cyanhematin that is formed by the combination of the hydrocyanic acid with the altered blood pigment (see Plate 8). This appearance is not noted, however, if the contents of the stomach were acid when the poison was swallowed.

CASES OF POISONING BY HYDROCYANIC ACID.

CASE 1.-A man, aged twenty-two, swallowed rather more than of an ounce of the fresh per cent. solution of hydrocyanic acid, corresponding to 4.8 grains (0.31 gm.) of the anhydrous acid. He experienced a feeling of numbness and anesthesia of the lips, quickly followed by shortness of breath and loss of consciousness. When admitted to hospital shortly afterward, pupils were widely dilated, the right a little more so than the left; pulse 86, small and compressible; respirations shallow, and ranging between 40 and 50 a minute. No cyanosis; face had a rosy tint, but the surface was cold. Rectal temperature, 97.5° F. There was soon complete insensibility, with abolition of reflexes; pulse increased to 112 and became irregular. The dyspnea was extreme, but there was no pallor of the mucous membrane or lividity, the color continuing of the same bright arterial hue throughout. There was decided trismus, rendering the introduction of the stomach-tube difficult, and for a brief space there was rigidity of the limbs. There was involuntary escape of the urine.

The treatment consisted in thorough lavage of the stomach, the hypodermic injection of whisky, camphorated ether, strychnin and atropin sulphates, the administration of whisky and ammonia by the mouth, and the application of dry heat. Sugar, albumin, casts, leukocytes, epithelial cells, and oxalate of calcium crystals were found in the urine.

There were signs of returning consciousness in two hours after admission, and recovery was rapid.

Two drops of the portion of the acid remaining in the bottle found on the patient's person caused death in two and a half minutes when placed upon the tongue of a healthy kitten.1

CASE 2.-A woman, aged twenty-two, swallowed an ounce of a lotion containing to 1 grain of hydrocyanic acid. The patient, who was seated in a chair, instantly jumped up, ran the distance of a few feet, and then fell to the ground insensible. There were violent convulsions, the face was distorted, and the limbs were extended and fixed in tetanic spasm. After five minutes the limbs were still extended and inflexible, the face swollen and turgid, the lower jaw spasmodically fixed, the eyelids half closed, but the eye prominent and glistening, with pupil strongly dilated. She was foaming at the mouth, breathing at long intervals with a deep, inspiratory effort, and uttering a moaning noise; pulse imperceptible at wrist. She died quietly, without any further struggle, fifteen or twenty minutes after taking the medicine. The patient had not spoken after taking the poison; she did not scream, nor was she sick; feces and urine were not passed. Postmortem four days later; limbs still rigidly extended, fingers strongly clutched, countenance turgid and distorted, jaws fixed, eyes glassy and bright. The vessels of the brain and lungs were congested; the chest evolved a strong odor of hydrocyanic acid.2

CASE 3.—A stout, muscular man, aged forty, drank by mistake half an ounce of a 1.48 per cent. solution of hydrocyanic acid. "The bottle was found replaced and the cupboard door put to, and it would seem that he had poured out his dose into a measure, and had drank it off standing at the cupboard; and, finding out his mistake, had put down the measure, and mechanically restoppered and replaced the bottle, closing the cupboard door, and had then run upstairs to the house surgeon, having on his way to cross the dispensary room, to open a spring door, to go up a crooked flight of fourteen stairs, across a long landing, up a second flight of eighteen stairs, and a distance of several more paces through two other doors into the house-surgeon's room." He told the house-surgeon that he had taken half an ounce of prussic acid and asked him to come to the basement; he then retraced his steps-a distance of from twenty-five to thirty paces and 1 Shively, Amer. Jour. Med. Sci., n. s., 1890, vol. c., p. 42. 2 Letheby, Lancet, 1845, vol. ii., p. 99; also vol. i., p. 638.

L

STOMACH AND UPPER PORTION OF SMALL INTESTINE AFTER POISONING WITH

POTASSIUM CYANID (VON HOFMANN).

Hydrocyanic-acid poisoning gives rise to no especial organic changes, but when the cyanogen is in combination with potassium, forming potassium cyanid, well marked and fairly characteristic postmortem appearances are seen in the stomach, and sometimes in the duodenum, esophagus, pharynx, and fauces. This effect is due to the marked alkalinity of the potassium cyanid, enabling it to dissolve albuminous bodies, causing the tissues to swell and to become cleared, disintegrating the blood, and, as a consequence, producing hemorrhagic imbibition of the swollen structures. The cyanogen in the salt, by its specific action on the hemoglobin, forms cyanohematin, which is of a striking red color. The structures charged with blood, therefore, are of a red or brownish-red color. The stomach is generally contracted, with walls apparently thickened to the touch. As a rule, the organ contains a large quantity of soapy, hemorrhagic, rather tenacious mucus, of alkaline reaction. The mucous membrane throughout, but especially in the dependent portions, is of a diffuse blood-red or brownish-red color and markedly swollen. These alterations may affect the entire thickness of the mucous membrane and even invade the submucosa. At times they may also be followed into the duodenum, less frequently beyond it, and sometimes also into the esophagus, pharynx, and fauces.

A portion of these changes unquestionably do not develop until after the death of the individual; they are the consequence of the long-continued action of the potassium cyanid on the hyperemic stomach, and therefore are not found at a postmortem examination made immediately after the death of a person, or of an animal experimentally killed by the poison.

If the potassium cyanid is taken in acid solution, it is decomposed, hydrocyanic acid being evolved; and, likewise, if the stomach-contents are strongly acid, the same decomposition occurs. In both these instances the case is one of poisoning by hydrocyanic acid, and no particular organic changes are found.

cyanhematin that is formed by the combination of the hydrocyanic acid with the altered blood pigment (see Plate 8). This appearance is not noted, however, if the contents of the stomach were acid when the poison was swallowed.

CASES OF POISONING BY HYDROCYANIC ACID.

CASE 1.-A man, aged twenty-two, swallowed rather more than of an ounce of the fresh 2 per cent. solution of hydrocyanic acid, corresponding to 4.8 grains (0.31 gm.) of the anhydrous acid. He experienced a feeling of numbness and anesthesia of the lips, quickly followed by shortness of breath and loss of consciousness. When admitted to hospital shortly afterward, pupils were widely dilated, the right a little more so than the left; pulse 86, small and compressible; respirations shallow, and ranging between 40 and 50 a minute. No cyanosis; face had a rosy tint, but the surface was cold. Rectal temperature, 97.5° F. There was soon complete insensibility, with abolition of reflexes; pulse increased to 112 and became irregular. The dyspnea was extreme, but there was no pallor of the mucous membrane or lividity, the color continuing of the same bright arterial hue throughout. There was decided trismus, rendering the introduction of the stomach-tube difficult, and for a brief space there was rigidity of the limbs. There was involuntary escape of the urine.

The treatment consisted in thorough lavage of the stomach, the hypodermic injection of whisky, camphorated ether, strychnin and atropin sulphates, the administration of whisky and ammonia by the mouth, and the application of dry heat. Sugar, albumin, casts, leukocytes, epithelial cells, and oxalate of calcium crystals were found in the urine.

There were signs of returning consciousness in two hours after admission, and recovery was rapid.

Two drops of the portion of the acid remaining in the bottle found on the patient's person caused death in two and a half minutes when placed upon the tongue of a healthy kitten.'

CASE -A woman, aged twenty-two, swallowed an ounce of a lotion containing to 1 grain of hydrocyanic acid. The patient, who was seated in a chair, instantly jumped up, ran the distance of a few feet, and then fell to the ground insensible. There were violent convulsions, the face was distorted, and the limbs were extended and fixed in tetanic spasm. After five minutes the limbs were still extended and inflexible, the face swollen and turgid, the lower jaw spasmodically fixed, the eyelids half closed, but the eye prominent and glistening, with pupil strongly dilated. She was foaming at the mouth, breathing at long intervals with a deep, inspiratory effort, and uttering a moaning noise; pulse imperceptible at wrist. She died quietly, without any further struggle, fifteen or twenty minutes after taking the medicine. The patient had not spoken after taking the poison; she did not scream, nor was she sick; feces and urine were not passed. Postmortem four days later; limbs still rigidly extended, fingers strongly clutched, countenance turgid and distorted, jaws fixed, eyes glassy and bright. The vessels of the brain and lungs were congested; the chest evolved a strong odor of hydrocyanic acid."

CASE 3.-A stout, muscular man, aged forty, drank by mistake half an ounce of a 1.48 per cent. solution of hydrocyanic acid. "The bottle was found replaced and the cupboard door put to, and it would seem that he had poured out his dose into a measure, and had drank it off standing at the cupboard; and, finding out his mistake, had put down the measure, and mechanically restoppered and replaced the bottle, closing the cupboard door, and had then run upstairs to the house surgeon, having on his way to cross the dispensary room, to open a spring door, to go up a crooked flight of fourteen stairs, across a long landing, up a second flight of eighteen stairs, and a distance of several more paces through two other doors into the house-surgeon's room." He told the house-surgeon that he had taken half an ounce of prussic acid and asked him to come to the basement; he then retraced his steps-a distance of from twenty-five to thirty paces and 1 Shively, Amer. Jour. Med. Sci., n. s., 1890, vol. c., p. 42. 2 Letheby, Lancet, 1845, vol. ii., p. 99; also vol. i., p. 638.