The Neuroscience of War

Understanding chemical weapons as the U.S. talks red lines and convenient morality

That's an update from Sarah Palin's Facebook page yesterday. One could find it confusing, as she is quoting herself. The answers to Palin's questions, respectively, seem to be no and yes. I won't touch the invocation of Allah.

In the discussion of the significance of chemical warfare and the importance of the U.S. red line, Atlantic National Correspondent James Fallows remains unconvinced that military intervention in Syria is advisable. As do most Americans. Fallows noted today, "The United States has not acted previously as if chemical-weapons use was an end-of-history, line-drawing occasion," referring to the 1988 use of nerve gas on civilians by Saddam Hussein during the Iran-Iraq war. As he put it, "Nerve gas was hideous then. Chemical weapons are hideous now." 

President Obama called on the U.S. Congress today to authorize a strike against the Assad regime. While as a nation we wait for that, let's talk about hideousness—what John Kerry yesterday called "moral obscenity." The United Nations estimates that more than 100,000 people have died in the Syrian civil war. Chemical attacks have been estimated to involve something on the order of 355 to 1400 of those deaths. As Dominic Tierney wrote for The Atlantic in December 2012, "Blowing your people up with high explosives is allowable, as is shooting them, or torturing them. But woe betide the Syrian regime if it even thinks about using chemical weapons! A woman and her child under fire in Aleppo might miss this distinction." 

In May I wrote about the physiology of nerve gas, which I'll excerpt in the following paragraphs (like Palin, quoting myself), because it's worth being on the same page about what nerve agents are, as context for why many consider it defensible to land a bullet in someone's spine or to force-feed detainees, but not to gas. There are a few compounds that are lumped together as "nerve agents," "nerve gas," or "chemical weapons," like sarin, soman, and taubun. Based on the symptoms reported in Syria, the leading suspect is sarin. All are banned by a 189-country international convention.

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Inspecting gas masks during manufacture, c1941 (Argus Newspaper Collection, State Library of Victoria)

On April 22, 1915 in Belgium, the German army killed or injured 5,000 Allied soldiers by releasing 150 tons of chlorine gas. That is regarded as the first modern use of large-scale chemical warfare, though the concept goes back to snake-venom-tipped arrows in the Stone Age. By 1937, German chemist Gerhard Schrader had developed an insecticide that the Nazis soon realized was a more toxic agent than chlorine gas: sarin. They did not use it in World War II, though, reportedly because they understood its potential and feared retaliation in kind.

In 1988, around 5,000 Kurds died at Halahbja after Iraq used both sarin and sulfur mustard. Sarin further became a household name after the 1995 Tokyo subway attack in which the religious cult Aum Shinrykio used sarin to kill 12 people and harm thousands more.

So, what does sarin do to our bodies?

SHARK300200.jpgEffect of sarin on the left eye of a rabbit (pupil constriction) [Journal of Medical, Chemical, Biological, and Radiological Defense]

Sarin is unique in potency but not in mechanism. There are other drugs, pesticides, and plants that work the same way. They are called cholinesterase inhibitors.

Our nerves talk to each other by releasing chemicals called neurotransmitters. The amount of a particular neurotransmitter helps determine whether a nerve fires or not. What so-called nerve agents do is alter those neurotransmitters. They kink the signaling between our nerves, telling them to do things they normally do, but with altered frequency.

After a neurotransmitter has done its job, delivered its message, an enzyme usually comes along and demolishes it. But nerve agents block those enzymes. The enzyme can't break down the neurotransmitter, so the neurotransmitter stays around and keeps giving its message. If that message was, say, to release a little water onto your eye because your eye was dry, now the repeated message becomes "make your eyes water uncontrollably." 

Here is a drawing of that reaction, just like in organic chemistry class (still a requisite for all U.S. doctors). The big block is the enzyme (acetylcholinesterase). In the top image, it's working normally: breaking down the neurotransmitter (acetylcholine) into smaller parts. In the bottom images you can see how the "nerve agent" (sarin in our case) just kind of hangs out in the "esteric site," so then the enzyme cannot do its job.

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Screen Shot 2013-05-06 at 10.59.36 AM.pngScreen Shot 2013-05-06 at 10.59.44 AM.png


As acetylcholine builds up in our bodies, we become extremely uncomfortable and die. We are killed by the accumulation of our own normal neurotransmitter telling our own nerves to do the normal things they normally do, just in excess. One could draw an analogy to cancer. In this case, though, neurotransmitters live and die on an order of milliseconds, so it happens in a flash.

Within seconds of exposure to sarin gas (or liquid, which evaporates easily), we start to notice the immediate effects of acetylcholine buildup. First, our smooth muscles and secretions go crazy. The nerves to those areas keep firing, keep telling them to go. The nose runs, the eyes cry, the mouth drools and vomits, and bowels and bladder evacuate themselves. It is not a dignified state.

Since sarin has no smell or taste, the person may very well have no idea what's going on. Their chest tightens, vision blurs. If the exposure was great enough, that can progress to convulsions, paralysis, and death within one to 10 minutes.

If the exposure was not enough to kill them, though, the person should recover pretty quickly and completely. It is not the sort of agent that leaves people blind and infertile and glowing green. The U.S. military also has a lotion that can be applied immediately after exposure, Reactive Skin Decontamination Lotion, to good effect, among other antidotes. Most people exposed to sarin do not die. A large exposure is not a death sentence.

Richard M. Price, a professor at the University of British Columbia and author of The Chemical Weapons Taboo—in which he looks at how we came to see chemical weapons as "particularly abhorrent" and how they "have been successfully institutionalized in international proscriptions" in the context of arms control more broadly—spoke with CBS News recently about what he considers the two factors that perpetuate the taboo of nerve agents:

Presented by

James Hamblin, MD, is a senior editor at The Atlantic. He writes the health column for the monthly magazine and hosts the video series If Our Bodies Could Talk.

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