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.
The coeliac axis being one of the greatest centres for the action of Quinine, and its branches being so abundantly supplied to the spleen, shows us at once why Cinchona has such a powerful action upon this organ. The ganglionic life of the Malpighian bodies of the spleen is destroyed through its action upon the coeliac axis, and their catalytic blood-making functions are lost. This is one cause of the anaemia we see in those who are suffering from Cinchonism.
Abdomen.–The action of Cinchona upon the intestinal canal is to produce debility, through the ganglionic nervous centres of the abdomen. Its action upon the liver and spleen, clogging their circulation, causes great venous congestion of the bowels; the stagnation of the blood in the vena porta causes ascites.
Urinary Organs.–Through the vascular system Cinchona and its alkaloid, the Sulphate of Quinine, affect prominently the urinary organs, greatly diminishing the uric acid.
Dr. Ranke tried it in three individuals in health, and found that under the influence of Quinine the uric acid was diminished nearly one-half. Dr. Hammond made a series of observations during an attack of intermittent fever, where, as in all fevers, the amount of uric acid is always greatly increased. He found in this case the quantity promptly reduced more than one-half by the action of Quinine.
Quinine may be easily detected in the urine; the solution employed by Bryant for this purpose contained, to two parts of iodine, eight of iodide of potassium and two hundred and fifty of water. He found the action of the test to correspond closely with the observable effects of the medicine upon the nervous system. After the exhibition of eight grains of Quinine in one dose, a precipitate sometimes appeared in half an hour, though more frequently at the end of two hours; after four grains, in two or three hours; after two and a half grains, if any appeared it was not till the expiration of five or six hours.
The length of time, therefore, before the appearance of Quinia, is invariably proportion to the quantity taken, and the same rule hold in relation to the period at which the effects are felt.
Another fact noticed by the same experimenter, is that the quantity of the salt of Quinia eliminated is directly proportionate to that introduced. A third, also highly interesting, is that elimination always ceases after a short time, generally little exceeding that during which the effects of the Quinia persist.
Thus, after a single dose of about three grains, the Quinia disappeared from the urine in from twenty to twenty-four hours; after thirty grains taken during twelve hours, in about forty hours; and after large doses, taken for several days, in from sixty to eighty hours. This beautifully illustrates to us that the action of Quinine is not through any chemical combination with the tissues, but that it is through its spiritual medicinal principle upon the vital organ.
Under the action of Quinine the urine becomes scanty and turbid, depositing a brick-dust sediment; it also sometimes deposits a whitish sediment.
Sexual Organs.–The powerful and specific action of Cinchona and its alkaloid, the Sulphate of Quinine, upon the organs of special sense located in the cerebellum, shows us at once why Cinchona is so useful in diseases of the generative organs.
Although we do not know for certain, just the exact location of the organ of special sense that controls the sexual functions, we are certain that its location is in the cerebellum. Cinchona affects the whole nervous life of the cerebellum, debilitating and prostrating its functions, consequently affects specifically the organ of special sense hat controls the sexual functions. I also believe that some portion of the medulla oblongata has something to do with the sexual appetite. The regulation of the motor functions is certainly presided over and controlled by the cerebellum, and it may be that debility of this function, so prominently produced by Cinchona, explains in a great measure its great action upon the sexual organs, for it is in diseases where debility of the motor nervous system is so prominent that China is especially called for.
Of course we must keep constantly in our mind the fact that debility of the ganglionic nutritive fibres is one of the great effects of Quinine.
Respiratory Organs.–The action of Cinchona upon the respiratory organs is not of a specific character. No particular pathological changes are produced in these organs, excepting debility of the ganglionic nervous centres which preside over their nutrition. The long-lasting hemorrhages of the lungs, and profuse suppurations, through its action on the ganglionic nervous system, it becomes one of the most useful remedies in the Materia Medica.
Back.–Cinchona causes anaemia and debility of the muscles of the back, in this way causing neuralgia, and myalgia of the muscles of the back.
Extremities.–Upon the extremities Cinchona produces debility of the muscles, myalgia and intermittent rheumatic neuralgia. Full doses of Quinine produce complete prostration of the motor nervous system, similar to Gelsemium and veratrum viride; but it takes but a small quantity of the two last-named remedies to produce profound prostration of the muscular system, while it takes immense quantities of Quinine to get this great prostration.
The effects of Quinine are more lasting (chronic in nature), the prostration of the muscular system being caused by anaemia of the blood from prostration of the vegetative nervous system; while Gelseminum and Veratrum viride act directly upon the motor nervous system, producing great prostration of the muscular system, but soon pass away, leaving no bad results. The long- lasting bad effects of Cinchona are beautifully shown in Cinchonism (Quinine poisoning).
Skin.–In the Quinine factories of France, it seems that an acne-like eruption is one of the most common effects of exposure to the Cinchona dust, and it is so clearly recognized that some workmen are obliged to abandon the business on account of its persistence. It appears in the form of an acne-like, itching eruption, principally upon the thighs, scrotum, &c., though often over the whole body, exuding a sero-pus, and finally forming scabs. When the suppuration attacks the face, it occasions great swelling of the head, face, and eyelids (similar to the effects of the poison of the Rhus), and the sufferings of the patient are often very acute, especially when it attacks the genital organs. It makes its appearance very shortly after exposure to the poison, and disappears upon the removal from its influence.
Cinchona and its alkaloid have often cured moist gangrene of the scrotum and vulva. The above effects show that it has a special action upon those parts. From the prostration and decay of the productive system, ulcers may be produced upon the skin.
Quinine has often cured such ulcers.
Quinine produces anasarca by its action upon the liver and spleen, checking the portal circulation.
Blood.–In the Dublin Quarterly, for August 1856, Dr. S.
Garden has shown that Quinine defibrinates the blood, rendering it fluid and uncoagulable; this is brought about from prostration of its ganglionic neuropathic element of nutritive force that presides over composition and decomposition. There are other changes it produces in the blood, but as yet its haematic action is not fully understood.
In anaemia and chlorosis, where they have been caused from loss of vital fluids, and debility of the muscular system in the most prominent symptom, Cinchona, or its alkaloid, will be found the remedy par excellence.
In various blood diseases, Cinchona and its alkaloid will often be indicated where debility of the muscular system is long- lasting and prominent.
Fever.–Fever is the effect of specific agents being carried by the circulatory system to those structures of the body for which they have a special affinity, where they constantly emit, or give off, their toxic principle; affecting, first, the ganglionic nervous system; second, the circulatory system; third, those organs that constitute the system of secretion and excretion. Dr. Smith says: The chain of diseased organs consists of the brain and spinal cord; the heart arteries, especially their capillary extremities; the secreting and excreting organs, which in fact, are composed essentially of the capillary extremities of the arteries; the secreting and excreting extremities of these arteries, especially as they terminate in the external skin, and in the mucous membranes which form the internal skin.
There never was a case of fever in which all these organs and function were not more or less in a disordered state; and this complete circle of organs was never in this morbid state without fever. A deviation from a healthy state in one or two circles will not produce fever; there must be deviation in the three circles before ever can exist.
Every fever remedy must act upon the nervous system, and especially upon the vasa-motor part of it. In our study of Cinchona we have found that its centre of action is upon the base of the brain, and the ganglionic nervous centres that control the functions of organic life.
This explains at once to the Homoeopath why Cinchona, and its alkaloid, are so useful in fevers, because it acts specifically upon the same organs and tissues that are affected in fevers. The poison causing the fever, and the Quinine poison, are so constituted that they have an affinity for each other so strong that the system acting upon them unites them by catalysis, forming an entirely new substance that has no more affinity for the same organs and tissues, consequently are easily thrown off, and the functions of the body become normal again.
Every fever to which the human organism is subject, affects certain organs and tissues peculiar to themselves; for instance the effects of scarlatina differ from those of diphtheria; the specific agents that cause small-pox and morbilli differ greatly in their effects; the same with typhoid fever and malarial fever.
All produce fever, but each specific agent produces changes in the organism peculiar to itself. So it is with our remedies.
Cinchona produces changes in the organism identical with those produced by malarial fever; this makes it the great specific for intermittent fever. The effect of Cinchona being altogether different from the effect of the specific agent that causes typhoid fever, shows us at once why it is not homoeopathic to typhoid fever.
A remedy that is really specific for any disease, must produce changes in the organism similar to those produced by the disease, and affect the same organs and tissues. We find this to be true with Quinine. The cerebro-spinal and ganglionic nervous centres, that are especially invaded in malarial fevers, are the exact centres for the action of Cinchona, and the changes produced by both in the organism are identical. This great truth was first grasped, and shown to the world by the immortal Hahnemann.
We find, then, that the fever to which Cinchona is homoeopathic, is of a malarial character, but not every malarial fever will be cured by Quinine. The fevers curable by Quinine must be malarial in origin, and their symptoms must be similar to those produced in the healthy organism by Cinchona.
The fevers, then, in which it will be found especially useful, are, intermittent, pernicious intermittent, remittent and bilious fevers. Typhus, typhoid, and the various eruptive fevers, will scarcely ever find their homoeopathic remedy in Cinchona; but for some of the sequelae following those diseases, it will sometimes be found of great value. Paludal malaria often, instead of producing intermittent fever, takes the form of neuralgia, and no remedy can compare with Cinchona and its alkaloid for this neuralgia, when it comes on periodically, is worse in the afternoon and evening. It is more apt to be located about the eye, or head, when China is called for. The temperature of the body is greatly elevated by the action of Cinchona and its alkaloid, the sulphate of Quinine. This shows us again the great truth of our law, for in fevers curable by Quinine the temperature of the body is greatly elevated, as shown in intermittents.
For a complete and exhaustive treatise on Cinchona and its alkaloid the sulphate, see my monograph on this remedy published by John W. Munson, Esq., of St. Louis, in 1871. Is was written as my ideal form of a materia medica, and is still my ideal material medica.
The system has been debilitated by the loss of vital fluids, especially blood, semen, diarrhoea, leucorrhoea, or over- lactation. Patient is worse every other day.
The touching of the affected parts, or motion, brings on the most horrid and intolerable neuralgia.
Head.–Long lasting congestive headache, with deafness and noises in the ears.
Heaviness of the head, with loss of sight, fainting and ringing in the ears.-.
Intense throbbing headache, after excessive hemorrhage.
Congestive throbbing headache, with singing, roaring, hissing noises in the ears, especially if the person has been debilitated by the loss of blood or vital fluids.
Headache, aggravated by a draft of air, in the open air, from the slightest contact, and relieved by hard pressure.-.
Sleeplessness at night; he lies awake nearly all night, thinking, restless and uneasy, and miserable the next day.– HEMPEL.
Full of plans and projects, especially in the evening and night.–HEMPEL.
Headache improves by moving the head up and down.-.
She thinks she is very unfortunate, and constantly harassed by enemies.
Convulsions with rush of blood to the head and chest, with throbbing of the carotids.
Greatly depressed in spirits, aggravated by noise or anything that affects the senses.
Complete deafness, in weak debilitated people from loss of blood. Intermittent neuralgia of the fifth pair of nerves, worse evenings and by contact.
Digestive Organs.–Thick, dirty, yellow coating upon the tongue, with bitter taste.
Complete loss of appetite, in people suffering from malaria.
Great longing for acids.
Canine hunger, especially at night.
Stomach is excessively acid.
Enormous distension of the abdomen, feels packed full, not relieved by eructations or dejections.
Abdomen fell full and tight as if stuffed, eructations give no relief.
Sour vomiting of water, mucus and food.–JAHR.
Diarrhoea, of water, or undigested food, mostly at night.
Infarctions of the liver, with jaundice.
Excessive jaundice in those suffering from malaria.
For gall-stones, Dr. Angel thinks it is a specific.
Diarrhoea of yellow, watery, undigested stools, with much flatulence and no pain.
After eating fruit, undigested stools, sometimes involuntary.-.
Much colic every afternoon.
The liver is swollen, hard, and tender.
Great fermentation in the bowels, with frothy, sour diarrhoea.
Urine dark, scanty, and throws down a brick-dust sediment.
Sexual Organs.–Spermatorrhoea of long standing, where debility is the prominent symptom.
Nocturnal emissions, with great sadness and debility.
Women.–Menses too profuse, with sensation of great distension of the abdomen.
Hemorrhage after miscarriage, with great loss of blood, placenta retained.–F.
She cannot bear to be touched during labor pains, not even her hands.
Metrorrhagia, and menorrhagia, where a great amount of blood has been lost.
Leucorrhoea before the menses, with painful pressure towards the groin and anus or bloody, fetid leucorrhoea, with contractions in the inner parts.
Generalities.–Neuralgia, the pain is excited by merely moving the affected parts, and gradually rises to a most fearful height.
Neuralgia may have disappeared for a moment, but the touching of the affected part brings on the most horrid and intolerable pains. Especially if it is of a malarious origin.
Congestion of any part of the body, with well marked periodicity, worse every other day.
Weakening night-sweats till morning.-.
Very debilitating morning and night sweats.-.
Cough with a granular expectoration during the day, or in the evening, not at night or in the morning.-.
Fever.–Intermittent fever, paroxysms come on an hour or two earlier, every day, or every other day.
The three stages are sharply marked; chill, fever, and perspiration. The chill may be absent, but the fever and perspiration must be present.
There must be perspiration following the fever, or Quinine will be utterly useless.
Recent intermittents, there may, or may not be a chill, but there must be fever, and it must be followed by sweat, and it generally is profuse and exhaustive.
As a rule, chronic, long-lasting intermittents are only aggravated by Quinine.
Recent intermittents, with gastro-bilious symptoms, followed by accompanied by exhaustive perspiration.
Periodicity is the ruling symptom of China.