368  Rare  form  of  Poisoning  hy  Quinine,  {^"iugl'iim™ 
The  case  which  is  the  subject  of  this  article  occurred  about  a  year 
since,  in  the  practice  of  a  physician  of  this  city,  who  has  kindly  given 
me  the  notes  from  which  the  account  is  compiled.  I  am  convinced 
that  this  form  of  quinism  occurs  more  frequently  than  might  be  sup- 
posed from  the  fact  of  its  having  been  overlooked  by  systematic  writers 
on  materia  medica.  My  object  in  publishing  this  case  is  to  elicit  simi- 
lar reports  from  others,  and  thus  to  secure  the  recognition  of  such 
accidents  by  our  text  books  on  this  subject. 
On  April  15th,  1870,  Mr.  A.,  a  merchant  of  this  city,  who  had  pre- 
viously enjoyed  good  health,  was  taken  ill  with  febrile  symptoms  which 
lasted  five  days,  and  were  thought  by  his  physician  to  be  of  a  malarial 
nature.  In  accordance  with  this  view,  quinine  was  prescribed  in  the 
form  of  two-grain  sugar-coated  pills,  of  which  the  patient  took  three 
on  April  22d,  two  days  after  perfect  recovery  from  the  previous  at- 
tack. On  retiring  at  night,  Mr.  A.  noticed  that  his  hands  were  be- 
ginning to  swell,  and  soon  experienced  severe  burning  and  itching, 
which  deprived  him  of  rest.  Towards  morning,  the  feet  became  simi- 
larly effected.  When  seen  on  the  23d  inst.,  the  hands  and  feet  were 
swollen  and  erythematous,  the  eruption  being  most  conspicuous  on  the 
palms  and  soles,  extending  to  the  wrists  and  ankles,  marked  by  a 
sharply-defined  border,  and  resembling  the  eruption  of  scarlatina. 
There  was  no  febrile  disturbance,  and  the  patient  expressed  himself 
as  feeling  very  well,  with  the  exception  of  the  annoyance  from  the 
burning  and  itching.  Daring  the  following  day,  the  rash  extended 
over  the  whole  body,  and  on  the  fourth  day  the  cuticle  of  the  hands 
and  feet  began  to  desquamate.  Desquamation  shortly  ensued  upon 
the  trunk  and  limbs.  The  cause  of  these  singular  symptoms  being 
entirely  unsuspected,  the  quinine  was  ordered  to  be  resumed  on  April 
80th,  and  the  same  night,  after  having  taken  three  pills  (six  grains), 
the  patient  experienced  toxic  effects  of  still  greater  severity,  viz.,  high 
fever ;  pains  in  the  limbs ;  tongue  heavily  coated,  clearing  in  a  few 
hours  to  a  dark  red  color;  burning  and  pricking  of  hands  and  feet, 
with  a  return  of  the  swelling  and  rash,  which  eruption  extended  over 
the  trunk  and  limbs,  and  was  followed  by  a  second  desquamation. 
From  this  second  attack  he  failed  to  convalesce  quickly,  and  went 
into  the  country,  remaining  there  about  a  fortnight,  during  which 
time,  although  (so  far  as  can  be  ascertained)  he  took  no  more  quinine, 
he  occasionally  sufi"ered  from  burning  and  itching  in  his  hands  and 
feet,  and  on  one  or  two  occasions  there  was  a  slight  return  of  the  rash. 
