POISON-GAS FROM THE AIR
1
856 ANNOTATIONS POISON-GAS FROM THE AIR WHATEVER else remains undone, there need be no doubt that the possibility of improving the administra- tion of poison-gas is being studied. Medical journals abroad lay increasing emphasis on the desirability of practitioners familiarising themselves with the methods of chemical warfare, and there is nowadays a wealth of information about the various agents and their use. It appears to be generally thought that these do not as yet include any that differ essentially from those employed in the late war. These accepted forms of poison may be divided into (1) lacrymatory gases, chiefly used by non-military forces during civil commotion (white cross group); (2) lung poisons such as chlorine and phosgene (green cross); (3) arsenical smokes ("mask removers " or blue cross); and (4) vesicants such as mustard gas (dichlorethyl sulphide) and lewisite (yellow cross). A grim mnemonic of the Germans suggests a way of remembering the different effects of these groups. i White cross reddens the whites of the eyes. Green cross turns the lungs a putrid green. Blue cross makes the nose blueish red. Yellow cross turns the skin pale yellow. The green cross group can be neutralised by efficient chemical respirators and the arsenical smokes by mechanical respirators. As far as aerial attack is concerned it is the yellow cross or vesicants which are much the greatest danger since they are liquids which could be dropped from the air either as a rain or in bombs and which volatilise into a heavy vapour which might " drown " a town or area for some days. Masks are essential for protection from the vapour and special protective clothing is necessary against the spray of liquid. The essence of treatment is to remove all traces of the liquid from the patient’s skin and clothing while protecting his eyes and air-passages from the vapour. Speed and early treatment are very important, and with these ends in view a chemical warfare treatment unit has been designed by Captain F. A. Wells of the medical department of the United States Army.2 Two technicians of the Medical Corps, wearing impregnated clothing and head-pieces, gas masks, and rubber gloves, strip the patient (who must himself wear a mask)and scrub him with hand brushes irrigated with soda bicarbonate solution running from a Lyster bag suspended from the tent pole. Other solutions which may be used are bleaching-powder, soft soap, peroxide of hydrogen, or permanganate of potash.3 It is claimed that a " mustard " casualty can be cleansed by these methods in about two minutes. Such a result is attained, however, only with special equipment and trained personnel. Hence if it is true, as recently stated in the press, that as iittle as forty tons of gas would be needed to cover London with a layer of vesicant gas and that such a layer might be " canalised " by the Thames Valley and remain undispersed for five days or more, it is not impossible that the population of London could be exterminated or at any rate put out of action with comparative ease. This is, of course, disputed: e there are authorities who think that such dangers are in practice small. One thing, however, is certain. A national scheme of anti-gas defence, to be effective, would have to include the provision and distribution of masks suitable for protection against any kind of 1 Med. Welt, March 17th, 1934, p. 382. 2 Milit. Surg., February, 1934, p. 76. 3 THE LANCET, 1932, ii., 1013. gas likely to be used, and the thorough training of the public in their employment, and in other anti-gas measures. The realisation of such a scheme, with all its implications, hardly seems to be called for under present conditions. On the contrary, it would be actively objectionable, since any further spread of anti-gas drill habits must inevitably heighten the general sense of insecurity. ULTRA-VIOLET RADIATION FOR ERYSIPELAS IN CHILDREN THE fatality of erysipelas in children, especially in infants, is still uncomfortably high although it has been reduced by the prompt use of serum. Better results have however been claimed for ultra-violet radiation, and a recent paper 1 by Dr. L. M. Night. ingale and Dr. S. Starr, of Brooklyn, gives grounds for this belief. They have treated 51 children under twelve in this way and of these 23 were infants under one year of age. The routine employed was to give three applications of one and a half erythema doses on successive days, regardless of the clinical course. The lamp was set at a distance of ten inches and the rays were directed over an area extending one to two inches beyond the spreading border. If the area could be exposed only from two directions, over- lapping was permitted. No ill-results were seen from the radiation in the whole series. In many of the infants, early in the work, blood transfusion was also performed, but no particular benefit was observed and it was discontinued. Similarly early in the series serum was used in addition to the ultra-violet radia- tion for a few patients but later the latter was alone used. The results obtained were compared with those in 130 children with erysipelas treated by serum alone, by local treatment, by X rays, or by combina- tions of these. Some of the groups were too small to be of value for discussion, but a broad comparison with the serum-treated and the radiation-treated cases brings out certain points. Over one year of age 47 cases received serum with a total mortality of 6-4 per cent., while 28 cases received ultra-violet radiation with a total mortality of 7-1 per -cent. Under one year the respective mortalities were 59.3 and 39 per cent. The authors point out, however, that death in certain instances was not due to erysipelas but to some complicating factor such as pneumonia or mastoiditis. For example, one child was admitted with erysipelas and pneumonia. Clini- cally the erysipelas cleared in five days but the child died four days later of the pneumonia. Correcting the mortality-rates on these lines they claim that under one year of age ultra-violet radiation treatment gave a total recovery-rate of nearly 70 per cent. as compared with just over 50 per cent. for serum treatment. For the older children 2 cases out of 47 died from erysipelas after serum treatment and 1 out of 28 after ultra-violet radiation. There was considerable difference in the length of illness in the two groups, especially for infants where the average duration was only half in the ultra-violet treated cases of what it was in those receiving serum. Where treatment was instituted early the differences both in mortality and in length of illness were even more striking, and the number of complications was in general less in the irradiated cases than in those treated by serum. Of special interest is the youngest child in the series. This was a premature infant, 1 Jour. Amer. Med. Assoc., March 10th, p. 761.
Transcript of POISON-GAS FROM THE AIR
856
ANNOTATIONS
POISON-GAS FROM THE AIR
WHATEVER else remains undone, there need be nodoubt that the possibility of improving the administra-tion of poison-gas is being studied. Medical journalsabroad lay increasing emphasis on the desirability ofpractitioners familiarising themselves with the methodsof chemical warfare, and there is nowadays a wealthof information about the various agents and theiruse. It appears to be generally thought that thesedo not as yet include any that differ essentially fromthose employed in the late war. These acceptedforms of poison may be divided into (1) lacrymatorygases, chiefly used by non-military forces during civilcommotion (white cross group); (2) lung poisons suchas chlorine and phosgene (green cross); (3) arsenicalsmokes ("mask removers " or blue cross); and(4) vesicants such as mustard gas (dichlorethylsulphide) and lewisite (yellow cross). A grim mnemonicof the Germans suggests a way of remembering thedifferent effects of these groups. i
White cross reddens the whites of the eyes.Green cross turns the lungs a putrid green.Blue cross makes the nose blueish red.Yellow cross turns the skin pale yellow.
The green cross group can be neutralised by efficientchemical respirators and the arsenical smokes bymechanical respirators. As far as aerial attack isconcerned it is the yellow cross or vesicants which aremuch the greatest danger since they are liquidswhich could be dropped from the air either as a rainor in bombs and which volatilise into a heavy vapourwhich might " drown " a town or area for some days.Masks are essential for protection from the vapourand special protective clothing is necessary againstthe spray of liquid. The essence of treatment is toremove all traces of the liquid from the patient’s skinand clothing while protecting his eyes and air-passagesfrom the vapour. Speed and early treatment arevery important, and with these ends in view a chemicalwarfare treatment unit has been designed by CaptainF. A. Wells of the medical department of the UnitedStates Army.2 Two technicians of the Medical Corps,wearing impregnated clothing and head-pieces, gasmasks, and rubber gloves, strip the patient (who musthimself wear a mask)and scrub him with hand brushesirrigated with soda bicarbonate solution running froma Lyster bag suspended from the tent pole. Othersolutions which may be used are bleaching-powder,soft soap, peroxide of hydrogen, or permanganate ofpotash.3 It is claimed that a " mustard " casualtycan be cleansed by these methods in about twominutes. Such a result is attained, however, onlywith special equipment and trained personnel. Henceif it is true, as recently stated in the press, that asiittle as forty tons of gas would be needed to coverLondon with a layer of vesicant gas and that such alayer might be " canalised
" by the Thames Valleyand remain undispersed for five days or more, it isnot impossible that the population of London could beexterminated or at any rate put out of action withcomparative ease. This is, of course, disputed: ethere are authorities who think that such dangers arein practice small. One thing, however, is certain.A national scheme of anti-gas defence, to be effective,would have to include the provision and distributionof masks suitable for protection against any kind of
1 Med. Welt, March 17th, 1934, p. 382.2 Milit. Surg., February, 1934, p. 76.
3 THE LANCET, 1932, ii., 1013.
gas likely to be used, and the thorough training ofthe public in their employment, and in other anti-gasmeasures. The realisation of such a scheme, with allits implications, hardly seems to be called for underpresent conditions. On the contrary, it would beactively objectionable, since any further spread ofanti-gas drill habits must inevitably heighten the
general sense of insecurity.
ULTRA-VIOLET RADIATION FOR ERYSIPELASIN CHILDREN
THE fatality of erysipelas in children, especially ininfants, is still uncomfortably high although it hasbeen reduced by the prompt use of serum. Betterresults have however been claimed for ultra-violetradiation, and a recent paper 1 by Dr. L. M. Night.ingale and Dr. S. Starr, of Brooklyn, gives groundsfor this belief. They have treated 51 children undertwelve in this way and of these 23 were infants underone year of age. The routine employed was to givethree applications of one and a half erythema doseson successive days, regardless of the clinical course.The lamp was set at a distance of ten inches and therays were directed over an area extending one to twoinches beyond the spreading border. If the area
could be exposed only from two directions, over-
lapping was permitted. No ill-results were seen
from the radiation in the whole series. In many ofthe infants, early in the work, blood transfusion wasalso performed, but no particular benefit was observedand it was discontinued. Similarly early in the seriesserum was used in addition to the ultra-violet radia-tion for a few patients but later the latter was aloneused. The results obtained were compared withthose in 130 children with erysipelas treated by serumalone, by local treatment, by X rays, or by combina-tions of these. Some of the groups were too small tobe of value for discussion, but a broad comparisonwith the serum-treated and the radiation-treatedcases brings out certain points. Over one year ofage 47 cases received serum with a total mortality of6-4 per cent., while 28 cases received ultra-violetradiation with a total mortality of 7-1 per -cent.Under one year the respective mortalities were 59.3and 39 per cent. The authors point out, however,that death in certain instances was not due to
erysipelas but to some complicating factor such aspneumonia or mastoiditis. For example, one childwas admitted with erysipelas and pneumonia. Clini-cally the erysipelas cleared in five days but the childdied four days later of the pneumonia. Correctingthe mortality-rates on these lines they claim thatunder one year of age ultra-violet radiation treatment
gave a total recovery-rate of nearly 70 per cent. ascompared with just over 50 per cent. for serumtreatment. For the older children 2 cases out of47 died from erysipelas after serum treatment and1 out of 28 after ultra-violet radiation. There wasconsiderable difference in the length of illness in thetwo groups, especially for infants where the averageduration was only half in the ultra-violet treatedcases of what it was in those receiving serum. Wheretreatment was instituted early the differences bothin mortality and in length of illness were even morestriking, and the number of complications was ingeneral less in the irradiated cases than in thosetreated by serum. Of special interest is the youngestchild in the series. This was a premature infant,
1 Jour. Amer. Med. Assoc., March 10th, p. 761.
