Clinical and morphological findings on mustard gas [bis (2-chloroethyl) sulfide] poisoning

n 1984 and 1985, a total of eleven Iranian patients were
transferred to hospitals in Munich, Germany, after a reported gas
attack in the Iran-Iraq war. The initial symptoms and pretreatment
in Teheran, Iran, as well as the admittance examination data, the
clinical courses of the patients, and the clinical laboratory data
in Germany, are reported. The main injuries were to the skin, the
eyes, and the respiratory tract. One patient stopped breathing
suddenly on the third day of treatment (eight days after the
exposure). A large piece of mucous membrane blocking a bronchus was
removed during an immediate bronchoscopy, but attempts at
resuscitation failed. The most important autopsy findings in this
case were severe pseudomembranous inflammation of the trachea and
the bronchial tubes. The histological findings are reported.
Chemical proof of the poison (mustard gas) was established. A
review of the history of chemical warfare, the physical and
chemical properties of mustard gas, and a literature survey of
clinical findings (including, especially, experiences from World
Wars I and II) contribute to the understanding of the actual cases.