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November 22, 1985

Cyanide Intoxication-Reply

Author Affiliations

Cook County Hospital Chicago

JAMA. 1985;254(20):2889. doi:10.1001/jama.1985.03360200039007

In Reply.—  We appreciate Dr Wald's and Dr Goldfrank's interest in our study. The "index case" in this outbreak of cyanide intoxication was working in an active production area of the silver-reclaiming facility at the time he was stricken. Autopsy findings yielded blood and spleen cyanide levels of 3.45 and 1.90 mg/L, respectively. These values are consistent with reported fatal cases, although postmortem findings may exhibit a wide range of values.1 In this case, the Cook County Medical Examiner's Office determination of cyanide as the cause of death was indeed the basis of later successful criminal action against the owners of the facility.Environmental monitoring during active operations could not be obtained. Given the obvious imminent hazard to the workers, it would not have been ethical to continue exposure for the purpose of obtaining such samples. Since airborne cyanide levels were elevated after cessation of operations, it is likely