Ergot Poisoning at Pont St. Esprit

DISEASEBMEIsH dose to 100,000 units six-hourly was quite dramatic and a rapid improvement set in.Case 2 received 250,000 units three-hourly.After the first dose there was a sharp rise of temperature from 100 to 1040 F. (37.8 to 400 C.), the patient became violent and abusive, and he had to be given a sedative.Thereafter he improved rapidly and the temperature was normal by next morning.Suchett- Kaye drew attention to a reaction resembling the Jarisch-Herxheimer reaction which may occur at the beginning of treatment of Weil's disease with penicillin.Case 1 showed a slight rise of temperature, which might or might not have been of significance.In Case 2 the reaction was marked.Prognostically it may be regarded as a favourable sign, as it may mean that the strain of organism is sensitive to penicillin and is being destroyed.Case 4 showed no such reaction, and he went steadily downhill.He was jaundiced on admission, but his general condition was good.He received 100,000 units of penicillin initially and 50,000 units three-hourly thereafter.Necropsy revealed two striking features.The first was that neither macroscopically nor microscopically did the brain, lungs, liver, or kidneys appear to be irreparably damaged.The second was that a smear from the liver showed so many leptospires.One was left with the impression that had it been possible to destroy the organisms a few days earlier the outcome might not have been fatal.Case 3 had recovered spontaneously, but a course of 250,000 units of penicillin three-hourly was given for four days with the object of avoiding the carrier state or the possibility of smouldering renal damage.Patterson found that in his cases a large number of leptospires continued to be excreted in the urine for many weeks after clinical recovery. Summary and ConclusionsFour cases of Weil's disease treated with penicillin are described, including one which was presuimably contracted by actual rat-bite.