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January 28, 1922


Author Affiliations

Ensley, Birmingham, Ala.

JAMA. 1922;78(4):280. doi:10.1001/jama.1922.26410570002012c

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Nellie M., aged 3 years, had her shoes dyed at 5 o'clock in the afternoon. At 8 the same evening, the mother noticed some blueness of the lips, and at 8: 30, when I saw her, her appearance was alarming; the face and hands were very pale, and the lips and finger nails markedly cyanotic. The child was irritable and behaved as if tired. The pulse was 134, heart action regular but agitated, and there was a systolic murmur, heard all over the precordium. The temperature apparently was not elevated, and there were no respiratory or gastro-intestinal symptoms. The eyes, mouth and throat were negative except for cyanosis of the lips and tongue. During examination, the odor from the freshly dyed shoes was very noticeable. With fresh air and rest in bed during the night, the cyanosis gradually cleared up, and the next morning the appearance and condition of the