Quinine Amblyopia.

THE following case history demonstrated several interestingpoints and for that reason is worth recording. The patient, Mrs. L., was a leading Wren aged 27 years, and was stationed at a Royal Naval Establishment on the east coast of C-eylon. She was married in June, 1944, and went up country for her honeymoon. Towards the end of this period, July 2, she developed general symptoms of malaise, frontal headache, pain behind the eyes and on moving the eyes, shivering at times and teeth chattering. On her return to Trincomalee on July 4 she was admitted to the sick quarters where her temperature was found to be 1040 F. As wellas general malaise she was complaining of headache, backacheand nausea. She had left England in November, 1943, and had had no previous tropical diseases. I did not see her until July 24, 1944, when she was admitted to R.N. Auxiliary Hospital, Colombo, -and came under my care. The following physical signs up to that date are taken from the notes made by Surg.-Commander -H. L. Hoffman. R.N.V.R., Medical Officer in charge at Trincomalee. General examination revealed no abdominal tenderness or enlargement of liver or spleen. On July 5 her urine contained bile vpigments, but no albumen. On July 8 a blood film showed the presence of B.T. malaria parasites. The same day she started quinine and was given grs. x t.d.s. by mouth. On July 11 her spleen was palpable and she was also, tender in the gall bladder area. Two days later on July 13 she complained of deafness and of seeing black spots in front of her eyes, which became .bigger and paler turning greenish in colour. Her quinine therapy was stopped at once. She had had 120 grs. in all. She was put on tabatebrin until July 18th being given 1-2 grammes in all. On July 19 she was complaining of blurred vision, especially in the left eye and that hereyes were sore and hurt on movement. The next day her pupils were.dilated and -reacted sluggishly to light. On