SPHERE OF ACTION
I am at a loss to know whether this remedy should be placed in the ganglionic or cerebro-spinal group. All writers claim that its centre of action is upon the organic nervous system, but I believe the time will come when it will be placed in the cerebro-spinal group; certainly its action upon the brain would lead us to believe it was a narcotic, and I have concluded to place it in this group.
From cases of poisoning we learn that the. GRAND starting point and centre of action of Cinchona, and its alkaloid, the Sulphate of Quinine, is the ganglionic nervous centres that control the functions of organic life, and the base of the brain. Its great action is to cause debility of the ganglionic nutritive fibres. Debility is to the nervous system what anaemia is to the blood, and that is the great field for the action of Quinine. Its medicinal effect is to build up and prevent the destruction of nervous tissue; in such tastes, Quinine contributes wonderfully to the reparative process, in fact may be called the great conservator and builder of the ganglionic nervous system.
Head.–The action of this remedy upon the brain is very powerful and specific; its action especially centres upon the base of the brain, affecting those lobes that control the organic functions of the system, and sensation; that part of the encephalon that controls the emotional and intellectual functions are only affected sympathetically. This is why it so seldom produces mental excitement, delirium and coma; but its specific action upon the base of the brain is constantly shown us by the disturbance of hearing, loss of sight, and the reflex muscular movements of the circulation and respiration. These ganglia, in which Quinine produces such debility and prostration at the base of the brain, are the corpora, striata optic thalami and corpora quadrigemina. From the debility and prostration of these organs arises congestion of the brain, but the congestion hardly ever produces inflammation. Meningitis is said to have been produced in dogs. I do not think acute inflammation of the brain can be produced in man by the use of Quinine, I care not how large a quantity of it is given. It is to be regretted that no one has examined the base of the brain with the microscope in those what have died from the effects of Quinine.
Cinchona does not act directly upon that part of the brain in the cerebral lobes that performs intellectual and emotional functions; but sympathetically from the profound prostration of the ganglionic nervous centres, the mind is greatly affected.
Ears.–The Sulphate of Quinine acts specifically upon the auditory nerve, producing nervous irritation and complete prostration of its nerve cells. No remedy affects it so quickly, completely annihilating its functions; and for neurotic diseases of the ear, China and its alkaloid must be first in rank.
Eyes.–Upon the sensory ganglia of vision, Cinchona has a specific action, as shown by the dilatation of the pupil, and complete blindness. This is caused by its paralyzing the ganglionic nutritive fibres of the corpora quadrigemina.
Nose.–The action of Cinchona upon the nose is not of much importance excepting in hemorrhages from this organ; then, it is one of the most useful remedies we have.
Face.–In Quinine factories, the workmen are sometimes attacked with an acne-like eruption. When it located upon the face it produces great swelling of the face, eyelids and whole head, similar to the poisonous effects of Rhus. In acute poisoning with Quinine, the face becomes pale, sunken and Hippocratic, or it may be bloated and red.
Mouth, Teeth, and Throat.–Upon these organs Cinchona has no very specific action, but through sympathy they are prominently implicated; but upon the fifth pair of nerves it has a specific action, causing the most intense neuralgia of the teeth and jaws.
Appetite and Taste.–The powerful and specific action of Cinchona and the Sulphate of Quinine upon the ganglionic nervous centres that control the functions of appetite and taste, make it the king of remedies in diseases where they are perverted and destroyed. Its action is first to irritate, then to debilitate and completely destroy these functions.
Stomach.–From its specific action upon the semilunar ganglion, the nutritive functions are directly acted upon. Small doses increase the secretions of the stomach, and give great activity to the whole digestive apparatus; large doses debilitate and completely prostrate its functions, causing venous congestion of the stomach, but not active inflammation.
It also affects the pneumogastric nerve so as to produce nausea and vomiting.
Liver and Spleen.–We have now come to that part of the organism wherein lies the most useful sphere of Cinchona and its alkaloid, the Sulphate of Quinine. How does it affect those organs. This question is unsolved, yet let us all persevere until we can solve this very important question.
Let us first study its action upon the liver. We have learned in our study of Cinchona and its alkaloid, the Sulphate of Quinine, that its great action is to produce prostration and complete paralysis of the ganglionic nervous centres. Its great action then, upon the liver is to produce debility of the ganglionic nutritive fibres of the vaso-motor nerves of the hepatic cells, prostrating and annihilating their functions, producing long lasting congestion of the liver, with its many symptoms.
One of the most prominent of these symptoms is jaundice. Jaundice is not a disease but a symptom, and it is produced in the following way: The blood which has circulated through the capillaries of the intestines, spleen, pancreas and stomach, is carried through the portal system directly to the hepatic cells; the function of these cells is to prepare and secrete out of this venous blood by catalysis bile; the blood corpuscles of the portal veins contain all the constituents of bile in preformation, and when the hepatic cells have taken from, and prepared the ingredients of the bile from the blood corpuscles, it is transuded from one to the other until at last it is discharged into the small biliary ducts, located in the interlobular spaces. Now if we have congestion of the millions of lobules of the liver, the portal blood is entirely prevented from entering the liver by the clogged up state of that organ; bile is not manufactured and secreted, because the venous blood cannot enter the liver, but is carried into the vena cava by a collateral circuit, without touching the hepatic cells, and what little does come in contact with them, they are so prostrated that their functions cannot be performed.
This portal blood enters the general circulation, and the haematic properties of Cinchona dissolve the blood corpuscles, freeing the biliary elements, producing the jaundice in all its grades.
Upon the biliary ducts I believe Cinchona has a special action.
Dr. Angel, of Boston, says it is a specific for the expulsion of gall-stones; from this it not only increases the biliary secretions but must affect the muscular tissue so as to produce contractions of the neck of the gall bladder and larger biliary ducts.
Quinine never produces acute inflammation of the liver, but long lasting congestion.
Its action upon the spleen is more direct and powerful than any remedy we possess. To show its effects, I will introduce a table prepared by Dr. Smith. The Quinine was given internally:
—————————————————————– | Size | Dose of | Time which elapsed | Amount of reductions |of the | Quinine | before effect seen | |spleen. | given. | |In. long| Grains. | —————————————————————– 1 10 1/2 30 No effect observed 2 6 1/2 10 Three minutes… 1/4 of an inch.
3 6 1/4 10 No effect….. 4 6 3/4 15 Ten minutes…. 3/4 of an inch.
5 6 3/4 15 Two minutes…. 1 inch.
6 5 3/4 15 No effect…..
7 4 3/4 15 Ten minutes…. Distinctly reduced.
8 5 15 Ten minutes…. 1 inch.
9 4 15 No effect….. 10 5 3/4 15 Ten minutes…. 1/2 an inch.
11 5 1/4 15 Four minutes… Most marked reduction.
12 6 15 Ten minutes…. 1/2 an inch.
13 6 15 No effect…..
14 6 15 No effect…..
15 7 1/2 15 Five hours…. 1 1/2 inches.
16 7 15 Five hours…. 3 1/4 inches.
17 7 15 Five hours…. 3 inches.
—————————————————————– From this table the remedy failed entirely in six cases; of the eleven benefitted, seven proved permanent and four temporary, the spleen in these last having regained its previous volume.
In experiments made by Piory on several dogs, the spleen was uncovered and several liquids injected into that viscus without producing any change in its size.
An alcoholic solution of Quinine was then injected, and within one second the spleen contracted and lost one fifth of its volume, in one animal, and one sixth in the others.
Large doses of Quinine first diminish the size of the spleen by its action on the muscular fibres of the veins that this organ is so abundantly supplied with; the effect of organic reaction, or secondary effect, is an excessive supply of blood, producing enlargement and chronic hypertrophy of this organ, hence its great utility in enlargement of the spleen, following intermittent fever.
(1836-1897)
Characteristic materia medica Published 1873
Physiological materia medica, containing all that is known of the physiological action of our remedies; together with their characteristic indications and pharmacology. Published 1881