3. Pallid or Grey Type of Asphyxia from Phosgene Poisoning, with circulatory failure
(Plate 3)
The cyanotic hue of the cars and lips, despite the general pallor caused by the failure of the circulation, indicates the intense want of oxygen from which the patient is suffering.
History of the case. Drawing made on second day after exposure, when there was profuse frothy expectoration, hurried shallow breathing of 50 a minute and a rapid running pulse of 132. The patient died two hours later.
This pallid or leaden-hued type of asphyxia is characteristically frequent after phosgene poisoning, and it may either develop at once with a rapidly progressive failure of the circulation or follow a stage of venous congestion.
The patient is restless, often semi-delirious, and his skin may be dry and hot, or cold in the final collapse, though it is not often damp with perspiration. The hurrying small pulse and the panting rapid shallow breathing, often with sounds of fluid in the trachea, are both characteristic. Examination of the chest finds physical signs very similar to those of the blue congested type, a little dullness on percussion and numerous fine rales and rhonchi, especially in the axillae and over the back. In both cases the intensity of the pulmonary oedema is hidden from physical examination by the presence everywhere in the lungs of scattered islets of emphysema.