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

History of the Medical Management of Chemical CasualtiesFig. 3-12. In this posed instructional picture of a World WarI gas attack, the soldier on the right has removed his smallbox respirator and is inhaling poison gas. This photographreminds soldiers that removing their masks in the presenceof chemical agents leads to injury. Gilchrist pointed this outin 1928: “Investigation showed that these casualties werecaused by general lack of gas discipline. It was found thatthe standing order that ‘Men will not remove the mask untilordered to do so by an officer’ was absolutely disregardedby practically all units affected, and that fully 75 per centof the casualties were due to the disobedience of this order,casualties which efficient training and discipline would haveprevented.”1 Gas mask discipline was the key to low chemicalcasualty rates in the face of chemical weapons.(1) Gilchrist HL. A Comparative Study of World War Casualtiesfrom Gas and Other Weapons. Edgewood Arsenal, Md: ChemicalWarfare School; 1928: 16.Reproduced from: Moore WE, Crussell J. US Official Picturesof the World War. Washington, DC: Pictorial Bureau; 1920.Finding nothing to define his position when hereported for duty, Gilchrist made his first priority tospearhead chemical casualty management educationfor AEF MOs. On February 9, 1918, Gilchrist publisheda pamphlet titled “Symptomology, Pathology andGeneral Treatment of Gas Cases,” containing basicinformation on the medical management of chemicalcasualties. Following this publication, the medicaldirector’s office issued a constant stream of bulletinsaimed at keeping AEF MOs current on the latest medicaldevelopments in chemical warfare. Gilchrist visitedmost AEF divisions and hospitals, where he lecturedon chemical warfare from a medical perspective, emphasizingthe prevention and treatment of chemicalcasualties (Figure 3-12). Gilchrist also visited the sitesof battles where large numbers of gas casualties hadoccurred, as well as hospitals, hospital trains, and otherlocations, comparing their efficiency and relaying hisfindings to both the Gas Service chief and the MedicalDepartment. He also assisted medical researchersin developing new treatment techniques for chemicalcasualties. His approach emphasized combating theeffects of enemy chemicals therapeutically and prophylactically.27When the AEF’s 1st Division began encounteringGerman chemical attacks, no actions were initiallytaken to provide division medics with additionaltraining in the treatment of chemical casualties, andthey were unprepared to handle the sudden influx ofchemical victims. In the confusion of organizing andplacing an American army in combat, it took the AEFuntil October 1918 to establish a uniform procedure tohandle chemical casualties. 19,28Because the AEF division was on the ground longbefore the evolution of the corps and army organizationalstructure, the medical structure to treat chemicalcasualties first evolved within the division. Later,when the AEF army and corps evolved, so did theirmedical organization. On March 1, 1918, the 42nd Divisionbecame the second American division to occupya sector on the western front. Although initially thedivision had few chemical casualties, the divisionalMOs prepared for a large influx of victims. All fourof the division’s field hospitals were set up to acceptchemical casualties, with a total of 500 beds dedicatedto such cases. 29At 5:30 p m on March 20, approximately 400 Germanmustard rounds landed on a position held by the division’s165th Infantry. 30 In the space of a few minutes,the vesicant caused 270 casualties, including one death.The initial aid station through which the casualtiespassed also became secondarily contaminated withchemicals. Medical personnel had to wear masks asthey treated the casualties. 31,32 The weather conditionsenhanced the agent’s persistence; it had rained earlierand there was no breeze to dissipate the vesicant as ithung in the air. At midnight, soldiers began to sufferdelayed effects. One company (Company K) lost twothirds of its effectives. A week later, Gilchrist reported417 gas casualties from the 165th Infantry at a basehospital. 30As the intensity of fighting increased, so did thenumber of chemical casualties. Medical organizationsystems became taxed. Many shell-shocked soldierssuffering from exhaustion and hunger believed themselvesto be chemical casualties. Some panicked aftersmelling shell fumes, reporting themselves gassed,and some feigned being gassed. “The symptomologyof gas poisoning is so complex,” observed Major WilliamV Sommervell, a gas officer of the 3rd Division,“and at the same time so indefinite” that anyone whoclaimed to be gassed was immediately processed tothe rear. 24(p65) One division field hospital commander91