MADRAS AND BOMBAY CINCHONA COMMISSIONS. 
79 
By sulphate of cinchonine , , . 410 
„ „ cinchonidine . . 359 
„ „ quinidine , . . 376 
The doses and mode of administration varied a good deal. Some medical officers 
used large doses of from 15 to 20 grains ; others, medium doses of from 8 to 10 grains ; 
and some, small doses of from 2 to 5 grains. As a general rule, the members of the 
commission are of opinion that the experiments were most successful when medium 
doses were employed ; that is, the cases of fever in which 8 or 10 grains of alkaloid were 
administered in a single dose daily appeared to recover more expeditiously than where 
larger or smaller quantities were employed. Large doses of cinchonine, cinchonidine, 
and quinidine produce effects very similar to those of quinine. Disagreeable noises in 
the head, singing in the ears, deafness, and giddiness are the more noticeable of the 
symptoms produced by all the cinchona alkaloids. Vomiting, nausea, and purging also 
are occasionally noted to follow their use. On the other hand, small or moderate doses 
produce none of these peculiar effects, while they improve the appetite, strengthen the 
digestion, and, in many cases, appear to have a marked effect in reducing the size of 
congested spleens. 
5. The alkaloids were exhibited successfully, that is, with the result of a rapid cessa¬ 
tion of febrile proxvsms in a very large proportion of the cases. Out of the 1145 cases 
recorded, four deaths occurred, and all these took place at Goodaloor, in Wynaad. Dr. 
Keess observes of them, that the fever was complicated either with pneumonia or diar¬ 
rhoea, and that a great proportion of his patients were half-starved, emaciated persons, 
completely prostrated by the malarious influences surrounding them. 
In addition to the cases ending fatally, it is recorded that the alkaloids failed more or 
less to arrest febrile paroxysms in twenty-seven persons, a proportion a little in excess 
of two per cent, of the total cases treated. 
6. In regard to these failures, it must be noted that they occurred chiefly in the 
practice of gentlemen who tried the alkaloids, not in recent attacks of fever, but in 
patients whose systems were chronically poisoned by malaria. Thus, Mr. Walters, of 
the 4th regiment N. I., Secunderabad, records of many of his cases, that they had been 
from one to three or four months suffering from fever before he used the alkaloids, and 
that in some of them quinine failed just as much as quinidine, cinchonine, or cinchoni- 
diue had done. Mr. Chipperfield explains the probable cause of failure in his report. 
In recent attacks of uncomplicated paroxysmal fever, the new alkaloids appeared to 
most of the medical officers using them, and to the members of the commission, to be 
quite as efficacious in the curing of fevers as quinine. On this subject, however, it is 
impossible to speak with precision, until the results of treatment with the cheimcally 
pure disulphate of quinine, as supplied by Messrs. Howard, have been tabulated in the 
form used for recording the treatment by the other alkaloids. Instructions have been 
issued to the gentlemen engaged in the experiment to do this; and the returns, when 
received, will afford most valuable data whereby to compare the relative therapeutical 
effects of the several alkaloids. 
7. The evidence, so far as it has come before the commission, does not go to show any 
particular superiority of one alkaloid over another. 
The sulphate of quinidine is, perhaps, the one regarding which there is the least dif¬ 
ference of opinion as to its merits. All three are undoubtedly anti-periodic, and capable 
of controlling paroxysmal fevers. The sulphate of cinchonine in large doses perhaps 
causes more unpleasant symptoms than the others; but on this point further evidence is 
still wanting, to enable the commission to offer a positive opinion. As regards the 
general and practical question at issue, we agree with Dr. Keess in thinking that all 
three alkaloids are, equally with quinine, capable of controlling paroxysmal fevers. 
Dr. Keess’s experience led him to conclude that a 10-grain dose of either salt would 
check or postpone the febrile paroxysm in a considerable number of cases, while very 
few patients required more than a second 10-grain dose to subdue the disease for the 
time being. 
Other observers have employed larger quantities of the several drugs ; but it is by no 
means clear to the commission that the quantities exhibited were, in all cases, necessary 
to check the fever. As regards this part of the inquiry, it is intended to institute a 
distinct series of experiments for the more accurate comparison of the value of the 
several alkaloids, when contrasted with quinine or with each other. 
