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Amblyopia from Ingestion of Gelsemium Contained in a Nostrum
A M B L Y O P I A FROM I N G E S T I O N O F G E L S E M I U M
with the absence of deep scars of the cornea, the normal tension, and the lack of cupping of the optic disc, make it clear that we have true overgrowth
319
of the eyeball and not buphthalmos to deal with. 202 New Birks building
AMBLYOPIA FROM INGESTION OF GELSEMIUM CONTAINED IN A NOSTRUM EDWARD
STIEREN,
M.D.,
F.A.C.S.
PITTSBURGH T h e patient had taken a patent remedy for sciatica, which analysis showed to contain a mixture of gelsemine and gelseminine. Vision and hearing were disturbed, but returned to normal within a week after withdrawal of the nostrum. Read before the Allegheny County Medical Society, December 17. 1929.
F . E . S . , male, aged eighty-four years, had had his left eye operated upon for senile cataract nine years before, re taining continually corrected vision of 6/8. The right eye had a mature senile cataract. He appeared January 23, 1928, stat ing that he had recently lost his vision and was becoming deaf. Ophthalmoscopic examination re vealed nothing abnormal in his media or fundus to account for his reduced vision, which was now 6/60. There was no ptosis of either lid, and move ments of the globes in all directions were normal. Bone conduction was much lowered on both sides, and he could not hear ordinary conversation. In questioning him. the only depart ure he had made from an ordinary routine life was the taking of a remedy for sciatica which had been recom mended to him by a friend, and which was sold under the name of "Athlophoros." He had taken about three ounces over a period of four days, and about three ounces still remained in the bottle. As his symptoms appeared to be those of quinine amblyopia with deaf ness, the remainder of the mixture was submitted to Professor Julius A. Koch, dean of the Pittsburgh College of Pharmacy, with the request that it be examined, particularly in regard to qui nine content. Dr. Koch's report is as follows: "I found two reports on the composi
tion of Athlophoros in the literature. One by Oleson in 1903 was as follows: Potassium acetate 60 grains Sodium salicylate 490 grains Sugar 4 ounces Caramel 3 drops Water 14 fluid ounces "The other, a government report, gave the composition a s : Glycerin 69.5 per cent Sodium salicylate 11.8 per cent Methyl salicylate Oil of peppermint Oil of cinnamon Alcohol An alkaloid (not colchicine) Licorice "Our examination of the specimen submitted seems to confirm the govern ment analysis, as we found 11.6 per cent of sodium salicylate, and a small quantity of an alkaloid seemingly a mixture of gelsemine and gelseminine, dissolved in glycerin and water and flavored with volatile oils of pepper mint, cinnamon, and birch." As this patient had on a number of occasions taken as much as sixty grains of sodium salicylate daily over long periods without aflPecting either his sight or hearing, it seems logical to conclude that the mixture of gelsemine and gelseminine was the poisoning agent. His vision and hearing re turned on withdrawal of the nostrum, and the use of saline catharsis daily for a week.
320
EDWARD
STIEREN
A search of the literature fails to re rate, enfeebled muscular action, im veal a similar account of disturbance of paired sensibility, drooped eyelids, and vision from the ingestion of gelsemium, slightly dilated pupils. It is decidedly with a single exception. Amyat, in the mydriatic when locally applied to the British Medical Journal of March 16, eye, acting probably by paralyzing the 1901, reports the case of a twenty-two oculomotor terminals. It has been used year old female who purchased some with varying success in intercostal "neuralgic mixture" from a chemist, neuralgia, myalgia, sciatica, spasmodic sick headache, eczema, taking one dose. About three-quarters asthma, of an hour later she complained of her pruritus, and tetanus. head, and said that she could not count Ringer, in the American Encyclo the pips on playing cards. When ex pedia of Ophthalmology, states that amined by the physician he found the gelsemium when taken internally may pupils were slightly dilated and quite cause miosis, although it is a mydriatic insensitive to light. There was no when locally applied. No description marked diplopia, but the sensation of of the drug is given in the tenth revi giddiness and swimming of sight was sion of the United States Pharma extreme. copeia. According to the National The "neuralgic mixture" contained Dispensatory, gelsemium primarily de ammonium bromide, ammoniated tinc presses the sensory side of the spinal ture of quinine, and tincture of gel cord, but later if given in large amount semium. The one dose taken contained depresses the motor side. The drug has no effect upon the spinal nerves, but the ten minims of tincture of gelsemium. According to Potter's "Materia motor cranial nerves are paralyzed by medica", gelsemium contains two alka large doses. loids, gelsemine which forms crystal It would seem from this case that the line salts and is only slightly active, nerves of special sense may likewise be and gelseminine which is amorphous affected. and highly toxic. In moderate doses it causes languor, slowing of the cardiac 626 Union Trust building.
with the absence of deep scars of the cornea, the normal tension, and the lack of cupping of the optic disc, make it clear that we have true overgrowth
319
of the eyeball and not buphthalmos to deal with. 202 New Birks building
AMBLYOPIA FROM INGESTION OF GELSEMIUM CONTAINED IN A NOSTRUM EDWARD
STIEREN,
M.D.,
F.A.C.S.
PITTSBURGH T h e patient had taken a patent remedy for sciatica, which analysis showed to contain a mixture of gelsemine and gelseminine. Vision and hearing were disturbed, but returned to normal within a week after withdrawal of the nostrum. Read before the Allegheny County Medical Society, December 17. 1929.
F . E . S . , male, aged eighty-four years, had had his left eye operated upon for senile cataract nine years before, re taining continually corrected vision of 6/8. The right eye had a mature senile cataract. He appeared January 23, 1928, stat ing that he had recently lost his vision and was becoming deaf. Ophthalmoscopic examination re vealed nothing abnormal in his media or fundus to account for his reduced vision, which was now 6/60. There was no ptosis of either lid, and move ments of the globes in all directions were normal. Bone conduction was much lowered on both sides, and he could not hear ordinary conversation. In questioning him. the only depart ure he had made from an ordinary routine life was the taking of a remedy for sciatica which had been recom mended to him by a friend, and which was sold under the name of "Athlophoros." He had taken about three ounces over a period of four days, and about three ounces still remained in the bottle. As his symptoms appeared to be those of quinine amblyopia with deaf ness, the remainder of the mixture was submitted to Professor Julius A. Koch, dean of the Pittsburgh College of Pharmacy, with the request that it be examined, particularly in regard to qui nine content. Dr. Koch's report is as follows: "I found two reports on the composi
tion of Athlophoros in the literature. One by Oleson in 1903 was as follows: Potassium acetate 60 grains Sodium salicylate 490 grains Sugar 4 ounces Caramel 3 drops Water 14 fluid ounces "The other, a government report, gave the composition a s : Glycerin 69.5 per cent Sodium salicylate 11.8 per cent Methyl salicylate Oil of peppermint Oil of cinnamon Alcohol An alkaloid (not colchicine) Licorice "Our examination of the specimen submitted seems to confirm the govern ment analysis, as we found 11.6 per cent of sodium salicylate, and a small quantity of an alkaloid seemingly a mixture of gelsemine and gelseminine, dissolved in glycerin and water and flavored with volatile oils of pepper mint, cinnamon, and birch." As this patient had on a number of occasions taken as much as sixty grains of sodium salicylate daily over long periods without aflPecting either his sight or hearing, it seems logical to conclude that the mixture of gelsemine and gelseminine was the poisoning agent. His vision and hearing re turned on withdrawal of the nostrum, and the use of saline catharsis daily for a week.
320
EDWARD
STIEREN
A search of the literature fails to re rate, enfeebled muscular action, im veal a similar account of disturbance of paired sensibility, drooped eyelids, and vision from the ingestion of gelsemium, slightly dilated pupils. It is decidedly with a single exception. Amyat, in the mydriatic when locally applied to the British Medical Journal of March 16, eye, acting probably by paralyzing the 1901, reports the case of a twenty-two oculomotor terminals. It has been used year old female who purchased some with varying success in intercostal "neuralgic mixture" from a chemist, neuralgia, myalgia, sciatica, spasmodic sick headache, eczema, taking one dose. About three-quarters asthma, of an hour later she complained of her pruritus, and tetanus. head, and said that she could not count Ringer, in the American Encyclo the pips on playing cards. When ex pedia of Ophthalmology, states that amined by the physician he found the gelsemium when taken internally may pupils were slightly dilated and quite cause miosis, although it is a mydriatic insensitive to light. There was no when locally applied. No description marked diplopia, but the sensation of of the drug is given in the tenth revi giddiness and swimming of sight was sion of the United States Pharma extreme. copeia. According to the National The "neuralgic mixture" contained Dispensatory, gelsemium primarily de ammonium bromide, ammoniated tinc presses the sensory side of the spinal ture of quinine, and tincture of gel cord, but later if given in large amount semium. The one dose taken contained depresses the motor side. The drug has no effect upon the spinal nerves, but the ten minims of tincture of gelsemium. According to Potter's "Materia motor cranial nerves are paralyzed by medica", gelsemium contains two alka large doses. loids, gelsemine which forms crystal It would seem from this case that the line salts and is only slightly active, nerves of special sense may likewise be and gelseminine which is amorphous affected. and highly toxic. In moderate doses it causes languor, slowing of the cardiac 626 Union Trust building.