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

Medical Aspects of Chemical WarfareIntroductionA chemical agent is a substance “intended for usein military operations to kill, seriously injure, or incapacitateman because of its physiological effects.” 1(p1-1)Chemical warfare agents cause injuries directly byirritation, burning, or asphyxiation, and indirectlyby contaminating ground so that it cannot be safelyoccupied, creating smoke screens to obscure operationsor reduce the accuracy of an enemy’s firepower,and damaging an enemy’s equipment by incendiaryaction. In short, chemical warfare is the use of anysynthetic compound or material designed and usedfor the purpose of harming others. In the modern era,chemical agents have been divided into five categories:nerve agents, vesicants, choking agents, blood agents,and incapacitants. Excluded from consideration in thischapter are riot control agents, chemical herbicides,and smoke and flame materials.Chemical warfare evolved from studies of plantpoisons by ancient Egyptian and Indian civilizationsto the studies of Aristotle, Mithridates, Galen, da Vinci,and Nobel scientists at the turn of the 20th century. 2The concept that chemicals can be used as deadlypoisons on a small scale has been understood sincethe start of written civilization, and evidence of theiruse has pervaded myth and history for thousands ofyears. Some scholars suggest that the English colonistsat Jamestown were poisoned with arsenic trioxide bySpanish operatives intent on maintaining a monopolyin the New World. Throughout history, individualsused plant poisons and chemicals to remove romanticand political rivals, despotic rulers, prisoners, and evenunwanted spouses. Despite these small-scale uses ofchemical poisons before the 20th century, militaryuse of chemicals was rare. In the early 20th century,World War I changed the face of warfare with the useof chemicals on a massive scale.This chapter, the first in a series of three chapters onthe history of chemical warfare, focuses on the historicaldevelopment of chemical warfare, its large-scaleuse during World War I, post–World War I incidentsof chemical warfare, legislative efforts to ban chemicalagent use, chemical warfare plans during WorldWar II, and chemical warfare and terrorism today. Thediscussion will emphasize the historical experiences ofthe United States on the battlefields of Europe, Asia,and North Africa. It will be followed by Chapter 3,History of the Medical Management of ChemicalCasualties, and Chapter 4, History of the ChemicalThreat, Chemical Terrorism, and the Implications forMilitary Medicine.Chemical Concoctions Used in BattleToxic SmokesThe first recorded history from civilizations inEgypt, Babylon, India, and China contain references todeadly poisons. The first pharaoh, Menes, cultivated,studied, and accumulated poisons from plants, animals,and minerals in 3000 b c e. Egyptians also investigatedthe lethal effects of hydrocyanic acid. 2 Beginningin 2000 b c e, the great dynasties in India used smokescreens, toxic sleep-inducing fumes, and incendiarydevices on a large scale during battle. 2,3 Chinese writingsfrom 1000 b c e contain recipes for the productionof poisonous, noxious, and irritant vapors for use inwar, including arsenic-containing “soul-hunting fog.”The Chinese also developed stink bombs of poisonoussmoke and shrapnel, along with a chemical mortar thatfired cast-iron “stink” shells. 4The powerful city-states of ancient Greece alsoexperimented with chemical concoctions. During theFirst Sacred War in 590 b c e, Athens and Sicyon plottedto lay siege to the fortified city of Kirrha in retaliationfor the harassment of pilgrims to the Oracle of Apolloat Delphi. Solon, the sage of Athens, had the RiverPleistos, the main water supply to Kirrha, poisonedwith hellebore roots, causing diarrhea that led to thedefeat of the besieged city (as described by Pausanias in150 b c e). Thucydides described the first use of chemicalwarfare in Western civilization, by Sparta against Athens,in his History of the Peloponnesian War (431–404 b c e).During the siege of Plataea in 428 b c e, wood was saturatedwith pitch and sulfur to generate arsenic smoke,and then burned under the walls of the city to producepoisonous choking fumes (as well as fear and panic).A rainstorm minimized the effect, but the strategy wassuccessfully employed again by Sparta and its alliesduring the siege of Delium, an Athenian fortification,in 424 b c e. Dating from the 4th century b c e, Mohistsect manuscripts in China describe chemical tacticsemployed against entrenched, well-defended armiesin caves and tunnels, using bellows to pump smokefrom burning balls of mustard and other toxic plants. 3,4Chemical warfare was also practiced during the timeof the Roman empire. About 200 b c e, the Carthaginiansleft mandrake root in wine to sedate the enemy. 4 Inhabitantsof Ambracia in Epirus used toxic smoke to deterthe Romans from breaching their walls. 5 Between 8210