Abstract
Chemical weapons have been used both by military forces on the battlefield and by terrorists in cities and towns. In this respect, they are unique among the weapons of mass destruction (WMD) that have been used in the 20th century. The world’s recognition of the horror of chemical weapons prompted the only disarmament treaty that eliminates an entire category of weapons under strict international verification. Domestic and international terrorists have demonstrated repeatedly the intent to obtain, develop, and use chemical weapons. In the 1990s, the Japanese cult, the Aum Shinrikyo, employed hydrogen cyanide, VX nerve agent, and sarin nerve agent against civilians. The exploits of Al-Qaeda in Afghanistan to test unspecified lethal chemical agents on animals have been well covered. Incorporation of chlorine tanks into improvised explosive devices by Iraqi insurgents in 2007 produced ballistic shrapnel and clouds of toxic gas that inflicted civilian deaths and military casualties. There is a communicated and clear intent and capability by terrorists to use traditional or improvised chemicals.
The fundamental technology intrinsic to chemical weapons is more widespread than that of any other members of the weapons of mass destruction family: synthetic chemistry and much of the associated infrastructure are ubiquitous to the industrial world. Making chemical weapons does require some technical skill, but over time, much of the information needed to make these materials has drifted into the public domain. Technology is rapidly enabling new methods for creating novel advanced chemical agents and easier dissemination of traditional agents. All of which combines to increase terrorist capability and our vulnerability to the threat of chemical terrorism.
The book Chemical Warfare Agents is an important and edifying reminder of the threat—the physiological consequences and challenges that remain even with cutting-edge medical treatment—and the vulnerabilities that persist with respect to chemical weapons agents in a day when some perceive chemical weapons as a historical relic.* In the preface of the revised edition, the editors note, “We provided a rationale as to why an increased national investment [in epidemiologic and clinical studies, new treatments, and new diagnostics] had begun in the United States” in the first edition of the book. Although the current trend with respect to the threat of chemical weapons and chemical terrorism may be readily apparent to them, it is worth repeating particularly for the graduate student or practitioner who is among the likely audience of this substantial and substantive volume.
The medical, pharmacological, diagnostic, and associated science and technology detailed in the text is also evidence of the robust science and technology programs that have been driven largely by the Department of Defense—historically with the Army and the Army laboratories in the lead—over the past 50 years. Because of that sustained effort due to recognition of the threat to the soldier, the United States has reduced medical, detection, protection, and decontamination vulnerabilities to chemical weapons agents. Civilian agencies have leveraged that expertise, knowledge, and the treatments developed for use in the homeland. Passive defense, medical countermeasures, and consequence management contribute substantially to the resilience of the nation and the ability to minimize the impact of a chemical attack on the affected population.
The book also serves as the most comprehensive single volume on the chemistry, pharmacology, toxicology, and therapeutics available today and current directions in research. Overall, the text is highly readable, up-to-date, and extremely well referenced. A few (literally) Wikipedia citations were a rare exception. Chemical Warfare Agents serves the advanced student as an introductory text, the clinical expert who wants a brief review of a narrow subject, and the generalist looking for more information on chemical warfare agents.
Chapter 1 provides an excellent concise summary of chemical warfare throughout the ages with significant details of major 20th-century programs, excepting perhaps the World War II Bali–Italy incident as a historical footnote and illustration of unintended consequences of chemical agents. Notably lacking are a number of efforts by nonstate actors, such as the Aum Shinrikyo’s production of VX and improvised delivery methods for the generation of hydrogen cyanide, and the long-term impact of the March 1995 sarin subway attack on more than 200 people. Mention of Al-Qaeda’s improvised laboratory and testing program in Afghanistan and Al-Qaeda-affiliated insurgents’ use of chlorine in Iraq in 2007 (the latter may have occurred after the manuscript went to press) along with domestic incidents such as William Krar’s improvised chemical devices and pursuits of the Minnesota Patriots Council would have provided a more comprehensive, causally motivating, and effective introduction and establishment of the argument why the subsequent 690 pages are critical reading for those who may not be specialists.
The heart of Chemical Warfare Agents is Chapters 2 to 14, which addresses medical-related aspects from the underlying chemistry of chemical warfare agents (CWAs) and their effects on the human body to diagnosis and treatment. Included are all major classical chemical warfare agents, including nerve agents, vesicants (blister agents), blood agents (cyanides), and choking agents addressing the biochemistry, pharmacology, toxicology, human and animal model studies, pretreatment, and postexposure therapeutic treatment options for each agent type and many agents specifically. Excellent images prepared for the volume and reproductions of data and results from the original research appear throughout the chapters. The order of chapters largely flows well, with the exception of Chapters 12 and 13 related to the vesicants (blister agents), which would have been better served by an inversion of appearance in the book. Most of the chapters can be read as stand-alone entities, although they also function as a complementary whole.
Cutting-edge and emerging approaches to deal with medical treatment of chemical casualties are reviewed in Chapters 6 to 10. From applications of -omics science and technology (genomics, proteomics, transriptomics, and metabolomics) and use of microarrays that reveal new potential therapeutic targets and mechanisms of toxicity correlations with biochemical data to biomarker discovery, bioinformaticbased advances offer prospective research approaches to revolutionary countermeasure developments. The latest developments in bioscavengers are covered twice, being featured in Chapters 7 and 8, a rare duplication in the book. Chapter 10—on the exploration and extension of a galantine, a treatment for polio and Alzheimer’s disease, for organophosphate treatment— presents an interesting example of the potential leveraging and utility of pharmacologicals used for other medical conditions that show utility against chemical weapons.
Chemicals that do not fall into the traditional nerve-vesicant-blood-choking agent paradigm are addressed in Chapters 15 to 18. Chapter 15 covers riot control agents, Chapters 16 and 17 discuss ricin and botulinum toxins, and Chapter 18 focuses on the obscurants or smoke-generating compounds, such as red and white phosphorus smokes. Inclusion of these agents, which are not the part of the classical CWAs, increases the value and comprehensive nature of the volume as well as relevance to recent international events—for example, use of an unspecified fentanyl-like opiate by Russian security forces during the Moscow Theater siege by Chechnyan terrorists in October 2002 and recent allegations regarding use of white phosphorus in the Middle East.
Chapter 19 provides a thorough review of the science and technology of clinical diagnostics related to CWAs, including success and remaining challenges such as tests for assessing trace and low-level persistent exposure, which are likely to be prominent (and expensive) issues in the event of a major domestic chemical terrorism incident.
Findings gained through studies in the proceeding chapters are critical for development of what are usually categorized under the physical science areas—individual protection (Chapter 20) and skin decontamination (Chapter 21). Although a minor point, the third major component of the physical science area, detection of agents, is absent from the volume. Detectors are the main method which would alert to initiate donning of protective equipment or use of decontamination. Admittedly, detection of chemical agents is a vast topic.
Chapter 22 focuses on the psychological impact of terrorism in general, chemical terrorism, and lessons learned from industrial chemical accidents/catastrophes. This is an important chapter in bringing together the overall patient approach needed, whether the patient is an experienced Special Forces soldier or a civilian casualty, and the long-term consequences of chemical agents that need to be factored into risk assessments. This chapter provides a window into the wealth of technically robust research underpinning the traumatic stress responses associated with use or threatened use of CWAs on multiple populations.
The last 2 chapters (22 and 23) introduce concepts of emergency response policy and federal, state, and local coordination efforts along with practical emergency medical and public health management in the event of domestic use of CWAs. These round out nicely the overall volume and are likely to be especially useful for pedagogical use of the volume in educational settings.
A subsequent edition would benefit greatly from a glossary due to the extensive use of acronyms, many of which are specific to individual disciplines.
Overall, this book is a remarkably readable and consistent book for such a large edited volume, which is likely a credit to the editors and strong editorial guidance. Chemical Warfare Agents maintains the rich technical detail necessary to be the authoritative single text on the biochemistry, pharmacology, toxicology, and medical treatment of those exposed to chemical agents.