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

History of the Medical Management of Chemical Casualtiesfrequently employed, chiefly because they could traverseroutes impassable to motor vehicles and bypassroad obstructions. Chemical casualties could receivetimely management if they were transported byanimal-drawn ambulances because chemical agentsused in World War I had an overall delayed effect,unlike nerve agents or cyanide (which appeared later)in which immediate treatment was necessary.The second phase of AEF operations was foughtprimarily “over the top” in the offensive. The AEFunits participating in the Aisne-Marne offensive inearly summer were either under French or Britishcommand (Table 3-4). 65 In the early days of the AEFoffensive, it was necessary to remove all litter casualtiesthat required transportation from the aid stationto a pick-up point a kilometer (0.6 mile) or more tothe rear that could be easily accessed by ambulances.As soon as ambulances could evacuate directly fromaid stations, congestion was no longer an issue. 39Spanish InfluenzaIn mid June 1918 through mid July, Spanish influenzaappeared on the battlefield and affected thedegree of fighting during the defensive campaigns. Ittapered off by the end of July, but reappeared in theoffensive campaigns in October 1918. 15 Influenza’sTABLE 3-4MAJOR OFFENSIVE CAMPAIGNS OF THEAMERICAN EXPEDITIONARY FORCES, 1918DatesJuly 18–August 6August 8–November 11August 18–September 17(November 11)August 19–November 11September 12–September 16September 26–November 11CampaignAisne-Marne Offensive (Flanders Operations:Dickenbush/Scherpenberg)The Somme OffensiveThe Oise-Aisne OffensiveAEF: American Expeditionary ForcesYpres-Lys Offensive (AEF in BelgianFrench Sector)Saint Mihiel OffensiveMeuse-Argonne Offensive, AmericanSector The Meuse-Argonne Champagne,AEF in British Sector (PhasesI–III)attack on the pulmonary/respiratory system seriouslyaffected military operations twofold, first, byreducing the number of healthy soldiers, and second,by taxing the capabilities of the sanitary trains. Thechemical casualty patients in sanitary train facilitieshad compromised and vulnerable pulmonary systemsby virtue of the mechanism of action of pulmonary(phosgene) and vesicant (mustard) chemical agents.The Spanish influenza of 1918 did not stop militaryoperations in theater, but it slowed them noticeably.When its peak was passed, reinvigoration of offensiveoperations increased the already heavy strain uponmedical support capabilities. 67The First Army was hit hard by the influenza. Itschief surgeon reported 72,467 battle casualties in theMeuse-Argonne operation, of which 18,664 (25.7%)were chemical casualties. 69 It is possible that not allchemical casualties were reflected in the existingadministrative records. Many chemical casualtiespassed through the hospital without being admittedto the gas ward. Some required surgical interventionfor wounds and were categorized under otheradmission criteria. Others were so lightly gassedthey were treated in other categories, including generalizedrespiratory diseases. The “gassed” categoryincluded nearly all those who had been incapacitatedby mustard gas, which caused burns, conjunctivitis,laryngitis, gastroenteritis, and bronchitis.Medical Personnel as VictimsEven medical personnel became victims of chemicalattacks during the war. For example, Dr Eric P Dark, anAustralian army physician, was on the receiving end ofa chemical attack while managing chemical casualties(Exhibit 3-6). Dr Harvey Cushing also wrote of medicalpersonnel who became chemical casualties:Poor Telfer is all bunged up with a secondhand doseof this mustard-oil gas or whatever it is. Many moreof these men were brought in last night; and as theorderlies were panicky, owing to the raid, he did alot of handling of patients himself and to-night hasa bad cough, swollen and lachrymating eyes–likethe men themselves. One or two others who havehandled and undressed gassed Tommies have got ittoo in mild form. 14In the AEF’s 78th Division, the regimental aid stationof the 309th Infantry was located at Marcq, and its battalionstations were in Saint Juvin, about 1 km (0.6 mile)west, in the shelter of a hill. In this regiment, all but one ofthe MOs and most of the medical enlisted personnel wereevacuated as chemical casualties. The regiment itself wasso reduced in strength that line litter bearers could not be101