Medical Aspects of Chemical Warfare (2008) - The Black Vault

History of the Medical Management of Chemical CasualtiesTable 3-2SIX CHLORINE-PHOSGENE CLOUD ATTACKS:BRITISH CASUALTIES DECEMBER 1915–AUGUST 1916CasualtiesPercentageGas casualties as a percentage of exposed 4.1troopsDeaths from gas as a percentage of troops 0.7Deaths from gas as a percentage of total gas 23.6casualtiesAdapted with permission from: Moore W. Gas Attack. London,England: Leo Cooper; 1987: Appendix D.tions were encumbered by protective gear; soldierswho did not follow the strict protective measuressoon became casualties. Ultimately, half the battlecasualties during the war were attributed to gas. Oneofficer wrote of the attacks:When sent out into the darkness to bring in thewounded or perform other duties . . . the [soldiers]repeatedly removed the face part of the S.B.R. [smallbox respirator] so as to see what they were doing orwhere they were going. . . . Others, straining at theheavy loads of bringing in casualties found the maskpainfully oppressive and removed it. [Only] one whohas been under such a night bombardment can realizethe difficulties attending the supervision and controlof gas discipline during such a time. 15(p13)The early poor gas discipline was blamed on theineffectiveness of the British small box respirator andFrench M2 masks, which were issued to all AmericanExpeditionary Forces (AEF) personnel entering thetheater (Figure 3-4). The adoption of a better mask wasrecommended early in response to the AEF’s ChemicalWarfare Service (CWS) and 1st Division Medical Corpscomplaints. 15 One soldier said of the equipment: “. . .surgeons, stretcher bearers, and runners, had found itimpossible to carry on in the SBR because the arrangementof the eyepieces and the fogging of the lensesimpaired vision.” 15(pp19–20)Pulmonary agents were used first on the battlefield,and the resulting casualties were managed under themedical doctrine of the French and British medicalsystems. Later, the Germans developed sulfur mustard,a vesicant (blister agent) that attacked the skin, makingmasks less effective (Figure 3-5). Mustard was firstused on July 12, 1917, just prior to the Third Battle ofYpres, and the Allies had to devise a medical responseto this new type of agent. 16Fig. 3-4. The British small box respirator, introduced in 1916and seen in 1918 in this photograph, was vastly more effectivethan the earlier British versions. The wearer breathedthrough a mouthpiece. Because a spring clip was applied tothe nose, only air that had passed through the mouthpiececould enter the lungs. An absolute seal between the faceand mask was unnecessary. The mouthpiece was connectedby a tube to the canister containing neutralizing chemicals,which was worn around the trunk. Although the small boxrespirator was more protective than its predecessors, it wasprobably less user-friendly.Reproduced from: Pictorial History, Gas Defense Division,Chemical Warfare Service. Vol 5. Edgewood Historical Files.Located at: Chemical and Biological Defense CommandHistorical Research and Response Team, Aberdeen ProvingGround, Md.As World War I progressed, physicians became moreadept at managing chemical casualties, though bedrest remained the most common form of treatment.Soldiers who inhaled large volumes of asphyxiatinggases usually died. Mustard was probably the mostdifficult agent to medically manage because it temporarilyblinded individuals, produced blisters on theskin, and resulted in a large number of casualties whorequired extensive medical treatment. As the numberof chemical casualties increased, field hospitals becameoverburdened. Eventually, some special hospitals wereerected to deal solely with soldiers suffering fromchemical-related injuries. The number of chemicalcasualties produced was staggering, and the forwarddeployedCanadian, French, and Algerian dressingstations were quickly overwhelmed.Another setback early in the war was the abysmalfield sanitation French and British troops had to deal83