ABSTRACT
The acute respiratory distress syndrome (ARDS) may accompany both indirect and direct injury to the lung. An example of the latter is toxic gas inhalation. The poet Wilfred Owen described dramatically the sight of a World War I combatant felled by gas exposure (1):
The alveolar hemorrhage and edema that Owen describes fit well with the first medical description of ARDS provided in 1967 by Ashbaugh et al. (2). These investigators postulated that surfactant function might be diminished in patients with ARDS, with resultant alveolar collapse, edema, increased shunt, and hypoxemia. Indeed, using tools available at the time, they demonstrated a loss of surface-tension lowering capacity in fluid from the lungs of ARDS patients (3). Thus, the froth described by Owen would likely be un-stable and perhaps disappear, much as our ignorance of the pathophysiology of ARDS is, hopefully, fading.
