The pathology of dichlorethylsulphide (“mustard gas”) poisoning

Abstract

The specific microscopic pathology of the local lesions of dichlorethylsulphide poisoning consists in degeneration and necrosis of the cells with which it comes in contact. The earliest microscopic change is pyknosis of the nucleus and cell body, followed by hydropic degeneration, liquefaction or coagulation necrosis. In the skin, hyperemia, with regeneration of the damaged cells, pigmentation, vesicle formation, desquamation of the dead epidermis or eschar formation mark varying stages of severity of the lesion. The degenerative changes extend deepest in the hair follicles and sweat glands. In mild burns without vesication the papillary layer of the corium may show a greater degree of necrosis than the epidermis itself, thus explaining the frequent occurrence of Nikolsky's sign. Large pigmented chromatophores may be the only living cells left in the papillary layer. In severe burns the necrosis may extend entirely through the corium. In the cornea, pyknosis and simple or coagulation necrosis of the corneal epithelium and interstitial substance, even to the endothelial layer, in extent varying with the degree of exposure, constitute the microscopic features. On the conjunctivæ the epithelium shows pyknosis, hydropic degeneration, liquefaction necrosis, or there may be a deeper necrosis extending into the subconjunctival tissues. The conjunctival surface suffers to a less degree proportionately than the epidermis. On the mucous membranes the epithelium shows pyknosis, hydropic or mucoid degeneration, desquamation, liquefaction or coagulation necrosis. The necrosis may extend into the submucosa, but the depth of the lesions on the conjunctivæ and the mucous membranes of the respiratory tract is never so great from identical exposures, as it is in the skin. Following the necrosis there is marked hyperemia, and the development of an edema, more marked in the subcutaneous and subconjunctival tissues in animals, but less marked in man. Human skin, however, shows a much greater tendency to vesication.