Cinchona Officinalis

THOUGH Hahnemann wrote in his wonderful preface to the Provings of CHINA — Cinchona Bark — Cinchona officinalis

" Excepting opium I know no medicine that has been more and oftener misused in diseases, and employed to the injury of mankind, than cinchona bark," yet, it was quinine that revealed Homeopathy to Hahnemann.

This is how he describes that epoch-making discovery : —

" As long ago as the year 1790 (see W. Cullen's Materia Medica, Leipzig . . .) I made the first pure trial with cinchona bark upon myself, in reference to its power of exciting intermittent fever.

With this first trial broke upon me the dawn that has since brightened into the most brilliant day of the medical art ; that it is only in virtue of their power to make the healthy human being ill that medicines can cure morbid states, and, indeed, only such morbid states as are composed of symptoms which the drug to be selected for them can itself produce in similarity on the healthy.

" This is a truth so incontrovertible, so absolutely without exception, that all the venom poured out on it by the members of the medical guild, blinded by their thousand years old prejudices, is powerless to extinguish it ; as powerless as were the vituperations launched against Harvey's immortal discovery of the greater circulation in the human body by Riolan and his crew to destroy the truth revealed by Harvey .

These opponents of an inextinguishable truth fought with the same despicable weapons as do to-day the adversaries of the homoeopathic medical doctrine.

Like their modern congeners they also refrained front repeating his expel intents in a true, careful manner (for fear lest they might be confuted by facts) and confined themselves to abuse, appealing to the great antiquity of their error (for Galen's predecessors and Galeli himself had arbitrarily decided that the arteries contained only spiritual air, and that the source of the blood was not in the heart but in the liver), and they cried out, Malo cum Galen errare, quam cum Harveyo esse circulator . . . This blindness . . . was in those days not more stupid than the blindness of to-day, and the present aimless rancour against homeopathy which exposes the pernicious rubbish talked about ancient and modern arbitrary maxims and unjustifiable practices, and teaches that it is only by the responses given by nature when questioned that we can with sure prescience change diseases into health rapidly, gently, and permanently."

He says the ordinary physicians were guided by an utterly false principle : they confirmed the reproach he had so frequently made against them, that they had hitherto sought in traditional opinions, in guesses prompted by false lights, in theoretical maxims and chance ideas what they could and should only find by impartial observation, clear experience, and pure experiment, in a pure science of experience such as medicine from its very nature must be.

He tells us that in his day cinchona bark was regarded as " perfectly innocuous — as a wholesome and universally beneficial medicine in almost all morbid states, especially where debility was observed " : whereas, setting aside all guesswork and traditional unproved opinions, and adopting the method of experiment, he found as with other medicines, that as certainly as it is curative in some kinds of disease, so surely it can develop the most morbid symptoms of a special kind in healthy humans : symptoms often of great intensity and long duration, as he shows by the provings. And " thereby, the prevailing delusion of the harmlessness, the childlike mildness and the all-wholesome character of cinchona bark is refuted."

He tells us that this is one of the most powerful of vegetable medicines. Where it is accurately indicated in a patient suffering from a disease that China is capable of removing, he finds that " one drop of a diluted tincture of cinchona bark, which contains a quadrillionth (1 /000000,000000,000000,000000th) of a grain of China-power, is a strong (often too strong) dose which can accomplish and cure all alone all that China is capable of doing in the case before us . . . a second dose being rarely, very rarely, required."

He says, " in the case neither of this nor of any other medicine did a preconceived opinion or an eccentric fancy lead me to this minuteness of dose. No, multiplied experience and faithful observation led me to reduce the dose to such an extent. . . . and these smaller, and very smallest doses proved sufficient to effect a complete cure, and they did not display the violence of larger doses, which tend to delay the cure."

Again he tells us that, " A very small dose of China acts for hardly a couple of days, but a large dose, such as employed in ordinary practice, acts for several weeks, if not got rid of by vomiting or diarrhoea, and thus ejected. . . ."

" If the homoeopathic law be right — as it incontestably is right without any exception, and is derived, from pure observation of nature ", viz. " that medicines can only easily, rapidly and permanently cure, where the disease-symptoms match the drug-disease symptoms discovered by the administration of the drug to healthy persons, then we find, on a consideration of the symptoms of China that this medicine is adapted for but few diseases, but that where it is accurately indicated, owing to the immense power of its action, one single, very small dose will often effect a marvellous cure."

Then Hahnemann defines CURE. " I say cure, and by this I mean a ' recovery undisturbed by after sufferings.' "

" Have practitioners of the ordinary stamp another, to me unknown idea of what constitutes a cure ? . . . will they call cures the suppression by this drug of agues for which bark is unsuited ? I know that almost all periodic diseases, and almost all agues, even such as are not suited for China must be suppressed and lose their periodic character by this powerful drug, administered usually in enormous and oft-repeated doses : but are the poor sufferers thereby really cured ?

Has not their previous disease undergone a transformation into another and worse disease. . . Thus, they no longer complain of their paroxysms appearing on certain days and at certain hours ; but note the earthy complexion of their puffy, faces, the dullness of their eyes ! See how oppressed is their breathing, how hard and distended is their epigastrium, how tensely swollen their loins, how miserable their appetite, how perverted their taste, how oppressed and painful their stomachs by all food, how undigested and abnormal their faecal evacuations, how anxious, dreamful, and unrefreshing their sleep !

Look how weary, how joyless, how dejected, how irritably sensitive or stupid they are, as they drag themselves about, tormented by a much greater number of ailments than afflicted them in their ague ! And how long does not such a china-cachexy often last, in comparison with which death itself were often preferable.

" Is this health ? It is not ague, that I readily admit : but confess — and no one can deny it — it certainly is not health. It is another, but a worse disease than ague. It is the china-disease . . ." And he says, " should the organism, as it sometimes will, recover from this china-disease after many weeks, then the ague (suspended by the superior force of the dissimilar china-disease), returns in an aggravated form, because the organism has been so much deteriorated by the improper treatment . . . then, if the attack be renewed still more energetically with cinchona bark, and continued for a longer time in order to ward off fits, there becomes established a chronic cinchona-cachexy. . . ."

One finds it difficult to stop, but wanders on with sentence after sentence extracted from this delightful and illuminating little preface. But the above picture of what China can do to

pervert health, is the exact picture of what China can cure, provided it be administered after the manner of Hahnemann .

But, why stop ? Why not go on extracting and epitomizing ? for, after all, it is Hahnemann's Drug-picture of China. Here, as everywhere, it is the exact and absolute precision of the Master that makes the phrasing, at times, somewhat heavy and involved, and, one tries to catch the meaning and simplify, without sacrificing the idea.

And, in regard to DEBILITY, where he found China so useful, and where old school also esteems it, Hahnemann says :

" How can they ever imagine they can strengthen a sick person whilst he is still suffering from his disease, the source of his weakness ? Have they ever seen a patient rapidly cured of his disease by appropriate remedies who failed to recover his strength in the very process of the removal of his disease ? . . . These practitioners cannot cure diseases, but they attempt to strengthen these uncured patients with cinchona bark. How can such a stupid idea ever enter their heads ?

If bark is to make all sick persons strong, active and cheerful, it must needs be the universal panacea which shall at once deliver all patients from all their maladies. . . . As long as the plague of disease deranges the whole man, consumes his forces and robs him of every feeling of well-being, it is a childish, foolish self-contradictory undertaking to attempt to give such an uncured person strength and activity."

He defines the real China-debility thus, " There are no doubt cases where the disease itself consists of weakness, and in such cases bark is at once the most appropriate curative and strengthening remedy . . . as where the sufferings of the patient are solely or chiefly owing to weakness from loss of humours, from great loss of blood (also from repeated venesections) great loss of milk in nursing women, loss of saliva, frequent seminal losses, profuse suppurations, profuse sweats, and weakening by frequent purgatives, where almost all the other ailments of the patient are went to correspond in similarity with the China symptoms (see footnote in Materia Medica Pura) . . . in morbid debility of other kinds, when the disease itself is not suitable for this remedy, the administration of China is always followed by injurious consequences . . . although even in such unsuitable cases a stimulation of the strength is produced by it in the first few hours. ."

He says, " if there is no disease in the background to produce or keep up the loss of humours, then for this peculiar weakness, which has here become the disease, one or two doses as small as those mentioned, with nourishing diet, open air, and cheerful surroundings are as efficacious to effect recovery as larger and repeated doses are to cause secondary injurious effects . . ."

A quotation from Hughes (Pharmocodynamics) is of interest here. He says, " Hahnemann found Cinchona in use for two great purposes — as a tonic, and as a remedy for intermittent fevers. He proved it to discover on what principle it so acted. That it caused a febrile paroxysm was the Newton's apple which led him to formulate similia similibus as the law of specific therapeutics. . . .

He also found that it produced in the healthy a peculiar kind of debility ; and that its tonic properties in disease, when analysed, were demonstrably applicable to weakness of this very sort. . . . Where the weakness itself is the disease, Cinchona is curative, because homoeopathic to it. . . . He acutely pointed out that the best results which were obtained from it were seen in the convalescence from acute disease, and were just correlative to the super-added debility caused by the depleting treatment then pursued.

For all this you should read the preface to this proving, which is a masterpiece of observation and reasoning.

" This thought of Hahnemann was as original as it was brilliant and fruitful. It was a pure induction from his provings . . . Hahnemann's doctrine was far more definite, and at once fixed its genuine and certain range of action. It will not cure anaemic debility like Ferrum, or nervous debility like Phosphoric acid : but in that occasioned by loss of blood ; by diarrhoea, diuresis, or excessive sweating ; by over-lactation, etc., it is a most effectual remedy.

In all these cases ', said Hahnemann , ' the other symptoms of the patient generally correspond to those of China.' In one particular especially they do so, viz. in their tendency to pass into a hectic condition. We have here the succession of chill, heat and sweat which we shall see to be characteristic of the drug, and which gives it a place in the treatment of ague. It cannot be too strongly impressed on the mind that

China is the great antithectic. .

But remember that weakness from drain on the system is the sphere of the tonic action of Cinchona ; and within it you will find it manifesting some of the most beautiful curative powers known to the art of medicine. They are seen alike in the most acute and the most chronic forms of debility so induced."

In regard to the debility of China, one has again and again proved the value of the drug in patients who, after an attack of influenza, remained chilly and weak, and went crawling about feeling that they would never again be able to wear summer clothing, or go back to normal, and where potentized China promptly restored normality and the trouble was forgotten. Other, different cases, when, after 'flu, the patient would feel indefinitely unwell, with a temperature of about 99° (when one took it) and a feeling of heaviness and shakiness : here the rapid remedy is Gelsemium. Or where the legacy is nervous — even mental — Scutellaria comes in.

Or, again, Influenzinum ! One has always used it in the 200th potency ; and has seen it clear up such little legacies as furious, unbearable tempers, hitherto unknown in the patient, and epileptic fits. Influenzinum has done some pretty work after 'flu, though one cannot define its scope with any degree of accuracy : — except that these things have " only come on after an attack of influenza ".

But chacun a son métier — even with drugs. You cannot expect a plumber to do the delicate work of a cabinet maker, or a typist to be a Paderewski.

But among the out-patients who flock to us for help, there are quite a number of persons not demonstrably ill, but tired and below par, to whom a dose of China in potency is a marvellous pick-me-up. " Oh, that last medicine did me the world of good ! Can I have a repeat ? " If the trouble has been from anxiety, and night-nursing, and broken, or loss of sleep, one thinks rather of Cocculus : or if it has been a case of " moving house " and over-exertion and muscular fatigue, then Arnica will be the restorative : these are not China cases.

It is wonderful what Arnica will do for strain of all kinds — heart strain, even — from over-exertion ; or mental strain from overwork and anxiety — the doctor's overwork, when he begins to wonder, has he done this or that ? — and has to go back and look : here A mica every time. It is not in the big and savage ailments only that Homoeopathy comes in : it has great uses in restoring the overwrought, the " weary with dragging the crosses. Too heavy for mortals to bear." It pays to get a grip of the inwardness of our remedies !

And, mind ! the thing that you cannot cure, another person may, easily, because he has a grip of the remedy that is needed, which you have not : whereas, another case, impossible to him, is child's play to you — for the same reason. Some of our drugs are mere bowing acquaintances : we know their names, and have met them. Others, friends, have become " grappled to our souls with bands of steel ", because they have stood us instead in desperate situations, and we have learnt their powers, and can trust them with life and death.

But all these things come only with use.

In regard to DIARRHEA where one sees some of the most outstanding curative actions of China, Hahnemann says :

" As cinchona bark in its primary action is a powerful laxative (see the symptoms 497 et seq.) it will be found to be very efficacious as a remedy in some cases of diarrhoea when the other symptoms of China are not inappropriate to the rest of the morbid symptoms." The symptoms of the provings referred to are these :

"Three times soft stool with smarting, burning pain in the anus, and with bellyache before and after each stool.

" Looseness of the bowels, like diarrhea.

" Frequent diarrheic, blackish stools.

" Severe purging.

" Diarrhea of undigested faces, like a kind of lientery.

" Diarrhoea : as if the excrement contained undigested food . . . it comes away in separate pieces and when it is passed, there still remains desire to go to stool, but no more passes. . . ."

As to the extreme hyperaethesia of China, Hahnemann has this to say :

" Those attacks of pain which can be excited by merely touching (or slightly moving) the part and which then gradually increase to the most frightful degree, are, to judge by the patient's expressions, very similar to those caused by China. I have sometimes permanently removed them by a single dose of the diluted tincture, even when the attacks had been frequently repeated. The malady was homoeopathically (see note to 685) as it were, charmed away, and health substituted for it. No other remedy in the world could have done this, as none other is capable of causing a similar symptom in its primary action." (The footnote referred to reads, " It is peculiarly characteristic of China that its pains are aggravated not only by movement, and especially by touching the part " (here a number of the symptoms of the proving are referred to) " but also that they are renewed when not present by merely touching the part, as in the symptoms 749, 772 and then often attain a frightful intensity, hence this medicine is often the only remedy in cases of this description.")

All the writers since Hahnemann lay special stress on this extreme susceptibility to touch, as affecting pain : and often relief from hard pressure. As Guernsey expresses it, " from touching the parts softly ".

Practical tips in regard to the favourable action of China in intermittent fever are also given by Hahnemann in this preface. He says, " An intermittent fever must be very similar to that which China can cause in the healthy, if that medicine is to be the suitable, true remedy for it, and then a single dose of the above indicated minuteness " (i.e. the 12th potency) " relieves — but it does this best when given immediately after the termination of the paroxysm, before the operations of nature are accumulated in the body for the next fit . . ."

Hahnemann did not know the natural history of the malarial parasite : but, as usual, his observation fits the case !

He adds, " Cinchona bark can only permanently cure a patient, affected with intermittent fever in marshy districts, of his disease resembling the symptoms of China, when the patient is able to be removed from the atmosphere that causes the fever during his treatment, and until his forces are completely restored. For if he remain in such an atmosphere he is constantly liable to the reproduction of his disease from the same source. . . ."

Another nice little Hahnemannianism :

" That the ordinary physicians, by mingling iron in the same prescription with bark, often dish up for the patient a repulsive looking and unsavoury ink, may be overlooked, but they must be told that a compound results from this mixture that possesses neither the virtues of cinchona bark nor those of iron."

The article from which we have quoted is delightful : and should be read " in its entirety ", as they say when they put Hamlet , the whole Hamlet , on the stage — occasionally.

Guernsey says, ". The chief keynote calling for the use of China is found in the sufferings caused by the loss of fluids, such as hemorrhage, galactorrhoea, seminal emissions, diarrhea, etc. : debility whether much fluid has been lost or only a little . . . for any disease or troubles occurring periodically, at certain definite periods . . . extreme sensitiveness and irritability of nerves, or relaxation of solids.

" A peculiar feature of the diarrhea of China. Diarrhoea very debilitating : stools acrid, undigested ; watery ; bilious, black ; involuntary ; painless ; putrid ; profuse."

Here one has found China splendidly effective : one remembers a very hot summer with a great deal of epidemic diarrhea among small children. The painless, undigested stools, profuse and exhausting, very rapidly cured up with a few does of China. One was able to cure them easily in the out-patient department.

And Kent , . . . " Persons who have suffered much from neuralgias due to malarial influences, who have become anaemic and sickly from repeated hemorrhages, are likely to develop symptoms calling for China. It produces a gradually increasing anemia, with great pallor and weakness . . . symptoms are tending towards the cachectic state, which is avoided by the prompt action of the remedy. . . . Nerves in a fret : doctor what is the matter with me, I am so nervous ? ' . . .

Patient grows increasingly sensitive to touch, to motion, to cold air : so that he is chilled from exposure . . . till patient is always catching cold, has liver troubles, bowel troubles, disordered stomach, and is made miserable and sick by nearly everything he does. . . . Weak, relaxed, emaciated, pale, with feeble heart, feeble circulation and tendency to dropsy. . . . A peculiar thing about this dropsy is that it comes after haemorrhages. In the anaemic condition, directly following loss of blood, dropsy appears. . . ." This is the typical China patient.

"China has periodicity, but in no greater degree than many other remedies . . . still periodicity is a strong feature in this remedy. Pains come on with regularity at a given time each day. Intermittent fevers appear with regularity and run a regular course. Aggravation at night, sometimes sharply at midnight. (He gives a case of colic and bloating every night at 12. " After suffering many nights, a dose of China prevented any further trouble.")

" A chilly patient, sensitive to draughts, cold air, touch, motion." (One remembers a malarial case, where the slightest chill from a draught. brought on an attack, for which quinine was again and again taken, till it ended in a bout of black-water fever.)

In fevers, Kent emphasizes, " Thirst before and after the chill, and thirst during the sweat. During the heat, his thirst subsides, but all through the sweat he can hardly get water enough.

" Flatulent distension almost to bursting — (Colch., Carbo veg., Lyc.). Worse from fish, fruit, wine."

Now we will ask Nash to sum up for us Debility and other complaints after excessive loss of fluids. " Haemorrhages profuse, with faintness, loss of sight and ringing in ears.

" Great flatulence, as if abdomen were packed full : not > by eructation or passing flatus.

" Painless diarrhoea (yellow, watery, brownish, undigested). " Periodical affections, especially every other day.

" Excessive sensitiveness, especially to light touch, draught of air. Hard pressure relieves.

" Dropsy following excessive loss of fluids : great debility . . " Face pale, hippocratic. Eyes sunken, surrounded by blue margins : pale, sickly . . .

" Haemorrhages from all outlets (Crot., Sulph. a., Ferr .) Blood dark : or dark and clotted, with ringing in ears, loss of sight, coldness — sometimes convulsions.

" Shaking chill over whole body.

" Sweat with great thirst ; during sleep ; on being covered."