Erysipelothrix septicaemia without endocarditis.

has become unpopular because of its many side effects, which include vomiting, defaecation, abdominal pain, perspiration, salivation, bradycardia, and hypotension (Goodman and Gilman, 1970). The present case of spontaneous oesophageal rupture may well have been caused by the emetic action of the drug increasing the intraoesophageal pressure. In addition to its emetic property carbachol has a direct cholinergic stimulatory action on the smooth muscle of the oesophagus (Ingelfinger, 1958), which may also have contributed to the rupture by increasing intraoesophageal pressure. The transient chest and abdominal pain which may occur after an injection of the drug may reflect this smooth muscular spasm of the oesophagus and bowel respectively, and carbachol is contraindicated when mechanical obstruction of the bowel or urinary bladder is suspected. Nevertheless, I have been unable to find any reports of rupture of the bladder or bowel after the administration of the drug. At present carbachol should be considered only for the treatnent of intestinal and urinary atony.