National Academies Press: OpenBook
Suggested Citation:"Front Matter." Institute of Medicine. 1993. Veterans at Risk: The Health Effects of Mustard Gas and Lewisite. Washington, DC: The National Academies Press. doi: 10.17226/2058.
×

Veterans at Risk

The Health Effects of Mustard Gas and Lewisite

Constance M. Pechura and David P. Rall, Editors

Committee to Survey the Health Effects of Mustard Gas and Lewisite

Division of Health Promotion and Disease Prevention

Institute of Medicine

National Academy Press
Washington, D.C.
1993

Suggested Citation:"Front Matter." Institute of Medicine. 1993. Veterans at Risk: The Health Effects of Mustard Gas and Lewisite. Washington, DC: The National Academies Press. doi: 10.17226/2058.
×

NATIONAL ACADEMY PRESS
2101 Constitution Avenue, N.W. Washington, D.C. 20418

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for this report were chosen for their special competences and with regard for the appropriate balance.

This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.

The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy's 1863 congressional charter responsibility to be an advisor to the federal government and its own initiative in identifying issues of medical care, research, and education.

The work on which this publication is based was performed pursuant to Contract No. V101(93)P-1326 with the Department of Veterans Affairs. Funds for this contract were provided by the Department of Veterans Affairs.

Library of Congress Cataloging-in-Publication Data

Institute of Medicine (U.S.). Committee to Survey the Health Effects of Mustard Gas and Lewisite.

Veterans at Risk : the health effects of mustard gas and Lewisite / Constance M. Pechura and David P. Rall, editors.

p. cm.

"Committee to Survey the Health Effects of Mustard Gas and Lewisite. Division of Health Promotion and Disease Prevention. Institute of Medicine, National Academy of Sciences."

Includes bibliographical references and index.

ISBN 0-309-04832-X

1. Mustard gas—Toxicology. 2. Lewisite (Poison gas)—Toxicology. I. Pechura, Constance M. II. Rall, David P. III. Title.

RA1247.M8158 1993

615.9'1—dc20 92-40735

CIP

Copyright 1993 by the National Academy of Sciences. All rights reserved.

No part of this book may be reproduced by any mechanical, photographic, or electronic process, or in the form of a phonographic recording, nor may it be stored in a retrieval system, transmitted, or otherwise copied for public or private use, without written permission from the publisher, except for the purpose of official use by the United States Government.

Printed in the United States of America.

The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The image adopted as a logotype by the Institute of Medicine is based on a relief carving from ancient Greece, now held by the Staatlichemuseen in Berlin.

Suggested Citation:"Front Matter." Institute of Medicine. 1993. Veterans at Risk: The Health Effects of Mustard Gas and Lewisite. Washington, DC: The National Academies Press. doi: 10.17226/2058.
×

Committee To Survey the Health Effects of Mustard Gas and Lewisite

DAVID P. RALL (Chair),* Director (Retired),

National Institute of Environmental Health Sciences, Washington, D.C.

O. MICHAEL COLVIN, Professor of Oncology and Medicine,

Johns Hopkins University School of Medicine, Baltimore, Maryland.

ELLEN EISEN, Associate Professor,

Department of Work Environment, College of Engineering, University of Massachusetts, Lowell.

WILLIAM EDWARD HALPERIN, Associate Director for Surveillance,

Division of Surveillance, Hazard Evaluations and Field Studies, National Institute for Occupational Safety and Health, Cincinnati, Ohio.

CHARLES H. HOBBS, Assistant Director,

Inhalation Toxicology Research Institute, Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico.

DAVID G. HOEL,* Director,

Biometry and Risk Assessment Division, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina.

KARL KELSEY, Associate Professor of Occupational Medicine and Radiobiology,

Harvard School of Public Health, Occupational Health Program, Boston, Massachusetts.

CHARLES J. McDONALD, Professor and Director,

Division of Dermatology, Brown University,

Physician in Charge,

Division of Dermatology, Roger Williams Medical Center and Rhode Island Hospital, Providence.

JAMES MALCOLM MELIUS, Director,

Division of Occupational Health and Environmental Epidemiology, State of New York Department of Health, Albany.

JOHN A. MONTGOMERY, Distinguished Scientist,

Southern Research Institute, Birmingham, Alabama.

WILLIAM  NICHOLSON, Professor of Community Medicine,

Mount Sinai School of Medicine, New York, New York.

ROSWELL ROBERT PFISTER, Past Chairman,

Department of Ophthalmology, University of Alabama,

Director,

Brookwood Eye Research Lab, Birmingham, Alabama.

MARGARET SINGER, Emeritus Adjunct Professor,

Department of Psychology, University of California, Berkeley.

BAILUS WALKER,* Dean,

College of Public Health, University of Oklahoma, Health Sciences Center, Oklahoma City.

ANNETTA P. WATSON, Research Staff Member,

Health and Safety Research Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee.

Former Members

VINCENT MARCHESI,** Director,

Boyer Center for Molecular Medicine,

Professor of Pathology, Biology, and Cell Biology,

Yale University School of Medicine, New Haven, Connecticut.

LINDA ROSENSTOCK, Director of Occupational Medicine and Associate Professor,

Department of Medicine and Environmental Health, University of Washington, Seattle.

Suggested Citation:"Front Matter." Institute of Medicine. 1993. Veterans at Risk: The Health Effects of Mustard Gas and Lewisite. Washington, DC: The National Academies Press. doi: 10.17226/2058.
×

Institute of Medicine Staff

Constance M. Pechura, Study Director

Catharyn T. Liverman, Research Associate

Jennifer Hope Streit, Project Assistant

Gerri Kennedo, Project Assistant

Gary B. Ellis, Director,

Division of Health Promotion and Disease Prevention

*  

IOM member

**  

IOM and NAS member

Suggested Citation:"Front Matter." Institute of Medicine. 1993. Veterans at Risk: The Health Effects of Mustard Gas and Lewisite. Washington, DC: The National Academies Press. doi: 10.17226/2058.
×

Preface

So vivid were the memories of the first use of "mustard gas" (sulfur mustard) by the Germans in World War I that the United States government began to prepare for chemical warfare even before the Japanese attacked Pearl Harbor in 1941. This work was also spurred by the fury of war in Europe and reports of Japanese use of sulfur mustard against the Chinese. The U.S. preparations included the establishment of war-related research programs organized by President Roosevelt under the White House Office of Scientific Research and Development (OSRD). Two groups under the OSRD became involved in secret testing programs concerned with mustard agents (sulfur and nitrogen mustard) and Lewisite:

  •  The Committee on Medical Research

    This group studied protective ointments and other treatments through the National Research Council's Committee on Treatment of Gas Casualties.

  •  The National Defense Research Committee

    This group studied protective clothing and gas masks through military units such as the Chemical Warfare Service.

These testing programs involved the use of close to 60,000 military personnel as human experimental subjects. It was this use of human subjects more than 50 years ago that provided the impetus for the study reported in this volume. The initiation of this study in 1991 was finally prompted by long-delayed official admissions that human subjects had been used and the recognition that these subjects may have suffered

Suggested Citation:"Front Matter." Institute of Medicine. 1993. Veterans at Risk: The Health Effects of Mustard Gas and Lewisite. Washington, DC: The National Academies Press. doi: 10.17226/2058.
×

adverse, long-term, health consequences as a result of their exposure to mustard agents or Lewisite.

The committee, convened to produce this report by the Institute of Medicine in response to a request by the Department of Veterans Affairs, was comprised of experts in the fields of toxicology, epidemiology, occupational and environmental medicine, ophthalmology, dermatology, oncology, chemistry, and psychology. Its task was to survey the medical and scientific literature on mustard agents and Lewisite, assess the strength of association between exposure to these agents and the development of specific diseases, identify the gaps in the literature, and recommend strategies and approaches to deal with any gaps found. To accomplish this task, the committee met four times, examined nearly 2,000 scientific and medical reports in English and a number of foreign languages, and considered input from 13 military and civilian experts and over 250 affected veterans, including public testimony from 20 veterans. Although this task may have seemed straightforward in the beginning of the study, closer examination of the literature and the World War II (WWII) experimental protocols presented numerous scientific and ethical challenges.

The major scientific challenges were the meager literature on long-term health effects of exposure to these agents and the lack of quantitative exposure data for the veterans who served as human test subjects. The vast majority of the scientific and medical literature was concerned with the short-term, acute effects of mustard agents and Lewisite, because the research priorities of most countries had been placed on treatment of battlefield injuries and the fact that most investigations of mustard agents and Lewisite have been conducted throughout this century under the control of military establishments. Particularly distressing was the essential lack of information regarding the toxicology of Lewisite. Assessing the long-term health effects of mustard agents and Lewisite thus required the committee to integrate many types of data, from studies using laboratory animals to single human case studies, and to examine and compare closely the known biological mechanisms of injury from these agents with agents with similar properties for which more data were available.

The lack of exposure data for the WWII human subjects caused the committee to attempt to gather as much information as possible about the experimental protocols, the equipment used, and any injuries from official reports of the testing programs. The committee found that an atmosphere of lingering secrecy still existed in the Department of Defense regarding some of the testing programs. Reports of the specific experimental protocols were not always easy to obtain; in some cases, reports were not available or were obtained as the study was almost complete. Fortunately, enough information was gathered to allow

Suggested Citation:"Front Matter." Institute of Medicine. 1993. Veterans at Risk: The Health Effects of Mustard Gas and Lewisite. Washington, DC: The National Academies Press. doi: 10.17226/2058.
×

reasonable estimates of the exposures to human subjects, who were repeatedly exposed to mustard agents and Lewisite in gas chamber tests or under so-called field conditions.

As the full scope of the WWII testing protocols was revealed, compelling ethical questions emerged. At times, it seemed as if every new discovery only posed more questions. As the study progressed, the bits and pieces of information finally coalesced into a picture of abuse and neglect that was impossible for the committee to ignore. One of the first discoveries was that the end point of all the WWII mustard agent and Lewisite experiments was tissue injury—from mild skin burns to severe, and widespread, skin burns that took more than a month to heal. The chamber and field tests were actually called "man-break" tests.

Both veteran self-reports and official documents revealed that some subjects suffered damaging injuries to the lungs and upper respiratory system from inhalation of the agents. Committee analysis of expected gas mask efficiencies further showed that projected normal mask leakage under the hot, humid conditions of the gas chambers would have, in some cases, resulted in exposure levels as high as those reported on World War I battlefields.

The first response of many of the committee members to these discoveries was to try to understand the actions of the investigators in historical context—it was a war and the experiments were conducted before the Nuremberg Code of 1947 established formal principles to govern the proper treatment of human subjects. However, examination of the treatment and care of WWII chemical warfare production workers, and the conduct of later military experiments with human subjects from 1950 to 1975, demonstrated a well-ingrained pattern of abuse and neglect. Although the human subjects were called "volunteers," it was clear from the official reports that recruitment of the WWII human subjects, as well as many of those in later experiments, was accomplished through lies and half-truths.

Most appalling was the fact that no formal long-term follow-up medical care or monitoring was provided for any of the WWII human subjects, other exposed military personnel, or chemical warfare production workers, despite knowledge available by 1933 that mustard agents and Lewisite could produce long-term debilitating health problems, particularly in those people suffering severe burns and inhalation injuries. There was not even adequate short-term follow-up of the human subjects by the Department of Defense. Subjects in the chamber tests were sworn to secrecy and simply released on leave at the conclusion of the experiments. Some of these men still had blisters or evidence of skin burns upon release, but were not given any instructions about how to obtain knowledgeable medical care if they had needed it.

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Suggested Citation:"Front Matter." Institute of Medicine. 1993. Veterans at Risk: The Health Effects of Mustard Gas and Lewisite. Washington, DC: The National Academies Press. doi: 10.17226/2058.
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Although the experiments began in a wartime climate of urgency and secrecy, it was clearly a mistake in this case to continue the secrecy after the conclusion of the war. Follow-up of the exposed human subjects could have provided a wealth of information on the effects of these war gases and could have served as a basis for legitimate disability claims by injured subjects. By the end of the war, the use of nitrogen mustard as a chemotherapeutic agent (developed as part of the WWII testing program) clearly showed the serious health effects that the previous "volunteers" might be expected to experience.

In the face of the abuses uncovered, the committee members nevertheless sought to maintain an appropriate balance of their scientific responsibilities in assessing the available literature and their ethical responsibilities as physicians and scientists. In this effort, the committee members were guided by their stated task and their own individual judgments of the scientific and historical information examined. Thus, the committee believes that the findings and recommendations contained in this report are entirely justified by the scientific, medical, and historical evidence examined. There are, however, specific statements the committee wishes to offer as commentary on its findings.

First, the committee believes that each veteran who served as a human subject in the WWII experiments deserves honor for his sacrifice. 1 These men risked their health and safety to help develop better means of protection against chemical warfare. Yet, in most cases, their participation in these experiments was not even acknowledged in their service records and was, in fact, officially denied for decades. Further, these men were ordered to keep their participation secret. They did so for nearly 50 years, in some cases despite serious, disabling diseases that they believed were caused by their exposures. There can be no question that some veterans, who served our country with honor and at great personal cost were mistreated twice—first, in the secret testing and second, by the official denials that lasted for decades. They deserve recognition.

Second, the committee believes that any future military research with human subjects should be conducted according to publicly established ethical principles similar to those that apply to civilian research. The Department of Defense should consider including civilian medical experts in reviews of all proposed military research protocols involving human subjects. As was shown in the examination and evaluation by the Department of the Army Inspector General's report of the military drug and chemical testing programs from 1950 to 1975 (see Appendix F), a climate of secrecy provides a permissive environment for the neglect of

1  

According to all available reports, all the human subjects were males.

Suggested Citation:"Front Matter." Institute of Medicine. 1993. Veterans at Risk: The Health Effects of Mustard Gas and Lewisite. Washington, DC: The National Academies Press. doi: 10.17226/2058.
×

established rules of conduct. Such neglect should never be allowed to occur when human experimentation is involved.

Beyond the immense personal costs of the mistakes and failures of the United States government during and after the WWII testing programs, there are societal costs as well. The lack of available biological data concerning these chemical warfare agents also slowed the important fields of toxicology and cancer chemotherapy. Much would have been gained by careful observation after the end of WWII; instead much was lost.

The primary reason to identify and follow-up veterans exposed to mustard agents or Lewisite is to provide needed medical care. In addition, follow-up of these individuals now may also benefit our understanding of carcinogenesis. For example, recent advances in molecular biology have linked some chemical exposures in laboratory animals to specific changes in tumor cells; for example, activated oncogenes with unusual mutations or suppressor genes (and/or their protein products), or chromosome damage. In addition, it is well known that nitrogen mustard cancer chemotherapy can result in second tumors, which show unusual genetic changes. Therefore, study of any sulfur mustard-associated tumors should be explored, because the results could shed light on laboratory animal and human responses to carcinogens.

The committee wishes to acknowledge that this study could not have been done without the assistance of a number of people, many of whom are listed in the acknowledgments section of this report. Before this report was completed, the report draft was reviewed by experts in appropriate fields under the rules of the National Research Council's Report Review Committee. These individuals provided helpful commentary on the draft manuscript and the committee greatly appreciates the care and expertise that the reviewers brought to their task.

The work of the committee's Institute of Medicine staff deserves the highest praise. The committee is especially grateful for the thoughtful input, advice, and support given by Gary Ellis, the Director of the Division of Health Promotion and Disease Prevention. Thanks are also extended to Jennifer Streit, the study's project assistant responsible for planning travel and other meeting arrangements, who also translated some of the French papers requested by the committee. The massive job of finding, organizing, and procuring the hundreds of scientific papers and technical reports was accomplished with great skill by Catharyn Liverman, the study's research associate and medical librarian. The committee is truly indebted to Ms. Liverman—she always knew where something was, kept a thousand details straight, and did a wonderful job tracking down obscure references. Finally, the committee wishes to recognize the major contributions of the study director, Constance

Suggested Citation:"Front Matter." Institute of Medicine. 1993. Veterans at Risk: The Health Effects of Mustard Gas and Lewisite. Washington, DC: The National Academies Press. doi: 10.17226/2058.
×

Pechura. She knew and understood the literature, she worked tirelessly to obtain information from reluctant sources, and she organized the study plan, the meetings, the special presentations, and this final report. She clearly foresaw the major problems that this committee faced as it moved from the safe, but complex, problems of risk assessment to the thornier issue of human ethics.

This Preface is somewhat unusual in that it is signed by the entire committee, rather than by the chairman alone. However, the report itself is unusual because it tells a story about veterans involved in a long-secret wartime research program in the United States—a story that the committee and its staff hope will never have to be told again.

David P. Rall, Chairman

O. Michael Colvin

Ellen Eisen

William Halperin

Charles H. Hobbs

David G. Hoel

Karl Kelsey

Charles J. McDonald

James M. Melius

John A. Montgomery

William Nicholson

Roswell R. Pfister

Margaret Singer

Bailus Walker

Annetta P. Watson

Suggested Citation:"Front Matter." Institute of Medicine. 1993. Veterans at Risk: The Health Effects of Mustard Gas and Lewisite. Washington, DC: The National Academies Press. doi: 10.17226/2058.
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Acknowledgments

The committee wishes to acknowledge the valuable help and assistance it received from a number of individuals. First, the committee wishes to thank and honor the more than 250 veterans who participated in the public hearing process. The veterans' openness about their health problems and their understanding of the committee's role was of great value (see Appendix G). The committee is also very grateful for the input of the 13 civilian and military experts, who gave their time to make important presentations before the committee (see Appendix A).

Maria Lloyd and James Gately from the Naval Research Laboratory were tremendously helpful in sending technical reports of the World War II testing projects from their institution. In addition, they have worked diligently to provide documentation of participation to affected veterans. The assistance of Marjorie Ciarlante of the National Archives and Janice Goldblum of the National Academy of Sciences' Office of Archives and Information Services was also of great help in locating and obtaining historically relevant materials.

Susan Mather, Han Kang, and Robert Allen of the Department of Veterans Affairs aided the committee in many ways, but most especially by the determination of the feasibility of identifying the veterans who had served as subjects in the chamber and field tests (see Appendix E). Richard Patterson from the Disabled American Veterans and Richard Christian from the American Legion were valuable resources to the committee and their assistance in publicizing the public hearing process is greatly appreciated. The committee also wishes to thank Sanford Leffingwell of the Centers for Disease Control for sending an early bibliography and helping the committee to locate helpful toxicological

Suggested Citation:"Front Matter." Institute of Medicine. 1993. Veterans at Risk: The Health Effects of Mustard Gas and Lewisite. Washington, DC: The National Academies Press. doi: 10.17226/2058.
×

reports. Jeffery K. Smart, Historian at the U.S. Army Chemical and Biological Defense Agency, aided the committee by sending technical reports and photographs from work done at the Edgewood Arsenal in Maryland.

The committee appreciates the able editorial work of Paul Phelps, Florence Poillon, and Barbara Bodling. The committee is also indebted to the efforts of the Institute of Medicine's (IOM) managing editor, Michael Edington, and the sponsoring editor from the National Academy Press, Sally Stanfield. Laura Baird, the IOM librarian, provided helpful support and input in the literature search, and Susan Turner-Lowe, from the Office of News and Public Information, provided expert advice on the public hearing and interactions with the press. Gerri Kennedo, a project assistant who stepped in to help produce some of the final drafts of the report, deserves much thanks for her very competent handling of difficult assignments.

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Suggested Citation:"Front Matter." Institute of Medicine. 1993. Veterans at Risk: The Health Effects of Mustard Gas and Lewisite. Washington, DC: The National Academies Press. doi: 10.17226/2058.
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Suggested Citation:"Front Matter." Institute of Medicine. 1993. Veterans at Risk: The Health Effects of Mustard Gas and Lewisite. Washington, DC: The National Academies Press. doi: 10.17226/2058.
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Suggested Citation:"Front Matter." Institute of Medicine. 1993. Veterans at Risk: The Health Effects of Mustard Gas and Lewisite. Washington, DC: The National Academies Press. doi: 10.17226/2058.
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BOXES

3-1

 

Odor Threshold for Sulfur Mustard and Lewisite: Comparison with Tissue Damage Thresholds

 

53

11-1

 

Diagnostic Criteria for Post-Traumatic Stress Disorders

 

201

FIGURES

3-1

 

Vesicle formation on an Iranian patient

 

23

3-2

 

Organization of World War II civilian scientific research and testing programs,

 

30

3-3

 

U.S. naval personnel dressed for World War II sulfur mustard experiments

 

37

Page xvii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 1993. Veterans at Risk: The Health Effects of Mustard Gas and Lewisite. Washington, DC: The National Academies Press. doi: 10.17226/2058.
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3-4a

 

Naval Research Laboratory gas chamber

 

38

3-4b

 

Interior of the Edgewood Arsenal gas chamber

 

38

7-1

 

Structure of the respiratory tract

 

113

7-2

 

Illustration of the various types of cellular arrangements of epithelium that line internal body passages

 

114

8-1

 

Anatomy of the eye

 

132

8-2

 

Course of mustard gas lesions of rabbit cornea

 

136

9-1

 

Anatomy of human skin

 

149

9-2

 

Layers of the epidermis

 

150

9-3

 

Epidermal-dermal junction

 

152

9-4a

 

Epidermal melanin unit

 

155

9-4b

 

Summary of major events in melanocyte development

 

155

10-1

 

Model of the competent immune system

 

181

I-1

 

Relative carcinogenic potency of three nitrogen mustard derivative antineoplastic agents

 

394

TABLES

2-1

 

Bibliographic Databases Searched

 

16

2-2

 

Factual Databases Searched

 

17

2-3

 

Foreign Language Citations

 

18

3-1

 

Chemical and Physical Data

 

24

3-2

 

Known Gas Testing Facilities and Test Types

 

32

3-3

 

Concentration Versus Cumulative Exposure Level

 

32

3-4

 

Summary of Major Biological End Points Characterizing Sulfur Mustard Exposure to Humans

 

34

6-1

 

Pulmonary Tumors in Strain A Mice Injected Intravenously with Nitrogen Mustard and Sulfur Mustard

 

90

6-2

 

Pulmonary Tumors in Strain A Mice Injected Intravenously with Nitrogen Mustard and/or Exposed to X-Radiation

 

91

6-3

 

Tumors from Subcutaneous Injection of Sulfur and Nitrogen Mustard into C3H Mice and Sulfur Mustard into C3Hf Mice,

 

92

6-4

 

Tumors from Subcutaneous Injection of Sulfur Mustard into Strain A Mice

 

93

6-5

 

Number of Rats Developing Tumors Following Exposures to HD (Toxicity Study)

 

94

6-6

 

Number of Rats Developing Tumors Following Exposures to HD (Carcinogenicity Study)

 

95

6-7

 

Tumors Observed in Rat Carcinogenicity and Toxicity Studies, 96

 

96

6-8

 

Percentage of Female RF Mice with Neoplasms from Exposure to HN2 or X-Rays

 

96

7-1

 

Effects of Acute Sulfur Mustard Vapor Exposure on the Human Respiratory Tract

 

116

7-2

 

Antitumor Drugs That Produce Pulmonary Fibrosis

 

123

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Suggested Citation:"Front Matter." Institute of Medicine. 1993. Veterans at Risk: The Health Effects of Mustard Gas and Lewisite. Washington, DC: The National Academies Press. doi: 10.17226/2058.
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8-1

 

Effects of Acute Sulfur Mustard Exposure on the Human Eye

 

134

8-2

 

Effects of Acute Lewisite Exposure on the Mammalian Eye

 

135

8-3

 

Characteristics of Sulfur Mustard and Lewisite Ocular Lesions

 

138

12-1

 

Summary of Findings Regarding Specific Health Problems

 

217

I-1

 

Comparative Carcinogenicity of Selected Agents in Strain A Mice

 

393

Suggested Citation:"Front Matter." Institute of Medicine. 1993. Veterans at Risk: The Health Effects of Mustard Gas and Lewisite. Washington, DC: The National Academies Press. doi: 10.17226/2058.
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Veterans at Risk

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Recently, World War II veterans have come forward to claim compensation for health effects they say were caused by their participation in chemical warfare experiments.

In response, the Veterans Administration asked the Institute of Medicine to study the issue. Based on a literature review and personal testimony from more than 250 affected veterans, this new volume discusses in detail the development and chemistry of mustard agents and Lewisite followed by interesting and informative discussions about these substances and their possible connection to a range of health problems, from cancer to reproductive disorders.

The volume also offers an often chilling historical examination of the use of volunteers in chemical warfare experiments by the U.S. military--what the then-young soldiers were told prior to the experiments, how they were "encouraged" to remain in the program, and how they were treated afterward.

This comprehensive and controversial book will be of importance to policymakers and legislators, military and civilian planners, officials at the Department of Veterans Affairs, military historians, and researchers.

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