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Longton1971

What might cause oedema of the lungs

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Longton1971

I have a case of a North Staffordshire Regiment officer who died as a POW in German hands on 22 April 1918 after his capture in the Essling redoubt  near Maissemy on 21 March 1918.  His ICRC card shows that he died of oedema of the lungs and a wound to his chin.  Would I be right in thinking that his lung problem was the result of him being gassed?  Was the gas used likely to be phosgene or mustard?

Richard

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seaJane

Heart problems and pneumonia can also cause oedema of the lungs. The gas most likely to do so would be phosgene, whose effects were not instantaneous.

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Longton1971

That's great.  Thanks.  The Germans did use gas in their assault on the redoubt but I wasn't sure how long afterwards death could occur.  Lt. H.V. Tattersall died in Germany and is now buried in Berlin.  He was the officer i/c the redoubt with A coy 1 North Staffordshire Regiment.

Richard

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seaJane

Phosgene could have a delayed effects of up to 48 hours, I believe - unlike chlorine it didn't make you cough, so more of it was inhaled.

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Stoppage Drill

Blast.

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PhilB

I think the medics on the forum will agree that dying of oedema of the lungs would be a particularly unpleasant way to go. These days I imagine that diuretics and oxygen would be palliative but, in those days, would relief be available?

Edited by PhilB

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Dai Bach y Sowldiwr
1 hour ago, PhilB said:

I think the medics on the forum will agree that dying of oedema of the lungs would be a particularly unpleasant way to go. These days I imagine that diuretics and oxygen would be palliative but, in those days, would relief be available?

Yes, but not particularly high tech.

Morphine has  a dual effect on pulmonary oedema.

It is a vasodilator (opens up the blood vessels in the peripheries) which causes pooling of blood in the peripheries rather than the lungs.

It also is an anxiolytic, reducing much of the anxiety associated with breathlessness.

 

Whether morphine was ever in widespread use at the time for treating pulmonary oedema amongst military casualties, , I very much doubt, particularly in POW camps.

Edited by Dai Bach y Sowldiwr

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Garylewis
17 hours ago, Longton1971 said:

I have a case of a North Staffordshire Regiment officer who died as a POW in German hands on 22 April 1918 after his capture in the Essling redoubt  near Maissemy on 21 March 1918.  His ICRC card shows that he died of oedema of the lungs and a wound to his chin.  Would I be right in thinking that his lung problem was the result of him being gassed?  Was the gas used likely to be phosgene or mustard?

Richard

Very likely to have been pneumonia gassing would have damaged the lungs Remember also particularly POW in Germany would have late in the war been on starvation rations 

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Terry_Reeves

Richard

 

I think you need to be careful about attributing such deaths to gas poisoning. Lt Col CG Douglas RAMC  served as a medical officer with the Special Brigade, a physiologist with the Central Laboratory at Hesdin and eventually as Physiological Advisor to the BEF's Gas services, recognised the problems  of pinning down the number of gas casualties. In his 1919 report on the subject, which can be found at TNA in WO 32/5180 he noted the following:IMG_8177.jpg.8fa3870481e9ef6df05c23d96eea01de.jpg

 

 

Then Medical History of the  War (to which Douglas contributed) noted this:

SAM_2532.JPG.fcc931877465295ab8576ccd7e4293e5.JPG

 

Whilst I appreciate that he died as a POW , I think it is very likely that the Germans probably had a similar problem, even more so in cases like this where the circumstances were unlikely to have been known.  It could equally have been caused by TB for instance.

 

TR

Edited by Terry_Reeves

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TGM

Causes of pulmonary oedema can be complex, but in addition to the above,

I would recommend reading the following:

 

Wilkinson, O.  British Prisoners of War in First World War Germany  (CUP, 2017, p.118, and 276)

 

Gas injuries to the lungs / BMJ 1941 http://www.bmj.com/content/bmj/2/4215/550.full.pdf

(refers to the great war)

 

The year may also be significant here - see for example The pathology of influenza in France,  Medical Journal of Australia, 1920.

 

Edited by TGM
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Dai Bach y Sowldiwr
6 hours ago, TGM said:

The year may also be significant here - see for example The pathology of influenza in France,  Medical Journal of Australia, 1920.

 

Interesting article.

Lots of cases shown to have agglutinins to 'B(acillus). influenzae.'

Now known as Haemophilus influenzae, then also as Pfeiffer's bacillus, it was thought to be the causative organism of influenza until the 1930s when it was proven to be due to the influenza virus.

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TGM
10 hours ago, Dai Bach y Sowldiwr said:

 

Interesting article.

Lots of cases shown to have agglutinins to 'B(acillus). influenzae.'

Now known as Haemophilus influenzae, then also as Pfeiffer's bacillus, it was thought to be the causative organism of influenza until the 1930s when it was proven to be due to the influenza virus.

 

Good point, Brigadier. A hazard of using contemporary sources, but helpful for understanding the diagnosis and context at the time perhaps.

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PhilB

If a PoW died from influenza in 1918, (and in such an outbreak, it would have been presumably fairly obvious) would the doctor have put the cause of death as influenza or something more specific like oedema?

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Longton1971

This is a very interesting and informative discussion.  Thanks to everyone who has contributed. Lt. Tattersall's ICRC card shows what the doctors thought at the time.  Would he have contracted TB and died from it within a month of being captured.  I can't imagine he had that disease and remained on active service.  Influenza I can see, but they are very specific in their diagnosis.  Whatever caused the oedema, he would have had a painful and lingering death, as shown by the details on his ICRC card where they weren't able to identify his regiment fully.  

Richard

Screen Shot 2017-10-24 at 11.14.26.png

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Terry_Reeves

Richard

 

I used TB as an illustration of how complex the subject was, not as an answer to the OPs question. The extracts that I posted at the same time show the difficulty the medical authorities had.

 

TR

 

 

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Longton1971

No criticism intended, Terry.  I was just saying that he would have been treated by German doctors presumably, who would have been able to give an accurate diagnosis given the state of knowledge at the time. The Germans did use gas in their attack on his battalion but he could still have had influenza, given his weakened state.

Richard 

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TGM

Just to add to the discussion, I note the following para in  Taubenberger, J. K., Hultin, J. V., & Morens, D. M. (2007). Discovery and characterization of the 1918 pandemic influenza virus in historical context. Antiviral Therapy, 12(4 Pt B), 581–591.

Quote

Research efforts to identify the cause of the 1918–1919 pandemic

As noted, at the time of the 1918 influenza pandemic, biomedical thinking about influenza was dominated by Richard Pfeiffer’s 1892 claim that B. influenzae was its cause [7]. Indeed, in 1918 Pfeiffer was still active and vocal in making the case for the organism he had discovered [41,42]. That it was not universally cultivated from all influenza cases did not discredit Pfeiffer’s claim, because B. influenzae was difficult to grow under the conditions of the day.

The majority of individuals who died during the 1918 pandemic succumbed to secondary bacterial pneumonia [4345], caused by Streptococcus pneumoniae, Streptococcus pyogenes, H. influenzae, Staphylococcus aureus, and other organisms. Moreover, a subset died rapidly after the onset of symptoms, often with either massive acute pulmonary haemorrhage or pulmonary oedema, and often in fewer than 5 days. In the hundreds of autopsies performed in 1918, the primary pathological findings tended to be confined to the respiratory tree: death was due to pneumonia and respiratory failure. These findings are consistent with infection by a well adapted influenza virus capable of rapid replication throughout the entire respiratory tree with little clinical or pathological evidence for systemic virus infection [45].

 

7. Pfeiffer R. Aus dem Institut für Infektionskrankheiten. II. Vorläufige Mittheilungen über die Erreger der Influenza [From the Institute for Infectious Diseases. II. Provisional communication on the cause of influenza] Deutsche medicinische Wochenschrift. 1892;18:28.

41. Pfeiffer R. Das Influenzaproblem [The influenza problem] Ergebnisse der Hygiene, Bakteriologie, Immunitätsforschung und experimentellen Therapie. 1922;5:1–18.

42. Pfeiffer R. Neuere Forschungen zur Klärung der Influenzaätiologie [New research to clarify the aetiology of influenza] Deutsche medizinische Wochenschrift. 1925;51:10–13.

43. LeCount E. The pathologic anatomy of influenzal bron-chopneumonia. J Am Med Assoc. 1919;72:650–652.

44. Wolbach S. Comments on the pathology and bacteriology of fatal influenza cases, as observed at Camp Devens, Mass. Johns Hopkins Hospital Bulletin. 1919;30:104–109.

45. Winternitz M, Wason I, McNamara F. The Pathology of Influenza. Vol. 61. New Haven: Yale University Press; 1920.

 

 

Edited by TGM
add references

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TGM
15 minutes ago, Terry_Reeves said:

Richard

 

I used TB as an illustration of how complex the subject was, not as an answer to the OPs question. The extracts that I posted at the same time show the difficulty the medical authorities had.

 

TR

 

 

I took it as such and all views and contributions are useful for new and old forumites.

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Longton1971

We are not ever likely to know the real cause in this case, I guess.  Thinking about it, it does seem strange that he survived 1 month, when death usually occurred from phosgene gas poisoning within 36 hours according to the 1941 BMJ paper.  So, influenza it is, perhaps made worse by having been gassed.

Richard

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Dai Bach y Sowldiwr

I think Terry's post (#9) above is very relevant.

It warns about relying too much about the absolute accuracy of medical statistics, and I think  we have to understand that most  (and I would guess in a POW camp - all  )diagnoses made at that time were made clinically, i.e. based around the history of what the patient said about his illness, and a clinical examination.

I'm guessing here, but in 1918 Germany, resources and medical expertise would not have been abundant and the time and care spent on diagnosing and treating the medical conditions of prisoners of war would be far from ideal.

I think you have to treat a specific label of 'Pulmonary oedema' with a large degree of latitude, and that it could be that it was a diagnosis made in someone who had one or more from  a long list of possible  respiratory or cardiac diagnoses.

Even today, a diagnosis of Cardiac failure is unlikely to be made at a patient's first attendance, and depends on a combination of history, examination, but also special investigations- ECG, Chest Xray, Echocardiography, and biochemistry tests that either weren't available, understood or as good then as they are now.

I think if you were to ask- "Is it possible this man suffered from...?" and insert any cardiovascular, respiratory, and even some haematological disease, the answer will almost certainly be 'Yes'.

Just being specific now, 100 years later I think is impossible.

 

11 minutes ago, Longton1971 said:

We are not ever likely to know the real cause in this case, I guess.  Thinking about it, it does seem strange that he survived 1 month, when death usually occurred from phosgene gas poisoning within 36 hours according to the 1941 BMJ paper.  So, influenza it is, perhaps made worse by having been gassed.

Richard

 

I wouldn't disagree.

Edited by Dai Bach y Sowldiwr

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voltaire60

   There is some hope of further information.  Tattersall has an officer file at Kew:

 

Lieutenant Harold Vaughan TATTERSALL. The Prince of Wales's (North Staffordshire Regiment).

War Office: Officers' Services, First World War, Long Number Papers (numerical). Officers Services (including Civilian Dependants and Military Staff Appointments): Long Service Papers. Lieutenant Harold Vaughan TATTERSALL. The Prince of Wales's (North Staffordshire Regiment).

Held by: The National Archives - War Office, Armed Forces, Judge Advocate General, and related bodies
Date: 1914 - 1919
Reference: WO 339/1797
Subjects:

Armed Forces (General

 

I will try to get over to Kew for other things in the next week and get this file out.  I will be in touch when it is done.

 

 

I think it is unlikely that   pulmonary oedema is  gas related-    there is nothing on his ICRC card nor on the records from the German authorities to say he was wounded/unwounded when captured. Usually, the German lists would say "unv." for unverwundet=unwounded. That said, his ICRC record card-other side- has reference to a  German file where the reference does not show- A little searching either side of the file number may throw up the first notification entry from the Germans, which would say what condition he was in.

Edited by voltaire60

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Longton1971

Thanks for the offer, Voltaire. I'd be very grateful for anything you can add as he was the officer I/c the Essling redoubt on 21 March 1918.  This feature was central to the defence of the 1st battalion North Staffords' area that day.  The battalion history published in 1921 says he only surrendered when wounded and his ICRC card refers to a wound "in the chin", I think, although the writing is unclear. I wonder, do they mean shin?

Thanks again.  I look forward to hearing from you.

Richard

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seaJane
50 minutes ago, Longton1971 said:

I wonder, do they mean shin?

 

In comparison with the s in the same hand in those notes, chin is what it looks like to me, for what that's worth.

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Longton1971

That was my original thought too

Richard

 

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Longton1971

Here's another source on Tattersall's death from the ICRC records.  I have no German.  Can anyone translate for me, please?

 

Richard

 

 

59f1de7cd93cd_ScreenShot2017-10-26at14_06_23.png.3ce7886f617ac8e704df5dec872ef241.png

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