The bark of Alstonia constricta.—Australia.
Preparations.—The finely powdered bark. Tincture of Alstonia. Alstonine.
Dose.—The dose of the powdered bark will be from grs. j. to grs. v. Of the tincture, from gtt. ij. to gtt. x. Of the alkaloid, grs. ⅛ , to grs. ¼.
Specific Indications.—The disease shows distinct periodicity. The tongue is dirty, the skin is sallow and dirty, the urine is turbid.
Therapeutic Action.—The antiperiodic action of Alstonia is more marked than any other agent which has been employed as a substitute for quinine. It is a powerful remedy, and where it is adapted to the case, three or four doses (two grains each) of the bark, will arrest an ague. It does not meet the indication—periodicity—in as large a number of cases as quinine, but where the tongue is dirty and the skin dirty, it will be found very certain. As it cures cases of chronic ague that quinine will not reach, the practitioner will be able to study his cases well.
The bark of the Alstonia constricta, or Australian fever tree, has been known as a pharmaceutical curiosity—at least, since 1863, when Palm separated from it a bitter principle which he called Alstonine. Dr. Hesse, director of the alkaloid works of Fr. Jobst, at Feurbach, near Stuttgart, has done much within the past few years to clear up the chemical history of the bark. A precis of his recently published results may be found in the medical journals. His researches leave some points undetermined, and the more practical question of the therapeutical effects of the bark and its alkaloids has hardly been approached. Dr. Bancroft has long used the bark in the hospitals of Melbourne with admirable success in cases of fever. Indeed, its vernacular name shows that the settlers discovered its healing properties before the doctors troubled themselves about it. But this seems to be a drug which will occupy no subordinate place as a mere cinchona substitute.
Dr. Hesse says: "Besides, allow me to add that I doubt the efficacy of Alstonine as a harmless remedy for fever, but that, on the contrary, I hold it to be a strong poison akin to strychnine. The Alstonia constricta bark contains about 2 ½ per cent. of this alkaloid, whilst it only yields 0.05 per cent. of Alstonidin. Thus you will see it will be difficult to manufacture them. The Alstonidin might have no practical importance, whereas this alkaloid (Alstonine) possesses very eminent therapeutic properties."
Dr. Bixby has used the drug largely during eighteen months, and has prescribed it in hundreds of cases. He finds its action resembles in many respects the combined action of quinine and nux vomica. It is an antiperiodic of the highest type, better, in his opinion, than the quinine or cinchonidine. It is a cerebro-spinal stimulant and tonic, acts positively upon the great sympathetic nerve-centers, and consequently increases, positively and permanently, the vital forces of the entire system. A proper sedative should be given before the use of this bark is begun.
In general nervous depression it acts like a charm; in typhoid, puerperal and other fevers, in recent colds and rheumatism, it has produced good results.