IMAGE EVALUATION TEST TARGET (MT-3) Zk % // 4 i/.A » 1.0 If '^ IS4 === ^ li£ III! 2.2 1.1 \^ i^ nil ^ IIJ& L^ llil 1-6 t.11 ^ d ■ ^ • o ► vl c*l c>^ ^'S ^I«/ '^ >^ 7 Photographic Sciences Corporation 33 WIST MAIN STRUT WHSTIR.N.Y MSaO (716)l7a-4S03 % CIHM/ICMH Microfiche Series. CIHM/iCiVIH Collection de microfiches. : Canadian Institute for Historical Microreproductions / Institut Canadian da microreproductions historiquaa Technical and Bibliographic Notes/Notes techniques et bibiiographiques Th(i Institute has attempted to obtain the best orifjinal copy available for filming. Features of this copy which may be bibliographically unique, which may alter any of the images in the reproduction, or which may significantly change the usual method of filming, are checked below. □ Coloured covers/ Couverture de couleur I I Covers damaged/ D D □ D D Couverture endommagie Covers restored and/or laminated/ Couverture restaurie et/ou pelliculie □ Cover title missing/ Le titre de couverture manque I I Coloured maps/ Cartes giographiques en couleur Coloured ink (i.e. other than blue or black)/ Encre de couleur (i.e. autre que bleue ou noire) I I Coloured plates and/or illustrations/ Planches et/ou illustrations en couleur Bound with othar material/ ReliA avec d'autres documents Tight binding may cause shadows or distortion along interior margin/ La re liure serrie peut causer de I'ombre ou de la distortion le long de la marge intirieure Blank leaves added during restoration may appear within the text. Whenever possible, these have been omitted from filming/ II se peut que certaines pages blanches ajouties lors d'une restauration apparaissant dans le texte, mais, lorsque cela itait possible, ces pages n'ont pas At* filmAes. Additional comments:/ Commentaires supplAmentaires; L'Institut a microfilm* le meilleur exemplaire qu'il lui a iti possible de se procurer. Les details de cet exemplaire qui sont peut-*tre uniques du point de vue bibliographique, qui peuvent modifier une image reproduite, ou qui peuvent exiger una modification dans la m6thode normale de filmage sont indiqu6s ci-dessous. □ Coloured pages/ Paoas de couleur □ Pages damaged/ Pages endommagdes □ Pages restored and/or laminated/ Pages restauries et/ou pelliculdes r~n Pages discoloured, stained or foxed/ n Pages dicolordes, tachet^es ou piqu6es Pages detached/ Pages ditach^es Showthrough/ Transparence Quality of prir Qualiti inigale de I'impression Includes supplementary materii Comprend du materiel supplimentaire Only edition available/ Seule Mition disponible I I Pages detached/ r~71 Showthrough/ rn Quality of print varies/ r~1 Includes supplementary material/ I I Only edition available/ Pages wholly or partially obscured by errata slips, tissues, etc., have been refilmed to ensure the best possible image/ Les pages totalement ou partiellement obscurcies par un feuillet d'errata, une pelure etc., ont tti film^es A nouveau de fa^on A obtenir la mailleure image possible. This item is filmed at the reduction ratio checked below/ Ce document est filmi au taux de reduction indiqu* ci-dessous 10X 14X 18X 22X MX aox y 12X lex aox 24X 28X 32X 1 1" ails du )difier une nage Th« copy film«d hare has b««n reproducad thanks to tha ganarosity of: Medical Library McGill University Montreal Tha Imagaa appaaring hara ara tha baat quality possibia considaring tha condition and lagibiiity of tha original copy and in Icaaping with tha filming contract spacificationa. L'axamplaira film* fut raproduit grflca A la gAnirositA da: Medical Library McGill University Montreal l.aa imagaa suivantaa ont it* raproduitas avac la plus grand soin, compta tanu da la condition at da la nattat* da l'axamplaira fiimi, at mn conformity avac iaa conditiona du contrat da filmaga. Original copiaa in printad papar covars ara fiimad baginning with tha front covar and anding on tha laat paga with a printad or iiiuatratad Impraa- sion, or tha bacic covar whan appropriata. All othar original copiaa ara fiimad baginning on tha first paga with a printad or iiiuatratad impraa- sion. and anding on tha laat paga with a printad or iiiuatratad imprassion. Tha laat racordad frama on aach microficha shall contain tha symbol —i^-( moaning "CON- TINUED "). or tha symbol V (moaning "END"), whichavar appliaa. Laa axampiairaa originaux dont la couvartura mn papiar aat imprimia sont fiimte an commandant par la pramiar plat at an tarminant soit par la darnlAra paga qui comporta una amprainta d'impraaaion ou d'iiiuatration. soit par la sacond plat, salon la caa. Tous laa autraa axampiairaa originaux aont fiimAa an commandant par la pramiAra paga qui comporta una amprainta d'impraaaion ou d'iiiuatration at an tarminant par li darnlAra paga qui comporta una talla amprainta. Un daa symbolaa suivants apparattra sur la darniira imaga da chaqua microficha, salon la caa: la symbols «»• signifia "A SUIVRE", la symbols ▼ signifia "FIN ". Mapa, plataa, charts, ate, may ba fiimad at diffarant raduction ratioa. Thoaa too larga to ba antiraly includad in ona axpoaura ara fiimad baginning in tha uppar laft hand cornar, laft to right and top to bottom, aa many framaa aa raquirad. Tha following diagrama iliustrata tha mathod: Laa cartaa, planchaa, tablaaux, ate, pauvant itra filmia i daa taux da reduction diffirants. Lorsqua la documant aat trap grand pour Atra raproduit an un saul clichA, ii aat film* k partir da I'angia sup4riaur gaucha. da gaucha i droita, at da haut an baa, wi pranant la nombra d'imagas nicaaaaira. llaa diagrammaa suivants iliustrant la mAthoda. rrata o lelure, 1 A H 32X 1 2 8 1 a s 4 5 6 ,t. •;■.;*, -v;. Rqninted from the Montreal Medical Jownai, March, 1892. 65 A REMARKABLE CASE OF QDININE RASH PRO- DUCED BY VERY SMALL DOSES OF THE DRUG. By Fbancis J. Shbphbrd, M.D. The rashes produced by the internal administration of progs are sufficiently uncommon to be of interest. Many drugs, it is well known, will produce rashes, more or less severe, in indi- viduals with an idiosyncrasy. Some drugs, however, produce a rash merely by long continued administration in large aoses in persons without any special idiosyncrasy— «.^., iodine, bromine, etc. Among the many drugs which produce rashes, the most familiar are copaiba, bromides, iodides, tar, turpej^tine, cubebt, belladonna, arsenic, antipyrin, etc. One of the most frequently administered drugs is quinine, and considering the enormous number of times it is given in large and small doses, the number of cases reported in which it produces rashes is comparatively few. All practitioners have seen quinine rashes from the ad- ministration of large doses of the drug. The most common forms are the erythematous ; the urticarial, the purpuric, bullous vesicular, and gangrenous forms are much more uncommon. In some casos the rashes produced by quinine and other drugs have been mistaken for scarlatina. The case I am about to relate is a somewhat rare one, both because of the severity of the rash and the small dose which produced it : A. B., a strong, robust man, aged 41, whom I had frequently treated for eczema and rhus poisoning, and whose skin was easily irritated, consulted me in June, 1889, for an eruption of boils which had been ^troubling him for some time past.. He felt rather out of sorts, and I prescribed for him citrate of iron and quinine in five-grain idoses. Next evening he came complaining of great heat, soreness, and a burning sensation in groins and on inner sides of thighs.. On examining him I found these parts covered with large claret-coloured patches, which also extended a short distance n^ the abdomen. The skin was swollen and tender ; in the centre of the red patches purpuric spots could be seen, which did not disappear on pressure. The peripheral portions of the patches were purely erythematous, the colour rapidly dis- appearing on pressure. As he had always perspired a great deal about the groins, he attributed this rash to having over-heated himself, although he affirms that he thought the medicine had something to do with it. He had only taken three doses of the citrate, or 15 grains (three grains of quinine). I prescribed a lead lotion for him, and told him to stop his medicine. The next day t^e eruption had spread to the feet, and the hands were also beginning to be affected. On both wrists was a well-marked vesicuTar eruption, which did not itch. The eruption was con- fined to the abdomen, thighs, hands and feet. As it was accom- ^panied by t^great deal of burning and soreness, the patient was confined to the house, being unable even to wear slippers. At the end of ten days desquamation began, comparatively small flakes of skin coming away from the thighs, but the skin of the palms of hands and soles of feet coming away in one piece. In a few days more the patient was able to attend to his business. The strangest part of the story is yet to come. About a month later, towards the end of July, coming home one evening fagged out, he thought he would take a dose of his old medicine as a pick-me-up. This he did, taking the usual dessert spoonful (five grains) in a little water. Immediately he felt the old sensation in his thighs and about scrotum, and by next morning the same claret-coloured [latches with pur[)uric spots reappeared on thighs and abdomen, and were followed next day by a similar rash on hands and feet. The sensation of burning, itching and soreness was quite as severe as during the first attack, and the eruption