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

History of the Medical Management of Chemical CasualtiesFig. 3-15. This photograph from Gilchrist’s study of WW I gascasualties has the following figure legend: “War photograph:Special gas aid station for administering to gas casualties.Here cases suffering from different gases were, when possible,segregated.” The lack of protective equipment in thephotograph suggests that the casualty being loaded into theambulance was not deemed a threat, possibly because hewas a victim of a respiratory agent.Reproduced from: Gilchrist HL. A Comparative Study of WorldWar Casualties from Gas and Other Weapons. Edgewood Arsenal,Md: Chemical Warfare School; 1928.often carried in ambulances, and sometimes one ormore French Tissot masks were added for the use ofthe driver. 66By the time of the southern attack of the Saint Mihieloffensive on September 12, 1918, medical supportprovided for the initial treatment of chemical casualtiesnear the front. Ambulances were forbidden to speed;although it was acknowledged that casualties shouldbe transported as rapidly as possible, their arrival conditionwas severely compromised if their transport washurried or if they did not receive adequate stabilizationto prepare them for an ambulance journey (Figure3-16). This was particularly true of those intoxicatedby phosgene. 67Throughout the occupation of the Toul sector,ambulances drove directly to battalion aid stationsand carried the wounded to triage, almost withoutexception. Casualties tended to reach triage 1 to 3hours earlier than expected. In one instance, casualtiesloaded near Norroy reached Evacuation Hospital No.1 at Sebastopol barracks (40 miles) within 3 hours ofbeing wounded, though it typically took an average of4 hours to get a casualty from the place of injury to triage.Pulmonary and vesicant (inhalational) casualtieswho arrived without respiratory signs and symptomsin this 4-hour window had an excellent prognosis forrecovery (Exhibit 3-5). 53Part five of the Fourth Corps plan of communication,supply, and evacuation (Annex No. 4 of FieldOrder No. 14, dated Sept 6, 1918) determined thatthe divisional medical gas officer, psychiatrist, andFig. 3-16. This photograph, taken near Cheppy and Very,France, has the following figure legend: “War photograph–Special ambulances used for transporting mustard gas casualtiesrendered necessary due to insidiousness of mustard.”These vehicles from Ambulance Company No. 13 supportedthe First Division.Reproduced from: Gilchrist HL. A Comparative Study of WorldWar Casualties from Gas and Other Weapons. Edgewood Arsenal,Maryland: Chemical Warfare School; 1928.orthopedist would perform triage. The medical gasofficer would examine all chemical casualties andadvise preliminary medical management as required.Casualties would be either hospitalized or returned toduty if fit. The psychiatrist examined all cases of shockor simulated shock and other nervous conditions. Alltroops designated for evacuation were directed to agas hospital at the La Marche section of the JusticeHospital Group near Toul. All nonevacuated chemicalcasualties were to be managed in an established fieldgas hospital. 36 Although no specific plan for managingchemical casualties was presented, the following quotewas recorded, which placed the medical logistical missioninto context:The difficulties to be met and overcome by the medicalsupply unit of a division are of a unique character.A fairly comprehensive idea of them may be formedif one will draw a mental picture of managing theonly drug store in a city of 30,000 people, operatingit day and night, and frequently, sometimes daily,changing its location. There are only eight clerks, forno more can be obtained, and transportation consistsof two 3-ton trucks operating over congested roads.The community of which the unit forms a part is frequentlybombed and shelled. 29(p107)Evacuation in Trench Versus Open WarfareIn open warfare, the medical management (includ-99