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in English were professionally translated (Table 2-3). Given the large number of documents on this topic, it was necessary early on in the study to determine a method that would most effectively organize the material and serve as a tool in the dissemination of the literature to the committee. A list of index terminology was developed and subsequently revised at the first committee meeting. Each paper was indexed, and updated  subject bibliographies were distributed to the committee throughout the study to reflect new acquisitions, allowing committee members to request copies of the papers they needed for their information and analysis.

In assessing the associations between exposure and specific health conditions, the committee generally followed the guidelines proposed by Hill (1971). These guidelines include six considerations that can be brought to bear on judgments of causality. Strength of association reflects the relative risk or odds of an association. A dose-response relationship can reinforce the judgment of causality when the strength of association increases with increases in exposure. Further, associations need to be temporally correct; the effect occurs in a reasonable or expected time period following exposure. Consistency and specificity of associations are also important considerations. A consistent association is one that is found in a variety of studies. If, however, a particular health condition is reliably predicted by a given exposure, then specificity of an association is demonstrated. Finally, for an association to be judged causal it must be biologically plausible or explainable by known biological mechanisms.

Each of the considerations listed above is based on certain assumptions and requires varying amounts and types of information. In other words, the application of Hill's guidelines can be difficult when assessing literature that is incomplete or sparse. The assumptions made and the difficulties encountered in assessing the literature regarding the health effects of mustard agents and Lewisite are discussed in this report in the chapters dealing with specific organ systems and health conditions.

The complete bibliography at the end of this report is divided into three sections: published literature, military reports, and technical reports. Availability information is also provided at the end of the bibliography. A separate subject bibliography has been compiled and is available through the NTIS under the title Health Effects of Mustard Gas and Lewisite: Subject Bibliography.


Goldman M, Dacre J. 1989. Lewisite: its chemistry, toxicology, and biological effects. Reviews of Environmental Contamination and Toxicology 110:75-115.

Gray PJ. 1989. A Literature Review on the Mechanism of Action of Sulphur and Nitrogen

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