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      Information for Medical Officers



          Gas Warfare

          PREPARED IN THE OFFICE
          OF THE SURGEON GEN-
          ERAL, WAR DEPARTMENT
          WASHINGTON  :  : : 1917


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Washington :: Government Printing Office :: 1917 
NATIONAL LIBRARY OF MEDICINE
        Bethesda, Maryland
 
         Information  for Medical Officers

NOTES  ON   GAS  WARFARE
rT1HE subject of attack by gas  is developing in all
 J-  the services toward the greater importance of gas
projectiles.  Attack with projectiles allows of much
greater opportunity for  surprise than does the use of
cloud gas, and it is al>o becoming more important to
be on guard against projectile attacks of great inten-
sity, producing very high concentration of poisonous
gas in relatively  short divisions of the front.  Offen-
sive gas officers are working toward the  delivery of
highly  concentrated  gases  directly  upon  localities
where  relatively  large numbers  of  men are  congre-
gated.   " Direct hits " of this character must be looked
for.
            GERMAN EXPERIENCE.
  Data is at  hand relating to  the experience of the
Germans up to the end of August, 1917.  The follow-
ing from this source should prove of value to every
medical officer.
                  PROPHYLAXIS.
  Practice with the mask in order to be in readiness to
meet the attack is of great importance.

 TREATMENT AT THE AID OR DRESSING STATION.
  Rest  to the prevention of every bodily exertion is
insisted upon. The clothing is removed in order to
allow its thorough  ventilation, presuming that it  con-
tains gas. Morphine is distinctly forbidden.  Digitalis
is given intravenously.  If  the  heart's action is weak,
caffein is given subcutaneously.  Venesection  is done
on  severe  cases  up  to  200  to 600  c. c. of  blood,
126450—17
[1] 
Gas  W a r f ar e
according  to  the  degree of pulmonary  edema.  The
greater the edema  the  less blood  is drawn, because
where much edema already has appeared  the blood
has become concentrated.   The pulse also is watched
as a  guide to  the stopping of venesection.  Surgical
venesection is  done with  free exposure of the vein.
When there is great concentration of the blood and it
refuses to  flow, the  radial  artery is opened and later
ligated.
               OXYGEN INHALATION.
  Oxygen is given according to the severity of the case
for two periods of 10 minutes every hour up to four
periods of 10  minutes every hour.   At least 6 liters a
minute is given.  The breathing bag is never allowed
to become empty.

                IN  THE HOSPITAL.
  Cardiac stimulants are given, digitalis or strophan-
thus.   If time  is important, caffein and  camphor are
added.  Oxygen is given according to the requirements,
and venesection if it has not  been  done.  After this,
calcium chloride in solution is given subcutaneously in
at least four different parts of  the body.  The solution
consists of 1 per cent calcium chloride in 0.5 per cent
sodium-chloride solution.  Novocain is used to  relieve
pain,  and up to 800 c. c. of the calcium-chloride solution
is given. This drug  is believed  to be indicated in severe
cases  and strict asepsis is necessary to prevent necrosis.
  Experiments on animals  with calcium chloride ap-
parently have  proved its  value.  Of 24 treated ani-
mals,  55 per cent died; of 24 untreated animals, 88 per
cent died.  Adrenalin is encouraged  if the blood pres-
sure is low.  Atropin and artificial respiration are for-
bidden.  Small doses of  veronal and codeine are given
to relieve the cough,  and menthol and alcohol are given 
Gas   W ar f ar e
by  inhalation  to relieve pain.  Fluid must  be freely
given, possibly by enemata.

            IMPORTANCE OF DISCIPLINE.
  It is of importance to know that in the British Serv-
ice  the mask is always carried in the " alert  position "
when in the danger zone, which may be a considerable
distance behind the front line.   This is  required be-
cause of the danger from gas shells.  It is easily pos-
sible for a column of marching men to walk into an air
pocket of gas, and if the men are unprotected, casualties
will occur.  British officers state that false unconcern, a
spirit  of fear  of possible ridicule, has kept men from
putting on masks and so has caused casualties.  When
there is danger of gas, masks must he  required.

          NOTE ON  EXPERIMENTAL DATA.
  The following extract is taken from a research report
made by Yandell Henderson, engaged in investigations
under  our Gas Defense Service:
  There are  at least four ways  in which venesection probably
may influence the condition of the gassed animal—
  1. The asphyxial condition present would be improved by the
increased  hemoglobin accompanying  bleeding.
  2. The acidosis incident to gassing  probably  also would be
counteracted by bleeding because of the increased alkali  re-
serve of the blood.
  3. Bleeding would remove from the organism  in large meas-
ure  any possible toxic substances formed  as a result  of the
gassing.
  4. Bleeding would alleviate  the condition of  the pulmonary
edema.
  Experiments are being conducted  with a view to im-
provements in the treatment of gassed cases.
[3] 
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