Archives de médecine interne . insuffisance cardiaque. Dans certains cas, le sésediarrhée et l'effondrement sont observés, mais ce n'est pas une forme fréquente d'oftermination. 1. Czaplewski a été en mesure de démontrer la métheiroglobine dans un seul des douze facilite de l'empoisonnement grave, et ce n'était pas un cas fatal. 180 i l!f III l.s de I TEH i /. UEDIC1 E Chez les patients qui ont inhalé de petites quantités de gaz et ont non-provoceaprès l'attaque de Lrrsl d'œdème des poumons, la maladie peut continuer pendant; i nombre de jours avec les symptômes cliniques de bronchite aiguë andevidences dans le chesl de la pneumonie Lobar ou Lobar.

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Archives of internal medicine . cardiac failure. In some cases severediarrhea and collapse are observed, but this is not a frequent form oftermination. 1. Czaplewski was able to demonstrate metheiroglobin in only one out oftwelve eases of severe poisoning, and this was not a fatal case. 180 I l!f III l.s OF I TEH I /. UEDIC1 E In patients who have inhaled small amounts of gas and have unprovedafter the Lrrsl attack of edema of the lungs, the disease may continue for;i number of days with the clinical symptoms of acute bronchitis andevidences in the chesl of Lobular or Lobar pneumonia. Usually there isextreme dyspnea. The sputum is tenacious, yellowish or brown. Vomit-ing may be so extreme as to mask the pulmonary symptoms, though as arule this is uncommon. Such cases may recover, bui often show anincreased liability t bronchitis or pneumonia for months afterward. Ai autopsy the larynx, trachea and bronchi are congested and of areddish or brownish color. If the patienl dies shortly after exposure, the. Fig. 2. Dog i. Lobular pneumonia with emphysema five days after inhalationi gas. Low power. lung i- edematous; in those living for several days, il is emphysematous, with, in addition, a moderate amounl of pneumonic exudate. The vesselsof the Lung often contain thrombi. From the cu1 Burface exudes areddish or brownish fluid. In the other organs ecchymoses arc occasion-ally found. Focal necroses max occur in the Liver. The meninges arc often congested and there ar :asionally punctate hemorrhages through ciii the substance of the brain. The kidneys have in a few cases shownacute degeneration r acute nephritis; generally, however, the) arc ntinm-li altered. FRANCIS CARTER WOOD 481 The number of published cases of death following the inhalation ofvapors of nitrogen tetroxid is not very large; but owing to the greatlyincreased use of nitric acid in the arts, cases of such poisoning are likelyto lie more frequent in the future, and they may also assume a medico-legal

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