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A fatal case of poisoning following the ingestion of a large amount of crystalline cocaine hydrochloride is reported. Levels in the blood, urine, liver, kidney, spleen, bile and stomach and contents were determined. Some information is presented on the optimum extraction pH of cocaine.

I began the practice of otolaryngologic surgery in the late Dr. Emil Mayer's clinic over twenty-five years ago and had the benefit of Dr. Mayer's careful and thorough instruction in his specialty. I also had close hand knowledge of the work on the toxic effects of local anesthetics done by Dr. Mayer and his associates 1 for the Council on Pharmacy and Chemistry of the American Medical Association. With the precepts and recommendations of Dr. Mayer and his committee in mind, I did many intranasal operations with cocaine anesthesia without a mishap and almost reached the state of mind where I thought "This can't happen here." Well, it did happen. During the course of a submucous resection of the nasal septum, symptoms of acute cocaine poisoning developed. The patient recovered after desperate and intensive work, but the experience was so harrowing that I was impelled to make another study of Dr.

Ultraviolet spectrophotometric studies of brain and liver extracts of normal mice and of mice suffering a progressive aldrin intoxication or an acute cocaine poisoning were described. Using an optical method developed in this Institute and presented in a previous communication, tentative protein spectra characteristic for each individual organ could be obtained. Essential differences could be registered in the absorption spectra from animals poisoned with aldrin or cocaine as compared to the spectra of controls.

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To the Editor:— My comment on the article "Reaction Following Bronchography with Iodized Oil" by Capt. George S. Mahon (The Journal, January 26, p. 194) is prompted by my belief that he has misinterpreted the findings at hand. The proper interpretation of the accident would have prevented this death and should prevent further fatalities.In his discussion Dr. Mahon correctly disregards the possibility of cocaine poisoning and of allergic shock from cocaine sensitivity because of the time elapsed between the administration of the drug and the onset of the symptoms. The same reasoning should also pertain to the question of a localized lipiodol sensitivity in the bronchi or of allergic shock from the instillation of lipiodol: an allergic reaction severe enough to be fatal would have taken place immediately or shortly after the instillation of the lipiodol. It would have been characterized by generalized edema in most areas of the

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In a previous study of acute experimental cocaine poisoning and its treatment 1 we reported the following observations from experiments on the dog and the rabbit: Death in acute poisoning from the hypodermic injection of cocaine hydrochloride is due to respiratory failure. By the intravenous administration of appropriate hypnotics, e. g., barbital sodium (barbitalum soluble, U. S. P. X) with paraldehyde, the minimal lethal dosage of cocaine was raised from approximately 100 mg. per kilogram to 150 mg. per kilogram in the rabbit, and from approximately 26 mg. per kilogram to 65 mg. per kilogram in the dog. Convulsions ceased immediately during the injection of the hypnotics. The convulsions caused by cocaine are largely of cortical origin; this disturbance contributes or is parallel to the more direct drug injury of the medullary centers, particularly the respiratory center. If the cortical manifestations of cocaine poisoning were controlled by hypnotics it was

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