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HA Lee, R Gabriel, AJ Bale, D Welch. Clinical Findings in 111 Ex-Porton

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HA Lee, R Gabriel, AJ Bale, D Welch. Clinical Findings in 111 Ex-Porton J R Army Med Corps 2004; 150: 14-19 J R Army Med Corps: first published as 10.1136/jramc-150-01-03 on 1 March 2004. Downloaded from Clinical Findings In 111 Ex-Porton Down Volunteers HA Lee, R Gabriel, AJ Bale, D Welch ABSTRACT clothing. Also there has been considerable Objective research into protective pre-treatments and To determine whether the health of treatments for chemical and biological agent Porton Down volunteers (PDV) has poisoning and the effects of exposure to low suffered as a result of their participation doses of chemical warfare and potential in medical trials, during which they threat agents. These have included mustard were exposed to single low dose con- blister agents, organophosphate derivatives centrations of chemical warfare agents. such as nerve agents, lachrymators, vomiting inductors, incapacitants and antidotes. It is Methods this latter category of studies that has Data were obtained from a self-selected attracted most concern from the popular series of ex-Porton Down volunteers media and public alike. who attended the MOD’s Porton Down Approximately 3,000 volunteers have Volunteers’ Medical Assessment Prog- participated in studies involving nerve agents ramme (PDVMAP). One hundred and and about 6,000 with mustard gas. Some eleven men attended with a mean age of individuals have been potentially exposed to 62 (range 37-81) years. Information ob- both agents. Participation in such studies did tained was analysed to determine whe- not necessarily involve exposure to the agent ther clinical diagnoses and symptoms concerned; for instance, some volunteers reported had any relationship to acted as ‘control’ and where protective chemical exposures. clothing was being evaluated, this may have prevented actual exposure. It is estimated Results that several hundred volunteers may have The diagnoses were not unusual for UK been involved in studies evaluating potential nationals with a mean age of 62 years. therapeutic drugs and threat compounds The majority of volunteers went to such as lysergic acid diethylamide (LSD), Porton Down in the 1950s and then had sensory irritants and morphine derivatives http://militaryhealth.bmj.com/ a mean age of 19. The mean time be- and several tens of volunteers in studies with tween volunteers attending Porton artificial smog. Down and coming to MAP was 42 years. The Porton Down Volunteers’ Medical We found no correlation between chem- Assessment Programme (PDVMAP) was ical exposures and later development of established in February 2001 as a result of a established diagnoses, a latent period of Ministry of Defence initiative to investigate 30 years. the health concerns of some who took part in the volunteer trials and to assess whether or Conclusion not there was evidence to support their claims. Those people felt that they were On a clinical basis, no evidence was on October 1, 2021 by guest. Protected copyright. found to support the hypothesis that suffering unusual ill-health which might be participation in Porton Down trials linked to their participation in trials at Harry A Lee produced any long-term adverse health Porton Down. Many had already been Head of Porton Down investigated as a result of their health Volunteers’ Medical effects or unusual patterns of disease Assessment Programme compared to those of the general concerns, either by their own general population of the same age. practitioners or NHS hospital medical staff. Roger Gabriel Consultant Physician Introduction Methods The Service Volunteer Programme at Porton Assessment process Amanda J Bale Down came into existence in 1916 and since Eligibility to attend the programme was Database Manager then over 20,000 volunteers from the three based on a record of attendance by the Armed Services (Army, Royal Navy and volunteers at Porton Down, information Dawn Welch Royal Air Force) have taken part in various about the studies in which they participated Database Assistant studies. During the period from 1916 to the and subsequent health. Baird Health Centre, present day, they have assisted in research Before any volunteer attended the Gassiot House programmes to assess the acceptability and programme, a request was made to the St Thomas’ Hospital practicability of protective equipment by, for general practitioner to have photocopies of London SE1 7EH example, investigating skin sensitivity to the practice notes available for that E-mail: different mixes of rubber compounds to be consultation. Records were also obtained of [email protected] used for the production of protective the volunteer’s visit to Porton Down so that HA Lee, R Gabriel, AJ Bale, D Welch 15 J R Army Med Corps: first published as 10.1136/jramc-150-01-03 on 1 March 2004. Downloaded from the authors had the maximum possible methods as when addressing health problems information available before the volunteers of Gulf War veterans (1,2). attended. For some, a prior request was also made for military medical documents. Case series Every effort was made to offer a patient an The case series comprises an analysis of the appointment within 5 weeks of their first 111 Porton Down volunteers who application to attend. Letters following their attended the Assessment Programme consultation were sent out within 2 days. between 1 February 2001 and 30 September Travel costs were met by the Ministry of 2002. It was not possible, given the historical Defence for attendance at the programme, as background and immediate needs for a was overnight accommodation when medical assessment programme, to study a required. control group for this cohort. The Before the consultation, patients com- PDVMAP is not a treatment or research pleted a short questionnaire about their centre. military service with particular reference to their unit, rank and trade at the time of their Diagnoses attendance at Porton Down. A detailed hist- All volunteers were seen by one of two phy- ory was taken and a full clinical examination sicians, HAL or RG. Diagnoses were coded carried out. Exposures at Porton Down and according to International Classification of any immediate effects were recorded, based Diseases, 10th revision (3) and this public- on Porton Down records and patient recall. ation groups diseases in Chapters (see Some volunteers attended as controls for Clinical Findings). exposure groups, whilst others took part only in physiological experiments such as anthro- Results pometric measurements, blood volume All case notes were available for study. measurements and respiratory physiological Demographic characteristics of experiments. The patient was also given the volunteers opportunity to confirm any details that we Table 1 presents comparative sociodemo- had from his Porton Down visit – he always graphic information of the patients seen. had a copy of the same letter. The mean age was 62 (37-81) years and As most of these volunteers had previously 59% of patients attending were in the age been fully investigated, no routine range (60-69). The majority of attendees investigations were undertaken as a result of went to Porton Down in the 1950s and were their visit here. On four occasions there was aged 19 at the time of attendance there. Of a clinical indication for some extra the 111 patients seen at the PDVMAP, 75 investigation to be requested. A letter were in regular service at the time of their describing the assessment was sent to the attendance, and 36 were National Service- http://militaryhealth.bmj.com/ patient’s general practitioner and copied to men. All were other ranks, except one cadet the patient. officer and one officer. Most, 96, attended Acquisition of clinical findings, database Porton Down on one occasion, 11 on two input and subsequent analysis used the same occasions, and 4 on three or more occasions. All the data in Table 1 is based on Table 1.Sociodemographic data. information from their first visit to Porton Number Age range: Mean: Down. All volunteers who attended for Service at Porton Down: 1 assessment were male. Army 44 Royal Navy 20 Exposure data Royal Air Force 47 Table 2 presents the evidence on exposures on October 1, 2021 by guest. Protected copyright. Age at Porton Down: 1 based on data from Porton Down. Of the under 20 54 111 seen, we had exposure data on 109 from 20 to 24 52 17 to 34 20 Porton Down records, 70 were exposed to a 25 and over 5 variety of rubber mixes applied to forearm, Decade at Porton Down: 1 60 to sulphur mustard blister agent, 55 to 1940's 7 nerve agents such as organophosphate 1950's 63 derivatives (for example, sarin) and 45 to a 1960's 27 variety of sensory and centrally acting 1970's 12 incapacitants varying from orthochloro- 1980's 2 benzylidene malonitrite (CS) and dibenz Age at PDVMAP: [b.f] – 1, 4 oxazepine (CR) riot control under 50 10 agents, alcohol and LSD. 50 to 59 24 Incapacitants are divided into two sub- 60 to 69 66 37 to 81 62 groups known as central and sensory agents. 70 to 79 10 Central nervous system depressants include 80 and over 1 3 quinuclidinyl benzilate (BZ) and other Number of years between Porton Down and presentation at PDVMAP:1 42 centrally acting anticholinergic drugs. Information is based on 111 Porton Down volunteers' Central nervous system stimulants include 1 Information is based on first visit to Porton Down indoles such as LSD and cannabinols (for 16 Clinical Findings in Ex-Porton Down Volunteers J R Army Med Corps: first published as 10.1136/jramc-150-01-03 on 1 March 2004. Downloaded from Table 2. Exposures. the records were broadly accurate. Number The majority (54 of 64, 84%) did not have Rubber mixes: 70 any adverse reactions to the rubber mixes. Blister agent: 60 With respect to the sulphur mustard blister Nerve agent: 55 agent, based on Porton Down information Incapacitant: 45 and patient recall, some had local erythema, Decontaminant: 33 others developed local blisters and one Antidote: 1 33 developed a widespread vesicular eruption.
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