However if those killed in the air battle are included, the figure would be larger than those killed by illness. The high disease rate is likely due to the tropical conditions in the Pacific theatre, where illnesses such as malaria and dysentery resulted in high casualties. For comparison, here's the first world war figures where illness only accounted for 6. The number of deaths from wounds was significantly reduced between the two world wars, however, as penicillin and the production of blood plasma for transfusions became available. With the rank included, we can get a sense of how things are different between those with officer status and other ranks.
Both the number and proportion of non-officer rank deaths is higher than officer ranks — which isn't unexpected. Officer ranks had a higher proportion of deaths in the second world war than they did in the first world war, probably due to the increased presence of the air force. The second-highest cause of death for officer ranks was in the air. Turn autoplay off Turn autoplay on. Jump to content [s] Jump to comments [c] Jump to site navigation  Jump to search  Terms and conditions .
News Datablog. Australian war deaths: a graphic analysis of more than , records Analysis of Australian deaths during conflicts also shows more troops killed fighting for Broodseinde Ridge in Belgium than at Anzac Cove landing. Nick Evershed. Send to a friend. Sender's name.
Contact us. Report errors or inaccuracies: userhelp theguardian. If you need help using the site: userhelp theguardian. Here's the total deaths per day since the late s — note that I've used a log scale in increments of 1, 10, , so small numbers are visible: The worst single day occurred during the first world war, on 4 October, By comparison the landing at Anzac Cove on April 25, resulted in at least deaths.
It was particularly bad during the second world war, as this breakdown of cause of death by conflict shows: Illness was the highest cause of death listed — more than those killed in action, with However, it is the concentration and cumulative exposure to an unprotected target tissue e. Sections of this chapter to follow contain estimates and analysis of the probable cumulative exposures achieved in the chamber and field tests, as well as occupational situations.
Information on the specific protocols used in patch tests was obtained from a variety of sources, including archived materials from the NRC. It should also be noted that some subjects participated in tests in which only the protective ointments were applied to test skin sensitivity to the ointments themselves many of the ointments were found to be highly irritating and corrosive to the skin. Analysis of the amounts of vesicant used was difficult, however, due to great variability in reporting of concentrations and cumulative exposures in individual experiments.
There were three types of delivery systems for patch testing. One type was called ''Edgewood Rods," which were stainless steel rods with tips of varying diameters that were dipped into liquid sulfur or nitrogen mustard, or Lewisite, and then touched to the skin of a subject, usually on the forearm. A second type, "drod," was constructed from a small syringe that could deliver a measured amount of liquid to the skin.
Various types of "vapor cups" were also used. The most common was the Edgewood Vapor Cup, a small glass cup similar to a beaker in which a section of filter paper saturated with liquid vesicant was placed. The cup was placed on the skin, allowing the vapor to rise from the filter paper and contact the skin. The cumulative exposures achieved in the vapor cups have been estimated to be 40, to 78, Ct.
In some experiments, vapor cups were left on the skin for 15 minutes; in others, the cups were applied every 5 minutes for up to 3 hours and 40 minutes; in yet others, the cups were left on for more than an hour. Liquid patch tests, employing rods or drods, were more common than vapor cup tests and exhibited a wide variability in cumulative exposures. Most of these experiments involved the application of liquid vesicant either before or after some test ointment.
Most often, there were two or more sites on the forearm to which the vesicants were applied, thus providing for control sites at which no ointments were applied, and the liquids were allowed to remain on the skin for up to 2 minutes. The amounts used in these types of patch tests ranged from 0.
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In some experiments, concentrations were expressed in micrograms. In still other experiments of this type, concentrations were also expressed as dilutions, ranging from to , sulfur mustard, or Lewisite, to solvent. To further complicate analysis, a number of different solvents were used, including benzene, alcohol, paraffin oil, and chloroform. However, these sources are not exhaustive, and the details of chamber tests in locations such as Edgewood Arsenal and Great Lakes Naval Training Center were not made available to the committee for evaluation.
Further, only the NRL has maintained accurate records of the individuals who participated in the tests close to 2, men. Lacking similar information from the other locations, the total number of individuals involved in chamber tests is unknown. The vast majority of those participating in chamber tests were Caucasian men.
A small number of African American and Japanese American soldiers were recruited for tests to determine possible differential skin effects of sulfur mustard on members of these races. Similar to patch tests, there were a variety of types of chamber tests. For some chamber tests, the major questions were how long, under what conditions of temperature, and under what concentrations of gas would chloramide- or activated carbon-impregnated clothing afford protection of personnel against chemical attack with vesicants.
The vesicant used most often was sulfur mustard, but nitrogen mustard and, probably, Lewisite were also used. These tests were called "man-break" tests. The common procedure was to equip men with gas masks 2 and clothe them in the impregnated suits see Figure The men would then enter the gas chamber Figure and remain there for periods from 60 minutes to 4 hours. Following the period in the chamber, the men wore their gas masks for an additional 5 minutes and remained in the suits for additional periods of time, ranging from 4 to 24 hours 3 Taylor et al.
Navy, of the Bibliography for a complete listing of NRL reports examined. Twenty-four hours after each chamber trial, the men were examined for reddening of the skin erythema , evidence that the vapor had penetrated the suits and burned the skin. The men were required to repeat the procedure and enter the chambers either every day or every other day until they developed moderate to intense erythema. The number of trials tolerated depended largely on the vesicant concentration in the chambers. For example, a technical report by Taylor and his colleagues documents a specific set of minute trials in which, at a cumulative sulfur mustard exposure level of Ct per trial, the average number of trials tolerated was 5.
In trials with cumulative exposures of 9, Ct per trial, the average number of trials tolerated was estimated at two, because all the men developed some erythema after the first trial. Naval personnel dressed for World War II sulfur mustard experiments. Gas masks shown are Navy diaphragmtype masks. Photograph provided by Naval Research Laboratory.
Interior dimensions of this chamber were 10 ft. The chamber was designed to fit ten men and allow room for moderate exercise. B Photograph of the inside of a similar more The anatomical locations and intensity of erythema are reported in Taylor's paper for each individual. The majority of men experienced intense erythema that was widespread over their bodies, especially in moist areas of skin folds, such as behind the knee and under the arms, in large areas of the chest and shoulders, and on their arms and legs. Little involvement of areas such as the scrotum and buttocks was reported for this particular set of trials, possibly because the men wore an extra layer of impregnated undergarments.
In another set of trials reported by Heinen and his colleagues , multiple cumulative exposure levels ranged from 50 to Ct. In these experiments, the subjects were engaged in different levels of physical activity before, during, and after the chamber trials. No data, however, are included regarding the tests in which activity was performed inside the chambers. Significantly, subjects in this set of trials were not completely dressed in protective clothing.
Most were dressed in standard issue attire but wore carbon-impregnated suspenders. It was thought that the suspenders would protect a strip of skin that could then be compared with skin areas that were unprotected. In addition, only a few men were given impregnated underwear. Results from this set of trials are documented with photographs that show burns to the genital areas of many of the men. In one series, of 24 men participating, 13 experienced crusted lesions to the scrotum that were characterized as severe, and 8 experienced severe lesions to the penis. These lesions took up to one month to heal, according to the report.
In general, these two reports are representative of many of the chamber tests conducted at NRL Washington, D. The concentrations, times of exposures, and types of chemical agents used in other locations may not be similar, however, and full reports of other chamber tests were not made available to this committee. There is evidence that some chamber tests may have been done with higher cumulative exposures, because Taylor and colleagues refer to ranges of 3, to 11, Ct of sulfur mustard used at Edgewood Arsenal. Chamber tests were also conducted in Panama, North Carolina, and Maryland.
These tests were called "wear tests," designed to see how the impregnated clothing stood up to use under possible combat conditions. Thus, the men wore the protective suits during drills and combat simulations, ranging from 1 day of amphibious training to 6 weeks of simulated combat.
Following this, the men entered gas chambers in these suits, for minute trials as in the man-break tests , until erythema developed. These data are difficult to compare with other chamber tests, however, because only micrograms of sulfur mustard were reported without the usual accompanying notation regarding volume. If one assumes that the micrograms listed were per liter, then the exposures ranged from to 2, Ct in this series of chamber trials.
Finally, some men participated in arm chamber tests of protective ointments or clothing materials. In these, the arms of the men were placed in a wind tunnel with cumulative exposures reported to be 1, Ct. Some physiological measurements, including temperature and blood counts, were done on men participating in some of the tests, but these physiological measurements were not generally reported in the technical summaries. For those men who participated in Naval Research Laboratory tests, records of the experimental conditions, as well as any physiological measurements, were kept for each test subject and are available from NRL to individuals through the Freedom of Information Act also see Chapter 4.
Many field tests with mustard gas were conducted with human subjects, but relatively little information is available. Apparently, 1, U. There is also evidence that some U. The cumulative exposures reported for these tests ranged from 50 to 10, Ct. Some of these tests may have contributed data to the summary mentioned above. Appendix VIII of the conference report outlines field tests in which bombing runs dropped from to tons of sulfur mustard over a specified area.
Subjects wearing varying levels of protective clothing traversed the area in simulated patrols from 1 to 72 hours following the bombing. Such a protocol required the men to drop to the ground intermittently, thus coming into direct contact with contaminated surfaces. The resultant injuries were classified on the basis of the men's probable fitness for combat. Evidence of accidents during such trials can also be found in CWS documents. For example, one note describes how a group of men involved in a field test removed their gas masks after a rain storm and within two hours experienced ocular pain; three were hospitalized with acute conjunctivitis Adler, Preparations for chemical warfare before and during WWII involved many additional people in the production, handling, shipping, and training to use and defend against chemical warfare agents.
By the end of the war, the four CWS production facilities had produced close to million pounds of ordinary sulfur mustard H and over 9 million pounds of distilled, purified sulfur mustard HD Brophy et al. An additional 40 million pounds of Lewisite and , pounds of nitrogen mustard were produced. Once produced, the agents were shipped to various storage facilities, depots, and proving grounds around the United States and were shipped overseas through ports such as Seattle, New York, New Orleans, and others. This elaborate network of supply, coupled with the needs for training and chemical weapons testing, required many people from both the military and the civilian sectors.
In , CWS listed enlisted men on its personnel rolls; this number grew to over 5, by December and over 61, by June Some 17 percent of military personnel assigned to CWS units were African Americans, a very high percentage when compared to all other units of the War Department. Civilian workers numbered 7, at the beginning of the war and 28, by , of whom 40 percent were female and 45 percent were African Americans.
The latter percentage was lower at the Rocky Mountain Arsenal, where there were fewer African Americans available from the surrounding community Brophy and Fisher, Although many of the specific jobs performed by these military and civilian personnel did not involve handling of, or even proximity to, warfare gases, the number of documented injuries was quite high.
CWS, in fact, had the worst safety record of any branch of the War Department in both and , the peak years of production Brophy and Fisher, According to these authors, the safety record improved considerably after that, becoming among the best in the War Department by the end of the war. Nevertheless, the dismal safety record meant that many injuries were themselves studied by those involved in the CWS research branches or in studies contracted under NRC's Committee on Treatment of Gas Casualties.
One study of these accidental injuries, reported that over 1, cases of mustard poisoning, resulting in eye, ear, nose, and throat symptoms, occurred at Edgewood Arsenal over a two-year period Uhde, Of these, were eye injuries; these injuries occurred to both males and females. Slow leaks of mustard vapor accounted for close to 80 percent of the problems.
An additional 7 percent were from short-term exposures and accidents, such as explosions and mistaken use of real mustard in training exercises designed for simulated gas exposure.
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While the study did not present adequate information with which to judge the overall severity of injuries, it does report one death from sulfur mustard poisoning during this period. Little information is available from other locations, but Cochrane noted that during the first two weeks of December , patients were treated for eye and respiratory tract injuries from exposure to chemical warfare agents, especially sulfur mustard. The CWS locations where these injuries occurred were not reported.
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Finally, there is anecdotal evidence that the atmospheric concentrations of sulfur mustard around manufacturing areas at Edgewood Arsenal exceeded the odor threshold concentrations and thus may have been high enough to cause physiological effects Howard Skipper, personal communication; see also Appendix A. It is important to note that CWS personnel were exposed to a variety of toxic materials. For example, in addition to mustard agents, gases such as phosgene a choking agent , hydrogen cyanide and cyanogen chloride blood poisoning agents , and chloroacetophenone tear gas were also produced at the arsenals.
Other personnel were involved in biological warfare research and production, in locations such as Fort Detrick, Maryland, and a civilian plant in Terre Haute, Indiana Brophy and Fisher, Chemicals including napalm and white phosphorus were also stored and packed into bombs by CWS personnel. Even the production and testing of gas masks and filter canisters involved the use of toxic chemicals such as asbestos.
Under conditions of secrecy, 2, bombs, each of which held 60 to 70 pounds of sulfur mustard, had been loaded on the merchant marine ship S. John Harvey before it had sailed from Baltimore to Bari. During the raid on Bari harbor, the John Harvey was sunk and some of its load of mustard bombs was damaged, causing liquid mustard to spill out into water already heavily contaminated with an oily slick from other damaged ships. Men who abandoned their ships for the safety of the water became covered with this oily mixture that provided an ideal solvent for sulfur mustard.
The casualties were pulled from the water and sent to medical facilities unaware of what they carried with them on their clothes and skin. Equally unaware were the medical personnel who treated these casualties. Before a day passed, symptoms of mustard poisoning appeared in both the casualties and the medics. This disturbing and puzzling development was further compounded by the arrival of hundreds of civilians for treatment; they had been poisoned by a cloud of sulfur mustard vapor that blew over the city from some of the bombs that had exploded when the ship sank.
As the medical crisis worsened, little information was available about what was causing these symptoms. Eventually, however, the secret could not be kept Harris and Paxman, The destroyer U. Bistera, well outside the harbor and undamaged by the raid, had pulled 30 men from the water in a rescue effort.
By the next day, the officers and crew of the Bistera were blinded from the effects of the sulfur mustard carried onto the ship by those rescued.
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Bari was overloaded with casualties by then, and the Bistera and its crew struggled to nearby Taranto for treatment. Soon the U. With the assistance of Colonel Stewart Alexander, a military physician with extensive knowledge of mustard poisoning, better precautions and treatment were begun. By the end of the disaster, over victims of mustard poisoning were treated from the harbor area alone; of these, 83 died Alexander, Close to 1, civilians from the town also died Harris and Paxman, Unfortunately, no long-term medical follow-up of survivors of the Bari harbor disaster has been reported.
As history has repeatedly shown, the experience of medical personnel and researchers in wartime can lead to major innovations in medical treatment practices. Such was the case with chemical warfare research in WWII. Numerous advances were made in the treatment of metal poisoning, development of antibiotics, treatment of burn injuries, and other areas. Many of these advances were reviewed soon after the war in a two-volume summary Advances in Military medicine Andrus et al.
The story of the use of nitrogen mustard as a cancer chemotherapy agent is especially relevant to the present report. Nitrogen mustards were first synthesized in the s. These compounds were modifications of sulfur mustard and were found to have greater systemic toxicity than sulfur mustard Gilman and Philips, ; OSRD, Particularly potent was the effect of nitrogen mustard on cells that are actively proliferating, including the lymphoid tissue, bone marrow, and certain cells lining the gastrointestinal tract.
Under this contract, Louis C. Goodman headed a group that was responsible for the study of the pharmacologic effects of nitrogen mustards. The group, including Alfred Gilman, Frederick Philips, and Roberta Allen, focused its efforts on the study of the cytotoxic properties of nitrogen mustard. Enlisting the help of anatomist Thomas Dougherty, the group expanded its work to examine the effect of nitrogen mustard on experimental tumor cells in mice.
It was found, but not published until later, that systemic administration of nitrogen mustard caused dramatic regression of these mouse tumors. These data formed the experimental basis of the first clinical trials of nitrogen mustard as a cancer chemotherapy agent Gilman, , ; Gilman and Philips, ; Rhoads, Although the concept of chemotherapy does not seem radical today, in the idea of injecting poisons into cancer patients, especially poisons marked ''compound X" due to their classified status, would have been viewed by most physicians as "the act of a charlatan" Gilman, With the help of Gustav Lindskog however, clinical trials were begun in December with a patient dying of lymphosar-coma for whom all other treatments had failed.
The patient's tumors regressed, the outlook brightened, and another patient was begun on the nitrogen mustard therapy. In all, six patients made up this first trial. However, as had happened in the animal studies, the tumors reappeared as the bone marrow recovered, and no long-lasting cure was attained. The challenge remained to establish the regimen of therapy that would kill the cancer cells completely, yet preserve enough of the bone marrow to regenerate needed healthy cells.
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In addition, there was no reason to assume that all types of cancer cells would be equally affected by nitrogen mustard therapy. The Yale group dispersed in June , but clinical trials with nitrogen mustard continued in several other locations. By , close to patients in the terminal stages of Hodgkin's disease, lymphosarcoma, or certain leukemias had been treated with this agent Gilman and Cattell, The best results were obtained in cases of Hodgkin's disease. Derivatives of nitrogen mustard hydrochloride forms are still used today, particularly for treatment of lymphoma, in a regimen that includes an array of other drugs and chemicals administered with the nitrogen mustard see also Chapter 6.
The vast majority of the post-WWII research concerning mustard agents and Lewisite has been done in animal studies or in model systems, such as skin tissue culture. This research has been aimed toward the development of pretreatments to prevent mustard toxicity or toward improved treatments against acute poisoning. Emphasizing these issues, Papirmeister and colleagues reviewed the literature on sulfur mustard in , including consideration of all such work published up to For the purposes of the present report, discussion is confined to only those research programs that used human subjects.
Very little research was done during the period between and , and by the time research in chemical and biological weapons was revitalized in the s, military priorities had shifted to agents perceived to pose greater threats than sulfur mustard or Lewisite. For example, improvements to early nerve gases developed in WWII gave new importance to the development of antidotes to nerve agents.
Chemicals with intense psychoactive properties, such as lysergic acid diethylamide the hallucinogen LSD and phencyclidine PCP, known on the street as "angel dust" were also of special interest. Most of this research was done at or supervised by personnel from Edgewood Arsenal; it involved approximately 6, human subjects between and Only a few projects tested sulfur mustard or Lewisite. As has been documented in numerous government and popular press publications, abuses of human subjects in these research programs began to emerge almost as soon as the projects were begun but were largely covered up until the early s Harris and Paxman, ; Taylor and Johnson, ; see also Appendix F.
Finally, congressional hearings into these abuses in and resulted in fuller disclosures, eventual notification of all subjects as to the nature of their chemical exposures, and compensation of a few families of those who had died while serving as human subjects in these projects Harris and Paxman, ; Taylor and Johnson, As part of its effort to rectify the abuses discovered, the Department of the Army asked the National Research Council to assess the likelihood of long-term health consequences of exposure to the chemicals tested and to report on the current health status of the soldiers who participated in the testing programs.
The resulting study was published in three volumes in , , and The vast majority of these test subjects, however, had been exposed to nerve agents or hallucinogenic drugs. In the volume, the NRC committee reported that only individuals had been exposed to vesicants. In a section on vesicants, no conclusions were drawn for Lewisite on the basis of scanty information; for sulfur mustard, however, the group concluded:. Mustard gas is mutagenic in various organisms and test systems. One cannot readily predict the degree of genetic risk that it poses for man, however, because data on its mutagenicity in mammalian germ cells are very limited, and the mutagenic potency of mustards varies considerably among assay systems.
Nevertheless, the available evidence suggests that the possibility of mutagenic effects of mustard gas in human germ cells should not be disregarded. The clear mutagenicity of mustard gas in various assays is consistent with its carcinogenic potential. Mustard gas is not only a vesicant, but also a systemic poison. Its acute effects have been demonstrated in bone marrow, intestinal tract, and respiratory tract.
It can cause blindness and permanent skin scarring with a potential for skin tumors. It probably can also cause acute and chronic bronchitis. Other nonmalignant chronic effects have not been adequately documented. Single exposures, even if severe, as in military service, are not associated with statistically verifiable increases in mortality from tuberculosis and cancer; but repeated small exposures, such as occur in industrial operations, do increase cancer deaths significantly.
The NRC committee's report summarized the investigations of the current health status of test subjects and concluded that the number of subjects exposed to mustard gas was too small to detect any long-term health effects. Also cited were the only long-term follow-up studies of WWI sulfur mustard casualties. Overall mortality and morbidity data for a sample of men treated for sulfur mustard injuries in American Expeditionary Forces hospitals from August through November revealed a slightly increased incidence of lung cancer among gassed veterans, but this increase was not sufficiently high for statistical significance Beebe, A further study of this cohort 10 years later did not alter these results Norman, Military use of sulfur mustard was a topic at the Paris Conference on the Prohibition of Chemical Weapons in January Due to continued use of these weapons around the world, however, chemical weapons bans remain an ongoing issue of negotiation at the current chemical convention talks in Geneva, Switzerland.
This document reports use of sulfur mustard by the Egyptians in Yemen in and the Iraqis against the Kurds in Numerous reports of use of other agents, including tear gas, smokes, and herbicides, are also reported. Additional reports have surfaced of use of sulfur mustard by the Vietnamese in Cambodia and Laos between and Medema, Probably the greatest use of sulfur mustard, however, has been in the ongoing conflicts between Iran and Iraq, and many of these incidents have been confirmed D'Halluin and Roels, ; Dunn, a,b; Heyndrickx and Heyndrickx, ; Mandl and Freilinger, ; Medema, ; Physician's for Human Rights, ; Requena et al.
Some of the Iranian casualties were treated in European hospitals and thus could be documented medically. These patients suffered from pulmonary, eye, and skin lesions at similar incidence levels as battlefield casualties from WWI. In WWI, 80 to 90 percent of sulfur mustard casualties suffered skin lesions, 86 percent suffered eye involvement, and 75 percent had pulmonary damage Sidell and Hurst, Among the Iranian casualties, 83 percent suffered skin lesions, 92 percent had eye problems, and 95 percent had pulmonary damage Balali-Mood and Navaeian, There are also sketchy data that indicate that some Iranian soldiers may have been exposed to Lewisite.
London physicians who examined and treated the lesions of these soldiers reported that the signs exhibited were similar to those associated with Lewisite, rather than sulfur mustard Perera, For example, pain occurred very quickly following vapor exposure, and skin lesions showed none of the pigmentation changes characteristic of sulfur mustard exposure. In addition, the victims reported that the agent did not smell like garlic, as does sulfur mustard.
The U. Pacific Territory , is under congressional mandate for destruction Carnes, ; Carnes and Watson, Lewisite is stored in only one location, Tooele Army Depot, in ton containers. Although the locations listed here are the official storage facilities, it is not known on how many former military bases small amounts of agents such as sulfur mustard were left or buried when the bases were deactivated. For example, it was recently discovered that a dumping site, used to dispose of gallon drums of sulfur mustard in the mids, now lies near a large business complex in Edison, New Jersey Gallotto, This site may be one of many located on what was once the Raritan Arsenal, where reports of former soldiers claim that toxic chemicals were poured into pits, along with the emptied drums and shells, treated with lime, and covered over with soil.
Such reports are not only relevant to the issue of toxic waste from chemical weapons production in this century; they also point out locations, not apparent in official CWS histories, where military and possibly civilian personnel were exposed to chemical agents during WWII. In response, DoD established the Chemical Stockpile Disposal Program in , but the target completion date has been postponed to Unitary munitions contain a lethal chemical agent at the time the munition is loaded; in contrast, binary munitions contain agent precursors that mix and react to form lethal agent after the munition is fired.
The unitary stockpile includes the vesicant agents sulfur mustard and Lewisite, as well as organophosphate nerve agents. All but approximately 6 percent of the U. Approximately 60 percent of the unitary stockpile tonnage is stored in bulk as ton containers, spray tanks, or similar large containers. The remainder is stored on Johnston Island, including the North Atlantic Treaty Organization's stockpile that was moved in from a military site near Clausen, Germany.
DoD has tested, considered, and discarded a number of proposed disposal methods in favor of high-temperature incineration Carnes, ; Carnes and Watson, ; U. Department of the Army, The first step in this approach involves "reverse assembly" of the munition inside an explosive-containment room, resulting in the separation of agent from any explosive materials and munition hardware or containers.
These different fractions are sent to separate incinerators, and materials are incinerated by a specially designed system using four two-staged furnaces a furnace and an afterburner for each component e. Stack gases and incinerator ash are treated in advanced pollution-abatement systems intended to ensure safe handling and eventual disposal in a hazardous waste facility see Carnes, , for details of emission control systems. Incineration remains a matter of continuing controversy among environmental groups, citizens who live near some of the proposed incineration sites, and the involved government agencies.
The Programmatic Environmental Impact Statement, released by the Department of the Army in , concludes that timely disposal of the stockpile of chemical weapons entails less of a hazard than continued storage. Technical support and oversight for the Chemical Stockpile Disposal Program and the companion Chemical Stockpile Emergency Preparedness Program that assists nearby communities in developing emergency preparedness programs is provided by numerous Army commands and a host of civilian institutions.
Environmental Protection Agency, U. Analyses of vesicant toxicity and long-term health risks from these groups have been considered, along with other information, in generating the present report. The committee reached two principal conclusions based on its analysis of the chemical warfare testing programs from WWI through These conclusions relate directly to the estimated level of exposure to mustard agents and Lewisite experienced by the WWII chamber and field test subjects and to the exposures of workers in the Chemical Warfare Service during WWII. In addition, the committee's conclusions are pertinent to the health care concerns of those who have been injured by use of these agents in recent wars and conflicts, or who may be exposed in the future from belligerent use of these agents or through accidental exposure during their disposal.
The lack of follow-up health assessments of the human subjects in WWII gas chamber tests and field tests severely diminished the amount and quality of information that could be applied in the assessment of long-term health consequences of exposure to mustard agents and Lewisite. Although the reasons underlying the lack of follow-up health assessments are not explicit from the numerous documents and materials considered by this committee, a number of factors may have played a role:. The levels of exposure to mustard agents or Lewisite experienced by the test human subjects may have been much higher than inferred in the summaries of the experiments and field tests.
As in all chemical exposures, such exposure levels directly relate to the types and severities of exposure-induced injuries and diseases. One can infer the cumulative exposures to the skin of chamber subjects strictly on the basis that skin damage was the end point of these experiments see Table Therefore, if all other types of exposures were held to zero, these subjects received between and Ct. As has been documented, some of the subjects were hospitalized for as long as "a month or so" Taylor et al. Thus, exposures to the skin may have been as high as 1,, Ct. Under the hot, humid conditions in the chambers, however, lower exposure levels would have resulted in similar injuries Papirmeister et al.
The dose to the skin from such exposures would have been as high as those observed under battlefield and occupational conditions. Further, some sulfur mustard would also have been absorbed from the skin into the systemic circulation. In the chamber experiments, unmasked subjects were required to remain in their protective clothing from 4 to 24 hours following chamber trials, allowing ample opportunity for additional contact and inhalation exposures from contaminated surfaces and clothing.
Another factor that probably resulted in some inhalation exposure of subjects in the chamber tests was vomiting during the period subjects were in the chamber. This was reported by at least one of the subjects who spoke at the public hearing; this person reported conjunctivitis and laryngitis following such a vomiting incident on his seventh day of testing Elmer Hood, public hearing statement; see also Appendix G. Vomiting presumably would result in removal of the mask while in the chamber, with a resulting inhalation exposure of unknown duration at the chamber concentration being tested.
The most important route of additional exposure in the chamber and field tests was probably gas mask leakage. From the information available to the committee, it appears that the vast majority of the human subjects in the chamber and field tests wore full-face gas masks during their exposures. In fact, the documented exposures at the Naval Research Laboratory were delivered at concentrations and for durations that would have caused lethal respiratory effects if the subjects had not been equipped with respiratory protection.
Thus, exposure of the respiratory tract and eye to the agent would have depended on the protection factor PF afforded by the gas masks. The PF of a full-face respirator e. A PF of equals a penetration of 1 percent of the contaminant into the mask Adley and Uhle, A PF of 50 to , based primarily on leakage around facemasks, has been reported for relatively modern post-WWII full-face respirators Hyatt, Estimates from industrial hygiene research, however, indicate that the level of protection achieved in actual use of a respirator is usually below the stated PF for that respirator National Institute of Occupational Safety and Health, Thus, modern respirators are likely to function closer to the lower PF estimate of At even lower concentrations—under the odor threshold 0.
Information on the breakthrough capacity of the gas mask cartridges used in the WWII chamber tests was not available to the committee, but it is known that prolonged use of cartridges can result in breakthrough of the agent by exceeding the capacity of the absorbent filter material Stampfer, Even when enough agent had broken through their gas mask canisters to produce symptoms, chamber test subjects may not have noticed it, at least by odor. The odor more These masks were probably equipped with M9A1 prior to July or M9A2 canisters that contained Whetlerite, a copper-, chromium-, and silver-impregnated activated charcoal as the sorbent Brophy et al.
The PF afforded by these masks for sulfur mustard or Lewisite was not available to the committee. Yet some chamber tests were conducted at high concentrations. Even an assumed PF of 1, for the gas mask 10 times greater than that estimated for modern full-face respirators would have resulted in concentrations as high as 0.
This would have been below the odor threshold for sulfur mustard and, over five trials, would have resulted in a cumulative inhalation exposure of 30 Ct, enough to cause signs and symptoms in the eyes and respiratory tract see Table If a more realistic estimate is used, such as a mask with a PF of , the per trial exposure would have been 60 Ct. Over five trials then, a subject could have had an inhalation exposure of Ct, more than sufficient to cause an incapacitating injury see Table It is important to remember that any such inhalation exposure would have been in addition to any skin exposure through breakdown of the protective clothing.
It is important to note also that the gas masks and clothing used in the NRL tests were worn repeatedly by the subjects. In at least one series of studies, it was reported that the rubber of the gas mask facepieces and connecting tubes absorbed enough sulfur mustard after 12 to 15 exposures to cause conjunctivitis, laryngitis, and erythema of the face Taylor et al.
Therefore it is clear that some exposure to the respiratory tract occurred from absorption of sulfur mustard on masks. Finally, as mentioned previously, the special diaphragm element in the types of gas masks used in the NRL chamber tests was eventually shown to provide an additional route of mask leakage, independent of the filter capacity Brophy et al. The presence of erythema of the face, conjunctivitis, laryngitis, or bronchitis within 24 to 72 hours following an exposure to sulfur mustard or Lewisite would be clear evidence that a significant inhalation and eye exposure had occurred, even if the subject was wearing a mask during the exposure.
Conversely, it would appear that a lack of such symptoms following even a low-level exposure of 5 to 6 days to sulfur mustard would indicate a cumulative exposure Ct of less than about 12 Ct see Table However, in terms of the Centers for Disease Control's estimates of permissible exposure levels CDC, , the exposures actually reaching the breathing zone of chamber subjects from the above example, 0. In reality, some of the subjects in the chamber tests and field trials almost certainly breathed concentrations 10 or more times the 0.
The focus here on chamber and field test subjects is not meant to discount the probable exposure levels experienced by those who were involved in the production or handling of mustard agents and Lewisite. Indeed, as outlined above, the poor safety record of the Chemical Warfare Service during the peak years of production, the high rate of agent-induced injuries, and the anecdotal reports of perceptible odors of sulfur mustard in the manufacturing areas argue that workers and gas handlers were often exposed to levels of mustard agents and Lewisite sufficient to cause short- and long-term health effects.
Thus, these individuals should also be considered at risk for any of the adverse health effects this report identifies. In conclusion, the dose of sulfur mustard to the skin, eye, and respiratory tracts of the human subjects was substantial, especially in the case of the subjects involved in the chamber tests. Doses to the skin were probably equivalent to those received under combat conditions. Consideration of the probable gas mask leakage, additional exposures from contact or vapors from the clothing, accidents, and the documented signs and symptoms in the chamber test records indicate that the doses received by the human subjects were equivalent to those received in occupational exposures and, perhaps, even battlefield exposures.
A description of this involvement is included in Appendix C. These masks were eventually removed from use by the military, because the diaphragms were leaky for a fuller discussion, see the Conclusions and Further Analysis section of this chapter. It is not clear whether sulfur mustard, which is very persistent and evaporates slowly, was still present on the surface of the suits and, thus, a possible source of further contamination by inhalation or contact fuller discussion is included at the end of this chapter.
The model numbers of canisters used in gas masks employed in the chamber or field tests are not known, but M9A1 canisters were in common use prior to July Brophy et al. Review and analysis of the Beebe and Norman papers are included in Chapter 6. Turn recording back on. National Center for Biotechnology Information , U. Search term. Field Tests Many field tests with mustard gas were conducted with human subjects, but relatively little information is available. Gas Production, Gas Handling, and Chemical Warfare Production Preparations for chemical warfare before and during WWII involved many additional people in the production, handling, shipping, and training to use and defend against chemical warfare agents.
Medical Applications of Chemical Warfare Research As history has repeatedly shown, the experience of medical personnel and researchers in wartime can lead to major innovations in medical treatment practices. In a section on vesicants, no conclusions were drawn for Lewisite on the basis of scanty information; for sulfur mustard, however, the group concluded: Mustard gas is mutagenic in various organisms and test systems. Although the reasons underlying the lack of follow-up health assessments are not explicit from the numerous documents and materials considered by this committee, a number of factors may have played a role: There was no unified body of information, based on WWI research and the research done in the period from to , when research was intensified in the early pre-WWII period.
This lack of information seems to have contributed directly to a lack of appreciation for the serious long-term health risks associated with exposure to mustard agents and Lewisite, specifically chronic bronchitis, emphysema, chronic laryngitis, corneal opacities, chronic conjunctivitis, and keratitis. Scientific inquiry was controlled by the military establishment, whose primary concern was with acute rather than long-term injury. This control also probably contributed to the paucity of animal or other types of studies, following WWII, aimed toward elucidation of long-term consequences of damage to specific physiological systems.
For example, no long-term follow-up was done on workers involved in chemical warfare materials production, despite the high level of injuries that occurred. The atmosphere of immediacy caused by the outbreak of war, and the resulting prioritization of expected combat injuries, at least strengthened the focus on acute damage from chemical warfare agents, and at worst dampened any sensitivities that were present regarding the future health of human subjects or chemical warfare production workers.
Once the war was over, there may also have been ambiguities about which federal department or agency should have had responsibility for follow-up of veterans. Although the former Veterans Administration VA had that role traditionally, the VA could not have been expected to know about the testing programs and their possible effects on the health of human subjects without communication from the military.
Finally, and related to the issue of responsibility for follow-up, the continued secrecy maintained by the military regarding the WWII testing programs also created a barrier to follow-up assessments of exposed individuals. Even during the present study, which follows a five-year period of intensifying public scrutiny of these WWII programs, obtaining certain types of information was not easy and often involved piecing together bits of data from numerous sources. In fact, this committee was commonly required by many DoD and Department of the Army offices to file all requests under the Freedom of Information Act.
These requirements were often imposed even on the present Department of Veterans Affairs VA , when it attempted to aid this committee by making certain requests for information regarding the possible existence of records of individuals who participated in the testing programs see Appendix E. This committee is especially grateful to the NRL for its commitment to open its files.
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The NRL stands alone among sections of the Department of Defense in the maintenance of files and reports, and the sharing of those files with this committee and with the affected veterans. Report of consultant in ophthalmology on 6 cases of H vapor burns occurring at Bushnell Field Installation on April 20, Memo to Colonel C. Rhoads, dated May 1, Record Group , Group 4B, Folder Protection factors and self-contained compressed-air breathing apparatus.
American International Hygiene Association Journal Alexander SF. Medical report of the Bari Harbor mustard casualties. Military Surgeon Advances in Military Medicine. Boston: Little, Brown and Company. Balali-Mood M, Navaeian A.
World War II contrails: a case study of aviation‐induced cloudiness
Clinical and paraclinical findings in patients with sulfur mustard poisoning. In: Heyndricks B, editor. Terrorism: Analysis and Detection of Explosives. Gent: Rijksuniversiteit. Beebe G. Lung cancer in World War I veterans: possible relation to mustard gas injury and influenza epidemic. Journal of theNational Cancer Institute Brophy LP,Fisher G.
Budavari S, editor. The Merck Index. Carnes SA. Disposing of chemical weapons: a desired end in search of an acceptable means. Environmental Professional Disposing of the U. Journal of the American Medical Association Federal Register Report of Chemical Warfare Service Conference. October , Cochrane RC. Medical research in chemical warfare. Available through the U. Despretz M.