unwanted pregnancy and beaten and neglected children in the community might be interpreted as fact rather than fancy. Indeed, the authors fall into their own trap and conclude: "Thus the unwanted pregnancy, contributing to continuing population growth and possibly to child neglect.., places a heavy burden on the community." KEVIN J. TOMPKINS, MD
165 Plymouth Rd. Welland, Ont.
A 59-year-old man with chronic lymphocytic leukemia was admitted to hospital Nov. 2, 1974 with a temperature of 390C, weakness and malaise. He was receiving chiorambucil (Leukeran), 4 mg/ day and prednisone, 25 mg/day. Because of suspected sepsis he was given penicillin G, 2 million units intravenously q4h, carbenicillin, 2 g IV q4/i and gentamicin, 120 mg IV q8Ii. He remained intermittently febrile, his temperature spiking to 39.40C. The antimicrobials were discontinued Nov. 11. Two days later cloxacillin, 2 g IV in 100 ml of 5% glucose and water, was administered because of suspected osteomyelitis of the spine. After the infusion, rigors occurred for approximately 30 minutes, associated with a temperature spike to 39.8 0C. The patient received two additional infusions of cloxacillin at 4hour intervals and had a similar reaction after each. The only chills this patient had during his hospitalization were associated with the cloxacillin infusions.
To the editor: We would like to assure Dr. Tompkins that our study was not conceived in haste and that the labour was extremely difficult. The fourth objective of the study was in fact to determine if there are sufficient numbers of unwanted pregnancies that these infants may make up the majority of the beaten and neglected children in the community. We were astonished and disturbed to find A 75-year-old man was admitted to that in our own hospital 100 infants hospital June 3, 1974 with pain in the every year are unwanted during preg- hip containing a Moore's prosthesis. He nancy and are still unwanted after was afebrile. Infection of the prosthesis delivery, and that these are infants of was suspected. On June 5, because the married women with families. A pro- patient was anemic, a unit of packed red jection of these figures suggests that blood cells was transfused over a 5-hour approximately 500 such infants are period with no adverse effects. Ninety born in Nova Scotia every year, and minutes later cloxacillin, 2 g in 150 ml of 5% glucose and water, was infused. many thousands across Canada. There Approximately 1 hour later shaking chills certainly are, then, sufficient numbers occurred for about 10 minutes and his of unwanted pregnancies resulting in temperature was elevated for the first time unw.tnted infants to presume that they in this admission, to 38.60C. The next may make up the majority of the beat- day a similar episode occurred after the en and neglected children. We did not third infusion of cloxacillin. However, prove that they did make up the ma- intravenous administration of the drug jority of these children but, as stated was continued for 14 days with no further episodes of chills. The drug was then in the conclusions, it is a likely pos- given orally, 1 g q6h for an additional 7 sibility. A long-term study of the fate days. On June 27, because of increasing of these unfortunate children should pain in the hip, intravenous administrabe undertaken. tion of cloxacillin, 2 g q4h, was again started. On July 1 he had another similar KENNETH E. Scorr, MD SHARON H. STONE, RN episode of shaking chills. The drug was Grace Maternity Hospital continued for an additional 7 days withHalifax, NS out any further reactions. Febrile reactions after cloxacillin To the editor: We wish to report febrile reactions associated with cloxacillin in nine male patients, seen on five different hospital wards; shaking chills and fever developed soon after the intravenous infusion of cloxacillin in each patient. The first reaction was observed in a patient in 1972; however, it was not until January 1974, when a second such reaction was observed in another patient, that an association with cloxacillin was raised. In August 1974, after observing additional reactions, we returned our supply of cloxacillin to the manufacturer (Ayerst Laboratories). A new supply of the drug with a different lot number was received, but similar reactions have been observed with the new supply. We describe the cases of two of the nine patients.
The reaction to intravenous administration of cloxacillin was striking in our nine patients. Shortly after the infusion each patient had chills that became uncontrollable and lasted for 20 to 30 minutes. In some patients these reactions occurred after each dose of cloxacillin, but in others they occurred intermittently. It appears that the preparation and mode of administration of cloxacillin are not responsible for these reactions because other patients receiving cloxacillin on the same ward at the same time did not have such a reaction. It is, of course, possible that occasionally the method of preparation of the drug might have varied. Febrile reactions have also been reported after methicillin administration.' We report these cases to alert physicians to the possibility of these reactions in patients and to encourage the re-
280 CMA JOURNAL/FEBRUARY 8, 1975/VOL. 112
porting of such reactions to the drug adverse reaction program of Health and Welfare Canada and to the manufacturer. At present the cause of these reactions has not been uncovered and requires further investigation. J. PORTHOY, MD, FRCP(CJ A. TORCHINSKY, B SC PH, L PH, DPH J. MENDELSON, MD, FRCPIC] E. KAGAN, RN Division of infectious diseases Jewish General Hospital Montreal, Qu6.
Reference I. SPENGLER RF, MELVIN VB, LIETMAN PS, et at: Febrile reactions after methicillin (correspondence). Lancet 1: 168, 1974
Management of convulsion To the editor: Two wooden spatulas or tongue depressors bound together at one end with surgical tape and stuck to the head of the patient's bed are traditional signs in neurologic and other wards that the patient is liable to grand mal epileptic seizures or is suspected of having had them. Advice published by epilepsy associations over the years has tended to suggest to the first aider who sees the patient having a seizure that he should, if possible, attempt to put something in the mouth of the convulsing patient in order to preserve the airway. Whether or not this does any good is open to question. The potential harm of the procedure, however, is undoubted. The grand mal convulsion begins sometimes with a cry, which is followed by a brief tonic phase of total muscular contraction involving every voluntary and autonomically innervated muscle of the body. Extreme pressure exerted by the teeth, one against another, during the tonic phase makes it completely impossible to separate the jaws unless levers of great mechanical advantage are employed. The power of such implements as jaw separators is probably more than sufficient to break the teeth even if it were possible to insert the instrument between them - but it is not. If they are placed behind the teeth the power they can exert is sufficient to cause extensive soft tissue damage to the mucosa overlying the mandible and the maxilla. In the clonic phase extreme manual dexterity would be required to insert any such instrument between the teeth when the mouth is open, whereas in the succeeding flaccid phase such a maneuver would be simple. The value of opening the jaws is said to be twofold: first, the tongue will not be bitten; and second, it can be pulled forward so that the airway is not obstructed. In the tonic and clonic phases it is highly unlikely that there is any ventilation: air will certainly not flow into
165 Plymouth Rd. Welland, Ont.
A 59-year-old man with chronic lymphocytic leukemia was admitted to hospital Nov. 2, 1974 with a temperature of 390C, weakness and malaise. He was receiving chiorambucil (Leukeran), 4 mg/ day and prednisone, 25 mg/day. Because of suspected sepsis he was given penicillin G, 2 million units intravenously q4h, carbenicillin, 2 g IV q4/i and gentamicin, 120 mg IV q8Ii. He remained intermittently febrile, his temperature spiking to 39.40C. The antimicrobials were discontinued Nov. 11. Two days later cloxacillin, 2 g IV in 100 ml of 5% glucose and water, was administered because of suspected osteomyelitis of the spine. After the infusion, rigors occurred for approximately 30 minutes, associated with a temperature spike to 39.8 0C. The patient received two additional infusions of cloxacillin at 4hour intervals and had a similar reaction after each. The only chills this patient had during his hospitalization were associated with the cloxacillin infusions.
To the editor: We would like to assure Dr. Tompkins that our study was not conceived in haste and that the labour was extremely difficult. The fourth objective of the study was in fact to determine if there are sufficient numbers of unwanted pregnancies that these infants may make up the majority of the beaten and neglected children in the community. We were astonished and disturbed to find A 75-year-old man was admitted to that in our own hospital 100 infants hospital June 3, 1974 with pain in the every year are unwanted during preg- hip containing a Moore's prosthesis. He nancy and are still unwanted after was afebrile. Infection of the prosthesis delivery, and that these are infants of was suspected. On June 5, because the married women with families. A pro- patient was anemic, a unit of packed red jection of these figures suggests that blood cells was transfused over a 5-hour approximately 500 such infants are period with no adverse effects. Ninety born in Nova Scotia every year, and minutes later cloxacillin, 2 g in 150 ml of 5% glucose and water, was infused. many thousands across Canada. There Approximately 1 hour later shaking chills certainly are, then, sufficient numbers occurred for about 10 minutes and his of unwanted pregnancies resulting in temperature was elevated for the first time unw.tnted infants to presume that they in this admission, to 38.60C. The next may make up the majority of the beat- day a similar episode occurred after the en and neglected children. We did not third infusion of cloxacillin. However, prove that they did make up the ma- intravenous administration of the drug jority of these children but, as stated was continued for 14 days with no further episodes of chills. The drug was then in the conclusions, it is a likely pos- given orally, 1 g q6h for an additional 7 sibility. A long-term study of the fate days. On June 27, because of increasing of these unfortunate children should pain in the hip, intravenous administrabe undertaken. tion of cloxacillin, 2 g q4h, was again started. On July 1 he had another similar KENNETH E. Scorr, MD SHARON H. STONE, RN episode of shaking chills. The drug was Grace Maternity Hospital continued for an additional 7 days withHalifax, NS out any further reactions. Febrile reactions after cloxacillin To the editor: We wish to report febrile reactions associated with cloxacillin in nine male patients, seen on five different hospital wards; shaking chills and fever developed soon after the intravenous infusion of cloxacillin in each patient. The first reaction was observed in a patient in 1972; however, it was not until January 1974, when a second such reaction was observed in another patient, that an association with cloxacillin was raised. In August 1974, after observing additional reactions, we returned our supply of cloxacillin to the manufacturer (Ayerst Laboratories). A new supply of the drug with a different lot number was received, but similar reactions have been observed with the new supply. We describe the cases of two of the nine patients.
The reaction to intravenous administration of cloxacillin was striking in our nine patients. Shortly after the infusion each patient had chills that became uncontrollable and lasted for 20 to 30 minutes. In some patients these reactions occurred after each dose of cloxacillin, but in others they occurred intermittently. It appears that the preparation and mode of administration of cloxacillin are not responsible for these reactions because other patients receiving cloxacillin on the same ward at the same time did not have such a reaction. It is, of course, possible that occasionally the method of preparation of the drug might have varied. Febrile reactions have also been reported after methicillin administration.' We report these cases to alert physicians to the possibility of these reactions in patients and to encourage the re-
280 CMA JOURNAL/FEBRUARY 8, 1975/VOL. 112
porting of such reactions to the drug adverse reaction program of Health and Welfare Canada and to the manufacturer. At present the cause of these reactions has not been uncovered and requires further investigation. J. PORTHOY, MD, FRCP(CJ A. TORCHINSKY, B SC PH, L PH, DPH J. MENDELSON, MD, FRCPIC] E. KAGAN, RN Division of infectious diseases Jewish General Hospital Montreal, Qu6.
Reference I. SPENGLER RF, MELVIN VB, LIETMAN PS, et at: Febrile reactions after methicillin (correspondence). Lancet 1: 168, 1974
Management of convulsion To the editor: Two wooden spatulas or tongue depressors bound together at one end with surgical tape and stuck to the head of the patient's bed are traditional signs in neurologic and other wards that the patient is liable to grand mal epileptic seizures or is suspected of having had them. Advice published by epilepsy associations over the years has tended to suggest to the first aider who sees the patient having a seizure that he should, if possible, attempt to put something in the mouth of the convulsing patient in order to preserve the airway. Whether or not this does any good is open to question. The potential harm of the procedure, however, is undoubted. The grand mal convulsion begins sometimes with a cry, which is followed by a brief tonic phase of total muscular contraction involving every voluntary and autonomically innervated muscle of the body. Extreme pressure exerted by the teeth, one against another, during the tonic phase makes it completely impossible to separate the jaws unless levers of great mechanical advantage are employed. The power of such implements as jaw separators is probably more than sufficient to break the teeth even if it were possible to insert the instrument between them - but it is not. If they are placed behind the teeth the power they can exert is sufficient to cause extensive soft tissue damage to the mucosa overlying the mandible and the maxilla. In the clonic phase extreme manual dexterity would be required to insert any such instrument between the teeth when the mouth is open, whereas in the succeeding flaccid phase such a maneuver would be simple. The value of opening the jaws is said to be twofold: first, the tongue will not be bitten; and second, it can be pulled forward so that the airway is not obstructed. In the tonic and clonic phases it is highly unlikely that there is any ventilation: air will certainly not flow into
