356 VEGETABLE DRUGS 



effect of quinine in inhibiting the movement of leukocytes observed in the 

 frogj when large doses are introduced into the blood, occurs after the 

 therapeutic use of the drug in mammals. But it has recently been shown 

 that a solution of quinine in blood, equal to that when a small dose (gr. 

 iii., man) is ingested, increases markedly phagocytosis in the case of all 

 the common pathogenic organisms. Very large doses diminish phagocy- 

 tosis. It is hard to explain this action when we consider leukocytosis is 

 hindered by quinine, but it may show why benefit should be expected from 

 the drug in septic conditions. 



2. Red Blood Corpuscles. — Therapeutic doses increase the number 

 of red corpuscles. The latter diminish in size in febrile conditions, but, 

 under the action of quinine (and other antipyretic agencies), regain their 

 normal condition. This follows the effect of quinine in lowering tempera- 

 ture, and is not due to any specific power of quinine exerted on the cor- 

 puscles themselves. 



Heart and Blood Vessels. — Quinine in ordinary doses does not affect 

 the heart or vessels appreciably. Large doses at first stimulate the 

 muscle of the heart and blood vessels and cause the pulse to be accelerated 

 and vascular tension to be raised. In poisoning this effect is temporary 

 and is followed by depression of the muscle of the vessel walls and heart 

 and the cardiac pulsations become slow and weak and the blood tension 

 falls. Death occurs immediately from failure of respiration. Although 

 the heart is much weakened it commonly continues to beat for some time 

 after breathing ceases. The action on the heart is like that on all forms of 

 living tissues — primary stimulation followed by depression and paralysis. 



Nervous System. — Here again the general action consists in primary 

 stimulation followed by depression and paralysis of the the cerebrospinal 

 system. The breathing is first accelerated and then weakened and death 

 occurs from paralysis of the respiratory center. Fatal poisoning is very 

 rare after ingestion of quinine. Ounce doses have been swallowed by 

 man without serious result. Occasionally convulsions have occurred but 

 perhaps due to an admixture of the other alkaloids, as cinchonidine and 

 finchonine are convulsive agents in toxic doses. Toxic doses of quinine 

 injected into the carotid artery cause meningitis by direct irritation. In 

 man, ringing in the ears, fulness in the head, and slight deafness com- 

 monly follow a large medicinal dose (cinchonism). Blindness also very 

 rarely occurs in man after large doses. Vomiting, diarrhea, albuminuria 

 and skin eruptions sometimes occur in poisoning by the drug due to local 

 irritation. There are contraction of the retinal vessels and degenerative 

 changes in the retina and spiral ganglia of the cochlea, which account for 

 the loss of sight and hearing. There is some clinical evidence that quinine 

 in medicinal doses is a cerebral stimulant, but there is no experimental 

 proof of the fact. 



Spinal Cord and Nerves. — Quinine, in experiments on the frog, first 

 stimulates and then lessens reflex activity. This condition disappears on 

 section of the medulla. Toxic doses, however, cause permanent loss of 

 reflex excitability. The same alkaloid first excites and then paralyzes the 

 peripheral sensory nerve endings. These effects on the nervous system 



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