All five hospitals of the City became crowded quickly. The first victim staggered into Hamidia Hospital at 1:15 A.M. and within an hour thousands appeared. Hamidia was the largest of the five hospitals and is joined to a medical school and research center. The beds filled everywhere; then there were two to a bed. The prior bed tenants were bundled off to their homes unless gravely ill. Then the floors were lined with mats and no one could move about without difficulty. So tents were set up on the grounds.
Doctors, interns, students, nurses, orderlies, friends and relatives of victims, then volunteers, all threw themselves into the seemingly endless work. Soldiers and police joined them soon. The doctors who received the first patients had to improvise the therapy. The event and hence the symptoms were totally surprising. What is to be done with eyes that were struck as if rubbed with hot chillies, with choking so severe that patients strangled before your eyes?
The Union Carbide India resident medical officer evacuated his family and turned his attention to the medical scene, which he found in full frenzy. The superintendent of Hamidia Hospital is quoted as saying ; "Probably sometime around 3:00 A.M. Dr.- -, when contacted after repeated attempts by one of our doctors, only told us to give wet cotton pads to soothe the victims' eyes-- something which is commonsensical, and which many victims had resorted to, before coming to us."
For the eyes simple washing in water was advised, then atropine drops to enlarge the pupils, this later only after someone reported poison gas in waves and the idea that the cornea might crystallize occurred. But when the patient could not see because of the atropine it was difficult to explain in the confusion that this was supposed to happen. Drugs were used to suppress the bronchial and lung inflammation and to dehydrate the body so that its own fluids would cease to flood the lungs that drew upon them avidly. But the patients suffered an agony of dehydration for they were already complaining of the fever and heat that were produced by the low flow of fluids into the lungs. Other drugs were used to dilate the bronchial tubes. Antibiotics were dispensed freely in anticipation of the infections that might follow the destruction of throat and lung tissue.
The damaged respiratory system could not take in ample oxygen. Respirators were applied. Oxygen was soon in short supply. So were respirators. Masks and tanks were brought in and flown in, so that the supply of these became adequate, but some say that the supply became adequate because oxygenation proved ineffectual. Lung suction machines were flown in from Britain and France. All of the while untreated patients and inadequately treated patients were dying or worsening.
Medications were abundantly available, if one could agree that the medication being administered was appropriate to the disease. Hospital conditions were abominable, a word that most foreigners from the West would have used even before the disaster, and it is a situation that prevails all over India. However, Bhopal boasts a medical college and therefore a supply of competent personnel at all levels. Some 853 doctors plunged into the massive task. Some of them came to the hospitals in the first place because they were personally affected by the gas and sought therapy, and then they stayed on for several days of exhausting work.
On the seventh day, a City Councillor assaulted a senior doctor, after failing to persuade him to retain a patient for the five days necessary to qualify for a benefit of Rs. 2000. The doctors went on strike; a placard read "Congress Party muscleman-ship is deadlier than MIC;" they also got some needed rest. Soon, appeased, they returned to work.
A thousand volunteers were organized by civic groups and welfare organizations, it is estimated, or came as individuals to perform the work of orderlies, to set up beds and fabricate stretchers from cloth and sticks and rope and to cut and sew bed cloths.
Everyone had to conclude: there is no specific, no antidote for MIC poisoning. That the chief medical officer of Union Carbide India and the plant manager were unprepared for one case, let alone a quarter of a million cases, of MIC poisoning seems to have become evident in the beginning of the crisis. "An irritant," "a potent tear gas," these were the type of phrases applied, not only in India but also in the United States. When the dead began to pile up, they could not believe their own knowledge of what the tank contained. They wondered aloud whether some strange contaminant or reactant had somehow found its way into the tank and had proved to be highly toxic.
In the fatal hours inquiry was made to the parent company in America and the following telex message was returned the same day, December 3, to Union Carbide Ltd offices in Delhi, Bombay, and Bhopal. (Remember that the USA was running 10.5 hours behind Indian time.)
From Dr.Avashia, Medical Director-Institute Plant :
Urgent pass this info to doctors in Bhopal.
1. Treat patients with respiratory problems from methyl isocyanate by intravenous injection of hydrocortisone or prednisone 1 gm. immediately and after 24 hour. After also give oxygen and supportive treatment.
2. If cyanide poisoning is present administer sodium nitrite and sodium thiosulphate : if the patient does not respond to the amyl nitrite administration, or if severe exposure is suspected, administer intravenously 0.3 gm. sodium nitrite (10 ml of a 3 percent solution) at the rate of 2.5 to 5 ml/minute, followed by injection of 12.5 gm. sodium thiosulfate (50 ml of a 25 percent solution) at the same rate and via the same needle and vein.
3. Observe patient: The blood levels of methemoglobin should be monitored and not allowed to exceed 40 per cent. The patient should be kept under observation for 24 to 48 hours. If signs of intoxication persist or reappear, the injection of nitrite and thiosulfate should be repeated in one-half the above doses. Even if the patient appears well, this second injection may be given two hours after the first for prophylactic purposes."
Later on Dr. Avashia said that he had gotten his information from his wife, who had heard a radio broadcast about the disaster in which the theory that cyanide poisoning might be involved was reported. Therefore he inserted the advice on cyanide. This message thereupon added itself to the local rumor at Bhopal of mass cyanide poisoning, which was generating out of the severity of the symptoms and the suspicion that some new unexpected horrible gas had been released.
We note also, concerning the telex, that the third paragraph refers to the treatment for cyanide but might be construed as treatment also for methyl-isocyanate poisoning, and this too contributed to heated arguments among the attending doctors over experimenting with the cyanide treatment on the MIC patients.
Finally, concerning the telex, its language is obviously intended for the care of only several patients, not a mass poisoning. Practically none of the scores of thousands of victims received the attention here prescribed.
In mid-March, the Indian Council of Medical Research announced preliminary results of a study of persons exposed to MIC, who typically had high levels of thiocyanate in their urine. In a double-blind test, half of a sample were injected with thiosulphate and half with a placebo. The experimental group showed symptomatic improvement and an increased excretion of thiocyanate. This excretion was known to occur in cyanide poisoning and hence now to be indicative of MIC poisoning, for it implies a breakdown of MIC into cyanide. Thus, what was hotly argued by the doctors in the middle of the disaster and rejected -- that thiosulphate was an antidote to MIC -- now appears likely.
The symptoms of MIC poisoning have been familiar around the world and anyone who goes into the shanties of Bhopal can get first-hand accounts of them. MIC is a common element in pesticides and pesticidal poisoning is endemic everywhere. Yet there must be thousands of public health and medical officers around the world who have observed victims of poisoning without bringing effective pressure upon the sources of the poisoning to investigate and publicize what they know about the materials they are producing and shipping. In this case some fault must lie with the parent company and the U.S. agencies that are charged with research and dissemination of information in this area. Since the United States Congress votes the largest appropriations in the world for public health research, it would appear in order for a committee of Congress to investigate the failure on the part of both Union Carbide and the several Federal agencies concerned to live up to their responsibilities.
If the first symptoms of MIC poisoning are corroding lungs, inflamed bronchial tubes and throat, glazing eyes, and gastrointestinal upheaval, they are not the complete and final list. Comas, indicating a trauma of the central nervous system, were frequent, also dizziness, and often severe muscular weakness, again denoting neurological disorder. Postmortems were conducted in many cases. The lungs were found to weigh twice or three times the normal because of the weight of fluids in them. The blood of a patient who died on the first day was pink; if he died after a week of 168 hours of agony, his blood shows up a dark red and his organs are congested. MIC or its compounds, amines and cynamide, are found in the blood. The hemoglobin of the blood is deactivated.
Major questions of cure arose. That people continued to die settled the point whether the disability might be progressive. Several were dying each week, months later. For how long would the possibility of death be imminent? And, if not death, how long would the disability persist? Union Carbide USA arranged with well-known specialists, one on pulmonary conditions and the other on ophtalmology, to fly to Bhopal a week after the gas escape. Both gave optimistic statements after three days of examining patients. MIC, they said, does not course through the body and affect organs other than the lungs and eyes. Once past the initial crisis, the patient's bodily fluids will dissolve the MIC. However, pneumonia and bronchitis may more readily develop out of lung damage. Furthermore, in cases of prolonged oxygen deprivation, the heart, brain, nervous system, and, with pregnant women, foetuses, may suffer damage. Permanent eye damage was discounted; any damage would repair itself except where the cornea had become discolored and this would, the doctors promised, be repaired by corneal transplants.
The treatment afforded most victims was a matter of a few minutes. They then dragged themselves back to their hovels, thereabouts to remain to this day, three months later, mourning their lost ones, complaining of their physical weakness, trying to keep track of their periodically renewable medical prescriptions, and venturing out or sending someone to get their food rations. Mobile clinics go about dispensing liberally analgesics, antibiotics, eye washes, and antacids, arranging also, in cases of pathological changes, for hospital examination.
The deep mental depression that has settled down upon many thousands of victims goes unattended. This is not regarded as an "illness." No one has yet alluded to other mass traumas and counseled : "See here, you have a mass trauma as bad as those of the Nazi camps and Hiroshima. This requires as many doctors and clinicians as the physical trauma." And, of course, the physical and the mental are interacting. Despite all assurances and display of caution by the authorities and experts, when it came time to process the remaining tons of MIC in order to dispose of it safely, a terror seized the city and a massive evacuation took place. The officials and scientists in charge of the processing went to ridiculous extremes in providing safety measures, giving the pompous title of numbered safety systems to such impressive expedients as hanging wet cloths over the gas vent, draping wet cloths over the wire fences, arranging for extra fire-fighting and water-hosing equipment to stand by, and sending a water-laden helicopter into the air to flush any vapor cloud that might be aloft.
The "People's Movement," in close contact with the victims, realized their psychic state and brought forth as well the variety of physical symptoms that were both cause and effect of the mental ones. Besides breathlessness, burning of the eyes (it was painful to go out in the sun), impaired vision and coughing exhaustingly, there were adduced the common complaints of bodily weakness, bodily pains, palpitations, giddiness, frothing at the mouth, convulsions and comas. Long after the first week, people returning home felt dizzy and even fainted upon sweeping floors or opening doors and cupboards. That MIC clings to cloth and rugs an American reporter from a chemical journal discovered; all dry goods had to be well washed. To many the well water had a metallic taste. The City water and the lake waters were pronounced safe to use, but few believed the announcements, and the fish and meat and vegetables coming on the market were likewise shunned or eaten fearfully despite pronouncements of their edibility. It was also discovered that people who had been sitting by their smoky little fires or who had been drinking alcohol before the gas cloud crept in seemed to have been less affected by it.
The "People's Movement" registered some botanical and zoological observations as well. Leaves of all types of plants and trees were scorched to a blue-black except the tamarind (imli); pomegranate leaves turned yellow, pipal leaves black. Chickens were less affected than fish, goats, cows and dogs. The upper layers of stored wheat flour (atta) took on a greenish hue. The hundreds of animal carcasses, most bloated and near bursting with their gases, were finally picked up by hand or by crane and dumped in a freshly dug, one acre-square ten-foot pit and spread with salt, bleach, lime and caustic soda, then covered over with earth.
A month following the visit of the American doctors who gave an optimistic report, a McGill University pharmacologist came to Bhopal at the invitation of the People's Movement and examined about fifty patients. He condemned the governments for not providing public reports, even preliminary ones, on the pathology of and therapy for MIC poisoning, and he termed the pronouncements of the American doctors to be "outrageously unscientific." He commented upon the recurrent breathlessness and conjunctivitis, extreme weakness sensed, and loss of appetite and taste, the abdominal swellings, and the discoordination of physical movement. Further he stressed the severe disruption of menstruation in many women, and the occurrence of spontaneous abortions. It was elementary, he claimed, that when a poisonous gas arrives at the lungs, it proceeds to other parts of the body, and that the liver and gastrointestinal tract were likely to be affected. Despite much evidence of internal bleeding, no endoscopies were being performed because of a lack of instruments in working order. Mutagenic effects might take eight to ten years to detect. Finally, there was a total lack of any rehabilitation programs for the victims.
An equally critical account was published at the same time in the British journal, New Scientist. The lack of a long-term blood-testing program at Bhopal was deplored. A chance to learn of enduring and progressive effects of exposure was being lost; after January the blood levels of MIC in many persons might not be detectable. If blood tests were to demonstrate that MIC bound itself to hemoglobin and nucleic acids, mutations and possibly cancers might occur in the absence of countervailing mechanisms. Any highly reactive agent like MIC can react with proteins and DNA in the cells to cause cancer. Widespread metabolic disorders are possible, given the propensity of MIC to combine with amino acids and proteins.
Shortly before the Union Government appointed a committee of his group to investigate the disaster, the Director-General of the Indian Council for Medical Research declared, or so it is reported, that "there is no reason to believe that there will be any long-term effects of MIC poisoning on various organs and systems of the human body." Later his deputy vigorously denied that such a statement had been made. Nevertheless, this opinion, favorable to whoever wanted to underplay the events, seems to have preponderated for some weeks and still is prominent in interested circles of India and USA.
Yet the Indian Council's preliminary report of December 15 did state that "severe tensions would be expected to lead to significant scarring (of the lungs) in the course of healing amongst long term-survivors. Pulmonary fibrosis of a bilateral nature is expected to ensue with its attendant effect upon lung function. Careful contemporary and follow-up studies are needed not only to evaluate the nature and extent of the residual damage but also to search for any clues in the management of these cases in the short and long term to minimize residual damage. With the appearance of sub-acute and chronic syndromes as time passes, it is expected that target organ damage, if any, other than pulmonary damage, might be expected to become increasingly evident." The Committee set up a research unit to coordinate the work under the Dean of the Gandhi Medical College at Bhopal.
In a press conference at Delhi in February, the Director General announced that postmortem reports had revealed the presence of cyanide, that the respiratory systems of the cases examined had undergone "devastating changes", that a "significant and striking feature" was the cherry red color of the blood in all the organs of the body, and that there had been brain oedema, neurological disorders, degeneration of the liver and kidneys; further, lungs had doubled or trebled their weight. In confirmation, later deaths and illnesses occurred in conjunction with fat excesses in the liver, degeneration of kidney tissue, spleen injury and gastric and intestinal ulcers.
On March 21, an infant was reported born of a mother who was resident of an affected neighborhood of Bhopal (Jehangirabad) during the gas cloud release and who had suffered vomiting and burning eyes. She left Bhopal four days after the disaster and the baby was delivered at the Bilaspur Hospital in Raipur. The baby weighed nine pounds, came after what seemed to be a normal pregnancy, and was delivered by operative assistance. However, the infant's eye cavities were void; its skin appeared scorched, its fingers and toes were undeveloped; and its sex was indeterminate. It expired within forty hours. A pathological investigation was ordered to seek signs of MIC effects.
Under such circumstances, it would be premature to claim that permanent damage would not be suffered or that new symptoms would not occur or that injuries already evident would not worsen as the poison's effects gradually took command in various organs or that there was no possibility of birth and genetic problems. The resolution of the total complex of issues cannot be well considered, therefore, without some provision being made for the appearance of new symptoms or the worsening of old ones.
The heavy toll of the disaster and the blackout of company and government news on many aspects of the case has led to various conjectures about the substances employed, the large quantity of MIC on hand, etc.; at some point these must be investigated, even though they will be most likely dismissed as false. Union Carbide built a few years ago a research structure on the factory site at Bhopal. It is remotely possible that the research facility was being used or intended for use to test the chemical warfare potential of MIC or to develop other chemicals that would be hazardous in themselves or when compounded. Indian journalists have raised such issues, and have found a large audience receptive to the theories, despite a denial by the Indian Ministry of Science and Technology that it had authorized Union Carbide of India to undertake any research related to chemical warfare; the Bhopal facility was merely one of 900 laboratories in India that had been granted incentives. But, think the suspicious ones, the CIA would have been in association with the Company and certainly not reporting to the Ministry.
There is widespread suspicion of American motives and conduct in international affairs. Hence it may be well to open up the full record of the motives, economics, decisions, and correspondence that led to the founding of the research center. In the aftermath of Bhopal a not uncommon view is that voiced by the tabloid weekly, Blitz; it wonders whether Union Carbide will be permitted to escape full responsibility owing to the fact that the victims are Indians rather than Americans, and it criticized American law that gives compensation to U.S. servicemen who have suffered from their exposure while employing the defoliant "Agent Orange" in Vietnam, but offers nothing to the Vietnamese civilians who suffered from the same poison in much greater numbers.
The most effective mechanism for examining issues such as this would be the U.S. committee system in Congress; it can call hearings, order documents brought before the committee in charge, subpoena witnesses and eventually dispose of the issues.
In the tens of thousands of words of reportage and in all the eyewitness accounts of the events at Bhopal, one reads or hears of nothing that would constitute a systematic attempt at discovering the numbers of victims. Nor does it seem that anybody was in a position to make such an enumeration. At the hospitals, record-keeping is ordinarily done in a less than perfect manner; The Times of India recently published an investigative report documenting the lamentable state of medical records. During the emergency all semblance of control over admissions and releases was lost. Consider only that patients by the thousands were camped on the grounds outside. All control over burials at the Muslim cemeteries and of the mass cremations by the Hindus was lost. (A man, thought dead, climbed down from his own funeral pyre.) There was no accounting for the numbers of people leaving the city and returning.
The moment came when serious estimators were trying to arrive at the figures of the dead by guessing the amount of wood that was used in the fires that the Hindus used as funeral pyres. (The State Government later announced with macabre pride that its Forest Department had provided 20,000 quintals of wood, two million pounds, for the crematory holocaust.) Nobody knows how many bodies were cast into the waters. One small boy pulled himself from the waters into which he had been tossed as dead. Many bodies were carried to the villages and as far as Indore for burial or cremation, and many persons died too in these removed places.
The Delhi Science Forum sent in a team to visit the City shortly after the accident and estimated the dead at five thousand, the seriously injured at fifty thousand, of which 20,000 were in critical condition. The number of persons affected by MIC was guessed to be 250,000.
For death-gift purposes, as I have said, the Government of India chose to adopt the figure of deaths supplied by the State Government, about 1400. The Tata Institute of Social Sciences, with collaborating groups, was asked to survey gas-affected families. In mid-February a preliminary report, covering 25,294 families residing in 36 neighborhoods near the plant, confirmed 1,021 deaths and 1,064 cases of blindness. One hundred and fifty children were orphaned and 168 women widowed.
The survey was conducted by questionnaire, mostly in a fixed framework of response, and administered by paraprofessional investigators. Although the most extensive attempt to solve the problem, it raises some questions. The number of families appears to be about half of the people known to have been affected and treated in the hospitals apart from the dead. The number of blind in proportion to the dead seems excessive unless the dead are unreported. Orphaned probably means deprived of both parents. Given the 168 widows, of whom are the 1021 dead composed? Were only 168 of them married men? The many families and individuals who were erased from existence, or who permanently abandoned the area are not accounted for. In India, widows especially would be forced back to their villages. Our working estimate of 3000 deaths seems to hold up unless queries can be handled convincingly in a true, full report by the Institute. Furthermore, the field investigators were forbidden to make tallies, and the methodology has been concealed, an abuse of social science itself calling for investigation. The State government is sitting on the data, and the Tata Institute appears helpless to dislodge it.
A principal medical doctor and chief of section at Hamidia Hospital, who was in the thick of the holocaust, agrees with our estimate of 3000. Circumstantially, the burial procedures would support it, too. And if one examines the press accounts, they are observed to begin the first day with estimates of around 600, to move to 1000 the next day, and then to climb to the vicinity of our estimate before leveling off. They are probably more reliable that the Tata Institute figures, which followed in time and numbers the State government estimates adopted by the Federal Government, and were derived some weeks afterwards by methods that are not entirely clear.
When Bhopal voted, along with several other parts of India, in a special delayed election, six weeks after the disaster, participation was at least 25% below normal, 40% as contrasted with an average of 65% in all other areas voting. Where had this 100,000 or so people of voting age gone? Perhaps they were still refugees. If so, add another 100,000 for the young, making 200,000 semi-permanent refugees. To this day some persons insist that many more died; before one discusses such claims, it is well to recall how long it took to discover how many had died in the Nazi holocaust, and how "right-thinking" and official opinion was usually on the reductionist side.