the committee a strong base of understanding regarding risk perception and how such perceptions can be lessened or made worse (Appendix A). Of special value was a better understanding of how the study of risk communication could aid the committee in framing conclusions about exposure and disease in ways, and in language, that would be least likely to increase the perception of risk already felt by the veterans.

Finally, the committee sought input from a bioethicist regarding the conduct of the WWII experiments. The primary motivation for this request was the committee's wish to inform itself about the ethical and legal issues of informed consent and to explore what its responsibilities may be from a bioethical viewpoint, as physicians and scientists confronted with unanticipated and disturbing information about these testing programs. Professor Jay Katz from Yale University met with the committee in June 1992 to outline the history and development of the Nuremberg Code of 1947 and its ethical and legal ramifications, especially as they might apply to the issues in the present study (Appendix A; see also Appendix F). In addition, Dr. Katz commented about the way the experiments were conducted, the secrecy of the experiments, and the lack of medical follow-up of the human subjects, and urged the committee to take a strong stand on these issues. His presentation was followed by a letter further explicating his view that the committee would miss an important and needed opportunity if it simply completed an isolated survey of the scientific and medical literature, without comment on the experiments themselves. This letter is included in Appendix H.

The committee has drawn valuable information and guidance from the presentations described above. This report, its contents and its recommendations, reflects long and careful consideration of all the issues and suggestions, much discussion, and a final consensus. The inclusion of information about how the experiments were conducted and the medical treatment afforded to the human subjects is based on what the committee believes to be justified scientific, as well as humanitarian and ethical grounds.

Front Matter (R1-R20)

Executive Summary (1-8)

1 Introduction (9-13)

2 Methods of Literature Collection and Survey (14-20)

3 History and Analysis of Mustard Agent and Lewisite Research Programs in the United States (21-60)

4 Findings from the Public Hearing Process (61-70)

5 Chemistry of Sulfur Mustard and Lewisite (71-80)

6 Relationship of Mustard Agent and Lewisite Exposure to Carcinogenesis (81-111)

7 Nonmalignant Respiratory Effects of Mustard Agents and Lewisite (112-130)

8 Ocular Effects of Mustard Agents and Lewisite (131-147)

9 Dermatological Effects of Mustard Agents and Lewisite (148-178)

10 Other Physiological Effects of Mustard Agents and Lewisite (179-198)

11 Relationship of Mustard Agent and Lewisite Exposure to Psychological Dysfunction (199-213)

12 Summary of Findings and Recommendations (214-226)

Bibliography (227-330)

A. Scientific and Background Presentations Made to the Committee (331-334)

B. Excerpt from The Residual Effects of Warfare Gases (335-337)

C. Involvement of the National Academy of Sciences Complex in World War II Research Programs: A Summary (338-339)

D. Excerpts from Chamber Tests with Human Subjects I, II, and IX. Naval Research Laboratory Reports Nos. P-2208 and P-2579 (340-369)

E. Interim Report and Addendum: Feasibility of Developing a Cohort of Veterans Exposed to Mustard Gas During WWII Testing Programs (370-377)

F. Summary of the Department of the Army Report: Use of Volunteers in Chemical Agent Research (378-381)

G. Public Hearing Announcement (382-385)

H. Letter from Dr. Jay Katz to Dr. David P. Rall (386-389)

I. Risk Assessment Considerations for Sulfur Mustard (390-398)

J. Examination of the Effects of Certain Acute Environmental Exposures on Future Respiratory Health Consequences (399-416)

List of Acronyms and Abbreviations (417-420)

Index (421-428)