equipment to protect troops from chemical attack. The overall research program was divided into sections, each of which was responsible for specific types of research, ranging from gas production processes to treatment of gas casualties. As the program matured, the various organizational structures were modified. The details of these modifications are not presented here because they are largely irrelevant to consideration of the health effects of mustard agents and Lewisite. One modification, however, may have set the stage for how research into these substances' medical effects has been conducted and directed ever since.
In 1918, a presidential order moved the research program from essentially civilian control under NRC to military control under the War Department. This move gave birth to the Chemical Warfare Service (CWS), which, to the present day, is responsible for the majority of research concerning chemical and biological warfare agents. As time went on this administrative change altered the direction of almost all investigations into the toxicology of vesicants and other chemical agents. Mainstream biomedical science is "hypothesis driven": when interesting results are obtained by an investigator, either that investigator or other groups begin further research to better understand what has been discovered, even if the interesting results are not directly relevant to the original questions being asked. In addition, the results of most biomedical research are published in "open literature," critically reviewed by outside experts and available to all.
In contrast, most military research is "applications driven": priorities are determined on the basis of military needs (e.g., treatment of acute injuries, development of protective clothing), and results not directly relevant to the original questions are seldom pursued. Such research is commonly classified and is published only for other military groups. The tight controls and restrictions on military research can result in a "stunted" body of literature that presents major limitations to later assessments in areas that were never pursued—in this case, the long-term health effects caused by exposure to chemical agents in general, and mustard agents and Lewisite in particular.
Researchers in the medical aspects of chemical warfare began their work in 1917 with few of the guideposts that are normally available from previous studies. The only literature available on the medical effects of sulfur mustard and Lewisite was that produced by the English and French, who had only a small head start with their research programs. Nevertheless, perusal of the significant papers published after the war from these groups reveals that multiple lines of investigation were quickly initiated and pursued. Some of the work done by the medical research groups examined the mechanisms of absorption of mustard agents into human skin, the effects of various ointments and antidotes