On Quinia, and Some Analogous Substances in Prescriptions as Tonics and Efficacious Antiperiodics.
By J. B. R. PURNELL, M.D., of Snowhill, Md.
The object of what follows (a part of which has before appeared in the Medical and Surgical Reporter, Oct., 1869,) is not to allude to medicine of agreeable taste any more than to speak of certain combinations as more efficacious antiperiodics than quinia sulphate alone. Nevertheless, a knowledge of means of disguising any disagreeable taste—whenever this is possible without damage to remedial power—is and ought to be admitted as important, a palatable remedy being essential in a great many cases to comfort, in not a few to a cure. And, having noticed several accounts of formulae intended to conceal the bitterness of quinia, I am induced to make some statements—conclusions which I think can be relied upon, being arrived at, by some years of observation and many experiments made with care.
Ext. glycyrrhizae alone (better with a little tannic acid) answers a good purpose with many patients, but a large proportion is usually required (5 grs. may be used for each grain of quinia sulphate or 2 grains of cinchonia sulphate), and I find the taste of the extract is more often objected to than that of some other things that may be used—hence the importance of a knowledge, if possible, of a variety of substances to be employed to destroy the bitterness.
Tannic acid used in large proportion with quinia sulphate—less for cinchonia sulphate or the alkaloid quinia—conceals the bitterness, and the fact may be well known to the profession generally, or the majority; but it is probably not generally known that a slightly bitter taste of tannate of quinia—more properly a minute portion of precipitated quinine—will be perceived, though not until about a half minute after swallowing the mixture. The same is perceived, to some extent, in the case of any other combination by which the bitterness of quinia or cinchonia is disguised, but is probably more distinct with the tannic acid mixture; to prevent this it is only necessary to rinse the mouth with water, or with cold tea, which is better.
In the first place, however, it is important to know whether the medical properties of a remedy are at all impaired by the substance used to disguise its taste; and there is evidence that there are many practitioners who would be unwilling to depend upon quinia sulphate combined with tannic acid in large proportion as an antiperiodic.
Quinia, in the form of tannate in solution (or rather, in mixture) I have used for several years (in over a thousand cases), and believe it to be in no case less, oftentimes more, efficient as an antiperiodic than sulphate of quinia alone.
Without the aid of any other substance eight grains of tannic acid will be required to entirely cover the taste of ten grains of quinia sulphate; it is better, however, to use less and in combination with aromatics unless an astringent be indicated. But the roughness of tannic acid is unpleasant to many persons. To prevent this, add sugar in abundance and a little aromatic. But if sick stomach should be present much sugar cannot be retained or will be refused, (true at least in the majority of cases) and this will be a trouble; and if to the same person the taste of tannic acid should be very unpleasant, there will be another trouble, and the difficulty will be increased. Now in this case, as well as the case of a patient who for any other reason objects both to sweet medicine and tannic acid, if, while employing but little sugar, we use rather less tannic acid and a large instead of a small quantity of aromatic, and dilute the dose sufficiently—though unnecessary to dilute very largely—we will generally succeed. Though in regard to quinia sulphate directly, a small quantity of aromatic, however used, can accomplish nothing, and the effect of a large quantity, when employed alone, is too trivial to make it useful, the same (large quantity) will nevertheless assist much in disguising it, provided a certain proportion of tannic acid be present.
Some persons who sweeten quinine, expecting by this means to somewhat diminish the bitter taste, only add to the trouble, for the bitterness is increased by the addition of sugar without any other substance, or at least is not lessened in the slightest degree, and is caused to be perceived for a much longer time for the reason probably that it imparts an adhesive property to the solution which, consequently, remains longer on the organs of taste and penetrates.
Cinchona, though containing the alkaloids and not usually requiring tannic acid—a fact readily accounted for from the presence of Cinchotannic acid—will be sufficiently disguised by the use of sugar, cinnamon and orange. Tr. cinchonae comp., already containing aurantii cort., will require only sugar and cinnamon. For tr. gentianae comp. tannic acid and sugar may be used, though the addition of syr. sarsaparilla comp. or ext. sars. fl. co. will greatly improve it, or either of the last two named with an aromatic alone can be employed. A palatable and efficient elixir of cinchona may be found in Parrish's Pharmacy. The following recipes will be adequate to the end proposed
|Tr. Cinchona, Comp.,||fʒv.|
|Spt. Lavandulae Comp.,|
|Tr. Cinnamomi, aa||fʒij.|
|Tr. Gentianae Comp.,|
|Tr. Cinchon Comp., aa||f℥ss.|
|Ac. Tannici,||gr. ij.|
|Syr. Sarsaparillae, Co.||f℥i.|
|Tr. Cinchon Co.,||f℥ss.|
|Ferri et. Potass. Tart.,||ʒj.|
The fer. et potass. tart. here serves a twofold purpose, since it helps materially to conceal the bitterness. The following formulae will generally prove efficacious as tonics or antiperiodics, and not impalatable to the majority of persons, and may be varied somewhat according to the case and the taste of the patient.
|Quinia Sulphatis,||gr. xv.|
|Cinchoniae Sulphatis,||gr. x.|
|Acidi Tannici,||gr. x.|
|Syr. Aurantii Cort., aa||fʒvj.|
|Ol Sassafras, aa||gtt. iij.|
|Quiniae Sulph.||gr. xv,|
|Cinchoniae Sulph.||gr. viij.|
|Ac. Tannic,||gr. v.|
|Ext. Sarsapar. Fl. Co.||fʒiij.|
|Syr. Sarsapar. Co.||f℥iss.|
|Quiniae Sulph.,||gr. xx.|
|Liq. Potassae arsenitis,||m. xx.|
|Acidi Tannici,||gr. xij.|
|Syr. Aurantii Cort.||f℥vi.|
|Aq. Menth. Pip.||fʒiiij.|
|M. S. fʒj ter die. As an antiperiodic f℥ss-f℥ij.|
|Quiniae Sulph.,||gr. xx.|
|Cinchoniae Sulph.,||gr. xv.|
|Ac. Tannic,||gr. vi.|
|Syr. Sarsapar. Comp.||f℥iiiss.|
|Ol Anisi,||m. vi.|
|M. S. fʒj ter die. As an antiperiodic, f℥ss-i.|
To prevent the slightly bitter taste which begins to be perceived about a half minute after swallowing the dose, rinse the mouth with water, or with cold tea, which is better.
Coffee (if a good article) in strong decoction, or prepared by displacement or in powder, while it adds to the antiperiodic effect, disguises the taste of a large proportion of the sulphates of quinia and cinchonia and like bitters, as well as some other remedies, not impairing the medical properties, and though not new it seems not to be generally known. It is, perhaps, generally known to have been much used to conceal the taste of senna and magnesia sulphate, and in regard to quinia, Waring, mentions the fact on page 229, Practical Therapeutics. He says, "Coffee is of importance as a means of disguising the taste of nauseous medicines, particularly quinine, senna, and epsom salts." It is to be remembered, however, that a weak preparation will not do.
Rx Coffee ½ teacupful, Water Oiss.
Use no milk with it unless a very small quantity only is desired to flavor; with or without sugar according to taste.
In relation to this subject there is an important fact to be borne in mind. The quinia or cinchonia sulphate should be put in the coffee in form of powder. If dissolved first with an acid a decided bitterness will be perceived. So, in the case of anything employed to conceal the taste of quinia sulphate and like bitters, use the bitter in powder, avoiding an acid or (with a few exceptions) any perfect solution.
Cocoa or chocolate, if the quinia sulphate is not in large proportion, conceals the taste to a great extent, provided it be used of a sufficient strength, as in the solid or semi-fluid state. For cinchonia sulphate it will do better, since the taste of this substance is not so difficult to cover.
A decoction—five minutes boiling—of a certain strength (a weak preparation will not answer) of a mixture of green and black teas (I have not succeeded so well with either alone, yet there can be no reason why one will not do,) after standing with the leaves for eight, hours, disguises the taste of quinia and cinchonia sulphates, though not in so large proportion as coffee. For this purpose:
Rx Theae V. gr. xxv,—Theae n. gr. xxxiv, Aq. f℥viij.