[From Brian Harmon]

Some time ago, I mentioned that i had a source or two
mentioning that cyanide passing thru the skin
was not a major mode of poisoning.

It took me some time, but i dug out a couple
of sources from my photocopied pile of stuff.

The first is from an article in _American Family 
Physician_, July '93, V48 n1.  on page 109:

"Cyanide is readily absorbed by the mucous membranes
and eyes.  Clinical cases of cyanide poisoning after
dermal [skin] exposure are rare and have most oten 
involved burns with molten cyanide salts or immersion
in cyanide solutions."

Not much, really, but it's something.  This quote is 
included in 
ftp://nizkor.almanac.bc.ca/pub/camps/auschwitz/cyanide/cyanide.001

Something i never noticed before, however, is the article
mentions how to clinically diagnose cyanide poisoning.

This kind of thing could be very useful in smashing the 
denier's crying foul that no one did an autopsy report
on the gassed victims.  We already know that none the
corpses were around long enough for allied doctors
to have carried out the autopsy, as the gassing stopped
months before Auschwitz fell.  We might be able to take
away there other argument by showing that clinical diagnosis
of cyanide poisoning is difficult on living people, let alone
those who have been dead for some time.


On page 110:

  Clinical Evaluation
  
    History and Physical Examination
 
      A pertinent history in a patient suspected
    of cyanide poisoning may include occupation
    and hobbies, medications, diet, smoking habits, 
    and drinking water source.  Physical examination
    of chronically exposed petition should include 
    particular attention to neuropsychiatric, 
    opthalamologic, and cardiovascular systems, as 
    well as thyroid function

      Because cyanide can kill quickly, acute poisoning
   must be rapidly treated.  Unfortunately, diagnosis is
   often difficult, especially when the history cannot be
   obtained.  Knowledge of the patient's occupation, mental
   status before poisoning, probability of suicicidal 
   intent or location at onset of symptoms can be vital in 
   making a diagnosis.

and on page 111:

   Acute Signs and Symptoms

    [without going into the details, this lists 
     ways to diagnose people who are _still alive_
     including cardiovascular signs (ST segment 
     length), breathing, etc.]

    ...Retinal  veins and arteries may appear red
    in color as cyanide blocks cellular utilization
    of oxygen, elevation venous PO2 [pressure of oxygen]

    [..] Non cardiogenic pulmonary edema may be noted 
    after cyanide inhalation or ingestion.  Because of
    increased venous PO2 and percent oxygen saturation, 
    cyanosis may be absent despite respiratory depression.
    Severe metabolic acidosis results from anearobic 
    metabolism with increased lactic acid production.

   [..]

  Laboratory Tests
     
    Direct Biological indicators
    
      _Blood Cyanide Concentration_. Laboratory analysis
    of the whole-blood cyanide concentration takes at least
    four to six hours, and theraputic interventions usually
    must be made before results are available.  However,
    determination of whole-blood cyanide levels is useful in 
    confirming and documenting the diagnosis.  One of the
    most significant problems in measuring cyanide is its
    instability in collected samples.  A laboratory should
    be consulted for proper techniques in speciment handling.

    [discussion about how much cyanide is bad deleted]

    Indirect Biological Indicators

      _Plasma or Serum Thiocyanate Level_  Cyanide in the 
    body is biotransformed into thiocyanate. [..] Thiocyanate
    can be measured in serum or plasma, but interpretation of
    levels in a cyanide-poisoned patient is difficult.  Little
    correlation has been found between simultaneously obtained
    whole-blood cyanide and plasma thiocyanate levels.  

=====

  A summary and comment:

   * Cyanide poisoning causes metabolic acidosis:
      this wouldn't be helpful, as asphyxiation also
      causes acidosis as CO2 builds in the blood.

   * Red venoous blood/higher O2 concentration in blood:
     this won't be too helpful once the victim is dead 
     and stops breathing.  Higher O2 can also be caoused
     by many other things.

   * Whole blood cyanide: Given the instability of the 
     samples, this could be duff too, but it 
     work.

   * Plasma thiocyanate levels:  Given that the victims
     died within minutes of gassing, i doubt their livers
     will have much time to change any of the cyanide to
     thiocyanate.   
      
    
  The other diagnoses mentioned only work for
  people who are still alive (dyspnea, cardiovascular
  function, disorientation, etc.)  Even still, the article
  makes no bones about it: diagnosing cyanide exposure is 
  no easy task.

  I have the whole article here, so i can photocopy and mail it
  out to you.

  -- Brian.

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