History of Use and Epidemiology of Mustard Compounds

  • Leila Etemad
  • Mohammad Moshiri
  • Mahdi Balali-MoodEmail author


Chemical warfare agents (CWAs) are synthetic chemicals that have toxic effects on plants, animals and humans. Sulfur mustard (SM) is one of blister agents which is synthesized by Belgian chemist Cesar Mansuète Despretz in 1822 for the first time. Victor Meyer, a Germania chemist, in 1886, completely described the chemical structure of SM. In the World War One, German army used SM for the first time against British soldiers in a field near Ypres Belgium. Nitrogen mustard (NM) was initially synthesized as a CWA, but has never been used as a chemical weapon. Different analogues of NM were made during the early twentieth century and some of them have been prescribed as chemotherapeutic medications. Spain was the first government that used SM against the Rif rebellion civilian in 1921–1926. Mussolini also ordered the Italian army to use SM against unprotected Ethiopian forces and civilian population in 1935–1936. Through 1963–1967, the Egyptian air force used CWAs and SM in Yaman. Although a large amount of SM was made during the World War II, fortunately it was not used during that war. Iraqi army used SM and other CWAs against Iranian forces and Iranian and Kurdish civilian in 1983–1988. The result of repeated Iraq’s chemical attacks during the 8 years of war was above 100 thousand casualties, of which almost 5000 were died. It was estimated that more than half of the chemical casualties were due to SM poisoning, but 32,000 of them have medical records and around 30,000 of them are now suffering from the delayed toxic effects of SM. The most tragic use of SM was the chemical bombardment of the city of Sardasht (a city in the northwestern border of Iran with Iraq) in spring of 1987 and Halabja (a Kurdish town in Iraq) massacre in 1988.


Sulfur Mustard Nitrogen Mustard Chemical Warfare Agents War History Iraq-Iran War Word War One Chemotherapy Blister Agents 



Aerial bomb

Is a type of explosive weapon intended to travel through the air with predictable trajectories, usually designed to be dropped from an aircraft.


Were the countries that opposed the Axis powers together during the Second World War. The Allies promoted the alliance as seeking to stop German, Japanese and Italian aggression.

Artillery shells

Is a payload-carrying projectile which, as opposed to shot, contains an explosive or other filling.


Is a category of cancer treatment that uses chemical substances, especially one or more anti-cancer drugs that are given as part of a standardized chemotherapy regimen.

CWA: chemical warfare agents

A chemical substance whose toxic properties are used to kill, injure or incapacitate human beings.


Officially known as the Federal Democratic Republic of Ethiopia, is a country located in the Horn of Africa.


The condition of being subjected to something, as to infectious agents, extremes of weather, radiation, or chemical agent which may have a harmful effect.

Geneva Protocol

The Protocol for the Prohibition of the Use in War of Asphyxiating, Poisonous or other Gases, and of Bacteriological Methods of Warfare is a treaty prohibiting the use of chemical and biological weapons in international armed conflicts.

Iraq – Iran war (19811988)

Is a conflict that started by Republic of Iraq offence to Islamic Republic of Iran at September 1980 and lasting to August 1988. It was initially referred to in English as the Gulf War.


An abnormal state that is essentially a poisoning.


Is the name applied to a group of blood cell tumors that develop from lymphatic cells.


It is an explosive device concealed under or on the ground and designed to destroy or disable enemy targets, ranging from combatants to vehicles and tanks, as they pass over or near it.

Nitrogen mustard (NM)

Is cytotoxic chemotherapy agent similar to mustard gas and can induce blister. Although their common use is medicinal, in principle these compounds can also be deployed as chemical warfare agents.


The Rif is a mainly mountainous region of northern Morocco.

Rif War (1921–26)

Was a conflict between Spanish colonial forces (later assisted by France) and Moroccan Berbers of the Rif mountainous region led by Muhammad Abd el-Krim.

Mortar bombs

Is a weapon that fires explosive projectiles known as (mortar) bombs at low velocities, short ranges, and high-arcing ballistic trajectories.


Is a missile, spacecraft, aircraft or other vehicle that obtains thrust from a rocket engine.


Is a city in and the capital of Zeydun District, in Behbahan County, Khuzestan Province, Iran.

Security counsel of UN

Is one of the six principal organs of the United Nations and is charged with the maintenance of international peace and security as well as accepting new members to the United Nations and approving any changes to its United Nations Charter.

SM: Sulfur mustard

A class of related cytotoxic and vesicant chemical warfare agents with the ability to form large blisters on the exposed skin and in the lungs.


The degree to which a substance can damage an organism.

World War One (WWI)

It is also known as the First World War or the Great War, was a global war centred in Europe that began on 28 July 1914 and lasted until 11 November 1918.

World War II (1939–1945)

Also known as the Second World War, was a global war that lasted from 1939 to 1945.

Yellow rain

Is airborne substance that was alleged to have been used in biological attacks and contains trichothecene mycotoxin (a poison produced by fungi that was known to have potential as a biological weapon).


  1. Ahmadi KH, Reshadatjoo M, Karami GH (2010) Evaluation of ptsd in sardasht survivors of chemical warfare(in persion). J Urmia Univ Med Sci 21(1):1–9Google Scholar
  2. Al Jazeera (2011) Syrian forces tighten grip ahead of protests. Al Jazeera and Agencies 06 May 2011Google Scholar
  3. Albright RD (2011) Cleanup of chemical and explosive munitions: location, identification and environmental remediation. Elsevier, AmsterdamGoogle Scholar
  4. Anonymous (2013) Sulfur mustard. Available at: on: 24, 1, 2015
  5. Anonymous (2014) Chemical weapons in the Rif War. Available at: Wikipedia, the free encyclopedia
  6. Balali-Mood M, Hefazi M (2005a) The clinical toxicology of sulfur mustard. Arch Iranian Med 8(3):162–179Google Scholar
  7. Balali-Mood M, Hefazi M (2005b) The pharmacology, toxicology, and medical treatment of sulphur mustard poisoning. Fundam Clin Pharmacol 19(3):297–315CrossRefPubMedGoogle Scholar
  8. Balali-Mood M, Moshiri M, Etemad L (2013) Medical aspects of bio-terrorism. Toxicon 69:131–42. doi: 10.1016/j.toxicon.2013.01.005
  9. Balali Mood M, Balali Mood B, Moshiri M (2014a) Non-lethal weapons. In: Wexler P, Greim H, Moser V et al. (eds) Encyclopedia of toxicology, 3rd edn. Elsevier Amsterdam, pp 603–608Google Scholar
  10. Balali Mood M, Balali Mood B, Moshiri M (2014b) Sulfur mustard. In: Wexler P, Greim H, Moser V et al. (eds) Encyclopedia of Toxicology 3rd Edition. Elsevier, Amsterdam, pp 427–431Google Scholar
  11. Balali Mood M, Moshiri M, Etemad L (2014c) Bio Warfare and Terrorism:Toxins and Other Mid-spectrum Agents. In: Wexler P, Greim H, Moser V et al. (eds) Encyclopedia of Toxicology 3rd Edition. Elsever, Amsterdam, pp 503–508Google Scholar
  12. Balfour S (2002) Deadly embrace: morocco and the road to the Spanish civil war. Oxford University Press, Oxford/New YorkGoogle Scholar
  13. Barker AJ (1971) Rape of Ethiopia, 1936 (Ballantine’s illustrated history of the violent century. Politics in action). Ballantine Books, New YorkGoogle Scholar
  14. Black RM (2010) History and perspectives of bioanalytical methods for chemical warfare agent detection. J Chromatogr B Analyt Technol Biomed Life Sci 878(17–18):1207–1215. doi: 10.1016/j.jchromb.2009.11.025 CrossRefPubMedGoogle Scholar
  15. Bouziane M, Miao F, Ye N, Holmquist G, Chyzak G, O’Connor TR (1998) Repair of DNA alkylation damage. Acta Biochim Pol 45(1):191–202PubMedGoogle Scholar
  16. Chauhan S, Chauhan S, D’Cruz R, Faruqi S, Singh KK, Varma S, Singh M, Karthik V (2008) Chemical warfare agents. Environ Toxicol Pharmacol 26(2):113–122CrossRefPubMedGoogle Scholar
  17. Cordesman AH, Wagner A (1990) The lessons of modern war, vol 2, The Iran-Iraq war. Westview Press/Mansell, BoulderGoogle Scholar
  18. Duchovic RD, Vilensky JA (2007) Mustard gas: its Pre-World War I History. J Chem Educ 84:944. doi: 10.1021/ed1084p1944 CrossRefGoogle Scholar
  19. Ellison DH (2007) Hand book of chemical and biological agent, 2nd edn. CRC Press, LondonGoogle Scholar
  20. Fette L (2012) Chemical clean-up 70 years on. Defence 2:28–29Google Scholar
  21. Geoghegan J, Tong JL (2006) Chemical warfare agents. Contin Educ Anaesth Crit Care Pain 6:230–234CrossRefGoogle Scholar
  22. Gilman A, Philips FS (1946) The biological actions and therapeutic applications of the B-chloroethyl amines and sulfides. Science 103(2675):409–436CrossRefGoogle Scholar
  23. Goodwin B (1998) Keen as mustard: Britain’s horrific chemical warfare experiments in Australia. Univ. of Queensland Press, St Lucia, QueenslandGoogle Scholar
  24. Graham JS, Schoneboom BA (2013) Historical perspective on effects and treatment of sulfur mustard injuries. Chem Biol Interact 206:512–522, Scholar
  25. Hadden L (2012) The geology of Yemen: an annotated bibliography of Yemen’s geology, geography and earth science. Army Geospatial Center, AlexandriaGoogle Scholar
  26. Hilmas CJ, Smart JK, Hill BA (2008) Chapter 2. History of chemical warfare. In: Lenhart MK, Tuorinsky SD (eds) Textbooks of military medicine, medical aspects of chemical warfare. The Office of the Surgeon General at TMM Publications, Washington, pp 9–76Google Scholar
  27. Hurst G, Tuorinsky S, Madsen J, Newmark J, Hill B, Boardman C, Dawson J (2007) Medical management of chemical casualties handbook, chemical casualty care division. U.S. Army Medical Research Institute of Chemical Defense (USAMRICD), New York CityGoogle Scholar
  28. Iranian Revolutionary Guards of the Islamic Revolution (1985) Excursion to the fifth year of the war (in persen). Iranian Revolutionary Guards of the Islamic Revolution – Public Relations, TehranGoogle Scholar
  29. Islamic Republic News Agency (1983) Special Reports, No. 243, 27.08. p. 6Google Scholar
  30. Iyriboz Y (2004) A recent exposure to mustard gas in the united states: clinical findings of a cohort (n = 247) 6 years after exposure. Med Gen Med 6(4):4Google Scholar
  31. Javed A (2001) Chemical weapons and the Iran-Iraq War: a case study in noncompliance. Nonprolif Rev 8(1):43–58CrossRefGoogle Scholar
  32. Javier R (2006) Durante la guerra del Rif (1921–1927), la última pesadilla colonial, España fue una de las primeras potencias en utilizar armas químicas contra población civil. Los últimos de Alhucemas (in Spanish). 20 minutosGoogle Scholar
  33. Jernigan DB, Raghunathan PL, Bell BP, Brechner R, Bresnitz EA, Butler JC, Cetron M, Cohen M, Doyle T, Fischer M, Greene C, Griffith KS, Guarner J, Hadler JL, Hayslett JA, Meyer R, Petersen LR, Phillips M, Pinner R, Popovic T, Quinn CP, Reefhuis J, Reissman D, Rosenstein N, Schuchat A, Shieh WJ, Siegal L, Swerdlow DL, Tenover FC, Traeger M, Ward JW, Weisfuse I, Wiersma S, Yeskey K, Zaki S, Ashford DA, Perkins BA, Ostroff S, Hughes J, Fleming D, Koplan JP, Gerberding JL (2002) Investigation of bioterrorism-related anthrax, United States, 2001: epidemiologic findings. Emerg Infect Dis 8(10):1019–1028CrossRefPubMedPubMedCentralGoogle Scholar
  34. John Aa T, Øyvind AV, Marita L, Aase MO, Leif Haldor B, Fatima H (2002) Investigation and risk assessment of ships loaded with chemical ammunition scuttled in Skagerrak (TA-1907/2002), FFI/RAPPORT-2002/04951, Norwegian Defence estabilished, OsloGoogle Scholar
  35. Kehe K, Szinicz L (2005) Medical aspects of sulphur mustard poisoning. Toxicology 214(3):198–209CrossRefPubMedGoogle Scholar
  36. Khateri S (2013) Chronic health effects of exposure to chemical warfare agents (cellular response to sulfur mustard exposure). University of Newcastle, Newcastle, p: 20–30Google Scholar
  37. Khateri S, Ghanei M, Palmer C (2004) Long-term psycho-social impact of a chemical weapons attack on the population of Sardasht, Iran. ASA Newsletter 04–3(102)Google Scholar
  38. Krumbhaar EB, Krumbhaar HD (1919) The blood and bone marrow in Yelloe cross gas (Mustard Gas) poisoning: changes produced in the bone marrow of fatal cases. J Med Res 40(3):497–508.3PubMedPubMedCentralGoogle Scholar
  39. Lvarsson U, Nilsson H, Santesson J (1992) A FOA briefing book on chemical weapons: threat, effects, and protection. National Defence Research Establishment, UmeåGoogle Scholar
  40. Mansour Razavi S, Salamati P, Saghafinia M, Abdollahi M (2012) A review on delayed toxic effects of sulfur mustard in Iranian veterans. Daru: J Fac Pharm Tehran Univ Med Sci 20(1):51CrossRefGoogle Scholar
  41. Marrs TC, Maynard RL, Sidell FR (1996) Chemical warfare agents, Toxicology and treatment. Wiley, TorontoGoogle Scholar
  42. Marsh K (2011) Syria’s biggest day of unrest yet sees at least 20 people killed Saturday 9 April 2011 Katherine Marsh Guardian News. Guardian NewsGoogle Scholar
  43. Moshiri M, Darchini-Maragheh E, Balali-Mood M (2012) Advances in toxicology and medical treatment of chemical warfare nerve agents. Daru: J Fac Pharm Tehran Univ Med Sci 20(1):81. doi: 10.1186/2008-2231-20-81 CrossRefGoogle Scholar
  44. Nutritional Biochemistry Inc (2013) History of Cancer Chemotherapy and Radiation. Available at: available date 20 Feb 2015
  45. OPCW (2014) Consignment of Sulfur Mustard Delivered to Latakia and Removed from Syria, available on : “”. available at: 20 February 2015
  46. Opresko DM, Young RA, Faust RA, Talmage SS, Watson AP, Ross RH, Davidson KA, King J (1998) Chemical warfare agents: estimating oral reference doses. Rev Environ Contam Toxicol 156:1–183PubMedGoogle Scholar
  47. Organisation for the Prohibition of Chemical Weapons (2015) Types of chemical agent, mustard agents: description, physical and chemical properties, mechanism of action, symptoms, antidotes and methods of treatment. Available at:
  48. Peano F, Bernardi M (2015) Mustard Gas and Chlorine toxicity, Available at:
  49. Pearson GS (1993) Veterans at risk: the health effects of mustard gas and lewisite. Edited by Constance. Available from: vol 365. Nature. vol 6443. National Academies Press (US), Washington
  50. Rosemond ZA, Beblo DA, Amata D (2003) Toxicological profile for sulfur mustard (UPDATE). The Agency for Toxic Substances and Disease Registry (ATSDR), AtlantaGoogle Scholar
  51. Saladi RN, Smith E, Persaud AN (2006) Mustard: a potential agent of chemical warfare and terrorism. Clin Exp Dermatol 31(1):1–5CrossRefPubMedGoogle Scholar
  52. Security Council of the United Nations (1986) Reports of specialists appointed by the Secretary General to investigate allegations by the Islamic Republic of Iran concerning the use of chemical weapons. New York: S/16433Google Scholar
  53. Security Council of the United Nations (1987a) Letter dated 30 June 1987 from the Charg’ d’affaires a.i. of the Permanent Mission of the Islamic Republic of Iran to the United Nations addressed to the Secretary-General. New York: S/18956Google Scholar
  54. Security Council of the United Nations (1987b) Letter dated 29 July 1987 from the Permanent Representative of the Islamic Republic of Iran to the Urlited Nations addressed to the Secretary-Genera. New York, S/19006Google Scholar
  55. Security Council of the United Nations (21 April 1988) Letter dated 20 April 1988 from the acting permanent representative of the Islamic republic of Iran to the United Nations addressed to the Secretary-General. New York: No. S/19816Google Scholar
  56. Shoham D (1998) Chemical and biological weapons in Egypt. Nonprolif Rev 5:48–58. doi: 10.1080/10736709808436720 CrossRefGoogle Scholar
  57. Sidell FR, Maynard RL, Marrs TC (2007) Chemical warfare agents: toxicology and treatment, 2nd edn. Wiley-Blackwell (an Imprint of John Wiley & Sons Ltd), LondonGoogle Scholar
  58. Smart JK (1997) Chapter 2. History of chemical and biological warfare: an American perspective. In: Zajtchuk R, Bellamy RF, Sidell FR (eds) Textbook of military medicine. Part I. Warfare, weaponry, and the wasualty. medical aspects of chemical and biological warfare. Borden Institute, Walter Reed Medical Center, Washington, pp 9–86Google Scholar
  59. Sun J, Zheng W (2012) 44 victimization of sulfur mustard in Qiqihar, case reports. Int J Clin Med 3:685–687CrossRefGoogle Scholar
  60. The Associated Press (2010) Crewman aboard mass. Fishing boat exposed to mustard gas. Available at:
  61. The U S Army Chemical Materials Activity (CMA) (2015) About CMA . Available at:, at 14/2 /2015 The U S Army Chemical Materials Activity (CMA)
  62. Wikipedia (2015) Chemical warfare. Available at: Available at: 23 January 2015
  63. Yan H (2012) Syria’s chemical weapon potential: what is it, and what are the health risks?Google Scholar
  64. Yekta H (2012) The widespread use of chemical weapons in the war by Iraq. Available at: Available on: 14 Feb 2015

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  • Leila Etemad
    • 1
  • Mohammad Moshiri
    • 2
    • 3
  • Mahdi Balali-Mood
    • 4
    Email author
  1. 1.Pharmaceutical Research Center, Mashhad University of Medical SciencesMashhadIran
  2. 2.Pharmacodynamics and Toxicology DepartmentFaculty of Pharmacy, Mashhad University of Medical SciencesMashhadIran
  3. 3.Health Insurance Research OfficeArmed Forces Insurance Organization of Islamic Republic of Iran (Mashhad Branch)TehranIran
  4. 4.Medical Toxicology Research Centre, Faculty of MedicineMashhad University of Medical SciencesMashhadIran

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