Poisoning by Cinchona.—The fatal dose of any cinchona alkaloid is un known, and, as regards the bark, it would be difficult to ingest enough to cause fa tality, because of the facility with which the stomach rejects enormous doses. Cin chonism, already mentioned (see PHYSIO LOGICAL AcTiox), moreover, affords am ple warning of untoward effects. A full ounce of quinine has been ingested at a single dose without inducing any very alarming effects, but foreign literature records a case where 5 ounces proved fatal.
The skin of many persons is affected in a peculiar way by the internal adminis tration of the alkaloidal salts; these erup tions may present any of the forms of purpura, roseola, eczema, pemphigus, or even the exanthem of scarlatina.
Case in which, two days after taking 15-drop doses of compound tincture of cinchona, a patient complained of in tolerable itching, which was soon fol lowed by vesiculation on the genitals, face, and ears; the whole general surface of the body rapidly became the seat of a scarlatinoid dermatitis. As this began to decline, the palms and soles became affected with blebs, as much as eight ounces of serum being evacuated. The blebs recurred, and it 1N-as five or six weeks before recovery was complete, the palms being the last to recover. The same phenomena had before occurred from the administration of quinine. The chief points of interest a,re the variety of the bulbous manifestations and the great disproportion between the violence of the cutaneous outbreaks and the small amount of the drug ingested. Johnston (Med. Age., Aug. 25, '97).
Therapeutics. — Cinchona - bark no longer receives general employment, partly owing to the large doses de manded, and partly because of the su periority of the alkaloids, either singly or mixed., Once in a g,reat while it finds use in the application of a "cinchona jacket" in the agues of children, the powdered red bark being quilted between two folds of the garment, which is ap plied next to the skin. Cinchona (red) and snake-root, with spirit of Mindererus is also often employed as a tonic and.
stimulant in low forms of fever, typhoid more particularly.
Cinchonine alkaloid is found chiefly in the pale varieties of bark. Its action (and likewise that of its salts), is very similar to that of quinine, but less ener getic, and requires to be given in larger doses; it is sometimes substituted for quinine, being cheaper, and when the latter commanded a high price cinchona was often employed as an adulterant.
In intermittent it has an unquestion able, but variable, action; sometimes its action is slow, whatever the dose exhib ited, and the paroxysms cease gradually. It is only about two-thirds as active as quinine: a fact that must be considered when prescribing. Again, in doses of 10 to 15 grains it sometimes induces cin chonism, and which it is not usually prudent to exaggerate; further, its thera peutic action is not always proportion ate to the physiological effects; for, while it sometimes answers the purpose for which it is prescribed without the latter being manifested, on the other hand, the physiological effects may be most energetic, without any evidence of therapeutic activity. It certainly can not wholly replace quinine or its salts in severe intermittents or remittents, but may prove a valuable adjunct. The hy drochlorate salt is admittedly the best form for administration, though the sul phate is, perhaps, more generally em ployed.
Cinchonine appears to act very much in the same way as quinine, but less pow erfully; it depresses the heart more than quinine does. (Whitla.) According to Wood, it is about one third weaker than quinine, and must be used in correspondingly larger doses.
Cinchonine is recommended as a feb rifuge for children because it is nearly tasteless.
The cinchona alkaloids, when swal lowed in insoluble form, combine with the acids of the gastric juice and become soluble; so that, as a mere solvent, it is unnecessary to administer cinchonine with acids, and a large dose merely sus pended in fluid is quite as efficacious as when dissolved.
Many observers consider that ,cincho nine is superior to quinine as a prophy lactic. This alkaloid passes off in part by the urine, but a portion appears to be consumed in the blood or to be elim inated in some other way.
Cinchonidine is accepted as isomeric with cinchonine, and its alkaloids are used to a small extent as a substitute for the latter and its derivatives, or for qui nine salts; like all the derivatives of cinchona, it is toxic and antiperiodic. It is distinguished from cinchonine by its solution being levogyrate, and from qui nine and true quinidine by its acid solu tion not being fluorescent. Cinchonine solutions are dextrogyrate, and its acid solutions are not fluorescent; like cin chonidine, it does not give an emerald green color with chlorine-water and am monia like quinine and quinidine.