Clinical Uses of 2,3-Dimercaptopropanol (Bal). Vii. The Treatment of Arsenical Dermatitis With Preparations of Bal

The development of 2,3-dimercaptopropanol (British Anti-Lewisite, BAL) by Peters, Stocken, and Thompson (1) has made available a potent antidote for arsenical poisoning.Study of the chemical combination of arsenic with sensitive en- zymes and cells indicated that the arsenic could, under certain circumstances, be removed from the cells, and that enzymes could be reactivated by the action of BAL (1, 2).BAL administered to ani- mals exerted both protective and therapeutic ef- fects against local and systemic injury by toxic arsenicals (1, 2).These observations strongly suggested that BAL might be useful in arsenical poisoning in man, and cautious trials were ini- tiated in this hospital at the end of 1942. METHODSPatients were admitted to a special ward which was in part arranged for the care of civilians employed at Edgewood Arsenal, under contract between the Johns Hopkins Hospital and the U. S. Employees Compensation Com- mission, and in cooperation with the Chemical Warfare Service.A detailed clinical study was made of these patients both before and after the administration of BAL.BAL was given by inunction in 1 to 10 per cent ointment (3) and later by intramuscular injection in 5 to 10 per cent solution in peanut oil containing benzyl benzoate (4).Dosage was at first varied and rather small because of the lack of information on the therapeutic and toxic ef- fects of BAL.Arsenic in the urine was determined by the method of Magnuson and Watson (5) in the laboratory of Dr. H. Eagle.Chemical analyses of the blood were made under the direction of Dr. Mary Buell.RESULTS