INTRODUCTION:
Even after the lapse of 20 years, BGT of 3rd December 1984 due to the sudden
leak of 42 tons of Methyl Isocyanate (MIC) is unparalleled in the annals of history of
chemical disasters. Over 3000 people died and many more were condemned to long-
term morbidity. The loss of human life and life-long crippling of many survivors
have been. unprecedented and the sheer magnitude of the catastrophe in the
industry has roused the conscience of the world. In many cases, the sole bread earner
of the entire family died: many have been widowed: and many of the survivors are
either infants or minor children. The medical profession at Bhopal faced a situation,
which few others in their fraternity ever had to in the annals of history. In the early
hours of the morning of 3rd December 1984 hundreds and soon thousands of
innocent people crowded in on the doctors in the Hospitals -gasping for breath
frothing in the mouth, retching, fear and panic writ on their faces hoping against
hope to cling on to life. The helpless doctors, neither were aware about the killer gas
which had escaped into the air from the Union Carbide India Ltd. factory, nor
could they have an idea about antidotes to be administered. They did : whatever
they could -symptomatic treatment to make the last few minutes on earth more
comfortable for the victims'. As a result of these concerted efforts including
autopsies, toxicological studies, clinical management of the victims and
epidemiological investigations, many positive results have been obtained which have
helped to unravel some of the mysteries of this major industrial disaster.
DEATH RATES:
In the immediate wake of the disaster in the first 48 hrs, the death rate in
some of the worst affected areas ranged as high as 20 per thousand of population.
For the month of December 1984 the death rate was about 24 per thousand as
compared with the national average of 1 per thousand for a ~ corresponding period.
The worst affected victims belonged to the age group less than 5 years, with death
rate of 33 per ", thousand, followed by a figure of 15 per thousand both in the age
group of 15-40 years and above 45 years. Mortality in children and young and active
adults was very high affecting the future of many families. Although all dead bodies
were not brought to the morgue, 311 bodies were received on 3.12.1984 followed by
250 bodies on 4.12.1984. Thereafter the number of dead bodies brought into the
morgue declined. A total of 837 dead bodies were received in the morgue in
December 1984 following the gas disaster. The most poignant of the effects is total
disruption of a large number of families, in some with all children dying, in others
with both parents dying leaving the children as orphans.
Within hours of the deadly leak, hundreds perished and scores of dead
bodies started pouring into the morgue. Late Prof. Heeresh Chandra and his
dedicated team at the Medico Legal Institute, Bhopal, subjected them to meticulous
Post-Mortems. He described vividly the "Cherry Red" discoloration of the blood
and lungs, in particular. This unique finding set the pace for a multi-pronged
Toxicological investigation. Indeed, I was fortunate to participate actively in these
studies right from the inception. My colleagues, Dr. H.M.K.Saxena and Dr. Ashok
Mukherjee & Dr. A.K.Jain from the Institute of Pathology also joined the team to
help us in Light & Electron microscopic studies.
Histopathology: Literally, the hundreds of Aut.opsies were categorized into Acute,
Sub-acute and Chronic phases. Apart from the univ~;s-a:i 'o~ar involvement, cough
and severe dyspnoea at rest, which was accentuated on exertion characterized the
"Acute phase". Clinically, the situation was comparable to ARDS (Acute
Respiratory Distress Syndrome). Yet another striking feature was extreme muscular
weakness. Autopsies in this early phase revealed generalized edema and marked
congestion of the viscera, especially of the respiratory tract and the brain. The lung,
which was the most damaged organ, weighed over twice the normal.
Microscopically, there was widespread intra-alveolar & interstitial transudation of
albuminous fluid and emphysematous bullae. Inflammatory changes were minimal.
In fact, at that early stage up to January 1985, while the hazard of severe hypoxia
was recognized, even some Indian scientists envisaged a good prognosis for the
Bhopal survivors, on the analogy of HAPO! It was even doubted whether the severe
pulmonary edema caused by the chemical MIC could really lead to any permanent
tissue damage.
But these hopes were soon belied by the findings in the subsequent "Sub-
acute phase". The lungs showed progressive exudative changes, with varying
degrees of bronchitis, bronchiolitis and widespread pneumonitis. Still later, in the
"Chronic phase", there was evidence of organization and consolidation, with
widespread diffuse interstitial pneumonitis and fibrosis (DIPF & GIPF), clinically
corresponding to COPD. While a small group had persistent damage, surprisingly
enough, a large proportion of people slowly recovered. The brain was edematous to
the naked eye and had extensive hemorrhages, both grossly and microscopically.
Ring hemorrhages and Pericellular and Pericapillary edema were observed under
Light & Electron microscopy. All these features were suggestive of acute anoxic or
histo-toxic damage. A study of several hundred cases in the acute, sub-acute and
chronic phases revealed progressive changes of pulmonary edema and bronchiolitis,
followed by chronic fibrosis. Apart from widespread visceral hemorrhages, cerebral
edema and ‘selective neuronal damage’ indicated ‘acute histotoxic anoxia’
Experimental Studies: Dr. K Jeevaratnam of DRDE, Gwalior and myself
successfully developed a rat model. Following single exposures of MIC or its
derivatives, MA & DMU, over a period of 10weeks, the entire spectrum of lesions,
from pulmonary edema to fibrosis, were reproduced.
Scope for Molecular Biology: It may be added, in parenthesis, that the two
significant observations of BGT viz., massive edema of the lungs and brain and
widespread hemorrhages, are of universal applicability in future chemical disasters.
Detailed experimental studies with the newer tools of molecular biology such as
Interleukin–1 and TNFα of the “acute phase response” and adhesion molecule,
ICAM – 1 might explain the pathogenesis of edema and hemorrhage respectively.
The protective role of anti-inflammatory Cytokines, like Interleukin–6 and Heat
Shock Proteins might help, not only in understanding the pathogenesis of such
lesions, but also in developing newer therapeutic remedies in combating such
disasters.
(b) Hence, Prof. Chandra strongly invoked a possible exposure to HCN (Hydrogen
Cyanide). This resulted in a needless major controversy, in spite of a paper as recent
as 1982 by Blake & Ijadi-Maghsoodi. In fact, subsequent analysis of preserved
blood samples of Bhopal victims also showed elevated cyanide levels.
(c). With a view to explore other causes of cyanide-generating chemicals, detailed
forensic chemical analysis of the “Tank Residue was carried out. CC-MS studies
yielded valuable evidence about the presence of over 20 different chemicals, many of
which could be traced to the bodies of victims.
(d) Recalling the old adage that “the dead teach the living”, the alarming finding of
cherry-red discoloration of lungs, in the initial autopsies, led to the suspicion of
cyanide toxicity. The same was soon confirmed unequivocally by the demonstration
of elevated cyanide levels in the blood and tissues of the victims. The prompt
therapeutic response to NaTS (Sodium Thiosulphate), substantiated the hypothesis,
which was further confirmed by elevated levels of urinary SCN (Thiocyanate), in
individual cases and in "Controlled Double Blind Trials”, before undertaking its
wider use.
3. Studies and collection of data and samples from sporadic severely and
moderately ill patients and controls
Thus the Scientific Challenges posed by the Bhopal Gas Tragedy have been
almost fulfilled by the coordinated studies based on Toxicology, Autopsy & Histo-
Pathology, Respiratory Physiology and Clinical & Forensic Biochemistry. This is
perhaps the first Chemical Accident where the offending Chemicals have been
traced into the body of the victims and appropriate Measures of Detoxification were
evolved. Although accident involving may not recur, these experiences are of
immense value while encountering Future Chemical Disasters.