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Full text of "Medical Jurisprudence And Toxicology"

QUININE                                                           715

killed a widow in Paris in 1864, by giving her digitalin.   He had pecuniary
interest in her death.

Digitalis is not excreted by the kidneys as fast as it is absorbed into the
system, hence it is regarded as a cumulative poison. Persons, who have
been taking it for a long time, may suddenly develop the symptoms of poison-
ing without any subsequent increase in the dose. In such cases the quantity
of the urine should be measured to find out if it is diminished, or digitalis
should be prescribed with a diuretic, or should be omitted for one week in
every four weeks.

Strophanthus.—The seeds of Strophanthus kombe, N.O. Apocynacese,
contain as the chief active principle, the glycoside, strophanthin (kombe
strophanthin or strophanthin-k), which occurs as a white or yellowish-white,
crystalline, bitter powder. It is soluble in water and in alcohol, the non-
official dose being 1/240 to 1/60 grain by intramuscular or intravenous
injection. The official preparation made from powdered strophanthus (Stro-
phanthus pulvis) is Tincture, strophanthi, the dose being 2 to 5 minims.

The seeds of Strophanthus gratus and the wood of Acokanthera schim-
peri contain a crystalline glycoside, ouabain or strophanthin-g. It is soluble
in water and in dehydrated alcohol, and has a bitter taste. It is a pharma-
copoeial preparation, the dose being 1/500 to 1/240 grain by intravenous
injection. It is approximately twice as toxic as strophanthin-k.

Strophanthus resembles digitalis in its pharmacological and poisonous
actions, but it acts more rapidly. It is not a cumulative poison, as it is
excreted more rapidly.

Chemical Analysis.—Strophanthin may be isolated from the acidified
aqueous mixture of the suspected organic material by using amyl alcohol or
benzol as a solvent. On evaporating the solvent the residue is identified by
the following test: —

Strong sulphuric acid produces an emerald green colour, which changes
to brown.

QUININE (QUININA)  CaoHaiOoNa

This is an alkaloid which exists in combination with cinchonine and other alkaloids
as salts of quinic or chinic and quinotannic or cinchotannic acids in the bars of various
species of cinchona plants, N.O. Rubiaceae. These plants are native to Western South
America, but are now cultivated in Java and India.

Quinine occurs in white, acicular, inodrous crystals having a bitter taste. It is
insoluble in water, but dissolves in alcohol, ether, chloroform, benzene and carbon disul-
phide. It reacts like an alkali, and forms neutral and acid salts with acids. Thus, quinine
sulphate, quinine bisulphate, quinine hydrochloride and quinine dihydrochloride are offi-
cial preparations, the dose of each being 5 to 10 grains. Dissolved in water, these salts
have a blue fluorescence, when sulphuric acid is present.

Quinine is a protoplasmic poison and reduces the metabolism of the body. In suffi-
ciently large doses it paralyses and destroys all forms of living matter.

Symptoms.—These are giddiness, headache, ringing in the ears and partial deafness,
epistaxis, disorders of vision, e.g. blurring of vision, constriction of visual fields, etc.,
quinine amblyopia, difficulty of speech, pain in the abdomen, vomiting, diarrhoea, mental
depression, confusion of thought, muscular weakness, itching, erythematous or urticarial
rash on the skin, hsemoglobinuria, cold, clammy skin, gasping respiration, slow and imper-
ceptible pulse, collapse, cyanosis and death from respiratory failure. Delirium and con-
vulsions have sometimes been observed.

Fatal Dose.—Uncertain. Doses of 30 to 60 or 80 grains of quinine have caused
alarming symptoms. Forty grains of quinine have caused the death of a child,12 and
100 grains13 of quinine, 120 grains14 of quinine hydrochloride, 225 grains14 of quinine

12.   Beng. Chem. Examiner's Annual Rep., 1931, p. 6.

13.   Pharm. Jour,, April 10, 1948, p. 250.

14.   Autenrieth, Detection oj Poisons, Ed. VI (Eng. Transl. by Warren), pp. 212, 213;