COLD THERAPY IN BACTEREMIC SHOCK 



protection is dependent upon the pjn^idine nucleotides. An en- 

 couraging part of this study is the fact that an analogue of niacin, 

 3-acetyl pyradine, produces in mice some of the symptoms of 

 endointoxication. The ruffled fur, the apparent drop in blood 

 pressure, the adrenal insufficiency, etc. are obtained with this 

 nicotinic acid analogue. If one waits a matter of only four hours 

 after giving endotoxin and then attempts to protect with any of 

 these compounds, none is effective. I don't know why. But at 

 least there is hope that we may have one level of explanation for 

 the metabolic events that produce cell anoxia, Dr. Blair. We 

 need to do many more experiments. I hope what I report now 

 stands up on repetition. 



BLAIR: With regard to Dr. Berry's very exciting observations, 

 there is no question but that before this matter of endotoxic 

 shock, if that is really what it is, can be handled adequately by 

 physicians, you have to know a great deal more about the basic, 

 fundamental changes, and this is certainly an approach to that, 

 I personally would be most interested in this in relation to oxy- 

 gen tensions, because there has to be some relationship as to 

 whether it is the endotoxin itself that produces this deficiency, 

 or is the hypoxia secondary. In other words, is it simply a matter 

 of lack of oxygen? 



Just in line with this, we at the University of Maryland have 

 become interested in the use of hyperbaric oxygen and treat- 

 ment of varied and sundry illnesses. This is going to be the 

 latest gimmick on the surgical scene now, and I have taken two 

 of our dogs in septic shock, thrown them into a modified chamber 

 at three atmospheres of whole oxygen, and brought out two dead 

 animals, so I don't think that this particular approach is neces- 

 sary. Maybe we gave them too much oxygen. 



With regard to the matter of the hypothermia and the pseud o- 

 monas infections, on the surface, the matter seems to be an 

 incongruity from the standpoint of recommendations for cooling 

 a patient. On the one hand, it seemed that hypothermia is pro- 

 bably a bad thing to use, and certainly one gets in to very serious 

 trouble if he allows his patient either spontaneously or under 

 deliberate cooling conditions, to drop down to too deep a level. 



445 



