Chininum Sulphuricum - Appendix symptoms - T.F. Allen

APPENDIX

Authorities

55, C. Robbins, M.D., Bost. Med. and Surg. Journ., vol. xxxiii, 1850, p. 560, Mr. O., aet. thirty years, took half a drachm; 56, Chas. E. Slocum, Med. Rec., vol. xii, 1877, p. 334, effects on three ladies; 57, Prof. Köbner, Berlin, Klin. Woch., 1877 (Med. Rec., 12, p. 601), effects on a large, powerfully built woman, aet. twenty-eight years; 58, Prof. Köbner, Berlin, Klin. Woch. (Gaz. Méd., Paris, 1877, p. 590), a patient, suffering from facial neuralgia, took 1 gram.; 59, Dr. Ricklin, Gaz. Méd. de Paris, 1877, p. 590, a young woman, suffering from bronchitis, took a powder; 60, Henry M. Field, M.D., Lond. Med. Rec. vol. xiv, 1878, p. 427, effects of ordinary allopathic doses on a lady for chills and fever; 61, John S. Linsley, M.D., MSS., took at one 30 grains at night.

Great nervous excitement, with wakefulness all night. Sensation in auditory region, as if a horse railroad, with its continual roar and rumble, had its course through the brain incessantly; worse alternate days for one week,

In about three-quarters of an hour he began to feel as if intoxicated; this feeling, which was precisely similar to that produced by an overdose of alcohol, increased so rapidly that in about fifteen minutes his ideas became confused, and he was unable to walk without staggering; the next morning he complained of loss of appetite, dull pain, and dizziness of the head, and a general languor and debility, and incapacity for business,

She said that it poisoned her; "It is as if every drop of blood and every tingling nerve were in my skin." There was great heat, oedema in some places, especially in face and hands, great increase, of cutaneous sensitiveness; all followed in a few days by desquamation of the cuticle. With these accidents were associated more or less gastric disturbance, and upon one occasion violent and repeated vomiting, headache, and delirium. Even 4 to 5 grains Sulphate of quinine for the twenty-four hours produced a light attack of the skin disease, enough to suggest alarming results should the usual 1 to 3 gram doses be prescribed,

After two hours she was taken with internal chills, followed by very violent praecordial anxiety, with nausea and vomiting of mucus. In a few minutes the patient complained of very violent headache, accompanied by repeated chills, followed by a sensation of burning heat, especially in the head, and then over the whole surface of the body. On the next morning the fever was intense, and there was an exanthematous eruption, associated with burning heat and distressing itching. The patient also complained of difficulty of swallowing and cutting pains in the throat. The redness extended over the face, neck, shoulders, back, and limbs, and disappeared on pressure. The skin was very sensitive to touch, especially about the throat. There was oedema of the lids. The redness finally appeared on the extremities, where, however, it was not continuous, but in isolated patches, especially upon the anterior surface of the extremities. On the posterior surface of the thighs there was a series of papules very prominent, scattered, surrounded by a red areola. The posterior portion of the pharynx was deep red. The tongue did not present the usual characteristics of scarlatina, and on consultation it was decided that the symptoms were due to the Chinin., analogous cases having been seen by the consulting physician. On the ninth day intense desquamation commenced and lasted three weeks. The temperature was high during the first days, 39.8°C., pulse 124. Some time afterwards this patient had another attack of bronchitis, and took Chinin. again, which was followed by the same symptoms, but in a less violent degree. Desquamation commenced on the fifth day, on the palms and soles, and lasted three weeks,

She was attacked with a syndrome, closely resembling that of scarlet fever, whenever she took even a small dose of Quinine. The symptoms consisted in a chill, which was sometimes repeated, a feeling of praecordial anxiety, nausea, vomiting, intense headache, high fever, and angina. A few hours after the chill an erythematous eruption made its appearance on the face, and spread rapidly over the entire body. It was attended by intense burning and itching, by slight oedema of the face, and injection of the conjunctiva. The color disappeared for a moment on pressure. The eruption on one occasion completely covered the entire body; on another it was confluent on the upper part of the body, but discrete on the legs. On this occasion the eruption on the legs was slightly papular, and the lower border of the confluent part was not sharp, but gradually faded into the healthy skin. After a variable length of time, according to the amount of Quinine taken, the symptoms abated and desquamation began. The angina affected only the posterior wall of the pharynx, the soft palate and pillars being normal. Three times in the course of five months the patient was seized with these attacks. The first time the exanthem broke out after 3 1/2 grains of Quinine had been taken. As a diagnosis of scarlet fever was made, the Quinine was continued for eight days, and the eruption persisted for the same length of time. Desquamation then began, and continued for six weeks, and on the soles of the feet, in fact, for nine weeks. The fever was high and persistent, and the prostration was very great. Three months later the exanthem reappeared after a dose of 2 1/4 grains of Quinine. The stage of eruption lasted four days, and the desquamation three weeks. The third time the exanthem made its appearance after a dose of only 1 1/2 grains of Quinine. The stage of eruption lasted only two and a half days, and the desquamation fourteen days. The affection this time ran a milder and shorter course than on the two previous occasions. Dr. Von Heusinger, of Marburg, states that he has met with two cases, in which symptoms entirely analogous to those described above, were produced whenever even very small doses of Quinine were administered. In these cases, however, the eruption was confined to the face Both patients were women. One of them was at one time able to take Quinine without inconvenience,

I have had three patients, all ladies, with whom Sulphate of quinine has produced peculiarly unpleasant effects. Very soon, usually within half an hour, in one case almost immediately after the medicine was taken, the face became suffused with an erythematous eruption, and a tingling-itching sensation, very severe and distressing in its nature, followed and extended over the body and extremities. The effects produced in the three cases varied somewhat, but mainly were identical with the symptoms of urticaria ab injestis. In case first, I have at long intervals prescribed the various preparations from the bark unknown to her, and invariably with the same result, the less active preparations being the more slow in their effect. In this case nausea, vomiting, and great gastric distress followed the cutaneous irritation. In case second, there was produced considerable oedema, with wheals, ending with desquamation. In case third, the cutaneous eruption and irritation were not so severe as with the others, but the pulmonary oppression and constriction of the throat were the more prominent symptoms,

On the same day there developed a scarlatina-like eruption over the whole body, with very high fever, delirium, dyspnoea, and all the symptoms of pulmonary congestion. Scarlatina, with pleuro-pneumonia, was diagnosticated. The eruption disappeared on the fourth day, and was followed by desquamation, which lasted three weeks,

Supplement

CHININUM SULFURICUM.