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HUMAN AUTONOMIC PHARMACOLOGY:  XIV. THE USE OF ACETYL-BETA-METHYL CHOLINE CHLORIDE (MECHOLYL) AS A DIAGNOSTIC TEST FOR POISONING BY THE ATROPINE SERIES OF DRUGS

WILLIAM DAMESHEK, M.D.; OSCAR FEINSILVER, M.D.
JAMA. 1937;109(8):561-564. doi:10.1001/jama.1937.02780340017006.
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We have recently had the opportunity of observing five cases with brief psychotic episodes following administration of from three to six drops of a medication prescribed for mydriasis. The first patient, a medical student in our laboratory, presented a diagnostic problem on her admission. Although the diagnosis of atropine poisoning with psychosis was finally considered, it was at first thought that the patient might have dementia praecox or an acute manic-depressive episode. The use of acetyl-beta-methyl choline chloride (mecholyl, Merck), suggested itself as a diagnostic test for possible atropinism, since in our experimental work1 it had been shown that even a very small dose of atropine (1/100 grain, or 0.00065 Gm.) was sufficient to cause complete inhibition of most of the effects of mecholyl, even when the latter drug was given later in large dosage (from 25 to 50 mg.). Thus, the complete absence of the characteristic mecholyl effects (sweating,

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