CURARE: A PREVENTIVE OF TRAUMATIC COMPLICATIONS IN CONVULSIVE SHOCK THERAPY
A. E. BENNETT M. D.1
1 The psychiatric departments of the Bishop Clarkson Memorial Hospital, University of Nebraska College of Medicine, Omaha, and the Lincoln State Hospital, Lincoln, Nebraska.
1. Convulsive shock therapy has proved most useful as a means of terminating chronic resistant affective psychoses.
2. The usefulness of this therapy has been restricted and has been in danger of abandonment because of the severity of the convulsive shock with the hazards of traumatic complications.
3. There is something fundamentally sound in the application of this therapy. The problem has been to eliminate the traumatic hazards.
4. Previous attempts to eliminate traumatic complications have not been successful.
5. The principle of preliminary curarization before induction of metrazol shock has proved successful in eliminating all traumatic hazards.
6. A uniform standardized curare preparation has now been perfected that is non-toxic in physiologic doses and has proved to be a safe treatment.
7. The physiologic and pharmacologic effects of the drug have been discussed. The technic of this combined therapy is described.
8. Roentgenographic evidence and electro-encephalographic evidence are presented to show that the curare protects from traumatic complications, yet leaves the therapeutic effectiveness of metrazol undisturbed.
9. The results of previous metrazol therapy in affective psychoses re compared with curare-metrazol results to show the same therapeutic results are obtained without complication. Other investigators have confirmed our results with this new treatment.
10. A series of cases of depressive psychoses complicated with severe organic diseases are shown that widen the scope of usefulness of this modified therapy. A number of cases can now be salvaged that formerly could not have taken the treatment.
11. Curare is "tailor made" as a "shock absorber" for convulsive shock therapy.
12. A synthetic curare-like drug, quinine methochloride, has been prepared that has been shown to have a strong curare-like action. After intravenous injection it produces effective motor paresis sufficient to prevent traumatic complications of convulsive shock therapy. Further experimentation will be necessary, however, to determine the safety factor, before its use can be recommended.
13. If a continued, sustained supply of pure curare or a safe synthetic curare-like drug can be obtained, it will soon be illegitimate to administer convulsive shock therapy without this safeguard against the all too frequent and serious traumatic accidents.
