[Reprinted from 
The Philadelphia Polyclinic, 
Vol. V, March 28, 1896, No. 13.] 
A CASE OF DUBOISIN POISONING.1 
BY C. A. VEASEYj M.D. 
Adjunct Professor of Dismses of the Eye in the PhiladelphiiTfolyclinic ; Chief Clinical Assistant to the Ophthalmological 
Department of we Jefferson Medical College Hospital; Consulting Ophthalmologist to the Philadelphia 
Lying In Charity Hospital, etc. 
Cases in which there exists an intolerance 
of duboisin, either when administered inter- 
nally or when solutions are instilled into the 
conjunctival cul-de-sac, are not of such rare 
occurrence as to make it desirable that each 
new case should be reported. 
As early as 1879 Nettleship2 reported eight 
cases of poisoning from the instillation of 
several drops of a solution of this drug of the 
strength of 4 grains to the fluidounce, the 
symptoms varying from a slight transient 
giddiness to a violent delirium. In the same 
year a case was reported by Carl3 from the 
instillation into each eye of three or four 
drops of a solution of the same strength, and 
another by Tweedy,4 the latter case being 
one of iritis, the drug being employed to 
break up the synechiae, as it was supposed to 
be much stronger in its action than atropin. 
Later, cases were reported by' Chadwick,5 
Kollock 6 and others, but in all of the cases 
referred to the solution was of the strength of 
4 grains to the ounce and in most of them 
several instillations were made before symp- 
toms of poisoning were observed. 
In the present case, however, the quantity 
of the drug giving rise to severe symptoms 
was much smaller, and the rapidity with 
which these symptoms appeared was so 
marked that they give to the case additional 
interest. 
MissP , aged 27 years, female, stenog- 
rapher by occupation, consulted me in 1892 
for constant headache, always much worse in 
the afternoons and towards the close of the 
day and never so bad on the days on which 
she was not obliged to work. There were 
also symptoms of accommodative asthenopia, 
some ciliary pain, a slight conjunctivitis, all 
of which were made worse by close applica- 
tion to her work. Her general health was 
very good beyond the strain and annoyance 
caused by her ocular symptoms. 
Upon examination there was found to exist 
a compound hyperopic astigmatism, the axes 
being 1350 and 45 °, which was corrected 
with the use of cumulative instillations of 
homatropin hydrobromate as the cycloplegic. 
All of the eye-symptoms rapidly disappeared 
and she was able to perform her work with 
absolute comfort. 
In 1895, alittle more than three years from 
the time she had been glassed, she consulted 
me at my office, saying that she had acci- 
dentally broken her lenses, and inasmuch as 
some of the old symptoms had returned about 
a month before, she thought perhaps she might 
require some change. 
After making the preliminary examination, 
she was directed to employ cumulative instil- 
lations of homatropin hydrobromate, as be- 
fore ; but, with a trial of two different solu- 
tions obtained from two different sources, it 
was found impossible to relax all of her ac- 
commodation. A solution of duboisin sul- 
1 Read before the Philadelphia County Medical Society, 
March 11, 1896. 
2 London Lancet, 1879, ii, p. 352. 
3 Klin. Monatsbl.f. Augenheilk., 1879, xvii, p. 337. 
4 London Lancet, 1879, ii, p. 441. 
5 Brit. Med. Jour., 1887, i, p. 327. 
8 Medical News, 1887, i, p. 344. 2 
fate was then ordered, of the strength of 2 
grains to the fluidounce, of which she was to 
instil one drop into each eye, three times a 
day. 
The patient resided in one of our suburban 
towns, and, not' understanding that it was 
necessary for her to use the drops on the day 
previous to the one upon which she was to 
come to my office, did not have any in- 
stillations made until she was ready to leave 
home on her way to the city to be refracted. 
On the train she felt somewhat heated and 
flushed, and, to use her own expression, her 
" brain felt as .if too much champagne had 
been taken," she was so excited, and when 
she reached the station in the city, she found 
it almost impossible to walk. Taking a car- 
riage, she was driven at once to my office, 
arriving there in about forty minutes from the 
time the drops were put into the eyes. She 
staggered into the reception room, talking in 
an incoherent manner to my door attendant, 
so that it was at once reported to me that 
an intoxicated woman was in the office. 
I saw her at once, and, suspecting that either 
the duboisin or hysteria was the cause of 
the symptoms, immediately placed her on 
a couch in my library. In going from the 
office to the library, it was ascertained that 
she could not walk without assistance, 
and that her gait was of a dragging char- 
acter seen in certain lesions of the spinal 
cord. She was intensely excited, talking in 
an incoherent manner and replying to all 
questions vaguely. Occasionally a proper 
reply to a question could be obtained, but most 
of the answers indicated delirium. The throat 
was exceedingly dry and the pupils moder- 
ately, but not fully, dilated. The face and 
hands were flushed, looking indeed not 
unlike a scarlatinous eruption, the pulse was 
small but strong and rapid, the number of 
beats a minute being 124, the respiration 
shallow and hurried, being 28 a minute. In 
half an hour the patient lost almost all con- 
trol over herself, not being able to raise her 
head, arms or legs without assistance, though 
she was able at times to move her fingers. 
In regard to the latter movements, however, 
I was not sure they were not reflex. The 
flushed condition was now disappearing and 
she was becoming pale in spots, the speech 
was reduced to a whisper now and then, and 
no proper replies to questions could be 
obtained. The pulse had also become soft 
and compressible, though but slightly reduced 
in rapidity, and the respirations were now 
14 in a minute and still shallow. There 
semeed to be a partial anesthesia of the whole 
body. 
The symptoms above described lasted for 
about three hours, when they began to dis- 
appear gradually. When control of the voice 
began to return there was a low, muttering 
delirium, lasting about half an hour before 
full control was gained. In four hours 
from the time the patient had arrived at my 
office she was able to take a carriage and go 
to a friend's house, after having given me a 
most uncomfortable morning. 
On the following day she returned, accom- 
panied by her sister,who had made the in- 
stillation of the solution on the preceding 
day and by whom I was assured that only 
one drop was placed in each eye, as I had 
cautioned the patient that the drug was 
poisonous and mus.t be used very carefully. 
The probability of hysteria being the cause 
of the symptoms was excluded by cor- 
recting the refractive error with the use of 
atropin sulfate as the cycloplegic, and be- 
ginning its use at once, two instillations 
being first made at my office to ascertain if 
there was any systemic effect. I had the 
solution of duboisin sulfate examined and it 
contained only the quantity called for in the 
prescription, namely one grain to the half 
ounce of distilled water. 
It is impossible to say accurately just how 
much of the drug was absorbed into the 
system. The point of the dropper was a 
very small one, so that it is probable that 
about of a grain was placed in contact 
with the conjunctiva. ' It is, however, im- 
probable that all of this was absorbed. 
The case is interesting and instructive in 
showing that so small a dose of this drug may 
give rise to such alarming symptoms.