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
_History of the case._ The casualty was caused by the bursting of a
Yellow Cross shell close to the man when he was riding a restive mule,
and his box respirator was momentarily displaced. A fine spray of the
liquid must have splashed lightly over his right side, for cutaneous
blisters developed on the neck, the cheek, and the forehead on this side
only. The right eye showed serious burning with the central white band,
while the left eye was only in the state of general red conjunctivitis.
With the lowering of the nutrition of the corneal epithelium, secondary
infection is liable to take place. In this case an infiltrated corneal
ulcer is seen associated with a hypopyon. It is therefore important when
there is conjunctival discharge, which indicates secondary infection,
that in addition to the use of atropine the conjunctival sac should be
cleansed by frequent bland irrigations and by the instillation of
antiseptic drops so as to check infection of any corneal ulceration
which may develop. Otherwise the infective progress which has led to
hypopyon may progress till panophthalmitis supervenes.
PLATE NO. XIIA
Stage of resolution after severe burning.
The vascular injection is passing off, the solid oedema is becoming
absorbed, and the corneal epithelium has regained its normal lustre. In
this stage the use of atropine should be discontinued.
PLATE NO. XIIB
Late stage of resolution.
The earlier vascular injection above and below the cornea has
practically disappeared; the solid white oedema has been absorbed, and
the conjunctiva in the palpebral aperture now shows definite injection,
often of a bright violet tint. The entire picture has changed, so that
the parts which were red in the acute stage are now white and the part
which was formerly white is now red. This drawing would illustrate
equally well the condition that may follow immediately on a very slight
exposure to the irritant gas, when only a slight central band of red
injection develops instead of the bloodless state of white oedema that
is caused by the more severe burns.
At this stage atropine and shades should be abandoned. Astringent drops
should be instilled and photophobia combated with cold douching, &c.,
while fresh air and occupation will help to restore the general health
of the individual and mitigate any tendency to neurasthenia.
[Illustration: PLATE XII.]
PLATE NO. XIIIA
Drawing of the cornea in the acute stage of severe burning.
This corresponds with Plate No. XIA. The exposed central area shows grey
haze and loss of lustre on its stippled surface, which gradually fades
off to the bright lustrous normal surface in the part above that has
been protected by the eyelid. Injection of the conjunctival vessels is
seen only in relation to this upper and less burned area.
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