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Long-Term Psychological Consequences Among Chemical Warfare Survivors of World War I and Their Current Relevance

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Long-Term Psychological Consequences Among Chemical Warfare Survivors of World War I and Their Current Relevance CM E Long-term Psychological Consequences among Chemical Warfare Survivors of World War I and their Current Relevance CM E EDUCATIONAL OBJECTIVES 1. Describe the psychological, social, and cultural ramifi cations among World War I veterans of large-scale battlefi eld use of chemical ordnance. 2. Compare the similarities of that cohort to the experiences of recent victims of chemical warfare in Iran and elsewhere. 3. Discuss the nature of chemical at- tack threat as primarily a psycho- logical weapon. Edgar Jones, PhD, is Professor of the History of Medicine and Psychiatry at the King’s Centre for Military Health Research, London. Neil Greenberg, MD, is Surgeon Commander, Royal Navy, and Senior Lecturer in Military Psychiatry, Academic Centre for Defence Mental Health. Address correspondence to: Professor Edgar Jones, King’s Centre for Military Research, Weston Education Centre, 10 Cutcombe Road, London SE5 9RJ; or e- mail [email protected]. In undertaking the research for this article, Professor Jones was supported by a grant from the Economic and Social Research Council and the Ministry of De- fence (RES-000-23-1057). The opinions and views expressed herein are those of the authors and do not refl ect the offi cial policy of the Royal Navy or the Ministry of Defence. Photograph by Captain Frank Hurley Dr. Jones and Dr. Greenberg disclosed no relevant fi nancial relationships. Edgar Jones, PhD; and Neil Greenberg, MD 724 PSYCHIATRIC ANNALS 37:11 | NOVEMBER 2007 33711Jones.indd711Jones.indd 772424 111/2/20071/2/2007 111:11:241:11:24 AAMM as was the truly novel ele- SIDEBAR 1. ment of World War I. A range Gof toxins were used (princi- The Experience of Soldiers Exposed to Gas pally chlorine, phosgene, and mustard Private John Hall of the Machine Gun Corps about his service in France: gas), delivered by a variety of methods, “The enemy often sent over lachrymatory gas fi rst and then phosgene. I was terrifi ed of gas including cloud, shell and mortar. Pro- to tell you the truth … I was more frightened with gas than I was with shell fi re.” duction of chemical weapons grew pro- Imperial War Museum Sound Archive, 14599, code A, reel 2 gressively and, as a result, increasing numbers of servicemen were exposed to Infantry soldiers fi rst exposed to chlorine in May 1915: poison gas as the war drew to a close. “As the gassing continued the men became excited, and could not be prevented from put- Although the box respirator, introduced ting their respirators to their mouths after each dip without squeezing them dry, the result from the summer of 1916, protected the was that the men could not breathe through the saturated respirators and thinking that windpipe and lungs from all toxins used they were being suffocated by the gas dipped them at shorter intervals, breathing hard between the dips instead of holding their breath, with the inevitable result that they were in the war, many suffered from the vesi- rendered unconscious by the gas.” cant effects of mustard gas for which, in the absence of special clothing, there Report of Major General H.S.M. Wilson, May 31, 1915 was no adequate defense. Yet the num- bers killed by chemical weapons were relatively small as a percentage of total specifi c effects added to genuine anxi- by Douglas, a physiologist serving with deaths: an estimated 6,060 U.K. troops, eties. Soldiers traumatized or mentally the British Army, was that: which was about 1% of the total.1 For exhausted by the effects of prolonged “ … we have admittedly to deal with the U.S. Army, it was calculated that of warfare often misinterpreted the nature a large psychic element in very mild the 34,249 immediate deaths of soldiers of bombardments and assumed that they cases of gas poisoning, and this feature on the battlefi eld, only 200 (0.6%) were had been poisoned by gas. Powerful is naturally more prominent in the case from gas. However, of 70,552 U.S. ser- emotions inspired by chemical weapons of troops who have only a limited expe- vicemen exposed to chemical agents and not only had an impact on servicemen’s rience of gas shelling. Even with such admitted for treatment, 1,221 (1.7%) beliefs about damage to vital organs and experienced troops of our own, we have died in American Expeditionary Force long-term health but also infl uenced the to contend with this diffi culty — hence (AEF) medical units.2 number and range of symptoms that instructions to detain doubtful cases of Despite low mortality rates, gas ca- they reported. gas poisoning in medical units within the sualties were numerous, being the sec- army area until diagnosis is certain.”6 ond largest category (31.5%) of patients BATTLEFIELD RESPONSES Initial diagnosis was diffi cult because admitted to AEF hospitals after gunshot First, it is important to draw a distinc- the symptoms of anxiety often mimicked wounds (33.4%). In part, these fi gures tion between those who were severely the physical effects of mild exposure to refl ected the capacity of gas to trauma- gassed and suffered life-threatening gas.7 Charles Wilson, a medical offi cer tize soldiers. Indeed, some units exhib- physiological effects and those who working at a base hospital in Boulogne, ited outright panic when subjected to were minimally exposed and temporar- often found in newly admitted patients: chemical attack. Inexperienced troops ily incapacitated. One of the fi rst sys- “ … a nervous disorder — frequently were considered more vulnerable than tematic surveys of gassed servicemen hysteria — implanted on the physical units that had habituated to this new form showed that, where it occurred, death harm caused by the gas, which in itself of warfare. Clark showed, for example, was usually rapid and that the 95% who was often trivial. When after a few days that in July 1918 the U.S. 26th Division survived the initial phase went on to the bodily hurt had gone, there was left suffered four times as many gas casu- make a good recovery.4 With growing an emotional disturbance like a mild at- alties than the battle-hardened French clinical understanding, specialist physi- tack of shell shock … it was the mind 39th Division, although both units had cians recognized that non-severe cases that had suffered hurt.”8 been exposed to similar quantities of should recover within 6 to 8 weeks, al- By 1917, military doctors had de- chemical agent.3 Lack of knowledge lowing a soldier then to return to active vised a number of techniques designed about different types of toxins and their duty.5 A signifi cant diffi culty identifi ed to inhibit the accretion of symptoms LEFT: Australian infantry wearing Small Box Respirators (SBR). The soldiers are from the 45th Battalion, Australian 4th Division at Garter Point, Ypres sector, 27 September 1917. PSYCHIATRIC ANNALS 37:11 | NOVEMBER 2007 725 33711Jones.indd711Jones.indd 772525 111/2/20071/2/2007 111:11:251:11:25 AAMM 14 SIDEBAR 2. Pinard and Rendu, early in 1918. In the United States, a major government- Statements of Two U.K. Veterans Awarded a War Pension funded study by Gilchrist and Matz was for “the Effects of Gas” set up to “establish whether any or all of the several gases used during the “My condition came on in 1919 and has gradually got worse. I am unable to sleep properly at nights … I wake suddenly wet through with sweat and unable to get my breath. At World War left residua, either anatomi- the slightest excitement, or even from a noise, I am very often at a loss for speech, and cal or functional, after a period of ap- trembling from head to foot. I am a clerk and on repeated occasions, I am unable to use my proximately eight to ten years.”15 Based pen for nerves. I may add that previous to the above occurrence [gassing], I was in perfect on 838 servicemen exposed to chlorine health and had very strong nerves.” and 1,016 exposed to mustard gas, they Private R.W. reported on September 22, 1922 concluded that gassed veterans were at heightened risk of chronic bronchitis, “While working in the mine I had constantly to cease work and rest owing to tightness of although Gilchrist and Matz were un- the chest and stomach pains which I attributed to gas. I tried to carry on but fi nally had to able to control for confounders such a leave the mine and obtain work in the open air. I have however been considerably worse, the smoking, industrial pollution, and poor attacks being more frequent since working in the quarry. I have now come to the conclusion that instead of the effects of gas wearing off as hoped, it has gradually overpowered me.” quality living conditions. Evidence in the case of irritant-induced asthma, they Private E.D. reported on January 1, 1927 suggested, was unclear, and many cases were, in fact, misdiagnosed bronchitis.16 Retrospective study of U.K. World (including an insistence on activity, the servicemen who had recovered physi- War I veterans awarded a pension application of military discipline, and cally from the effects of phosgene and for the effects of gas found that many the removal of dark glasses as soon as mustard gas by Meakins and Walker gassed servicemen tended to interpret an ocular lesion was healed).9 However, found that one group of symptoms “out- any post-war respiratory event in terms once a veteran was discharged from the numbered all others, both in frequency of their traumatic battlefi eld exposure.17 armed forces, the Royal Army Medical and severity, those of the condition New upper respiratory tract infections Corps was no longer responsible for his called disordered action of the heart or (URTI) served to reinforce beliefs about continuing care.
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