A 65-year-old patient not known to you
arrives in your office complaining of dyspnea, chest tightness,
and burning of his nose and eyes. He appears rather dyspneic and
anxious and is immediately put into an exam room. The patient reports
that he had just left a major industrial fire where he had been
watching firefighters attempt to control the blaze. He noticed an
acrid odor in the air, and when he began coughing, he decided to
leave. Within a few minutes he noticed increasing difficulty breathing,
and seeing your office, he pulled in to request urgent evaluation.
His past medical history is significant only for childhood asthma.
He specifically denies any foreign travel and has never been a smoker.
On exam, he is tachypneic and tachycardic; you hear wheezes but
no crackles. His pulse oximetry finds an SaO2 of 88%. You
immediately call for an ambulance. What should you tell the emergency
On April 22, 1915, the German army released over 150 tons of
chlorine gas downwind toward British and Canadian troops at the
Battle of the Marne in Ypres, France (Fig. 23–1). Of the
7,000 soldiers present at the front that day, 5,000 suffered injury
or death (see Of Note . . box below). The modern era of chemical
weapons had begun. Later that same year on the very same battlefront,
the German army released phosgene gas, with far more deadly effects.
Further development of chemical weapons proceeded throughout the
war, prompting continuous refinement and development of field protective
gear in order to limit casualties (Fig. 23–2). The devastating
effect of chemical weapons during WWI mobilized the international
community and prompted the League of Nations in 1918 to institute
the first international treaty to ban chemical weapons. Relative
to the most potent nerve agents, pulmonary agents are easy to make
and inexpensive to buy. Chlorine and phosgene, two agents first
introduced as chemical weapons in WWI, are still available commercially
and are used widely in plastics, rubber, and dye industries worldwide.
Industrial or transportation accidents with these agents are much
more likely to occur than deliberate releases, but their potential
as chemical weapons must be considered.
United States Marines wearing gas masks on the frontline
Courtesy of The World War I Document Archive.
British soldier in gas mask.
Courtesy of the World War I Document Archive.
April 22, 1915, Yypres, France
We knew there was something wrong. We started to march towards
Ypres but we couldn’t get past on the road with refugees
coming down the road. We went along the railway line to Ypres and there
were people, civilians and soldiers, lying along the roadside ...