Chrysophanic Acid

C14H10O4

An organic acid obtained from Rhubarb and some lichens (Parmelia, Squamaria, etc.).

Authority.

J. Ashburton Thompson, M.D., Brit. Med. Journ., 1877 (1), p. 607.

Deductions from 319 observations; 206 of these were on persons who were out of sorts rather than ill.

The crude powder and the extracted acid have the same locally irritant effects; either kept in contact with the skin produces irritation, inflammation, and discoloration of the cutis. Either introduced in minute quantity to the eye causes conjunctivitis.

On reaching a dose of 6 grains, I experienced sensations of nausea, accompanied and followed by sensations of disturbance in the bowels; even an abortive attempt at vomiting; then relief from all symptoms (after four hours). Sensations of disturbance in the bowels, accompanied and followed the sensations of nausea (after four hours). A loose action of the bowels (after twenty hours).

My brother dined at 7; at 8.30 he took 8 grains of C. made into a pill with confection of roses.

Vomited (after two hours); aroused from sleep by another attack of vomiting (after three hours and a half). No depression, except during the act of vomiting.

Second series of observations, including 90 cases, 30 children and 60 adults : Vomiting is always the first sign of action; this is not attended by any depression at all comparable with that caused by tartar emetic or ipecacuanha; in children, as well as in adults, the acts of vomiting varied between none in three out of the whole number and six in two out of the whole number; they were usually two or three; very often only one; the nausea continues more or less markedly until the bowels recover.

The action on the bowels is variable, from none in a few cases to nine or ten in equally few cases; most often the range was between three and seven; there is no griping pain; the motions are very watery, and of such a brown color as suggests its origin with the powder taken; if the vomiting be very early, then the purgation, although marked by a fluid stool or stools, will certainly not be violent; and in some cases, in which there was no vomiting, the bowels acted very freely; it does not always happen so, however, under the same condition; and I conclude, therefore, that some persons can take a larger dose than others.

A dose of six grains produces scarcely any effect upon children of twelve, eleven, ten, or nine years; upon children of eight and six years, the effect is uncertain; upon children of from five years down to five weeks, it is certain to operate; but the time which elapses before its action is manifested may vary between ten minutes and nine, even, twelve, hours; the effect of the same quantity is not increased as the age of the child is diminished. (Thus, three children of five weeks, of three years, and of six years, respectively, were affected by the six-grain dose to the same degree). I am not able to say upon what this peculiarity depends, but the intervention of sleep delays the manifestation of any effect, and was the cause of delay in the two cases in which alone so long intervals as nine and twelve hours elapsed. A scruple is a moderate dose for an adult; the interval which elapses before it begins to operate may be so long as five hours; but, if the dose be well adapted to the individual, that is quite exceptional; four hours is a pretty frequent interval, but two hours or less is the most common interval; it may be so short as fifteen minutes, but is seldom shorter than thirty. I conclude that Chrysarobin is, in a dose of twenty-five grains for adults or of six or more grains for children, an emetic purge, of which the action is unattended by any inconvenient symptoms.

Observations of Chrysophanic acid upon 116 persons, of all ages, and both sexes : The action of Chrysophanic acid is similar to the action of Chrysarobin, with this difference, that while in a suitable dose each will cause vomiting and purging, if the dose be too small Chrysarobin is most likely to purge alone, while Chrysophanic acid is most likely to cause vomiting only. A larger full dose, that is to say, from fifteen to twenty grains, will always both vomit and purge the patient very freely, at the same time that it causes an inconvenient amount of either of those effects very rarely indeed. Farther, there is but little danger of inconvenience from too large a dose.

The dose of Chrysophanic acid . In this case, as in that of Chrysarobin, I observe first of all, with a quantity which acts well upon a child of five or six years of age, no increase in effect is observed with the same dose upon the very youngest children; yet farther, of Chrysophanic acid I am obliged to say what does not hold good of Chrysarobin, that on children of less than four or five years its action is uncertain, in that it sometimes fails to act entirely, or acts very feebly, or most often of all causes vomiting only; it never acts upon them with unexpected violence. I have found that six grains of Chrysophanic acid is a good dose for children of ten years and under. For adults, I find the action of the acid certain in a dose of fifteen grains; upon some adults I have found ten and even eight grains act as often as fifteen grains upon other adults apparently of similar physique; and again I have found some, but very few, who demand as much as a scruple for the manifestation of a reasonably brisk action.

Of Chrysophanic acid I have observed this effect: whatever the condition of the patient, it causes the evacuation, one way or the other, of large quantities of bile.

Fourth series of observations : I made ten observations on adults with the resin of Chrysarobin, made into pills with Tragacanth and Glycerin. One grain had no effect upon two individuals; in three cases three-grain doses caused vomiting from twice to five times, and purging from five to seven times; in one case, two grains were taken by a man, aged twenty years, instead of four as was intended; in six hours, the bowels began to act, and then they acted very loosely three or four times; there was no vomiting, but considerable nausea, which lasted for eighteen hours; in the remaining four cases, four grains were taken for a dose; and this in every case acted within two hours, in one within half an hour, vomiting being the first sign, and purging very quickly ensuing; in three of these cases the acts of vomiting were three to five; of purging from five to ten; in the fourth, a stout woman, fairly strong, and the subject of habitual constipation, the vomiting and purging were continued during five or six hours, with very small intervals; she was suffering from neuralgia, which I had traced to the state of the bowels, and it disappeared during this violent action; the sickness, except in the last case, was not said to be attended with much depression. It will thus be seen that the resin of Chrysarobin is identical with that of the crude powder and of Chrysophanic acid, but very much more powerful.

If a dose of Chrysophanic acid be taken, and immediately followed by a meal, its action will be considerably delayed; if it be taken after a meal, its action will be delayed in proportion (more or less) to the progress which has been made with digestion; if it be taken upon an empty stomach, its action is manifested quickly; there seems reason to believe that fulness of the stomach, or the consequent delay in action, determines its effects to the bowels, without in all cases obviously diminishing its emetic power; but emptiness of the stomach does determine it rather to emetic action, and does also diminish its purgative action, notwithstanding that, except in the case of babies, the latter is never entirely absent.

From these 319 cases I conclude that Chrysophanic acid is an emetic purge; its action is as certain, when given in appropriate dose, as that of any other drug which acts in either of these ways; if either kind of action should be wanting, on account of the dose having been too small, it is the purging which will fail to appear; but that is rare.