On the poisonous properties of quinine / by William O. Baldwin ; with remarks by J. Marion Sims.

  • Baldwin, W. O. (William Owen), 1818-1886.
Date:
1881
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Licence: Public Domain Mark

Credit: On the poisonous properties of quinine / by William O. Baldwin ; with remarks by J. Marion Sims. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    tain degree. Within the last twenL/ years, however, the practice has to a large extent been abandoned amongst us, and I have had occasion to materially modify my ow n views relative to its action as an anti-pyretic or anti phlogistic remedy. I am quite sure that I have seen some cases of pneumonia prove fatal under the operation of large doses of this remedy, which I believe would other- wise have recovered. In such cases I have known it to produce continued restlessness, with a profound state of insomnia, attended with mental delusions, finally resulting in a condition much resembling that of delirium tremens, and ending at last in death, after the grave symptoms of pneumonia had en- tirely disappeared. Quinine is unquestionably at times a pow- erful nervine irritant. I have often had oc- casion to deplore its effects upon the brain, especially in infants and young children when, after several days of persistent use, it had completely upset the nervous system, producing great wakefulnes.', restlessness, and fright, with an alarming sense of falling, ending sometimes in convulsions and even in death. I have become so cautious in the use of this remedy of late years that I have had no occasion to witness its poisonous effects in my own practice, but, in consultations, I have had opportunities of confirming the views which I have so long entertained as to its immediate and direct agency in producing the effects which I have ascribed to it. I am under the impression that the revival of its use in the large do=es in which it was given at the South thirty or forty years ago is doing a great deal of mischief throughout the country, and especially in some of our larger cities, and that it is often the cause of fatal injury when its agency is not suspected. The first case that led me to suspect that quinine was capable of producing poisonous effects occurred in my own household. A man servant, colored, thirty years old, had an attack of acute pneumonia of the right lung, on the 25th of October, 1845, whilst I was temporarily absent from home. He was at- tended by a professional friend, who made copious notes of the case, from which I gather that the pneumonia was at no time of a violent character. The patient com- menced taking quinine at five o’clock P. on the 27th and continued it until r.30 o’clock P. M. on the 28th, during which time he took sixty-eight grains. At three P. M. (one and a half hours after the last dose of quinine) the doctor was called in haste, and his notes at this visit I here give in full: “28th, 3 o’clock p. M, Called to patient. He had a little while before been taken with a jerking moiio7i of the whole body, which lasted sev- eral minutes, and immediately after his vision was so hnpei-fect that he could scarcely distinguish anything. Found whole surface hot; respiration irregular, from ii to 20; pulse 100, full and rather fiim ; temporal veins turgid and temporal artery throbbing ; great restlessness, anxiety and alarm ; thirst increased, tongue more dry ; pupils dilated; he dozes two or three minutes at a time, then starts up, breathing more quickly and audi- bly ; cough frequent and diy ; respiratory murmur heard over greater extent of whole lung. The convulsive movements of body come on every ten or twelve minutes, some- times apparently of whole body, at others confined to the arms. He was not insensi- ble during the convulsions, nor was there foaming at the mouth, but occasionally a star- ing and vacant look and rolling up of the eyes. By half after four o’clock he was completely blind. * * * * * It is unnecessary to pursue the subsequent de'ails of ihe case. His vision begin to im prove in about twenty-four hours, but it was never fully restored while I kept oversight of him, which was about twenty years. The agency of the quinine here, in pro- ducing blindness, convulsions, etc., is cer- tainly most manifest. It was commenced at five o'clock on the evening of the 27th and continued until 1.30 o’clock p. M. of the 28th, being twenty hours arrd a half from the first dose to the last, during which time sixty-eight grains were introduced into the system, the pernicious influence of which was visible at three o’clock, one hour and a half from the last dose. The restlessness, tremors, ^/(^Krand iitegular breathing, dilitalion of the pupils, blindness and convulsions, all supervening at the time they did, bespeak most pointedly and conclusively the poisonous operation of the quinine. The next case that led me to think that