Medical manual of chemical warfare, 1943 / War Office.

  • Great Britain. War Office.
Date:
1943
Catalogue details

Licence: Public Domain Mark

Credit: Medical manual of chemical warfare, 1943 / War Office. Source: Wellcome Collection.

    34/100 (page 34)
    The milder case is often drowsy and soon falls into a sleep from which he wakes refreshed. Coughing upon a deep breath, occasional vomiting after food or drink and a slight sense of rawness in the throat, together with general debility, may persist for a few days, after which the patient becomes convales- cent. During the early days of convalescence there is often a considerable slowing of the pulse from vagus action, which may bring it down to about 50 or even 45 in the minute. Such early bradycardia is often seen also in recovery from severe poisoning; it has no serious import, but is rather a sign that the patient is beginning to convalesce. Cases of severer cyanosis, if the depth of the reddish-blue colour is well maintained and the pulse does not exceed 100, tend to recover in two or three days, and their recovery is generally similar to that of the milder cases. Pro- vided that the circulation and the activity of the respiratory centre can be maintained, the cedematous fluid in the lungs is soon absorbed, most of it vanishing by.the fourth or fifth day. At any time, however, particularly if subjected to much physical effort, these cases may rapidly pass into the most dangerous condition of ‘“‘ grey’”’ cyanosis and collapse. The pulse becomes rapid, thready and irregular. The patient, though obviously weaker, becomes more restless and slightly wandering in mind, or semi-comatose. Even the worst of the “ grey ’’ cases may recover with proper treatment, but the mortality among them is always distressingly high. Recovery from this state of depressed circulation may be succeeded by broncho-pneumonia. When this infective complication develops, the sputum becomes purulent and the temperature rises. Death may follow rapidly. In 81 per cent. of deaths due to poisoning by phosgene and“chlorine the death occurred within 24 hours. (2) Acute cases with insidious onset Cases have been frequently reported in which men who have been exposed to gas have been able to carry on their work for an hour or two with only trivial discomfort, and even to march from their trenches to their billets, and then have become rapidly worse, with collapse and progressive oedema of the lungs. At other times men who have passed through a gas attack and have complained of only slight cough, nausea, and tightness of the chest, have collapsed and even died abruptly some hours later on making some vigorous muscular effort. A minor degree of the same effect has sometimes been shown when men who have been slightly gassed found on trying to walk down from the trenches that they got unusually “‘ done in”’ and breathless, and were obliged to rest frequently. In these cases the deficiency of oxygen, the result probably of pulmonary cedema already developing, has not been felt until muscular exertion increased the need for oxygen. This delay in the onset of serious symptoms is a striking feature in poisoning by the lung irritant gases, especially phosgene and diphosgene. It is not so evident in cases of poisoning by chlorine or chloropicrin when the violent paroxysms of coughing, the painful dyspnoea, and the vomiting convey the impression that the patient is seriously ill from the start. 42. Chest signs in lung irritant poisoning. The percussion note may remain resonant over the chest, notwithstanding the existence of pulmonary oedema. The breath sounds are weakened, especially over the back ; they may also be harsh in character, but never tubular. Fine rales are heard, chiefly in the axillary region and at the back and sides of the chest, while rhonchi may be noted occasionally. , In the early acute stage the chest signs give little indication of the gravity of the case or the extent of the damage to the lungs. The colour, the pulse and