Medical Aspects of Chemical Warfare (2008) - The Black Vault

Medical Aspects of Chemical WarfareINTRODUCTIONVesicants are agents that produce chemical burns.Sulfur mustard, the first vesicant used as a chemicalweapon, caused many injuries on the battlefields ofWorld War I and is still considered a major chemicalagent. 1-4 In the years since World War I, a number ofrecorded and suspected incidents of mustard use haveoccurred, culminating in the Iran-Iraq War in the 1980s.During this conflict, Iraq used mustard extensivelyagainst Iran. Graphic images of badly burned Iraniancasualties in the media brought public attention to thehorrors of chemical warfare. The possibility that Iraqwould again use mustard caused major concern as theUnited States joined United Nations forces preparingto liberate Kuwait in fall 1990 (fortunately mustard wasnot used). Although mustard is the most importantvesicant militarily, the vesicant category includes otheragents such as lewisite and phosgene oxime (Table 8-1).The clinical differences among the vesicants discussedin this chapter are shown in Table 8-2.There are two types of mustard: sulfur mustardand nitrogen mustard. Despretz probably synthesizedpoor quality sulfur mustard in 1822, but it was notidentified. Riche, in 1854, and Guthrie, several yearslater, repeated Despretz’s reaction to obtain the sameproduct. Guthrie described the product as smellinglike mustard, tasting like garlic, and causing blistersafter contact with the skin. Niemann, in 1860, alsosynthesized the compound. In 1886 Meyer preparedhigher quality mustard but discontinued his researchbecause of the hazards involved. During World War I,Germany used Meyer’s method of synthesis to manufacturemustard. 3Nitrogen mustard was first synthesized in the late1930s. Although the properties of nitrogen mustardare similar to sulfur mustard, it was not found suitablefor use as a weapon. One form of nitrogen mustard,HN2 (Mustargen, manufactured by Merck and Co,West Point, Pa) was found useful for chemotherapy ofTABLE 8-1CHEMICAL, PHYSICAL, ENVIRONMENTAL, AND BIOLOGICAL PROPERTIES OF VESICATINGAGENTSImpure Sulfur Distilled Sulfur PhosgeneProperties Mustard (H) Mustard (HD) Oxime (CX) Lewisite (L)Chemical and PhysicalBoiling Point Varies 227°C 128°C 190°CVapor Pressure Depends on purity 0.072 mm Hg at 20°C 11.2 mm Hg at 25°C (solid) 0.39 mm Hg at 20°C13 mm Hg at 40°C (liquid)Density:Vapor approx 5.5 5.4