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Higginbottam J, Melton B. 
“Some new experiences with L.S.D”. 
Nursing Mirror. 1961 December;29.
In view of the increasing use of lysergic acid diethylamide in psychiatric hospitals, two nurses here give a brief account of the drug's administration and its effect on two patients.

Described by Joan Higginbottam, R.M.N., Ward Sister, and Beatrice Melton, R.M.N., Staff Nurse, The Lawn Hospital, Lincoln

Lysergic Acid Diethylamide (or L.S.D. as it is more frequently called) was discovered in 1942 by a German named Hofmann who was working on Ergot derivatives in his laboratory.

He accidentally took a minute dose and began to feel restless and dizzy, experiencing peculiar visual sensations and disorientations. Later he isolated this drug and it has since been investigated by many prominent workers on the Continent and in Britain.

Potent in small doses

It is extremely potent in very small doses, 0.25 c.c. or 25 micrograms being an initial dose, but it can be given in larger doses up to 300-400 micrograms. It is usually given once in seven days and may be repeated eleven or twelve times but in some cases it is given fewer times, according to the reactions of the individual.

L.S.D. is produced in ampoules of 1 mgm. and measured by hypodermic syringe. It has to be mixed with 15-30 c.c.s of distilled water (tap water is not suitable because of the chlorines contained) and administered orally.

Course of treatment

The patient who is to be treated by L.S.D. is given a normal breakfast at least two hours before the dose is administered. No further food is to be eaten up to six hours after the beginning of the treatment, although drinks are allowed. The patient is treated in bed in a single room, and is only allowed out to the toilet. Quietness is essential if the drug is to act to its maximum efficiency.

The first general physical effects, which occur 20-50 minutes after ingestion, vary in different cases but may consist of one or more of the following signs and symptoms: a feeling of nausea, chilliness or warmth, numbness, headache, twitching and palpitation accompanied by emotional activity, a tendency to giggle, uncontrolled laughter or crying. No two patients react to the same dose in the same manner, just as their earlier symptoms differ. There appears to be some relationship between the size of effective dose and basic personality.

The more disturbing subjective experiences begin from 1 hour to 1.5 hours, and may last 1/2 hour to 3 or 4 hours. When this happens the patient becomes flushed, restless and can be completely withdrawn from reality. Everything may appear to her to be tinged with one colour, so that the treatment room and its furnishings all appear the same shade. Stability gives way to a more plastic environment, the walls appearing to move to and fro.

Nurse in attendance

During the early part of the treatment, if the patient wishes it, she may be left alone with a nurse always available, but later it is usual for a nurse to be in attendance . This is necessary during the heightened emotional state when unknown suicidal tendencies may appear.

After treatment it may be necessary to give a sedative, Nembutal grs. 1.5-3, being effective. Re-occurrence of the L.S.D. phenomena can happen several days after treatment. This is treated effectively by giving Largactil 25-50 mgm. Among our many experiences with this new treatment the following incidents may be of interest.

Sensation of climbing

A young woman who enjoyed climbing holidays in the Alps, and because of her climbing achievements in the mountains enjoyed a certain amount of admiration from her colleagues, for her courage and determination presented quite different characteristics during treatment. During the second L.S.D. experience it became obvious that her love of climbing had been implanted during her childhood by her father who had wished her to be a boy and so fulfil through him the father's own dream of climbing the Matterhorn. He had instilled into her a code of behaviour which was designed to make her tough, never to be beaten, never to give in or be satisfied. To her horror she had fainted on a mountain, which was completely unacceptable to a female conditioned to behaving in a more masculine way.

Through the successive L.S.D. experiences which this patient had, the theme was always the same in varying degrees of intensity. On occasions screaming and panting in terror when hanging on the rope, climbing up an overhang and, when the summit was reached, asking the guide, "Was I brave on that rope?" Then the horror of the descent, " Please don't put me first down, I'm not brave enough," then screaming, " I tell you, you must keep the rope taut." Then she would say, "Why do I always have pins and needles in my arms when descending, I never do when going up?"

When the visual "Sensation of the climb was safely over, calmness came back and the experience was over.

Patient's dream world

Another incident concerns a single girl, 28 years of age, who was suffering from memory disturbances and gastritis. There was a long history of alcoholism and she had twice received treatment for taking an overdose of drugs; she suffers from suicidal urges, and these are associated with periods of extreme depression.

This patient has now undergone five L.S.D. treatments given at weekly intervals. Clinical signs of the drug's action began about 50 minutes after being given orally and she had a feeling of nausea. In the treatments that followed the patient was in turn hilarious and giggling and very frightened, numbness and strangeness of both ears was also complained of. The L.S.D. was increased and the patient became very restless. She screamed, "I can't get out," and appeared to be fighting to pull her left arm free from somewhere. Although she was in a dream world the powers of hearing and of speech were still present, and she fully described how she was being born, how her left hand was caught and she was unable to get free. This phase lasted about 1 1/2 hours, after which peace was restored.

The next week during treatment, pupils of the patient's eyes were dilated and she again struggled and was afraid. This time she felt she was in a blue room with no exit. She experienced the sensation of both legs and feet being stuck together.

Although the treatments are still going on, this patient's feeling of captivity has persisted in various forms. An interesting fact concerning the case, was that before the patient was born the doctor had warned her mother during pregnancy that she would most likely have a multiple birth as, on an examination, there seemed to be two heads. This was, however, caused by the unnatural position of the baby's left arm which gave rise to some difficulty at the actual birth. The patient, herself, was unaware of this information at the time of the L.S.D. treatment. One cannot be sure whether this is a true memory experience going back to birth, or if it is due to a very early statement by her mother that she had had this difficulty at her daughter's birth. It may be that her mother had told the patient this when the patient was two or three years of age and this had been forgotten; or, on the other hand, it may be due to the L.S.D. having a selective action on certain parts of the mid-brain and medulla which are present in the embryo. This treatment is very interesting and has great potential possibilities in conjunction with psychotherapy, as it reacts deeper into the subconscious than ordinary psychotherapy, or abreaction, thus relieving the patient of a load of repressed, noxious emotions. It is obvious that it cannot supplant, but may be complementary to, the other known physical methods now used in psychiatric treatments.
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