Chemical Warfare Service during the peak years of production. Many other servicemen were trained to handle the gases or were assigned to jobs that put them in contact with mustard agents or Lewisite. A German bombing attack on the harbor of Bari, Italy, released sulfur mustard from a damaged American ship into the water and atmosphere, resulting in thousands of injuries and hundreds of deaths. Yet no follow-up studies were done with any of these groups; the committee had to rely instead on occupational studies from Japan and Great Britain for data on World War II production workers and their long-term health problems.

The following is a summary of the major conclusions reached by the committee regarding the association of exposure to mustard agents or Lewisite and the development of specific diseases in different organ systems. Much more is known about mustard agents than is known about Lewisite. Thus, the following summary pertains to mustard agents, except when Lewisite is indicated.

The findings generally fall into one of three categories. In some cases, the data examined were found to indicate a causal relationship between exposure and a particular disease. For a few diseases, the data were suggestive but not completely clear. Finally, there were many diseases for which very little or no data existed regarding the possible contributions of exposure to mustard agents or Lewisite. This means that many diseases in this category may (or may not) be caused by mustard agents or Lewisite, but no study has been done. It is important to emphasize that no condition evaluated could be removed from consideration as a health consequence of exposure to these agents. Thus, for many diseases there remains significant doubt.

The evidence found indicated a causal relationship between exposure and the following health conditions:

• Respiratory cancers

  • Nasopharyngeal

  • Laryngeal

  • Lung

•  Skin cancer

•  Pigmentation abnormalities of the skin

•  Chronic skin ulceration and scar formation

•  Leukemia (typically acute nonlymphocytic type, nitrogen mustard)

•  Chronic respiratory diseases (also Lewisite)

  • Asthma