6. The total result is negative. I have been unable to convince myself that strychnia exerts any influence upon the blood pressure of febrile cases when given in manner and dose above mentioned. 7. In the 24 hours following the administration of the drug there was a rise 5 mm. or more of pressure in 16 cases, a fall in 17 cases, and no change in 24. The average pressure in the 50 cases that received a daily dose of strychnia was no greater than in 18 cases without any drug. 8. To me one of the most striking features of the investigation was the fact that while strychnia and whiskey seemed to be entirely without influence upon the blood pressure, the sight of the dinner-tray or the prospect of getting up produced a most obvious, though transient, rise in the pressure. The only permanent gains in pressure occurred when the patient reached a crisis in pneumonia, or when convalescence enabled him to get up and walk. 9. As in the alcohol research of last year, I do not wish to be construed as saying that the drug under investigation is of no value. To prove so general a negative my work is altogether insufficient. My conclusion is, that in the dosage employed strychnia does not raise or in any way affect the maximum or minimum blood pressure so far as can be determined by the instrument employed. DISCUSSION. Dr. HENRY JACKSON, of Boston: It seems that the experiments certainly prove that, as far as we can tell, the blood pressure is not increased by the administration of strychnia. We do not know that an increase in the blood pressure is necessarily an indication of increased strength of heart. Personally, I should be much against giving up the use of strychnia. However, I admit that my own experiments made at the hospital have been in accord with the observations made by Dr. Cabot, but it does not make me feel that I do not care to use strychnia. Dr. E. A. LOCKE, of Boston: I have been associated only in a very remote way with this investigation, and consequently cannot speak authoritatively for Dr. Cabot. There certainly can be no doubt as to the action of strychnia on the circulation. Numerous animal experimentations have shown its action on the circulation to be two-fold; first, it acts on the vaso-motor nerves, causing a constriction of the peripheral blood vessels, with a consequent rise of blood pressure, and second, the rate of the heart's action is slowed. There is every evidence that a similar action takes place in man. Personally, I believe that strychnia has a very definite action, and I doubt very much if Dr. Cabot, were he present, would deny this on the strength of his negative results with the Stanton apparatus. |