Chlorum

Volume IV — Appendix

CHLORUM.

Chlorine gas, pure or dissolved in water (Liquor Chlori).

I. Prevings.—i. Small doses of chlorine water, equal in strength to iz, were taken for 2 d. Symptoms appeared in the following order, beginning on the 2nd d. : — Weakness and languor, indisposition for mental or physical effort : later, the stomach felt as if enormously distended and fiJled with fluid j sensation as if stomach hung loosely in abdomen, and it would gurgle and shake about on motion } a dragging in epigastrium as if stomach hung too heavily and was not properly supported. About 3 a.m. on 4th d. contents of stomach were suddenly

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and forcibly ejected through mouth and nose. This was not preceded by nausea or any premonition. There followed extreme prostration and death-like nausea. Great thirst, but water would be thrown up immediately. Vertigo as though being revolved through space, turning over and over — while lying it was as if the bed were turning to the right — no position could be assumed to overcome the feeling. A dull heavy headache was followed by one with some throbbing in temples, pulse full and hard. Great prostration led to abandonment of proving. (HoNAN, North Amtr. Journ, of Horn., April, 1890.)

II. Poisonings. — I. Accidental inhalation of large quantities of chlorine. The immediate effects were of asphyxia, and 4 h. after accident, following symptoms were noted : — Intensely bright red throat, worse on r. side, with superficial blue vessels over red ground i pain in larynx aggravated by using voice ; feeling of foreign body with constant effort to extricate it by hawking — each effort, no matter how frequently made (about 15 times a m. at first), would bring up a quantity of frothy mucus that looked like beaten white of egg.

The patient is in a state of anxious excitement ; can hardly control himself, wants to relieve himself quickly or fears a serious condition will surely arise ; tries to keep still knowing that there is no real occasion for alarm, but the presentiment of impending danger continues to return, Throat and larynx feel lifeless, and yet there is some pain. The parts feel as if sprinkled with impalpable powder which prevents phonation. This condition lasted 2 d. Some pain and distress developed in chest the next d. ; he could map out the trachea and its bifurcation by the sense of soreness and rawness. [Ibid.)

1. In 1850, after submitting to the manipulations of a dentist, I was advised to wash the mouth with a solution of chlorine. Scarcdjr had the liquid been received into my mouth, when I became sensible of a spasmodic action of some part of the respiratory organs of the following character '.—Inspiration was unimpeded, and could be effected in the natural manner, but expiration was absolutely impossible, apparently from a closure of the rima glottidis. Inspiration was accordingly repeated, and was accomplished fully and easily, although the act was attended with a slight crowing noise. Expiration, which was again attempted, was impossible as before. By these successive operations the lungs became inflated to a most painful degree j but so firmly did the glottis appear to be closed, that it seemed as though air might pass through any part of the thoracic walls more readily than by way of the larynx. This arrest of respiration having endured for about a m., the face becoming turgid and livid, the spasm relaxed, and respiration became free again. (Carroll DtrNHAM, Hem. the Sc. of Thiraftutitiy p. 490.)

2. In 1852 I had the opportunity of witnessing the effect of a strong accidental inhalation of the gas by an adult. The same phenomena, of free, but crowing inspiration, and of absolutely obstructed expiration, presented themselves ; the face became extremely livid, convulsive movements of extremities began, and paticnt.became partiallj comatose. I administered ammonia by olfaction, the spasm rclaxco, and consciousness returned along with normal respiration, [fbid.)

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1. Dr. S. A. Jones accidentally inhaled the gas. An asthmatic attack immediately followed, regarding which the following notes ^were taken at the time : — At once tightness of chesty whistling-wheez- Bg cough, some dyspnoea. Dyspnoea rapidly increasing, profound fiense of impending suffocation ; cough with expectoration of thick, white, frothy mucus. Dyspnoea still increasing ; great (physical) anxiety ; inspiration easy, but not sufficient to fully inflate lungs, and attended with a short rattling-crackling rale ; expiration difficult, prolonged, and as if insufficient — as if air-cells were hardly half-emptied, it is accompanied by prolonged loud whistling rales (not one sound only but a combination of several), and each pulsation of heart gives a crtscinda-diminuendo effect to them. Constant cough, bronchi apparently filled with thick, tenacious mucus; no relief from expectoration, chest seemed to fill again at once ; when coughing he felt as if he 'Oust vomit (though there was no nausea), and warm sweat broke out on forehead. Was restless ; desired to walk about ; could not be easy either lying, sitting, or walking ; it seemed as if whole attention must oe centred on act of respiration ; cold open air gave no relief. Nose "'^charged mucus freely. There was sensation in lower third of I. Jung as if it was ruptured, as if air escaped into pleural cavity at each Il'spiration, accompanied by a rale of its own, whose vibrations could °^ felt by the hand and heard by the bystanders. All this took 2 h. *** enacting. After 2J h. chest felt sore interiorly, especially on ^^ighing \ whistling rales, which are quite loud on a forced expiration j ^^st still oppressed. Throat sore from uvula to bronchi. After 2 J h. ^^fkiration easy and noiseless, inspiration a little difficult and attended . *^h rales ; feeling as if rima glottidis were stiff — as if made of an iron '^gi cough seldom; no expectoration, but a little hoarseness; at *^h cough, a spot in chest (region of r. bronchus) feels sore, as if *-igh Jarred and hurt it. When dyspnoea was at its worst it was

J ^«nded with feeling as if a narrow band was drawn tightly around

^ *~e and voice was hoarse. (Dr. Jones is hereditarily subject to j~ "^hma i hearty laughter gives him a fit of wheezing, and a whiff f _^^^ni an ignited sulphur match entails an hour's semi-suffocation.) ^ '^^X/. r. Journ, of Horn., II, 249.)

ircr third of whole chest. For 2 d. after, throat and chest were