1. GILBERT DREYFUS

Napalm and its Effects on Human Beings

The word `napalm' is derived from the two words `naphthene' and `palmitate'. Napalm itself is a jelly obtained from the salts of aluminium, palmitic or other fatty acids, and naphthenic acids. These acids give a viscous consistency to gasoline so that an incendiary jelly results. We have developed the habit of calling `napalm', not only the napalm itself, but also the material resulting when it is mixed with gasoline to form the incendiary weapon.
     The generic precursors of this weapon go back to the flame-throwers first used in the First World War. These flame-throwers had a limited effective range because of the fluidity of the liquids. Therefore an attempt was made to diminish fluidity and render the liquids more adherent. An example of primitive success in this area is the early Molotov cocktail in which a simple fragment of cotton was added to adhere to a tank and to render the combustion of the gasoline more effective.
     The first napalm was developed by American technicians of the Chemical Corps during the Second World War. They observed that latex mixed with gasoline took on a viscous consistency which gave good results. But as the sources of latex were blocked after Pearl Harbor, they had to find a synthetic. They sought a jelly which could be prepared at low temperatures, which was easily handled, stable and not too costly. A soap-like aluminium mixture - aluminium salts with fatty acids - met these requirements, especially the acids having from ten to sixteen carbons, like palmitic acid and oleic and other unsaturated acids. Napalm comes in the form of a grey-white powder resembling soap powder; it can be made effective by mixing it with gasoline on the battlefield.
     The use of fire as a weapon by soldiers is very ancient, but the {191} technology in modern terms really began, in a rudimentary way, during the First World War and became generalized during the Second World War. Napalm conferred on a flammable substance the properties necessary for extended use and the aeroplane furnished an efficient delivery system.
     Until the beginning of the Second World War, magnesium was the incendiary substance most frequently employed by all belligerents. But from 1942 on, it was recognized that magnesium was expensive and in too short supply for massive use. Therefore, as napalm was developed, it became the prime material in the manufacture of incendiary bombs. The first model in service, the M-69 bomb weighing six and a half pounds, was used in great quantities against Japan. The models which followed were developed too late to use against Japan, but they were used during the Korean War and then by the French in Indochina and Algeria.
     To utilize napalm effectively, large target areas are preferable. Flame-throwing aircraft have proved ineffective because conventional aircraft fly too fast to be accurate. On the other hand, excellent results are obtained by dropping fire bombs made from launchable drums filled with gasoline jellied with napalm. The napalm drums have exterior ignition devices consisting of small incendiary bombs or phosphorous grenades.
     There are a number of different containers for napalm. Those most frequently used contain nearly 500 litres of gasoline, jellied by an addition of napalm varying from six to thirteen per cent - six per cent seems more often used. Such a bomb will cover with flames a surface 75 feet wide by 270 feet long. To obtain the best results, the bomb should fall as rapidly as possible, giving, by momentum, a greater length to the surface covered. Therefore the best means of delivery is not to drop the bomb vertically, but to launch it from low altitude - about 100 feet - from a `hedge-hopping' aircraft.
     The Americans use two types of napalm and several different means of delivery. The two napalms are `ordinary', which produces a temperature of 800-1,200°C [1,472-2,152°F] and `super-napalm', enriched with polystyrene, sodium, magnesium or phosphorus, with which the temperatures reach 1,500-2,000°C [2,732-3,632°F]. These two napalms are principally used in {192} drums of from 60 to 630 litres capacity and in bombs weighing from 100 to 200 kilos [220-440 lbs.]; the US 7th Fleet also uses napalm missiles.
     Since napalm is essentially an incendiary product, it sets fire to any combustible matter with which it comes in contact. A human being in the open cannot protect himself against it. Napalm acts not only by burning but has an equally devastating effect which consists of a complicated process whereby shock, absorption of oxygen from the air [deoxygenation], smoke and noxious gases become lethal. The Surgeon-General of the French Army has described the massive poisoning by carbon monoxide after a napalm attack and points out that none of those burned in the central strike area survives because of this phenomenon. Only those who have been on the periphery of the strike zone can survive the massive deoxygenation.
     An examination of some of the methods of execution practised during the Middle Ages sheds some light on these effects. In executions by burning at the stake, when large fires were used, the victim died rapidly from carbon monoxide poisoning before being actually burned by the flames; when small fires were used, a longer and much crueller death by flame resulted. (From this has come the popular French expression for being on tenterhooks: brûler à petit feu, to roast over a slow fire.)
     During the Second World War, troops found Japanese shelters which had been struck by napalm bombs in which all the occupants were dead without having been burned at all. These soldiers had died, apparently without pain, and with an expression of fright and surprise frozen on to their faces; they had been instantaneously and massively poisoned by carbon monoxide. The only way to escape the asphyxiating effects of napalm is to flee into the open air - where the direct destruction by burning from flaming splashes is greatest. In a strike zone it is almost impossible to escape the effects of napalm by taking shelter, for one cannot hold one's breath for the time it takes napalm to burn off. The carbon monoxide poisoning itself paralyses the will and robs the victim of the ability to move.
     From the above it can be seen that a napalm bombardment has two principal effects: fire and asphyxiation. When napalm strikes human beings the resulting burns are distinguishable from ordinary {193} burns by the fact that they are covered with a viscous black magma resembling tar. The depth of the burn is always considerable. The extensive fires caused by the combustion of flammable structures in contact with napalm prolong the effect of the primary burning.
     The asphyxiating effect of napalm is due to the incomplete combustion of the compound, which produces carbon monoxide. This phenomenon has been reported in areas ravaged by the fire storms caused by bombardment of cities with conventional bombs during the Second World War. The lethality of carbon monoxide is well known and it was tried by the Nazis as a destructive gas for the mass execution of civilians. The source of this gas was the exhaust of diesel motors which was either directed into an enclosure built on to a truck or into a gas chamber. The method was too primitive and was abandoned in favour of cyanide derivatives.
     We now turn to the poison-and-burn pathology of napalm. Carbon monoxide poisoning is most effective. Carbon monoxide dissolves rapidly into blood plasmas. Combined with haemoglobin, it imparts to the red corpuscles a very stable combination of carboxy-haemoglobin, which is more stable than the combination with oxygen. The combining with haemoglobin is powerful and rapid, occurring within a few hundredths of a second. It is 250 times more rapid and powerful than the reaction with oxygen. The elimination of carbon monoxide, on the other hand, is much more slow and difficult. Once combined with haemoglobin, carbon monoxide suppresses the oxygen-carrying capacity of the blood pigment, thereby inhibiting the function of haemoglobin in supplying oxygen to the tissues. Carbon monoxide also seems to have an effect on the iron-containing cells and combines readily with the respiratory enzymes, bringing about direct disturbances of cellular respiration in addition to those caused by the lack of oxygen.
     The chemical effects of carbon monoxide depend on its concentration in the surrounding air. With as little as one per cent, it is toxic. With higher concentrations, ideation is disturbed and there are hallucinations. Concurrently there occur motor disturbances and paralysis which prevent walking and all desire to escape. Beginning with a saturation of fifteen to forty per cent of {194} the haemoglobin, encephalic disturbances, cardio-respiratory failure and fatal coma appear. Survivors of poisoning who have received emergency treatment exhibit permanent neurological after-effects which range from mild to very severe. Prognosis for coma depends in large part on the therapeutic facilities. The immediate use of oxygen therapy is called for since the symptoms are reversible with a forced intake of oxygen. Modern resuscitation equipment is imperative. One can imagine the unavailability of such equipment in a target area in Vietnam.
     The second and most evident effect of napalm is the burn. The explosion of a 200-litre napalm incendiary bomb precipitates massive destruction by flames in a circle about 240 feet in diameter. In that zone the heat is from 1,800-3,600°F and the carbon monoxide release is massive; within this zone, there will be no survivors. Outside this zone unsheltered individuals will suffer burns from flaming splashes of napalm of a gravity in proportion to the amount of cutaneous surface affected. Parts not protected by clothing - face, hands, often the upper and lower members will be burned. The fire affects the clothing also, which can contribute to localized burning, rendering the effect worse.
     After bombardment of a group of people by napalm, the wounded - in need of immediate treatment if they are to survive - will be found around the periphery of the strike zone. The possibility of treatment is a function of the gravity of the burn. Besides the extent and depth of burning, age is a determining factor since the effects are more severe on children and the old. Also, burns on the face and neck are more serious for a child than for an adult. Gravity is expressed in terms of percentage of the body surface affected. Any adult burned on more than ten per cent of the body, or any child burned on more than eight per cent, is considered critically burned.
     Doctors also distinguish between superficial burns - first and second degree burns where the thermal lesion involves only the epidermis - and third degree burns, where the destruction of all skin, epidermis and dermis, renders any spontaneous healing impossible. Burning which goes as deep as the tissues (third degree) develops scabs which, when they fall off, leave an open wound susceptible to infection. A third-degree burn will never heal aseptically. Because of napalm's adhesive quality, the burns it {195} causes are almost always of the third degree. It is estimated that a napalm burn affecting as little as five per cent of the body surface is grave.
     A serious burn progresses through successive stages: first of shock and poisoning; second of infection; and third of healing. Any grave burn becomes a generalized illness due to the loss of body fluid and the breakdown of the body's mechanism for fluid balance. Immediately after burning there is shock due to pain and fear. Towards the sixth hour and for three or four days thereafter, true physiological shock due to the leakage of liquid plasma from the burned areas sets m. The amount of this fluid loss is proportional to the amount of burned surface. Some loss occurs at the exterior but mostly in the subcutaneous tissues, causing oedema which is sometimes considerable. The direct consequence of the plasma leakage is a haemoconcentration from diminution of the blood mass. The diminution of the blood mass leads to a circulatory slowing and often to cardiovascular collapse, which in turn compromise the oxygenation of the tissues and cause multiple metabolic disturbances.
     Beginning with the third and fourth days, a reverse phenomenon of reabsorption of the exuded liquids takes place. The tissues and red corpuscles release their liquids into the circulatory system bringing about a haemodilution causing anaemia and hypertension with crises of cerebral and pulmonary oedema. Also around the third day, the consequences of liver and kidney damage appear. This is an anoxia of the tissues due to the build-up of toxic products coming from the reabsorption into the blood stream of the destroyed tissues. Later, nutritional disturbances appear which are a result of the nitrogen loss following nitrogen destruction. Thus within ten days such a burned person loses about eleven pounds from fluid loss alone.
     In addition every profound burn is a wound that is susceptible to infection. This is especially true since the initial inadequacy of general resistance facilitates the multiplication of microbes. Once established, this infection further inhibits nutrition and blocks healing. Thus a vicious, often irreversible circle is created which is responsible for more than fifty per cent of the secondary deaths from burns. Such deaths can often appear months after the trauma.
     Finally, the healing process develops with elimination of the {196} necrotic tissues. A second-degree burn heals in a few weeks. By contrast, in a deep burn, the epidermatization [growth of new skin] can only start from the periphery of the wound, if one has been unable to make a graft, to build a fragile scar tissue. This tendency to heal from the periphery causes granular, sclerotic tissue to form on the wound, further inhibiting healing.
     In napalm burns, a final element is of great importance; this is the gravity of facial burning. Eye burns can lead to loss of one or both eyes. Nasal and ear passages involved develop extended suppuration and necrosis which abscess with unbearable pain to the patient. The face becomes hideous with psychological trauma of formidable proportions. There are other lingering damages: lesions of the bone, which do not show up on X-rays, and appearance of cysts of certain joints and bones of the hand - for instance, the metacarpus - which persist for many years after the initial burning.
     The treatment of the burned is directed at those symptoms we have just enumerated. It is simple and generic, but requires that treatment be undertaken immediately, that it should be prolonged and attentive and that it should be given by a very advanced medical organization. At the bombardment site, extreme care must be taken not to increase the risk of infection. The patient should be wrapped in a sheet and given pain-killing injections, and antibiotic injections and anti-tetanus serum to combat infection. If possible, an infusion of glucose or saline solution should be given and the victim evacuated immediately to a medical facility of the `general hospital' level. Every burn victim should be treated as an incipient shock case and should receive emergency treatment without delay. This is of extreme urgency; if shock is not prevented it will establish itself and become irreversible. If so treated, the burned person will pass the crisis in from six to ten days. It can be seen that in countries with good medical organization it is possible to reduce the mortality from severe burning. In underdeveloped areas, or during great cataclysms such as war, this is another matter.
     In medical summation, then, treatment consists of compensation for liquid loss by blood transfusion, plasma, substitutes, saline solutions (especially at the time of haemodilution), prevention of infection by antibiotics, oxygenation under pressure {197} and high-calorie intake. After these emergency treatments follow long-term care, dressing, antiseptic cleaning of the wounds, excision of necrotic tissue and, if possible, grafting. Grafting requires good general health, clean wounds and the availability of skin from unburned parts of the body. The present state of medical science does not allow us to take grafts from any donor other than the recipient himself. It is evident that the treatment of a burn victim is difficult, even with specialized personnel and the most modern equipment. Even with this, the suffering of the patient is intense and onerous.
     It is obvious that under repeated bombardments which destroy structures which might be used for evacuation - when medical personnel are overworked and subject to lethal attacks themselves - these ideal conditions we have described are impossible. There is no resemblance between conditions prevailing when treating accident victims during peacetime and victims of deliberate attacks. The emergency treatment of a mass of burn victims in areas remote from medical centres and without adequate means of evacuation presents insuperable problems. It is therefore inadvisable in such conditions to try to save the worst case, who will, no matter what is done, die within a week. One ought to concentrate efforts upon the less gravely burned with between ten and twenty per cent of the body surface affected and without impairment of the digestive tract.
     In Vietnam, a limited number of gravely burned persons can be treated in a general hospital, especially those in Hanoi, but the majority of victims are treated in the village maternity infirmaries and the district hospitals where skin grafting is not possible. Instead of grafting, wounds are left to heal by slow skin extension from the wound periphery.
     I do not have definitive statistics, but it seems that only about thirty per cent of those wounded by napalm and not killed outright can be saved. If the victim does survive, the dermatological consequences of napalm burns are especially serious. After the surgery there is a great risk of superinfections. Poor grafting also leaves serious after-effects. Retractile skin and contraction of scars form huge welts which will need further treatment. Keloid and hypertrophic scars will form to limit and inhibit the normal elasticity of the skin, which in turn inhibits the normal movement {198} of the member. These scars are prone to pyodermic and microdermic infections. The new skin is extremely fragile, and scleroatrophied skin will always be susceptible to minor infections that a normal skin would easily combat.
     Lastly, concerning the medical effects of napalm recovery, there is the spectre of secondary cancers. Old burn scars show a frequency of skin cancer out of proportion to such appearance in normal skin. This cancer consists of a spino-cellular epithelioma with a negative prognosis because of the rapid invasion by the malignant cells of the related ganglion areas.
     Napalm, to conclude, whether it is used strategically on the battlefield or in the bombardment of urban areas or village collectives, is a means of extensive undiscriminating destruction. It affects primarily human beings, livestock, crops and light inflammable structures such as houses. Its use in heavily populated areas will produce immense loss of life from burning and asphyxiation. In survivors, corporal injuries of the greatest gravity with functional sequels which prevent the resumption of normal life are the rule.
     Though some of the victims may partially recuperate after long and costly treatment, nothing much can be done for the majority of napalm-burned persons.
 

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