Noxious Gases and Bronchiectasis

The effects of repeated exposures to varying concentrations of mustard gas as reflected in the bronchial tree are described, based upon observation of one hundred forty-four patients who were employed in a gas shell loading plant. It may reasonably be assumed that similar changes in the bronchi will be observed as a result of chemical burns due to other agents such as concentrated ammonia fumes, slack lime, etc., as encountered in industrial work.

It is shown that forty-six of one hundred forty-four patients have developed a definite moderately or far advanced bronchiectasis. An additional forty-one patients exhibit a minimal bronchiectasis. In combination with minimal bronchiectasis, or as the only demonstrable anatomical change, bronchitis was demonstrated in sixty-four patients. Asthmatic bronchitis associated with hypertrophic bronchitis or atrophic bronchitis was found in forty patients. Eleven patients had advanced bilateral pulmonary emphysema.

The treatment applied to all cases consisted of a bronchial drainage routine including ammonium chloride, 15 grains four times a day, postural drainage with forced coughing for two or three minutes four times a day, a high fluid intake and abstinence from smoking. Removal from contact with mustard gas was likewise recommended. Patients with asthmatic symptoms were benefited by supplemental use of Tedral (theophylline, ephedrine and phenobarbital) as a "bronchial relaxing" agent. Penicillin therapy by injection and by inhalation has been more recently used by those patients with marked secondary infection in the bronchial tree.

The majority of patients faithfully following this routine have been able to work at sedentary occupations which do not require heavy physical exertion. The emphysema patients are totally disabled.

As yet no pulmonary resection has been carried out in this group because of the progressive character of the pathology observed.

A review of this group of patients five years from now will be of extreme interest and help in evaluating disability following exposure to noxious fumes and chemical agents.