Howard W. Haggard

BROMIDISM AFTER EXCESSIVE DOSAGE OF PROSTIGMINE BROMIDE

To the Editor:— In the June 19 issue ofThe JournalDr. J. M. Nielsen reports a case of bromidism attributed to excessive use of prostigmine bromide in myasthenia gravis. The author of the report is, as he states, aware of the fact that the amount of bromide taken was small but that even with the small dose such an accumulation resulted that a blood concentration of 225 mg. per hundred cubic centimeters was eventually reached. The author explains this remarkable accumulation on the ground that for any dosage of bromide the concentration in the blood shows enormous individual variations. On the contrary, it has been thoroughly demonstrated that the accumulation of bromide depends on definite physical characteristics and physiologic functions: dosage in relation to body weight, volume of extracellular fluid and rate of excretion of sodium chloride. The accumulation shows no greater individual variations than those of these characteristics

The influence of oxygen in expelling CO2 from the blood

Considerable theoretical significance attaches to the interaction of oxygen and CO2 in blood. That variations of CO2 tension influence the capacity for oxygen is generally accepted. There has not been, however, universal agreement among observers as to the influence of variations in oxygen tension upon CO2 capacity. Our experience has led us to believe that the quality of exhibiting this reaction depends upon the previous treatment of the blood. Thus in our hands freshly drawn dogs blood shows it when defibrinated, but not when oxalated. The following is typical of our results. Experiments are under way to determine whether the influence of CO2 upon oxygen capacity is likewise lacking in oxalated normal blood. Variations within the body in respect to the capacity of the blood for interaction of the two gases would afford a possible ground for reconciling some otherwise difficult discrepancies.