Description: Natural Order, Cinchonaceae. Genus CINCHONA: "Evergreen trees or shrubs. Leaves opposite, entire, petiolate; stipules inter-petiolar, usually free, and soon deciduous. Flowers cymose-paniculate, white, or usually roseate-purplish, very fragrant. Calyx with a turbinated tube, connate with the ovary , pubescent; limb superior, five-toothed, persistent, the teeth valvate in aestivation. Corolla salver-shaped, with a roundish tube; limb five-cleft, the segments lanceolate, valvate in aestivation. Stamens five, the filaments inserted on and adnate to the lower part of the tube; anthers linear. Ovary crowned with a fleshy disk; ovules numerous, peltate; style simple, stigma bifid. Capsule ovate, oblong, or lance-linear, grooved on both sides, crowned by the limb of the calyx, two-celled, many seeded, septicidal, dehiscing from the base to the apex. Seeds winged." (Pereira.) To this may be added that the really medicinal Cinchonas have woolly blossoms; while the allied Cascarillae have smooth blossoms.
The Cinchonas are natives of South America, in countries lying between the tropics; growing in the valleys of the Andes at an elevation of from four thousand to ten thousand feet above the sea. The best qualities are found in the hot valleys of Bolivia and Peru; but a large portion is obtained from Ecuador and New Granada. There are numerous species, all apparently possessing the same general properties, but differing materially in degrees of strength. The following are the most important kinds–described in the order of their value:
C. CALISAYA. Yellow Bark. There are, according to Weddell, two varieties of this, only one of which is the true or medicinal. It is a magnificent tree, two to three feet in diameter, sixty to one hundred and twenty feet high, naked and erect, elevated above all the other trees of the forest, with a large leafy head. Leaves four to six inches long, and nearly half as broad, of a velvety appearance. Corolla rose colored, with a tube four lines long, and fringed edges. It is found almost exclusively in Bolivia and South-Western Peru, on the declivities of the Andes, at an elevation of six thousand feet or more. Flowers in April and May. The bark is derived from both the trunk and branches. The trunk bark of true Calisaya comes to market in quilled (rolled) pieces, a few inches to two feet long, a quarter of an inch to two inches in diameter, and of variable thickness. It generally is covered by its rough, cracked, brown and inert epidermis. The derm (or fiber) itself is of a tawny-brown color, with a faint orange tint, of a very fine and short fiber, furrowed distinctly by the fissures in the epidermis, and of an intense and peculiar bitter taste without much perceptible astringency. That from the branches is flat, rather browner and less brittle than the quilled variety, not covered with the epidermis. It is not so strong as the bark from the trunk. The Calisaya is now admitted to be better than any other species, though the preference was for a long time given to the pale barks. Spurious barks are frequently introduced as Calisaya; but they lack materially in the density, shortness of fiber, brittle fracture, and intense bitterness which belong to the quilled variety of the true article. The genuine Calisaya may further be known by the facts that one hundred grains of it will yield not less than two grains of pure quinia, and that its quinia is readily soluble in dilute sulphuric acid.
C. CONDAMINEA (var. LANCIFOLIA.) Pale Bark, Crown Bark. This is a small and branched tree, a foot in diameter and fifteen to twenty feet high, the lower branches usually horizontal. Leaves about four inches long, very smooth and shining above. It is principally found in the Loxa forests of Ecuador; and is now much cultivated in somewhat open grounds, at an elevation of eight thousand feet. Several varieties–as pallida, macrocalyx, crispa, chahuarguera–Yield a product of the same general character. Its bark varies in color from a pale-red to a yellowish-red, the color not being so deep as in Calisaya. One variety (and a truly good one) is somewhat rusty-red; and nearly all the varieties are cinnamon-red on the internal surface, the fractured surface being much lighter-even to a pale lemon tint. The yellow tints are most in repute, and are second only to the true Calisaya. They come in quills, which easily split lengthwise, and break with a short fracture; the fiber is rather long, the density is not equal to the Calisaya, they all have a distinct aroma, and their taste is decidedly astringent.
C. RUBRA. Red Bark. This is a tree from twenty to forty feet high, with an erect trunk branched above. Leaves large, broadly ovate. Other species yield a bark almost identical with this. It appears in commerce in flat and slightly incurved pieces, not often in quills; outer surface brown or reddish-brown, inner surface red, fractured surface brick-red, fibers fine. Its taste is very bitter and astringent. Inferior varieties of this and similar species, are among the most common forms of Peruvian bark. A really good article is nearly equal to the pale barks; but the market seldom presents any but the very ordinary specimens.
In all, about twenty-five species of Cinchona are medicinal; but the other species are easily arranged under the above three heads of Yellow, Pale, and Red. The variety lancifolia is the one now most abundant and in most common use–true Calisaya being very scarce.
History: The history of the introduction of this agent to the profession, is a marked illustration of the astounding bitterness with which learned men will oppose the progress of knowledge. The following succinct account of the matter is copied from the Institutes of Medicine, by Prof. M. Paine, who certainly is not to be suspected of any disposition to portray the bigotry of his own branch of the profession in any stronger terms than it deserves:
"Condamine [a French scholar who thoroughly investigated the botanical and medical history of this plant in 1 738] says that the Countess of Cinchona, wife of the Viceroy of Peru, carried the bark to Europe in 1640; from which circumstance, and from her previous connection with the introduction of the bark into use, Linnaeus immortalized her name [by calling the genus after her]. The Countess brought the bark into use in Peru by a first experiment upon herself, at the suggestion of the Corregidor of Loxa. She then transferred its patronage to the Jesuits, [at that time so active in South America,] from whom it became known as ‘Jesuits' Bark'. The bark was by them early carried into Spain and Italy. The commendations which it received from the priesthood were not sufficient to establish its success everywhere; for even in Spain the physicians were either disposed to reject the remedy, or to meet it with opposition. But its demonstrations were such in the Italian climate that Pope Innocent X made it the subject of a communication to the Church; and cooperated with the Italian physicians by directing the publication of their report, in which the curative virtues of the bark were set forth with all the confidence that has been warranted by subsequent experience.
"This report soon became a target for those who had been hostile to the bark. The warfare was begun by Chifletus, who met with a partial failure in the use of it in one case; and proceeded to denounce it in such violent terms that it lost many of its warm friends, and rekindled the animosity of its opponents. Chifletus boldly assumed that all the Roman and other encomiums were mere pretense; and that the bark was not only useless as a remedy, but absolutely pernicious, and should be utterly proscribed by the profession. He challenged any well-authenticated cases of cure; and by this arrogant style he attracted the attention of no small part of Europe. The credulous came to believe his assertions, and the evil-disposed united in a crusade against the article. Chifletus was hailed as a great public benefactor for having relieved the world of a scourge. His publication was reprinted in the language of different European countries, and for a while the whole profession appeared to acquiesce in the justice of the decision.
"But this is only a passage in the early history of the Peruvian bark. It is scarcely possible for us to appreciate the angry and vindictive reproach heaped upon it. Nor was this condemned article ultimately rescued from the trammels of ignorance and prejudice by its proper guardians, but by a learned Jesuit, who once more bore it aloft by unequivocal proof of its extraordinary control over the great bane of Italy. From that time opposition became more and more feeble, and the merits of the remedy were gradually established. But we see in the nature of the hostility which was for a while waged by a great part of the profession against this invaluable remedial agent, and in the very face of its triumphant success, a disposition to trample on the best interests of society, when professional pride, or cunning jealousy, or malevolent envy, may hope for gain." To the above remarks of Dr. Paine may be added the fact that the opponents of Peruvian bark denounced as quacks all who used it, and sought their restraint by law. Communities, and even nations, were agitated by the quarrel; and while the people upheld the article, the doctors in the main condemned and derided it—even, as our author remarks, " trampling on the best interests of society ." And its final adoption into general use was not at all due to the profession, but to those wholly outside of the profession. The names of its defamers are now known to medical history only for the malevolence and untruthfulness of their assertions against it. The quarrel over it in every respect resembles the modern Allopathic warfare against Lobelia; and the latter will as surely ride triumphantly into universal favor in spite of Allopathic detraction; and the physicians who have unjustly maligned it, will as surely be forgotten, or remembered only for their passionate hostility to truth.
Composition: The various species of cinchona have undergone numerous and careful manipulations; and a large variety of products obtained, according to the mode of procedure. Among the unimportant products may be mentioned a volatile oil, an insoluble red coloring matter, a yellow coloring matter, kinic acid, and others. Tannin exists in appreciable quantities in some varieties, especially the red barks. But the characteristic qualities of the article are dependent upon an alkaloid principle, which, according to the procedure, is obtained in different forms–all of which possess properties in common, though varying in physical characters. These are, 1st. Quinia, or Quinine. This principle abounds most in calisaya bark; is obtained in white and flocculent crystals, intensely bitter, inodorous; readily soluble in alcohol, ether, and the fixed oils; soluble in four hundred parts of cold and two hundred and fifty parts of boiling water; and forms various salts with acids, of which the most common is sulphate of quinine. 2nd. Cinchonia. This also is a white, crystalline substance. It is scarcely soluble in ether or the fixed oils; soluble in boiling alcohol, which deposits a portion of the crystals on cooling; almost insoluble in cold water, and slowly soluble in two thousand five hundred parts of boiling water; is very bitter, but imparts its taste slowly; is so decidedly alkaline in its character as to neutralize the strongest acids; and most of its salts are soluble in water. 3rd. Quinidia. This is nearly the same as quinia, but crystallizes in anhydrous, hard prisms, of a glassy appearance. It is less soluble and not so bitter quinia; melts and becomes a wine-yellow liquid at 347E F.; and acts toward acids as quinia does. 4th. Quiniodine, or Chiniodine. The term amorphous (or uncrystallizable) quinia, has been given to this product. It remains in the mother liquors, after sulphate of quinia has been separated by crystallization. It is precipitated from these liquors as a rather resinous, brownish mass, possessing the ordinary appearances of an extract, completely soluble in alcohol and dilute sulphuric acid.
Different barks yield the above alkaloid principles in varying proportions. The following is a condensation of some excellent tables given on this point by Pereira :
|100 parts||Yellow Bark.||Quinia.||Cinchonia.||Quinidia.|
|Calisaya, best large quills,||5.00||0.06||0.64|
|Calisaya, flat pieces, with epidermis,||2.50||0.06||0.05|
|100 parts||Pale Bark.|
|Crown bark, large and best quills,||2.07||0.35||1.43|
|100 parts||Red Bark.|
Properties and Uses: An account has already been given of the violent opposition through which this agent had to battle for a place in the Materia Medica. Since it has been received there, the profession has hurried to an opposite extreme of attributing to the agent almost miraculous powers–employing it in almost every form of disease, and prescribing it lavishly for conditions to which it has no fitness whatever. Such indiscriminate use and laudation are unwise. They have grown out of two errors: First, the practice of prescribing for disease by name, instead of for conditions; second, because the action of the article on tissues has not been studied with sufficient care. It is a delicate task to venture a description of the true character and appropriate uses of the agent, especially as I therein differ materially from some general opinions; but my views are based upon careful and persevering observation, and are given with the conviction that they are correct. The bark alone, and not its pharmaceutical products, is here spoken of.
This bark is a slow and very permanent stimulant of the astringing order to the nervous structures. Beginning its action upon the stomach, it slowly and steadily extends its impressions through, first, the sympathetic nerves; second, the sensory nerves of the frame at large; third, the spinal cord and brain. It will scarcely reach this third circle of influence, unless given in a considerable quantity, or continued for some time. Accompanying this stimulating action is its distinct astringent influence–more marked in the red than the Calisaya bark, and most marked in the pale varieties. This astringency is also manifested upon the nerve structures, causing a protracted state of tension in them. Through the nerves, the agent reaches nearly all the organs of the body, thereby leading to increased sensibility and excitement, and inducing a peculiar and marked state of tension everywhere. By thus indirectly affecting the system at large, it causes excitement of the stomach and throat, with dryness; constipation, and warmth throughout the bowels; increased frequency and hardness of the pulse after a time, and dry warmth upon the surface; a general diminution of the secretions; finally a throbbing headache, and perhaps giddiness, with a general feeling of increased firmness of the muscular and other structures, as if the patient were " strung up." These results advance slowly, generally requiring from four to six hours; and may not entirely pass away under ten or twelve hours. When the stomach is sensitive, it occasions an oppressive sense of heat in this organ; and large doses may excite protracted nausea, or even vomiting, with considerable irritation. It seldom improves the appetite much; but will, in the conditions just named, impair the appetite. It will exasperate all febrile excitements, and induce gastric tenderness; and full or continued doses will give a ringing sound in the ears, with partial deafness.
From such a view of the action of cinchona, its uses and misuses become plain and definite. It is valuable in conditions of atony and laxity of the tissues; and where there are excesses of secretion consequent upon such atony. It is utterly inappropriate when the structures are tense, when there is febrile or inflammatory excitements, dryness of the tongue and fauces, nervous irritability, and a deficiency of secretion; and when harm may ensue from diminishing secretions and excretions. It is not, therefore, a distinct tonic; for it only occasionally improves digestion. It is an entire misnomer to call it a febrifuge; for it will increase febrile excitement, and do injury by causing a retention of secretions at the very time when the safety of the patient depends upon having the secretions eliminated freely. It is by being employed so freely in the latter conditions that this article and its alkaloids have worked such immense mischief, causing the retention of animal poisons, and driving the nervous centers with an unnatural vehemence which leads to their permanent exhaustion, and to an almost incurable roaring in the ears, and dizziness. For similar reasons, this agent serves but a poor purpose in chlorosis and anaemia–maladies that require freedom in the assimilative organs, while the cinchonas limit that freedom by inducing too much tension.
The chief use of this article is as an antiperiodic. Its principal reputation is in averting the "chill" of ague and other intermittent difficulties. Its place in such maladies has been misunderstood, and therefore its powers have been overstated. As the chill is dependent upon recession of blood from the surface to the portal organs, and in itself constitutes nature's first step in the effort to restore the circulation to a balance, successful medication must fulfill three indications: first, remove the hepatic obstructions and accumulations which are the prime disturbers of the circulation; second, sustain the firmness of the nervous tissues, so as to avert that relaxation of these structures which really forms the chill; third, secure a full outward circulation, so that the heart and arteries shall be sustained simultaneously with the nerves. Now the cinchonas fill only the second of these requirements; and, though that is important, it is wholly insufficient without the other two. Hence it is that the cinchonas and their alkaloids may "break the chill," by virtue of their giving the nerves the tension lacked at that especial time; but such agents, and all agents that act like them, can never permanently cure an intermittent–as overwhelming experience testifies. Any successful attempt at cure demands a thorough purification by an emetic or cathartic some hours before the chill; the support of the arterial system coetaneous with that of the nervous system; and an intermediate treatment that will maintain the tone and activity of the digestive and hepatic apparatus. From this outline, it will be seen that the only proper use of bark in the management of intermittents, is to anticipate the nervous relaxation. Hence it is best to begin the use of the agent from three to six hours before the chill, using a suitable dose each hour and a half or two hours, and not giving any of it nearer to the chill than one hour. By this method, the slow advances of the nervous relaxation are anticipated; and yet the tension induced by the bark is mainly gone before the febrile action sets in–to which the influence of this agent would give greater intensity, and add much headache and nausea. The antiperiodic dose of the powdered bark is about ten to fifteen grains, if but one dose is given an hour before the paroxysm; or five to ten grains, if three hourly doses are used. It is decidedly preferable to add from a grain to a grain and a half of capsicum to each dose, to sustain the arterial action; but a suitable quantity of hydrastine should take the place of capsicum in gastric intermittents, or it may be made an addition with the capsicum whenever the patient is nervous. Some have advised the use of the agent during the fit, rather than fail of using it; but this rarely shortens the chill, will almost surely nauseate the stomach and turn the patient against any further use of the agent, and will aggravate the suffering during the febrile stage. This kind of practice does not accord with the nature of the agent or the wants of the system; neither is it a suitable agent to use during the intervals between the paroxysms, when hepatic tonics and arterial stimulants are needed.
In bilious and other remittents, this agent has procured but indifferent results; and the same may be said of its use when any visceral disease, or inflammatory disturbance, accompanies distinct intermittents. In these latter cases, the agent will almost invariably prove harmful. In any periodical recurrence of suffering, where the nerve tissues become relaxed and there is no tendency to excitement or engorgement of the brain, it is often of much service; as in such forms of periodical neuralgia, rheumatism, diarrhea, headache, etc. It is sometimes beneficial in chronic congestions, (improperly called inflammations–see my treatise on Surgery,) when the system is much enfeebled; but is then merely a secondary agent. In other atonic difficulties it is useful, as in mortification, passive hemorrhages, passive menorrhagia, chronic leucorrhea and diarrhea with laxity of fiber, etc. It may also be employed in low cachectic conditions, during convalescence from small-pox and other prostrating maladies, in exhaustion from excessive suppuration or sweating, etc. But even in such difficulties, the agent is admissible only when the general tonicity and firmness of the fibers are greatly reduced, and should not be used while inflammatory excitement remains.
From what has been said, it will be seen that the term febrifuge is a misnomer, as applied to this agent. Yet under the use of this title, practitioners have been led to employ it in typhus, typhoid, scarlet, and continued fevers; and it is largely relied on as almost a specific in typhus affections. This is a decided error, and has unquestionably wrought great mischief. In typhoid, the nervous system does indeed need sustaining; but not with that peculiar forcing and tightening influence that belongs to cinchona. And the manner in which this agent represses the secretions, and thereby causes an accumulation of morbific and semi- putrescent materials in the system, is a most unfortunate influence to exert in any such cases. Again, it is an unsuitable article wherever there is the least tendency to gastric or intestinal irritation; and that is a common and most undesirable condition in typhoid cases. The dry tongue of typhus also points out its unfitness for such cases. The idea of then sustaining appetite and digestion by its use, shows an utter ignorance of the action of the article; for it will do nothing of this kind, but will merely fasten the more firmly upon the system the very putrescence which is the cause of the failing appetite and digestion. Its use in typhoid difficulties will prolong the fever and the coma, increase the turgescence of the brain and the irritability of the bowels, and increase the liability to tedious convalescence and to deafness. I have seen such immense mischief wrought by the article in this connection, that it is a duty for me thus warmly to caution the profession against this wild misapplication of the agent. After all febrile excitement has passed by, and the emunctories have been opened fully, and morbific materials have been removed effectually, the bark may be used in moderate quantities to give tone to the nervous system–provided that the tongue is moist, the urine free, and all intestinal irritability has disappeared.
Employed outwardly, this agent is an astringent and moderately antiseptic article for weak and degenerating ulcers, aphthous sores, etc. It is not often used in such connections, but is excellent.
The dose as an antiperiodic has already been mentioned. As a nervine tonic under other circumstances, the dose of powder is from two to five grains, three times a day. Immense doses are often given, but are seldom borne well. The powder is rather bulky, and is often disagreeable to the stomach; on which accounts it is now usually given by infusion, though its alkaloid preparations have almost superseded it. But the bark itself has been known to succeed in intermittents after sulphate of quinia had entirely failed; and it unquestionably contains good virtues that can not be retained in any of the alkaloids. Usually, it is more easily taken, and probably more beneficial, when combined with some aromatic. Among the most suitable of these are ginger and the prickly ash, or serpentaria when not contraindicated. Orange peel, cascarilla, etc., are also much used with it. Sometimes the bark incites purging, especially if the bowels and liver have not been put into good condition before its use; in which case, after attending to the biliary organs, the bark should be combined with some hamamelis. In agues, a moderate portion of alkali is a good addition; while in lingering dysentery and diarrhea, with a periodical exacerbation, a small portion of lemon juice is often a grateful adjunct, and makes its alkaloid principles more soluble.
I. Decoction. Yellow cinchona, in coarse powder, one ounce; water, one pint. Boil gently in a covered vessel for ten minutes; strain through muslin, and add water upon the filter till a pint is obtained. When cold. it deposits a portion of its tannates, leaving the clear liquid less astringent than it otherwise would be. The Allopathists often add a minute portion of sulphuric or hydrochloric acid, which dissolves this precipitate and gives additional strength to the decoction; but the practice is objectionable, though if the tannate is desirable, a very little lemon juice or good vinegar will dissolve a considerable portion of it, and leave a neutral compound. Dose, one to two fluid ounces. The decoction may be flavored by adding a small portion of sirups of ginger and cinnamon, or of orange peel. The red bark is not used in this preparation, unless especially desired for its greater astringent property.
II. Tincture. Yellow cinchona, four ounces. Crush into coarse powder and macerate in diluted alcohol for forty-eight hours, with occasional agitation. Transfer to a percolator, and treat with diluted alcohol till twelve ounces pass. Press the dregs strongly; filter the product, and add it to the first liquid; and add enough spirit to make one pint. Dose, one to two fluid drachms. The diluted spirits act well upon the bark, and solve most of its properties. It is a better representative of the drug than any watery preparation. It is seldom used except as an adjunct to decoction of cinchona, or the solution of sulphate of quinia. The U. S. officinal tincture directs eight ounces of the bark and the passage of two pints of diluted alcohol by percolation. The pale or red barks may be used, if desired; and a lighter preparation may be made by employing Sherry wine instead of alcohol.
III. Compound Tincture. "Red cinchona, powdered, two ounces; orange peel, bruised, one and a half ounces; Virginia snakeroot, three drachms; saffron and red saunders, each, a drachm. Macerate with diluted alcohol for forty-eight hours; transfer to a percolator, and treat with diluted alcohol till twenty fluid ounces pass." (U. S. P.) This is a pleasant and mild preparation, and probably one of the most agreeable forms for using this agent as a tonic and stimulant for convalescence.
IV. Extract. A hydro-alcoholic extract is prepared by first macerating a pound of the bark in alcohol, and treating it by percolation till four pints of alcohol have been used; then continuing percolation with water till six pints have passed; bringing the two liquids to the consistence of honey, then mixing them and completing the evaporation. It is sometimes used in pill, of which the full antiperiodic dose is from five to ten grains, with one grain of capsicum. The yellow bark alone is used.
V. Fluid Extract-Concentrated Sirup. Yellow cinchona, in coarse powder, one pound. Moisten with diluted alcohol, and pack it firmly in a percolator after ten hours. Exhaust by dilute alcohol, (using about four pints,) evaporate on a water-bath to two pints, add a pound and a half of sugar, and strain while hot. Or the clear liquid may be poured off, the precipitate dissolved in eight ounces of alcohol, the sugar added to this, the first liquor then returned, and the whole carefully evaporated to two pints. By the latter process, it will be nearly free from turbidity. Each fluid drachm of this represents a half drachm of the strength of the bark, or about one grain of quinia. It is a pleasant and acceptable preparation.
Sulphate of Quinia-Quinine.
Preparation: It has already been stated (p. 350) that the alkaloid quinia is a prominent active property of the cinchonas. This principle is obtained in the form of a neutral salt with sulphuric acid (the common quinine of the shops) by the following process: Boil forty-eight troy ounces of the bark (coarsely powdered) in thirteen pints of distilled water, containing nine troy drachms of hydrochloric acid. Strain through muslin, and treat the bark in the same manner twice more, mixing the products. The three alkaloids, quinia, quinidia, and cinchonia, are contained in the bark in combination with kinic and kivinic acids, in which form they are nearly insoluble; but they are separated from these acids, and brought into a soluble form, by the above hydrochloric acid. The liquids above obtained are made hot, and into them is slowly mixed five troy ounces of fresh powdered lime, stirring constantly. The lime neutralizes the hydrochloric acid, and the three alkaloids, being in themselves insoluble, fall to the bottom, while the hydrochlorate of lime remains in solution. The precipitated alkaloids carry down some excess of lime, and also an insoluble compound of lime and coloring matter. This conglomerated precipitate is then to be thoroughly washed with distilled water; and afterward dried and powdered. This powder is then to be digested with boiling alcohol; repeating this digestion with fresh portions of alcohol till the liquid ceases to be bitter. The alcohol dissolves out the three alkaloids. From the liquids thus obtained, the alcohol is distilled off till the mass becomes viscid. Upon this are now poured four pints of distilled water, which is then brought to the boiling point; and to this is carefully added enough sulphuric acid to combine with the alkaloids–the acid being a few drops only in excess of absolute neutrality. One and a half troy ounces of animal charcoal are now mixed with the liquid, the whole brought to the boiling point for two minutes, and strained while hot. The sulphate of quinia is almost insoluble in water, while the sulphates of quinidia and cinchonia are moderately soluble; hence the two latter salts remain in solution in this liquid, while the former salt slowly falls as a crystalline precipitate when the liquid cools. This precipitate is then carefully dried on blotting paper; when it yields the white, feathery crystals known as quinine.
The mother-water in the last step of the above process contains a little quinia; and this may be precipitated by some water of ammonia, and the precipitate made to yield the sulphate of quinia as before. From the liquid then remaining, the other alkaloids may be obtained.
Properties and Uses: The sulphate of quinia is a neutral salt; and no estimate is to be formed of it on account of the presence of sulphuric acid, as some ignorantly suppose. (§32.) It is inodorous, white; in long, flexible and silky crystals, which effloresce a little in the air. One grain is soluble in eighty grains of cold alcohol of sp. gr. eighty-five; or in seven hundred and forty grains of cold and thirty grains of boiling water. The saturated solution formed by boiling, again precipitates on cooling. Insoluble in ether. Partially soluble in glycerin. Its purity may be tested as follows: Put into a test-tube ten grains of quinine, sixty grains of ether, and ten drops of standard spirits of ammonia. Shake, and leave to rest. Two transparent and colorless layers form in the liquid; and pure quinine will leave no white or crystalline powder at the line of contact between these liquids: Quinine is decomposed by alkalies and their carbonates, and therefore should not be given in company with them. Astringent infusions also decompose it, forming insoluble tannates of quinia.
The action of quinine upon the system is nearly identical with that of the bark itself, though not astringent; but it stimulates the cerebral center much more decidedly, and is so much the more liable to cause dizziness and ringing in the head, and to leave behind a wretched sense of tightness and roaring–and also to cause deafness–if used before the emunctories have been put into good action. It may easily be pushed so as to exhaust the brain by over-stimulation, and leave a pernicious state of mental enervation, with a persistent, turgid condition of the encephalon and the meninges. Though most intensely bitter, it is often better received by the stomach than the bark; though large doses excite local irritation. It is a common suspicion that this article is poisonous, and I was at one time inclined to share in this belief; but careful observation has satisfied me that such is not the case. The mischiefs following its use, occur when it is used in quantities to force the nervous system beyond all natural bounds; and when it is given before morbific materials have been eliminated–these materials being thus fastened into the system, where their corruption causes great injury. The extent to which this article is often given, and the lack of judgment as to the time for giving, are in some cases utterly indiscreet and discreditable. It is the most powerful of all antiperiodics; but is less aromatic, and also less of a general tonic, than the bark itself.
One grain of quinine represents from thirty to fifty grains of ordinary bark; hence doses of ten to twenty grains of this salt, as some physicians tell of giving, are manifestly monstrous. The law of limitation in the frame forbids the idea that any such doses are allowable. (§19.) The system does not need, and will not accept, any such driving. Two grains of these light crystals represent a bulk nearly as large as a grain of Western corn; and half that bulk, or one grain, is a fair ordinary dose. Half a grain is usually enough, if repeated at intervals of two or three hours for a suitable period before a chill. As with the bark, a grain of capsicum is almost a necessary adjuvant to every dose. But in severe congestive chills–where the breathing is hurried, the voice tremulous, the pulse creeping, and the nervous system greatly agitated–it would be nearly useless to give these small doses. Two grains, (often spoken of by physicians as ten grains,) with two grains of capsicum, may then be employed every four or three hours, without interruption; but in such cases it is even more imperative than in ordinary agues that the biliary apparatus be vigorously acted on by hepatics with stimulants, and that strong and diffusive stimulating drinks and enemas be pushed steadily.
Compound Tincture of Quinine: The London preparation directs to dissolve five drachms and a scruple of quinine in two pints of tincture of orange peel. A fluid drachm of this, containing a grain of quinine, is a full dose. My own method is, to dissolve sixty grains of the quinine in twelve ounces of the Com pound Tincture of American Gentian, and add four ounces of Ginger Sirup. Each fluid drachm of this preparation contains about half a grain of the quinine; and is usually well received by the stomach.
Compound Pills of Quinine: Sulphate of quinia, thirty grains; capsicum and gum arabic, in powder, each ten grains; soften the quinine with a little vinegar; mix the powder intimately, form into a pill mass with honey, and divide into forty pills. Each pill contains three-fourths of a grain of quinine, and one-fourth of a grain of capsicum. I prefer this to the pill of the U. S. Pharmacopoeia–which uses two scruples of quinine and omits the capsicum. A quinine pill now common in the shops, is the simple quinine softened into a pill mass by the aromatic sulphuric acid. Each pill contains about four grains; but it is an objectionable preparation on account of the excess of sulphuric acid.
Quinine with Tannic Acid: Take fifteen grains each of quinine and tannin, and triturate (by gradual additions) with two ounces each of sirup of ginger and simple sirup. This is a somewhat empirical preparation; but I have found it peculiarly serviceable in the agues of children; and also in dysentery and diarrhea, when the acute symptoms have passed by, and the patient is feeble and has periodic exacerbations. It commends itself for the little folks by its being much more palatable than many other preparations containing quinine. Dose, for a child, half a fluid drachm every six hours in periodic diarrhea; and the same at proper intervals in ague.
Quinine enters into many other compounds; among the more fashionable of which are preparations with pyrophosphoric acid and iron, in sirup. These are pleasant, but are decidedly objectionable to the Physio-Medicalist. It seems probable that the solvent powers of glycerin may be used to advantage in exhibiting this article.
Sulphate of Cinchonia.
Preparation: Take the liquor left after the quinine has been obtained, and add solution of soda gradually, with stirring, till the liquor has become slightly alkaline. On standing, a precipitate falls; and this is to be collected on a muslin filter, thoroughly washed with water, and dried. Then wash it repeatedly with small portions of alcohol, to remove all traces of other alkaloids. Mix the residue with eight times its weight of water, heat it, and gradually add diluted sulphuric acid till the liquid presents a faint trace of acidity. Then boil it with a small portion of animal charcoal, strain, and set it aside to crystallize.
Properties and Uses: This is a salt in short, prismatic, white, shining crystals. It dissolves in fifty-four parts of cold, in much less boiling water, in seven parts of alcohol, and very sparingly in ether. Its action is very nearly that of quinine; but it seems to act more upon the nervous peripheries and less upon the brain, and hence is not so liable to over-string the nerve centers. It is cheaper than quinine; and some practitioners decidedly prefer its therapeutical action. Dose, as a tonic, one to two grains; as an antiperiodic, five to ten grains. It can be prepared in tincture, etc., the same as quinine.
By evaporating the liquor left after obtaining the quinine, a dark-colored, extractive substance is obtained, which contains both quinia and cinchonia, and has been used under the name of Extract of Quinia. But if the above liquor is treated with an alkaline carbonate, there will fall down a brownish-yellow mass, of a somewhat resinous character, and not crystallizable. This is called Chinoidine; and seems to contain both quinidia and cinchonia, It has excellent antiperiodic properties. In the hands of several practitioners of my acquaintance, it has acted as if a diffusive and stimulating nervine; and seems to deserve further careful notice, Z. Hockett, M. D., of Anderson, Ind., gives me the following as his mode of using these articles: Chinoidine, in fine powder, twenty grains; oil of capsicum, five drops; podophyllin, two grains; sugar, one ounce. Triturate, and make into eight powders; of which give one every two hours, commencing five hours before the anticipated chill. After the chill use, Compound Tincture of Cinchona bark, six ounces; Fluid Extract Taraxacum, two ounces: half a fluid ounce three times a day, Every sixth day, repeat four of the powders. He says in no instance has this course failed him; and that it has succeeded completely in some cases that had been treated unsuccessfully on other plans for three years, He gives a small portion of lemon juice, or cider vinegar, after each powder, which aids the solubility of the Chinoidine.
The Physiomedical Dispensatory, 1869, was written by William Cook, M.D.
It was scanned by Paul Bergner at http://medherb.com