Ventilatory function in normal children.

His skin was strikingly dry and flushed. Shallow, irregular, round blebs, up to one inch across and filled with opalescent straw-coloured fluid, were observed on the shoulders, hip, knees and feet, in no particular pattern. These blebs were surrounded by a 3-mm. halo of erythema. The conjunctivae were moderately injected; the pupils were 8 mm. in diameter and feebly responsive to light. Extraocular movements of normal scope could be obtained by turning his head while the eyes were fixed on a source of light, but convergence was not demonstrated. Examination of the optic fundi revealed no abnormalities. The mucosa of the nose and mouth was dry, and a sticky mucous exudate was swallowed as it was coughed up. The chest was clear on percussion and auscultation, and heart sounds were normal. Palpation of the abdomen met with generalized resistance and evasive movements. The patient was incontinent of urine several times daily in small amounts. The bladder was not palpably distended. Neurological examination, besides the aforementioned signs, showed generalized hypotonia, with weakly present tendon reflexes, absent abdominal and cremasteric reflexes, and extensor plantar responses. He was too weak to sit without support. During the next three days, his temperature rose to 1030 F., then returned to normal. He remained delirious, becoming more restless before consciousness gradually cleared. A few new blisters formed adjacent to the old ones before they all broke down, leaving encrusted, red-rimmed ulcers. His treatment was symptomatic. Ample amounts of fluids were accepted orally when intake was encouraged. Mouth care was administered. Medication with aspirin and sponging with alcohol were used while the patient was febrile. Chloramphenicol (Chloromycetin) was administered for two days, and penicillin was given for three weeks (after a six-day interval) to combat skin infection. As early as the second day of admission he was able to walk to the bathroom with help, and on the third day normal motor function had returned. The natural course of the intoxication, if the time of ingestion was correctly given, was five to six days. When the intoxication cleared, the returning symptoms of his primary disease required treatment with chlorpromazine, 300 mg. thrice daily, and trihexyphenidyl was resumed in doses of 2 mg. thrice daily because of the side effects of parkinsonism. The only residual signs of the intoxication were the skin ulcers, which took several weeks to heal. The patient was amnesic throughout the five days of this condition, his amnesia beginning shortly after the ingestion of the drug.