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Mainstream, VOL 62 No 6 February 10, 2024

Woodard’s Review of ’Toxic Exposures’ by Susan L Smith

Friday 9 February 2024



Reviewed by Scott C. Woodard

Toxic Exposures: Mustard Gas and the Health Consequences of World War II in the United States

by Susan L Smith

Rutgers University Press
Critical Issues in Health and Medicine Series
2017. 209 pp. (cloth), ISBN 978-0-8135-8609-0

Susan L. Smith’s Toxic Exposures: Mustard Gas and the Health Consequences of World War II in the United States gathers a rich and thoroughly documented collection of mustard gas experiments, discoveries, and the poisonous legacy of this chemical weapon. In the introduction, the author’s scope, purpose, and content are presented: human experimentation on military servicemembers with mustard gas by “scientists, physician-researchers, and military officials”; effects on the research subjects; and outcomes and legacy of the research. Before describing each logically presented chapter, Smith succinctly explains what “mustard gas was, and still is, a defining feature of the war’s legacy for soldiers’ health, racialized science, ocean environments, and cancer treatment in the United States” (p. 3). The chapters are organized logically and are well presented in two sections. Part 1, "Preparation for Chemical Warfare," includes two chapters: “Wounding Men to Learn: Soldiers as Human Subjects” and “Race Studies and the Science of War.” Part 2, "Toxic Legacies of War," contains “Mustard Gas in the Sea around Us” and “A Wartime Story: Mustard Agents and Cancer Chemotherapy.”

While the work does not break new ground, it is valuable in its consolidation of research done by Smith and others to document the legacy of mustard gas from World War II and beyond. She masterfully synthesizes years of research where she has been highly involved foreshadowing this much-needed work. This book is important because it tells the medical history from a war where the health legacies of mustard gas production, experimentation, and subsequent attempts to dispose of the chemical weapon continue to leave a toxic legacy today.

Medical ethics as a moral code has improved since the “volunteer” soldiers and sailors sacrificed themselves for the war effort in the 1940s. The attention paid in documenting the hardships of the research subjects serves to remind the reader that not every sacrifice during the war was made on the combat field. Highlighting “volunteers” accepting harm for the greater good makes the reader better understand these sacrifices. I would also add, without yesterday’s exposure and testing, today’s soldier would not benefit from the protection gained from proven chemical protective suits used even in the modern age.

The book discusses the merging of the seemingly opposites “military” and “medicine.” This “militarization of medicine” juxtaposition highlights the conflict of the Hippocratic Oath and the military’s desire to harm the enemy while keeping their own safe and protected (p. 16). The mission of US Army medicine in World War II and today is to bring to the combatant commander the healthiest soldier through preventative medicine and quick repair of the wounded to return to duty. The US military medical services are not civilian health-care workers in a uniform. Ethical priorities can differ. The US military has paid much attention to this as evidenced by the Borden Institute’s Textbooks of Military Medicine series two-volume Military Medical Ethics.[1] Not mentioned in Toxic Exposures, the purpose of military medicine of World War II and today is to bring soldiers back to the fight, thus providing combat power to the combatant commander. This is one of the primary missions of medicine in the armed forces today.[2]

I would have liked to have seen pictures of the numerous training aids, posters, and photographs mentioned in the text. Website addresses change and archival investigation requires in-person research. I was particularly curious to examine one photo containing mustard gas effects on a soldier’s buttocks labeled with “kissing blisters” in the report that was described where “hands and label produce a sexualized image with homoerotic overtones” (p. 39). The citation does not provide the source for the photograph in question or insight into the author’s comment. Previous research by Smith, however, describes this same photograph from the Defence Research Reports (Suffield Experimental Station in Alberta, Canada), Defence Research and Development Canada (DRDC), but makes no observation of any sexualized imagery or homoerotic overtones that are mentioned in Toxic Exposures.[3] From this work’s citation, one can access the DRDC website to view the picture in the report. Plate 4 is labeled “After 48 hours, ’Kissing’ blisters between buttocks made walking very difficult. Area was also involved in diffuse vapour burn.”[4] One American contemporary of the Canadian World War II chemical warfare researchers in Bushnell, Florida, also witnessed the wounds caused by mustard gas and relayed that the phrase was used by nurses to describe mustard gas blisters on the buttocks.[5]

The US government did consult and review other Allied nations’ mustard gas testing as done in Suffield. This collaboration influenced US policies. Throughout the book, numerous mustard gas experimentation and veteran testimonies are included from Canadian, Australian, and British militaries. Perhaps the title should read Toxic Exposures: Mustard Gas and the Health Consequences of World War II in the United States, Canada, Australia, and United Kingdom.

The book rightly points out the harm that comes from racialized scientific thinking. Smith explains that preconceived assumptions about racial differences before the mustard gas experiments were not proven. She writes that those conducting the experiments “hypothesized that nonwhite racial groups would be less sensitive to mustard gas” and their “assumptions were not proven by their scientific investigations” (pp. 45, 65). Smith found that the “race-based mustard gas experiments on soldiers produced no military benefits” (p. 65). The scientific method tests a hypothesis. It is an effective method of science that can prove any hypothesis. That hypothesis is modified when the theory is not duplicated in experiments. Science requires experimentation and testing to disprove an incorrect theory. Knowing that mustard gas harms all US soldiers equally is a point of knowledge that military commanders would find most useful in war.

Following the examples of racial experimentation in World War II, Smith writes that “race matters did not disappear from military medical research. For example, in the early 1950s the US Army conducted experiments on differences between black and white American soldiers’ responses to cold during the Korean War. Notably, at a time when the American military was finally officially desegregated, the studies claimed that black soldiers were more susceptible than white soldiers to injures from the cold” (p. 66). I am not sure if she is implying that this claim was false. Her cited sources show the susceptibility of black soldiers to cold-weather injuries because they reference the US Army studies, not experiments, stating these observations.[6] This is not to disagree with the errors of past racism and bigotry by medical doctors and scientists or the possibility of factors leading to this from past substandard healthcare, nutrition, or housing. Regardless of military occupational specialty, non-Hispanic black soldiers incur cold-weather-related injuries from two to six times the rate of other service members.[7] This vitally important observation of differing disease non-battle injuries enables commanders to protect all their soldiers and is emphasized in today’s Department of the Army Technical Bulletin Medical 508, Prevention and Management of Cold-Weather Injuries (April 2005).

The remaining chapters provide an easily understood narrative informing the reader of the real danger now hidden in the world’s oceans. The continuing harmful legacy of mustard gas after the war is aptly discussed, detailing the danger still posed by shifting the toxin from the land into the sea in an attempt to remove the danger from populations. Again, examples from other countries in addition to the United States are given leaving me to wonder about the subtitle’s focus on the US. Ironically, the same toxicity polluting the sea also can be used to kill cancer cells through chemotherapy. It was from the World War II bombing of a US merchant ship secretly carrying mustard gas in the harbor outside Bari, Italy, and the subsequent investigation that revealed mustard gas as useful in treating certain cancers. Smith rightly observes that the “connection between chemical weapons and cancer treatment may seem surprising, even disturbing, to us” (p. 101).

In conclusion, the book details how mustard gas veterans were eventually properly recognized for their sacrifice—not in awards but in medical assistance of their continued suffering caused by the chemical weapon experimentation and in the recognition that their work was sacrificial to the war effort just as if gassed in the field of combat. These veterans were instrumental in Constance Pechura and David Rall’s landmark study, Veterans at Risk: The Health Effects of Mustard Gas and Lewisite (1993). The secrecy of experiments in the Second World War fell as the activism of these “volunteers” rose (p. 128). As Smith lays out well, the cost of mustard gas experimentation will continue beyond those soldiers’ collective service and sacrifice.


[1]. Thomas E. Beam and Linette R. Sparacino, Military Medical Ethics, 2 vols. (Washington, DC: Borden Institute, 2003). I recommend particular attention to chapter 11, “Physician-Soldier: A Moral Dilemma?,” in volume 1.

[2]. FM 8-10, Medical Service of Field Units, 1942, 9; FM 100-10 Field Service Regulations Administration, 1943, 84; FM 8-10, Medical Support Theater of Operations, 1959, 164; FM 8-10, Medical Support Theater of Operations, 1970, 7-1; FM 8-10, Health Service Support in a Theater of Operations, 1991, 1-1, 3-16; FM 4-02, Army Health System, 2020, 1-9; and Army Techniques Publication 4-02.10, Theater Hospitalization, 2020, F-2.

[3]. Erika Dyck and Christopher Fletcher, Locating Health: Historical and Anthropological Investigations of Place and Health (London: Pickering & Chatto, 2011), 94.

[4]. “The Casualty Producing Power of Mustard Spray,” Suffield Experimental Station, January 4, 1943, Defence Research Reports, Defence Research and Development Canada,

[5]. Harold Johnston, A Bridge Not Attacked: Chemical Warfare Civilian Research during World War II (London: World Scientific, 2003), 157.

[6]. K. D. Orr and D. C. Fainer, “Cold Injuries in Korea during Winter of 1950-51,” Medicine 31, no. 2 (1952): 177-220; and “Cold Injury—Korea 1951-52,” Cold Injury Research Team from Army Medical Research Laboratory, Fort Knox, April 1, 1953, Defense Technical Information Center,

[7]. “Update: Cold Weather Injuries, Active and Reserve Components, U.S. Armed Forces, July 2015–June 2020,” Armed Forces Health Surveillance Branch, Defense Health Agency,, accessed June 6, 2023,

(Review author: Scott C. Woodard (US Army Medical Department Center of History and Heritage))

[This work from H-Net is reproduced under a Creative Commons License]

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