The toxic action of dichlorethylsulphide (“mustard gas”)

Abstract

The investigations recorded in these two papers are founded upon numerous series of animal experimentations and also clinical observations of human mustard gassing.

1. Local Action: Skin.—Dichlorethylsulphide (“mustard gas”), in liquid or in vapor form, even in very low concentrations, is an escharotic poison for the animal tissues (skin, conjunctivæ, cornea, mucous membranes of respiratory and gastrointestinal tracts) with which it comes in direct contact. The degree of the injury is proportionate to the concentration of the gas, the time of exposure, individual susceptibility, and local physical conditions, such as moisture, sweating, warmth, pressure and friction. The escharotic action is, for the greater part, painless, the anesthetic effect being especially notable upon the skin; while upon the mucous membranes its action may be more irritant, probably chiefly reflex in character. The cutaneous surfaces most susceptible are those with thinner, more delicate skin, well supplied with sweat glands and hair follicles, where sweat may collect, and which are exposed to friction or pressure, such as the axillæ, flexor surfaces, genitals, inner surface of arms and corresponding surface of trunk, inner surfaces of thighs, between the fingers, etc. There is a penetration of the gas into the sweat and sebaceous glands, and a re-solution of mustard gas vapor into the sweat or sebum occurs. The injuries are particularly striking in their insidious, slowly progressive development, becoming first apparent only some hours after the exposure. Upon human skin the lesion appears as a hyperemia, followed by vesication, eschar formation, sloughing and slow healing, with more or less pigmentation. Depilation may occur; in severe cases the eschar may extend entirely through the corium into the subcutaneous tissues. Secondary infection and gangrene of the eschars occur invariably in cases not properly treated. Milder lesions may show only the earlier stages of hyperemia, vesication or pigmentation. In general the injuries may be classed as burns of first, second or third degree.