 I'm going to talk about the history of the medical response to chemical warfare. Chemical warfare goes back any number of years and as you know, one of the things about chemical warfare over the centuries has been the question, is chemical warfare cruel? Is it humane? Is it inhumane? Is it a proper way to fight a war? Now, one would ask, this Patagonian Indian, is that weapon that put that hole in his head? Is that a humane weapon? Is the weapon that put the dent in the spine of this native of South Africa many centuries ago? Is that a humane weapon? The crossbow was used frequently in warfare in the Middle Ages. It was declared inhumane by Pope Leo, who said the crossbow is inhumane and not fit for Christian use, except of course when the Christians went on the Crusades against the Muslims, then it was fit for Christian use. Well, chemical warfare generally is acknowledged to have started back in the Peloponnesian area, which is a sea off of Greece during the Peloponnesian wars. And during that war, most of the fighting was hand-to-hand infantry combat, as fighting has been throughout the ages. But in the book, The History of the Peloponnesian War, there is a story about the siege of the town of Delium. Some of the allies of Sparta were trying to take the town. They couldn't do it. So finally they hollowed out a log, they filled it with pitch, naphtha, sulfur, other things, and put smoke and fire through the wall. And by that means they managed to break the siege and capture the city. The Greeks, 1,000 years later in 600 AD, used a similar mixture of various things, although we don't know exactly what, to make Greek fire. Now this was particularly good for use at sea because it floated on water. In the Middle Ages, Venetians and other people used different compounds in shells and vases. They used them to poison livestock, to poison crops, and for other purposes. This is Admiral Cochrane of the British Navy, who in 1812, during the War of 1812 urged the British to put sulfur in ships and burn it and send it into the enemy's ports. This was turned down as being not a proper way to conduct war. This is Sir Leon Playfair, again in England, who in 1854, during the Crimean War, suggested the use of cyanide in shells. That was the use of cyanide 140 years ago. These are not modern weapons. This is Mr. Stanton. Mr. Stanton was Lincoln's Secretary of War during the Civil War. He got a letter from a gentleman in New York which includes a drawing of a shell which he proposed be filled with chlorine and used against the Confederacy. The letter was either lost or ignored, and of course this didn't happen. In fact, there's a general order that we shall not use poisons in warfare. This is Nobel, a distinguished scientist who was not German, but during the period of the late 1800s, the Germans developed a tremendous chemical industry. They had a dye industry, they're chemist-fed with new inventions, new chemicals, knew this and knew that, and they had at least 10 to 20 times more chemical patents than all the other countries combined. So they had a tremendous chemical industry at that time. People turned their attention to chemical warfare. This is the Hague Convention of 1899. Chemical warfare was discussed at length. Is it humane? Is it proper? Is it legal? As though anything is legal or illegal in wartime. And this is our representative, Admiral Mohan, if any of you are in the Navy, some of you already might recognize that name. He argued on behalf of the United States that we should not prohibit the use of chemicals in war. He said they might be used to lessen the suffering on the battlefield. Well, despite his argument, chemicals were prohibited with a very weakly stated proposal from that convention. Parties agreed to abstain from the use of projectiles, which might have poison gas. Well, we've had the development of the chemical industry. We've had the proposed use of chemicals. We've had the political discussions about them. And then in 1914, the first large-scale testing ground of chemical agents. The first agents used a variety of control agents. They were used in very small skirmishes, mostly by the French, because they had used them before the war, and they weren't too successful. Then along came the flamethrower. Now we get back to the concept of fire, smoke, burns, asphyxiation, as chemical weapons. And some of them still do those things. Most of them do one or another of those things. Nonetheless, flamethrower was not too successful. It lasted only a minute. You could get rid of it by shooting the holder. And besides that, they tended to blow up while being used. So joining the flamethrower corps was not a popular thing to do. World War I was fought mostly in trench lines. These were dug-in trenches, complex systems of trenches, and they didn't move too much during the whole war, no more than 10, 20 miles in either direction. And it kind of roughly went that way, if you can see where it is. Now along that trench line in the middle, in Belgium, was the town of Ypere, an old, beautiful walled town which still exists. And one late afternoon in April of 1915, suddenly over the battlefield, there were large clouds of greenish-yellowish gas, chlorine used by the Germans. A complete surprise has caused large numbers of casualties, many of whom died from asphyxiation, pulmonary agents. Well, this caught the Allies by surprise. There was a hole in the line, and the Germans could have walked all the way to England had they so chose. But they weren't ready. They were surprised by the success of this. Their reserves were over on the Eastern Front, fighting the Russians. And part of their surprise was due to the fact that this chemical agent was developed by civilian scientists, and therefore it wasn't going to work. Among those civilian scientists was Professor Nernst, and this is Professor Fritz Haber. Both Nernst and Haber later went on to win Nobel Prizes, not for this work, but for other things they later did. Well, the Allies shouldn't have been surprised, because POWs had told them the Germans were putting down chambers of chlorine, or containers of chlorine. And this is all they were, tanks, you know, like we get oxygen, nitrogen, and other things in. They just opened the valve and let it go. Now they had to wait two weeks for this initial attack, until the wind was blowing in the right direction. You don't want to do this when the wind's against you. Well, the Allies responded. Mask. Choreying damaged lungs and very little else. So if you protected the airways, you were completely protected against it. That veil mask wasn't too much protection. This is a leather mask with gauze containing glycerin and chloride, which we still use. Little more sophisticated mask. This is a mask with a canister up on the mask itself. And this is a mask with a canister in the pouch. Now what was the prime mover in World War I? Does anybody know? Big question? Horses. Horses. Or Colonel Hearst once looked at a picture and said they were jackasses. But nonetheless, whatever they were, soldiers had to cover them to their horse or their jackass to protect them against the agents as well. So the British began to retaliate and keep in mind at this point in time we were not in World War I in 1915. First they used canisters, just like the Germans had. Then they developed a projector or mortar to shoot the shells more precisely, not as wind-dependent as the other. Some soon found out it was no fun fighting a war in protective mask and it is no fun to take care of casualties wearing a protective mask. Well, we got into the war in 1917. The U.S. Army did not have a chemical core. In fact, the chemical mission was dispersed throughout the Army. Research was done by contractors. This is American University in Washington and some of the results of that research were dug up a few years ago. Shells and other things were found buried in that area of Washington, left over from this. The signal corps made alarms, the engineers made weapons, and the medical department was responsible for training in four protective masks. This is a factory on Long Island. These women are making masks. This was one of the first times that women in the workforce did find technical tasks. Women had been in the workforce for centuries, but not doing this type of task. Posters were out. You can't see it. It says the final inspector to encourage people to do better. Well, the first mask that was sent to Europe didn't work too well. It didn't filter out some of the things they should. So we had to use French masks. This is basically where you sit today. This is this peninsula in October 1917, shortly after we entered the war. This is that same site about four months later, a large industrial complex making drums of agents. Now, can you imagine something going from a pasture to a large industrial complex today? You couldn't even get a contract written in four months to do something like that today. Nonetheless, this was the agent that was made. Most of it was bulk agent. It wasn't in munitions. And a lot of it never got to Europe. The war was over before some of it got overseas. This is General Pershing, Supreme U.S. or Supreme Allied Commander in Europe. He recognized that there were problems with the military and the chemical operations of the military. He wanted to combine chemical service. So he appointed Colonel Fryes as Chief of his chemical service. Colonel Fryes in turn appointed Colonel Gilcrest to be the medical officer. Colonel Gilcrest was from Yale. He'd done research in infectious disease before the war and was well known. Now keep in mind Colonel Gilcrest will see him a little bit later. They set up decon stations, treatment stations and methods of treatment. The agents in use at that time, up until that time, had been chlorine and phosgene, two agents that did pulmonary damage but little else. All you need was assisted ventilation or all you had basically was assisted ventilation. And then the Germans changed the agents. The first effect of this agent resembled scarlet fever or other some disease. It was a rash and it irritated the eyes and caused redness. Later the skin irritation went on to produce blisters. This agent of course was mustard. Germans used it first. Now mustard caused blisters, it caused skin damage, it caused airway damage, it caused eye damage and most of this damage was reversible. Very few people died from mustard exposure. But there were tremendous numbers of casualties like these guys. They're healthy. It's just that their eyelids are swollen and their eyes are shut. They cannot see. They require care. People had to provide total body covering since this agent damaged skin. And this made fighting a war even more difficult. This is World War I equivalent of a mop suit. And it wasn't as comfortable as a mop suit. Areas got contaminated. And as you know by now this is a persistent agent that stayed around for a while. This area remained contaminated for a while. Mustard has a late onset of effects, effects occur many hours later. So somebody potentially exposed had to be watched and sometimes they marked them. So you could watch them better. Evacuation vehicles had to be separate. Some of these are contaminated, some are not. Finally, they had to set up more thorough decontamination facilities for total body decontamination with showers, which people went through as a final stage. People who wore oil suit or oil cloth type suits or rubber suits, which were extremely hot in the summertime. And the medical staff tried to figure out how to treat mustard burns. Now you don't see this too well on this projection. This guy's skin is covered with an oily greasy substance, which was one of the things that was first tried. It didn't work. They finally decided the best thing they had was hypochlorite. Now they used it because they thought it would pull mustard out of the skin, detoxify it, which it doesn't do. But they also used it for decontamination, which we still do. This guy in black and white, you don't see it, but you do see the mark where his belt was on him and protected that area of skin when he got exposed. Sunglasses were first used back then. Over here, I can't see it too well from here. People with mustard burns in their eyes have photophobia for a long period of time afterwards. And sunglasses don't really cure their photophobia, but it makes them more comfortable. What agents were used in World War I, anything the chemists could come up with that might be toxic? Cyanide was not too successful for a number of reasons. Chlorine and phosgene were important agents before mustard was used. Various mixtures were used for different reasons. These are the major agents. This is when they were first used, 1915, mustard, 1917. Death rate, low. Casualties, large numbers. If you look at these numbers, they are about 4% of these numbers. In the U.S., the death rate was about 2.2% of chemical casualties who died. In Russia, it was 11%, aside from that, 4%. Very few died, but they required a lot of medical care. This is one reason why the Russian rate was so high. They had very poor protective masks. And other protective equipment. Well, here's Colonel Gilchrist again. Only by now, he has two stars, and he's in the chemical corps. He is chief of the chemical corps. And after World War I, he wrote a book, which you can't see. It has to do with casualties from chemical injury and other weapons. And he pointed out that chemical casualties comprised 30% or so of total U.S. casualties in World War I. He also pointed out that hospital stay was considerably longer than it was for other type of injury. Usual injury had to stay, a person injured had to stay in the hospital two to three weeks. And these go up eight or nine weeks. Tremendous burden. After World War I, there were a lot of meetings, a lot of international meetings. There were treaties, protocols, et cetera. And research continued. This is a laboratory here at Edgewood. I remember working in this lab. My workbench was right over here. This is back in the 20s. And they developed a lot of new equipment, a lot of new things. This is a mask for the Navy. Now why the Navy masks look like that? You people in the Navy, do you have an idea? Why these strange eyepieces? We're looking through the big eyes or periscope. Periscope might be. But it's primarily for using binoculars. People in the Navy use binoculars a lot more than people in the Army do. And masks were developed for a variety of purposes, which I won't try to name each one of them, but different type masks. Better protection for the prime mover. And since we're dealing with mustard, which is something that burns skin, we had to protect that as well. So we had booties for the prime mover. Better methods of dissemination. This is a tank spraying agent. Including aircraft spray. And despite all this, New York survived this attack. This is Colonel Vetter, Edward Vetter, for whom this building is named. Colonel Vetter was chief of the Medical Research Laboratory in the mid-20s, much as Colonel Little is now, and Colonel Hearst before him. And under his direction, laboratories developed better resuscitation devices, better filtering devices. They studied the effects of small amounts of agents in humans. They studied mask resistance. And Colonel Vetter wrote a textbook, which for years was the best textbook written on the subject of chemical agents in humans. And in that book, he argues the humanness of chemical agents. He said, are chemical agents, which rarely leave residual scars more or less humane than a weapon that causes a wound like that in a living soldier? Well, also during the wars, the British trained and had drills using protective mask. Keep in mind, they were afraid, and this might have come in handy, Germans had used these weapons during when they were bombing London. The Japanese went about their daily task using protective masks. And this is ironic because Japan was probably the only country that used chemical agents in World War II. They used them against China in the late 30s and perhaps in the early stages of World War II. The Italians, you recognize Elduche, Ethiopia, they did it by aerial spray against poor unprotected people. Now, we've heard about the use of chemical agents against poor unprotected people in Laos, in Cambodia, in Afghanistan, et cetera. It goes on and on. These people, some of whom, if you could see that better, you'd see they didn't even have shoes. And to put mustard down caused them a lot of problems. Well, World War II broke out. And once again, the flamethrower, a chemical weapon in a sense, backed to fire and smoke and burning and asphyxiation. The British trained for chemical warfare in masks and bare legs. British schoolchildren carried protective masks. US soldiers trained in protective masks. US soldiers learned to decon. These guys in protective suits, the sergeant up here, directing operations without a protective suit. And even the women's auxiliary Army Corps trained in preparation for chemical warfare. Walt Disney was hired by DoD, or the War Department at that time, to design a mask that children would not be afraid of, the Mickey Mouse mask. And I know that some of you still feel that your protective mask is really Mickey Mouse. We had a new first use policy about chemical agents in World War II. President Roosevelt said we would not use them first, but we would always be prepared to retaliate. As a result, we had chemical weapons on many Pacific islands as we took them. And we had them behind the lines in other places. And as a result of that, there were some chemical casualties in World War II, but not among combatants. This is the harbour at Barry, Italy. Barry is down in the Achilles tendon of the boot of Italy. We had invaded Italy. We're about halfway up that boot. We thought this harbor was safe. And one night in December 1944, 1943, the Germans bombed it, surprisingly. In that harbor was a ship, the USS John Harvey. It contained 1,100-pound mustard bombs. No one knew that agent was on that ship in that harbor, except a small group of chemical core people who accompanied that shipment. The ship was hit. Those chemical core people were all killed. There was a lot of mustard in water. And a lot of semen from other ships got mustard poisoning from swimming in that water. A lot of civilians got injured by this smoke. And most of them fled town. And an accurate count of the number of casualties is unknown. There are a lot of casualties among the semen. A lot of people were sick. A lot of people were dying. And of course, the local medical personnel did not know what was wrong. They did not know what was causing this strange illness. Colonel Stuart Alexander was on Eisenhower's staff. He is a physician. Before the war, he had been stationed here at Edgewood as a research physician. He knew something about chemical agents. He attended this course. I remember him well. He sat right over there in that part of the room and snoozed about half the time. But nonetheless, he was Eisenhower's medical chemical man, if you will. And he went to the scene at Barry. He made the diagnosis of mustard poisoning and assisted in the treatment of the casualties. Now, he was a smart physician, but it also helped that he knew that mustard had been on that ship. He wrote a report about this two years after the war, which is an excellent report. Military surgeon is now military medicine, if you try to look this up. After the war, we discovered several things. One is places like this, gas chambers, poison gas was used, but not on a battlefield. Now, what was used in these chambers was primarily things like carbon monoxide, a lot of cyanide, cyclone B, which is a fumigant, was used. And it was also used, to some degree, to test things like nerve agents and treatment for some of the more poisonous agents. The Germans before the war had first synthesized what we call today nerve agents, extremely toxic materials, and they put them in munitions. And they had a fair-sized stockpile of nerve agent munitions during the war. They didn't use them. Why didn't they use them? You know, if they'd used them, the war might have ended differently, because we didn't have them. We didn't even know about them. We had no defense, no protection, no antidote. Well, nobody knows why they weren't used. Hitler probably didn't like chemical agents that he'd been a victim of mustard exposure twice in World War I. A lot of his senior officers had fought in World War I on chemical battlefield, and they didn't like chemicals, because it messed up the battlefield. But the truth probably is that by the time that Germany had its back against the wall toward the closing of the war, they didn't have air superiority. They had no means to deliver these weapons. I mean, you can just imagine what would have happened if they'd put nerve agents on the beaches of Normandy. It would have been a disaster. Anyway, we found gas chambers, and all of that led to. You're familiar with that story, I'm sure. And we found reactors for making nerve agents. We shuttered when that happened. Well, since World War II, where have agents been used? They were used by Egypt in the Yemeni Civil War. They were used by the US in Vietnam, riot control agents. They allegedly were used against the Hmong in Laos. They allegedly were used against Cambodian refugees. They were used in Afghanistan. And certainly, they were used by Iraq and Iran, Iraq against Iranians, and Iraq against its own people, the Kurds. So with that background, when we were preparing to go to war for Desert Shield, Desert Storm, Colonel Hirsch is probably going to tell you all about this, we had to look back and think about the medical response to chemical agents. And what we could do about taking care of casualties from those agents.