T]=I:E DUt3LIN JOUP N2kL OF

MEDICAi SCIENCE.

MAY 1, 1912.

PART I.

ORIGINAL COMMUNICATIONS.

ART. XVI.--Fatal Result followinq [njection of "606. ''~ By HENRY MOORE, L .R.C.P .S . I . ; Visiting Surgeon to the Royal City of Dublin Hospital.

IT is my unpleasant duty to bring before the Academy a fatal result following the administration of " 606." My objec~ in doing so is to emphasise the fact that there is danger in the administration of this potent remedy in certain cases--a fact that we are inclined to lose sight of-- and to elicit a discussion which I hope will prove useful to myself and my p~tients.

CASE.--Mr. W. A., aged twenty-five, was admitted to the Royal City of Dublin Hospital on the 29th of May, 1911, when he stated that he had contracted syphilis and gonorrhcea three years previously, and had been treated by several doctors; that ten months ago he had suffered from very severe headaches, and that his doctor had informed him that he had meningitis, and that his paralysis was the result of this meningitis.

On admission his gait was feeble and insecure, his speech a Read before the Section of Surgery in the Boyal Academy of Medicine

in Ire land on Friday, November 3, 1911. [For the discussion on this paper see the number of this Journal for December, 1911. (Vol. cxxxm-- No. 480, page 459)].

VOL. CXXXIII . - -NO. 485, THIRD SERIES, X

329, Fatal Result following Injection of " 606."

jerky, his manner exalted, his writing not so good as it used to be, urine normal, heart sounds weak, otherwise normal; Wasse rmann ' s reaction negative; weight 9st. l lb. 5oz.

Diagnosis of early General Paralysis of the Insane was made, and, having explained to him the nature of his disease, and the danger of the t rea tment , he asked to be given " 6 0 6 "

On the 10th of June, at 12 o'clock, an intravenous injec- tion of 0.5 gr. " 606 " was given. He had a rather severe reaction; tempera ture at 4 o'clock 103 ~ , pain in the stomach, vomiting, and diarrhoea (eight motions in th~ twenty-four hours), but at eight o'clock the next morning he was all right, tempera ture 97.4 ~ . He left the hospital on the 15th, on which day Wasse rmann ' s reaction was positive.

He was re-admit ted to the hospital on the 5th of July, 1911. His general condition was much improved, speech less jerky, manner quiet, walking greatly improved, urine normal, heart sounds still weak, writing improved, Wasser- m a n n ' s reaction positive.

A comparison of the reflexes on the two dates is as follows : - -

29.5. '11 5 . 7 . ' 1 I Motor--

Knee jeIks - Exaggerated in both legs Ankle clonus Babinski -

Rectus clonus Wrist jerk Elbow jerk

~qensory-- Eyes

Speech Smell Taste Hearing Tactile sense

Same - Present in both legs Same . Present in both feet, per- Same

sistent in right foot Present - Same

- Exaggerated - Same - Exaggerated - Not so much

Fundus normal ; pupils irregular, contracted, left s m a l l e r than right, react very badly to light

Jerky - Normal

Normal Normal

- Normal

Pupils still unequal, light reaction brisker

Electrical reaction Normal Writing - Not so good as it used to be Writing i m p r o v e d

On the 26th of July, 1911, a second intravenous injection of 0.5 gr. of " 606 " was given. Ab 4 o'clock his tempera :

The Clinical Estimation of Blood-pressure. 323

ture was 105 o, pulse weak, almost imperceptible, heart sounds feeble; lips, ears, nose, and nails blue; tremor of right hand, speech indistinct, severe vomiting and diarrhoea (fourteen motions in the twenty-four hours), pain in stomach, head, and limbs, loss of sensation, and tingling in the feet, loss of all reflexes except slight clonus in right leg.

On the morning of the 27th his general condition was much better, temperature normal, reflexes still absent, pains much better, vomiting and diarrhoea better, tongue not white. :But at 4 o'clock in the afternoon he had a rigor, temperature of 100 ~ , and the general condition again became grave: As the vomiting and diarrhoea had ceased, whisky and beef tea were given by the mouth, and salines by the rectum, but were rejected. At 10 o'clock he became much worse, temperature 102% respirations 48, pulse very weak and quick, lips retracted, teeth clenched, ptosis of left eye- lid, bilateral paresis of limbs, difficulty of articulation. In my absence from town he was kindly seen by my colleague, Dr. Meldon. He died at 11 30 that night.

Professor Ehrlich, in his preface to Mr. M'Donagh's book, says : - - " I do still maintain, as I have from the beginning, that severe and advanced disease of the ce;~- tral nervous and circulatory system is a contra-indication to this t reatment ." With this warning, was I justified in giving " 606 " to Mr. W. A. ? If my diagnosis of early CT. P. I. was correct I believe I was, and, in a similar case, having explained the nature of his disease and the special dangers of the treatment in his case to the p~tient I would give it again, but in smaller doses repeated at short intervals.

ART. XVIL- -The Clinical Estimation o/ Blood-pressure.a By G. E. NESBITT, M.D., F .R .C .P . I . ; Assistant Physician, Richmond, Whitworth, and Hardwicke Hospitals, Dublin.

FROM the time of Stephen Hales' classical experiments on blood-pressure, published in 1733--experiments which in

Read before the Section of Medicine in the Royal Academy of Medicine in Ireland, on Friday, February 9, 1912. [For the discussion on this paper see page 383].