32% lymphocytes. Although the total cell count remained about the same, the ratio of granulocytes to the lymphocytic series was reversed. On the last day of drug treatment the count was 4,500 total with 37% polymorphonuclear cells, 61% lymphocytes, and 2% monocytes.After the drug was again withdrawn, the total white blood cell count decreased over a three-day period; the lowest reading was 2,650 per cubicmillimeter. Within a week the differential ratio had returned to normal and the total count was 7,550 per cubic millimeter. Psychiatric symptoms returned as promptly as the granulocytes, and the severity of those symptoms required the use of other organic therapy (electroshock therapy).
SummaryLeukopenia occurring after treatment with the newer phenothiazine, thioridazine (Mellaril) hydrochloride, has been described. Because of doubt as to the offending agent, and because psychiatric symptoms returned when the drug was withdrawn, another course of drug therapy was instituted. There was prompt decrease in number of granulocytic elements in the blood stream a second time and equally prompt recovery to a normal blood cell count when the drug therapy was discontinued again. Other organic therapy was necessary to control the psychiatric symptoms. Thioridazine and other phenothiazine drugs can suppress the number of granulocytes. However, the suppression was neither permanent nor prolonged. 412 Union St. (14) (Dr. Fleeson).on the subject of deleterious effects of methylene blue injected intrathecally prompted us to report this case study as a warning. The only reference 1 we have found is a letter by Evans warning against its use. His report dealt with a patient who developed paraplegia and almost completely recovered.A 21-year-old woman was in an automobile accident on Aug. 16, 1958. She fell asleep momentarily while driving her automobile, which struck a lamp post. She remained conscious after the accident and was treated as an outpatient for abrasion over the bridge of the nose, hematoma of the right forearm, discoloration of both eyes, and Bennett's fracture of the left thumb.Five days later, she was hospitalized for observation of supposed rhinorrhea. On Aug. 28, spinal fluid examination revealed a total protein level of 38 mg.%, with no cells. To rule out a cerebrospinal rhinorrhea, 1 cc. of methylene blue, 1% aqueous solution, was injected into the lumbar subarachnoid space. Fifteen minutes after the injection, the patient experienced pain and tingling in the lower extremities and began to hyperventilate. Carpopedal spasm was also present, but that and the tingling were relieved by rebreathing into a paper bag. However she was unable to move the lower extremities and showed symptoms of diplopia. She was unable to void, so an indwelling catheter was inserted.On Aug. 29, the sensory examination gave normal results, but motor examination revealed only feeble toe movements. All the extremities were areflexic. On Sept. 1, the patient was able to move the toes, ankles, and knees, though not against resistance. On Sept...