PLATE NO. II Blue type of asphyxia from phosgene poisoning, with intense venous congestion.

History of case. Drawing made early on second day after gassing; when there was copious frothy sputum, frequent cough, and hurried shallow respiration of 40 to 48 with temperature of 101° and pulse 100. The patient was bled 15 ozs. and oxygen added to the air that he breathed. He soon made a complete recovery.

Such venous congestion was more frequent with chlorine poisoning than it now is with phosgene. It is associated with a full strong pulse at the outset, though later the pulse may fail and the asphyxia change to the pallid type shown in Plate III. The patient as a rule is fully conscious and complains chiefly of headache and pains in the chest; he turns restlessly to and fro in extreme general discomfort, and his hurried breathing is interrupted from time to time by short bursts of coughing and of expectoration. The lung is in the oedematous state shown in Plate I.

Oxygen, when given by an efficient apparatus, will at once change the blue tint of the face to a full pink colour, showing that it can still be absorbed by the blood through the lungs. Venesection relieves the discomfort felt by the patient, and probably lessens the embarrassment of the circulation.

Plate II.