During the fall of 1887 it was noticed by the nurse that the eyebrows were growing darker, and that the hair of the head was darker in patches. These patches and the eyebrows continued to become darker, until at the time of her death they were quite black, the black tufts on the head presenting a very curious appearance among the silver-white hairs surrounding them.
Quinin being such a universally used drug, numerous instances of idiosyncrasy and intolerance have been recorded. Chevalier mentions that through contact of the drug workmen in the manufacture of quinin are liable to an affection of the skin which manifests itself in a vesicular, papular, or pustular eruption on different parts of the body. Vepan mentions a lady who took 1 1/2 grains and afterward 2 1/2 grains of quinin for neuralgia, and two days afterward her body was covered with purpuric spots, which disappeared in the course of nine days but reappeared after the administration of the drug was resumed.
Lewin says that in this case the severity of the eruption was in accordance with the size of the dose, and during its existence there was bleeding at the gums; he adds that Gouchet also noticed an eruption of this kind in a lady who after taking quinin expectorated blood. The petechiae were profusely spread over the entire body, and they disappeared after the suspension of the drug. Dauboeuf, Garraway, Hemming, Skinner, and Cobner mention roseola and scarlatiniform erythema after minute doses of quinin.
In nearly all these cases the accompanying symptoms were different. Heusinger speaks of a lady who, after taking 1/2 grain of quinin, experienced headache, nausea, intense burning, and edema, together with nodular erythema on the eyelids, cheeks, and portion of the forehead. At another time 1 1/2 grains of the drug gave rise to herpetic vesicles on the cheeks, followed by branny desquamation on elimination of the drug. In other patients intense itching is experienced after the ingestion of quinin.
Peters cites an instance of a woman of sixty-five who, after taking one grain of quinin, invariably exhibited after an hour a temperature of from 104 degrees to 105 degrees F., accelerated pulse, rigors, slight delirium, thirst, and all the appearances of ill-defined fever, which would pass off in from twelve to twenty-four hours. Peters witnessed this idiosyncrasy several times and believed it to be permanent. The most unpleasant of the untoward symptoms of quinin exhibition are the disturbances of the organs of special sense. Photophobia, and even transient amblyopia, have been observed to follow small doses. In the examination of cases of the untoward effects of quinin upon the eye, Knapp of New York found the power of sight diminished in various degrees, and rarely amaurosis and immobility of the pupils. According to Lewin, the perceptions of color and light are always diminished, and although the disorder may last for some time the prognosis is favorable. The varieties of the disturbances of the functions of the ear range from tinnitus aurium to congestion causing complete deafness. The gastro-intestinal and genito-urinary tracts are especially disposed to untoward action by quinin. There is a case recorded in which, after the slightest dose of quinin, tingling and burning at the meatus urinarius were experienced. According to Lewin, there is mentioned in the case reported by Gauchet a symptom quite unique in the literature of quinin, viz., hemoptysis. Simon de Ronchard first noted the occurrence of several cases of hemoptysis following the administration of doses of eight grains daily. In the persons thus attacked the lungs and heart were healthy. Hemoptysis promptly ceased with the suspension of the drug. When it was renewed, blood again appeared in the sputa. Taussig mentions a curious mistake, in which an ounce of quinin sulphate was administered to a patient at one dose; the only symptoms noticed were a stuporous condition and complete deafness. No antidote was given, and the patient perfectly recovered in a week. In malarious countries, and particularly in the malarial fevers of the late war, enormous quantities of quinin were frequently given. In fact, at the present day in some parts of the South quinin is constantly kept on the table as a prophylactic constituent of the diet.
Skinner noticed the occurrence of a scarlatiniform eruption in a woman after the dose of 1/165 grain of strychnin, which, however, disappeared with the discontinuance of the drug. There was a man in London in 1865 who died in twenty minute's after the ingestion of 1/2 grain of strychnin. Wood speaks of a case in which the administration of 1/100 grain killed a child three and one-half months old. Gray speaks of a man who took 22 grains and was not seen for about an hour. He had vomited some of it immediately after taking the dose, and was successfully treated with chloral hydrate. A curious case is mentioned in which three mustard plasters, one on the throat, one on the back of the neck, and another on the left shoulder of a woman, produced symptoms similar to strychnin poisoning. They remained in position for about thirty minutes, and about thirty hours afterward a painful stinging sensation commenced in the back of the neck, followed by violent twitching of the muscles of the face, arms, and legs, which continued in regular succession through the whole of the night, but after twelve hours yielded to hot fomentations of poppy-heads applied to the back of the neck. It could not be ascertained whether any medicine containing strychnin had been taken, but surely, from the symptoms, such must have been the case.
