Veterans at Risk -- Copyright -- Preface -- Acknowledgments -- Contents -- Executive Summary -- BACKGROUND -- GENERAL CONCLUSIONS -- SPECIFIC FINDINGS -- RECOMMENDATIONS -- 1 Introduction -- REFERENCES -- 2 Methods of Literature Collection and Survey -- ONLINE DATABASES -- OTHER SOURCES -- SUPPLEMENTAL WORLD WAR II MILITARY REPORTS -- LITERATURE TRANSLATION, DISSEMINATION, AND ANALYSIS -- REFERENCES -- 3 History and Analysis of Mustard Agentand Lewisite Research Programsin the United States -- INTRODUCTION -- Sulfur Mustard -- Lewisite -- RESEARCH PROGRAMS OF WORLD WAR I AND THE POSTWAR PERIOD -- TESTING PROGRAMS AND CHEMICAL WARFARE PRODUCTION IN WORLD WAR II -- Patch or Drop Tests -- Chamber Tests -- Field Tests -- Gas Production, Gas Handling, and Chemical Warfare Production -- The Bari Harbor Disaster -- Medical Applications of Chemical Warfare Research -- RESEARCH, USE, AND DISPOSAL OF CHEMICAL WEAPONS AFTER WORLD WAR II -- Postwar Research Programs -- Continuing Use of Sulfur Mustard and Other Chemical Weapons in International Conflicts -- U.S. Chemical Stockpile Disposal Program -- CONCLUSIONS AND FURTHER ANALYSIS -- REFERENCES -- 4 Findings from the Public Hearing Process -- RESULTS AND FINDINGS -- Types of Veteran Exposures -- Health Problems Reported -- Personal Aspects of Veteran Reports -- TREATMENT OF HUMAN SUBJECTS -- CONCLUSIONS AND ACTIONS TAKEN -- REFERENCES -- 5 Chemistry of Sulfur Mustard and Lewisite -- SULFUR MUSTARD -- Reaction of Sulfur Mustard with Various Nucleophiles -- Reactions of Biologic Importance -- LEWISITE -- REFERENCES -- 6 Relationship of Mustard Agent and Lewisite Exposure to Carcinogenesis -- ACUTE EFFECTS AND BIOLOGICAL MECHANISMS -- Sulfur Mustard -- Biologic Fate and Mechanisms of Action -- Nucleic Acid and Protein Conjugation -- Cytogenetic and Mutagenic Effects -- Summary -- Lewisite.

Biologic Fate and Mechanism of Action -- Cytogenetic and Mutagenic Effects -- Summary -- EVIDENCE OF LONG-TERM HEALTH EFFECTS -- Animal Studies -- Early Studies in Mice and Rats -- Heston's Studies in Mice -- Later Studies of Mustard Agents and Other Alkylating Agents -- Summary of Animal Studies -- Human Studies -- Occupational Exposure -- Battlefield Exposure -- Medical Therapeutic Exposure -- SUMMARY -- Gaps in the Literature -- Conclusions -- REFERENCES -- 7 Nonmalignant Respiratory Effects of Mustard Agents and Lewisite -- PHYSIOLOGY AND ANATOMY -- ACUTE EFFECTS AND BIOLOGICAL MECHANISMS -- EVIDENCE OF LONG-TERM HEALTH EFFECTS -- Animal Studies -- Human Studies -- Occupational Exposure -- Battlefield Exposure -- Medical Therapeutic Exposure -- RELATIONSHIP BETWEEN ACUTE AND CHRONIC EFFECTS CAUSED BY EXPOSURES TO OTHER RESPIRATORY HAZARDS -- SUMMARY -- Gaps -- Conclusions -- REFERENCES -- 8 Ocular Effects of Mustard Agents and Lewisite -- PHYSIOLOGY AND ANATOMY OF THE EYE -- ACUTE EFFECTS AND BIOLOGICAL MECHANISMS -- Dose-Related Considerations -- Clinical Observations -- Physiology and Histopathology of Injury -- EVIDENCE OF LONG-TERM HEALTH EFFECTS -- Animal Data and Cellular Bioassay -- Human Studies -- Occupational Exposure -- Battlefield Exposure -- Chronic Course -- Medical Therapeutic Exposure -- SUMMARY -- Gaps in Knowledge -- Limbal Vascular Damage -- Ocular Epithelial Damage -- Protection of the Corneal Epithelium with a Contact Lens -- Sulfur Mustard Compared to Alkali Injury: The Stromal Component -- CONCLUSIONS -- REFERENCES -- 9 Dermatological Effects of Mustard Agents and Lewisite -- ANATOMY AND PHYSIOLOGY OF SKIN -- Epidermis -- Dermis -- Eccrine Sweat Glands -- Apocrine Glands -- Melanocyte System -- ACUTE EFFECTS AND BIOLOGICAL MECHANISMS -- Sulfur Mustard -- Clinical and Microscopic Observations -- Mechanisms of Skin Injury.

Lewisite -- EVIDENCE OF LONG-TERM HEALTH EFFECTS OF MUSTARD AGENTS -- Animal Studies and Cellular Bioassays -- Human Studies -- Occupational Exposure -- Battlefield Exposure -- Medical Therapeutic Exposure -- Experimental Exposure -- EVIDENCE OF LONG-TERM HEALTH EFFECTS OF LEWISITE -- Animal Studies and Cellular Bioassays -- Human Studies -- Occupational Exposure -- Battlefield Exposure -- Medical Therapeutic Exposure -- Experimental Exposure -- SUMMARY -- Gaps in the Literature -- Conclusions -- REFERENCES -- 10 Other Physiological Effects of Mustard Agents and Lewisite -- EFFECTS ON THE IMMUNE SYSTEM -- Anatomy and Physiology -- Animal Studies -- Human Studies -- Conclusions -- EFFECTS ON SYSTEMS OTHER THAN THE IMMUNE SYSTEM -- Gastrointestinal Effects -- Hematological Effects -- Neurological Effects -- Conclusions -- REPRODUCTIVE RISKS -- Sulfur Mustards -- Animal Studies -- Human Studies -- Summary and Conclusions -- Lewisite -- Introduction -- Animal Studies -- Human Studies -- Summary and Conclusions -- REFERENCES -- 11 Relationship of Mustard Agent and Lewisite Exposure to Psychological Dysfunction -- HISTORICAL DEVELOPMENT OF THE CONCEPT OF PTSD -- CURRENT RESEARCH IN PTSD -- EVIDENCE FROM STUDIES OF MILITARY PERSONNEL AND VETERANS -- Chemical and Biological Warfare Environments -- Studies of PTSD in Veteran Populations -- EVIDENCE FROM STUDIES OF THE PSYCHOLOGICAL EFFECTS OF ENVIRONMENTAL CONTAMINATIONS -- CONCLUSIONS -- REFERENCES -- 12 Summary of Findings and Recommendations -- GENERAL CONCLUSIONS -- CONCLUSIONS REGARDING THE CAUSAL RELATIONSHIPS OF EXPOSURE TO THE DEVELOPMENT OF SPECIFIC DISEASES -- GAPS IN THE LITERATURE REGARDING MUSTARD AGENTS AND LEWISITE -- Human Studies -- Animal Studies -- RECOMMENDATIONS -- Bibliography -- PUBLISHED LITERATURE -- MILITARY REPORTS UNITED STATES -- U.S. Army Reports -- 1923-1946 -- 1947-1992.

U.S. Navy Reports -- Other U.S. Military Reports -- UNITED KINGDOM -- Chemical Defence Experimental Station, Porton Down -- Other British Military Reports -- AUSTRALIA -- CANADA -- Experimental Station, Suffield, Alberta -- Chemical Warfare Laboratories, Ottawa -- INDIA -- OTHER MILITARY REPORTS -- TECHNICAL REPORTS -- Office of Scientific Research and Development -- 1947-1992 -- AVAILABILITY INFORMATION -- OFFICE OF SCIENTIFIC AND RESEARCH DEVELOPMENT (OSRD) REPORTS: -- COMMITTEE ON TREATMENT OF GAS CASUALTIES (CTGC) REPORTS: -- NATIONAL TECHNICAL INFORMATION SERVICE (NTIS): -- NAVAL RESEARCH LABORATORY REPORTS: -- BRITISH REPORTS: -- APPENDIXES -- A Scientific and Background Presentations Made to the Committee -- January 6, 1992 -- April 15-16, 1992 -- JUNE 11-12, 1992 -- B Excerpt from The Residual Effects of Warfare Gases (1933) -- SUMMARY AND CONCLUSIONS -- C Involvement of the National Academy of Sciences Complex in World War II Research Programs: A Summary -- REFERENCES -- D Excerpts from Chamber Tests with Human Subjects I, II, and IX. Naval Research Laboratory Reports Nos. P-2208… -- E Interim Report and Addendum Han K. Kang, Dr. P.H. -- Feasibility of Developing a Cohort of Veterans Exposed to Mustard Gas During WWII Testing Programs -- I. Background -- II. Naval Research Laboratory (NRL) Tests -- A. NRL Lab Log -- B. Suitland Federal Records Center -- C. National Personnel Record Center (NPRC), St. Louis, MO -- D. Bainbridge, MD, Navy Training Center -- E. Conclusions -- III. The U.S. Army Chemical Warfare Service Tests -- A. Special Orders No. 152 -- B. Conclusions -- IV. Summary -- ADDENDUM -- I. Naval Research Laboratory (NRL) Test Participants -- II. U.S. Army Chemical Warfare Service Test Participants -- III. Conclusions -- F Summary of the Department of the Army Report by James R. Taylor and William Johnson.

USE OF VOLUNTEERS IN CHEMICAL AGENT RESEARCH (1975) -- KEY ELEMENTS OF THE NUREMBERG CODE OF 1947 -- G Public Hearing Announcement -- PUBLIC HEARING ANNOUNCEMENT -- COMMITTEE TO SURVEY THE HEALTH EFFECTS OF MUSTARD GAS AND LEWISITE -- VETERANS WHO APPEARED AT THE PUBLIC HEARING -- SUMMARY OF HEALTH PROBLEMS REPORTED BY VETERANS -- H Yale Law School -- I Risk Assessment Considerations for Sulfur Mustard -- SULFUR MUSTARD -- NITROGEN MUSTARD -- CANCER RISKS FROM SIMILAR COMPOUNDS -- RAPID SCREENING OF HAZARD (RASH) APPROACH -- RELEVANCE OF EXPERIMENTAL RESULTS TO HUMAN RISKS -- HUMAN EXPOSURES -- REFERENCES -- J Examination of the Effects of Certain Acute Environmental Exposures on Future Respiratory Health Consequences -- REVIEW OF AGENTS CAUSING ACUTE AND CHRONIC RESPIRATORY EFFECTS -- Chlorine -- Sulfur Dioxide -- Miscellaneous Irritants -- Cotton Dust -- Isocyanates -- Notes on Selected Inorganic Agents -- THE FUNDAMENTAL QUESTION -- Narrowly Structured -- Alternative Broadly Structured -- THE RESPIRATORY END POINTS -- Simple Chronic Bronchitis -- Chronic Obstructive Bronchitis and Emphysema -- Allergic Bronchoconstriction -- Inflammatory Bronchoconstriction -- Pharmacologic Bronchoconstriction -- HOST FACTORS -- CONCLUSIONS -- LITERATURE CITED -- List of Acronyms and Abbreviations -- Index.