An atlas of gas poisoningGreat Britain. Medical Research Committee
History
An atlas of gas poisoning
Great Britain. Medical Research Committee
Gases, Asphyxiating and poisonous -- War use
If the patient lives, his bronchial mucous membrane is slowly
regenerated; and during this time he is naturally subject to reflex
spasms of coughing or even to a protracted bronchitis.
[Illustration: PLATE X.]
PLATE NO. XIA
Severely burned eye in the acute stage.
Early in the second day after exposure to mustard gas vapour the eyelids
and the external surface of the globe show an intense inflammatory
reaction. Tears stream from between the closed oedematous eyelids, which
may even be blistered, and there is often severe pain behind the eyes
and in the forehead. The conjunctiva is swollen, oedematous, and bright
red from injection of the blood vessels. The injury of the cornea, even
when severe, is not so obvious, and careful examination is of great
importance for its detection. Photophobia and blepharospasm render
examination of the eye very difficult.
The majority of gassed eyes exhibit inflammation of a general character
that is not illustrated in this Atlas. But examples are continually
occurring in which the eye is more severely burned, and these may be
recognized by certain characteristic features that are depicted in the
drawing, Plate No. XIA. Whenever a dead white band crosses the exposed
area of the conjunctiva, while the parts of this membrane covered by the
upper and lower lids are red and oedematous, serious injury from the
burning is likely to have occurred.
In the case illustrated, the caustic effect of the vapour is seen
chiefly in the interpalpebral aperture. On each side of the cornea there
is a dead white band due to coagulative oedema, which compresses the
vessels, impairs the circulation, and thus acts as a menace to the
nutrition of the cornea. The swelling in the region of this white band
is slight, while the protected conjunctiva above and below it is greatly
swollen and injected and may even bulge between the lids.
The exposed portion of the cornea is grey and hazy; it has lost its
lustre, and when viewed with a bright light and a magnifying glass it
shows a blurred ‘window reflex’ and a typical ‘orange-skinned’ surface.
The haze gradually fades off above in the region of the protected part
of the cornea where the surface is usually bright and smooth. The pupil
is at first contracted as the result of irritation and congestion. In
this drawing it is shown as artificially dilated by atropine ointment,
which should always be used early in severe cases or where there is much
pain and blepharospasm.
PLATE NO. XIB
Slightly later stage of acute burning.
The swelling in the conjunctiva above and below has subsided, but the
vascular injection remains, and the solid white oedema in the palpebral
aperture is still well marked. The cornea is grey in the exposed area.
[_For_ History of the case _see page facing Plate XII_.
[Illustration: PLATE XI.]
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