F. Knowles
1890 The Lancet  
the brain were deeply congested ; on section a few minute red points were observed. The heart, the right side, was found dilated and contained dark-blue clotted blood; the left side was contracted and practically empty. There was a large deposit of fat, otherwise the heart was notmal. The lungs on removal presented a dark congested and mottled appearance. On section, frothy exudation followed, the lung tissue was crepitant throughout. There was no disease of the lungs. The peritoneal surface of
more » ... ritoneal surface of the stomach was of claret colour. On cutting the organ open it was found empty; the mucous membrane was thickened and congested in patches, especially towards the pyloric end-these patches were observed at intervals almost throughout the small intestine. The liver weighed seven pounds and a half. The kidneys were enlarged. The remaining organs were normal. The washings of the stomach presented the usual tests for cyanides. A few comments on the case may be made. Cases of poisoning by cyanide of potassium are of rare occurrence, though the salt is largely used by photographers. The few cases of poisoning which have occurred have been in connexion with this trade, as in this case. The salt is usually adulterated with carbonate of potash ; probably this caused the signs of corrosive poisoning, whilst the cyanide of potassium itself was the immediate cause of death by paralysing the respiratory centre. There was a history of alcoholism of two years' duration; this intensified the congestion of the membranes of the brain, and would also account for the enlarged liver and disease of the kidneys. Blackpool. NOTICING Dr. Dawtry Drewitt's communication or. the Rarity of Gangrene after Typhoid Fever, the following case occurring in the Murston epidemic may be of interest. Fred. P-, aged eighteen years, a brickmaker, fair and spare, with family history of phthisis ; heart normal. The onset was sudden and ii3flLienza-like, with temperature occasionally reaching 105° F.; but after the third week, when he was removed to the Infectious Hospital, it never exceeded 102°, and at the end of the fifth week of the fever it became normal. There was no excessive diarrhoea or hsemorrhage, but the patient was very asthenic and torpid. The convalescence was slow, with disinclination for exertion, the feet and legs being cedematous. At the third week of convalescence the dorsum of the left foot became first purple, then mottled and gangrenous, and extremely sensitive. Perchloride of iron and quinine were given, and boric fomentations applied to the foot and leg. In a few days a line of demarcation formed, enclosing an area of about twelve square inches. It was then poulticed with linseed-meal and carbolic oil. The slough came away in a week, exposing the tendons and muscles; this had nearly granulated up when the patient was discharged in the ninth week of convalescence. In considering the pathology of the case, the oedema appears due to cardiac weakness, as there were no varicose veins. The gradual onset points rather to thrombosis than to embolism of the anterior tibial artery, which is also rendered more probable by the fact of the patient being an amateur sprinter, the artery being supported by muscles until it reaches the ankle-joint, where it would be exposed to injury and strain, and where the occlusion most likely occurred. There was no sudden pain in the limb, such as would be caused by the impaction of an embolus. Sittingbourne. TWO CASES OF CHLOROFORM NARCOSIS, WITH NECROPSIES. BY F. KNOWLES, L.R.C.P., M.R.C.S. HAVING recently been called in by our coroner to examine two cases of death from chloroform, the following brief notes may be of interest. The first case was that of a well-nourished woman, aged thirty-four, an idiot, who died after inhaling less than three drachms of chloroform. On examination, the pericardium was healthy, the heart normal in size and position, slight deposit of fat on outside, muscle rather pale, but presenting no distinct evidence of fatty degeneration. Valves all com-potent and healthy ; no atheroma of aorta. The lungs were both studded from apex to base with miliary tubercles, and there was an old cavity the size of a walnut in the apex ot the left. The intestines contained numerous typical tubercular ulcers and many scattered grey tubercles. All the other organs were fairly healthy. In the second case the subject was an emaciated boy aged seven. Here again the heart was healthy; no fatty changes in the muscle ; the valves competent and perfectly healthy, with the exception of a very small patch on the anterior flap mitral valve, which appeared slightly thickened. The lungs were extensively diseased, the right being bound down throughout its greater extent with old pleuritic adhesions, and the lung itself collapsed at the base ; the left lung wab practically absent, being represented by a mass of soft caseous matter. The kidneys were large and congested, the right containing a small abscess. The spleen and liver were large (amyloid). The right knee-joint was one bag of pus with drainage from two places. In both these cases the heart was distinctly noticed to beat after the respiration had ceased, and in both that organ was in a healthy condition, while in both instances there was extensive disease of the lungs, and consequent diminished breathing capacity-in the first case by at least one-third, and in the second by even more than that. The practical inference here is that the lungs have quite as much to do with the risk of chloroform antsthesia as the heart has; and it is quite as essential that before giving this anaesthetic the lungs should be examined as it is that the heart should be stethoscoped. In both cases death occurred before the intended operation was commenced.
doi:10.1016/s0140-6736(01)86668-x fatcat:lacpol43y5fyvetoqy6cmgtk6e