ABSTRACT
I. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 245 II. Clinical Effects of Sulfur Mustard . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 246
A. Carcinogenesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 247 B. Chronic Pulmonary Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 248 C. Chronic Eye Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 248 D. Scarring, Pigmentation Changes, and Cancer of Epithelial Surfaces . . . . 248 E. Central Nervous System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 249 F. Summary for Symptomatic Exposures . . . . . . . . . . . . . . . . . . . . . . . . . . . 249
III. Acute Subclinical Exposure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251 A. Carcinogenesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251 B. Radiation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 252
IV. In Vitro Studies of Sulfur Mustard Toxicity . . . . . . . . . . . . . . . . . . . . . . . . . . 253 V. Dose Dependency of the Mustard Lesion. . . . . . . . . . . . . . . . . . . . . . . . . . . . 254
VI. Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255 Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255
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 B.C. 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 A.D., 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.1 –3 Finally, World War I and the Iran-Iraq War saw the advent of modern chemical warfare.
