Family Name: Apocynaceae

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Notes from the Eclectic Physicians

Notes from the Eclectic Physicians

1883: Scudder: (tonic)
(The Bark of Alstonia Constricta – Australia)

Preparations -the finely powdered bark. Tincture of Alstonia. Alstonine.

Dose – The dose of the powdered bark will be from grs. j. to grs. v. Of the tincture, from gtt. ij. to gtt. x. Of the alkaloid, grs. 1/8, to grs. 1/4.

Specific Indications – The disease shows distinct periodicity. The tongue is dirty, the skin is sallow and dirty, the
urine is turbid.

Therapeutic action -The antiperiodic action of Alstonia is more marked than any other agent which has been employed as a substitute for quinine. It is a powerful remedy, and where it is adapted to the cae, three or four doses (two grains each) of the bark, will arrest an ague. It does not meet the indication – periodicity- in as large a number of cases as quinine, but where the tonue is dirty and the skin dirty, it will be found very certain. As it cures cases of chronic age that quinine will not reach, the practitioner will be able to study his cases well.

The bark of the Alstonia constricta, or Australian fever tree, has been known as a pharmaceutical curiosity – at least, since 1863, when Palm separated from it a bitter principle which he called Alstonine. Dr. Hesse, direct of the alkaloid works of Fr. Jobst, at Feurbach, near Stuttgart, has done much within the past few years to clear up the chemical history of the bark. A precis of his recently published results may be found in the medical journals. His researches lease some points undetermined, and the more practical question of the therapeutical effects of the bark and its alkaloids has hardly been approached. Dr. Bancroft has long used the bark in the hospitals of Melbourne with admirable success in cases of fever. Indeed, its vernacular name shows that the settlers discovered its healing properties before the doctors troubled themselves about it. But this seems to be a drug which will occupy no subordinate place as a mere cinchona substitute.

Dr. Hesse says: “Besides, allow me to add that I doubt the efficacy of Alstonine as a harmless remedy for fever, but that, on the contrary, I hold it to be a strong poison akin to strychnine. The Alstonia constricta bark contains about 2.5 percent of this alkaloid, whilst it only yields 0.05 per cent of Alstonidin. Thus you will see it will be difficult to manufacture them. The Alstonidin might have no practical importance, whereas this alkaloid (Alstonine) possesses very eminent therapeutic properties.”

Dr. Bixby has used the drug largely during eighteen months, and has prescribed it in hundreds of cases. He finds its action resembles in many respects the combined action of quinine and nux vomica. It is an antiperiodic of the highest type, better, in his opinion, than the quinine or cinchonidine. It is a cerebro-spinal stimulant and tonic, acts positively upon the great sympathetic nerve-centers, and consequently increases, positively and permanently, the vital forces of the entire system. A proper sedative should be given before the use of this bark is begun.

In general nervous depression it acts like a charm; in typhoid, puerperal and other fevers, in recent colds and rheumatism, it has produced good results.

1895: Watkins
Skin sallow and dirty, pastry, dirty coat on tongue, deposits in urine, malaria. Thirty drops to four ounces water; teaspoonful every four hours.

1898; Webster; (Antiseptics, Antizymotics, Correctives)
This agent proves a corrective in malarial cachexia. It has been termed an antiperiodic by some writers, but the term is hardly appropriate, I believe, as it cures chronic ague, not by interrupting a habit so much as by correcting the depraved state of the fluids which predisposes to it.

In chronic malarial cachexia this remedy has no superior, if any equal. Dr. Fearn, with whom it has been a favorite for a long time, considers the special indications for its use, to be the dirty tongue, sallow skin, and turbid urine, in connection with periodicity.

Though not all strictly applicable to this place, the opinions of Dr. F. are so valuable as to this remedy that I will quote at some length from an article contributed by him to vol. 7. of the California Medical Journal: -

As an antiperiodic, first prepare the way by the use of the bath and special sedative, just as you would for quinine. The powdered bark is the most generally used; this may be given in capsules containing from two to five grains each, repeated every hour for three or four doses, giving the last capsule one hour before the expected trouble; this may be repeated the second or third day to make sure. Dr. R. E. Kunze, of New York, attributes to it slightly narcotic, cerebro-stimulant, antiperiodic, febrifuge, and tonic properties. He thinks it contraindicated in patients of delicate and highly nervous organization. In such patients it might produce head symptoms. I have heard of no complaint of this as yet. It is true it is an intense and lasting bitter, but this is overcome by administering it in capsules, C. P. Higgins, M. D., who has frequently used this medicine as an antiperiodic as above, says it will often act as a powerful diaphoretic. More often its action in this direction is mild. But it is not only the antiperiodic properties of this drug that will win for it laurels, it will also be found to be a most excellent tonic, having properties very much like nux vomica. In general nervous depression, when that depression arises from lack of digestion and assimilation, it is a good remedy, and may be given in doses of from one to two grains every three or four hours. Dr. Scudder says: ?It is a cerebro-spinal stimulant and tonic, acting positively upon the great sympathetic nerve centers and consequently increasing positively and permanently the vital forces of the entire system.’ I quite agree with Dr. Scudder in this opinion. In all diseases of the digestive tract, accompanied by loss of appetite and depraved secretions, when we want a stimulant tonic to arouse the slumbering energies and vital forces, this remedy is a very good one.?

Form for Administration – The best form for use is a powder of the bark, administered as Dr. Fearn has suggested, in capsules. The fluid preparation is too bitter to permit an effective dose to be administered without its being objectionable.

Dose – Two or three grains of the powdered bark in a capsule, given after meals, suffice for an adult. It may be advantageously combined with caulophyllin or macrotys in rheumatic complications, with chionanthus or chelidonium in appropriate hepatic disturbances, or polymnia when splenic complication exist.

1898: Webster: (digestive)
Alstonia is a valuable remedy in lienteric diarrhoea, in dysentery with malarious complication, and in atonic dyspepsia. It is one of the best remedies known in chronic malarial poisoning; and gastro-intestinal troubles depending upon, or complicated with, such a condition would suggest its use in practice.

Dose-From two or four grains, three or four times a day. As the drug is extremely bitter, it should be taken after meals (powdered bark) in capsules.

1901 : Harvey W Felter (Tonics)
SYNONYM – Native Quinine of Australia

BOTANICAL ORIGIN – The bark of Alstonia consticta, F. Mueller; Nat. Ord., Apocynaceae. Australia.

SPECIFIC ALSTONIA CONSTRICTA – This is not Alstonia Scholaris, which is very much inferior. The true Alstonia constricta is not easily obtained, and mixtures of wild cherry and bitter barks, as well as Alstonia Scholaris, have been sold for it. True Alstonia constricta is highly esteemed by many physicians.

This is a tree with leaves four inches long and white flowers, a native of Australia. The inner bark is the part used.

It is antiperiodic, febrifuge, and tonic. In large doses it produces cerebral disturbance, irritation of the stomach and ringing inthe ears like quinine. It is better in chronic than in acute ague. As a tonic give from one to five grains.

1901: Locke
It is antiperiodic, febrifuge, and tonic. In large doses it produces cerebral disturbance, irritation of the stomach, and ringing in the ears like quinine. It is better in chronic than in acute ague. As a tonic give from one to five grains.

1909: Felter and Lloyd:
Action, Medical Uses, and Dosage – The inner bark of Alstonia constricta is said to possess marked antiperiodic properties, while the outer bark is stated to have been efficacious in curing certain forms of rheumatism. Further trials are needed, however, before it can be ranked as a substitute for quinine, or other of the cinchona alkaloids, yet it has proved as efficient in intermittents. “Hesse attributes to alstonidine properties analogous at once to those of quinine and to nux vomica. The experiments of Bancroft and of Bixby prove that this drug is valuable as a tonic febrifuge, and more valuable as a febrifuge than as a tonic, while the Alstonia scholaris is more generally employed against dysentery” (Beringer, Amer. Jour. Phaarm 1895, P. 167).

Prof. King has used the bark in several cases with prompt and decided success; four of these cases were small children. The inner bark was given to the patients in a dose of from 4 to 8 grains, an hour or two before the expected chill, repeating the dose 2 or 3 times, each time anterior to the anticipated chill. Three doses were usually required; in one case, only 1 dose was given, and in two others, 4 doses were taken before the chills disappeared. The most marked influence was in an obstinate case, tertian, invariably attended during the attacks with gastric pain and irritability, and neuralgic pains in the superior extremities; the first dose afforded much relief, and since the third dose the patient has been entirely free from any symptoms of the malady, an dhas, for the first time in several years, passed an autumnal season without any chills, while neighbors were suffering more or less severely from them. Professor Locke has used it successfully in chronic intermittent, but thinks it not so efficacious in the acute forms. prof. J. M Scudder also had considerable success with it. He regarded it an excellent tonic and restorative when the secretions are depraved, the bowels irregular, tongue inclined to be dirty, skin dirty and sallow, and the urine depositing a sediment (Spec. Med., 69). Many physicians have reported favourably as regards its antiperiodic virtus, having successfully used it where quinine had failed.

From the fact that it corrects depraves states of the blood in malarial disordes, Webster contends that it should not be termed an antiperiodic, but rather a corrective of malarial cachexia. Dr. John Fearn favors its use in chronic malarial poisoning, and gives as its specific indications: Tongue dirty, skin sallow and urine turbid, with periodicity. Gastro-intestinal disorders, depending upon chronic malaria, such as lienteric diarrhoea, dysentery and atonic dyspepsia, are reputed to be cured bu it.

According to Dr. R. E. Kunze, of New York City, this bark possesses slightly narcotic cerebro-stimulant, antiperiodic febrifuge, and tonic properties; he has used it with success in several cases of intermittent fever, though, from its peculiar effects in certain cases, he is rather inclined to consider its use contraindicated in “patients of a delicate and highly nervous organization.” Among the patients with whom it has acted favorably, it not only checks the ague, but appears also to prevent its return, for the season, at least.

The bark is very bitter, and produces different effects with different parties; among these effects may be named a persistent disagreeable taste, more or less nausea or a sense of disgust, dizziness, pain in the forehead and occiput, tinnitus, weight in the epigastrium, etc. With many, the only appreciable symptoms noticed are the unpleasant taste left in the mouth and fauces, and the prompt disappearance of the chills.

The dose of the bark, which should be well masticated, is from 2 to 8 grains; but the more desirable form for administration and efficacy appears to be the powdered bark, in capsules, 2 to 5 grains every 3 or 4 hours; as a tonic, grain doses. Of the tincture the dose will vary from 10 to 60 minims every hour or two, and should be given on the days of the attack, commencing several hours before the expected chill. This is certainly an agent that should be thoroughly tested by the profession.

Specific Indications and Uses – Chronic malarial cachexia an dgastro-intestinal disorders depending thereon, with dirty, sallow, or tawny skin, and dirty, pasty tongue; the urine is turbid and cloudy, with urinary deposits. Periodicity, with exacerbations, and remissions, or intermissions.