ABSTRACT
I. Background .......................................................................................................................... 294 II. Mustard ................................................................................................................................ 294
A. Properties of Mustard................................................................................................... 295 B. Toxicity of Mustard ..................................................................................................... 295 C. Biochemical Mechanism of Sulfur Mustard Toxicity ................................................. 296 D. Clinical Manifestations and Diagnosis......................................................................... 296
1. Skin........................................................................................................................ 298 2. Eye......................................................................................................................... 300 3. Airways ................................................................................................................. 301 4. Gastrointestinal Tract ............................................................................................ 302 5. Central Nervous System........................................................................................ 303 6. Death ..................................................................................................................... 303
E. Diagnosis...................................................................................................................... 303 F. Laboratory Tests........................................................................................................... 303 G. Patient Management ..................................................................................................... 304 H. Long-Term Effects ....................................................................................................... 305
III. Lewisite ................................................................................................................................ 306 A. Military Use ................................................................................................................. 307 B. Properties...................................................................................................................... 307 C. Toxicity ........................................................................................................................ 307 D. Biochemical Mechanisms of Injury ............................................................................. 307 E. Clinical Effects ............................................................................................................. 307
1. Skin........................................................................................................................ 307 2. Eyes ....................................................................................................................... 308 3. Airways.................................................................................................................. 308 4. Other Effects.......................................................................................................... 308
F. Diagnosis ...................................................................................................................... 308 G. Laboratory Tests........................................................................................................... 309 H. Patient Management ..................................................................................................... 309 I. Long-Term Effects ....................................................................................................... 309
References ..................................................................................................................................... 309
Chemical warfare agents have been around for at least 4000 years and probably were originally used as poisons on individuals. The use of chemical weapons dates from at least 423 BC when allies of Sparta in the Peloponnesian War took an Athenian-held fort by directing smoke from lighted coals, sulfur, and pitch through a hollowed-out beam into the fort. Other conflicts during the succeeding centuries saw the use of smoke and flame. During the seventh century AD, the Greeks invented ‘‘Greek fire,’’ a combination probably of rosin, sulfur, pitch, naphtha, lime, and saltpeter that floated on water and was particularly effective in naval operations. During the fifteenth and sixteenth centuries, Venice employed unspecified poisons in hollow explosive mortar shells and sent poison chests to its enemy to poison wells, crops, and animals (Prentiss, 1937; Heller, 1984; Medema, 1986). Finally, World War I and the Iran-Iraq War saw the advent of modern chemical warfare.
