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Excerpt from The Residual Effects of Warfare Gases (1933)

Harry L. Gilchrist, M.D., and Philip B. Matz, M.D.

SUMMARY AND CONCLUSIONS
  1. Mustard gas as used during the World War affected particularly the skin, mucous membrane of the upper portion of the respiratory tract, and the eyes and their appendages. Secondary bronchopneumonia was a frequent complication and cause of death following mustard gas poisoning.

  2. The principal residua noted in the series studied were: Chronic bronchitis, emphysema, bronchial asthma, and certain chronic disabilities of the eyes, such as conjunctivitis, blepharitis, keratitis, and corneal opacities.

  3. A group of 89 living and 53 deceased ex-service men who had been gassed with mustard during the World War was selected for the study of residual effects. The standard of selection was on the basis of complete clinical histories, severity of gassing and aftereffects. A number of cases with a doubtful relationship of the disabilities to mustard gassing were also investigated.

  4. Of the 89 living cases included in the study it was found that 27 gave evidence of definite anatomic or symptomatic residua which could

From: Gilchrist HL, Matz PB. 1933. The Residual Effects of Warfare Gases. Washington, DC: U.S. Government Printing Office.



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OCR for page 335
Veterans at Risk: The Health Effects of Mustard Gas and Lewisite B Excerpt from The Residual Effects of Warfare Gases (1933) Harry L. Gilchrist, M.D., and Philip B. Matz, M.D. SUMMARY AND CONCLUSIONS Mustard gas as used during the World War affected particularly the skin, mucous membrane of the upper portion of the respiratory tract, and the eyes and their appendages. Secondary bronchopneumonia was a frequent complication and cause of death following mustard gas poisoning. The principal residua noted in the series studied were: Chronic bronchitis, emphysema, bronchial asthma, and certain chronic disabilities of the eyes, such as conjunctivitis, blepharitis, keratitis, and corneal opacities. A group of 89 living and 53 deceased ex-service men who had been gassed with mustard during the World War was selected for the study of residual effects. The standard of selection was on the basis of complete clinical histories, severity of gassing and aftereffects. A number of cases with a doubtful relationship of the disabilities to mustard gassing were also investigated. Of the 89 living cases included in the study it was found that 27 gave evidence of definite anatomic or symptomatic residua which could From: Gilchrist HL, Matz PB. 1933. The Residual Effects of Warfare Gases. Washington, DC: U.S. Government Printing Office.

OCR for page 335
Veterans at Risk: The Health Effects of Mustard Gas and Lewisite be attributed to mustard gassing. In one instance the relationship of gassing to present disabilities was questionable. Of the 53 deceased beneficiaries with a history of mustard gassing, in 11 instances death was an immediate result and in 4 instances a late result of mustard gassing. In 38 of the deceased cases death was not considered a result of mustard gassing. The principal residual disabilities of the positive cases noted 9 to 10 years after mustard gassing were: Chronic bronchitis and emphysema, bronchial asthma, chronic conjunctivitis, and corneal opacities. . (a) Cases with chronic conjunctivitis gave a history of an acute inflammation of the conjunctivae from the date of gassing, followed by continual symptoms referable to the eyes and the development of chronic conjunctivitis, blepharitis, keratitis, or corneal ulcerations and opacities. (b) Emphysema was frequently found in combination with bronchitis. It usually appeared immediately after gassing and was compensatory in character, due to the extensive atelectasis found following gassing with mustard. It may also have been due to the obstruction by the exudate or false membrane in the bronchi or bronchioli which brought about an imprisonment of the inspired air in the pulmonary alveoli and resulted in their distention. (c) Bronchial asthma as a residual disability following mustard gassing may be due to the following: Hypersusceptibility of the asthmatic subject to mustard gas. Irritation of upper or lower portions of the respiratory tract resulting in spasm of the bronchi or bronchioli and swelling of the mucous membrane. Such spasm and swelling interfere with normal inspiration and expiration. Anoxemia or prolonged shortage of oxygen and an increase of carbon dioxide due to interference with normal respiration may cause a degeneration of the myocardium. the latter in turn may result in abnormal heart action and abnormal respiratory effort. Of the 27 positive cases [only] 2 gave evidence of residual pulmonary tuberculosis following mustard gassing. In these two cases the histories indicate that a quiescent tuberculosis was present at the time of gassing and that, as a result of severe traumatism of the respiratory parenchyma by mustard gas and a lowered resistance, the latent tuberculosis foci became reactivated and a reinfection of the lungs followed. In the four cases in which death was due to a residual disability following mustard gassing, in one instance pneumonia was the cause of

OCR for page 335
Veterans at Risk: The Health Effects of Mustard Gas and Lewisite death and in three instances pulmonary tuberculosis. It is believed that gassing reactivated quiescent tuberculosis foci which ultimately resulted in an activity and extension of the tuberculosis disease and later resulted in death of the veterans. Of 38 men who had been gassed by mustard and subsequently died from various disease, in no way related to gassing, tuberculosis was the cause of death in 8 instances. One must not generalize on the relationship of mustard gassing to the development of tuberculosis. Each case must receive individual study for the purpose of establishing the part played by mustard gas in the inception of tuberculosis.