Modern chemical warfare: a history.

Recent events including the Sept. 11, 2001 attacks in New York, Washington, DC, and Pennsylvania have illustrated the vulnerability of the United States to terrorist activity. Many experts agree that a chemical or biological event is likely to occur within the continental United States during our lifetime. The anesthesiologist, as well as, emergency medicine provider and critical care specialist will represent an integral part of the initial recognition and medical response to such an attack. A modern chemical attack on the United States could involve many differing agents including: nerve agents, vesicants, cyanide compounds and pulmonary irritants. In this situation, the anesthesiologist will be in the unique position to respond and treat affected patients. Physicians trained in anesthesiology possess expertise and knowledge in a variety of areas including airway protection, ventilation, oxygenation, pharmacology, cardiovascular physiology and pulmonary physiology. It is this training which gives the anesthesiologist the flexibility to respond to a chemical threat more effectively than most other medical specialties. We present a history of chemical warfare as practiced in the modern era. Comprehensive coverage of all chemical agents would be beyond the scope of this paper, therefore we will focus on the development and history of the major chemical agents.