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MUSTARD GAS INJURIES TO THE EYES

MUSTARD GAS INJURIES TO THE EYES Abstract OUTLINE Incidence Dose necessary to produce lesion Course of severe corneal burns Action on tissue Local Action Liberation of hydrochloric acid Derivatives Whole molecule Tissue hypersensitivity Systemic Action Break-down products Metabolism Bone marrow Antibodies Changes secondary to burns Fundus changes Prophylaxis Treatment Patients without corneal involvement Reassurance Irrigations Bland solutions Hypertonic solutions Neutralizing agents Irrigating apparatus Dark glasses or eye shade Convalescence Patients with corneal involvement Immediate treatment Oily drops and ointments Ascorbic acid Secondary infections Mild silver protein and boric acid Antiseptics Sulfanilamide and derivatives Convalescence Late treatment Summary of present treatment I. INCIDENCE The present treatment of mustard gas—dichlorodiethylsulfide, or ClCH2CH2)2S—injuries to the eyes is largely derived from the methods developed during the first World War. The incidence of mustard gas injuries during that period, with the clinical and the pathologic characteristics, has been summarized in the "Official History of the War."1 References 1. History of the Great War, Based on Official Documents: Medical Services ; Diseases of the War , London, His Majesty's Stationery Office, 1923, vol. 2, p. 425. 2. Teulières: Lésions oculo-palpébrales par nouveaux gaz , J. de méd. de Bordeaux 48:37, 1918. 3. Beauvieux: Les lésions oculaires par gaz vésicants , Arch. d'opht. 37:597, 1920. 4. Genet, L.: Ypérite, ischémie conjonctivale, ulcère cornéen tardif , Bull. Soc. d'opht. de Paris , 1937, p. 409 5. abstracted, Zentralbl. f. d. ges. Ophth. 40: 41, 1937-1938. 6. Heckford, F.: Delayed Corneal Ulceration Following Mustard Gas Burns , Proc. Roy. Soc. Med. 30:949, 1937. 7. Genet, L., and Delord, E.: Ypérite, kératite symétrique tardive à allure trophique , Bull. Soc. d'opht. de Paris , 1936, p. 521 8. abstracted, Zentralbl. f. d. ges. Ophth. 37:685, 1937. 9. Neame, H.: Late Result After Mustard Gas Burn of the Eyes , Proc. Roy. Soc. Med. 22: 25, 1928. 10. Jacqueau and Bujadoux: Infection aigue et spontanée des deux globes oculaires, à deux ans d'intervalle, chez un ancien ypérite , Cong. Soc. franç. d'opht., Bruxelles , 1925 11. abstracted, Zentralbl. f. d. ges. Ophth. 16:787, 1926. 12. Warthin, A. S., and Weller, C. V.: The Medical Aspects of Mustard Gas Poisoning , St. Louis, C. V. Mosby Company, 1919 13. J. Lab. & Clin. Med. 4:785, 1919. 14. Mann, I., and Pullinger, B. D.: Experiments on Effect of Ascorbic Acid in Mustard Gas Burns , Brit. J. Ophth. 24:444, 1940. 15. Arnold, H.: Beiträge zur Pathologie der Augenschädigung durch Dichlordiäthysulfid auf Grund von Tierversuchen, Thesis, Berlin, 1937 16. abstracted, Zentralbl. f. d. ges. Ophth. 40:42, 1937. 17. Pellathy, B.: Versuche zur Ermaszigung der Wirkung des Senfgases , Klin. Monatsbl. f. Augenh. 98:688, 1937. 18. Vejdovsky, V.: Die Wirkung flüssigen Yperits auf die Augen einiger Tiere , Českoslov. ofth. 3:169, 1937 19. abstracted, Zentralbl. f. d. ges. Ophth. 40: 554, 1937-1938. 20. Wessely: Ueber die Wirkung des Dichloräthylsulfids auf das Auge , Klin. Monatsbl. f. Augenh. 94:100, 1935. 21. Eyester, J., and Maver, M.: An Apparatus for the Exposure of Skin or Mucous Membrane to the Vapor of Toxic Substances, with Observations on Dichlorethylsulphide , J. Pharmacol. & Exper. Therap. 15:95, 1920. 22. Reed, C. I.: The Minimum Concentration of Mustard Gas Effective for the Eyes of Man , J. Pharmacol. & Exper. Therap. 15:77, 1920. 23. Livingston, P. C., and Walker, H. M.: Effects of Liquid Mustard Gas upon Eyes of Rabbits and of Certain Methods of Treatment , Brit. J. Ophth. 24: 67, 1940. 24. Poole, L. T.: Chemical Warfare in Relation to Ophthalmology , in Ridley, F., and Sorsby, A.: Modern Trends in Ophthalmology , London, Butterworth & Co., Ltd., 1940, p. 636. 25. History of the Great War, Based on Official Documents : Medical Services ; Surgery of the War , London, His Majesty's Stationery Office, 1922, vol. 2, p. 530. 26. Lynch, V.: Smith, H. W., and Marshall, E. K., Jr.: Systemic Effects and Mechanism of Action of Mustard Gas , J. Pharmacol. & Exper. Therap. 12:265, 1918. 27. Marshall, E. K., Jr., and Williams, J. W.: The Toxicity and Skin Irritant Effect of Certain Derivatives of Dichloroethylsulfide , J. Pharmacol. & Exper. Therap. 16:259, 1920. 28. Lillie, R. S.; Clowes, G. H. A., and Chambers, R.: Penetration of Mustard Gas into Marine Organisms, and the Mechanism of Its Destructive Action on Protoplasm , J. Pharmacol. & Exper. Therap. 14:75, 1919. 29. Erdmann, P.: Ueber Augenveränderungen durch Dimethylsulfat , Arch. f. Augenh. 62:178, 1909. 30. Peters, R. A., and Walker, E.: Rate of Liberation of Acid by Mustard Gas and Its Analogues in Its Relation to the "Acid" Theory of Skin Vesication , Biochem. J. 17:260, 1923. 31. Kamm, O., and Waldo, J. H.: B-B′ Dichlorodiethyl Ether: The Oxygen Analogue of Mustard Gas , J. Am. Chem. Soc. 43:2223, 1921.Crossref 32. Flury, F., and Wieland, H. : Ueber Kampfgasvergiftungen : VII. Die pharmakologische Wirkung des Dichloräthylsulfids , Ztschr. f. d. ges. exper. Med. 13: 367, 1921.Crossref 33. Merkulov, I. : Therapeutische Behandlung bei Augenentzündung durch Yperit , Arch. oftal. 8:97, 1931 34. abstracted, Zentralbl. f. d. ges. Ophth. 26:152, 1932. 35. Vedder, E. B.: The Medical Aspects of Chemical Warfare , Baltimore, Williams & Wilkins Company, 1925. 36. Lawson, W. E., and Reid, E. E.: Reactions of Bb′-Dichloroethylsulfide with Amino Compounds , J. Am. Chem. Soc. 47:2821, 1925.Crossref 37. Sollmann, T. : The Question of Induced Hypersusceptibility of the Skin to Mustard Gas , J. Pharmacol. & Exper. Therap. 12:319, 1918. 38. Berenblum, I., and Wormall, A.: Immunological Properties of Proteins Treated with Mustard Gas and BB′-Dichlorodiethyl Sulphone , Biochem. J. 33:75, 1939. 39. Berenblum, I.; Kendal, L. P., and Orr, J. W.: Tumour Metabolism in Presence of Anti-Carcinogenic Substances , Biochem. J. 30:709, 1936. 40. Jany, J., and Sellei, C.: Ueber die Wirkung einiger giftiger Gase auf den Stoffwechsel den der Zelle , Biochem. Ztschr. 275:234, 1935. 41. Peters, R. A.: Effect of Dichlordiethylsulphone on Brain Respiration , Nature, London 138:327, 1936. 42. Krumbhaar, E. B., and Krumbhaar, H. D.: J. M. Research 40:497, 1919 43. Pappenheimer, A. M., and Vance, M.: Effects of Intravenous Injections of BB′-Dichlorodiethylsulfide in Rabbits, with Special Reference to Its Leucotoxic Action , J. Exper. Med. 31:72, 1920. 44. Krumbhaar, E. B.: Role of the Blood and the Bone Marrow in Certain Forms of Gas Poisoning: Peripheral Blood Changes and Their Significance , J. A. M. A. 72:39 ( (Jan. 4) ) 1919. 45. Hektoen, L., and Corper, H. J.: Effect of Mustard Gas on Antibody Formation , J. Infect. Dis. 28:279, 1921. 46. Herrmann, H.: Influence of Pontocaine Chloretone on the Respiration and Glycolysis of the Cornea, 1941, to be published. 47. Bonnefon: L'œil ypérité. Son traitement , Gaz. hebd. d. sc. méd, de Bordeaux 60:168, 1939 48. Siècle méd. , (Sept. 1) , 1939 49. Gas Injuries to the Eyes, Special Articles , Lancet 2:756, 1939. 50. Dor, L.: Gaz de combat et brûlures des yeux , Arch. d'opht. 3:873, 1940. 51. Heinsius, E.: Experimentelle Untersuchungen über die Prophylaxe und Therapie der Gelbkreuzerkrankungen der Augen , in Heinsius, E.: Busch, H. G.: Stutz, E., and Reil, G.: Veröffentlichungen aus dem Gebiete des Marine-Samtätswesens , Berlin, Mittler, 1938 52. abstracted, Zentralbl. f. d. ges. Ophth. 43:389, 1939. 53. Pellathy, B.: Versuche zur Minderung der Senfgaswirkung , Szemészet 74:48, 1938 54. abstracted, Zentralbl. f. d. ges. Ophth. 43:346, 1939. 55. Lustig, A.: Effetti dei gas di guerra sull'occhio. Rivista sintetica , Boll. d'ocul. 13:685, 1934 56. abstracted, Zentralbl. f. d. ges. Ophth. 32:340, 1935. 57. Whiting, M. H., and others: Discussion on Gas Injuries of the Eyes , Proc. Roy. Soc. Med. 33:225, 1940. 58. Bickerton, R. E., in Discussion on Gas Injuries of the Eyes , Proc. Roy. Soc. Med. 33:235, 1940. 59. Stallard, H. B.: Improvised Eye-Irrigator for Use in the Field , Brit. J. Ophth. 24:53, 1940.Crossref 60. Bradbury, S.: Decontamination of Eyes Which Have Been Contaminated by Mustard Gas , J. Roy. Nav. M. Serv. 22:341, 1936. 61. Gas Casualties: Manual of Treatment , Great Britain, War Department, London, His Majesty's Stationery Office, 1930. 62. Rea, L., in Discussion on Gas Injuries of the Eyes , Proc. Roy. Soc. Med. 33:235, 1940. 63. Bursuk, G. G. : Zur Frage der Infektion des mit Dichlordiäthylsulfid affizierten Auges , abstracted, Zentralbl. f. d. ges. Ophth. 36:513, 1936. 64. Guyton, J. S.: Local Use of Sulfanilamide Compounds in the Eye , Am. J. Ophth. 24:292, 1941 65. Castroviejo, R.: Keratoplasty , Am. J. Ophth. 24:1 and 139. 1941. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Ophthalmology American Medical Association

MUSTARD GAS INJURIES TO THE EYES

HUGHES, WILLIAM F.
Archives of Ophthalmology , Volume 27 (3) – Mar 1, 1942
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References (19)

Publisher
American Medical Association
Copyright
Copyright © 1942 American Medical Association. All Rights Reserved.
ISSN
0003-9950
eISSN
1538-3687
DOI
10.1001/archopht.1942.00880030154009
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Abstract

Abstract OUTLINE Incidence Dose necessary to produce lesion Course of severe corneal burns Action on tissue Local Action Liberation of hydrochloric acid Derivatives Whole molecule Tissue hypersensitivity Systemic Action Break-down products Metabolism Bone marrow Antibodies Changes secondary to burns Fundus changes Prophylaxis Treatment Patients without corneal involvement Reassurance Irrigations Bland solutions Hypertonic solutions Neutralizing agents Irrigating apparatus Dark glasses or eye shade Convalescence Patients with corneal involvement Immediate treatment Oily drops and ointments Ascorbic acid Secondary infections Mild silver protein and boric acid Antiseptics Sulfanilamide and derivatives Convalescence Late treatment Summary of present treatment I. INCIDENCE The present treatment of mustard gas—dichlorodiethylsulfide, or ClCH2CH2)2S—injuries to the eyes is largely derived from the methods developed during the first World War. The incidence of mustard gas injuries during that period, with the clinical and the pathologic characteristics, has been summarized in the "Official History of the War."1 References 1. History of the Great War, Based on Official Documents: Medical Services ; Diseases of the War , London, His Majesty's Stationery Office, 1923, vol. 2, p. 425. 2. Teulières: Lésions oculo-palpébrales par nouveaux gaz , J. de méd. de Bordeaux 48:37, 1918. 3. Beauvieux: Les lésions oculaires par gaz vésicants , Arch. d'opht. 37:597, 1920. 4. Genet, L.: Ypérite, ischémie conjonctivale, ulcère cornéen tardif , Bull. Soc. d'opht. de Paris , 1937, p. 409 5. abstracted, Zentralbl. f. d. ges. Ophth. 40: 41, 1937-1938. 6. Heckford, F.: Delayed Corneal Ulceration Following Mustard Gas Burns , Proc. Roy. Soc. Med. 30:949, 1937. 7. Genet, L., and Delord, E.: Ypérite, kératite symétrique tardive à allure trophique , Bull. Soc. d'opht. de Paris , 1936, p. 521 8. abstracted, Zentralbl. f. d. ges. Ophth. 37:685, 1937. 9. Neame, H.: Late Result After Mustard Gas Burn of the Eyes , Proc. Roy. Soc. Med. 22: 25, 1928. 10. Jacqueau and Bujadoux: Infection aigue et spontanée des deux globes oculaires, à deux ans d'intervalle, chez un ancien ypérite , Cong. Soc. franç. d'opht., Bruxelles , 1925 11. abstracted, Zentralbl. f. d. ges. Ophth. 16:787, 1926. 12. Warthin, A. S., and Weller, C. V.: The Medical Aspects of Mustard Gas Poisoning , St. Louis, C. V. Mosby Company, 1919 13. J. Lab. & Clin. Med. 4:785, 1919. 14. Mann, I., and Pullinger, B. D.: Experiments on Effect of Ascorbic Acid in Mustard Gas Burns , Brit. J. Ophth. 24:444, 1940. 15. Arnold, H.: Beiträge zur Pathologie der Augenschädigung durch Dichlordiäthysulfid auf Grund von Tierversuchen, Thesis, Berlin, 1937 16. abstracted, Zentralbl. f. d. ges. Ophth. 40:42, 1937. 17. Pellathy, B.: Versuche zur Ermaszigung der Wirkung des Senfgases , Klin. Monatsbl. f. Augenh. 98:688, 1937. 18. Vejdovsky, V.: Die Wirkung flüssigen Yperits auf die Augen einiger Tiere , Českoslov. ofth. 3:169, 1937 19. abstracted, Zentralbl. f. d. ges. Ophth. 40: 554, 1937-1938. 20. Wessely: Ueber die Wirkung des Dichloräthylsulfids auf das Auge , Klin. Monatsbl. f. Augenh. 94:100, 1935. 21. Eyester, J., and Maver, M.: An Apparatus for the Exposure of Skin or Mucous Membrane to the Vapor of Toxic Substances, with Observations on Dichlorethylsulphide , J. Pharmacol. & Exper. Therap. 15:95, 1920. 22. Reed, C. I.: The Minimum Concentration of Mustard Gas Effective for the Eyes of Man , J. Pharmacol. & Exper. Therap. 15:77, 1920. 23. Livingston, P. C., and Walker, H. M.: Effects of Liquid Mustard Gas upon Eyes of Rabbits and of Certain Methods of Treatment , Brit. J. Ophth. 24: 67, 1940. 24. Poole, L. T.: Chemical Warfare in Relation to Ophthalmology , in Ridley, F., and Sorsby, A.: Modern Trends in Ophthalmology , London, Butterworth & Co., Ltd., 1940, p. 636. 25. History of the Great War, Based on Official Documents : Medical Services ; Surgery of the War , London, His Majesty's Stationery Office, 1922, vol. 2, p. 530. 26. Lynch, V.: Smith, H. W., and Marshall, E. K., Jr.: Systemic Effects and Mechanism of Action of Mustard Gas , J. Pharmacol. & Exper. Therap. 12:265, 1918. 27. Marshall, E. K., Jr., and Williams, J. W.: The Toxicity and Skin Irritant Effect of Certain Derivatives of Dichloroethylsulfide , J. Pharmacol. & Exper. Therap. 16:259, 1920. 28. Lillie, R. S.; Clowes, G. H. A., and Chambers, R.: Penetration of Mustard Gas into Marine Organisms, and the Mechanism of Its Destructive Action on Protoplasm , J. Pharmacol. & Exper. Therap. 14:75, 1919. 29. Erdmann, P.: Ueber Augenveränderungen durch Dimethylsulfat , Arch. f. Augenh. 62:178, 1909. 30. Peters, R. A., and Walker, E.: Rate of Liberation of Acid by Mustard Gas and Its Analogues in Its Relation to the "Acid" Theory of Skin Vesication , Biochem. J. 17:260, 1923. 31. Kamm, O., and Waldo, J. H.: B-B′ Dichlorodiethyl Ether: The Oxygen Analogue of Mustard Gas , J. Am. Chem. Soc. 43:2223, 1921.Crossref 32. Flury, F., and Wieland, H. : Ueber Kampfgasvergiftungen : VII. Die pharmakologische Wirkung des Dichloräthylsulfids , Ztschr. f. d. ges. exper. Med. 13: 367, 1921.Crossref 33. Merkulov, I. : Therapeutische Behandlung bei Augenentzündung durch Yperit , Arch. oftal. 8:97, 1931 34. abstracted, Zentralbl. f. d. ges. Ophth. 26:152, 1932. 35. Vedder, E. B.: The Medical Aspects of Chemical Warfare , Baltimore, Williams & Wilkins Company, 1925. 36. Lawson, W. E., and Reid, E. E.: Reactions of Bb′-Dichloroethylsulfide with Amino Compounds , J. Am. Chem. Soc. 47:2821, 1925.Crossref 37. Sollmann, T. : The Question of Induced Hypersusceptibility of the Skin to Mustard Gas , J. Pharmacol. & Exper. Therap. 12:319, 1918. 38. Berenblum, I., and Wormall, A.: Immunological Properties of Proteins Treated with Mustard Gas and BB′-Dichlorodiethyl Sulphone , Biochem. J. 33:75, 1939. 39. Berenblum, I.; Kendal, L. P., and Orr, J. W.: Tumour Metabolism in Presence of Anti-Carcinogenic Substances , Biochem. J. 30:709, 1936. 40. Jany, J., and Sellei, C.: Ueber die Wirkung einiger giftiger Gase auf den Stoffwechsel den der Zelle , Biochem. Ztschr. 275:234, 1935. 41. Peters, R. A.: Effect of Dichlordiethylsulphone on Brain Respiration , Nature, London 138:327, 1936. 42. Krumbhaar, E. B., and Krumbhaar, H. D.: J. M. Research 40:497, 1919 43. Pappenheimer, A. M., and Vance, M.: Effects of Intravenous Injections of BB′-Dichlorodiethylsulfide in Rabbits, with Special Reference to Its Leucotoxic Action , J. Exper. Med. 31:72, 1920. 44. Krumbhaar, E. B.: Role of the Blood and the Bone Marrow in Certain Forms of Gas Poisoning: Peripheral Blood Changes and Their Significance , J. A. M. A. 72:39 ( (Jan. 4) ) 1919. 45. Hektoen, L., and Corper, H. J.: Effect of Mustard Gas on Antibody Formation , J. Infect. Dis. 28:279, 1921. 46. Herrmann, H.: Influence of Pontocaine Chloretone on the Respiration and Glycolysis of the Cornea, 1941, to be published. 47. Bonnefon: L'œil ypérité. Son traitement , Gaz. hebd. d. sc. méd, de Bordeaux 60:168, 1939 48. Siècle méd. , (Sept. 1) , 1939 49. Gas Injuries to the Eyes, Special Articles , Lancet 2:756, 1939. 50. Dor, L.: Gaz de combat et brûlures des yeux , Arch. d'opht. 3:873, 1940. 51. Heinsius, E.: Experimentelle Untersuchungen über die Prophylaxe und Therapie der Gelbkreuzerkrankungen der Augen , in Heinsius, E.: Busch, H. G.: Stutz, E., and Reil, G.: Veröffentlichungen aus dem Gebiete des Marine-Samtätswesens , Berlin, Mittler, 1938 52. abstracted, Zentralbl. f. d. ges. Ophth. 43:389, 1939. 53. Pellathy, B.: Versuche zur Minderung der Senfgaswirkung , Szemészet 74:48, 1938 54. abstracted, Zentralbl. f. d. ges. Ophth. 43:346, 1939. 55. Lustig, A.: Effetti dei gas di guerra sull'occhio. Rivista sintetica , Boll. d'ocul. 13:685, 1934 56. abstracted, Zentralbl. f. d. ges. Ophth. 32:340, 1935. 57. Whiting, M. H., and others: Discussion on Gas Injuries of the Eyes , Proc. Roy. Soc. Med. 33:225, 1940. 58. Bickerton, R. E., in Discussion on Gas Injuries of the Eyes , Proc. Roy. Soc. Med. 33:235, 1940. 59. Stallard, H. B.: Improvised Eye-Irrigator for Use in the Field , Brit. J. Ophth. 24:53, 1940.Crossref 60. Bradbury, S.: Decontamination of Eyes Which Have Been Contaminated by Mustard Gas , J. Roy. Nav. M. Serv. 22:341, 1936. 61. Gas Casualties: Manual of Treatment , Great Britain, War Department, London, His Majesty's Stationery Office, 1930. 62. Rea, L., in Discussion on Gas Injuries of the Eyes , Proc. Roy. Soc. Med. 33:235, 1940. 63. Bursuk, G. G. : Zur Frage der Infektion des mit Dichlordiäthylsulfid affizierten Auges , abstracted, Zentralbl. f. d. ges. Ophth. 36:513, 1936. 64. Guyton, J. S.: Local Use of Sulfanilamide Compounds in the Eye , Am. J. Ophth. 24:292, 1941 65. Castroviejo, R.: Keratoplasty , Am. J. Ophth. 24:1 and 139. 1941.

Journal

Archives of Ophthalmology – American Medical Association

Published: Mar 1, 1942

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