SCIENCE 



NEW YORK, SEPTEMBER 16, 1893 



DANGER FROM THE POPULA.R MISUSE OF QUININE. 



BY W. THORNTON PARKER, M.D 



A RECENT editorial in the Medical Neu'S of April 2, 1892, con- 

 cerning deaths from cocaine, may %vell be noticed in connection 

 with the investigation of dangers from the popular misuse of qui- 

 nine. " I have never seen it," ergo " No man's experience, 

 however wide, can cover all the possibilities of disease and acci- 

 dent. It may be well and wise for one to say. ' I have not seen 

 it," %vhen the possibility or lilielihood of this ot that pathologic or 

 toxic accident is under discussion; but it is never wise and never 

 well because of the perhaps limitation of one's own experience to 

 deny the reality of occurrences vouched for by competent ob- 

 servers, and not in themselves incredible." 



A recent item in one of the daily journals has prompted me to 

 say a word against the misuse of the popular remedy known as 

 quinine. The item referred to states that a sea-captain, sailing 

 his craft too near a sunken ledge, was warned to give the dan- 

 gerous quarter a wide berth. He replied, by yeUing out at his 

 adviser, " You go straight to hell; lam sailing this craft where 



I please.'' The vessel was wrecked, and the insurance money 



refused on the ground that the captain wilfully destroyed his 

 vessel. This the defence emphatically denied. In explanation of 

 his extraordinary language, the captain stated that he had been 

 suffering from malaria, and had taken large doses of quinine for 

 relief, and had become so much "influenced'' by its action that 

 really he did not know what he was saying or doing. 



Few, if any medicines, enter so largely and generally into popu- 

 lar use as quinine. Throughout the world we find it almost 

 everywhere for sale; it can be purchased in any quantity by any- 

 body, and used as the purchaser may think best, in larger or 

 smaller doses, at intervals, or continually. Few seem to under- 

 stand its poisonous action, or even suspect that its continual use 

 can result in any special injury to the system. It is prescribed by 

 all sorts and conditions of men, women, and children. Ruse, in 

 his excellent text-book of medical jurisprudence, defines a poison 

 as '-a substance which, when introduced into the body by swal- 

 lowing or by any other method, occasions disease or death; and 

 this as an ordinary result in a state of health, and not by a me- 

 chanical action. It must be as an ordinary result; a substance, 

 for example, which affects one person injuriously through idiosyn- 

 crasy, is not to be called poison. Again it must be in the healthy 

 system, as is well known, many diseases render the system ex- 

 tremely susceptible to impressions by external agents, e. g., in 

 gastritis, the blandest substance, even water, may excite vomit- 

 ing.'' 



The action of the malarial poison upon the system is of such a 

 nature that many would claim that any abnormal nervous im- 

 pression would be more likely to have its origin in the malarial 

 poison than in the quinine, which is given with a view to neutral- 

 izing that poison. We know of so many diseases following the 

 inception of the malarial germs that any attack upon quinine, as a 

 poisonous remedj', may reasonably expect prompt resentment. 

 Ringer states, that " large doses produce severe frontal headache 

 with dull, heavy, tensive, and sometimes agonizing pains. While 

 these symptoms last, and, indeed, generally before they appear, the 

 face is flushed, the eyes suffused, and the expression is dull and 

 stupid. Even small doses in persons very susceptible to the ac- 

 tion of this medicine will produce some of the foregoing symp- 

 toms, especially the headache and mental disturbance. Many of 

 these symptoms are, no doubt, due to the action of quinia on the 



brain. In toxic doses it excites convulsions. Chirone and Cure 

 find that the removal of the motor centres of the brain prevents 

 these convulsions; and, if the central hemisphere is removed on 

 one side, the convulsions are unilateral. Albertoni, on the other 

 hand, finds that quinia wUl induce convulsions when the central 

 hemisphere or the cortical motor centres are removed." Dr. Bar- 

 tholow states, that " In full medicinal doses, as the quinia accumu- 

 lates in the brain, a sense of fullness in the head, constriction of 

 the forehead, tinnitus aurium, more or less giddiness, even de- 

 cided vertigo, may be produced. In actually toxic doses all of 

 the above symptoms have been intensified. There are intense 

 headache with constriction of the forehead, dimness of vision, 

 or complete blindness, deafness, delirium, or coma, dilated 

 pupils, weak, fluttering pulse, irregular and shallow respira- 

 tion, convulsions, and finally collapse and death." Dr. Wood 

 states, that "The minimum fatal dose of quinine is not 

 known, but it must be large, and probably varies very 

 much." Brown-Sequard states, that "In epileptics the attacks 

 are rendered decidedly more frequent by the cinchona alkaloids." 

 Dr. Wood is of the opinion, also, that "In large doses quinia, 

 without doubt, abolishes the functions of the cerebrum." 



From the foregoing we have evidence to demonstrate that 

 quinia is too dangerous a remedy to be prescribed recklessly by 

 medical men, and that its popular use by people ignorant of its 

 action should be condemned and, if possible, prevented. In our 

 o\vn practice we have known of four cases where moderate doses 

 continued even for two or three days would produce serious cere- 

 bral disturbance amounting to almost homicidal mania. There 

 are very many cases in every community where the use of quinine 

 will affect the nervous system of patients in a serious manner. 

 One patient, after using ten grains, did not know whether it was 

 morning or evening, and was bewildered in finding his way home. 

 Another complained to me that he could not take quinine with- 

 out feeling cross and out of sorts for a week afterwards. Still 

 another, a very peaceful man naturally, stated that the use of 

 quinine for a day or so made him quarrelsome and pugilistic, 

 and he feared that under its influence he might commit some 

 act which might bring him into serious trouble. .Supposing that 

 a lawyer should offer in defence of his client the statement that, 

 acting under the advice of his physician, the patient had been 

 taking large doses of quinine for several days, and in a paroxysm 

 of rage, while under the influence of the drug, he had committed 

 homicide, would this man in equity be responsible for his deed ? 

 That quinine is a dangerous drug with many there can be 

 no doubt, that it is universally dangerous there may be some 

 question. It seems to me but just, under the circumstances, that 

 it should be rated as a poison. The study of the action of quinine, 

 from a medico-legal standpoint, is one, therefore, not without in- 

 terest. 



POPULAR ERRORS ABOUT WILD ANIMALS. 



BY THEODORE B. COMSTOCK. 



In the issue of the Popular Science Monthly for September, 

 1893, at page 719, is the following item under "Notes" : — 



" A novel view of the puma, or panther, as it is commonly 

 called, is taken by Mr. W. H. Hudson, in his ' Naturalist in La 

 Plata,' who insists that it never attacks men except in self-defence. 

 In the pampas, where it is common, the gaucho confidently sleeps 

 on the ground, although he knows that pumas are close by; and 

 it is said that a child may sleep on the plain unprotected in equal 

 security." 



There are many popular notions concerning the danger from 

 wild animals which evervone who has travelled out of the Ijeaten 



