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

Medical Aspects of Chemical WarfareINTRODUCTIONIn 600 b c e, soldiers of the Greek king Solon induceddebilitating diarrhea in enemy troops by throwinghighly poisonous hellebore roots into streams supplyingtheir water. Today, scientists seeking new nonlethalincapacitating substances are studying neuropeptidesand neuromodulators. Both then and now, the goal hasbeen to weaken an enemy without the use of lethalforce. In the last half-century, “incapacitating agent”has become the accepted military term for such unconventionalweapons.According to the US Department of Defense, an incapacitatingchemical agent falls into the more generalcategory of nonlethal weapons (NLWs) and thereforeshares the following characteristics:[Non-lethal weapons] are explicitly designed andprimarily employed so as to incapacitate personnelor materiel, while minimizing fatalities, permanentinjuries to personnel, and undesired damage to propertyand the environment.Unlike conventional lethal weapons that destroytheir targets principally through blast, penetrationand fragmentation, non-lethal weapons only employmeans other than gross physical destruction to preventthe target from functioning.Non-lethal weapons are intended to have one, orboth, of the following characteristics:1. They have relatively reversible effects on personnelor materiel.2. They affect objects differently within their area ofinfluence. 1Use of an incapacitating agent by conventionalmilitary forces would face political, military, medical,and budgetary constraints. Factors such as effectiveness,relative lack of toxicity or excessive persistence,logistical feasibility, predictability of behavior, manageabilityof casualties, availability of antidotes,limitations imposed by treaties, and cost would needto be considered. No proposed incapacitating agenthas yet been acceptable. 2 Further considerationswould come into play before any decision to deployan agent. Methods and equipment must be designedto manufacture, store, and transport the agent.Troops in the field would require extensive trainingto operate what might be a complex delivery system.Medical personnel would need to learn how best totreat the casualties, working within the confines ofthe battlefield.This chapter reviews the properties of many possiblechemical incapacitating agents, as well as a fewthat are physical in nature, and their diagnosis, treatment,and general principles of management.HISTORY AND MODERN DEVELOPMENTAlthough few references to the historical use ofdrugs for military purposes appear in contemporarypublications, a substantial literature describes a varietyof tactical efforts to incapacitate enemy forces withmind-altering chemicals. The rarity of new publicationsabout the incapacitating chemical agents consideredmost promising can be attributed in part to theexponential acceleration of pharmaceutical discovery,which has eclipsed interest in many drugs used widelyin the past. In addition, computerized databases tendto include only research reports published since 1970.Consequently, the current focus is on new drugs tailoredto specific nervous system targets. The “newage” neurochemicals under consideration are notnew—they incorporate advances in neuropharmacologybut no new modes of action; some are even lesspractical than those proposed in the 1960s. Even theagents attracting interest in the 1960s were not as newas they seemed.In 1961 Ephraim Goodman, a psychologist in theEdgewood Medical Laboratories, Maryland, systematicallyreviewed 100 years of reports and letters appearingin four leading American and British medicaljournals (as well as a more limited number of severalrespected German medical periodicals). Goodmandiscovered numerous reports of deliberate administration,particularly of atropine and related drugs,to produce “behavioral toxicity” (a term introducedby Joseph Brady in 1956). Often, these substanceswere used by single individuals, but some can beconsidered examples of drugs used as “weapons ofmass destruction” or “mass casualty weapons.” Thefollowing excerpts from Goodman’s review showthat incapacitating agents are not a new approach tomilitary conflict:According to Sextus Julius Frontinus, Maharbal, anofficer in Hannibal’s army about 200 b c e, …. sent bythe Carthaginians against the rebellious Africans,knowing that the tribe was passionately fond ofwine, mixed a large quantity of wine with mandragora,which in potency is something between a poisonand a soporific. Then, after an insignificant skirmish,he deliberately withdrew. At dead of night, leavingin the camp some of his baggage and all the druggedwine, he feigned flight. When the barbarians capturedthe camp and in frenzy of delight greedily drank the412