Part 1

For official use only

MEDICAL RESEARCH COMMITTEE

AN ATLAS OF GAS POISONING

1918

The Medical Research Committee have made the necessary arrangements for the preparation and reproduction of the drawings shown in this Atlas. The Atlas is printed for distribution in size uniform with the series of Reports issued by the Chemical Warfare Medical Committee with the sanction of the Director-General A.M.S. and of the Controller of the Chemical Warfare Department, Ministry of Munitions. The arrangements have been facilitated by the co-operation of the American Red Cross Society, who have undertaken to provide part of the present issue of this Atlas for official distribution in the American Army Medical Service.

The following Reports of the Chemical Warfare Medical Committee have already been issued:

No. 1. Notes on the Pathology and Treatment of the Effects of Pulmonary Irritant Gases. (March, 1918.)

No. 2. The Histological Effects produced by Gas Poisoning and their Significance. (April, 1918.)

No. 3. The Symptoms and Treatment of the Late Effects of Gas Poisoning. (April, 1918.)

No. 4. Polycythæmia after Gas Poisoning and the Effect of Oxygen Administration in the Treatment of Chronic Cases. (April, 1918.)

No. 5. The Reflex Restriction of Respiration after Gas Poisoning. (April, 1918.)

No. 6. Investigations into the Reaction of the Blood after Gas Poisoning, and the Results of the Administration of Saline and other Substances. The Effects of Bleeding and of the Injection of Calcium Chloride. (April, 1918.)

No. 7. Changes observed in the Heart and Circulation and the general After-Effects of Irritant Gas Poisoning. (April, 1918.)

No. 8. Reports on Fatal Cases of Poisoning. (i.) Ethyl iodoacetate. (June, 1918).

AN ATLAS

GAS POISONING

These drawings have been reproduced by the permission of the Director-General of Medical Services, B. E. F., and they are presented as a supplement to the official memoranda on the Nature and Treatment of Gas Poisoning that have already been issued by General Headquarters to Medical Officers.

The drawings illustrate only the chief features in the pathology of the lesions produced by Enemy Gas, and the primary aim of their distribution is that of general instruction for Officers who are not already familiar with the subject by experience in the field.

The copyright of all these drawings is reserved and the contents of the Atlas must be regarded as confidential and not to be communicated to the press.

B. E. F. FRANCE. AUGUST 1, 1918.

Out of all the various substances used by the Enemy in Gas Warfare only two have been chosen for illustration of their effects in this Atlas. They are Phosgene (COCl{2}), and Di-chlorethyl-sulphide, (C{2}H{4}Cl){2}S, or ‘Mustard Gas’.

=Phosgene= is the chief of all the many gasses and liquids that are used for their effects as pulmonary irritants. Chlorine belongs to this group and was the first Poison Gas used by the Germans in April 1915, but it has long since been superseded by more effective chemical substances. The pulmonary irritants are inhaled as gasses or vapours. They may cause some watering of the eyes, but the chief effect noticed at once is a catching of the breath or a choking sensation so that the chest feels gripped and incapable of free respiration. Coughing and vomiting may follow, and then after a delay of time varying from a few minutes to several hours an inflammatory reaction appears in the lungs themselves, with the development of an acute oedema that may commence insidiously and yet progress so rapidly as soon to be an immediate menace to life itself.

The alveoli fill with oedema fluid, which then rises into the bronchial tubes and may appear in a most abundant expectoration of thin frothy fluid. Aeration of the blood is seriously interfered with, because the air sacs are either drowned with oedema fluid or burst by the efforts of coughing. Moreover the actual circulation through the lungs is embarrassed, both by the pressure of the oedema fluid on the capillary vessels and by the local thrombosis that occurs in many places in the smaller lung vessels. The blood itself is concentrated by the loss of serum so that the count may rise to even eight or nine million red corpuscles to the cu. mm. and this change probably adds to the difficulties of the circulation.

The gassed man can no longer get the oxygen that he wants, and he either dies in obvious asphyxia with progressive circulatory failure, or he collapses as the result of some muscular effort that suddenly makes a greater call for oxygen and so reveals the deficiency of the supply. Death is the result simply of this inflammatory oedema of the lung, and it occurs chiefly in the first and second day after exposure to Phosgene. A few cases may chance to develop secondary bacterial infections of the lungs and to succumb to a later broncho-pneumonia, but they are relatively rare.

The main clinical features of acute Phosgene poisoning may therefore be summarized as follows:

(i) Catching of the breath, choking, and coughing immediately on exposure to the gas.

(ii) Inability to expand the chest in a full breath after removal from the poisoned air.

(iii) Vomiting, hurried shallow respiration, and sometimes coughing with an abundant expectoration, follow. Pain is felt behind the sternum and across the lower part of the chest. Fine râles are heard in the axillae and over the back.