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Medicine’s First Response to Modern Chemical Warfare
Jason G. Ramirez, M.D., Douglas R. Bacon, M.D., M.A.
Anesthesiology, Mayo Clinic, Rochester, Minnesota.
We present a history of western medicine’s first response to a chemical attack. We illustrate how a multidisciplinary approach was instrumental in confronting this event. We propose that early 20th century exposure to anesthesia techniques during general surgery training played a key role in this early response.

World War I (1914-1918) had already developed into a stalemate by 1915, characterized by combat involving large fixed troop emplacements. This type of fighting was later termed trench warfare. In an attempt to break this stalemate, German forces introduced a novel form of combat now known as chemical warfare.

April 22nd, 1915 Belgium- Allied and German forces were involved in a struggle near the city of Yrpes and the surrounding area. Defending against any German advance was an 8 mile allied line manned by French colonial troops on the left, Canadian soldiers in the center and British forces to the right. A German artillery barrage was followed by a cloud of yellow-green gas which crept toward the allied positions. The allies had not seen such a cloud before. Soon the colored vapor reached the French positions causing symptoms of respiratory irritation, coughing, and dyspnea among the soldiers. Panic set in, and the French line soon broke, leaving a 4-mile gap in the allied defenses. The stunned Canadians looked at their exposed left flank is horror. The world had just witnessed the first successful large scale gas attack utilizing chemical weapons in the form of chlorine gas.

Two critical events prevented the attack from being a total rout of allied positions. First, the Germans were stunned by the effectiveness of the chlorine gas attack and did not have the manpower mobilized to exploit the breach in allied lines. Secondly, the Canadians had two medical corps doctors present, Lieutenant Colonel (Dr) George Nasmith and Captain (Dr) FAC Scrmiger who would prove instrumental in responding to this chemical insult.

Dr Nasmith and Scrmiger, both experienced physicians, recognized the gas as chlorine. Dr Scrmiger’s immediate orders to his battalion included instructions to urinate on handkerchiefs, placing them over mouth/nose when encountering the gas cloud. The urine present in these crude masks caused the chlorine gas to crystallize, preventing pulmonary effects. The Germans, determined to exploit this new weapon, launched several gas attacks the next few days. By this time, Dr Nasmith had constructed crude gas filters made by soaking cotton pads in hyposulfite. As a result of these actions, many lives were saved and the Canadian military was able to hold the allied positions almost single handedly for 17 days.

The above case illustrates the importance of innovate thinking and adaptability in the face of a novel threat to human health. Dr Nasmith and Scrmiger’s quick recognition of the threat and instructions to form very crude mask filters undoubtedly played a key role in saving the lives of many young soldiers

We assert that diversity in training provided these physicians with the skills necessary to meet this new threat. Although, not specifically mentioned, we hypothesize that Dr Scrimger’s exposure to anesthetic techniques of the day and Dr Nasmith’s background in chemistry facilitated this early and important response to chemical warfare.

Anesthesiology 2003; 99: A1264