An outbreak of atropine poisoning.

FiFTEEN men, all Royal Air Force personnel, varying in age from nineteen to forty-two years, but mainly in the early twenties, were given a period of prolonged narcosis intended to last ten days in each case. They were all in satisfactory physical health but suffered from psychoneuroses. The technique of treatment was a modification of that advocated by Brody (1940) for restless, older patients: 3 gr. of dial twice a day, together with paraldehyde in 3 drachm doses to a maximum of 9 drachms daily. To offset vomiting, 1 minim of liquor atropinxe is suspended in each 1-5 drachms of paraldehyde, thus giving a maximum of 6 minims of liquor atropinae daily, which Brody states may be maintained for several days. He reported that fifteen of twenty-one patients vomited without atropine and only twenty-one of sixty-nine with atropine. From his description of the daily incidence of the minor complications which developed, it appears that vomiting, pyrexia, and albuminuria were evenly distributed throughout the treatment, whereas restlessness was more frequent in the second week, with fifty-three restless days to sixteen in the first week. The facts to be reported suggest that this restlessness is an atropine symptom, and it is possible that in some of Brody's cases more serious poisoning was escaped by a hair's breadth. In this series, before some patients had finished the course and at the commencement of the treatment in others, the dose of atropine recommended by Brody was doubled because vomiting persisted. The doctor in charge of the treatment left before the narcoses were completed and the present writer took over, unfortunately unaware that any atropine was being used, and believing the drugs employed to be paraldehyde and dial only. As patients came out of the narcosis, several developed severe reactions and there appeared to be an epidemic of schizophrenia. Cases of atropine poisoning reported from time to time are usually concerned with the effects of a single large dose. Here the dosage was cumulative and spread over several days, and symptomatology was complicated by the simultaneous administration of large doses of dial and paraldehyde. The amounts of atropine taken are shown in the Table. DOSAGE TABLE