Cinchona Officinalis

[CHINA, PERUVIAN BARK. NATURAL ORDER, RUBIACEJS.]

Up to the middle of the seventeenth century, the medicinal prop- erties of this plant seem to have remained unknown. The name cinchona is derived from that of the countess El-Chinch on, wife of the then vice-king of Peru. This lady is said to have had an attack of fever and ague, and was cured by taking bark. She gave it to the Jesuits who distributed it among the poor, afflicted with the fever.

Hence it was named pulvis patnwi, powder of the fathers. It was also named powder of the Countess, in honor of the Countess El-Chinchon. The Jesuits of Peru sent some of the powder to Cardinal Lugo, the general of their order. Hence it derived the name of cardinal's powder.

The bark is found in Peru, Bolivia, in the neighborhood of Loxa, in the forest of Huanco, near Santa Fe de Eogota. The trees are first cut down and afterward stripped. Great care is used in drying the bark, in order to preserve the internal brightness and the lichens attached to the epidermis.

Of the crown of Loxa bark very little is now in the market. This bark always comes to us in quills distinguished by tints of grey in- clining to liver-brown, and marked by longitudinal furrows and transverse fissures. The lichens which are attached to it, give it the appearance of silver filagree. The yellow bark or Calisaya comes to us partly in quills and partly in flat pieces.

From the bark we obtain various alkaloids, which form salts by combination with acids. Among the latter, sulphate of quinia and sulphate of cinchona are worthy of experimentation.

We prepare an alcoholic tincture from the bark, having a bitter taste and a fine deep-red blood-color. We also use a watery decoc- tion of the bark. In order to make this as energetic as possible, it is best to add a little dilute sulphuric acid, which dissolves the other- wise insoluble cinchona, and, together with the quinine, forms a very powerful salt. In the course of these lectures on china we shall relate several cases of cure, where the decoction was used.

According to old-school experience, bark is a tonic ; it is one of the leading amara or bitter medicines, and this bitter principle is supposed to be endowed with tonic properties. Sundelein describes the strengthening virtues of Peruvian bark in the following words :

CINCHONA OFFICINALIS. 695

"The general operation of cinchona bark consists in the increase and exaltation of the tone of the irritable fibres and of the fibres of the vessels ; hence by its use the pulse becomes fuller, stronger and regular, and the muscular power increased ; also in the general aug- mentation of the cohesion of the organic mass ; hence it counteracts a tendency to liquefaction and disintegration, diminishes profuse secretions which proceed from atony of the extremities of the vessels and of the secreting surfaces and organs, and it improves generally the crasis or combination of the vital constituents in the tissues or blood, and lastly it consists in the augmentation of the vital energy of the sensible system. By the last mentioned property it restores sensibility, when defective or abnormally increased, and it restores the reactive faculty of the nervous system to its normal condition and augments the influence of this system on the muscular fibre and on the reproductive system."

The action of china upon the living organism is analogous to the action of arsenic. Both china and arsenic have a tendency to disin- tegrate the cohesion of vital constituents. Arsenic acts more sud- denly and destructively ; but china exhibits the same tendency as arsenic to taint the very fountains of life. It affects more particu- larly that portion of the ganglionic system of nerves which presides over the functions of the vegetative sphere; hence the semi-lunar ganglion seems to be the chief focus for the action of Peruvian bark.

It is a misnomer to call bark a tonic. The first effect of bark may be more or less stimulating; it causes a sort of vascular erethism char- acterized by an increase of warmth, muscular power, flushed face ; but this effect is not permanent. You will find that it is soon fol- lowed by an opposite condition of the organism, pale and bloated face, sunken eyes, expression of suffering in the features. Add to this the marked symptoms of deep-seated gastric derangement, slimy coating of the tongue, bad taste of the food, eructations with nausea, or bitter eructations after eating; oppression and anxiety after eating, worse while sitting, and passing off when rising from a seat; flatulent distention of the bowels, diarrhoea as if mixed with undigested food, or bilious, blackish-looking diarrhoea ; if we consider moreover that it causes lassitude, a bruised sensation in the muscles, stitches in the chest accompanied with asthmatic dyspnoea, palpitation of the heart, rush of blood to the head, and a variety of tearing, stitching and lancing pains; and if we consider lastly that cinchona deranges the action of the ganglionic system by establishing periodical fever

696 CINCHONA OFFICINALIS.

paroxysms in the organism, similar to fever and ague, we have an undoubted right to assert that, so far from being a tonic, cinchona bark exercises a disturbing and disintegrating influence upon the animal tissues.

It may not be superfluous to mention in this place the affections for which Hahnemann recommends cinchona bark;

1. Cinchona bark, having for its first consequence an aperient effect, will be found for that reason very useful in certain cases of diarrhoea, provided the patient has no other symptoms indicating some other remedy.

2. Hahnemann has sometimes seen pains which a mere touch or the least movement increased to intensity, and which, as described by the sufferer, greatly resembled those caused by bark, yield at once and permanently to a small dose of the attenuated tincture, although the attacks had often occurred; the evil was cured homoeopath] cally and. health restored as by enchantment.

3. Bark is seldom effectual unless it disturbs the rest of the patient at night, as it does that of persons in health who make a trial of this drug ; it causes frightful dreams which rouse the patient when he is on the point of falling asleep, and are often accompanied by oppression and anxiety.

4. There are some cases of suppuration in the lungs, principally such as are accompanied by shooting pains in the breast, excited or increased by external pressure, that have been cured by bark; a characteristic indication for the use of bark is a burning pressure on the chest, hectic fever, colliquative night sweats and profuse expecto- ration of pus, which may be streaked with blood. In cases of genuine phthisis it is not probable that china can do more than to palliate the symptoms. The palliating effects of china in this disease are beautifully shown in a case quoted in Frank, *s Magazine:

The patient was a brick-mason, thirty-three years old and born of healthy parents. Three months ago, he had been attacked with pneumonia, since which time he had been sick, expectorating every day a pint of fetid pus. His breathing was rattling, voice hoarse, pulse one hundred and twenty to one hundred and thirty, urine reddish, turbid, depositing a copious sediment ; feet swollen ; he had night-sweats, was sleep- less, had fever with delirium during the paroxysm, and, in spite of his appetite, became emaciated and weak.

He took every day one drachm of pulverized china in water acidulated with a little sulphuric acid. He went on improving from day to day, until he had taken one ounce and a half of the bark. He looked and felt quite well, except a little cough in the morning.

To these remarks I would add that the intermittents to which cinchona bark is homoeopathic, are characterized by a variety of peculiar symptoms. They often set in with the accompaniment of

CINCHONA OFFICINALIS. G97

numerous accessory symptoms, violent congestion, more particularly about the head, causing severe headache; or about the heart, causing severe palpitation and stitching pains in that region; or on the chest, causing oppression, cough and severe stitching pains with tearing and racking cough ; or in the bowels, causing distention and spasmodic tearing, stitching and colicky pains ; or in the back, nape of the neck or small of the back, causing a distressing aching and cramp-pains.

The attack is moreover ushered in by stretching, chattering of the teeth, paleness, a shaking chill, thirst and after- ward hot fever and profuse perspiration. Sometimes the thirst sets in before the chill and sometimes after; the tongue is thickly coated and the patient often complains of nausea and even vomiting. Be- tween the paroxysms the patient looks sallow, feels rather weak, has little appetite, although at other times the appetite is ravenous. He wants to be covered up or to sit near the fire.

In

PHYSCONIA LIENIS or enlargement of the spleen, china is recommended even by alloeopathic authorities as a specific remedy upon the principle of homoeopathicity.

A journeyman confectioner of cachectic appearance had been suffering with fever and ague for ten weeks without doing anything for it except drinking chamomile tea and aromatic bitters. His digestion broke down, and he experienced a sense of heaviness and fulness in the left hypochondrium. His skin assumed a dingy, sallow tint, the sclerotica had a lead-colored appearance, and the region of the spleen was considerably enlarged. He took pulverized china, a powder of eight grains every three hours.

The spleen decreased in size from day to day, and the patient was perfectly restored in twenty-four days. (Dr. Weitenweber, Austrian Med. Journal.)

Dr. Weitenweber admits in reporting this case that china cures enlargement of the spleen and liver by virtue of its power to cause similar morbid conditions in the healthy. He furthermore asserts that cures of this kind have been effected where the antagonistic or self-styled rational system of treatment had proved utterly power- less.

NEURALGIC AND RHEUMATIC AFFECTIONS.— We may likewise recommend cinchona for neuralgic and rheumatic affections, characterized by stitching, tearing and drawing pains in the head or extremities, especially when the pains are made worse by contact and are accompanied by slight vascular erethism, occasional creepings and flashes of heat about the head, and excessive restlessness, nervous- ness, wakefulness.

Our record shows a number of interesting cases of neuralgic affec- tions, and of rheumatic affections of a neuralgic or arthritic character, where china and its alkaloid quinine have effected beautiful cures.

698 CINCHONA OFFICINALIS.

i

A leading indication for china in these affections was the periodicity of the paroxysms.

ISOHIAS INTERMITTENS

A lady of thirty, who is frequently suffering with rheumatic pains, especially in the face, was attacked at the commencement of December, with an extremely violent pain in the lumbar region ; the paroxysm set in regularly every afternoon and con- tinued until late at night. After several sleepless nights, the patient became so excited that, with her eyes wide open, she was haunted by alarming phantasms and came very near being attacked with delirium. These paroxysms had been continuing for eight days, when a few doses of china stopped them immediately.

Even in other affections, the intermittent type of the paroxysms may be regarded as a prominent indication for china. Paroxysms of asthma, of bloody urine and of rheumatism of the abdomen, have been successfully treated with china, where the principal indi- cation was the periodicity of the attacks.

INTERMITTENT HEADACHE— The following case of inter- mittent headache is reported in Huf eland's Journal:

A girl of fifteen years was attacked with periodical pains in the head, which came on shortly after rising, and continued until the afternoon. The paroxysms were accompanied by dizziness, and very often violent vomiting. In the evening the patient was free from pain. The girl became pale, lost her appetite and strength, and wanted to be lying down all the time. The urine deposited a brick-dust sedi- ment. China restored her in a very short period.

MOIST GANGRENE.— Hahnemann tells us that, in studying cases of moist gangrene, one may perceive, in the general habit of the patient, morbid symptoms resembling those of bark, which ex- plains why Peruvian bark is so valuable under such circumstances.

The records of the old school contain many a cure of gangrene achieved by means of bark. Several of these cases have been trans- ferred by Frank to the pages of his valuable magazine, whence we translate them for our own columns.

GANGRENE OF THE SCROTUM—

A young man who had been successfully treated for inflammatory fever, was at- tacked with gangrene of the scrotum. He was found pulseless, with livid face, with- out consciousness and all his muscles convulsively twitching. Almost the whole of the scrotum was sphacelated. He took every four hours a drachm of pulverized china.

Very soon his pulse came up, a slight moisture began to make its appearance upon the skin, the scrotum began to suppurate and in about a month from the time he was taken the wound had become cicatrized.

GANGRENE OF THE ARM.—

A man of thirty years was attacked with phlegmonous erysipelas which was repelled (by lead- washes I suppose). The consequence was that the whole arm became gan- grened. It was cold and livid, the hand was swollen, the fingers immovable, pulse small ; constant fainting turns ; the patient did not even feel deep incisions. He took two drachms of a decoction of china every three hours.

The same decoction was applied externally in combination with brandy. Next morning the pulse rose, the warmth returned, suppuration took place, and in one month the patient's health was perfectly restored.

CINCHONA OFFICINALIS. 699

A wound of considerable size on the right leg, which had been neglected for a long time, began to look black and emitted a cadaverous odor. Diarrhoea set in. The patient took a small glassful of the decoction of china morning and evening, and ap- plied it likewise externally. Two days after, considerable improvement set in; in a few days more, a large scurf sloughed off, and the patient was entirely well three weeks thereafter.

ULCERS If ulcers should break out in consequence of the gen- eral decay of the reproductive system ; in cachectic individuals, of a sallow jaundiced appearance, cold or dry or clammy skin, china may be appropriate for the purpose of stimulating the reproductive func- tions of the organism. Under the influence of china, the ulcer may gradually be made to secrete a more healthy pus, and may finally heal up. In ulcers arising by a process of metaschematismus, in fever and ague, china may be in its place.

In either of these two cases, arsenic may have to be used sometimes.

DEOPSY. — In connection with this subject we may here mention the fact that dropsy may develop itself after mismanaged or neglec- ted intermittent fever. China may prove a specific remedy for this form of dropsy.

A farmer, forty years old, was attacked with bilious fever, which was succeeded by a tertian intermittent. This had already terminated in anasarca and ascites, when the patient sought the assistance of a physician. The use of china cured him com- pletely in a fortnight.

The fact that bark stimulates vital action after the excessive loss of animal fluids, will not be forgotten ; hence patients who have be- come weakened by bleeding, by venereal excesses, by diarrhoea and the like, may be benefited by china. In the case of women who have become enfeebled by nursing, china is often indispensable.

EMACIATION AND GRADUAL PROSTRATION.— In cases of emaciation and gradual prostration induced by chronic vomiting, china may prove useful.

A lady of tolerably good constitution who was in the sixth month of her preg- nancy, vomited every day whatever she put into her stomach. She became so reduced that fears were entertained for her life. No treatment was of any avail. She finally took the extract of china in a spoonful of soup. This treatment was continued for eight days, at the end of which period she had recovered perfect health. The precise dose is not stated, but it may have been about ten drops of the tincture at a dose.

JAUNDICE. — Bark seems to have a marked effect upon the liver and spleen ; in patients who had taken bark for a long period these organs have been found considerably enlarged. Hence the good effects of cinchona in some forms of jaundice, characterized by sal- low-dingy, yellow complexion, spasmodic-stitching pains in the liver, a crawling sensation, with stitches and enlargement in the region of

700 CINCHOXA OFFICINALIS.

the spleen, slimy, bilious taste, vomiting of bitter bile, loss of appe- tite, stitches and swelling in the pit of the stomach.

DYSPEPSIA AND GASTRALGI A.— Before we close this chap- ter on china, let us briefly glance at the relation which this drug holds to the functions of the intestinal canal and the digestive system generally. China may be of great use in dyspepsia and gastralgia.

Upon looking at our provings we shall find that it causes abnormal changes in the taste, such as slimy and bitter or insipid taste ; it causes drowsiness and oppression after eating ; qualmishness in the stomach, a shuddering after drinking, fetid flatulence.

CONSTIPATION.— The secondary effect (organic reaction) of small doses of china seem to be to bind the bowels; this costiveness is accompanied with vascular erethism, flushed face, fulness in the head, headache, palpitation of the heart. China is therefore homoeo- pathic to constipation accompanied by these symptoms. Also to

DIARRHCEA, where the discharges are slimy, bilious, sometimes blackish, or mixed with undigested food, and of a very offensive smell. Scrofulous children, with large abdomens, are subject to attacks of this kind.

The urinary secretions are likewise affected by china. The urine becomes scanty and turbid under the influence of china. Sometimes it deposits a whitish, and at other times a brick-dust sediment. This condition of the urine may confirm our selection of china in various arthritic and gastric conditions.

MENORRHAGIA. — China acts as a stimulant to the sexual organs. It causes increased erections, and involuntary nocturnal emissions ; in the female it causes excessive secretion of the men- strual blood, with discharge of dark coagula. Hence we may use it for menorrhagia, and likewise for excessive secretions of the seminal fluid, when arising from weakness with over-excitement of the sexual instinct. We may find china more specifically indicated in excessive

NOCTURNAL EMISSIONS and in spermatorrhoea, especially if the patient becomes weak and low-spirited, and is troubled with costiveness, dyspeptic derangement.

China is seldom indicated in affections of the air-passages ; never- theless if there should be difficult respiration, wTith wheezing; or with sensation as if the voice were deeper and rough, or as if the larynx were filled with phlegm, causing a suffocative sensation, or if the patient coughs up blood, especially toward evening, on waking from sleep ; bark may be prescribed with advantage. These symp-

CHININUM SULPHUKICUM. 701

toms may occur in asthmatic conditions of the air-passages ; in chronic catarrhal irritation of these organs, and in the suppurative stage of chronic bronchitis or chronic haemoptysis.

After long treatment, in which large doses of bark have been given, many inconveniences often remain which require to be coun- teracted by ipecacuanha, arnica, belladonna or veratrum. Veratrum is indicated by chilliness of the body with cold sweats.

OHENmiTM SULPHUEIOUM.

[quinine.]

Chininum sulphuricum is a most important alkaloid of china which fulfils therapeutic offices of a high order. Several remarkable cases of poisoning with quinine are related by Trousseau and Pidoux.

A soldier took forty-eight grains of sulph. q. for spasmodic asthma, which returned daily at a certain hour. Four hours after taking it he experienced buzzing in the ears, diminished sensibility, giddiness, and violent vomitings. Seven hours after taking the quinia, he was blind and deaf, delirious, incapable of walking on account of the giddiness, and vomited bile copiously. He was intoxicated with quinine. These effects subsided in the course of the night.

Recamier prescribed for a patient affected with acute rheumatism, forty-six grains of sulph. q. in twelve powders, one every hour. Next day the quantity was increased to seventy -seven grains similarly divi- ded, to be taken every hour as before. When the patient had taken fifty-three grains, he was suddenly seized with violent agitation, fol- lowed by furious delirium, and death in a few hours.

DELIRIUM TREMENS.— Guided by these symptoms we might perhaps prescribe quinine for furious delirium tremens, or for the sequelae of severe cerebral diseases, more particularly typhus cere- bralis and hydrocephalus, where

PARALYSIS of the special senses, especially of sight and hear- ing, is sometimes entailed upon the patient after the original malady had left him.

It is evident, from the many facts which have been gathered con- cerning the action of quinine upon the brain, that this agent causes severe irritations of the cerebral nerves, which lead to congestions of the cerebral vessels, and are characterized by other remarkable symptoms, such as violent buzzing in the ears, loss of hearing and vision, and violent gastric irritations which may be either consen-

702 CHININUM SULPHURICUM.

sual or the effect of a direct irritation of the lining membrane of the stomach.

Briquet's experiments in France have shown that quinine is pos- sessed of narcotic powers. Large doses of quinine depress the pulse, rendering the heart's action not only slower, but feebler. In cases of violent cerebral irritation, where quinine may have to be employed, these disturbances of the special senses, and the depression of the vascular system, constitute important indications for its use.

It is evident that these signs of depression may not be present if quinine is given in doses which are not large enough to overpower the organic reaction. Moderate doses of quinine, but sufficiently large to affect the organism medicinally, may cause vascular erethism and a congested condition of the cerebral vessels, characterized by severe pain in the head, and a disordered condition of the sensorium as manifested by flightiness, phantasms, excessive activity of the sensorial functions. Considering the effects of large as well as of smaller doses of quinine in their totality, we feel justified in con- cluding that it must be capable of effecting curative results in various cerebral affections, besides those to which we have already directed your attention. Indeed this agent has been found useful in mania of an intermittent type.

A lady who had taken an emetic on account of some gastric derangement, about a week after her confinement, was tormented a week later by frightful precordial anguish; her look was unsteady, and showed symptoms of an approaching delirium. In spite of her efforts to keep quiet, she jumped out of bed all the time in order to run away from home ; she loathed the sight of her husband and child, and threatened to destroy herself. She had violent palpitation of the heart, irritated but not very much accelerated pulse.

A subsequent paroxysm terminated in profuse perspiration. A few doses of quinine during the perspiration cured her completely.

SANGUINEOUS APOPLEXY of an intermittent type, may like- wise require the exhibition of quinine.

A lady of thirty years, of a plethoric habit of body, was attacked on the first of September, with flushed face, loss of consciousness, immobility, deep and stertorous breathing, large, very slow and strong pulse. She fell into the hands of an allceopath, and was bled. In the evening she was quite well. On the 3d of September, at the same hour, she was attacked in the same way, was bled, and as soon as the paroxysm had subsided, was put upon quinine, of which she took a single dose of twenty-four grains.

On the 6th, about the same hour, she felt a slight chill, followed by mode- rate heat and sweat ; she took another but smaller dose of quinine, and had no fur- ther trouble.

PERIODICAL CEPHAL^EA.— In this affection, periodical ceph- alsea, quinine will prove useful.

A lady who had been disposed to headache, menstruated very profusely after her forty-eigth year. After each turn she was attacked with severe pain in the head, nausea, disposition to vomit," chilliness, cold feet and debility. She took six doses of quinine of one-sixth of a grain each, and remained perfectly well ever after. (Kopps' Memorabilia, Vol. ii.)

CHININUM SULPHURIC CM. 703

HEMIORANIA. — In hemicrania of a paroxysmal character, where the attacks come on every day or every other day, quinine has often proved a remedy. These attacks are generally characterized by an abscence of gastric symptoms, although there may be diarrhoea. The symptoms of congestion and nervous irritability prevail. The pains may b 3 various: tearing, lancinating, hard aching and burning pains.

CEREBRAL CONGESTIONS, where the disease is paroxysmal, and the paroxysms are worse every other day, will often yield to qui- nine. Paroxysmal congestions of this character may affect other organs beside the brain, such as the spleen or heart. In

NEURALGIA INTERMITTENS, quinine has effected beautiful cures. These affections are regarded by some as masked fever and ague. The attacks are most frequently ushered in with a slight chill, followed by an increase of temperature generally, some vascular ex- citement and generally perspiration. The local pains vary according as one or the other portion of the nervous system is the seat of the affection. There may be gastric derangement, though not necessarily.

The periodical intermissions of nervous and congestive paroxysms point to quinine in a variety of other affections. This periodicity has been observed in trismus, in paraplegia, in ophthalmia, in pul- monary haemorrhage, and in all these cases quinine effected a speedy and permanent cure.

INTERMITTENT DYSENTERY.— In Frank? & Magazine, the following case of intermittent dysentery is quoted from the Medizin- isclien Correspondenzllatt :

A child was attacked every afternoon at four o'clock with violent pains in the abdo- men, followed by heat and from six to eight bloody evacuations, after which it fell asleep exhausted and in profuse perspiration. The intermittent character of the par- oxysms induced the medical attendant to prescribe quinine, which was administered endermically, the child refusing to take the medicine by the mouth. The attacks ceased at once.

INTERMITTENT CHRONIC RHEUMATISM

A chlorotic girl of eighteen years was attacked with rheumatic pains in the legs which was at first continual, but afterward became periodical. The attack set in every day at ten o'clock in the evening, and continued all night. Sleep was entirely banished by the pain. She took four powders of quinine of two grains each, after which the next attack was much milder, and the attacks ceased entirely after the second night.

EPILEPSY. — Even in epilepsy, the periodicity of the attacks may constitute an indication for quinine.

A boy of thirteen years old had been subject to epileptic attacks. The boy fell down, with loss of consciousness, without uttering a cry ; there was no sign of con- vulsions except a spasmodic clenching of the fists. The paroxysms recurred regu-

704 CHININUM SULPHURICUM.

larly every seventh day. The means used remained unavailable, until quinine was given ; this arrested the paroxysms permanently. The dose is not stated ; it may have been from five to ten grains from one paroxysm to the next following.

INTERMITTENT FEVER— While speaking of china, I have taken occasion to allude to the use of quinine in intermittent feveiv The indications for quinine are the same as those which i have given, for china.

Hypertrophy of the spleen is one of the permanent changes result- ing from a series of fever and ague paroxysms. This effect has been observed by thousands in numberless cases. During the chill the blood seems to recede from the splenetic vessels. A diminution of the size of this organ seems to be the primary effect, or rather the accompaniment of the chill.

The subsequent enlargement sets in with the supervention of the hot staga, when the blood is returned to the spleen with increased force as it were. This sanguineous en- gorgement may result in permanent hypertrophy of the parenchyma of the spleen.

Peruvian bark and its alkaloid quinine act in this respect simi- larly to fever and ague. The first effect of large doses of quinine upon the spleen is to diminish the size of this organ by cutting off the supply of blood ; the secondary effect, or the effect of organic reaction is to increase the size of the spleen by an excessive supply of the vital fluid. An acquaintance with this fact leads us to pre- scribe both the bark and quinine for

HYPERTROPHY OP THE SPLEEN, whether resulting from fever and ague paroxysms, or from simple sanguineous engorgement in consequence of exposure, dyscrasia, etc.

DEAFNESS Before closing our chapter of quinine, I desire to advert to the fact that quinine causes deafness, accompanied by buzzing in the ears, disagreeable noises in the head and vertigo. Scrofulous individuals, and persons of a cachectic habit of body; are sometimes suffering in this way. They are deaf, complain of a dis- tressing buzzing and ringing in the ears and head ; their ears are dry, and they sometimes have the appearance of being imbecile or absent-minded.

Arsenic is of immense use under such circum- stances ; let us not forget quinine.

CHLORAL. 705

loss of si°-ht and confusion of sense which may even amount to an actual loss of consciousness. A solution of quinine in a little dilute sulphuric acid may prove eminently adapted to the emergency.

DYSPEPSIA. — The power of quinine to derange the bowels has been alluded to before. Quinine causes a train of gastric disturb- ances that make it a most valuable agent in some forms of dyspepsia and cardialgia. where the patient complains of nausea, loathing of food, bitter eructations, bitter taste in the mouth, vomiting of bile, oppression of the stomach, heartburn, or a burning sensation in the stomach and oesophagus, or a feeling of constriction and a pulling sensation in the stomach. AVe know that quinine has occasioned a similar train of symptoms by applying it endemically to the epi- gastric region.

Costiveness is attended with symptoms of congestion, fulness about the head, increased warmth in the head and body, flushed face, oppression.

OHLOEAL.

[CHLORAL HYDRATE, HYDRATE OF CHLORAL.]

Chloral was discovered in 1832 by the eminent Liebig, who pro- duced it by the action of chlorine upon alcohol, forming "heavy muriatic ether." If this is washed with three times its volume of sulphuric acid, an oily liquid floats on the surface, which upon re- distillation, after being once more mixed with sulphuric acid, distilled, and receiving an addition of quick-lime, yields pure chloral. This colorless, oily liquid is heavier than water, comparatively tasteless and mixes with water, alcohol or ether. Equal parts of pure chloral and water unite, forming by their union the chloral hydrate, a white, glistening solid of bitter, acrid taste. Dumas, Wurtz and others

VOL. I. — 44.

706 CHLORAL.

studied it perseveringly ; but it was little known, until Dr. Otto Liebreich discovered the remarkable effects which it produces upon the animal economy.

According to Liebreich the effects of chloral are due to a paralysis of the ganglionic cells, first of the brain, then of the spine, and lastly (and in fatal doses only) of those of the heart. He considers its mode of action due to the production of chloroform in the blood, by decomposition of the chloral, under the influence of the alkaline salts of the serum. This proposition has been emphatically denied by others, but is endorsed by Dumas, Persoune and other eminent authorities.

Usually some twenty to forty-five minutes elapse before the first effects of chloral show themselves upon the patient by slight agita- tion, followed by a state of somnolence, varying in length and pro- fundity according to the size of the dose, and from which the patient arouses with a dazed, troubled feeling, lasting but a short time. In a few cases there exists for some little time after awakening a lack of co-ordination of the voluntary movements ; and in one case,

CHLOBAL. 707

"The physiological action of chloral may be summed up as follows: Upon the cerebrum it acts as a most powerful and certain hypnotic ; in full doses it acts as an intense depressant upon the centers at the base of the brain, and upon the spinal cord, causing slowing and weakness of the heart's action, probably vasor-motor paralysis, slow- ing of the respiration, and muscular weakness, with a certain amount of anaesthesia ; in fatal doses it causes death, generally by arresting, through paralysis of the nerve-centers, first respiration, and finally the heart in diastole.

Its action in very small doses is uncertain, but there is considerable evidence to indicate that chloral irritates or stimulates the spinal and the cardiac, and even the vaso-motor centres. On the vagi and on the motor nerve trunks it has no marked influ- ence. (Dr. H. 0.

Wood in Therapeutic Materia Medica and Toxi- cology, page 320.)

In children about four years old a dose of one drachm, given by the stomach or in solution as an enema, will produce profound sleep. "Above five years, and up to fifteen, it is necessary to give from two to four grammes, but, at this dose, the sleep is profound, and the

708 CHLORAL.

Dr. Bricheteau, the author of the sentences just quoted, holds, with other authorities, that the purity of the drug is a most impor- tant item, and claims that the many unpleasant and at times fatal results, are due to impurities of the article administered. The fol- lowing hints will be of assistance : First of all be sure to procure the solid hydrate ; a solution, if more than a day or two old, is never reliable ; freshly prepared, as you desire to use it, you can invariably depend upon its acting promptly.

Tested with a concentrated solu- tion of potash, it will give to the solution a light yellow color, if pure ; a decided brown color, if it is impure. The pure chloral will evolve an odor of pure chloroform ; the impure article will produce an acid, strong odor, which, however, has the characteristic of cholo- form.

Presuming that no sensible physician will deny the absolute neces- sity of making occasional use of these sleep-producing agents, we will not waste space in arguing the question, but will cite a few cases, illustrating the value of chloral.

In September, 1875, I was called to see a man, aged about twenty-seven, who had delirium tremens, this being the third attack in less than one year. For two days homoeopathic remedies were faithfully used, with no success, although the remedies prescribed were well indicated. The sick man had been without sleep for four suc- cessive nights ; and being among strangers and with limited means his case seemed very hopeless, when at the end of the second day of my attendance violent convul- sions set in.

He received at first teaspoonful doses of a solution of one grain of the sulphate of morphia every fifteen minutes, with no effect whatever ; the doses were increased gradually, but with no greater success; a subcutaneous injection of mor- phine was next in order, with equally unsatisfactory results. Fifteen grains of chloral were then administered, producing a few moments quiet slumber and freedom from convulsions, the latter returning as soon as the sleep was broken. Forty grains of chloral-hydrate gave him over five hours quiet sleep, and twenty grains more carried us through the night.

While fully under its influence his sleep seemed absolutely natural ; the pulse was normal ; breathing was easy and he awakened, weak and weary, it is true, but without a single unpleasant symptom, much less a return of the convulsions.

The eminent Professor Playfair recommends the use of chloral during labor, especially in women of a highly developed nervous

CIILOKAL. 709

As a matter of course the use of chloral is not without its dangers. Frequently it has been given in enormous doses, without unpleasant consequences ; and moderate doses have been known to produce poisoning; the smallest dose on record (Neiv Remedies, April, 1874,) which caused poisonous effects consisted of only fifty grains, Vhile four hundred and sixty grains have been taken without causing un- toward symptoms.

The following cases may be looked upon as involuntary provings of chloral : A lady of about thirty years of age was in the habit of taking, every ten to fifteen minutes, half-grain doses of chloral dis- solved in water, for neuralgia of the face, without experiencing any unpleasant effects. Since a recent confinement she has taken it in similar quantities and has had each time an attack of erythema on the fingers of both hands. There were about a dozen oval-shaped inflamed spots of about one inch in length, which caused constant

710 CHLORAL.

German writers have observed that the administration of chloral in patients who labor under hepatic derangements is unsafe, because it is apt to develop icterus and subsequent serious conditions. Why this is the case, they do not pretend to explain ; nor do they assert that it produces these effects in all cases.

In one case chloral produced temporary paralysis of both legs below the knee.

CHLOROFORM. '\ 11

Another peculiar condition which occasionally follows the use of chloral, is a marked irritation of the eyes, which shows itself by injections of the conjunctiva, swelling of the eyelids and sensitiveness to light.