Report on cardiazol treatment and on the present application of hypoglycaemic shock treatment in schizophrenia / by W. Rees Thomas (medical senior commissioner of the Board of Control) and Isabel G.H. Wilson (medical commissioner of the Board of Control).

  • Great Britain. Board of Control
Date:
1938
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Licence: Public Domain Mark

Credit: Report on cardiazol treatment and on the present application of hypoglycaemic shock treatment in schizophrenia / by W. Rees Thomas (medical senior commissioner of the Board of Control) and Isabel G.H. Wilson (medical commissioner of the Board of Control). Source: Wellcome Collection.

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    1] Quiet and skilled nursing, an orderly method in injecting, the absence of ‘too many interested spectators and white coats ”’ (Rombouts, in discussion)*, all conduce to ease and calm in treat- ment. Von Meduna remarks that one doctor and two or three nurses could treat 60 to 80 cases in one morning, or, more practically, 20 in one hour. It will be found convenient to have two nurses, or even three, for the actual injection. Of these, one is at each side of the patient, the nurse on the side chosen for injection holding the rubber band which is used as a tourniquet until almost all the injection is in the vein, and both are prepared to control restlessness and to prevent the patient from falling off the couch after the injection. The third nurse watches the jaw, holding it pressed upwards in patients subject to dislocation, and putting the tampon between the teeth. Patients must be watched after treatment until they have fully recovered consciousness and have ceased to be very restless. . DIFFICULTIES AND POSSIBLE DANGERS, 1. The treatment is very unpleasant unless, as sometimes happens, the patient has an adequate amnesia after it. His anxiety and reluctance are almost always observable as soon as he improves enough to express himself®, 124, 2. Symptoms are particularly distressing if no fit follows the injection. Patients complain that they are freezing, or dying, or that lightning is running through them. They may have visual hallucinations. It is desirable to begin with a dose which may be expected to produce a fit; to stop the injection at once if the fluid is missing the vein, so that the syringe may be removed and filled with an adequate dose which will produce a fit when injected, this time into the vein; to give the injection fast, as described, and to give the second injection, if one is necessary, one to two minutes after the first. To allay the patient’s anxiety, Humbert and Friedmann*’ on the Continent and Cook® in England give scopolamine and morphine before the injection, but this is only necessary with the most apprehensive patients. Barbiturates and luminal lessen the efficacy of cardiazol and may interfere with treatment; paraldehyde! also has proved to be unsatisfactory for this purpose. The ‘summation treatment ’”’ of Georgi is described in a later section; it consists in allowing the patient to become comatose and in a condition in which a fit will readily occur, by giving him an appropriate dose of insulin about 14 hours before the cardiazol is given. ‘This of course avoids the unpleasantness of treatment by cardiazol alone. 3. The veins may be difficult to find, or they may become obliterated; this happened much more frequently with the stronger solution of cardiazol formerly used, but still occurs at times with the present technique. If clotting occurs, the danger of pulmonary embolism must be remembered*®,