further action necessary, as he closed the door and left the persons to their fate, merely remarking to the other servants what he had seen. The information" was finally conveyed, an hour later, to her mistress, by the ayah, in m most casual way, and some time after she had been in personal attendance. On receiving the news, the master of the house at once went to see what had happened. Suspecting the cause, he dragged the patients into the open air, and despatched a note, asking me
FIVE CASES
OF CHARCOAL VAPOUR POISONING.
By A. Scott
Reid, M.B.,
Sara con-Major, 8th B. I.
On the morning of the loth January, 1885, I received a note from an officer to the effect that a member of his syce's family was dead, and that all the others appeared to be dying. On my arrival at 8-30 a.m., I found the above description to be literally true. In one of the servants' houses, consisting of a single apartment, lying on a charpoy, with the face upwards, was the dead body of a young man. The legs hung over the end of the bed, with the feet touching the ground as if the man had A fallen backwards from a sitting posture. quantity of froth protruded from the mouth, which was firmly closed; the eyes were shut. The body had partially cooled, and cadaveric rigidity was commencing in the limbs. On the floor were four persons?two men and two women?husband and wife, with daughter a,nd son-in-law, all perfectly insensible, and evidently in a very precarious condition. They appeared as if profoundly under the influence of an anaesthetic; the breathing was laboured and stertorous. The elder man was frothing at the mouth and clutching at his chest, as if endeavouring to remove some oppression. The others evinced no signs of suffering beyond occasional moans. The muscles were completely relaxed, the cheeks protruding and receding with each act of respiration. In only one, the younger man, could I detect any pulse at the wrist. The pupils were contracted. In a corner of a room were the embers of a charcoal fire, with At one side, one or two pieces still unburnt. of food but a untouched. cooked, large quantity I ascertained that the syce had invited his daughter and son-in-law, with a stranger, to The weather dinner the previous evening. being cold, they had shut the door, the only X 12', and aperture in a room 167-6^ X liad apparently lighted a charcoal fire. Nothing unusually was noticed until seven o'clock next morning, when the grasscutter entered the house, and observed what had happened. He, however, did not appear to have considered /?
?
?
T
to
come.
By the time I arrived, the persons had been replaced in the house on account of the intense cold,
conveyed to my hospital as soon and I shall now describe the subsequent treatment and progress of the cases :? They were all wrapped up in blankets ; large sinapisms applied to the left side of the chest, and hot water to the feet, which were very cold. I tried to administer Aromatic Spirits of Ammonia, but only partially succeeded in getting it down, as the jaws wrere firmly closed, and they Avould make no effort to swallow. They soon began to revive. By noon the daughter and son-in-law were partially sensible, and at 3 P.M. they were able to talk rationally. The elder mail did not recover his senses fully until 10 p.m., and his wife not until next day. They all complained of great pain in the lower extremities, which appeared to be temporarily paralysed. This condition did not pass off in the case of the younger man until the third day, in that of the women until the fourth, and of the elder man until the fifth day. They were discharged on the 19th January convalescent, but still weak. In answer to my enquiries, they stated that they had assembled in the house at 6 P.M., the food having been brought from the bazar ready cooked, and that they became insensible au hour after without having eaten any of it. This would limit the time to which they had been exposed to the charcoal vapour to fourteen hours, one hour's exposure having been suffi1 could elicit no cient to produce insensibility. further description of their sensations than that they had experienced distressing head symptoms and lain down. They said that there had been no difficulty in breathing. I performed a post-mortem examination upon the body of the man who had died, with the following result, on 15th January, 1-45 p.m. :? Muscular development good; rigor mortis well marked ; hypostatic congestion of back and sides of trunk ; froth at the mouth ; bloody froth issuing from the nostrils. The venous system was congested and bled on making the skin inOn opening the skull, the sinuses and cisions. superficial vessels of the brain were found to be engorged. They bled freely on division. The They
as
were
possible,
AMCHUR?ABSORPTION OF PHALANGEAL BONES.
March, 1885:] piamater
was
very much
injected
over
the
whole of the cerebrum aud cerebellum, present-
appearance. The substance of the of firm consistency, and presented bloody points on section. The lateral ventricles were empty. There were old pleuritic adhesions on both sides of the chest, especially on the right. The bronchial tubes contained a quantity of frothy fluid; lungs otherwise normal. The heart was contracted. The right auricle contained some dark blood, the left was empty. A small decolorized clot was found in each ventricle; valves health}'. The stomach contained about n pound of chyme. There were some patches ?f ecchymosis in the submucous tissue. The liver, spleen, and kidneys appeared to be healthy. Remarks.?There can be no doubt that the cases detailed were instances of poisoning from the inhalation of the vapour of burning charcoal, but at the same time had they come under observation without any knowledge of the circumstances in connection with them, it might have been difficult to form a correct diagnosis. It is on this account that I consider them a subject of medico-legal interest in a country "ke India, where charcoal forms a common article of fuel, and where the natives, from their Jgnorance and habits, are specially liable to suffer from its effects. The possibility of such au accident should, therefore, be borne in mind where no evident cause of death exists. It is to be noted that the man who had died was found at a higher elevation and further removed from the fire than the others, which fact is prima facie opposed to the supposition that the gaseous products of the combustion of charcoal collect in a stratum near the ground. ing
pink
a
brain
was
It must, however, be remembered that the natural density of carbonic acid, the principal ingredient, is diminished by the lieafc of combustion, and that the current produced by the same cause carries the gas upwards ; while, on the other hand, carbonic oxide, the less abundant but more poisonous product, is ordinarily lighter than air. The symptoms and post-mortem appearances were similar to those recorded in former cases, the los3 of muscular power, amounting in the lower limbs to temporary paraplegia, being most
marked. To
student of human nature, the utter inexhibited by the natives to the welfare of their countrymen as shewn in this case forms a subject for reflection. a
difference
Nowshera,
30th
January,
1885.
67
FIVE CASES
OF CHARCOAL VAPOUR POISONING.
By A. Scott
Reid, M.B.,
Sara con-Major, 8th B. I.
On the morning of the loth January, 1885, I received a note from an officer to the effect that a member of his syce's family was dead, and that all the others appeared to be dying. On my arrival at 8-30 a.m., I found the above description to be literally true. In one of the servants' houses, consisting of a single apartment, lying on a charpoy, with the face upwards, was the dead body of a young man. The legs hung over the end of the bed, with the feet touching the ground as if the man had A fallen backwards from a sitting posture. quantity of froth protruded from the mouth, which was firmly closed; the eyes were shut. The body had partially cooled, and cadaveric rigidity was commencing in the limbs. On the floor were four persons?two men and two women?husband and wife, with daughter a,nd son-in-law, all perfectly insensible, and evidently in a very precarious condition. They appeared as if profoundly under the influence of an anaesthetic; the breathing was laboured and stertorous. The elder man was frothing at the mouth and clutching at his chest, as if endeavouring to remove some oppression. The others evinced no signs of suffering beyond occasional moans. The muscles were completely relaxed, the cheeks protruding and receding with each act of respiration. In only one, the younger man, could I detect any pulse at the wrist. The pupils were contracted. In a corner of a room were the embers of a charcoal fire, with At one side, one or two pieces still unburnt. of food but a untouched. cooked, large quantity I ascertained that the syce had invited his daughter and son-in-law, with a stranger, to The weather dinner the previous evening. being cold, they had shut the door, the only X 12', and aperture in a room 167-6^ X liad apparently lighted a charcoal fire. Nothing unusually was noticed until seven o'clock next morning, when the grasscutter entered the house, and observed what had happened. He, however, did not appear to have considered /?
?
?
T
to
come.
By the time I arrived, the persons had been replaced in the house on account of the intense cold,
conveyed to my hospital as soon and I shall now describe the subsequent treatment and progress of the cases :? They were all wrapped up in blankets ; large sinapisms applied to the left side of the chest, and hot water to the feet, which were very cold. I tried to administer Aromatic Spirits of Ammonia, but only partially succeeded in getting it down, as the jaws wrere firmly closed, and they Avould make no effort to swallow. They soon began to revive. By noon the daughter and son-in-law were partially sensible, and at 3 P.M. they were able to talk rationally. The elder mail did not recover his senses fully until 10 p.m., and his wife not until next day. They all complained of great pain in the lower extremities, which appeared to be temporarily paralysed. This condition did not pass off in the case of the younger man until the third day, in that of the women until the fourth, and of the elder man until the fifth day. They were discharged on the 19th January convalescent, but still weak. In answer to my enquiries, they stated that they had assembled in the house at 6 P.M., the food having been brought from the bazar ready cooked, and that they became insensible au hour after without having eaten any of it. This would limit the time to which they had been exposed to the charcoal vapour to fourteen hours, one hour's exposure having been suffi1 could elicit no cient to produce insensibility. further description of their sensations than that they had experienced distressing head symptoms and lain down. They said that there had been no difficulty in breathing. I performed a post-mortem examination upon the body of the man who had died, with the following result, on 15th January, 1-45 p.m. :? Muscular development good; rigor mortis well marked ; hypostatic congestion of back and sides of trunk ; froth at the mouth ; bloody froth issuing from the nostrils. The venous system was congested and bled on making the skin inOn opening the skull, the sinuses and cisions. superficial vessels of the brain were found to be engorged. They bled freely on division. The They
as
were
possible,
AMCHUR?ABSORPTION OF PHALANGEAL BONES.
March, 1885:] piamater
was
very much
injected
over
the
whole of the cerebrum aud cerebellum, present-
appearance. The substance of the of firm consistency, and presented bloody points on section. The lateral ventricles were empty. There were old pleuritic adhesions on both sides of the chest, especially on the right. The bronchial tubes contained a quantity of frothy fluid; lungs otherwise normal. The heart was contracted. The right auricle contained some dark blood, the left was empty. A small decolorized clot was found in each ventricle; valves health}'. The stomach contained about n pound of chyme. There were some patches ?f ecchymosis in the submucous tissue. The liver, spleen, and kidneys appeared to be healthy. Remarks.?There can be no doubt that the cases detailed were instances of poisoning from the inhalation of the vapour of burning charcoal, but at the same time had they come under observation without any knowledge of the circumstances in connection with them, it might have been difficult to form a correct diagnosis. It is on this account that I consider them a subject of medico-legal interest in a country "ke India, where charcoal forms a common article of fuel, and where the natives, from their Jgnorance and habits, are specially liable to suffer from its effects. The possibility of such au accident should, therefore, be borne in mind where no evident cause of death exists. It is to be noted that the man who had died was found at a higher elevation and further removed from the fire than the others, which fact is prima facie opposed to the supposition that the gaseous products of the combustion of charcoal collect in a stratum near the ground. ing
pink
a
brain
was
It must, however, be remembered that the natural density of carbonic acid, the principal ingredient, is diminished by the lieafc of combustion, and that the current produced by the same cause carries the gas upwards ; while, on the other hand, carbonic oxide, the less abundant but more poisonous product, is ordinarily lighter than air. The symptoms and post-mortem appearances were similar to those recorded in former cases, the los3 of muscular power, amounting in the lower limbs to temporary paraplegia, being most
marked. To
student of human nature, the utter inexhibited by the natives to the welfare of their countrymen as shewn in this case forms a subject for reflection. a
difference
Nowshera,
30th
January,
1885.
67
