(Report of two cases of poisoning from Quinine.).
November 2d I was asked by Dr. Swan to see a patient of his, suffering, as he declared, from Quinine poisoning.
Mr. A-, age 35, weighing one hundred and seventy- five pounds, was taken with a slight chill after a cold bath following a horseback ride. His father, the only allopathic member of the family, in the absence of the young man’s mother, hastily summoned an allopathic physician near at hand, who declared the attack pneumonia, and gave him twenty grain doses of Quinine, until he could no longer endure them, when the dose was reduced, but Quinine continued.
After some six weeks-I can not give the exact dates-of this sort of treatment, he was declared consumptive, and sent to the Adirondacks.
Here he was dosed with Quinine and whisky and ordered to take long walks, which so exhausted him that his suffering was extreme. He wrote most pitiable letters to his mother, declaring the medicine was making him insane, and finally broke away and appeared unexpectedly at home in a lamentable frame of mind and body.
Dr. Swan was not able to see him, being himself quite ill, but for a week sent medicine for the intense pain in his head, and failing to relieve him asked me to call and examine the man.
November 2d I found him with an intense throbbing and shooting pain in front of the head particularly, but more or less in all parts, greatly < by motion. He had not slept for a week, with the exception of a few moments now and then, from sheer exhaustion. Pupils dilated, could not see distinctly, or saw double; holding his head with both hands and crying, “My head! my head!” There was an occasional intermission of the pain, but the suffering was constant; p. 100, t. 101 1/2.
This pain came on two weeks since-the Quinine was stopped three weeks ago, or one week before the pain came on-as he absolutely refused to continue it.
November 3d, 10 A.M. -P. 100, t. 101 1/2. Had much less pain; slept much of the time and feels better than for a long time. Up and down stairs, but seems dazed, can not control his eyes, acts as if he could not see distinctly, very weak, sweats easily on least exertion. My suspicion of typhoid fever is allayed by the fact that he had it several years since. 10 P.M., had a chill lasting ten minutes during the P.M. followed by delirium;two hours later his skin was cold and damp. Careful examination of his lungs shows nothing abnormal. Talking to himself; very restless with his feet; after sleep delirious; no pain in head.
November 4th, 9 A.M. -No pain during the night, some sleep; very restless after 1 A.M. P. 64, t. 101 1/2. Taken him a long time to pass water; talks incoherently, 11 P.M.
Dr. E. Carleton saw him with me, twice daily, until the 8th, when Dr. Swan was able to resume charge of the case.
November 9.-Patient can not see nor answer questions; gurgling of what he swallows.
Dr. Bell having come to New York to see a patient, very kindly consulted with us, carefully reviewing the history of the case, reading the patient’s letters to his mother, in which he declared he was being killed with medicine.
Dr. Bell gave no hope, but advised Laurocerasus. Nurse draws his urine, natural stool during the night. P. 70, t. 99 1/2. No reaction to pupil. No sordes on teeth, no cough, not once expectorating during the time I saw him. Extremities always warm. Thirsty, takes water and milk freely.
November, 10th. -P. 120, t. 101 1/2. Warm perspiration on face, jaw dropped. Breathing quicker. Dr. Bell saw him again to- day.
November, 11th. -During at 2:10 P.M. Six hours before the death of this man, a young allopathic physician, friend of the family, called and asked to see the patient as a friend. To him I also declared it a case of poisoning from Quinine, which he indignantly declared impossible and loudly informed the family that the man was not dying, that there were nine chances out of ten for his recovery. He also urged that Dr. A. be called in consultation. The family having had quite enough of Allopathy, refused to follow such advice, but after such an unfortunate row I insisted that Dr. A. be called and he met Dr.Bell and myself as soon as he could reach the house. Now comes the curious part of this history. Dr. A., after a very hasty examination, declared the man in quick consumption and the immediate cause of death tuberculous meningitis. The idea was scouted by the entire, family, and I held the fort until the sad tragedy ended.
Dr. A. defended the position of the man who sent the patient to the Adirondacks for consumption, but could not protect the young man who declared death from Quinine impossible, and thought there were none out of ten chances for recovery.
A few weeks later I sent the following from the October number of the Satellite, an allopathic journal, well known to you all. On the 14th page, number 21890, we find:.
RARE AND GRAVE FORMS OF CINCHONISM.
Dr. I. E. Atkinson. of Baltimore, at the meeting of the American Medical Association, June 25, 1889, read a paper on the above subject, which treated of blindness, deafness, and general poisoning from the use of excessive doses of Cinchona preparations. The symptoms of blindness may develop slowly, or, more generally, suddenly. It may last a few hours or many weeks. Though the blindness is never permanent, perfect vision is never recovered.
The symptoms which are characteristic and pretty constant, are: 1. Transitory blindness, complete or incomplete. 2. Color blindness. The color sense is restored ultimately. 3. Wide dilation of the pupil, which is irresponsive to light. 4. Pallor of the optic disks and extreme diminution of the calibre of the retinal vessels. 5. Contraction of the visual field. This now entirely disappears. The effect is probably a local one, produced upon the blood vessels of the part.
Complete permanent deafness has never been known to follow the use of quinine, and permanent impairment of hearing is very uncommon, but impairment of hearing with tinnitus is almost always present, through rarely lasting more than twenty-four hours. Permanent partial deafness is probably by a decided hyperaemia of the auditory apparatus.
General poisoning is rarely fatal, although the patient’s condition may border upon collapse. Convulsions have been reported in a large number of cases, the nature of which have not been determined. -Medical News, June 29, 1889.
CASE II. –
January 13th was called to see Mrs. H.-, aged 30. Since the middle of December has had “La Grippe” and being determined to break it has taken of her own accord “lots and lots of Quinine” in whisky. taken it in a teaspoon and does not know how much but thinks thirty and forty grains on some days. Yesterday she called a young allopathic M. D., who diagnosed consumption and recovery impossible. This prospect did not please her and she sent for Mrs. F’s doctor, who happened to be a homoeopath.
I find her with a hacking cough, slight expectoration greenish in color, and a dull aching pain in the upper part of right lung, shooting pains in head, and frequent slight bleeding at the nose. P. 80, t. 101; no such thing as sleep for days and days. Intense nervousness, gasping, sighing breathing, sweating so as to saturate the night clothes and sheets after 12 (midnight), smelling very sour. Apprehensive. Fears she will sink down and die. A dreadful gone feeling at the stomach, no desire for food, not, much thirst.
Is sure she will die before I see her again, and calls me back to assure her that she will not die with the dreadful sinking in region of stomach and heart. Laughs every other word as she talks. Feels so silly. Laughing, sighing and fear all mixed up together. Slept two and one-half hours and coughs less. Says there is a horrid black imp sitting on chest and clutching it, and making dreadful faces at her; asks if I can see him.
15th. -P. and t. normal. Slept about three hours, and on waking could hardly reach down deep enough to get her breath, it will surely drop out. Such a dreadful feeling in heart, it jumps and sinks. Terrible sinking. Laughing, silly way of talking. Scolds the family, no crying, called the cook in to scold her. Sweats on the least movement, wakes drenched, no motion of the bowels, and I will say here that it was two weeks before they did move.
Telegraphed me to come to her at once, as soon as I got home. Great fear that she will die and that her heart will stop, that her breath will drop out.
She gradually improved, the symptoms growing less intense.
The cough soon passed away, together with the exaggerated breathing in right lung and the imp that sat on her chest. She could not stand nor hardly sit up in bed before the end of January. it took her weeks to get control of her legs so that she could walk; would sink down exhausted after a few steps, gasping for breath.
March 15th I made my last visit and in two weeks she called at my office, still gasping for breath and laughing whatever she had to say; could not control her face in the least.
May 7th I sent her to her uncle in the country. She was so afraid she would die that she did not sleep a wink and in three days staggered into my office and is now at home.
Her will power did not leave her at any time. She would go into the park and walk when she could not possibly walk straight. She was nearly paralyzed and seemed destined never to sleep again.
Ign. Dig. Mosch. Sulph. and Plat. gradually helped her and May 29th she made the following report:.
“Sleeping very well all night, does not want to get up in the morning, never slept so well as now.” (Moschus was her last remedy.) Previous to this sickness had backache and neuralgia continually, now has none. Still has the awful gone feeling in stomach which she never had before. Strength leaves her “at nothing,” but much better than it was, and stronger than she was.
All through this sickness has been ‘worse at 6 P.M.;” wants air, to be fanned, and can not bear to have anything touch her stomach, her sinking, gone stomach. The sleeplessness began with taking the Quinine.
It always kept her awake and her old family doctor (allopathic) told her she should never take it.
Can not bear to see any one. Felt positively ugly; wanted to tear her nurse’s hair out; to fight every one; cried with anger; felt abused; melancholy, but always ugly.
Terribly, terribly nervous. Felt that her strength bad all gone out, not the least control of herself. Never had these laughing, talking, fighting fits, sleeplessness, nor faint stomach.
With the gone feeling is terribly ugly; sent the girl away because she felt the must “smash her.” Could not answer a civil question, wanted to strike, constant ringing in cars, aversion to meat, desire for fruit, milk, etc.
Here we have two cases of genuine poisoning from Quinine. The first in a strong young man, of very dark complexion and excitable temperament. he received with the Quinine, Antipyrine (more or less) and other doses, of the effect of which he complained. The second, a woman, under forty, of small stature, dark brown hair and a nervous and excitable temperament, took only Quinine, and a little whisky. The first was dosed from the fifth of August to the twenty-fifth of October, and died. The second got Quinine for three weeks only and requires relieved, and it will take five more to cure her.
The first patient was dying when I first saw him. The effect of the Quinine (and probably the other drug) was seen principally in his head. The irritation passing into paralysis of the brain, pure and simple, or into inflammation with exudation. A post- mortem was not allowed.
His symptoms, such as they are, do not seem to be of much value, but we have what I believe to be a fact: “death from Quinine”.
Paralysis showed itself first in the ears, eyes, oesophagus, stomach and bladder, and he had excruciating pain in his head. “Cheyne-Stokes” respiration came at last.
The second case lasting months, ending in the cure of an intelligent person, gives us her picture of Quinine poisoning from beginning to end; but, of course, including the possible effects of “la grippe,” but which I saw in no other, among a good number of patients.
A motion was made and carried that a vote of thanks be given Dr. Dillingham for his papers.
The following charges were preferred by Dr. C.W. Butler:.
WHEREAS, Dr. W.D. Gentry, a member of this Association has recently published in the American Homoeopathist a paper in which he advocates the use of Quinine, Eucalyptus and other drugs in the treatment of malarial troubles, and these not singly but in combination, and not upon homoeopathic indications but as “antidotal to the poison materia” as he asserts, whatever that may mean.
I hereby prefer charges against the said W.D. Gentry, of conduct inconsistent with his professions as a member of this Association, and calculated to do injury and injustice in the opinion of others to it, and respectfully request that these charges be referred to the Board of Censors for investigation, and such action as may in their opinion be just and proper.
The committee on the selection of the place of the next meeting reported that they recommended Cresson Springs, Pa., or Atlantic City, N. J.
It was moved and carried that the report be accepted and the committee discharged.
A motion was made and carried that the matter be referred to the executive committee.
The following resolution was introduced by Dr. Custis and was unanimously adopted:.
Be it Resolved, That the officers of this Association are hereby authorized to incorporate the Association with the name, membership and officers as they now exist, and that they are directed with the assistance of the Board of Censors to prepare a constitution and by-laws for the consideration of and the adoption by the Association at the next meeting, provided that they submit a copy of the same to all the members at least two weeks before the meeting.
A vote of thanks was given to the president, Dr. Joseph A. Biegler, for his able and just manner of presiding.