Cinchona. Cinchona Calisaya.

Synonyms—Peruvian bark.

CONSTITUENTS—

Quinine, Quinidine, Cinchonine, Chinchonidine, Quinamine, tannic acid; thirty-two natural and eight artificial alkaloids, resinoid, volatile oil, gum, sugar and wax.

PREPARATIONS—

Extractum Cinchonae, Extract of Cinchona. Dose, one to five grains.

Extractum Cinchonae Fluidum, Fluid Extract of Cinchona. Dose, ten to sixty minims.

Specific Medicine Cinchona. Dose, one to thirty minims.

Quinine.

The pure alkaloids of cinchona are not employed in medicine, but their salts, formed from acid and basic combinations, are in common use.

In the consideration of the therapeutic properties of the various alkaloids of cinchona there is but little difference observed in their action. There is almost no influence exercised by any one of them that is not exercised to an equal extent by quinine, and except where otherwise specified, the Sulphate. of Quinine is the agent here considered.

Quinine Sulphate.

Dose, one to twenty grains.

Physiological Action—In doses of five grains three or four times a day for a few days, it produces fullness of the capillary circulation of the brain, throbbing in the head, suffusion of the face, ringing in the ears, with dullness of hearing, headache, mental confusion and nervous excitement. If the above doses be given every three hours continuously there is muscular feebleness, with general impairment of motility, increasing debility, great restlessness, with wakefulness, dilated pupils and partial loss of sight.

A single dose of sixty grains of quinine sulphate, given to an adult male caused extreme depression, with feeble circulation, coldness of the surface and extremities, respiration slow and sighing; pulse slow and almost imperceptible, pupils widely dilated, sight and hearing almost extinct, voice very feeble; thirst great, tongue pale and moist, breath cold. While in some cases blindness from quinine has continued for some time in no case has it been permanent. Quinine has produced deafness also, which in many cases has been permanent. In some cases death has followed the administration of the remedy in disease, a result fairly attributed to the drug. In small doses it is tonic, in large doses stimulant, and in still larger doses sedative, acting on the cerebro-spinal nervous system and through the ganglionic nervous system on the heart. Besides the above named effects, large and repeated doses may cause gastric irritation, eructations, chill and fever paroxysms headache, perspiration, vertigo, staggering and delirium— the condition known as cinchonism.

Specific Symptomatology—Quinine will act favorably upon the system if the skin be soft, if the mucous membranes of the mouth are moist, and if the tongue is moist and inclined to clean, if the pulse is full and soft and the temperature declining or at normal. In other words, when the secretory functions of the body are in a working condition, quinine will produce no unpleasant results.

Quinine is specifically an antiperiodic. It will overcome malarial periodicity, especially if the above named conditions are present when the agent is administered.

It is profoundly tonic; under limited conditions it is antipyretic and also antiseptic. It has specific oxytocic powers over the parturient uterus.

Quinine destroys the plasmodium malariae readily, even in the minute quantity of one part to twenty thousand of water. Its influence upon malarial conditions can thus be readily understood.

Therapy—In the administration of quinine as an antiperiodic, the beneficial influences are not altogether in proportion to the size of the dose. Enormous doses may abort a chill if given during its course, or during the course of the fever. They are very likely, however, to increase the nervous erethism and the temperature; whereas, if proper doses be given during the intermission, from one to three hours preceding the anticipated attack, or at the time when the temperature has reached its lowest point, small doses will accomplish positive results.

In continued fever, with a sufficiently marked remission occurring at a given time each day, or on each alternate day, the agent should be given during the remission, provided the temperature declines to a point sufficiently low to admit of a temporary restoration of the suspended secretions. This point is usually not above 100 ½ degrees. If the remission be short, a single dose may be given. As a result the temperature does not run quite as high as on the previous day, and the next remission is more marked and of longer duration. At this time, perhaps, two full doses, two hours apart, may be given. The fever is still lower and the remission so marked by the third day that the agent, in reasonable doses, may be continued through the exacerbation, the temperature at no time, probably, rising above 101 degrees and not increasing above normal after the third day.

The writer has adopted this course for so many years, with perfectly satisfactory results, that the method is confirmed in his mind as the proper one in all cases where malaria is the cause,

Where continued fever exists, quinine is of no benefit if there is no marked remission or other evidence of malaria. It is thus of no use during the progress of typhus, typhoid and other protracted fevers. In such cases it causes nerve irritation and increased temperature, especially if there is deficient secretion.

When the fever is broken and there is a tendency toward a restoration of secretion, and the temperature is normal or subnormal, then this agent is a vitally important one. Here the bisulphate, being readily absorbed, produces the happiest results.

In intermittent fevers it is excellent practice to give the remedy in broken doses during the intermission. The absorption of the sulphate of quinine takes place so slowly that a period of between four and six hours is required, under favorable circumstances, to develop the full effect of the remedy. A dose of from three to five grains, given five hours before the expected paroxysm, will exercise its full influence upon the paroxysm when it should appear.

If another dose of two and one-half grains be given two hours after the first dose, and a third dose of the same size be administered after another period of two hours, or one hour before the chill will occur, the effect of the agent will be uniformly continued during the time in which both the chill and the fever would have reached their highest point. The repetition of this course on the second and third days will usually be sufficient to overcome the most severe. cases. It is well to adopt the same course on the seventh, fourteenth and twenty-first days following the attack.

The following formula is of excellent service in those cases in which the liver and other glandular organs have been profoundly influenced by the disease, and where the nervous system shows considerable depression:

In the treatment of congestive chill, and in malignant conditions of malarial origin, quinine is specific, but should be given in much larger doses, and usually with some direct stimulant and in conjunction with the use of external heat. It may be given in doses of twenty grains preceding the attack, or with stimulants during the attack. If a severe attack is fully anticipated, large doses should be repeated every two or three hours during the entire remission.

As an antipyretic quinine is no longer used. It was once considered of essential importance in the reduction of high temperatures, but the conditions and character of its action were so imperfectly understood that it often did harm, and caused an increase in the temperature instead of a reduction. In the regular school the coal tar antipyretics have replaced it. With our own school it has been at no time depended upon to allay fever.

As a restorative after pneumonia, where hepatization has been extensive, this agent is an important one. Two grains of the bisulphate of quinine, with one-fourth of a grain of ipecac, and perhaps the one-fourth of a grain of nux vomica, will rapidly improve the function of the nervous system and of the circulation, and as rapidly overcome the hepatization and other results of inflammatory action. The influence upon the stomach and intestinal canal, and thus upon the digestion and assimilation of food, is marked and immediate.

Quinine is a stimulant tonic of great value. Its influence is exercised to the best possible advantage when there is impaired or deficient nerve force.

It is indicated as a restorative after prostrating disease, especially after continued and inflammatory fevers. It strengthens the action of the heart, improving the character of the circulation of every organ. It arouses the digestive organs and encourages assimilation and nutrition. It stimulates the liver and kidneys, and thus assists in the rapid elimination of the waste products of the disease. It stimulates the respiratory function, promoting oxygenation of the blood, thus assisting in the restoration of the character of that fluid.

These results are accomplished largely through its profoundly stimulating influence upon the cerebral and spinal centers.

It has been the writer's custom to use the bisulphate of quinine as a tonic instead of the sulphate, because of its free solution and rapid absorption. It is milder in its effects upon the nerve centers and fully as efficacious in its tonic influence. It is combined to excellent advantage with hydrastine, nux vomica or the salts of iron.

Or it may be given with strychnine or picrotoxin or ignatia with excellent results, and if liver complications exist, it may be combined with leptandrin, podophyllin or iris.

In chronic congestion of the liver, or splenitis, quinine dissolved in the tincture of the chloride of iron, and combined with syrup of orange or simple elixir, produces satisfactory results.

In the prostrating night sweats following malarial fever this agent, in the above combination, is a fine tonic, quickly overcoming the sweating and other results of the disease.

Where paludal miasm is the cause of various indefinite disorders, or of general malaise, the phenomena occurring periodically, quinine should be given to anticipate the unpleasant symptoms. Dumb ague, hemicrania and severe general headaches, neuralgias of various kinds and asthmatic attacks occur from this cause and are satisfactorily treated with this remedy. It may be afterward given as a tonic, in combination with any other tonic agent which may be specifically indicated.

Quinine has a direct power in inducing contraction of the parturient womb, especially if from inefficient strength the labor has been prolonged until the nervous force of the patient is well nigh exhausted. If fifteen grains be given in one dose, it may overcome all undesirable conditions at once and prove sufficient. The contractions are normal in frequency and of regular character and force.

It thus overcomes inertia and will prevent post-partum hemorrhage. It is a good remedy for this latter condition when it has occurred, acting also as a stimulant to the heart and nervous system. It is a dangerous remedy in large doses during pregnancy, as it may bring on premature labor.

In amenorrhea, from cold it is useful and may be prescribed alternately with aconite, after a hot bath has started secretion from the skin.

As a stimulating antiseptic it has been used as a wash in very many conditions. In sluggish ulcers and old sores, where there is no activity to the capillary circulation, it may be applied with good results. It is useful in threatened gangrene and in chilblain. It was at one time extensively used as a throat wash in diphtheria, and to its antiseptic character is credited its beneficial influence upon whooping cough, having been much depended on for the cure of that disease.

A douche made by dissolving six or eight grains in a pint of hot water will be found of service in chronic catarrh, with fetid discharge, and in hay fever. In the latter condition, full doses internally, three times a day, will materially improve its local influence.

In the administration of quinine to children in all but the severest of malarial conditions, it may be given by inunction, and all of the results of internal use will be thus obtained. The soft skin of the chest, axillae, abdomen or groins is bathed with hot water and quickly dried, and the ointment immediately applied. From three to five grains of the sulphate is thoroughly rubbed into two drams of lard, and the whole applied during the early part of a remission or intermission. The course must be repeated on consecutive days for four or five days. If the fever is then broken or the chill does not occur, the application can be made regularly once in eight or twelve hours, using less quinine, and continued as a tonic as long as a tonic is needed. No one will administer quinine per os to infants who has used this method successfully.

The American Materia Medica, Therapeutics and Pharmacognosy, 1919, was written by Finley Ellingwood, M.D.
It was scanned by Michael Moore for the Southwest School of Botanical Medicine