Chemical casualties diagnosis

The differential diagnosis of mustard casualties on the battlefield after a known chemical attack is not difficult. The history of a chemical attack is useful, particularly if the chemical agent is known. Simply questioning the casualty about when the pain started, whether it started immediately after the exposure or hours later, is very helpful. Pain from Lewisite (the other vesicant that causes blistering) begins seconds to minutes after exposure pain from mustard does not begin until the lesion begins to develop hours later. 

In the absence of a biological detector or a particular characteristic of the aerosol (such as color or odor), diagnosis of an attack with trichothecene would depend on clinical observations of casualties and identification of the toxins in biological or environmental samples. This would involve a combined effort between the medical and chemical units in the field. The early signs and symptoms of an aerosol exposure to trichothecene mycotoxins would depend on particle size and toxin concentration. For a large-particle aerosol (particles > 10 pm, found in mist, fog, and dust similar to that used in Southeast Asia), the signs and symptoms would include rhinorrhea, sore throat, blurred vi-... 

Hughes, W.J., 1945b. The symptomatology and diagnosis of mustard gas injuries of the eyes Prepared for the Committee on Medical Research of the Office of Scientific Research and Development. Committee on Treatment of Gas Casualties, comp. Fasciculus on Chemical Warfare Medicine. National Research Council. Division of Medical Sciences, Washington, DC. 

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