CINCHONA AND ITS ALKALOIDS IN MALARIA 
259 
TABLE II 
Approximate Impurities in Medicinal 
Preparations 
Alkaloid 
Approximate percentage of 
impurities 
Quinine 
Cinchonidine 2%; Hydroqui¬ 
nine 1.5% 
Quinidine 
Hydroquinidine 6—30% 
Cinchonine 
Hydrocinchonine 10% 
Cinchonidine 
Quinine 10%; Hydroeinchoni- 
dine 8% 
brief summary modified from Dawson’s ex¬ 
tensive discussion of this important report 
in the report of the Madras Cinchona Com¬ 
mission. These early observations have 
been essentially confirmed by the more 
recent workers in this field. The exact 
relationship varies, but it can be assumed 
that any of the four alkaloids listed is effec¬ 
tive. In India, in the treatment of chronic 
benign tertian malaria, Sinton and Bird 
(1929) concluded that the percentage of 
cases showing relapse was about the same 
for the four alkaloids. According to 
Fletcher (1928) this is true not only for 
benign tertian, but also in estivo-autumnal 
infections. In the latter, however, cin¬ 
chonine and cinchonidine are perhaps some¬ 
what inferior. Quartan fevers yield to any 
of the four alkaloids. Since by far the 
largest amount of alkaloid in the currently 
available Dutch barks is quinine, the use 
of the other alkaloids is of importance only 
in those cases showing an idiosyncrasy to 
quinine. As already mentioned, in some 
cases at least, idiosyncrasy to quinine does 
not extend to its isomer of the opposite 
sign so that it is possible to treat malaria 
TABLE III 
Effectiveness of Four Chief Cinchona 
Alkaloids 
Total 
cases 
Cured 
Per cent 
cured 
Quinine . 
846 
840 
99.2 
Quinidine . 
1040 
1025 
98.5 
Cinchonidine 
762 
745 
97.7 
Cinchonine ... 
969 
946 
97.6 
in an individual showing abnormal reac¬ 
tions to quinine with quinidine (Dawson 
et al. 1933). 
No general discussion of the pharmacol¬ 
ogy of quinine or the related alkaloids 
seems desirable here. It should always be 
kept in mind that there are two groups of 
untoward reactions that may follow these 
alkaloids, namely, the symptoms of over¬ 
dosage, or einchonism, which may be ex¬ 
pected in any individual if enough alkaloid 
is given, and the symptoms of idiosyncrasy, 
occurring in a small number of individuals, 
even from small doses. By einchonism is 
meant the well known complex, character¬ 
ized chiefly by headache, ringing in the 
ears, sensation of fullness in the head, dis¬ 
turbances of vision. While this complex 
is undoubtedly more easily brought on in 
certain individuals than in others, there is 
reason to believe that all individuals would 
show it after adequate dosage. Idiosyn¬ 
crasy to quinine, however, is shown by a 
different group of symptoms. The most 
common of these are skin eruptions which 
may take a variety of forms. Other effects 
may be pseudo-asthmatic attacks, or gastro¬ 
intestinal disturbances, with vomiting or 
diarrhea. Some patients according to Bas- 
tedo (1937) may show “typical anaphylac¬ 
tic phenomena with swelling of face, hands, 
and feet, a sense of suffocation, colic and 
prostration.” The mechanism of idiosyn¬ 
crasy is unknown. In many such cases, 
quinidine has been substituted successfully 
(Dawson et al. 1933). 
Absorption of quinine or of its salts from 
the gastro-intestinal tract is reasonably 
rapid and probably complete. Quinine can 
be detected in the urine within 15 minutes 
after oral administration and it continues 
to be excreted by the kidney for some time. 
Excretion is most rapid in the first 24 
hours, but traces occur in the urine for as 
long as three days. Only about one-third 
of that ingested can be recovered from the 
urine. The fate of the balance is unknown. 
After intravenous administration quinine 
disappears from the blood stream very rap¬ 
idly, 95 per cent of it within 5 minutes. A 
part of this can be recovered from some 
