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days to weeks and were designed to simulate combat exposures in terms of concentration, humidity, and temperature.

World War I. In a 1922 clinical study of 83 pensioners with recognized disability due to gas poisoning, the principal symptom was shortness of breath (Sandall, 1922). Persistent cough, expectoration, and chest tightness were also frequent. Sandall reported that, on physical examination, 26 percent showed signs of "emphysema," while another 20 percent had some definite signs of bronchitis.

A similar clinical study published in the same year involved 166 sanatorium patients, who gave a definite history of having been gassed during the war and hospitalized for at least 20 days (Hankins and Klotz, 1922). Of these young adults, 25 percent gave a history of influenza or pneumonia, and all reported having never regained their health since the gassing. Shortness of breath, cough, and expectoration were common, as were asthmatic symptoms. Based on X-ray findings, the clinical picture was one of chronic peribronchitis, resulting from a permanent thickening of the bronchial mucous membrane.

Berghoff reported clinical data based on 2,000 U.S. servicemen who had been gassed with chlorine or sulfur mustard and were examined in the course of their related discharge (Berghoff, 1919). Of those exposed to sulfur mustard, most had been exposed in an explosive attack three to four months prior to discharge. Of the total group, 30 percent were diagnosed to have bronchitis, characterized by prolonged expiration and coarse moist rales. Another 22 percent had characteristics associated with emphysema, including a rigid chest, limited diaphragm movement, and impaired expansion.

Gilchrist and Matz (1933) selected 89 living and 53 deceased cases from among 1,016 U.S. servicemen who had been gassed with sulfur mustard during World War I. The 89 living cases were examined clinically and roentgenologically eight to ten years after exposure to sulfur mustard. The basis for selection of cases was the availability of full and well-documented histories of exposure to sulfur mustard, based on military records, and the severity of the effects, also from information in military records. These investigators concluded that 27 of the 89 men who were examined nine to ten years after gassing had evidence of anatomic or symptomatic disease attributable to their exposure to sulfur mustard. The residual effects on the respiratory tract they noted were chronic bronchitis, emphysema, and bronchial asthma.

There is also evidence that British soldiers exposed to mustard gas during combat in WWI had a higher incidence of chronic bronchitis than the general population (Case and Lea, 1955). One study, designed to examine for lung cancer, identified a group of 1,267 war pensioners who had suffered from sulfur mustard poisoning; 80 percent of the group had



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