Injuries in World War I
Gas! GAS! Quick, boys! — An ecstasy of fumbling,
Fitting the clumsy helmets just in time;
But someone still was yelling out and stumbling,
And flound'ring like a man in fire or lime ...
Dim, through the misty panes and thick green light,
As under a green sea, I saw him drowning.
In all my dreams, before my helpless sight,
He plunges at me, guttering, choking, drowning.
— Wilfred Owen, "Dulce et Decorum est", 1917
Chlorine Attack Using Gas CylindersFirst introduced on April 22, 1915, the use of poison gas quickly became commonplace by all of the combatants. In the popular imagination, poison gas became one of the defining symbols of the Great War. All of the European powers had signed the Hague Declaration in 1899, never to use poison gas in artillery shells or other projectiles. Again, the Hague Convention of 1907 forbade the use of poison weapons. But once Germany used gas on the battlefield, all other armies began to use it. By 1917, one third of all artillery shells contained gas. Not surprisingly, then, about one-third of all casualties in the AEF were from gas.
Poison gas evolved rapidly during the war. That first use at the second battle of Ypres employed tanks of gas half-buried in the earth. When the wind was blowing away from their own lines, Germans opened the valves and allowed the gas to billow towards the French lines. There were 1,000 deaths and 4,000 casualties. It was used twice more during the same battle, against British and Canadian troops. By the fall of 1915, all sides were using poison gas, including in artillery shells. Chlorine gas, when it contacts tissue, dissolves in water to form hydrochloric acid. Its primary target is the lung, and death usually results from inhalation injury. Chlorine can also cause severe damage to eyes and exposed mucous membranes.
Soldiers Under Gas AttackPhosgene was introduced in late 1915. It was used extensively, frequently combined with chlorine. The British called the combination “White Star”, after the symbol painted on artillery shells filled with it. The accompanying picture was actually staged in 1918 by the U.S. Army Corps of Engineers to illustrate the effects of phosgene. While the picture is dramatic, the truth is that phosgene may not show major symptoms for up to 48 hours. It causes pulmonary failure and heart failure. Death is usually from lung failure.
Lung Lesions from Mustard Gas, with Plugging of Terminal BronchiolesNitrogen mustard was Introduced in July 1917 by the Germans. Mustard gas became known as the “King of Battle Gases”. It eventually caused more chemical casualties than all the rest put together. Mustard gas is a vesicant, causing severe blistering of the skin, and attacking the respiratory tract and the mucous membranes of the eyes, nose, and mouth. It is especially dangerous to the eyes. While most patients recovered their vision, a significant number remained permanently blind.
A number of other gases were developed. The most important of these was lewisite, which was developed only late in the war. It is also a vesicant, but with more immediate action than mustard. It can enter the body through the skin, and do further internal damage.
Gas Casualties, British 55th Division
Official response was rapid. The Army Medical Department formed the Gas Defense Division on August 31, 1917, to carry out gas mask research and supervise manufacture and supply. The Chemical Warfare Service (later Chemical Corps) was formed on June 28, 1918.
Treatment was limited to supportive care. About all the medical services could do for chlorine and phosgene gas victims was to put patients on bed rest, and hope that severe symptoms didn’t emerge. Mustard gas was another story. The casualty had to be stripped, and completely washed. The eyes had to be washed out completely to avoid late damage. Although it acted more slowly, mustard also attacked the lungs, especially the lower respiratory tract, causing a refractory kind of pulmonary edema.
Canadian Soldier with Mustard Gas BurnsThe AEF had about 1500 deaths from poison gas, out of 52,000 battlefield deaths. But the total number of gas injuries was estimated at 90,000 to 100,000, or 30% of all casualties. Overall, there were 1.3 million gas casualties during the war, and about 90,000 deaths. About half of the deaths were among the Russian army, which was notably slow in providing protective gear to its soldiers.
American Signal Corps Operators working in Gas Masks
After the war, an international agreement – the 1925 Geneva Protocol – was signed, with all nations swearing never to use poison gas. And in fact, it was not used during World War II. It has been used in lesser conflicts since, notably the Iran-Iraq war. The US, which didn’t formally sign the Protocol until 1975, has maintained stocks of poison gas, but has never used them on the battlefield since World War I. It is probably worth noting that newer poison gases, such as the organophosphate nerve agents sarin, soman, tabun, and VX, are much more potent. They cause death from pulmonary edema and respiratory failure, and are more lethal and more rapidly-acting than the gases used in World War I..