Persian Gulf War Illnesses
Andras L. Korenyi-Both, MD,PhD. President: "Al Eskan" Foundation
Views, opinions, and findings in this report are those of the author's and should not be construed as an official Department of Defense, Department of the Army, U.S.A. position, policy or decision.
This work was not supported by a grant from any agency or pharmaceutical company.
The role of the sand in chemical warfare agent exposure among PGW Veterans
CONTENT:
Synopsis
Introduction
Al Eskan Disease
The mechanism of gas stream particle separation and its correlation to the human respiratory system
Absorption of gaseous or liquid CW agents by particles
Tangibility of CW agents in the Theater of Operation
CW in the Theater of Operation
Conclusions
Future Research Plans of Al Eskan Foundation
Key words
References
Synopsis
The author investigated the role of the sand of the Arabian peninsula in chemical warfare agent exposure among the victims of Persian Gulf War illnesses.
Al Eskan Disease, reported first in 1991/1992, compromises the body’s immunological defense and is a result of the pathogenic properties of the extremely fine, dusty sand located in the Central and Eastern region of the Arabian peninsula. Signs and symptoms of Al Eskan Disease have been lumped together by the media and termed “Persian Gulf Syndrome.”
The dust becomes a warfare agent when toxic chemicals are micro-impregnated into inert particles. The “Dirty Dust” concept that the toxicity of the agent could be enhanced by absorption into inactive particles dates from World War I.
Evidence suggests that Coalition Forces have encountered Iraqi chemical warfare in the Theater of Operation / Persian Gulf War in the form of direct [deliberate] attacks by chemical weapons: missiles, mines and indirect [accidental] contamination from demolished munition production plants and storage areas, or otherwise.
The authors conclude that the micro impregnated sand particles in the Theater of Operation, Persian Gulf War were depleting the immune system simultaneously were acting as vehicles for low intensity exposure to chemical warfare agents and had an intensifying effect upon the toxicity of those exposed.
Motto:
“The antigen is nothing, the terrain is everything”
/Pasteur/
Introduction
Although the conduct of the military campaign called Persian Gulf War was not affected as much by disease as many previous wars, there have been many cases of service members returning home with continuing medical problems or having unexplained problems arise since their service. In some cases, family members of returned veterans have also been stricken. Cases are reported from the United States of America, from the United Kingdom, from Canada, and from other members of the Coalition Forces. Although the Arab participants reported no cases, the reader’s kind attention is invited to remember that “This campaign took place in a region where freedom of expression is virtually nonexistent” . The Government of the Czech Republic ordered a formal investigation of the illnesses reported on members of the Czechoslovakian Independent Chemical Defense Battalion Contingency of Coalition Forces as the Defense Minister of Czech Republic Miloslav Vyborny validated dismally in an interview with the New York Times in 1996. Hungary participated with a Military Hospital Professional Staff increment and after years of latency, cases of Al Eskan Diseases are being observed on the veterans and on their family members.The government of Iraq held a conference on “Post-War Environmental Problems in Iraq” in 1998, on illnesses as the consequences of the Coalition Forces’ conduct of the War. Information on the conclusions of the conference is spare and suppositious but may support the fact that Iraq’s daredevil production, storage and usage of chemical bacteriological warfare my backfired.
Illnesses of Persian Gulf War veterans are lumped together by the media and termed Persian Gulf Syndrome. Many possible causes are being investigated, but in the wide variety of duty positions, and differing exposures to the various suspect agents, investigators failed to identify any common exposure to a single causative agent. We reported previously that the extent to which a Persian Gulf Syndrome can be called a discreet condition, rather than a collection of unrelated medical problems, may be the result of a common exposure to the unique sand dust of the Central and Eastern areas of the Arabian Peninsula. Exposure is aggravated often by various other agents attacking individuals whose immune system are already compromised. This exposure to the Arabian sand is the one common denominator experienced by all service members deployed to the South West Asia Theater of Operation in Operation Desert Shield / Storm.
Al Eskan Disease
Our original and subsequent publications reported a previously unrecognized disease specific to the Arabian Peninsula. It did not fit traditional diagnostic categories. We observed that during the conduct of the Persian Gulf War the respiratory problems observed in Al Eskan village near Riyadh, Saudi Arabia was primarily owed to the fine, ubiquitous Saudi sand, causing a hyperergic lung reaction with additional symptoms caused by various opportunistic infections or by irritation resulting from other agents in the immunocompromised lungs. We also raised the possibility of a second phase of this disease. Al Eskan disease resulting both from a continuing compromise of the lung and from fine silicon particles actually entering the blood stream. We studied the pathogenesis of Al Eskan Disease to include the ultrastructural and micro-analytical studies of the sand, aerobiological studies of the kingdom of Saudi Arabia, and the etiopathogenesis of the disease. We reported the environmental circumstances, symptoms of the veterans, prognosis, treatment, prevalence and frequency.
We discussed the most commonly suspected agents in the Persian Gulf Syndrome: Post Traumatic Stress Disorder; seasonal diseases; infectious disease; atmospheric pollution; depleted Uranium; chemical agent resistant coating; pesticides and rodenticides; pyridostigmine; calcium content of the Saudi sand; psittacosis, ornithosis, airborne fungi, allergic genera , biological warfare agents and our special interest in this article, the chemical warfare (CW] agents. It is certain that silicon particles of less than 1 µm average sizes were present in substantial quantity in the Central and Eastern regions of the Arabian Peninsula, and they were presumed to be inhaled in large quantities. We concluded that each of these factors, including CW agents are adjuvant or contributing causes. The only common exposure which would lead to the recognition of Persian Gulf Syndrome as a single medical condition, rather than all encompassing phrase for unrelated conditions, appears to be exposure to the ubiquitous, fine sand of the area, and a resulting immunosuppression which is aggravated by opportunistic infections and other non-microbial ailments.
The mechanism of gas stream particle separation and its correlation to the human respiratory system
There are consistent processes through which a particle may settle from a gas stream. The human respiratory system is not exempt from the same dynamic principles effecting innumerable other gas stream applications. The basic methodology is four-fold however being that other contributory influences do exist with respect to specific conditions both qualitatively and quantitatively. Therefore, focusing on the behavior of particles in a gas stream allows us to show how the human respiratory tract is influenced. Engineering principles dictate that the main influences effecting the outcome of gas stream particle deposition are as follows:
DESCRIPTION - CAUSATIVE INFLUENCES
thermal precipitation - temperature gradients
electrostatic deposition - polarity and field gradients
gravitational deposition - elevation gradients
flow line interception - physical impediments
inertial deposition - velocity gradients
Brownian diffusions - concentration gradients
The actual parameters associated with determining the specific component’s influence is in depth, complex, and beyond the scope of our discussion. Fundamentally, it should be stated that the nature or properties of the particle and the environment are determinant. When one examines the field of influences by magnitude, a few are of a much larger order. Air velocity and the particle size seem paramount. This consideration turns parallel with many industrial applications with the exclusion of radiation. The methodology on mechanisms mentioned as controlling influences are: inertial interception, flow line interception, Brownian diffusion, and sedimentation:
a./ inertial interception follows Newton’s law. A particle of given mass at a relative velocity [relative to the respiratory mechanism] enters the species with each breath. As the lower respiratory conducting system the bronchial passage become increasingly smaller in diameter finer impaction occurs, much like an industrial impingement separator. This mechanism has the greatest effect with higher air velocity.
b./ flow line interception occurs as a particle becomes increasingly nearer to the respiratory tract surface at the terminal bronchioli. As a particle arrives at a given distance perpendicular to the flow direction, it is impeded by obstructions and deflected against the wall. By definition, the phenomenon occurs when a particle arrives one particle radius away from the collecting species in a slightly “off parallel” direction.
c./ Brownian diffusion influences the smallest particles [<0.5µm] the greatest. This deposition mechanism is mostly independent of gas flow patterns. The particle in question is actually so small that its collision with other molecules in the stream influences its behavior based on gradients. Specifically of interest is when the particle approaches the fine mean path of its carrier the alveoli.
d./ sedimentation is based on the most fundamental of principles [density and gravity]. Specifically, density ratios, gravity and time effect the outcome quantitatively. Since the relative air velocities are so much lower within the finer respiratory tract, it represents one of the more prominent mechanisms in the broncioalveolar portion of the lower respiratory area.
Outside the basic methodology, the particle or aerosol concentration gradient is not as much a controlling influence, but rather more of a controlling factor. Its significance is in its ability to increase the total outcome of the deposition mechanism. Over a given period, the integration yields a greater amount of deposited solids. Therefore particle deposition in a laden gas stream is never whether it occurs but how much and how fast is it occurring. Categorically the distinction between dust and fumes is not related arbitrarily. It is based purposefully upon size. If a particle’s diameter is less than 1µm it is categorized a fume. If a particle is measured greater than 1µm it is categorized as dust. Potential lung damaging particles are those whose size fall in the range of 0.5µm to 5µm.
The influence of each respective mechanism shifts as the characteristics of the particle and its environment change. There are many order of magnitude differences in distance traveled by a particle when comparing sedimentation and Brownian diffusion based solely on particle size.
In summation of this corollary to gas stream particle separation, the basic mechanisms are the same as those effecting any other engineering application. The concept of impregnating particles with chemicals to enhance a reaction is not far remote from many current manufacturing techniques. Gas stream filtration is accomplished through the passage of contaminated air over specific agent-targeted absorptive beds. The homeostatic function obviously is not to disinfect the air, however the transport and deposition mechanics are similar. Our bodies screen contaminants, filter, absorb and become clogged due to the same causes effecting any gas stream particle separation process.
Absorption of gaseous or liquid CW agents by particles
The caprice of “Dirty Dust” dates from World War One. It was put forward again during the Iran - Iraq War when CW agents were used on a large scale, and then again in the Persian Gulf War. In an attempt to increase the persistence of phosgen under field condition, German scientists studied the physicochemical properties of mustard nitrogen impregnated inert particles. Mustard gas has a low volatility and therefore can persist in the field as an effective agent for days to weeks after dissemination with the length of time depending on climatic condition. It was observed that beside the advanced life time, which has been achieved by microimpregnation to solid particles of the agent, the toxicity of sulfur mustard could be enhanced by the presence of submicronic inert carbon - black particles. Lefebure recorded that a prisoner of a German Gas Battalion had reported the use of pumice granules impregnated with phosgen.
Comparing our studies on the sand particles in Al Eskan disease with those of reported results it is safe to conclude that the effectiveness of CW absorption into sand particles could be enhanced by:
a./ Poisoning the first respiratory filter system, the upper respiratory trunk, and by delayed presence of CW agents in the lower respiratory trunk, in the alveoli, and could produce tissue damage as well as increasing the duration of tissue exposure to CW agents at the alveolo/capillary block level;
b./ Dust particles encountering the bodies first line of immune defense [alveolar macrophages] experience the direct toxicity of the substance and becomes the bioactive vehicle by depleting the engulfing capacity at the alveolar level which, in turn, will compromise immune defense mechanism;
c./ The CW agent saturated submicron size particles penetrate the alveolocapillary block, entering the blood stream, and disseminate via the lymphatic and blood vessels. Contrary to the views that absorption of toxic gases by submicron particles without subsequent release would be expected to reduce the agent’s toxicity indiscriminately, the absorption of such to bioactive particulate matter, sand granules in this instance, would readily increase it’s toxic effects.
Tangibility of CW agents in the Theater of Operation
The U.S. Defense Intelligent Agency’s [DIA] pre ground war reckoning stated that “DIA assessed that in the Kuwait Theater of Operation [KTO], the CW [agents] stockpile was likely distributed to the general support ammunition depots having chemical storage bunkers as well as field supply areas for the deployed units”. Whether Iraq possessed CW agent impregnated dust [‘Dirty Dust”] and whether the sand particles were used as a vector remains a mater of dispute. The probability is worth considering in some details. What we do know: That Iraq had unrivaled combat experience in employing such agents, both offensively and defensively; That Iraq’s CW agents production was headquartered at the State Establishment for pesticide production at Al Muthanna, near Samarra, North of Baghdad; that CW agents were inserted into bombs, artillery shells and rockets; That the ingredients for CW agents were manufactured at Habbaniyah, West of Baghdad; that Iraq dispersed equipment for production of CW agents throughout the country and stockpiled the CW weaponry in twenty to thirty known storage sites. Ar Rumaiyah was a CW storage complex located in the rear of the Iraqis Republican Forces Command and another was located just South of An Nasiriyah [3100 North], known as Khamisiyah.
Iraq produced the following major CW agents: mustard gas, also called Yperite [was used on the night of 12 July 1917 at Ypres. The name mustard was given to the compound by soldiers during World War I because of its smell.] There are several nitrogen mustards. Those of relevance here are: the blister agent H: mustard gas, Yperite, sulfur mustard, Kampfstoff Lost 1,1'-Thiobis[2-chloroethane], the HN1: N-ethyl-2,2’-di(chloroethyl)amine, the HN2: N-methyl-2,2’-di(chloroethyl)amine and the HN3: 2,2’,2”-tri(chloroethyl)amine. And nerve agents: tabun (GA [Ethyl N-dimethylphosphoramidocyanidate]), sarin (GB [Isopropyl methylphosphonofluoridate]), cyclosarin (GF [Cyclohexyl methylphosphonofluoridate]). Iraq also was to develop soma n(GD [Pinacolyl methylphosphonofluoridate]), a persistent nerve agent VX [O-Ethyl-S-[2(diisopropylamino)ethyl] methylphosphonothioate, and the superhallucinogen, a standard incapacitating agent called BZ [3-quinuclidinyl benzilate]; (alpha-hydroxy-alpha-phenylbenzeneacetic acid; 1-azabicyclo[2.2.2]oct-3-ylester; alternatively 3-quinuclidinyl benzilate] or EA 2277 and CW agent 15. Iraq is believed to have possessed the CW mental incapacitant since 1980. Our knowledge of CW agent 15 itself is limited. It belongs to the group of glycolates [esters of glycollic acid]. A prominent member of the group is the BZ agent. The pathophysiologic mechanism of the group is chollinergic nerve transmission blockage in the central and peripheral nervous system by an anticollinergic effect.
Marrs and his Colleagues argue that sarin and mustard gas, in this instance, which act systematically and do not produce their effect by damage to the lung, little is likely to be gained by absorption onto particles. In addition, dilution of toxic material with particles inevitably reduces the weapon payload of that toxic material. Our investigations presented here can not confirm this opinion. To the contrary, the absorption of CW agents to particles [ inert or bioactive] can advance, modify or alter their action and most importantly can camouflage their presence with fatal consequences of nonrecognition.
Iraq’s delivery systems included the 122 mm multiple rocket launchers, helicopter launched 90 mm rockets, the 250/500 kg bombs, projectiles for 155 mm artillery pieces, 120 mm mortals, and SCUD warheads. SCUD is a Russian build SS-1 type surface to surface guided ballistic missile, is copied after the German III-rd Reich’s V2 and designed in the 1950-es. It is powered by a storable liquid propellant motor [single stage], has a range of approximately 300 km and carries a conventional warhead of approximately 1,000kg. Although originally transported on a “Josip Stalin” heavy tank chassis, the SCUD-B is primarily mounted on a transporter-ejector-launcher vehicle based on the MAZ-543 [8x8] wheeled chassis. Unlike the unguided missiles, the SCUD has movable fins. The Al Hussein is the Iraqi version of the SCUD missile. It has a longer range but a smaller payload than the original SCUD. The target acquisition accuracy is measured in km2-s. The SCUD modified B and C version [ Hwasong, translates to Marsh] 5 and 6 have an improved range to 340 - 500 km with a decreased warhead weight to 770 - 700 kg.
Iraq also possessed forty Mistral-2 aerosol generators with a military potential to disperse CW agents, liquid or solid even when simultaneously mounted on remotely piloted MiGs [MiG is the Soviet designation for aircraft from Mikoyan-Gurevich design bureau]; for example. Air bases at Tallil, Al Jahrah, Shaibah, Al-Taqaddum and Balad were reported as CW agent storage sites.The Iraqi Air Force Swiss made turbo propeller driven Pilatus planes had been used to deliver CW agents during the Iran - Iraq War and were based at Umm Quasr Airbase near Basra. Iraqi Forces were preparing their ground forces for combat in a chemical contaminated environment in the KTO. Thirteen CW ammunition storage areas and at least twenty four decontamination sites were identified in southern Iraq where any soldiers, vehicles and equipment could be decontaminated if caught by their own gas in unfavorable combined winds, temperature and rain. Specific reports are available that suggest that the Iraqi III-rd Corps area of operation was preparing to use chemical weapons.
For the clarity of terminology, we want to press that the term “Yellow Dust” characteristic of dried mustard gas and used by Soviet supplied insurgents in Laos, matches in appearance and claimed to be the yellow dust coated tents and outdoor coats in the KTO. It seems paramount to note that the “Dusty Mustard [Yellow Dust]” also falls into the category of Dusty CW agents. It seems to be that the so called “White Dust” could easily be produced by the incinerated Depleted Uranium rounds and could have formed dusty white ash like substance that covered the target vehicles and their surroundings, producing a new and radioactive category of “Dirty Dust”. The Yellow rain was caused by a biological substance called tricothcene mycotoxin [ Mycologia, Deuteromycotina, Hyphomycetales, Tuberculariaceae]. Mycotoxins are chemical compounds produced by fungi. Aflatoxins are a type of mycotoxin produced by the Aspergilus flavus. They were researched in the Soviet Union and its satellite countries. Example is the liver toxicity research project in the Ist. Pathology and Oncology Research Institute , Semmelweis Medical University, Hungary in the late 1960 and early 1970-es in where the researchers were kept blindfolded about the true nature of the compound aflatoxin and its military application. It has been evidenced that Iraq possessed this mycotoxin and used against Coalition Forces. Reports indicated a “yellow” precipitation after the Al Jubayl attack on Jan. 19/20 1991.
CW in the Theater of Operation
Whether the Coalition Forces had any exposure to CW agents is debated extensively and remains as controversial as the quantity and quality of the exposure. Possibilities of exposure without any attempt to prioritize:
a./ That although the Pentagon declared that it had air raided and destroyed Iraq’s CW agents’ production sites, and CW weapons’ storage bunkers by the careful timing of attacks and choice of ammunition, it might have released plums of CW agents to drift towards Coalition Forces held territory;
b./ That demolition of Iraqi ammunition bunkers and the destruction of marked and unmarked CW weapons caused accidental release.The most eclant examples are the reports available about the Khamisiyah ammunition depot destruction between March 4 - 15 1991;
c./ That Iraqi Forces might have employed air or ground delivered CW agents during the campaign. An example is the incident which occurred on January 19/20, 1991 at Port al Jubayl, Kingdom of Saudi Arabia. Lieutenant General C. Horner, as the Joint Forces Air Component Commander in his congressional testimony brought up that as soon as intelligence sources indicated that medium-range bombers were being loaded with chemical weapons at Al Taqaddum, Iraq, F 117A Stealth aircraft were promptly reassigned to destroy six of these aircraft on the ground.
Although evidence exists that Iraq had BCW agent capacity, intelligence reports concluded that there was no intention to use it. That information was accepted at face value and corrupted our research for the cause, understanding and cure of Persian Gulf War illnesses for a time. To the contrary of the U.S. Intelligence Community, the Czechoslovakian Independent Chemical Defense Battalion Contingency of the Coalition Forces [contracted to the Kingdom of Saudi Arabia to support Saudi Forces only] did detect nerve agent [sarin] on January 19, 1991, and mustard nitrogen on January 24 1991 in the area and vicinity of the Wadi al Batin as well as in King Kahlid Military City [KKMC] within the military encampment in which the units were billeted. The Czechoslovakian Contingency required to provide chemical reconnaissance, treat any CW casualties, and organize courses on CW instruction for the Kingdom’s troops. The Battalion’s four task force were: placed on charge on NBC reconnaissance in KKMC; attached to the Saudi Army’s Field Hospital near the town of Hafa-al-Batin; and to the 4th and 20th Saudi Mechanized Infantry Brigade respectively. British and French forces also reported CW agents from a farther distance.
Conclusions
In this study we concluded that:
1./ The physicochemical peculiarities of the sand particles of the Central and Eastern region of the Arabian Peninsula: contained a significantly high percentage [18 %] of free floating sand particles; the aggregate surface area of particles per liter of aerosol, by their physical characteristics, could acted as intensifying factor on low intensity CW agent exposure among Persian Gulf War Veterans .
2./ When the CW agent is micro impregnated into small solid particles of silica, it’s properties may change in the following ways: There is not as much vapor, rendering it less detectable to many vapor samplers M8A1,-M256A1 kits and XM93 NBCRS vehicles; e.g. The agent is no longer a vapor or liquid and thus may not be recognized or noticed. The authors have no sufficient convincing data about the FOX NBC reconnaissance vehicles capability detecting CW saturated sand.
3./ Resulting from the bioactive properties of the Arabian sand on the immune system, a toxic synergism was, in effect, eventuated in Al Eskan Disease .
4./ When the CW agent is in low density but absorbed by bioactive particles, [sand], in submicronic size, the result easily can be misinterpreted as a non CW agent ailment that could manifest in a variety of clinical symptoms.
5./ Since “Dirty Sand” appears similar to dust or fine sand, it shares some of the same characteristics, such as being able to be blown by the wind to any location.
Future Research Plans of Al Eskan Foundation
1./ Systematic sand sample studies to detect CW agent contamination from areas under suspicion of being saturated by CW agent from the Theater of Operation Persian Gulf War.
2./ Additionally to the presented evidence of CW agent presence in the KTO, and the ways of sand saturation and production of “Dirty Sand”, to further support of the general trust of this paper, research needs to be conducted to detect CW agent breakdown byproducts in the collected sand samples.
3./ Testing the presence of antibodies against CW agents’ breakdown byproducts, most likely the more persistent H agents, in the system of the victims of Al Eskan disease seems to be a key and we recommend it.
4./ Study the neuromuscular junction in muscle biopsies of symptomatic Persian Gulf War veterans by histochemical, electronmicroscopic and cytochemical means for detection of the pathomorphology of low density exposure to cholinesterase - inhibiting chemicals.
5./ Reproducing the role of the sand in low intensity CW agent exposure among Persian Gulf War Veterans in experimental models.
Key words: immune depletion, sand, chemical warfare, dirty dust, environment
References
References are available from
AL ESKAN FOUNDATION
ATTN.: András L. Korényi-Both, MD, PhD.
202 Wickford Road
HAVERTOWN, PA 19083
T.: (610) 446-6333
FAX: (610) 446-6518
E-mail: Andras@AOL.com |
