Recently, World War II veterans have come forward to claim compensation for health effects they say were caused by their participation in chemical warfare experiments.
In response, the Veterans Administration asked the Institute of Medicine to study the issue. Based on a literature review and personal testimony from more than 250 affected veterans, this new volume discusses in detail the development and chemistry of mustard agents and Lewisite followed by interesting and informative discussions about these substances and their possible connection to a range of health problems, from cancer to reproductive disorders.
The volume also offers an often chilling historical examination of the use of volunteers in chemical warfare experiments by the U.S. military—what the then-young soldiers were told prior to the experiments, how they were "encouraged" to remain in the program, and how they were treated afterward.
This comprehensive and controversial book will be of importance to policymakers and legislators, military and civilian planners, officials at the Department of Veterans Affairs, military historians, and researchers.
- Veterans at Risk
- Copyright
- Preface
- Acknowledgments
- Contents
- Executive Summary
- BACKGROUND
- GENERAL CONCLUSIONS
- SPECIFIC FINDINGS
- RECOMMENDATIONS
- 1 Introduction
- 2 Methods of Literature Collection and Survey
- ONLINE DATABASES
- OTHER SOURCES
- SUPPLEMENTAL WORLD WAR II MILITARY REPORTS
- LITERATURE TRANSLATION, DISSEMINATION, AND ANALYSIS
- REFERENCES
- 3 History and Analysis of Mustard Agentand Lewisite Research Programsin the United States
- INTRODUCTION
- RESEARCH PROGRAMS OF WORLD WAR I AND THE POSTWAR PERIOD
- TESTING PROGRAMS AND CHEMICAL WARFARE PRODUCTION IN WORLD WAR II
- Patch or Drop Tests
- Chamber Tests
- Field Tests
- Gas Production, Gas Handling, and Chemical Warfare Production
- The Bari Harbor Disaster
- Medical Applications of Chemical Warfare Research
- RESEARCH, USE, AND DISPOSAL OF CHEMICAL WEAPONS AFTER WORLD WAR II
- Postwar Research Programs
- Continuing Use of Sulfur Mustard and Other Chemical Weapons in International Conflicts
- U.S. Chemical Stockpile Disposal Program
- CONCLUSIONS AND FURTHER ANALYSIS
- REFERENCES
- 4 Findings from the Public Hearing Process
- RESULTS AND FINDINGS
- Types of Veteran Exposures
- Health Problems Reported
- Personal Aspects of Veteran Reports
- TREATMENT OF HUMAN SUBJECTS
- CONCLUSIONS AND ACTIONS TAKEN
- REFERENCES
- 5 Chemistry of Sulfur Mustard and Lewisite
- SULFUR MUSTARD
- Reaction of Sulfur Mustard with Various Nucleophiles
- Reactions of Biologic Importance
- LEWISITE
- REFERENCES
- 6 Relationship of Mustard Agent and Lewisite Exposure to Carcinogenesis
- ACUTE EFFECTS AND BIOLOGICAL MECHANISMS
- Sulfur Mustard
- Biologic Fate and Mechanisms of Action
- Nucleic Acid and Protein Conjugation
- Cytogenetic and Mutagenic Effects
- Summary
- Lewisite
- Biologic Fate and Mechanism of Action
- Cytogenetic and Mutagenic Effects
- Summary
- EVIDENCE OF LONG-TERM HEALTH EFFECTS
- Animal Studies
- Early Studies in Mice and Rats
- Heston's Studies in Mice
- Later Studies of Mustard Agents and Other Alkylating Agents
- Summary of Animal Studies
- Human Studies
- Occupational Exposure
- Battlefield Exposure
- Medical Therapeutic Exposure
- SUMMARY
- Gaps in the Literature
- Conclusions
- REFERENCES
- 7 Nonmalignant Respiratory Effects of Mustard Agents and Lewisite
- PHYSIOLOGY AND ANATOMY
- ACUTE EFFECTS AND BIOLOGICAL MECHANISMS
- EVIDENCE OF LONG-TERM HEALTH EFFECTS
- Animal Studies
- Human Studies
- Occupational Exposure
- Battlefield Exposure
- Medical Therapeutic Exposure
- RELATIONSHIP BETWEEN ACUTE AND CHRONIC EFFECTS CAUSED BY EXPOSURES TO OTHER RESPIRATORY HAZARDS
- SUMMARY
- REFERENCES
- 8 Ocular Effects of Mustard Agents and Lewisite
- PHYSIOLOGY AND ANATOMY OF THE EYE
- ACUTE EFFECTS AND BIOLOGICAL MECHANISMS
- Dose-Related Considerations
- Clinical Observations
- Physiology and Histopathology of Injury
- EVIDENCE OF LONG-TERM HEALTH EFFECTS
- Animal Data and Cellular Bioassay
- Human Studies
- Occupational Exposure
- Battlefield Exposure
- Chronic Course
- Medical Therapeutic Exposure
- SUMMARY
- Gaps in Knowledge
- Limbal Vascular Damage
- Ocular Epithelial Damage
- Protection of the Corneal Epithelium with a Contact Lens
- Sulfur Mustard Compared to Alkali Injury: The Stromal Component
- CONCLUSIONS
- REFERENCES
- 9 Dermatological Effects of Mustard Agents and Lewisite
- ANATOMY AND PHYSIOLOGY OF SKIN
- Epidermis
- Dermis
- Eccrine Sweat Glands
- Apocrine Glands
- Melanocyte System
- ACUTE EFFECTS AND BIOLOGICAL MECHANISMS
- Sulfur Mustard
- Clinical and Microscopic Observations
- Mechanisms of Skin Injury
- Lewisite
- EVIDENCE OF LONG-TERM HEALTH EFFECTS OF MUSTARD AGENTS
- Animal Studies and Cellular Bioassays
- Human Studies
- Occupational Exposure
- Battlefield Exposure
- Medical Therapeutic Exposure
- Experimental Exposure
- EVIDENCE OF LONG-TERM HEALTH EFFECTS OF LEWISITE
- Animal Studies and Cellular Bioassays
- Human Studies
- Occupational Exposure
- Battlefield Exposure
- Medical Therapeutic Exposure
- Experimental Exposure
- SUMMARY
- Gaps in the Literature
- Conclusions
- REFERENCES
- 10 Other Physiological Effects of Mustard Agents and Lewisite
- EFFECTS ON THE IMMUNE SYSTEM
- Anatomy and Physiology
- Animal Studies
- Human Studies
- Conclusions
- EFFECTS ON SYSTEMS OTHER THAN THE IMMUNE SYSTEM
- Gastrointestinal Effects
- Hematological Effects
- Neurological Effects
- Conclusions
- REPRODUCTIVE RISKS
- Sulfur Mustards
- Animal Studies
- Human Studies
- Summary and Conclusions
- Lewisite
- Introduction
- Animal Studies
- Human Studies
- Summary and Conclusions
- REFERENCES
- 11 Relationship of Mustard Agent and Lewisite Exposure to Psychological Dysfunction
- HISTORICAL DEVELOPMENT OF THE CONCEPT OF PTSD
- CURRENT RESEARCH IN PTSD
- EVIDENCE FROM STUDIES OF MILITARY PERSONNEL AND VETERANS
- Chemical and Biological Warfare Environments
- Studies of PTSD in Veteran Populations
- EVIDENCE FROM STUDIES OF THE PSYCHOLOGICAL EFFECTS OF ENVIRONMENTAL CONTAMINATIONS
- CONCLUSIONS
- REFERENCES
- 12 Summary of Findings and Recommendations
- GENERAL CONCLUSIONS
- CONCLUSIONS REGARDING THE CAUSAL RELATIONSHIPS OF EXPOSURE TO THE DEVELOPMENT OF SPECIFIC DISEASES
- GAPS IN THE LITERATURE REGARDING MUSTARD AGENTS AND LEWISITE
- Human Studies
- Animal Studies
- RECOMMENDATIONS
- Bibliography
- PUBLISHED LITERATURE
- MILITARY REPORTS UNITED STATES
- U.S. Army Reports
- U.S. Navy Reports
- Other U.S. Military Reports
- UNITED KINGDOM
- Chemical Defence Experimental Station, Porton Down
- Other British Military Reports
- AUSTRALIA
- CANADA
- Experimental Station, Suffield, Alberta
- Chemical Warfare Laboratories, Ottawa
- INDIA
- OTHER MILITARY REPORTS
- TECHNICAL REPORTS
- Office of Scientific Research and Development
- AVAILABILITY INFORMATION
- OFFICE OF SCIENTIFIC AND RESEARCH DEVELOPMENT (OSRD) REPORTS:
- COMMITTEE ON TREATMENT OF GAS CASUALTIES (CTGC) REPORTS:
- NATIONAL TECHNICAL INFORMATION SERVICE (NTIS):
- NAVAL RESEARCH LABORATORY REPORTS:
- BRITISH REPORTS:
- APPENDIXES
- A Scientific and Background Presentations Made to the Committee
- January 6, 1992
- April 15-16, 1992
- JUNE 11-12, 1992
- B Excerpt from The Residual Effects of Warfare Gases (1933)
- C Involvement of the National Academy of Sciences Complex in World War II Research Programs: A Summary
- D Excerpts from Chamber Tests with Human Subjects I, II, and IX. Naval Research Laboratory Reports Nos. P-2208…
- E Interim Report and Addendum Han K. Kang, Dr. P.H.
- Feasibility of Developing a Cohort of Veterans Exposed to Mustard Gas During WWII Testing Programs
- I. Background
- II. Naval Research Laboratory (NRL) Tests
- A. NRL Lab Log
- B. Suitland Federal Records Center
- C. National Personnel Record Center (NPRC), St. Louis, MO
- D. Bainbridge, MD, Navy Training Center
- E. Conclusions
- III. The U.S. Army Chemical Warfare Service Tests
- A. Special Orders No. 152
- B. Conclusions
- ADDENDUM
- I. Naval Research Laboratory (NRL) Test Participants
- II. U.S. Army Chemical Warfare Service Test Participants
- III. Conclusions
- F Summary of the Department of the Army Report by James R. Taylor and William Johnson
- USE OF VOLUNTEERS IN CHEMICAL AGENT RESEARCH (1975)
- KEY ELEMENTS OF THE NUREMBERG CODE OF 1947
- G Public Hearing Announcement
- PUBLIC HEARING ANNOUNCEMENT
- COMMITTEE TO SURVEY THE HEALTH EFFECTS OF MUSTARD GAS AND LEWISITE
- VETERANS WHO APPEARED AT THE PUBLIC HEARING
- SUMMARY OF HEALTH PROBLEMS REPORTED BY VETERANS
- H Yale Law School
- I Risk Assessment Considerations for Sulfur Mustard
- SULFUR MUSTARD
- NITROGEN MUSTARD
- CANCER RISKS FROM SIMILAR COMPOUNDS
- RAPID SCREENING OF HAZARD (RASH) APPROACH
- RELEVANCE OF EXPERIMENTAL RESULTS TO HUMAN RISKS
- HUMAN EXPOSURES
- REFERENCES
- J Examination of the Effects of Certain Acute Environmental Exposures on Future Respiratory Health Consequences
- REVIEW OF AGENTS CAUSING ACUTE AND CHRONIC RESPIRATORY EFFECTS
- Sulfur Dioxide
- Miscellaneous Irritants
- Cotton Dust
- Isocyanates
- Notes on Selected Inorganic Agents
- THE FUNDAMENTAL QUESTION
- Narrowly Structured
- Alternative Broadly Structured
- THE RESPIRATORY END POINTS
- Simple Chronic Bronchitis
- Chronic Obstructive Bronchitis and Emphysema
- Allergic Bronchoconstriction
- Inflammatory Bronchoconstriction
- Pharmacologic Bronchoconstriction
- HOST FACTORS
- CONCLUSIONS
- LITERATURE CITED
- List of Acronyms and Abbreviations
- Index
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