Letter from Horace G. Smithy to Louis H. Klinger, July 22, 1948

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July 22,  1948
Dr.  Icuis If. Klinger
105 Asst ISSth Street
U&W York,  Us?? York
Dear Doctor Klinger:
You have heard from Dr.  Blaiock concerning our patient,  Allen
Goldfarb.     k'eedless to say,  the  outcome  of this  ease was a distinct
shock to everyone who hzi seen hia,   in addition to being a cause  of
great personal concern to both Dr. Bialock and myself•
A-aong the preliminary studies vihich were carried out before operation,
we can find nothing 7?hich may have had a bear.in:; on the  patient's de-ash*
Following catheterization of the heart there occurred a mild febrile
reaction which w$ thought to be  pyrotenio in origin  and v,hich disappeared
without incident several days before  operation.     Of the preliminary
medications,   the r^intonsnce -dose  of di; it ox in,   0.2   i:^u.,  was   ;;ivon
daily prior to operation,     k course of prophylactic penicillin therapy
was  also  carried oat.     Aft^r ,a test  doss  of 0*5  :;yi.   of quinidine
sulphate,  the patient received this  drug in zhs  $mm dose four times
the day before  operation.     On the.niornin^. of operation 0.3  ip»*   of
quinidine  sulphate was .^iven aionp; -with tho maintenance dose ef
digitoxi.fi by ncuth tv.ro hears before  operation*     Other preoperative
medications  included nembutal ^^ kjss.  the iilaht heforo,   solium luminal
0.1  gn«  throe hours before operation,   and  the usual dose of morphine
and atropine on call to the  operating roo:n.
Induction of anesthesia was beppm at 10:30 A.M.  p?ith cyclopropane
administered through an endotracheal catheter  in a closed system.
Following  induction,   cyclopropane was discontinued and nitrous oxide-
ether-oxygon sizture \t\s ^iveu.     The skin  incision had been  completed
and dissection of the pectoralis isajor musq^di^i^^ peen undertaken
:when y^ntriculiar tachycardia supervened.    Thor.o occurred an i-r.tediate
ifall in blood pressure  and disappearance of th« peripheral  pulse.
This 7fas  followed ainost simultaneously filth the  administration of
intravenous procaine by ventricular fibriiiGtion.    The latter arrhythmia
;terTiin?fted, quickly. ,in cardiac standstill.    Thereupon a&aual raassage
of the h-aart was undertaken through a short upper abdoiainai  incision.
l!assa*?;e. snuji, oipe,r ;$££*?£• ts r,at ^^u^i^^^^j-^royej^jTu^^-^^d the patient
expired, prior, ^o opening the. thoraaic cayity*: A  -««a*w  «  «  .'.-,-;■;.„*•
pjrefit ptsTScnal cc^ccm '      both  Dr«   ; irdock and cn/self.
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lailv  nrior  t-c  c 3r?tio A course  of  orophyiactic  p-a icili -a   bherar?y
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