurred occasionally for a long time afterwards, especially after mental emotions, particularlythe palpitation of heart and intermissions of pulse. The 9th beat was followed by an intermission, after which 3 or 4 rapid beats occurred. Physical examination showed dilatation of the r. ventricle. (Göz, Russ. Med. Z., 1851 , quoted in Z. f. hom. Klin., i, 117.) III. Experiments on animals.- 1 . Friend states that Ziss of strong decoction injected into jugular vein of dog caused in 15 m. strong palpitation and frequent spasms. On ss more being injected, there followed tetanus and death. The blood was found after death liquid, the lungs red and turgid ; the r. ventricle was distended with blood, the 1. contained scarcely any. Rauschenbusch has also made experiments with C. bark. In animals to whom he had given it for some d. he found stomach and alimentary canal contracted, and their coats

thickened, but no traces of inflammation. Heart was firmer, lungs covered with red spots, liver yellowish, bile watery and greenish . When blood was exposed to air, it remained dark coloured longer than usual, was less coagulable, and serum separated more slowly ; it appeared like that drawn in inflammation. During life pulse was stronger and fuller, and animal heat increased ; but when bark had been used for a long period muscles were pale and their energy enfeebled. (PEREIRA.)

Volume IV — Appendix

(See vol. ii, p. iiS.)

I. 17. C. F. S., in full health, pulse 60 and regular. Took iQ of tinct. in water at S a.m. Soon distension of stomach and repei iratcry regurgitations. 8.10, warm perspiration on face and hai vitliout Cause. 8.25, fulness and rumbling in abdomen with gripio parsed much flatus ; perspiration continues. 8.4-5> copious u 9-30, stool urgent and loose j increased saliva; tongue whitish; /noist all over. 10.30, pulse 80, thin and irregular ; feels restless 1 uneasy; occasional twitching of limbs. 11, head and face hot | congested, veins full and swollen. 11. 15, fluent coryza, with sncea ar»cJ lachrymation ; slight photophobia. 12, pulsating headache w h^^t; cold hands and feet ; repugnance to food. 2, pulse 84, full h^rd; headache continues; palpitation of heart after slight exen with oppressed breathing; slight chilliness, increased by drinking, ac^f^ing in sacral region, extending down thighs, with languor ; abdoi distended; ineft'ectual desire for stool. Sleep, dreamful at n. ; a with languor, coated tongue, and anorexia; urgent call to stool s4 aftcrrising. (Woodward, Trans. o/Int, Horn. Convention^ 1881, p

II, 3. On 3rd July, 1878, Dr. L. M. Yale asked me to sec a 0^ loss of sight, of which the following history was obtained : B.,a;t. 50, a man of very intemperate habits as regards the use alcohol, had been accustomed for years to drink enormously of brj and whiskey at intervals ; but there were periods of varying Jenj from one to three or four months, of total abstinence from incoxicai ''rinks. Mr. B. was told that the use of the tincture of cinchfl "'ould relieve him from his periodic craving for alcohol. On June 2J of this year he began its use, with a view of correcting his intempea "t>it5. On that day, as well as on the 25th, 26th, 27th, and 28th ^ontfnued to take the compound tincture in ounce and two oul doses, at short intervals, literally drinking it as a beverage from a qi| ^^tle, in which he had caused an apothecary to place as stron:

preparation as possible. On the 28th, although he had taken nom

*^ Ordinary alcoholic stimulants, his clerk thought from his condl

f**t Mr. B. had been drinking heavily. Dr. Yale estimates thad

j/'ese days the patient took an amount of the tincture which wo

«<^uivalent to 125 gr. of an alkaloid of cinchona. Mr. B. has

^^^^llection of any occurrence after the 27tb. He is confident that

. ^K no alcohol, except that contained in the preparation of cincho

j^*^rig these days. This, however, may be doubtful, for the clerk

^ hotel to which he went, when in what proved to be a sei

^*>scious state, on the 28th, states that while he lay in bed he 1

5**istantly ringing the bell for liquor. It is possible that during I

Vl**e some doses of alcohol were added to those of cinchona, althoi

^■*'- B. docs not believe this to be the case. On the m. of July ist

. * This tincture contains also some bitter oranze-pcel and a little serpentaria *^^ do not seem to have played any part in the poisonous action exerted

was seen by Dr. Hills in the absence of Dr. Yale. He found the patient stupid or half conscious, with flushed face and conjunctivz^ and apparently unable to see or hear. Mr. B. remembers Dr. Hilh' visit on Sunday, and knows that he was then blind and deaf. Dr. Yale saw the patient on Monday and Tuesday, July 2nd and 30!. His hearing power improved so much in that time as to become apparently normal, but his vision remained very much impaired. On the day I saw Mr. B., the 3rd, he was groping about his room, apparently in excellent general health. V. ^.£. «= quantiutire perception of light. L. E. counts fingers at one foot. The ophthilmoscope showed lessened size of the arterial vessels ; no abnormity in the veins ; lessened number of vessels on the papillae, but no marked paleness. No changes observed in the membrana tympani. The patient was advised to take strychnia in increasing doses and nutritious diet. On July 6th he was able to walk about. V. = |-g^ each eve, but the visual fields were very much contracted, so that vision) was telescopic. On 16th both visual fields were found concentrically limited. The measurements, drawn on a blackboard 14" distant, were as follows: — R. field, vertical, g in,\ horizontal, 7I in.; limitation most marked on temporal side. L. field, vertical, 7 In.; horizontal, 8 in. \ limitation more regular. B — found this symptom rather novel than troublesome. The optic papillae looked very pale, and the arteries were narrow. a3rd. — V. = i^ each eve. Patient states that he can see perfectly well in a straight line, but that when walking about room he has some difficulty in seeing small artido of furniture. Sept. lOth. — The same condition is maintained, Tlie strychnia was taken until j^ grain had been reached at a dose, and was continued for two months. I'he visual field remains as on July i6di. April 23rd, 1879. — Mr. B — 's condition remains substantially the siine. He continues to abstain entirely from the use of alcohol, and carria on a large business successfully. His vision is still |-J each eye. The visual field has increased somewhat in the 1. eye. It now measure* 9 in. verttcallv and 16 in. horizontally. F. of R. E. 6" vertically, <£' horizontally. Limitation most marked at upper inner quadrant. The optic disks are pale, and the arteries small. There are no other ophthalmoscopic appearances.

Remarks. — Mr. B — had taken no alcohol for some months prior to

his beginning the use of the cinchona, and he took none until he

became unconscious on the fourth or fifth day. Although he went

about and transacted business on the fourth day, he has no recollection

of what he did. When found, he had an empty bottle (holding «

quart) in his room, labelled and giving positive evidence of having

contained cinchona. He certainly did not take many drinks, if any,

after he reached the hotel, for the clerk, knowing his former habits and

supposing him to be suffering from an ordinary debauch, refused to

answer his demands. It is not known that he took anything but the

cinchona at any time after he began the treatment of the alcohol

habit. We have here, then, a case of hyperemia of the vessels of UlC

car from the use of cinchona and alcohol — a hypcrzmia which

away without gom^ on to atv exudative process i but the same

tionin the vessels supplying the retina continued until a true vas< with its consequences, resulted. The future condition of this cvtn if he never resumes the alcohol habit, cannot be regarded anxiety. It is to be feared that in time the macula may be insuffic nourished from further contraction of the vessels. The perij prts of the retina have now very little, if any, perceptive power nerve is perhaps undergoing atrophy. It is, I think, undoubted many experiments, among which are my own, that cinchona cati leijt temporary hyperaemia of the vessels of the base of the bra am fully aware, however, that, although certainly there was absc no loss of sight until the poisoning by cinchona occurred, ther have been changes in his circulation induced by alcohol prior U ittacic, and I also do not forget that there was enough alcohol f preparation which he took to prevent the case from being a typi« o( cinchona poisoning, yet the quantity must have been too sr hive added much to the effect of the other drug. He may, he liave drunk considerable brandy on the day of which he has no re tion, and some also after reaching the hotel. Certain it is, he 'hat he reached the unconscious state upon doses of the tincti cinchona alone. Imperfect as is the case in some respects, it think, be regarded as a contribution to our knowledge of the ef cinchona upon the nutrition of the eye. (St. John Roosa, ^hihalm.^ viii, 392.)

1. I was called to see a man xt. 35, who had taken withi ^ about 3ij of china in small doses. He was complaining of hfl ^ound temp, of loi", and a slightly flushed face. Next d., tens '^°, and a papillary eruption had appeared all over the body | '^^ no itching, but a burning sensation ; pulse irregular, ^ver subsided in 3 d,, and rash faded without desquamation. ■^- Engl. Med. Gaz.y xxiii, 270.)