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some diseases, no literature would exist. Thus, in order to determine the constellation of health problems that exposed individuals might have, the committee held a public hearing and collected written and oral statements from over 250 individuals regarding the details of their exposure and their health problems. This information was used to identify those diseases for which gaps in the medical and scientific literature might be of particular consequence. In addition, by holding scientific workshop sessions and by soliciting input from experts with technical knowledge applicable to the issues, the committee gathered information pertaining to a variety of questions about the molecular mechanisms of mustard and Lewisite toxicity, the specific protocols used and dose levels achieved in the WWII testing programs, the psychological health effects of chemical warfare environments and exercises, and other related topics (Appendix A).

This report focuses on the published scientific and medical literature that pertains to the contribution of mustard agent or Lewisite exposure to the development of disease. It includes a bibliography of most of the published literature in English and foreign languages, as well as government technical reports and material from military archives. All served as the basis of the committee's deliberations. A historical analysis of mustard agent and Lewisite research programs, conducted by the military, is included. This analysis was accomplished in part to determine the possible exposure levels the human subjects received in the WWII testing programs. Also included is a summary of the information obtained through the public hearing process (Chapter 4), consultation with outside experts (Appendix A), and analysis of documents relating to military testing programs that used human subjects (Chapter 3). Further, the report assesses the strength of association between specific diseases and exposure to these agents, identifies the gaps in the present knowledge base, and highlights those gaps that warrant special attention. Finally, the report details the committee's final recommendations.

In order to cover this wide range of topics, the report necessarily includes varied levels of information from complex scientific analysis to descriptive sections regarding the public hearing findings and historical analysis. Efforts have been made to make the scientific sections accessible to as broad an audience as possible.

It is hoped that this report will be useful to policymakers and legislators responsible for programs dealing with the health of veterans in the United States. The report may also be of interest to military and civilian planners who face important issues relating to potential future use of chemical warfare agents and to the destruction of current stockpiles of chemical weapons. Further, for these groups and for the affected veterans and their families, the committee hopes that this report is successful in explaining and clarifying the multiple factors that



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