Observations on 685 Cases of Poisoning by Noxious Gases Used by the Enemy

Abstract

THE following notes are founded on observations on 685 cases of gas poisoning which came under treatment in a casualty clearing station between May 2nd and May 7tl, 1915. The patients were brought in by motor ambulance convoys from the field ambulances-a journey of about ten miles. Some arrived only six lhours after being "gassed," wlhile in other cases a muclh longer period had elapsed before ;they were brought in." Tiley were detained in tlle casualty clearing station only until they were deemed fit to evacuate to the base. The slighter cases were sent down at the earliest possible moment, the mlajority were evacuated within forty-eiglht hours, while Fourteen men died out of the first batch of seventeen admitted.Among the hundreds of cases subsequently observed, all degrees of asphyxia were evident, and it is difficult to convey a composite clinical picture of all of these. Certain common features, however, stood out so prominently that our purpose will be served by calling attention to them.Certain of these have been alluded to already.The typical case was on admission cold, with a subnormal temperature, conscious but restless, the pulse slow and full (except in the collapsed cases). The face was cyanosed, intensely so in many cases, and tlle expression was strained and anxious. Nearly all the cases on admission were in the first or asphyxial stage, whiclh lhas just been described. This condition demanded immediate and energetic treatment, and was that whiclh chiefly occupied us at the casualty clearing station. Grave symptoms appeared with startling suddenness, but if patients could be safely brouglht through this stage, recovery was tlle rule.The first stage gradually passed off after some thirty-six hours, and the patient fell into a sleep from which he woke feeling muclh better. He continued in this state for perhaps lhalf a day, and during this period every effort was made to evacuate hiim safely to tlle base.After these few 1oULrs of comparative quiet, symptoms of bronchitis began to manifest themselves. In the majority of cases, as far as our experience went, these were not severe. In the cases, however, which had been kept alive with difficulty there was a very short quiescent stage, followed by intense bronchitis. Four of the most severe cases died in this bronchitic stage. Their sym. ptoms, as compared with the first stage, were as follows : 'rlie frothing secretion gave way to thick greenish mucopurulent expectoration, consciousness was replaced by delirium, temperature rose from subnormal up to -1040 F., and the pulse became of small volume, white its rate increased to perhaps 160. Respirations were less choking, but more shallow, and numbered up to 70 per minute before death. TREATMENT.As po8t-mortemn examination showed that the patients died of acute congestion and oedema of the lungs, the aim of our treatment was:1. To expel the excessive secretion from the lungs by emetics and stimulating expectorants.

Terror Weapons: The British Experience of Gas and Its Treatment in the First World War

“…Few had any knowledge of how to treat the toxin, and medicine could offer little to counteract severe pulmonary damage. 100 As a result, military physicians took an exceptionally precautionary approach to any case of poisoning. Great emphasis was placed on rest, and Sir Arthur Sloggett, the director general of army medical services, ordered that for a minimum of two days 'no casualty should be allowed to leave his bed or stretcher for any purpose whatever'.…”

Medical planning for toxic releases into the community: the example of chlorine gas.

“…Typically these will be establishments dealing with the old, the very young, and those with chronic respiratory disorders who may respond adversely to concentrations in the [3][4][5][6][7][8][9][10][11][12][13][14][15] On the other hand, in the event of thousands of victims (a result more commonly produced by natural rather than manmade disasters-but one which is not unknown with chemical major accidents-for instance, Bhopal) the goal of rapid and effective treatment for all may be unattainable and the emergency planning has to be more akin to that for battle casualties. Where there are overwhelming numbers of injured, or inadequate treatment facilities, the severely ill who are obviously beyond the scope of medical care will need to be separated from those urgent cases which could benefit from treatment in the field or in the limited hospital facilities available.…”

Cross-sectional assessment of workers with repeated exposure to chlorine over a three year period

“…The health effects of inhalational chlorine toxicity were initially described during and after World War I [1,2]. After a single acute exposure, conjunctival and nasal irritation, acute pneumonitis, pulmonary oedema and transient bronchospasm can occur, as reviewed by DAS and BLANC [3].…”