Chemical Warfare Agents: from 1915 to the present day

Chemical Warfare Agents: from 1915 to the present day

Chemical Warfare Agents: from 1915 to the present day Dr D J Baker Hpital Necker Enfants Malades Paris Objectives of the presentation Overview of a century or deliberate release of toxic chemical agents against both military and civil targets The role of industry and academic research in the development of chemical weapons

Discussion of toxic agents in terms of effects on specific somatic systems Assessment of the current threat particularly in relation to international terrorism Acknowledgement Dr JB Cazalaa for his invaluable help in preparing the slide presentation and for many years of support and friendship Toxic Trauma This lecture concerns the effects of exposure to

toxic chemical agents in both war and peace The damage caused to man from such exposure goes beyond the conventional concept of poisoning Toxic trauma part of the spectrum of physical trauma which has been developed in recent years Toxic trauma may be defined as the disruption of the function of somatic systems by mechanisms other than physical force. 1914 2014: a century of toxic trauma

Chemical warfare: the deliberate release of chemicals specifically conceived to cause harm Chemical accidents: toxic trauma as a result of accidental release of toxic industrial chemicals Several chemicals belong to both classes Chemical warfare agents grew out of toxic industrial chemicals that had legitimate industrial use with one notable exception, Yperite Classification of chemical warfare agents in terms of somatic effects

Lungs and the respiratory system Internal respiration chemical asphyxiants Skin, eyes and epithelial membranes vesicant agents Central and peripheral nervous systems The importance of latency when considering chemical agents The origins of modern chemical warfare Use of irritant smokes and fire in battle knows for centuries

1915 usually considered as being the start of the modern era of chemical warfare But the origins go back well into the 19th century The Industrial Revolution and the rise of the European chemical industries: the war of the chemists William Perkin the discovery of aniline dyes Mauraine the first synthetic purple

Development of the British dye industry Later 19th century saw a rapid dominance of Germany in this area Fritz Haber German chemist and head of the Kaiser Wilhelm institute in Berlin By 1914 Haber worked within a vast chemical production

capability Involved in planning and executing the first chemical attacks in 1915 1919 Nobel prize for developing a completely synthetic process for making ammonia and hence nitrates Discovery of the Haber concept ( for any inhaled toxic gas concentration x time of inhalation is constant)

Franois Auguste Victor Grignard French chemist and professor at the University of Nancy Work on the development of phosgene and the detection of mustard gas Nobel prize for the discovery of the Grignard reaction allowing the synthesis of large organic

molecules Gerhardt Schrader German chemist who worked within the post First War chemical dye conglomerate, IG Farben Work on pesticides in the 1930s led to the chance discovery of a whole new class of toxic agents the nerve agents

This opened up a completely new area of chemical warfare the attack on the nervous system. The beginnings of modern chemical warfare 1854 the British chemist Lyon Playfair suggested the use of a shell containing cyanide to break the siege of Sevastopol 1862 the US Civil War: the chemist John Doughty suggested the use of shells containing

chlorine against an entrenched enemy Both suggestions rejected by the military on moral grounds Chemical agents: weapons of desperation Both the previous examples demonstrate that chemical warfare was considered where there was a situation of military stalemate Exactly the conditions of the trench war in 1915 1915 and other examples of the military use of chemical agents through the 20th century show

that gas warfare is driven by conditions of stasis in battle The use of chemical warfare agents against unprotected civilians different: weapons or terror. The control of chemical warfare prior to the First World War 1675 Strasbourg treaty following the use of incendiary devices by Bernhard von Galen, Bishop of Munster 1899 Hague Convention banned the use

of chemical weapons but only if delivered by shell or other projectiles Chemical weapons acting on the lungs and respiratory tract Development by the Germans based upon strong industrial capacity Earliest lung damaging agents were widely used toxic industrial chemicals: chlorine and phosgene Although April 1915 is usually regarded as the first use of a lung damaging agent

there were earlier attacks The first use of lung damaging agents 1914 use of lachrymogens ( which are not classed as chemical warfare agents) by the French Army to harass the enemy January 1915 German use of T shells ( containing the irritant xylyl bromide) against the Russians at the Battle of Bolimov Attack failed since the cold conditions did not permit evaporation of the agent The Russians did not think it worthwhile to report

this attack to the Allies since the gas was of little effect Ypres: April 22nd 1915: the first proper chemical warfare attack German attack against Zouave and Canadian troops in the Ypres salient 168 tonnes of chlorine released by the Germans from 6000 prepositioned cylinders. Aerial intelligence warnings ignored Mass casualties and fatalities from upper respiratory tract effects and toxic pulmonary oedema. Accurate figures not know but estimated to be 5000 dead and

10000 wounded Further chlorine attacks two days later, but the line was secured by the Allies The Germans created a hole several km wide in the front but could not exploit the advantage due to non provision of reserves. Further chlorine attack at Bolimov: May 1915 6000 dead and 20,000 wounded First lesson of gas warfare for the Russians

which dominated their military thinking for the next 100 years. Key lessons from the first chemical attacks using lung damaging agents Effectiveness of inhaled chemical agents against unprotected and untrained troops The very high concentration of chlorine achieved at Ypres produced toxic pulmonary oedema quicker that 18 24 hours. An example of inconsistency of the Haber principle in some

cases Totally unprepared medical responses 1915 1918 the continuing use of inhaled agents Development of phosgene and diphosgene which penetrated further into the lungs than chlorine and had a greater toxicity. Also these agents were heavier and more persistent Dual latency Initial choking sensation followed by an apparent rapid recovery following moderate

exposure Development of fulminating pulmonary oedema after 18 24 hours Medical countermeasures against lung damaging agents Little or none at the time although it was quickly realised that the first attack was with chlorine, Limited availability of oxygen therapy Importance of resting a patient who had been exposed to phosgene well understood reduction of pulmonary artery pressure

Respiratory protection Effectiveness of inhaled chemical agents gradually reduced by the development of filtration respirators 1915 Early devices pads of cotton soaked in urine

Early civilian respirators: Reims, 1915 Lung damaging agents post WW 1 Continued fear of aerial attack on civilians who were untrained and unprotected Mass issue of respirators to civilians at the start of WW2 Better protection and training reduced the effectiveness of pulmonary oedemagens agains trained troops But the hazard from lung damaging agents remains to the present day Chlorine and phosgene are widely used industrial chemicals

2006 Terrorist chlorine attack in Iraq Medical countermeasures against pulmonary oedemagens now well developed Airway and ventilation management Steroids Protective ventilation strategies and the management of ARDS

Agents acting on the skin and epithelial membranes: vesicants 1917: the arrival of mustard gas Sulphur mustard (bis 2 chloro ethyl sulphide) known since 1860 Rejected by the British as a chemical warfare agent because of its long latency of action Germans realised its potential as an agent designed to wound and demoralise Active through both skin and the respiratory tract the agent is a liquid.

First use of mustard gas July use against Canadians who had no protective suits First large scale use against the British at Nieuport 14,000 casualties, 500 of whom died within 3 weeks August first use against

the French 2nd Army 100,000 shells fired causing 14,000 casualties The effects of mustard gas No immediate effects other than a smell of garlic or mustard Early symptoms rhinorrhoea and sneezing After 2 3 hours development of skin erythema, followed by painful blisters Breakdown of blisters causing deep ulceration with a long healing process

Respiratory tract damage in high concentrations more marked at high temperatures Important effects on the eyes blindness ( usually temporary) Casualties from mustard gas Add details 1917 1918 continued use of Mustard Gas until the end of the war Germans continued heavy use of mustard gas shells

Allies did not use the agent until Cambrai in November 1917 after capturing a large stock of German shells British and French production not effective until 1918 1918 the war became more mobile but use of the agent continued October 1918 the wounding of Corporal Schikelgruber 1917 2014 : a century of research into mustard gas

Now known that the agent forms sulphonium ions in the tissues which attacks the guanidine nitrogen in DNA leading to cell death and mutations Of all the chemical agents used in WW 1 mustard gas still remains a major hazard today. Still no antidotes or specific therapy after nearly 80 years of research 1919 1945: use of mustard gas against civilians Use of mustard against civilians in Iraq by the British in

1922 and on a large scale by the Italians in Abyssinia in 1936 1937 - Use by Japanese against the Chinese in Manchuria Widespread fear that the agent would be used against civilians Europe 33 Large stocks of mustard held by both sides but chemical weapons not used since much of the war was very mobile 1940 Churchill planned a massive use of mustard gas against a possible German invasion of Britain

1943 the Bari harbour incident Large scale Luftwaffe attack against Allied ships in Bari harbour USS John Harvey bombed and released a large quantity of its cargo of mustard gas into the sea Heavy naval and civilian casualties Confirmed the view that

chemical warfare agents were weapons of mass destruction Mustard gas: 1945 2014 Mustard gas still regarded as a major hazard but its position during the Cold War eclipsed by the development of the nerve agents Iran Iraq War 1982 88 First major use of mustard gas in battle since WW1 Pronounced effects on the respiratory tract in high

temperatures Iranian casualties sent to hospitals in Western Europe confirmed evidence of chemical bronchiolitis in addition to skin lesions The hazard of mustard gas today Military formations equipped with total personal protection

Mustard gas can be detected and monitored easily Civilians still remain a major potential target particularly from terrorists Chemical asphyxiant gases Hydrogen cyanide Carbon monoxide actively reduce the distribution of oxygen to the

tissues and its use in the mitochondria HCN early studies and use in WW1 Early French studies on toxicity disputed by the British Barcroft and his dog an early demonstration of the importance of species when determining toxicity Uses of HCN in chemical warfare WW1 not much used due to difficulty in obtaining sufficient concentrations

WW2 Zyklon B used by the Nazis in their extermination camps. Carbon monoxide also used in early attempts Afghanistan 1984 possible use by Russians against Taliban in caves The current status of HCN as a chemical weapon Regarded as being a potential terrorist threat Plans for a terrorist device using cyanide salts and nitric acid discovered

Chemical agents affecting the nervous system Central and peripheral nervous systems as targets Work did not begin in this area until the chance discovery of nerve agents in the late 1930s Crucial role of the German chemical industry IG Farben, a conglomerate of several companies dating from 1925. Agents attacking the cholinergic nervous

system the nerve agents Discovery of ACh by Otto Loewi in 1921 Central and peripheral actions of acetyl choline well known to anaesthetists Critical role of acetyl cholinesterase in the autonomic and voluntary nervous systems Gerhardt Schrader and the discovery of nerve agents 1936 Schrader working on organophosphate pesticide compounds for IG Farben. Discovery of parathion and bladan.

(OP known since the mid 19th century first OP discovered by de Clermont in 1863) 1936 discovery of TABUN followed by SARIN and SOMAN WW2 production and stockpiling of nerve agents Research programme placed under conditions of the highest secrecy. By 1945 several hundred tonnes of nerve agents had been produced In a secret factory at Dyhernfurth

Nerve agents never used in WW2 fear of reprisals since the Germans thought that the Allies must have discovered nerve agents (absence of publications fuelled this suspicion) The collapse of Nazi Germany and the dispersion of nerve agents Dyhernfurth factory captured by the Russians and reconstructed in Volgograd. Beginning of the Cold War chemical arms race Intense Allied research following the discovery of the new chemical agents

Highly toxic through both the inhalational and cutaneous routes Highly lethal within a short period without medical intervention Problems in managing the effects of nerve agents in 1945 Antimuscarinic effects of atropine known but no effect at the neuromuscular junction and other nicotinic receptors Artificial ventilation, a key step in managing the cholinergic syndrome was understood by some

workers (eg Dautrebande) but IPPV was barely used at that time The Cold War chemical arms race Detection, protection and treatment The original nerve agents (with the exception of TABUN were relatively non persistent Development of new agents ( VX and R 55 ( the Soviet version) produced agents that combined high toxicity with battlefield contamination Development of better personal protective suits and treatment strategies for nerve agent exposure reduced their effectiveness

against trained troops Oximes ( to regenerate AChE), atropine (anticholinergic) and diazepam anticonvulsant were the mainstay of pharmacological treatment Development of field ventilators by the 1980s that could be used in a contaminated environment The use of nerve agents against civilians As with Mustard Gas following WW1 civilians were a very vulnerable target Iran Iraq War 1982 88

Hallabjah 1988 attack against a Kurdish village Cocktail of chemical agents used in bombing attacks, probably to confuse the detection and identification of the agents used Mustard Gas TABUN SARIN

VX Little or no medical support available 5000 dead Tokyo 1995 First documented production and use of Sarin by terrorists Attack in metro Very low dead to wounded ratio (12 dead) due to positive effects of early life support Many thousands were mildly affected, including medical personnel who could not continue their work due to

effects on the eyes Attack underlined the importance of airway and ventilatory support. Several badly affected cases survived after a period of ventilation in hospital Damascus 2013 Sarin used against civilians in a rocket attack Casualty estimates vary between 300 and 1,300 No co- ordinated civilian medical response Chemical agents acting on the central nervous system

Nerve agents epileptiform convulsions 1960 development of agents that alter perception, cognition and the will to fight LSD, BZ, Agent 15 1970 - the search for a non lethal knockdown agent Intensive Soviet research into centrally active pharmacological compounds -short chain neuropeptides eg Delta Sleep Inducing Peptide 2002 Moscow theatre siege

Russian special forces use of a calmative gas to attempt to anaesthetise all in the theatre 168 persons died of acute respiratory failure. Later Russian explanation that a fentanyl had been used Incident highlights again the importance of early airway and

respiratory support for chemical casualties Toxins Cold War research and development into neurotoxins and DNA toxins Botulinun toxin discovery that this was active by the inhalational route Other neurotoxins included saxitoxin and bleu water algal toxins 1972 biological and chemical warfare treaty classed toxins as being biological agents despite their essential chemical nature.

Attempts at control of chemical weapons 1899 Hague conventional broken completely by all sides in WW1` 1925 Geneva convention banned the first use of chemical weapons but not production 1972 BCW Treaty leading to chemical disarmament by US and the start of a massive new Soviet secret research and development programme. Defectors after the end of the Cold War revealed that new super powerful nerve agents had been developed

(Novichoks) 1992 Chemical Weapons convention and the establishment of the Office of the Prevention of Chemical Warfare in the Hague. OPCW currently the lead agency in investigating and controlling chemical weapons Following 100 years of chemical warfare where are we?

Much of chemical warfare has been controlled But use of chemical agents in three areas of conflict over the past 10 years (Iraq, Libya and Syria) shows that the threat still remains Growing concern about terrorist use of chemical weapons against unprotected civilians Medical treatment of toxic trauma has improved but the essential lessons of early life support in often chaotic circumstances have still to be learned

Many emergency medical services now have trained responders who can operate within contaminated zones and training is improving Trauma from chemical warfare agents remains relatively rare but the many lessons of the past 100 years must not be forgotten Civilians remain particularly vulnerable and the fear of chemical weapons remains Important for the medical profession to convey the message that chemical agents are not inherently weapons of mass destruction and that protection and treatment exists.

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