This section is from the book "A Treatise On Therapeutics, And Pharmacology Or Materia Medica Vol1", by George B. Wood. Also available from Amazon: Part 1 and Part 2.
Sulphate of quinia may be administered in substance or solution. In my own experience, I have been able to discover little difference, in therapeutic results, between these two modes of exhibition; though it is asserted by M. Briquet, as an inference from his experiments, that the solution formed by the addition of a little sulphuric acid, and containing, therefore, the bisulphate, will produce the antiperi-odic effect more quickly, and in considerably smaller doses, than the ordinary sulphate given in substance. There can be no doubt that the salt in solution will be more readily absorbed into the circulation than the undissolved salt; but the ordinary sulphate is so readily dissolved by water slightly acidulated with almost any acid, that the instances must be very few, in which there is not sufficient acid in the primae viae for this purpose. It is, I presume, very seldom that the sulphate of quinia passes undissolved through the stomach, unless secured against the action of the gastric acids by a vicious mode of exhibition. The salt in substance is usually given in pill, or suspended in water; very rarely in the form of powder.
The officinal Pills of Sulphate of Quinia (Pilulae Quiniae Sul-phatis, U. S.) are made by the addition of gum and honey, and contain, each, a grain of the salt. They answer very well when made extemporaneously; but, if kept very long, there is danger that they may become so hard as to afford a mechanical impediment to solution, and consequently to pass through the stomach unchanged. Nevertheless, I have used very old officinal pills, with prompt and powerful effect, as an anti-periodic. A method of preparing them suggested by Mr. Edward Par-rish seems to offer some advantages. This plan is simply to triturate together 20 grains of the salt and 15 drops of aromatic sulphuric acid, until a pilular mass is formed. The pills are thus obtained of smaller bulk and more soluble; and a pill of five grains is not inconveniently large.
The salt, if finely powdered, may be suspended in water by simple agitation; but the intervention of syrup or mucilage is preferable. M. Trousseau gives it stirred up in hot and sweetened coffee, which seems to correct its taste. The probable conversion of the salt into an insoluble tannate may be urged against this method of exhibition; and the same objection holds against the plan of mixing the salt with tannic acid, as recommended by the late Dr. Thomas, of Baltimore; but when it is very important, as in some infantile cases, to destroy the taste, either method may be employed; as, though the tannate may act less rapidly, and require a larger quantity for a given effect, than the sulphate, yet it is in fact dissolved in the stomach whenever acid is present, and experience has proved its efficiency. Dr. W. H. Edwards, of Virginia, has found that, by enveloping sulphate of quinia in a spoonful of thick mucilage of slippery elm, without allowing it to touch the sides of the spoon, it may be taken without the taste being in the least degree observed. (Stethoscope, iv. 338).
The solution of sulphate of quinia, which, when its bitter taste is not objectionable, is the best form for administration, may be made by adding twelve minims of aromatic sulphuric acid to eight grains of the salt in a fluidounce of water; in other words, a minim and a half for each grain.
Twelve grains of the sulphate may be considered as equivalent to one ounce of good bark.
The doses proper under different circumstances have been already stated. It may be repeated that, as a tonic, the dose of sulphate of quinia is a grain, to be repeated in chronic cases three or four times a day, in acute cases every two or three hours; as an antiperiodic, from twelve to twenty-four grains between the paroxysms, in ordinary periodical diseases, which may be increased, in pernicious fever, and very obstinate neuralgia, to from thirty to sixty grains, these amounts being, as a general rule, divided into doses of from one to five grains at equal intervals; and, in reference to the secondary sedative effects, not less than fifteen or twenty grains daily, which must sometimes be considerably increased.
A Tincture of sulphate of quinia is directed in the Br. Pharmacopoeia under the name of Tinctura Quiniae Composita, being made by dissolving sulphate of quinia in tincture of orange-peel. A fluidrachm of it contains a grain of sulphate of quinia. It is a convenient preparation in some cases where the conjoint use of quinia and alcohol is indicated.
If the stomach will not retain the salt, it may be given by the rectum; from six to twelve grains, in ordinary cases, either dissolved by means of a little citric acid, or suspended in two fluidounces of mucilage or solution of starch, and mixed with from twenty to forty drops of laudanum, being injected into the rectum every six hours. In urgent cases, this quantity may be very greatly increased.
The endermic method is sometimes resorted to; but the application of sulphate of quinia, undiluted, upon a surface deprived of the cuticle, is apt to produce superficial sloughs; and its employment in this way should be restricted to cases of emergency. It should also be mixed, before application, with some unirritating substance, as powdered gum or arrow-root. The epigastrium, and insides of the thighs and arms, are proper positions for its endermic use.
The hypodermic method has come into considerable use, and in certain cases may be very advantageously employed. Indeed, sulphate of quinia is peculiarly adapted for subcutaneous injection; being readily absorbed by the areolar tissue, and producing its effects in quantities not too large for this mode of application; but it is liable to the objection, that it is not readily dissolved, while the success of the plan depends upon the perfect fluidity of the substance injected. This objection, however, may be obviated by means which will be mentioned directly. The characteristic effects of quinia on the system are more rapidly and more certainly obtained in this than in the ordinary modes of administration; and, in the same dose, the medicine will produce greater effects. Besides, the patient escapes all those disturbances of the stomach which occasionally follow its use when swallowed. The hypodermic method, however, is liable to some slight inconveniences, which will prevent its general substitution for the usual methods; but there are circumstances which decidedly indicate, and some which imperatively call for it. 1. Whenever there is an obvious indication for the use of quinia, and, after a fair trial by the mouth and rectum, it fails to produce the desired effect, there is clearly a call for its subcutaneous use. 2. A still stronger demand is made for it in cases where, from an irritable state of the stomach or bowels from an inability or refusal to swallow it, as in some low cases of disease, and with maniacs or infants, or from idiosyncrasies of the patient, it is either very difficult or altogether inexpedient to give it by the mouth. 3. There are, besides, affections so exceedingly painful, and others so imminently dangerous to life, that it is imperatively necessary to have recourse to the most prompt and most effectual means of relief and safety. This condition of things is presented in certain cases of neuralgia, and in all cases of the pernicious form of miasmatic fever, especially in the latter, when, as often happens, the stomach is excessively irritable.