Delayed death caused by gassing in a silo containing green forage.

Three workers died from carbon dioxide poisoning in a partly underground silo which had been almost completely emptied of green forage. Two died at once, the third after five days without regaining consciousness. Several similar cases are reported in the literature. Wrede (1936) described a case of carbon dioxide poisoning which occurred in a cellar through the escape of gas from a beer barrel. The patient, seen four minutes after he had been removed from the cellar, was unconscious but recovered in a few minutes. The clinical picture was one of narcosis followed by excitation and could easily have been mistaken for drunkenness or epilepsy. Bemauer and Blume (1937) reported the cases of three Chinese employees working in the hold of a ship in Canton port who were poisoned by carbon dioxide produced by the fermentation of rice and soya. One of them died at once, the second recovered quickly, and the third succumbed after four days without regaining consciousness. Taeger (1937) reported the case of a youth of 22, who collapsed in a silo containing green forage. When removed from the silo he was completely unconscious, the pupils dilated and reacting feebly to light, and Cheyne-Stokes respiration was present. After 20 hours he began to improve slowly. Acrocyanosis then appeared in the hands and feet which was still present two years after the incident and was considered by the author to be aetiologically connected with the attack of carbon dioxide poisoning. Symanski (1939) described four workers who lost consciousness in a silo containing green forage but recovered. One had aphasia for a short time after recovering consciousness, and in one case seen a week after the incident there was marked acrocyanosis of the hands.