DISCUSSION ON THE TREATMENT OF INTERMITTENT FEVER


Is not QUININE the similimum to Intermittent Fever, par excellence? By QUININE, here, I mean, Sulphate of Quinia, Peruvian Bark, China, Cinchonidia, and others of that like. These are nearly identical so far as their pathogenetic or curative effects are concerned….


BY DR. E.A. Farrington, M.D., and others.

AT the December (1881) meeting of the Philadelphia County Homoeopathic Medical Society, the following discussion was held upon the treatment of Intermittent Fevers., the subject having been reported upon by the Bureau of Clinical Medicine and Zymoses:

Dr. McClatchey, having been invited by the President to open the discussion, did so as follows: “The Society will bear me out on the statement that my voice is not often heard in these discussions, and that I rarely refer to my cases,- least of all, to my cases. But I feel that I must not be silent, being called upon to speak, and must even do a little bragging too. On comparing may success in treating cases of Intermittent Fever, with that of others, that I hear or read about, I feel that I have been very successful.

I attribute my success entirely to this that I treat my cases Homoeopathically, rigidly adhering to the principle, similia similibus curantur in all cases. I follow the precepts of Hahnemann, and prescribe for the totality of symptoms. I individualize each case, and get all the symptoms together, those that are most prominent and those that are least so, the modalities, etc., and having done this, I choose that which is the Homoeopathic remedy for the case, and I find that this is in most cases, or at least, in a very large percentage of them, QUININE, and I believe that all my success in treating such cases is due to my close adherence to Homoeopathy

Is not QUININE the similimum to Intermittent Fever, par excellence? By QUININE, here, I mean, Sulphate of Quinia, Peruvian Bark, China, Cinchonidia, and others of that like. These are nearly identical so far as their pathogenetic or curative effects are concerned. I have heard quite a good many lectures on Homoeopathy, and one of the most frequently repeated statements, made on such occasions, was to the effect that Hahnemann, while engaged in translating Cullen’s Materia Medica into German, was dissatisfied with the explanation given by Mr. Cullen as to the action of Peruvian Bark in the cure of Ague, and that he set himself to experiment with that drug, and very greatly to his surprise, found that the drug, when taken by a person in good health, produced symptoms very similar to those produced in an attack of Ague.

This, together with other experiments, led to Hahnemann finding that drugs would cure symptoms similar to those that they were capable of producing, or similia similibus curantur. Thus Homoeopathy may be said to have had its foundations laid on Bark. Now was Hahnemann mistaken in all this? And if he was, is it not possible that he was mistaken in other things just as well, and might not Homoeopathy be an error altogether? But my experience proves to me that it is not, for just as Hahnemann found that Bark would produce symptoms analogous to those of Intermittent Fever, I have found that bark, or its alkaloid or alkaloids will cure genuine and true Malarial Intermittent Fever.

There are other remedies for Intermittents besides QUININE, as every physician knows, and it is not always necessary to give QUININE or China to cure Intermittent, as is also known to every physician. But there is not one, in my experience, so frequently indicated as QUININE, nor so often the similimum for a case of Ague. In that magnificent treatise, which we should all read daily, Allen’s Encyclopaedia of Materia Medica, you will find a complete record of the pathogenetic effects of QUININE and China, and in these records you will find nearly every symptom of a very large majority of Intermittent Fever cases.

If I were to ask this assembly to give me the keynote or notes for Natrum Muriaticum in Intermittent, the reply must be: :Chill commences at eleven O’ clock in the morning”, and “Herpes Labialis” The QUININE chill may commence at eleven o’ clock and there may be Herpes Labialis also. In regard to Capsicum, I would be told that the chill “commence in the back, thence spreading”, and so on. The China chill also begins in the back. The indications for the concentrated essence of bed-bugs (I confess I do not know what the indication for this delicious medicine is) a voice behind me says, “always worse at night.” If that be true, the chills of QUININE may be worse at night or at many other times.

In using QUININE it is not necessary to give it in the large doses of the old school, for if you do the effect of the drug will be superadded to those of the disease, the curative effect will be crowded out by the toxical effect, and the patient is apt to be made worse. I have never been quite able to understand why out school objected so to the use of QUININE, and seemed almost afraid of it. That the old school uses it is surely no good reason why we should not. It is Homoeopathic to Ague, no matter who uses it.

The old school are almost daily making use of our remedies, and shall we abandon them so soon as Ringer, or Harley, or Phillips introduces them and their methods to their old-school brethren? They are constantly making such experiments. There is a man almost within the sound of my voice, and his name is Horatio C. Wood, who is constantly making such experiments-rediscovering Homoeopathic screws. If we are to abandon our remedies so soon as the Allopaths take them for their use our whole Materia Medica is in great danger.

The physician who fails to use QUININE for Ague because of its Allopathic history, and with knowledge of its action, casts dirt on the graves of his ancestors, and is also belittling Homoeopathy.

Dr. C. E. TOOTHAKER: In what doses Dr. McClatchey give QUININE?

Dr. McCLATCHEY: In whatever doses I please or think will be best in the given case. ” Let no pent-up Utica contract our powers. The whole boundless continent is ours”.

Dr. TOOTHAKER: I cured a child of chills with China 30, after it had been extravagantly dosed with QUININE.

DR. FARRINGTON: I have been waiting for some other member to get up and reply to the remarks of the gentleman of my left. The insinuations which he has thrown out concerning Hahnemann are so outrageous that I wonder that so many did not rise, eager to defend, that the chair would find it difficult to decide as to who should be the first to reply. Is it possible that the gentleman’s eloquence has wrought this wonderful effect? If so I had better sit down, as I cannot compete with him. The assertions that he has made to-night in all truth (of course he does not mean them for a farce) show that Hahnemann claimed Peruvian Bark to be the remedy for Intermittent Fever. That is a “reading between the lines” which is rather too broad for me to comprehend.

Hahnemann thought when he was translating Cullen, s Materia Medica, that certain of the symptoms attributed to Peruvian Bark were rather peculiar. So he determined he would test them. He was astonished to find that he produced the same symptoms which he had, when he suffered from chills and fever. Now may good friend asserts that Hahnemann considered that, with few exceptions, Peruvian bark was the remedy for Intermittent Fever. Hahnemann distinctly says that China is the remedy when the chill comes so and so, the fever so and so, and the thirst so and so this is flat contradiction to the assertion that QUININE is the remedy for Intermittent Fever.

I deny, too, that those symptoms which he found under QUININE are as characteristic of QUININE, as they are of the others referred to. In may experience China is frequently indicated. If his remarks had ended here, I should have applauded. I find that the potency must not enter into the question at all. I do not believe in any “pent-up Utica.” I have given the drug high, low and crude. But the worst cases that I have ever had to handle were those in which QUININE had been abused.

The results of the administration of QUININE are two, either a cure, which oftener results, I confess, or a spoiling of the case, which often results, If the case has been one of malarial poisoning, and is taken in the beginning, if there is no systemic taint, psoric, sycotic, or syphilitic, QUININE will often by its power of destroying germs, prevent the manifestations of the disease. If there is anything in addition to the malarial poison, QUININE will ruin the case. The question is a broad one and is one which seriously involves Homoeopathy.

It is a question Which calls up the power of Homoeopathy to cure any disease in which there is a substantial poison, Rheumatism Scarlatina, Diphtheria, and the puerperal fevers. I never saw a clearly indicated remedy given which was not followed by relief. I have had many failures in the treatment of Intermittent Fever. I agree with the gentleman that it is more important to mention our failures than our success. I do not pretend to say that I have cure every case. But when my remedy has been properly selected, it has never failed, and that remedy has not always been China. I will not be confined to Cinchona, but I will take the whole of Nature’s gifts, and use them according to law, and not according to empiricism.

Dr.McCLATCHEY: I rise to correct an error on the part of Dr.Farrington. I said that Hahnemann claimed that while taking Bark he produced in himself symptoms very similar to those of an Intermittent Fever. This he surely did say, and if he mis- stated these circumstances, then might he not have mis-stated all other things from which he and we have deduced Homoeopathy? I did not accuse Hahnemann of stating the Bark is the chief remedy for Ague. It was I who stated that on my own behalf. I find the symptoms of Ague well and prominently

marked in the provings China and Quinine, much more so than any other drug in the Materia Medica, and I have abundantly proved, and seen it proved by others, by countless Homoeopaths and Allopaths, that Hahnemann’s provings and those of others are true and correct, and that Cinchona, as QUININE, is the remedy for Ague and that similia similibus curantur is here proven to be true. I am not responsible for the mischief which Allopaths do by giving those large doses of Quinia, and producing the pathogenetic effects to the drug to be added to those of the disease. I only wish to get curative effects.

DR. FARRINGTON: Dr. McClatchey said that if the father is not right in saying that QUININE is the similimum for chills and fever, is he not wrong in everything else? Hahnemann never said it; and, besides, what he said or did in the beginning of his work should not be charged against him; for later he said that China is the remedy when certain definite symptoms present. In one place he states that China is not the remedy for Intermittent Fever, because it is not even an intermittent remedy at all.

DR. McCALATCHEY: I don’t care whether Hahnemann said that Cinchona is an intermittent remedy or not. I know that it is a remedy for Intermittent Fever, and does cure it, in contra- distinction to the suppression or palliation it is charged with. Indeed, it acts as a true cure, and not by the suppression or palliation of symptoms.

DR. DUDLEY: I expected that something would be said about QUININE to-night, and as I have a weakness for QUININE, I prepared my speech in advance. If I could get along without QUININE, as some claim to do, I could get along without Homoeopathy altogether. Dr. McCLATCHEY stated that the symptoms of a majority of our cases of Intermittents can be found under the symptoms of China or Quinine. I believe that this is strictly true, and, consequently, physician who prescribes China or one of its preparations for Ague, is not far from Homoeopathy, whether he gives it in large or small doses. Why, therefore, should men be afraid to use QUININE? Is it simply because Allopaths use it? Dr. Dudley then read a collation of symptoms of China and Quinia, taken from Allen’s Pure Materia Medica, showing the prevalence of Ague symptoms of all kinds in the pathogeneses of these drugs, as follows:

Chill.- In the morning; in the forenoon; before dinner; in the afternoon; the whole afternoon; in the evening; the whole day.

Chilliness.- Slight; violent; transient; persistent; constant; periodic; with cold hands; with cold feet; with external coldness; without external coldness; with internal coldness; without internal coldness; with nausea; without nausea; with vomiting; without vomiting; with thirst; without thirst alternating with thirst; followed by thirst; preceded by heat; with heat; followed by heat; alternating with heat; over the back over the stomach; in the stomach; over the arms; over the legs; over the thighs over the forehead; above the elbows;;above the knees; on the chest; all over; external; internal; when walking; when sitting; when lying; when standing; in open air; in a warm room; in bed; after eating; after every swallow of drink; with heat; without heat; alternating with heat; before the heat; during the heat; after the heat; with red face; with yellowness of the face; with pallor; with goose-flesh; with chattering of the teeth; with weakness; with headache; followed by heat, then thirst; without subsequent heat, and without thirst.

Coldness.- Of hands; of feet; of nose; of left hand or of both hands; of left leg or of both legs; of stomach; internal; external; periodic; preceded by heat; followed by heat; with shivering; followed by heat, then thirst; followed by heat, then sweat.

Heat.- Preceded by coldness; followed by coldness; transient; in flushes; internally; externally with sweat; without sweat; with nausea; without nausea with slight thirst; with intense thirst; without thirst; of face; of abdominal region; of head; of trunk; of thighs; of cheeks; of extremities; of whole body.

Sweat.- At night; in the morning; after 3 A.M. during sleep; after waking; incessant; profuse; cold; with feverish heat; oily; exhausting; after fever; on face; on forehead: on neck; on back; on trunk; all over; with thirst; without thirst; in warm room; in open air.

Thirst.- In the morning; in the evening; before the chill during the chill; after the chill; before the heat; during the heat; after the heat; without heat; for water; for beer; for wine.

Nausea.- Without hot risings; in pit of throat; with vomiting; without vomiting; during the chill; during the heat.

Headache.- Confusion of the head; with vertigo; with dizziness; tensive pain in forehead and orbits; heaviness and heat in the head, worse on turning the eyes; jerking pain in the temples; headache now in one part and now in another; dull, stupefying headache, as though the skull would burst; as though the brain were pressed together from both sides; as though the brain were pressed out at forehead; like a congestion in the head ( this symptom ought to be italicized); violent pressive headache deep in the brain, with sense of constriction in forehead and occiput; jerking-tearing headache, worse on motion; headache, as if the brain were sore; headache, which changes its location on moving the head.

Urine.- Dark-colored, scanty, with brick-dust sediment.

Pain.- Across lower portion of chest and the stomach with anxiety and shortness of breath, and oppression; in or between the shoulder-blades; tensive and intolerable in small of back, as if crushed or bruised; jerking-tearing in bones of upper or of the lower extremities, in almost every part of their length., with numbness or paralyzed sensation.

Besides these we have jaundice, prostration, oedema, and host of other symptoms which I have not undertaken to include. Now about the cases which have suffered relapses while taking china. I have had cases come back at the end of week and tell me that they have had a relapse. I have had the same thing happen under Eupatorium, Belladonna, Capsicum, Arsenicum and other remedies. The trouble is that we have not learned how to administer out drugs in all cases. There is a difference of opinion as to when and how to administer QUININE. I learned how to administer it from Professor Dickson. He said that the proper time was shortly before the onset of the rigor in typical cases. I have nearly always found that I obtained the best effect by administering it three, two, and one, hours before the chill. The same is true of all other Homoeopathic remedies. I caution the patient not to take it after the chill comes on. I am satisfied that

QUININE, Eupatorium, or any other Homoeopathic remedy, if administered during the chill, will make the case worse and cause trouble afterwards. China Tincture I have given in from one to five drop doses. When I am sure of QUININE as my remedy I give from one to three grains. All my cases are well with one exception, and that is the case of a lady from Washington, who caught Potomac flat chills and took immense quantities of QUININE before I saw her. I have not cured her and I doubt if I ever will. Hypertrophy of the spleen complicates the case.

DR. MOHR. : Dr. Dudley appears to make out a very good case, and I only wish that I had thought to take my Material Medica and write down the chill and fever symptoms of Arsenicum, Baptisia and Eupatorium. I could have done the same thing, and the symptoms would have appeared as characteristic. Until this fall, I have never given QUININE in substance, although I have used Cinchona. When I have given Cinchona it has usually been for what I esteemed to be characteristic symptoms. I have always given Sulphate of Quinine in potency when I found the chill anticipating. Dr. Dudley asks us why we look to Allopathy in administering QUININE for chill and fever patients. Yet he says that he learned how to administer the drug from Professor Dickson, who was an Allopath. I do not believe in looking to Allopaths. so far as the administration of QUININE is concerned, as I have made up my mind that they do not know how to administer it. While they can prevent chills and fever, they cannot prevent relapses. Dr. DUDLEY refers to the fact that Eupatorium is much like Chinu in regard to the bone-pains. My interpretation of the symptom is somewhat different; while Cinchona has jerking- tearing pains, Eupatorium has more of a broken, aching feeling in the bones. If I had jerking-tearing pains I would give Cinchona; if it was a bruised, sore feeling I would give Eupatorium. My own preference has been for giving the remedy before the chill, and stopping it when the chill begins. I would not hesitate at all to give QUININE when it is indicated. I must confess, that in the case in which I resorted to QUININE, it did not help me out. Dr. McClatchey, in his remarks, refers to the fact that he will find Natrum Mur. and Capsicum-symptoms under Cinchona. It is a mistaken idea to give any remedy on any one symptom. I never prescribe Natrum Mur because a man has a chill at 11 A.M. because I have cured cases having that symptom with Cinchona and Eupatorium. I do not give Capsicum because the chill commences in the back; I must have other symptoms.

Dr. FARRINGTON: I have willingly admitted that some preparation of Quinine is frequently indicated in chills and fever. Dr. Dudley’s quotations from the provings, giving all sorts of symptoms of chill, and fever, and sweat, do but confirm my statement.

A German Homoeopathic physician quoted by Dr. Dunham, gives China when no other remedy seems to be called for. I have no objection to this method. It is a sort of reduction by exclusion. But the main issue between us, as I understand it is whether or not Quinine is so often the remedy. so precisely similar to all, or nearly all cases, as to deserve the specific use which Dr. McClatchey gives to it.

Now a misinterpretation may be taken from Dr. Dudley’s paper. Let me illustrate by two examples. Dr. Boenninghausen made the remarkable assertion that the anti-psoric remedy. Dr. Hering was astonished at the remark, and he inferred that Boenninghausen said that any anti-psoric would do when psora was present. But Boenninghausen meant that these remedies were so well-selected by Hahnemann that each one seemed to grasp the whole constitution, yet there are individual distinctions in each anti-psoric which render its selection certain. I say this in order to counteract the effect of the remark that all these symptoms being under Cinchona, therefore Cinchona is the remedy par excellence for chills and fever. Arsenicum is a remedy that covers 90 per cent. of the symptoms of Cholera Asiatica, and yet I would not say that it is to be given as the remedy for Cholera Asiatica. The rules of the ORGANON for the selection of a drug are true or they are not true. Let the discussion turn on that. If they are true, then we must be careful how we draw inferences from the remarks of Dr.Dudley.

DR. MOHR: I believe that the question of hygienic treatment is one of great importance. I make the patient to avoid the use of stimulants. If I had to depend, in the treatment of Intermittent Fever, on either the remedy or hygiene, I most certainly would prefer to depend on the hygiene.

E. A. Farrington
E. A. Farrington (1847-1885) was born in Williamsburg, NY, on January 1, 1847. He began his study of medicine under the preceptorship of his brother, Harvey W. Farrington, MD. In 1866 he graduated from the Homoeopathic Medical College of Pennsylvania. In 1867 he entered the Hahnemann Medical College, graduating in 1868. He entered practice immediately after his graduation, establishing himself on Mount Vernon Street. Books by Ernest Farrington: Clinical Materia Medica, Comparative Materia Medica, Lesser Writings With Therapeutic Hints.