POISONING WITH HYDRO-CYANIC ACID

349

would most probably be affected, and there would be loss of consciousness, or convulsions, &c. May it be myelocele, (a tumour in the spinal cord,) or myeloma

thumb, the palms of the hands, and the soles of the feet; the feet are drawn up, flexed, rigid, and contracted, so that he appears to have talipes equinus; the calves of the legs are hard, cord-like, and painfullacia, (ramollissement of the cord,) or hæmomyelorrhagia, on pressure; the muscles of the thighs are also some. what contracted and rigid. On examining the spine, percussion over the cervical region produced no effect whatever, but on approaching the fifth dorsal vertebra, the patient cried out as if in great pain, and the legs, feet, and thighs were spasmodically contracted. On descending towards the lumbar region, the contractions and pain were greatly aggravated; the patient referred nearly the whole of the pain to the inferior extremities, the shocks being but slightly felt in the spine itself, and not at all in the head and upper extremities, nor were the muscles of the trunk affected in the least. The respiration is natural; the lungs and heart appear to be quite healthy; the pulse is firm, resisting, and 90; the tongue is slightly furred; there is no thirst, nor nausea, nor vomiting, nor tenderness on pressure over the abdomen; the bowels are regular; the urine is passed freely, and is natural in colour and quantity. The patient states that he has not received any injury to the spine, nor has he been exposed to cold, nor is he aware of any circumstances likely to have induced the attack.

Ordered thirty leeches to the spine, and afterwards four small blisters, two to be placed above, and two below, where the leeches were applied. To have ice applied over the spine. Low diet.

About an hour and a half after the application of the leeches, the pain in the head gradually abated, the contraction and rigidity of the extremities was almost removed, but the pain and formication in the thumb and soles of the feet continued.

22nd. The patient expresses himself greatly improved; he still complains of the heat, and tingling, and formi. cation in the right thumb and the soles of the feet; the calves of the legs are stiff, sore, and tender on pressure; percussion over the vertebræ occasions no pain or contraction of the extremities; the pulse is soft, small, and 80; the bowels are regular; the appe. tite is improved. To have a large blister applied over the lumbar region.

24th. The formication in the thumb and soles of the feet has nearly disappeared; there is still tenderness on pressure in the calves of the legs; the patient feels weak, but can walk perfectly well; convalescent. To have middle diet.

28th. The whole of the distressing symptoms entirely removed. The patient continues rather feeble, but will be able to leave the hospital in a few days.

(spinal apoplexy.) If it were any one of these affections, there would be partial paralysis or convulsions, and the nerves given off below the seat of the disease would be chiefly implicated. Again, is it probable that it may arise from epilepsy, convulsions, or chorea? There is nothing in the history of the case to indicate a predisposition to one or other of these affections, and the symptoms are totally opposed to such a supposition. Again, can we regard it as a case of what authors designate spinal irritation? It is true the debility of the patient, the absence of any recognizable exciting cause, and the small degree of reaction, might lead as to conclude it was so; but if, on the other hand, we consider the suddenness of the attack, the gradual augmentation and persistence of the symptoms, the violence, character, and extent of the pain, &c., we are perfectly justified in pronouncing it to be a case of meningo-myelitis. Thus, under inflammation, the sensibility of the cord is exalted; on percussing over the spine, the shock is carried to the extremities, causing contraction of the muscles, pain, &c. Again, the meninges being also affected, the irritation is propagated to the nerves as they pass through the foramina; this irritation extends by small communicating branches to the superficial nerves of the head, the ninth nerve, and the nerves of the upper extremities.

Having determined the inflammatory nature of the affection, our indications for treatment are very obvious. The patient's strength will scarcely admit of general bleeding, nor is it indeed necessary. The free circulation in the rachidian vessels, and their communication with those of the exterior through the foramina, point out how readily we may produce a decided effect upon congestion of the cord and its membranes by local blood-letting alone, and how easily we may subdue the excited circulation by the application of topical refrigerants; the after application of blisters will tend to remove the inflammatory products, should there be any. The speedy and favourable results of the treatment prove the diagnosis to have been perfectly correct, and show that resolution was obtained before the occurrence of any very material or extensive lesion, and the case may be considered as having proceeded no farther than what is denominated by Professor Millar" active congestion.” Paris, June 3rd, 1847.

PROVINCIAL

Professor Fiorry observed, that in forming our Medical & Surgical Journal.

diagnosis of the case before us, we must carefully take into consideration the whole of the symptoms, and the circumstances likely to have induced them, for should we be deceived in determining the nature of the disease, we might be led to adopt a treatment the most hurtful and injurious. Thus, we may ask, is it possible that it may be a lesion of the brain? If it were so, the pain in the head would be more deeply seated, more intense, and extended over a larger surface; the organs of sense

WEDNESDAY, JUNE 30, 1847.

A case of poisoning with hydrocyanic acid, attended by circumstances which give peculiar interest to it in a medico-legal point of view, has recently occurred in Worcester. It will be recollected that an inquiry into a case of poisoning by the same agent, in which there was the

manifestation both of consciousness and volition after swallowing the poison, took place some time ago at Bristol. In this case, which was reported at the time by Mr. Godfrey, (Provincial Medical and Surgical Journal, 1844, p. 398,) the individual, a man 44 years of age, after taking half an ounce of the acid, had walked ten paces to the head of the stairs, descended the stairs, seventeen in number, and then proceeded rather quickly to a druggist's shop, forty-five paces distant, where he had procured the acid, entering the shop in his usual slow and easy manner, and asking for "more of that prussic acid," before he became evidently affected by the poison which he had swallowed. In this instance, at least five minutes must have elapsed from the time of swallowing the poison before death took place, but there was no evidence to show the actual strength of the acid taken. Another somewhat similar case is reported by Mr. Nunneley, of Leeds, (Provincial Journal, 1845, p. 461,) but in this also neither the strength of the acid, nor the quantity actually swallowed,m could be accurately ascertained. Both cases were, however, further remarkable, in that there was neither convulsions nor shriek.

POISONING WITH HYDRO-CYANIC ACID.

351

into Mr. Stringer's parlour. Witness entreated Mr.lowing of the acid to the fatal termination Stringer to follow him, as she was afraid there was must have been some minutes. There was both something the matter with him. Mr. Stringer returned consciousness and volition manifested, according in a minute, exclaiming, “He has taken it." Witness to the evidence of Mr. Stringer, about two rushed into the parlour and met her brother, who advanced towards her about a yard into the room, and minutes, and according to that of the sister, for said, "Good bye, Mary; God bless you; I have taken some time longer, after the poison had been it." The witness's recollection here became indistinct taken. There was no evidence of the occurfrom excitement. She said that her brother at first rence of either convulsions or shriek. complained of being sick, but almost immediately he fell upon the floor. He did not eject anything from his stomach. She fully believed her unfortunate brother to have been much bewildered, and not in his right senses, when he was in Mr. Stringer's shop. He had previously complained of want of sleep, and took laudanum on Sunday for the purpose of procuring sleep. He had taken it on previous occasions for the same purpose, and to prevent coughing, he having some twelve months ago ruptured a bloodvessel in the lungs. Her brother had lately carried about him a large knife from his surgical instrument case, saying that "it was quite necessary in these times." He appeared afraid to go out alone.

M. Pierpoint, Esq., surgeon, stated that he was called in by Mr. Stringer to the deceased about one o'clock yesterday morning. He found him lying on his back on the floor in Mr. Stringer's parlour, his head lying on a sofa-pillow, and apparently dead. Mrs. Hill and Mrs. Stringer were present, and having raised the deceased, witness mixed some ammonia and water in a wine-glass, and attempted to pour it down his throat, but he did not swallow any portion of it, and none reached the stomach. Witness also applied a feather to the inside of the throat, with the object of producing vomiting, but without effect. He then sent for a stomach-pump, and in the mean time the deceased heaved a sigh or two and was dead. There was no pulsation at the wrist or heart."

The appearances observed on a post-mortem examination were here detailed. The following are the notes taken by Mr. Pierpoint at the time, to whom we are indebted for them:

:

Countenance (particularly the lips,) livid; neck, shoulders, and all the posterior part of the trunk purple. On dividing the integuments, dark blood flowed freely; the blood of the body universally dark and quite fluid; the lungs loaded with dark blood, which had to a considerable extent gravitated to their posterior portion. The right auricle and right ventricle of the heart, and vena cava, full of dark fluid blood; the left ventricle firmly contracted and quite empty. Five out of six gentlemen did not perceive any odour of prussic acid upon approaching the body, either before or after it was opened. All the abdominal viscera healthy; urinary bladder half full of urine, which exhaled no unusual odour; brain natural, but full of fluid blood. The stomach contained about one onnce of raspberry-coloured looking fluid, and had a strong smell of almonds; the stomach itself, particularly at its cardiac extremity, had a very vascular appearance, and in some of the patches oozing of blood had evidently taken place. Some of the patches had also a brownish appearance.

It is obvious from the foregoing account that the time which elapsed from the swal

As the quantity of the acid measured out to the deceased was known, and as he was seen to drink it out of the bottle," the bottle being afterwards found quite empty, it became very desirable that the strength of the acid should be accurately ascertained, Mr. Stringer was therefore asked for a similar quantity of the acid taken from the same bottle. This was put up in a sealed phial, and sent to Mr. Alfred Taylor, of Guy's Hospital, with a request that he would be good enough to submit it to examination. To Mr. Taylor's kind compliance with this request we are indebted for the following notice:

The phial contained 105 drops, weighing 98 grains. The whole of this was precipitated by a solution of nitrate of silver in excess. The precipitate (cyanide of silver,) was thrown on a filter, and washed until the washings were no longer affected by chloride of sodium. It was then thoroughly dried in a vapour bath, and weighed in a balanced filter.

The quantity of dry cyanide of silver obtained was 9.3 grains; and as 100 of cyanide are equal to 20.14 of anhydrous acid, the quantity of anhydrous prussic acid, present in the 98 grains of the acid forwarded, was equal to 1.87 grains. Ag.Cy. 100 : 20.14 :: 9.3 : 1.87 The acid, therefore, had a strength of rather more than 1.9 per cent., or nearly 2 per cent. I presume therefore it was intended to be the acid of the London Pharmacopoeia.

H.Cy.

Ag.Cy.

H.Cy.

The quantity of acid taken, according to Mr. Stringer's evidence, may possibly have been somewhat more.

Traces of the acid were found by Mr. Orwin in the fluid taken from the stomach, by whom it was submitted to examination.

which have here been detailed, adds another This case, therefore, the leading features of instance to those already on record, in which life was not immediately extinguished by a fatal dose of the poison,-in which certain acts implying consciousness and volition were performed, and in which death, as far as could be ascertained, was not preceded either by convulsions or the "shriek." It differs from former cases in this important particular, that the actual quantity taken, and the strength of the preparation, have been determined.

The Secretary then read the following report of the a high moral tone, but basing that culture on religion Council:

SUFFOLK BRANCH MEETING OF THE ASSOCIATION.

services. Having paid this merited tribute to departed worth, we may now turn to a more cheering theme in the future.

353

Crowfoot, H. Davey, sen., Esq., William Crowfoot, jun., Esq., R. Dashwood, Esq., W. Sharpin, Esq., Beccles; N. B. Fisher, Esq., Bungay; Dr. Lanchester, "The prospects of the future are cheering. Knowledge Yoxford; the Rev. Mr. Howman, Bexwell; and Lieut. is being generally diffused; prejudices once deeply Salmon, (East India Company's Service,) Stoke Ferry. rooted, are rapidly yelding to the progress of the age; In the absence of Mr. Bullen the chair was taken by the bounds of professional knowledge are becoming J. G. Crosse, Esq., who, after addressing the meeting wider and wider; and we may hope, that as an im-resigned it to the President-elect, William Henchman proved preliminary education may better enable the Crowfoot, Esq. aspirant to medical knowledge to cultivate the wide field before him, so it will also render him, when he shall have entered upon its active duties, a still more useful and respected member of our common community. To elevate the character of our profession generally, we must endeavour to raise the individual standard of intelligence and high mindedness of its members, and thus elevate the dignity of the healing art,' by rendering each of its followers a representative of the intelligence and high character of the whole." Dr. Shearman moved, and Dr. de Bartolomé seconded the adoption of the report, which was carried unanimously.

Mr. Husband proposed, and Dr. Chadwick seconded the appointment of Leeds, as the place for holding the next Annual Meeting.

Mr. Crowfoot, on taking the chair, claimed the indulgence of the meeting, and stated that he should rely upon their kindness for aid in the discharge of the duties of his office, more particularly as those duties had been so ably fulfilled by his predecessor, Mr. Bulien. He expressed his gratification in seeing so many of the members of the Association and their friends around him, for they had probably all seen the coarse and unprovoked attack which had been made on the Council of the Association by the Medical Times, and they would now be able to form their own opinions as to the character of our proceedings. To the accu. sation that the Association had not strenuously supported the cause of Medical Reform, he would reply that he should be glad if it were so. (Cheers.) The Association was not formed for political purposes, but

Mr. Hey, of Leeds, was unanimously chosen Presi- for the diffusion of practical information, for the pro. dent-elect.

The Branch Council was re-appointed.

No observations being offered on matters connected with the interests of the profession, the following papers were read:

"On the Inhalation of Æther," by Mr. Thomas. "A description of a new instrument for dividing small bones, or the protruding ends of the larger bones when fractured; and of a needle for passing a ligature

for the cure of bronchocele."

"On Perforation of the Carotid Artery by an external Ulcer," by Mr. W. Jackson.

"A Case of Fæcal Abscess," by Dr. Thurnam. Votes of thanks were passed to the authors of the papers, the President, and the Secretary. The Members then retired and afterwards dined together at the

Tontine Hotel.

SUFFOLK BRANCH OF THE PROVINCIAL
MEDICAL AND SURGICAL ASSOCIATION.

ANNUAL MEETING.

The Annual Meeting of the Suffolk and Norfolk Branches of the Provincial Medical and Surgical Association, was held at Beccles, on Thursday, the 17th of June. There were present-J. G. Crosse, Esq., Dr. Ranking, Edward Crickmay, Esq., W. B. Francis, Esq., Norwich; W. H. Crowfoot, Esq., W. H. Davey, Esq., Beccles; J. Beales, Esq., Haleswater; William Jeaffreson, Esq., Framlingham; Dr. Kirkman, Melton; W. Muriel, Esq., Wickham Market; W. Worthington, Esq., Lowestoft; H. L. Freeman, Esq., Saxmundham; H. C. B. Steele, Esq., Stoke Ferry; Alfred Harmer, Esq., Wrentham; John Currie, Esq., Bungay; Dr. Wake, Southwold; C. R. Bree, Esq., Stowmarket, Hon. Secretary for Suffolk. And as visitors, Dr.

motion of social and friendly intercourse amongst its members, and for sustaining the honour and respectability of the profession by cultivating a high and generous tone of feeling among practitioners, both towards their patients and towards each other, and by discountenancing all mean and unworthy conduct. (Loud cheers.)

In the attainment of these objects, he thought we had been eminently successful, and that the more closely we confine ourselves to the first principles of the Institution the better. He was happy to inform the meeting' that some interesting papers would be read, and that Mr. Hutchinson, the author of the very ingenious and elaborate paper in the last volume of the "MedicoChirurgical Transactions," on respiration, would afford them some valuable information on the use of the spirometer in detecting incipient disease of the lungs, and on the mechanism of respiration. (Cheers.)

The following papers and cases were then read to the meeting:

1. Dr. Ranking detailed an interesting case of supposed syphilitic disease of the larynx, and exhibited -, the morbid specimen, as well as a beautiful model of the same in wax, which we understood was made by Mr. Cobbald, a pupil of Mr. Crosse. The disease, as shown in the preparation, consisted of two circular ulcerations, at the base of the oral aspect of the epiglottis, extending on to the superior surface of the root of the tongue. The patient had nearly complete aphonia, and died with all the symptoms of laryngeal ulceration. The singular and unusual position of the disease excited much attention, and elicited an interesting discussion from the meeting.

2. A paper (which will be published in the Journal,) was read by Mr. William Crowfoot, jun., upon an extremely interesting and rare case of cirsoid aneurism

"