1012 Summary and Conclusions 



Dr. Heiberg then gives interesting details of the autopsy of 

 two workmen whom he had seen die and of the symptoms appear- 

 ing in the patients he observed. I have already (p. 389) given a 

 very brief summary of the results of one of these autopsies, that of 

 Kiva, but here we are given more detailed information: 



Kiva Ferdinando, thirty years old, was attacked, as he left the 

 work chamber, by pains in his limbs, with complete paralysis of the 

 bladder, the rectum, and the lower limbs; he half fainted, cyanosed, 

 his respiration is rattling, there are sounds of moist rale in the lungs, 

 the pulse is weak and rapid. He is taken to the hospital July 26, 

 1875; his condition does not change, the paralysis remains in the same 

 place, he is continually delirious, then the collapse comes and death 

 occurs July 30 during the night. In the autopsy the lungs are found 

 to be full of blood, with a secretion from the bronchial tubes mingled 

 with blood and a frothy lymph. The spinal cord was quite soft over 

 an extent of several inches in the lower dorsal and upper lumbar 

 region. The softening had very definite limits, without a trace of 

 blood, inflammation, or exudation. In the brain, heart, kidneys, and 

 spleen, nothing abnormal; but my attention was not yet directed to 

 the development of air in the veins, because at that time it was un- 

 known to me. 



The other case, which also ended in death, could not be observed 

 while the patient was alive. The workman was returning home seem- 

 ing well. On the way he felt ill and fell dead as if struck by lightning. 

 The next day the autopsy was performed; the body was already stiff; 

 a deep cyanosis was observed on the body, particularly on the breast, 

 under the armpits, and on the left arm, where a very distinct 

 emphysematous condition could be felt; when an incision was made at 

 these places there issued a bloody lymph with a considerable mix- 

 ture of air; the spleen, which was very emphysematous, crackled all 

 over its surface at pressure, and when an incision was made, there 

 issued blood mixed with a great deal of air; no air bubbles in the 

 aorta, the jugular vein, the iliac and crural arteries. The kidneys and 

 the liver are in normal condition, the urinary bladder empty, a de- 

 velopment of air in the epiploon, the brain not full of blood, very dis- 

 tinct and large bubbles of air in the basilar artery, in the sinus, and 

 in the veins of the upper surface of the brain; among these air 

 bubbles, very small, almost liquid spots of blood. The stomach was 

 much lengthened and contained a certain quantity of vegetable food. 

 No investigation of the spinal cord was made because careful ex- 

 amination of the veins required much time for making the liga- 

 tures. 



Although these two autopsies are very imperfect, and leave much 

 to be desired, it seems to me that they agree completely. In the first 

 case, in which the symptoms of the disease had developed for several 

 days, and in which bubbles had met and concentrated in the spinal 

 cord, a complete softening occurred entirely in agreement with the 

 experiments of P. Bert. In the second case, in which death was in- 

 stantaneous before the bubbles had advanced so far, there were 



