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''ordinary" patients at a Japanese clinic, the group exposed to mustard agent and Lewisite had more chronic bronchitis, chronic cough, and reduced FEV1/FVC. Among nonsmokers, almost half of those previously exposed to mustard agents or Lewisite reported persistent productive cough, compared to 30 percent in the unexposed group. The former poison gas workers showed a more bronchitic type of airway obstructive pattern than did the ordinary patients with chronic obstructive pulmonary disease (COPD); however, they did not have less anatomical evidence of emphysema.1 Based on this literature, the Agency for Toxic Substances and Disease Registry (ATSDR) concluded in the recent Toxicological Profile for Mustard "Gas" (1991) that, "when the vapors are breathed for a prolonged period, other respiratory diseases, such as chronic bronchitis . . . can eventually occur."

None of the epidemiologic studies of occupational exposures provided estimates of exposure level. It has been reported that worker protection was inadequate in the Japanese factories and that employees were exposed to significant levels of sulfur mustard, and to a lesser extent to Lewisite (Wada et al., 1962). Conditions may have been better, but still relatively poor, in British munitions factories (Haber, 1986). It is difficult to judge the safety conditions, however. For example, as discussed in Chapter 3, all sulfur mustard and Lewisite production in the United States was accomplished at military bases controlled by the Chemical Warfare Service. This group's safety record was the worst in the military during the peak years of production, with hundreds and probably thousands2 of documented injuries resulting from  sulfur mustard and Lewisite (Brophy and Fisher, 1959; Cochrane, 1946). Given this high incidence of injury, it is surprising that follow-up studies of chemical warfare production workers have not been conducted on the U.S. worker populations.

Battlefield Exposure

The risks associated with acute combat exposures are probably more relevant for predicting the likely long-term effects of the experimental chamber exposures. Chamber exposures were delivered over a period of

1  

Bronchitis is an inflammation of the mucous membrane lining the respiratory passages. Emphysema is a disease in which the air spaces of the lungs are widened and their walls or linings are destroyed. Although symptoms of these diseases may be similar and the diseases can commonly occur together, they are different anatomically. Both emphysema and bronchitis can be called chronic obstructive pulmonary diseases (COPDs).

2  

One thousand injuries of this type were reported for a two-year period just at Edgewood Arsenal.



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