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September 28, 1970

Bullous Skin Lesions in Barbiturate Overdosage and Carbon Monoxide Poisoning

Author Affiliations

New York city

JAMA. 1970;213(13):2271. doi:10.1001/jama.1970.03170390061020

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To the Editor.—  Mandy and Ackerman (213:253,1970) noted a lack of recognition in the United States of bullous skin lesions in persons with drug- or carbon-monoxide-induced coma. The authors overlooked the excellent description and photographs of these lesions in Legal Medicine: Pathology and Toxicology by Gonzales et al (New York, Appleton-Century-Crofts, 1954), and similar descriptions in other forensic pathology texts. Gonzales et al in this leading text attributed the lesions to hypoxia and pressure as have Doctors Mandy and Ackerman in their recent article.Unfortunately, in this country there is such great separation between the many physicians who study natural disease and death (at medical centers) and the few who study unnatural death (in medical examiners offices) that much knowledge obtained from investigation of death due to drugs, carbon monoxide, suicide, accidents, battered children, lead poisoning, etc, is not known to the medical community at large. This failing is