A STUDY OF THE RESIDUAL EFFECTS OF PHOSGENE POISONING IN HUMAN SUBJECTS. I. AFTER ACUTE EXPOSURE

Abstract

Clinical and psychiatric observations and detailed studies of respiration and circulation were carried out in 6 patients, 3-14 mos. after accidental acute exposure to phosgene, which in 4 patients resulted in acute pulmonary edema and emphysema. After 3 wks. following exposure, physical examination and roent-genograms revealed no definite evidence of disease of the lungs but the patients complained of symptoms like those reported in phosgene casualties during World War I. The most impressive and persistent feature of the physical examination was rapid, shallow breathing, previously described by Haldane et al. This pattern of respiration was present at rest and during exercise and sleep, could be voluntarily controlled, and was not altered by breathing pure O2. There was no limitation of breath-holding ability. They did not exhibit any disturbances jn pattern of respiration characteristic of respiratory neuroses. The studies of pulmonary function revealed a number of borderline changes and frank abnormalities in lung volume, intra-pulmonary mixing of gases, voluntary breathing capacity, and transfer of O2 to the arterial blood. Exercise to the point of dyspnea and then maintained for 1/2 tain, did not produce anoxemia in any of the patients, and actually abolished the anoxemia observed in 1 patient at rest. There was no tendency to polycythemia. Some abnormality was observed in every patient but there was no consistent pattern. Circulatory studies indicated no instability of vascular control, no abnormality of configuration of ballistocardiographic pattern, and a moderate reduction in cardiac output (ballistocardio-gram) in 1 patient. Symptoms were quite uniform in type, but their severity and the ensuing disability were much more closely related to the patient''s psychological reaction than to any demonstrable physical or physiological abnormality.