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A CASE OF LEOPARD BITE
133
teaspoon used would be 0-15
mg.
The
I
stomach, stomach
to be free from morphine. and urine contained not more than 0-02 mg.,
that this case may be an isolated one ; hand, others may not have been recog-
am aware
contents, and duodenum proved
on
The kidneys and the liver about the same quantity ; in the intestines and their contents there was about 0-1 mg. From these findings it was concluded that more than 0-15 mg. of morphine was administered, but that some of this had passed into the blood stream. Cause of death.-At the inquest I gave my opinion that death was due to asphyxia not caused by mechanical violence, but by morphine poisoning. A verdict of death by misadventure was returned.
nised, through suppression
the other
of information.
I wish to thank Mr. R. M. Barlow, the coroner, for D. Elsdon
permission to report these facts, and Mr. G. for allowing me to give his chemical results.
,
Cases have been reported in which quantities of the order 0’5 mg. morphine have resulted in the death of very young children. Thus E. Smith1 describes a case in which opiumgr. 1/20 (= 3’3 mg. opium=0’33 mg. morphine) caused the death of an infant 16 days old. A. and M. Winter Blyth2 state that cases are recorded of infants dying from extremely small doses of opium-e.g., 0’7, 4’3, and 8’1 mg. (1/90, 1/15, and l of a grain)-but in such instances one cannot help suspecting some mistake. It may be conceded, they add, that a very small quantity might be fatal to infants, and that 3 mg. (0’3 mg. of morphine) given to a child under one year would probably produce serious symptoms. In the present case it is to be noted that although the bottle when full would contain 2’6 mg. of anhydrous morphine, only 2 mg. was found left in the bottle. The dose however was given by candlelight, and the mother in evidence stated that she had knocked over the bottle and that some had escaped in this way. It can be assumed therefore that at least 0-15 mg. was administered but possibly less than 0’3 mg., of which 0’14 mg. was recovered from the stomach, duodenum, large and small intestines, liver, kidneys, and urine. In evidence at the inquest the manufacturer stated that he thought the medicine was safe and that he had heard of children drinking out of the bottle ; he further stated that the morphine content was not ascertained by analysis. Accepting 0’5 mg. as a known lethal dose and 0’3 mg. or less as the dose given in this case, the bottle would contain 5-8 times the known minimum lethal dose. In view of the known idiosyncrasy of young children to morphine and the variable composition of syrup of poppies used in the medicine I offer the following suggestions. 1. All such preparations should be analysed for morcontent and a log book kept of all batches made and sold. 2. All such preparations should be sold only under Schedule 1 of the Poisons and Pharmacy Act, 1908, and the same description should be applied as is at present applicable under the Ireland Schedule (Part II.). Thus the present schedule exempts any preparation containing less than 0-2 per cent. morphine from Part I. of the schedule, whereas Part II. of the Ireland Schedule includes " Opium and all preparation of opium or poppies." Since the present medicine which contained only 0-006 per cent. morphine was able to cause death it is obviously possible for an unscrupulous person to encompass the death of an infant by the free use of preparations containing much less than the specified amount of morphine without any register of the sale of such a product being
phine
A CASE OF LEOPARD BITE WITH A NOTE ON CLAW MARKS
BY JAMES MEDICAL
WALKER, M.B. Glasg., D.P.H. OFFICER, BEBIANIHA, GOLD COAST
ON Jan. 7th, 1935, a Sefwi hunter was brought to the African hospital belonging to Bibiani (192 7) Ltd. suffering from injuries inflicted by a leopard. Either by accident or bad shooting, he had hit the creature near the tail, so angering it that it turned on him and pulled him down, worrying him till two other hunters killed it. His left arm just above the wrist was bitten through, both bones being crushed. Both nis arms were
clawed exten-
sively, and a fang had passed right through the inner side of the right orbital fossa to the floor of the
skull, missing the eyeball. An unusual feature of the case was that a
blte ill the
t h r 0 a thad throat h a d pierced the trachea in such a manner as
Diagram showing the gaping wound in the skin (through which muscle is visible), the long subcutaneous pocket, not at first evident, made by the leopard’s
and
curved claw.
to leave a valve which caused air to be
pumped into the tissues of the neck and face, pro. ducing conspicuous surgical emphysema. The patient was conscious, and his breathing obstructed and difficult ; so I opened up the wound so far as was necessary to allow of easy respirations, and for some three hours he was comfortable. Then he announced he was going to die and did so. The accompanying diagram shows a type of claw mark seen on the right arm. These lesions were roughly half-moon-shaped and looked deceptively clean-cut and shallow, but in addition to the obvious wound there were conical pockets running well under what looked like sound skin, following the curves of the animal’s claws. This multiple pocketing, if overlooked, would give every chance to the tetanus bacillus and other bacteria. It is caused by the animal holding the limb, without tearing it, and differs from the rending wounds.
available.
3. The inspection of premises and records of all such manufactured products should be made possible by the Dangerous Drugs Acts, 1920, 1923, 1925, amending in such a way as to alter the amount of morphine from 0-2 per cent. to much less in amount before premises come within the purview of these Acts.
1 Smith, E.: Amer. Jour. Med. Sci., 1854, liv., 381, quoted by Peterson, Haines, and Webster, Legal Medicine and Toxi2nd edition, London and Philadelphia, vol. ii., p. 523. cology, 2 Blyth, A. W, and Blyth, M. W.: Poisons, their Effects and Detection, 5th edition, London, p. 294.
THE
LATE
MR. H. JOHNSON.-The death of Mr.
Harry Johnson, house governor and secretary of the Leicester Royal Infirmary on July 14th, is announced. Mr. Johnson had held this position for 31 years, and during his long service for the hospital had seen it expand from an institution with 226 beds to one with 486 beds and 92 convalescent beds. He was a member of the British Hospitals Association, and,took an active part in the deliberations of the East Midland Regional
branch.
teaspoon used would be 0-15
mg.
The
I
stomach, stomach
to be free from morphine. and urine contained not more than 0-02 mg.,
that this case may be an isolated one ; hand, others may not have been recog-
am aware
contents, and duodenum proved
on
The kidneys and the liver about the same quantity ; in the intestines and their contents there was about 0-1 mg. From these findings it was concluded that more than 0-15 mg. of morphine was administered, but that some of this had passed into the blood stream. Cause of death.-At the inquest I gave my opinion that death was due to asphyxia not caused by mechanical violence, but by morphine poisoning. A verdict of death by misadventure was returned.
nised, through suppression
the other
of information.
I wish to thank Mr. R. M. Barlow, the coroner, for D. Elsdon
permission to report these facts, and Mr. G. for allowing me to give his chemical results.
,
Cases have been reported in which quantities of the order 0’5 mg. morphine have resulted in the death of very young children. Thus E. Smith1 describes a case in which opiumgr. 1/20 (= 3’3 mg. opium=0’33 mg. morphine) caused the death of an infant 16 days old. A. and M. Winter Blyth2 state that cases are recorded of infants dying from extremely small doses of opium-e.g., 0’7, 4’3, and 8’1 mg. (1/90, 1/15, and l of a grain)-but in such instances one cannot help suspecting some mistake. It may be conceded, they add, that a very small quantity might be fatal to infants, and that 3 mg. (0’3 mg. of morphine) given to a child under one year would probably produce serious symptoms. In the present case it is to be noted that although the bottle when full would contain 2’6 mg. of anhydrous morphine, only 2 mg. was found left in the bottle. The dose however was given by candlelight, and the mother in evidence stated that she had knocked over the bottle and that some had escaped in this way. It can be assumed therefore that at least 0-15 mg. was administered but possibly less than 0’3 mg., of which 0’14 mg. was recovered from the stomach, duodenum, large and small intestines, liver, kidneys, and urine. In evidence at the inquest the manufacturer stated that he thought the medicine was safe and that he had heard of children drinking out of the bottle ; he further stated that the morphine content was not ascertained by analysis. Accepting 0’5 mg. as a known lethal dose and 0’3 mg. or less as the dose given in this case, the bottle would contain 5-8 times the known minimum lethal dose. In view of the known idiosyncrasy of young children to morphine and the variable composition of syrup of poppies used in the medicine I offer the following suggestions. 1. All such preparations should be analysed for morcontent and a log book kept of all batches made and sold. 2. All such preparations should be sold only under Schedule 1 of the Poisons and Pharmacy Act, 1908, and the same description should be applied as is at present applicable under the Ireland Schedule (Part II.). Thus the present schedule exempts any preparation containing less than 0-2 per cent. morphine from Part I. of the schedule, whereas Part II. of the Ireland Schedule includes " Opium and all preparation of opium or poppies." Since the present medicine which contained only 0-006 per cent. morphine was able to cause death it is obviously possible for an unscrupulous person to encompass the death of an infant by the free use of preparations containing much less than the specified amount of morphine without any register of the sale of such a product being
phine
A CASE OF LEOPARD BITE WITH A NOTE ON CLAW MARKS
BY JAMES MEDICAL
WALKER, M.B. Glasg., D.P.H. OFFICER, BEBIANIHA, GOLD COAST
ON Jan. 7th, 1935, a Sefwi hunter was brought to the African hospital belonging to Bibiani (192 7) Ltd. suffering from injuries inflicted by a leopard. Either by accident or bad shooting, he had hit the creature near the tail, so angering it that it turned on him and pulled him down, worrying him till two other hunters killed it. His left arm just above the wrist was bitten through, both bones being crushed. Both nis arms were
clawed exten-
sively, and a fang had passed right through the inner side of the right orbital fossa to the floor of the
skull, missing the eyeball. An unusual feature of the case was that a
blte ill the
t h r 0 a thad throat h a d pierced the trachea in such a manner as
Diagram showing the gaping wound in the skin (through which muscle is visible), the long subcutaneous pocket, not at first evident, made by the leopard’s
and
curved claw.
to leave a valve which caused air to be
pumped into the tissues of the neck and face, pro. ducing conspicuous surgical emphysema. The patient was conscious, and his breathing obstructed and difficult ; so I opened up the wound so far as was necessary to allow of easy respirations, and for some three hours he was comfortable. Then he announced he was going to die and did so. The accompanying diagram shows a type of claw mark seen on the right arm. These lesions were roughly half-moon-shaped and looked deceptively clean-cut and shallow, but in addition to the obvious wound there were conical pockets running well under what looked like sound skin, following the curves of the animal’s claws. This multiple pocketing, if overlooked, would give every chance to the tetanus bacillus and other bacteria. It is caused by the animal holding the limb, without tearing it, and differs from the rending wounds.
available.
3. The inspection of premises and records of all such manufactured products should be made possible by the Dangerous Drugs Acts, 1920, 1923, 1925, amending in such a way as to alter the amount of morphine from 0-2 per cent. to much less in amount before premises come within the purview of these Acts.
1 Smith, E.: Amer. Jour. Med. Sci., 1854, liv., 381, quoted by Peterson, Haines, and Webster, Legal Medicine and Toxi2nd edition, London and Philadelphia, vol. ii., p. 523. cology, 2 Blyth, A. W, and Blyth, M. W.: Poisons, their Effects and Detection, 5th edition, London, p. 294.
THE
LATE
MR. H. JOHNSON.-The death of Mr.
Harry Johnson, house governor and secretary of the Leicester Royal Infirmary on July 14th, is announced. Mr. Johnson had held this position for 31 years, and during his long service for the hospital had seen it expand from an institution with 226 beds to one with 486 beds and 92 convalescent beds. He was a member of the British Hospitals Association, and,took an active part in the deliberations of the East Midland Regional
branch.