(By Professor Dr. A. Hirt, and Staff Surgeon of the Luftwaffe,
Professor Dr. Wimmer, Strasbourg, 1944)
General Observations
The effect of Lost as a poison gas is immediate and, by causing other pathological reactions within the cells and organs, it damages the entire efficiency of the individual cell as well as that of the organs. The organism stands the best chance of absorbing the damage caused by Lost if there is a large vitamin reserve in the body. In administering the vitamin treatment after Lost damage has been inflicted, care must be taken that the medicaments are not administered indiscriminately. The vitamin combinations (A, B complex, C) taken orally or vitamin B1 administered intravenously in glucose suspension have proved most effective. Both methods aim at raising the resistance of the reticuloendothelial system, while simultaneously introducing therapeutic measures to protect the liver which can be further strengthened by food with a high carbohydrate and vitamin content. When definite damage to the organs (liver, cardiac muscles, kidneys) manifests itself, vitamin treatment has to be discontinued and injections of B1 glucose substituted, as the excretion of the surplus quantity of vitamins results in a temporary additional overstimulation of the cells of the excretory organs.
In addition the inter-connection between the effect of sulfanilamide and vitamin B complex should be noted. In the case of pulmonary complications (bronchial pneumonia, pulmonary abscess) which are treated with sulfanilamides, the administration of yeast is definitely not indicated.
The general treatment, as set forth, especially the administration of vitamin B1 glucose, also has a salutory effect on the healing of cutaneous necrosis. In average and serious cases, the length of the healing process can thereby be considerably decreased. Supporting measures to be taken are bandaging the affected limb in splints until the appearance of clean granulation or placing the patient in a suitable recumbent position as well as vigorous, systematic psychotherapy. The psychological influencing of the largely apathetic Lost patient constitutes an essential part of the treatment, due to the possibility of thereby influencing the parasympathetic system (circulation, circulatory system).
Outline of treatment
1. All the directions given for the elimination of the Lost poison are to be followed carefully. Only after elimination of the poison has resulted may Lost patients be treated and accommodated together in enclosed rooms. (Inhalation of Lost vapors!)
2. Damp dressings with Rivanol (0.1-0.05 percent) and Trypaflavin (0.1 percent) have proved to be a successful treatment of the skin symptoms (reddening, swelling, blisters) of the first to fourth day. If necessary, ointment dressings (10 percent cod liver oil tannic ointment, boric acid ointment, etc.) may be applied. With the opening of the blisters, the exposed corium of the skin becomes extremely sensitive to the drying reflex. Introductory treatment; daily bathing with a potassium permanganate solution, constant damp dressings of Rivanol-Trypaflavin solution; later on ointment dressings (5 percent cod liver oil tannic ointment, boric acid ointment). With the development of cutaneous necrosis and increasing disinfection of the affected parts of the skin, the damp dressings are to be substituted—if only for nursing reasons—by ointment dressings, after bathing with a potassium permanganate solution at body temperature, which are to be changed daily. Usually after the 17th day, the necrotic spots on the skin can be removed by drying them up or better still by brushing them off (under narcosis if necessary) with a potassium permanganate solution. In this way the local healing process is considerably shortened.
With the beginning of the knitting of the skin granulation stimulating ointment dressings (alternately cod liver oil ointment, boric acid ointment, unguentine, etc.) are sufficient. Lexer’s cod liver ointment (only 2 hours, painful!) can provide a strong stimulus should granulation formation be slow and drag itself out.