This section is from the book "Materia Medica: Pharmacology: Therapeutics Prescription Writing For Students and Practitioners", by Walter A. Bastedo. Also available from Amazon: Materia Medica: Pharmacology: Therapeutics: Prescription Writing for Students and Practitioners.
1. Quinine and urea hydrochloride in solution has come into extensive use as a local anesthetic. Hertzler, Brewster, and Rodgers consider it suitable in all operations which can ordinarily be done under cocaine. They use 0.25 per cent. in normal saline, and have determined that stronger solutions retard healing. Many operators use solutions of 1 to 3 per cent. strength. To lessen shock Crile uses it in major operations to anesthetize the field of operation in advance of cutting, and so abolish all afferent impulses. Quinine bisulphate, 1: 3000 to 1: 500, has also been used as a local anesthetic.
2. Both of these salts have been employed as disinfectants in gonorrheal urethritis, vaginitis, cystitis, and as wet dressings for infected wounds.
4. In exophthalmic goiter Watson uses 1 to 4 c.c. of a 30 to 50 per cent. quinine and urea solution for injection into the thyroid, repeating the dose every three or four days for eight to fifteen times. It produces connective-tissue proliferation with destruction of thyroid cells, and is almost painless.
5. In hemorrhoids a similar solution is injected at the base of the pile, or 5-grain (0.3 gm.) suppositories inserted.
6. The quinine salts have frequently been added to hair tonics.
Its sole value by mouth is as a bitter, and for this the preferred preparation is the compound tincture of cinchona. It is not a true tonic, for it tends to inhibit the proteolytic enzymes, to irritate the stomach, and to retard absorption, and does not have any good effect on muscle at all.
It is employed to reduce the pains of influenza, the afternoon fever of tuberculosis, and the discomfort of a cold. In neuralgia and headache it is analgesic, and may also act by lessening the nitrogenous waste products which are sometimes the cause of headache. It is not a very powerful antipyretic or analgesic. In the paroxysms of acroparesthesia Putman considers it almost specific. In bacterial injections, e. g., septicemia, it would seem to be harmful rather than helpful, for it depresses vitality and checks phagocytosis. For uterine effect it is employed in menorrhagia and uterine inertia. Among skin diseases, it has been recommended internally in pemphigus, exfoliative dermatitis, and pityriasis rubra.
In pneumonia, Solis-Cohen uses 15 grains (1 gm.) of quinine and urea hydrochloride hypodermatically, repeated every two or three hours for two, three, or four doses. The fever disappears by lysis instead of by crisis.
In malaria it is practically specific. The asexual forms are, as a rule, vulnerable to quinine; the gametes or sexual forms are not, but in the human body die naturally in a few weeks. In tertian or quartan malaria, about two or three hours after a large dose of quinine, the parasites in the red cells can be seen to have lost their ameboid motions, and they soon become granular and die. The quinine acts most strongly on the forms just breaking into spores and on the free-swimming organisms; and as these are present in the blood about the time of the chill, the quinine, on account of its rapid absorption and rapid excretion, is best given just at this time. Fifteen grains (1 gm.) may be administered just before, during, or after the chill, and because of possible development of new asexual forms from gametes, should be followed by 5 grains three times a day for two or three months. In malarial regions quinine is taken in large quantities as a prophylactic. Craig recommends 10 grains (0.7 gm.) every fifth night. There is much evidence to show that it does reduce the number of cases in a malarial community, and does not seem to do any harm to the takers. In pernicious malaria the quinine and urea hydrochloride in 10 per cent. solution has been employed up to 100 grains in a day, but recovery from this condition is rare in any case. Brewster reports the intravenous administration in pernicious malaria of 100 grains in six hours without untoward effects.
In blackwater fever, which is believed by many to be a malarial manifestation, Cardamitis says that quinine does more harm than good. He cites 1347 cases treated by quinine, with 24.42 per cent. of deaths, and 1134 treated without quinine, with 7.32 per cent. of deaths. The Panama Canal Commission advises against its use during an attack of hemoglobinuria unless there are numerous malarial parasites in the blood.
In amebic dysentery, Major Brooke believes 30 grains (2 gm.) a day to be as effective as ipecac.
As a postoperative prophylactic against nausea, vomiting, gas-pains, backache, and thirst Bonnot recommends 10 grains (0.7 gm.) of the hydrochloride in 2 ounces (60 c.c.) of water by rectum every six hours for four to six doses. The effect is enhanced by the addition of sodium bromide.
For its bitter effect, the cinchona preparations are employed, diluted with water. For systemic effect, the quinine salts are preferred.
These salts, because of their bitterness, are usually given in capsules or coated pills. The sulphate is the one in common use, and its absorption is more sure and more rapid if it is given in solution with a dilute mineral acid, as sulphuric, hydrochloric, phosphoric, or aromatic sulphuric. The hydrochloride, the di-hydrochloride, and the bisulphate are to be preferred, as they are soluble without the addition of acid. For hypodermatic and intravenous use the bimuriate of quinine and urea is employed. Quinine is thought to act better in malaria if given with arsenic and some aromatic, as ginger or capsicum, and this is especially the case in the estivo-autumnal variety, in chronic or relapsing malaria, and in "gamete carriers."
For children, it may be given in the form of the comparatively tasteless (because insoluble) tannate, made into tablets with chocolate - the so-called "quinine chocolates"; or it may be mixed with fluidextract of licorice (incompatible with acids), or with syrup of yerba santa, which has the peculiar property of lessening the appreciation of bitter taste. As it takes some time for the action on the taste-buds to develop, the yerba santa probably lessens the bitterness solely by forming the insoluble tannate.
Lascoff states that a mixture of quinine and acetylsalicylic acid, allowed to stand for some time, develops a poisonous substance resembling digitoxin in its action.
The other alkaloids, quinidine, cinchonine, and cinchonidine, act in malaria like quinine, but in poisoning cause epileptiform convulsions. They have no advantages over quinine and are more expensive.