Demon Doctors:Physicians as Serial Killers
Ethics in Emergency Medicine, 2nd ed.

The History of Biological Warfare

From: "Chapter 8: Viruses and Vivisections:
Japan's Inhuman Experiments" in Demon Doctors:
Physicians as Serial Killers
By Kenneth V. Iserson, M.D.
Galen Press, Ltd., Tucson, AZ,

> Biological weapons are either living organisms that can reproduce, such as bacteria or viruses, or toxic materials produced by living organisms, such as toxins or physiologically active proteins or peptides. (Few biological weapons produce skin lesions; mycotoxin, such as was used in Kampuchea around 1980, is the rare exception.) Since they must be either inhaled or ingested, biological warfare (BW) agents must be dispersed as 1 to 10 µm particles or placed in food or water sources.
> While many potential BW agents exist among the thousands of naturally occurring bacteria and viruses, those of use in BW are limited by their:

> > 1. Ease of production
> > 2. Stability
> > 3. Infectivity or toxicity.

> The bacteria causing anthrax, Bacillus anthracis, is often considered the best biological agent because of its stability for decades in spore form and ease of production. Among viruses, Venezuelan equine encephalitis is one of the most lethal, and among toxins, staphylococcal enterotoxin and botulinum toxin are potential weapons.
> Unlike chemical weapons (CW), which have immediate devastating effects, BW agents often cause early symptoms similar to common illnesses, take time to develop their full potential, and, if caused by active agents, can lead to widespread epidemics before the problem, agent, or source is recognized. The terror produced by even the threat of such weapons magnifies their effect on both military and civilian populations.

> Military Use of BW
> Armies have used biological warfare for millennia. As early as the sixth century B.C., Assyrians poisoned enemy wells with rye ergot, and Solon of Athens used the purgative herb, hellebore (skunk cabbage), to poison the water supply during his siege of Krissa. In 400 B.C., Scythian archers dipped their arrows in blood and manure, attempting to cause illness in their enemies. The Greeks polluted their enemy's wells and drinking water supplies with animal corpses in 300 B.C.; later the Romans and Persians would adopt the same strategy.
> At the battle of Tortona, Italy, in 1155, Barbarossa put human corpses in his enemy's water supply, successfully contaminating it. Catapulting infected corpses into besieged cities was commonplace during the medieval period. In 1346-47, for example, the Muslim Tatar, De Mussis, catapulted bubonic plague-infected corpses over the walls of Caffa on Russia's Black Sea in Crimea, causing an epidemic. The city surrendered and the defending Christian Genoese sailors fled to Italy, possibly beginning the Black Death pandemic throughout Europe.
> In 1422, during the siege of Karlstejn in the Holy Roman Empire, soldiers' corpses and 2,000 cart loads of excrement were hurled at the enemy. And, in 1485 near Naples, the Spanish supplied their French enemies with wine laced with leprosy patients' blood.
> In the eighteenth century, unsophisticated but effective BW continued to be used. In 1710, Russians catapulted plague-infected corpses into Reval, Estonia, held by their Swedish enemies. In 1763, during the French and Indian War, British Colonel Henry Bouquet gave smallpox-infected blankets to the Indians at Fort Pitt, in western Pennsylvania, resulting in a devastating epidemic. Using the same technique, Tunisians besieging Christian-held La Calle in 1785 threw plague-infested clothing into the city. While besieging Mantua, Italy in 1797, Napoleon attempted to infect the inhabitants with swamp fever.
> During the American Civil War, Dr. Luke Blackburn, who would later become Kentucky's governor, tried to infect Union troops by providing them with clothing exposed to smallpox and yellow fever. (At that time, no one knew that yellow fever can only be transmitted through mosquito bites.) It is uncertain if this plan was successful, even though friends and relatives of some Union officers claimed they died because of Dr. Blackburn's efforts. Confederates under General Johnson, retreating in Mississippi in 1863, tried to contaminate potential water sources by leaving dead sheep and pigs in wells and ponds they passed. That same year, however, U.S. Army General Order No. 100 stated: "The use of poison in any manner, be it to poison wells, or food, or arms, is wholly excluded from modern warfare."
> During World War I, bacteriological warfare became more sophisticated as microbiology developed, the causative organisms for many diseases were identified, and many were grown in laboratories. During the war, most biological attacks were directed at animals using anthrax and glanders. The Germans launched BW attacks in Romania, Italy, France, Russia, and Mesopotamia. In the United States, the center for BW activity was in Maryland, where Johns Hopkins-trained surgeon Dr. Anton Dilger and his brother Carl produced bacteria to inject into military horses, mules, and cattle destined for the Allied Expeditionary Force in Europe. Although never used, the United States tested a devastating biological toxin derived from castor beans, ricin, for military use. A 1918 report reads:

> > These experiments show two important points: (1) easily prepared preparations of ricin can be made to adhere to shrapnel bullets, (2) there is no loss in toxicity of firing and even with the crudest method of coating the bullets, not a very considerable loss of the material itself . . . It is not unreasonable to suppose that every wound inflicted by a shrapnel bullet coated with ricin would produce a serious casualty . . . Many wounds which would otherwise be trivial would be fatal.

> Scrutinizing BW Programs
> Despite this research in the mid-1920s, both the United States and the new League of Nations claimed that BW was impracticable, either because of inadequate delivery systems or because of enhanced public health and preventive medicine systems. BW was banned in the 1925 Geneva Protocol signed by 28 nations (the U.S. Senate refused to ratify it), about the time that Dr. Ishii Shiro was making his two-year tour of foreign microbiology research facilities.
> In 1931, as Japanese Prince Mikasa revealed only in July 1994, his country's military laced fruit with cholera germs in an unsuccessful attempt to poison members of the League of Nations' Lytton Commission assigned to investigate Japan's seizure of Manchuria. As Japan began its human research experiments in BW and the Germans began the military training and testing of offensive BW in the 1930s, the U.S. military was disparaging the idea that it should be researched or that it could be used. In an influential 1933 article in The Military Surgeon, Major Leon F. Fox wrote, "Bacterial warfare is one of the recent scare-heads that we are being served by the pseudo-scientists who contribute to the flaming pages of the Sunday annexes syndicated over the Nation's press."
> The U.S. military appeared to be nearly alone in this attitude. In 1929, the Soviet Union had opened a BW research facility north of the Caspian Sea, and, by 1936, France had a large BW research program and Britain had established a group to investigate offensive and defensive BW issues. By 1939, Sir Frederick Banting, the discoverer of insulin, had initiated Canada's BW research program with anthrax, botulinum toxin, plague, and psittacosis. Britain opened their BW laboratory in 1940.
> Only in 1941, when credible evidence arrived that the Japanese were using BW against Chinese troops, did the U.S. government appoint a committee to study BW, although no preparations were in place at the time of Pearl Harbor.
> By February 1942, the United States had established the War Research Service to coordinate defensive efforts against BW contamination of the nation's food and water supply. As the war progressed, the government established both offensive BW research programs and supplied selected troops with defensive BW equipment. In June 1944, the U.S. government placed an order for 1 million four-pound SPD Mk I BW cluster bombs, but canceled it as the war ended.
> During World War II, Germany had a relatively small BW program, working mainly with plague, cholera, typhus, and yellow fever. Japan had an extensive program, as described in this chapter. BW, however, proved lethal for even those working on or distributing the material. For example, during the 1940s, about 1,600 Japanese researchers and soldiers died from mishandling Unit 731's pathogens.

> Common Bw Agents: Used, Stockpiled, And Weaponized

> Disease: Agent | Signs and Symptoms | Theoretical Toxicity* | Time to onset
> Anthrax:Bacillus anthracis | Malaise, fatigue, myalgia, fever, non-productive cough (early); followed by severe respiratory distress, chest pain, sweating, swelling, and shock. | One gram of spores could kill more than one-third of U.S. population. 50% exposed contract meningitis. Has a mortality rate of 100% (despite appropriate treatment). | 1 to 6 days (inhaled)
> Botulism:Botulinum Toxin, Type-A; Clostridium botulinum | Blurred vision, lid droop, difficulty swallowing and speaking, muscle weakness, respiratory distress, and death. | Few tenths of a microgram is lethal. Eight ounces could kill every living creature on the planet. | 2 to 4 days (variable)
> Brucellosis:Brucella suis, melitensis, abortus, canis (human pathogenic types) | Localized inflammatory process, or acute febrile illness or chronic infection. Depression, headache, and irritability frequently occur. | Relatively large amounts. | 3 days to several weeks
> Plague:Yersinia pestis | Fever, headache, vomiting, chills plus: Pneumonia with blood-tinged sputum (pneumonic) or painful large skin blisters, altered mentation, abdominal pain (bubonic) or purpura, disseminated intravascular coagulation, abdominal pain, cyanosis/ necrosis of fingers and toes (septicemic). | Disease caused by 1 to 10 organisms through the skin, or 100 to 20,000 inhaled. Up to 12% of those infected die from disease. | 24 hours (inhaled); 1 to 8 days (skin); 2 to 6 days (septicemic)
> Q Fever:Coxiella burnetii | No common pattern. | One organism. | 10 to 40 days
> Smallpox:Orthopoxviridae varioloa | Malaise, fever, rigors, vomiting, headache, backache, typical skin erruption. | ? | 12 days (average)
> Tularemia:Francisella tularensis | Fever, chills, headache, cough, myalgias, and pneumonia. Plus single ulcer and lymphadenopathy (ulceroglandular) or systemic symptoms, more common and severe pneumonia, without local skin lesion or marked lymphadenopathy (typhoidal). | 10 to 50 inhaled organisms cause disease. Without treatment, has a mortality rate of 4% (ulceroglandular) to 35% (typhoidal). | 3 to 6 days
> Typhoid:Salmonella typhosa | Chills, fever, cough, nosebleed, weakness, abdominal swelling and tenderness, delirium, and rash. | One lb. of culture in drinking water is as toxic as 11 lbs. of botulinum toxin or ten tons of potassium cyanide. | 10 to 12 days

> *If optimally distributed. Higher doses are generally used in BW weapons, since optimal dispersion generally cannot be achieved.

> BW Testing and Dissemination
> In the 1950s, the United States continued its BW program, developing multiple delivery methods for BW agents. The most successful of these was the M114 four-pound antipersonnel bomblet, designed to be part of a cluster bomb. It contained 320 milliliters of Brucella suis (the bacteria causing brucellosis). The U.S. military also concentrated on testing anthrax and yellow fever-producing up to 500,000 mosquitos a month to carry the latter agent.
> In several large-scale open-air tests near heavily populated areas of the United States, the military used Bacillus globigii, Serratia marcescens, and inert particles to demonstrate that BW agents could be distributed using natural continental air flows, making them potent weapons of mass destruction. They also tested BW agents on human "volunteers," including civilian prisoners. During this period, the Soviet Union was also conducting BW tests and was producing and storing large amounts of BW agents.
> By the 1960s, the U.S. military was testing a number of vaccines against BW agents on human "volunteers." (In late 2000, the VA hospital system began testing former military personnel who may have been unknowingly exposed to BW tests.) These vaccines included immunizations against Venezuelan equine encephalomyelitis, tularemia, anthrax, botulinum toxin, Rift Valley Fever, Q fever, Eastern equine encephalomyelitis, and Western equine encephalomyelitis.
> They had also developed the SD-2 Drone, a 300-knot, remote-controlled, recoverable aircraft, with a 100 nautical mile range, that could hold more than 200 pounds of biological agent. They then developed the SD-5, which sped along at Mach 0.75, had a 650 nautical mile range, and sprayed its 1,260 pounds of BW agent through a tail nozzle. The U.S. Military also developed and mass-produced several BW bombs. In additional large-scale tests on unsuspecting civilians, they disseminated Bacillus globigii, supposedly a noninfectious agent with properties similar to anthrax, at various public sites, including Washington, DC's National Airport and Greyhound Bus Terminal and New York City's subway system.

> Banning BW
> Only in November 1969, four months after the United Nations issued a report condemning the production and stockpiling of chemical and biological weapons, did President Richard Nixon renounce America's use of BW, saying:

> > I have decided that the United States of America will renounce the use of any form of deadly biological weapons that either kill or incapacitate. Our bacteriological programs in the future will be confined to research in biological defense, on techniques of immunization and on measures of controlling and preventing the spread of disease.

> At the time, the United States had put into delivery systems ("weaponized") the lethal BW agents for anthrax, tularemia, and botulinum toxin. They also had stockpiles of at least four incapacitating BW agents, as well as anti-crop agents. In February 1970, Nixon also banned BW toxins.
> In the mid-1970s, reports began to surface that BW agents-mostly toxins-were being used in Southeast Asia and Afghanistan, primarily by the Russian and the Vietnamese armies. The Soviet Union had signed the Biological Weapons Convention in 1975 and specifically stated that "the Soviet Union does not possess any bacteriological agents and toxins, weapons, equipment or means of delivery."
> Yet, on April 3, 1979, an accidental airborne leak of anthrax spores occurred at a previously undetected biological weapons plant, the Soviet Institute of Microbiology and Virology in Sverdlovsk, Russia. Although only one BW weapon discharged and Soviet troops quickly attempted to decontaminate the facility and the city, 66 people downwind of the plant died of anthrax.
> Only in 1992 did Russian President Boris Yeltsin admit that Russia had an offensive BW research program. Subsequently, it has been discovered that they also were attempting to use recombinant DNA technology to produce lethal venoms in common bacteria.

> Estimates of Casualties Produced by Hypothetical Biological Attack *

> Agent | Downwind Reach (Miles) | Dead | Incapacitated
> Rift Valley Fever | 0.6 | 400 | 35,000
> Tick-borne Encephalitis | 0.6 | 9,500 | 35,000
> Typhus | >3 | 19,000 | 85,000
> Brucellosis | >6 | 500 | 125,000
> Q fever | >12 | 150 | 125,000
> Tularemia | >12 | 30,000 | 125,000
> Anthrax | >12 | 95,000 | 125,000

> * Release of 110 lbs. of agent from an aircraft along a 1¼ mile line upwind of a population center of 500,000.
> Adapted from: Health Aspects of Chemical and Biological Weapons, WHO, 1970.

> Increasing BW Risk
> Over the past two decades, the risk of BW has actually increased. In the 1980s, authorities discovered terrorist groups in the United States and Europe manufacturing typhoid bacillus, ricin, botulinum toxin, and other BW agents that they planned to use on civilian populations. The reasons are obvious: ease of production and low costs. For example, NATO estimated that, in 2001, to produce 50 percent casualties in a square kilometer, it would cost about $9,000 for conventional weapons, $4,000 for nuclear weapons, $3,000 for chemical agents and less than $5 for BW agents.
> They also have the benefit of not being detectable by ordinary means, such as x-rays, dogs, and other devices, making them easy to transport. Their delayed onset of action, from a few hours to a few weeks; the ability of perpetrators to protect themselves against the agent with a vaccine; difficulties recognizing a BW attack; and no "signature" left at the scene makes it unlikely that the perpetrators would be caught. And, much like a neutron bomb, BW only affects living things, leaving structures intact.
> The 1990s' Persian Gulf War produced evidence that Iraq had a large BW facility at al-Hakam. In 1995, Iraq admitted that this facility had prepared about 19,000 liters of botulinum toxin, 8,400 liters of anthrax, and 2,000 liters of aflatoxin and clostridium since 1988. They had "weaponized" some of this material, loading it onto more than 200 BW missiles, plus additional artillery shells, rockets, aircraft spray tanks, and bombs. Iraq is not alone in its offensive BW capability. Experts now believe that Iraq, North Korea, and Russia may have stockpiled the smallpox virus for BW use. Smallpox was eradicated from natural occurrence due to Herculean worldwide public health efforts, so there is little immunity in any population.
> Only in 1998 did the world realize that Japan's Aum Shinrikyo cult, before its 1995 lethal nerve gas attack on a Tokyo subway, carried out at least nine BW attacks. Over a five-year period, they had tried to use BW agents against the Japanese legislature, the Imperial Place, several sites in Tokyo, and U.S. Navy facilities. No deaths resulted, because either their agents were not of sufficient virulence or their delivery systems were faulty.
> Civil defense agencies now take the threat of BW agents seriously and work to counteract terrorist groups that adopt Dr. Ishii's philosophy: to employ the "silent enemy" of microbiology as a "silent ally."
> In 2001, shortly after the World Trade Center tragedy, terrorists used the U.S. postal system to distribute deadly anthrax spores, exposing thousands to the biological weapon, and killing four victims. As of mid-November, the identity of the perpetrators-whether foreign, domestic, or both-is unknown.

> © Copyright 2001 Galen Press, Ltd.

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