he sweated blood directly from the pores of his skin,
I MIGHT POINT OUT AT THIS JUNCTURE THAT MY DAUGHTER, KRISTEN AMBER STONE, DIED IN 1980 AT THE AGE OF 6 DAYS, EXHIBITING THIS PHENOMENON, 10 YEARS AFTER MY PARTICIPATION IN PROJECT 112/SHAD IN THE U.S. NAVY....ALONG WITH HER HAVING BEEN BORN PREMATURELY AT A WEIGHT OF 2 POUNDS, 1 OUNCE, HAVING HYALIN MEMBRANE DISEASE, BEING OPERATED ON AT THE AGE OF 3 DAYS FOR A PERFORATED INTESTINE, EXPERIENCING GRAND MAL SEIZURES DUE TO MASSIVE HEMMORHAGING IN HER BRAIN, AND HAVING EXPERIENCED SEVERAL TOTAL BLOOD TRANSFUSIONS...
GOD REST HER SOUL
I will have no other children.
I'm not that selfish...
PREFACE TO THE FOURTH EDITION
The Medical Management of Biological Casualties Handbook, which has become affectionately known as the "Blue Book," has been enormously successful - far beyond our expectations. Since the first edition in 1993, the awareness of biological weapons in the United States has increased dramatically.
Over 100,000 copies have been distributed to military and civilian health care providers around the world, primarily through USAMRIID's on-site and road Medical Management of Biological Casualties course and its four annual satellite broadcasts on this subject.
This fourth edition has been completely re-edited and updated. New chapters have been added on melioidosis, the medical management of a biological weapon attack, and the use of epidemiologic clues in determining whether an outbreak might have been intentionally spread.
In addition, a reference appendix has been added for those interested in more in-depth reading on this subject. Our goal is to make this a reference for the health care provider on the front lines, whether on the battlefield or in a clinic, who needs basic summary and treatment information quickly. We believe we have been successful in this regard.
We appreciate any feedback that might make future editions more useful. Thank you for your interest in this important subject.
Medical defense against biological warfare or terrorism is an area of study unfamiliar to most military and civilian health care providers during peacetime. In the aftermath of Operations Desert Shield/Desert Storm, it became obvious that the threat of biological attacks against our soldiers was real. Increased incidents and threats of domestic terrorism (e.g., New York City World Trade Center bombing, Tokyo subway sarin release, Oklahoma City federal building bombing, Atlanta Centennial Park bombing) as well as numerous anthrax hoaxes around the country have brought the issue home to civilians as well. Other issues, including the disclosure of a sophisticated offensive biological warfare program in the Former Soviet Union (FSU), have reinforced the need for increased training and education of health care professionals on how to prevent and treat biological warfare casualties. Numerous measures to improve preparedness for and response to biological warfare or terrorism are ongoing at local, state, and federal levels.
Training efforts have increased both in the military and civilian sectors. The Medical Management of Chemical and Biological Casualties Course taught at both USAMRIID and USAMRICD trains over 560 military medical professionals each year on both biological and chemical medical defense. The highly successful 3-day USAMRIID satellite course on the Medical Management of Biological Casualties has reached over 40,000 medical personnel over the last three years. Through this handbook and the training courses noted above, medical professionals will learn that effective medical countermeasures are available against many of the bacteria, viruses, and toxins which might be used as biological weapons against our military forces or civilian communities.
The importance of this education cannot be overemphasized and it is hoped that our physicians, nurses, and allied medical professionals will develop a solid understanding of the biological threats we face and the medical armamentarium useful in defending against these threats. The global biological warfare threat is serious, and the potential for devastating casualties is high for certain biological agents.
There are at least 10 countries around the world currently that have offensive biological weapons programs. However, with appropriate use of medical countermeasures either already developed or under development, many casualties can be prevented or minimized. The purpose for this handbook is to serve as a concise pocket-sized manual that will guide medical personnel in the prophylaxis and management of biological casualties. It is designed as a quick reference and overview, and is not intended as a definitive text on the medical management of biological casualties.
HISTORY OF BIOLOGICAL WARFARE AND CURRENT THREAT
The use of biological weapons in warfare has been recorded throughout history. Two of the earliest reported uses occurred in the 6th century BC, with the Assyrians poisoning enemy wells with rye ergot, and Solon’s use of the purgative herb hellebore during the siege of Krissa. In 1346, plague broke out in the Tartar army during its siege of Kaffa (at present day Feodosia in Crimea). The attackers hurled the corpses of plague victims over the city walls; the plague epidemic that followed forced the defenders to surrender, and some infected people who left Kaffa may have started the Black Death pandemic which spread throughout Europe.
Russian troops may have used the same tactic against Sweden in 1710. On several occasions, smallpox was used as a biological weapon. Pizarro is said to have presented South American natives with variola-contaminated clothing in the 15th century, and the English did the same when Sir Jeffery Amherst provided Indians loyal to the French with smallpox-laden blankets during the French and Indian War of 1754 to 1767. Native Americans defending Fort Carillon sustained epidemic casualties which directly contributed to the loss of the fort to the English. In this century, there is evidence that during World War I, German agents inoculated horses and cattle with glanders in the U.S. before the animals were shipped to France.
In 1937, Japan started an ambitious biological warfare program, located 40 miles south of Harbin, Manchuria, in a laboratory complex code-named “Unit 731”. Studies directed by Japanese General Ishii continued there until 1945, when the complex was burned. A post World War II investigation revealed that the Japanese researched numerous organisms and used prisoners of war as research subjects. Slightly less than 1,000 human autopsies apparently were carried out at Unit 731, mostly on victims exposed to aerosolized anthrax. Many more prisoners and Chinese nationals may have died in this facility - some have estimated up to 3,000 human deaths.
Following reported overflights by Japanese planes suspected of dropping plague-infected fleas, a plague epidemic ensued in China and Manchuria. By 1945, the Japanese program had stockpiled 400 kilograms of anthrax to be used in a specially designed fragmentation bomb. In 1943, the United States began research into the use of biological agents for offensive purposes. This work was started, interestingly enough, in response to a perceived German biological warfare (BW) threat as opposed to a Japanese one.
[IT IS WIDELY RUMORED THAT THE U.S. HIRED EXPATRIATE JAPANESE AND NAZI "SCIENTISTS" FROM THESE VARIOUS PROGRAMS AFTER WWII, UNDER THE CIA CODE NAME, "OPERATION PAPERCLIP"...!!!]
The United States conducted this research at Camp Detrick (now Fort Detrick), which was a small National Guard airfield prior to that time, and produced agents at other sites until 1969, when President Nixon stopped all offensive biological and toxin weapon research and production by executive order.
[PROJECT 112/SHAD, PLEASE SEE OTHER THREADS FOR MORE INFORMATION]
Between May 1971 and May 1972, all stockpiles of biological agents and munitions from the now defunct U.S. program were destroyed in the presence of monitors representing the United States Department of Agriculture, the Department of Health, Education, and Welfare, and the states of Arkansas, Colorado, and Maryland. Included among the destroyed agents were Bacillus anthracis, botulinum toxin, Francisella tularensis, Coxiella burnetii, Venezuelan equine encephalitis virus, Brucella suis, and Staphylococcal enterotoxin B. The United States began a medical defensive program in 1953 that continues today at USAMRIID. In 1972, the United States, UK, and USSR signed the Convention on the Prohibition of the Development, Production and Stockpiling of Bacteriological (Biological) and Toxin Weapons and on Their Destruction, commonly called the Biological Weapons Convention.
Over 140 countries have since added their ratification. This treaty prohibits the stockpiling of biological agents for offensive military purposes, and also forbids research into such offensive employment of biological agents. However, despite this historic agreement among nations, biological warfare research continued to flourish in many countries hostile to the United States. Moreover, there have been several cases of suspected or actual use of biological weapons. Among the most notorious of these were the “yellow rain” incidents in Southeast Asia, the use of ricin as an assassination weapon in London in 1978, and the accidental release of anthrax spores at Sverdlovsk in 1979.
Testimony from the late 1970’s indicated that Laos and Kampuchea were attacked by planes and helicopters delivering aerosols of several colors. After being exposed, people and animals became disoriented and ill, and a small percentage of those stricken died. Some of these clouds were thought to be comprised of trichothecene toxins (in particular, T2 mycotoxin). These attacks are grouped under the label “yellow rain”. There has been a great deal of controversy about whether these clouds were truly biological warfare agents. Some have argued that the clouds were nothing more than feces produced by swarms of bees. In 1978, a Bulgarian exile named Georgi Markov was attacked in London with a device disguised as an umbrella. The device injected a tiny pellet filled with ricin toxin into the subcutaneous tissue of his leg while he was waiting for a bus. He died several days later.
On autopsy, the tiny pellet was found and determined to contain the toxin. It was later revealed that the Bulgarian secret service carried out the assassination, and the technology to commit the crime was supplied by the former Soviet Union. In April, 1979, an incident occurred in Sverdlovsk (now Yekaterinburg) in the former Soviet Union which appeared to be an accidental aerosol release of Bacillus anthracis spores from a Soviet Military microbiology facility: Compound 19. Residents living downwind from this compound developed high fever and difficulty breathing, and a large number died. The Soviet Ministry of Health blamed the deaths on the consumption of contaminated meat, and for years controversy raged in the press over the actual cause of the outbreak.
All evidence available to the United States government indicated a massive release of aerosolized B. anthracis spores. In the summer of 1992, U.S. intelligence officials were proven correct when the new Russian President, Boris Yeltsin, acknowledged that the Sverdlovsk incident was in fact related to military developments at the microbiology facility. In 1994, Meselson and colleagues published an in-depth analysis of the Sverdlovsk incident (Science 266:1202- 1208). They documented that all of the cases from 1979 occurred within a narrow zone extending 4 kilometers downwind in a southerly direction from Compound 19. There were 66 fatalities of the 77 patients identified.
In August, 1991, the United Nations carried out its first inspection of Iraq’s biological warfare capabilities in the aftermath of the Gulf War. On August 2, 1991, representatives of the Iraqi government announced to leaders of United Nations Special Commission Team 7 that they had conducted research into the offensive use of Bacillus anthracis, botulinum toxins, and Clostridium perfringens (presumably one of its toxins). This open admission of biological weapons research verified many of the concerns of the U.S. intelligence community. Iraq had extensive and redundant research facilities at Salman Pak and other sites, many of which were destroyed during the war.
[THE QUESTION STILL REMAINS AS TO THE WHEREABOUTS OF THESE DOCUMENTED ITEMS...???]
In 1995, further information on Iraq’s offensive program was made available to United Nations inspectors. Iraq conducted research and development work on anthrax, botulinum toxins, Clostridium perfringens, aflatoxins, wheat cover smut, and ricin. Field trials were conducted with Bacillus subtilis (a simulant for anthrax), botulinum toxin, and aflatoxin. Biological agents were tested in various delivery systems, including rockets, aerial bombs, and spray tanks. In December 1990, the Iraqis filled 100 R400 bombs with botulinum toxin, 50 with anthrax, and 16 with aflatoxin. In addition, 13 Al Hussein (SCUD) warheads were filled with botulinum toxin, 10 with anthrax, and 2 with aflatoxin. These weapons were deployed in January 1991 to four locations. In all, Iraq produced 19,000 liters of concentrated botulinum toxin (nearly 10,000 liters filled into munitions), 8,500 liters of concentrated anthrax (6,500 liters filled into munitions) and 2,200 liters of aflatoxin (1,580 liters filled into munitions).
The threat of biological warfare has increased in the last two decades, with a number of countries working on the offensive use of these agents. The extensive program of the former Soviet Union is now primarily under the control of Russia. Former Russian president Boris Yeltsin stated that he would put an end to further offensive biological research; however, the degree to which the program was scaled back is not known. Recent revelations from a senior BW program manager who defected from Russia in 1992 outlined a remarkably robust biological warfare program, which included active research into genetic engineering, binary biologicals and chimeras, and industrial capacity to produceagents.
[THE WORDS "WEST NILE VIRUS", "RECOMBINANT DNA", AND "SARS" COME TO MIND AT THIS JUNCTURE...]
[MANY TONS OF THESE AGENTS ARE RUMORED TO HAVE BEEN RELEASED ON THE BLACK MARKET TO TERRORIST ORGANIZATIONS WILLING TO PAY ANY PRICE FOR THE TECHNOLOGIES AND BASIC MANUFACTURING AND RESEARCH COMPONENTS...]
There is also growing concern that the smallpox virus, now stored in only two laboratories at the CDC in Atlanta and the Institute for Viral Precautions in Moscow, may be in other countries around the globe. There is intense concern in the West about the possibility of proliferation or enhancement of offensive programs in countries hostile to the western democracies, due to the potential hiring of expatriate Russian scientists.
It was reported in January 1998 that Iraq had sent about a dozen scientists involved in BW research to Libya to help that country develop a biological warfare complex disguised as a medical facility in the Tripoli area. In a report issued in November 1997, Secretary of Defense William Cohen singled out Libya, Iraq, Iran, and Syria as countries “aggressively seeking” nuclear, biological, and chemical weapons. Finally, there is an increasing amount of concern over the possibility of the terrorist use of biological agents to threaten either military or civilian populations.
There have been cases of extremist groups trying to obtain microorganisms that could be used as biological weapons. The 1995 sarin nerve agent attack in the Tokyo subway system raised awareness that terrorist organizations could potentially acquire or develop WMD's for use against civilian populations. Subsequent investigations revealed the organization had attempted to release botulinum toxins and anthrax on several occasions.
The Department of Defense has been leading a federal effort to train the first responders in 120 American cities to be prepared to act in case of a domestic terrorist incident involving WMD. The program will be handed over to the Department of Justice on October 1, 2000. In the past two years, first responders, public health and medical personnel, and law enforcement agencies have dealt with the exponential increase in biological weapons hoaxes around the country. Certainly the threat of biological weapons being used against U.S. military forces and civilians is broader and more likely in various geographic scenarios than at any point in our history. Therefore, awareness of this potential threat and education of our leaders, medical care providers, public health officials, and law enforcement personnel on how to combat it are crucial.
Table 1. Epidemiologic Clues of a Biologic Warfare or Terrorist Attack
• The presence of a large epidemic with a similar disease or syndrome,
especially in a discrete population
• Many cases of unexplained diseases or deaths
• More severe disease than is usually expected for a specific pathogen or failure to respond to standard therapy
• Unusual routes of exposure for a pathogen, such as the inhalational route for diseases that normally occur through other exposures
• A disease that is unusual for a given geographic area or transmission season
• Disease normally transmitted by a vector that is not present in the local area
• Multiple simultaneous or serial epidemics of different diseases in the same population
• A single case of disease by an uncommon agent (smallpox, some viral
• A disease that is unusual for an age group
• Unusual strains or variants of organisms or antimicrobial resistance patterns different from those circulating
• Similar genetic type among agents isolated from distinct sources at different times or locations
• Higher attack rates in those exposed in certain areas, such as inside a building if released indoors, or lower rates in those inside a sealed building if released outside
• Disease outbreaks of the same illness occurring in noncontiguous areas
• A disease outbreak with zoonotic impact
There is no cure. Source: National Centers for Disease Control and Prevention
To the Ministry of Defence in the United Kingdom and Department of Defence in the United States of America your motto should be
"Lie, Lie, Lie again, and if Evidence to the contrary is provided, Still lie"
JAPAN ADMITS DISSECTING WW-II POWs
The following article was written by Thomas Easton of the Baltimore Sun
UKUOKA, Japan "I could never again wear a white smock," says Dr. Toshio Tono, dressed in a white running jacket at his hospital and recalling events of 50 years ago. "It's because the prisoners thought that we were doctors, since they could see the white smocks, that they didn't struggle. They never dreamed they would be dissected.
The prisoners were eight American airmen, knocked out of the ksy over southern Japan during the waning months of World War II, and then torn apart organ by organ while they were still alive.
What occurred here 50 years ago this month, at the anatomy department of Kyushu University, has been largely forgotten in Japan and is virtually unknown in the United States. American prisoners-of-war were subjected to horrific medical experiments. All of the prisoners died. Most of the physicians and assistants then did their best to hide the evidence of what they had done.
Fukuoka is midway between Hiroshima and Nagasaki, cities that are planning elaborate ceremonies to mark the devestation caused by the United States dropping the first atomic bombs. But neither Fukuoka nor the university plans to mark its own moment of infamy.
The gruesome experiments performed at the university were variagions on research programs Japan conducted in territories it occupied during the war. In the most notorious of these efforts, the Japanese Imperial Army's Unit 731 killed thousands of Chinese and Russians held prisoner in Japanese-occupied Manchuria, in experiments to develop chemical and biological weapons.
Ken Yuasa, now a frail, 70-year-old physician in Tokyo, belonged to a military company stationed just south of Unit 731's base at Harbin, Manchuria. He recalls joining other doctors to watch as a prisoner was shot in the stomach, to give Japanese surgeons practice at extracting bullets.
While the victim was still alive, the doctors also practiced amputations.
"It wasn't just my experience," Yuasa says. "It was done everywhere.".
Kyushu University stands out as the only site where Americans were incontrovertibly used in dissections and the only known site where experiments were done in Japan.
On May 5, 1945, an American B-29 bomber was flying with a dozen other aircraft after bombing Tachiaral Air Base in southwestern Japan and beginning the return flight to the island fortress of Guam.
Kinzou Kasuya, a 19-year-old Japanese pilot flying one of the Japanese fighters in pursuit of the Americans, rammed his aircraft into the fuselage of the B-29, destroying both planes.
One of the Americans died when the cords of his parachute were severed by another Japanese plane. A second was alive when he reached the ground. He shot all but his last bullet at the villagers coming toward him, then used the last bullet on himself.
Two others were quickly stabbed or shot to death.
At least nine were taken into custody.
B-29 crews were despised for the grim results of their bombing raids, so some of the captives were beaten.
The local authorities assumed that the most knowledgeable was the captain, Marvin Watkins. He was sent to Tokyo for interrogation, where he was tortured but nonetheless survived the war.
Every available account asserts that a military physician and a Colonel in a local regiment were the two key figures in what happened next. What happened cannot be easily explained. Perhaps caring for the Americans was an impossible burden, especially because some were injured. Perhaps food was scarce.
Whatever the reason, the colonel and doctor decided to make the prisoners available for medical experiments, and Kyushu University became a willing participant.
Teddy Ponczka was the first to be handed over to the doctors and their assistants. He had already been stabbed, in either his right shoulder or his chest. According to Tono, the American assumed he was about to be treated for the wound when he was taken to an operating room.
But the incision went far deeper. A doctor wanted to test surgery's effects on the respiratory system, so one lung was removed. the wound was stitched closed.
How Teddy Ponczka died is in dispute. According to US Military records, he was anesthetized during the operation, and then the gas mask was removed from his face. A surgeon, Taro Torisu, reopened the incision and reached into Ponczka's chest. In the bland words of the military report, "Torisu stopped the heart action".
Tono remembers events differently. The first experiment was followed by a second, he says. Ponczka was given intravenous injections of sea water, to determine if sea water could be used as a substitute for sterile saline solution, used to increase blood volume in the wounded or those in the state of shock. Tono held the bottle of sea water. He says Ponczka bled to death.
Then it was the turn of the others.
The Japanese wanted to learn whether a patient could survive the partial loss of his liver. They wanted to learn if epilepsy could be controlled by removing part of the brain.
According to US Military records, physicians also operated on the prisoners' stomachs and necks.
All of the Americans died.
"There was no debate among the doctors about whether to do the operations ... that is what made it so strange," Tono says.
Word of the experiments eventually leaked out.
Thirty people were brought to trial by an Allied War Crimes Tribunal in Yokohama, Japan, on March 11, 1948. Charges included vivisection, wrongful removal of body parts and cannibalism ... based on reports that the experimenters had eaten the livers of the Americans.
Of the 30 defendants, 23 were found guilty of various charges. (For lack of proof, the charges of cannabilism had been dismissed.) Five of the guilty were sentenced to death, four to life imprisonment. The other 14 were sentenced to shorter terms.
But the attitude of the American occupation forces began to change largely because of the start of the Korean War in June 1950.
The United States had less interest in punishing Japan, an enemy-turned-ally.
In September 1950, US General Douglas MacArthur, as supreme commander for Allied Forces, reduced most of the sentences.
By 1958, all those convicted were free.
None of the death sentences was carried out.
The Combat Studies Institute, U.S. Army Command and General Staff College, tasked by the TRADOC Commander, developed The Integrated Battlefield Bibliography. It encompasses the literature of NBC warfare during the period of 1945-1965, now part of the historical record of Army doctrinal changes. The Integrated Battlefield Bibliography contains a variety of sources which record the thoughts, ideas, and research of U.S. and foreign writers who, in the period of time under consideration, faced a doctrinal shift from conventional warfare to a battlefield which they believed would be dominated by NBC weapons.
The selection of material for the bibliography was based on set criteria. Each item originated in the given time period or appeared later but dealt with matters of concern to the military at that time. Another factor in the selection process was a perceived need by commanders at all levels, instructors at TRADOC schools, authors of field manuals, or military personnel who might merely wish to learn more about various aspects of NBC warfare. Technical documents were not part of this survey. The eight major categories, which emerged after the bulk of the material was reviewed and selected, are: COMMAND/CONTROL, DOCTRINE/ORGANIZATION, LOGISTICS/ SUPPORT, MEDICAL, SOVIET, TACTICS/OPERATIONS, TRAINING/PERSONNEL and WEAPONRY/EQUIPMENT.
Entries include magazine and journal articles, government contract studies, maneuver reports, field manuals, official reports, student research papers and books by private authors. A significant number of documents are from the Defense Technical Information Center (DTIC) bibliographies and the annual Air University Periodical Index. Many collections were researched by Combat Studies Institute staff with the thoughtful assistance of the staffs of the Combined Arms Research Library at Fort Leavenworth, the Library of Congress, the U.S. Army Center of Military History, Washington, DC, the Army Library at the Pentagon, the National War College, Fort McNair, and the Concepts and Studies Division, U.S. Army Chemical School, Fort McClellan. In addition, Combat Studies Institute sent requests to possible source locations throughout TRADOC for information on historical "Integrated Battlefield" literature. A variety of useful sources were received by using this method. Special thanks for contributions go to the U.S. Army Infantry School, U.S. Army Engineer School, U.S. Army Combat Developments Experimentation Command, Defense Information School, U.S. Army Quartermaster School, U.S. Army Institute for Military Assistance (Marquat Memorial Library), U.S. Army Aviation Center, Transportation Technical Information and Research Center and the U.S. Army Military History Institute.
Each item was first categorized and then entered according to a standard bibliographical format. Although most studies prepared by research corporations or government agencies list authors, several items are listed by title only, especially those found at the Concepts and Studies Division, U.S. Army Chemical School, Fort McClellan. Some entries have additional descriptive information in parentheses. At the end of each entry the source of the document is indicated (a complete list of abbreviations precedes the text). The one exception is magazine and journal articles which are available at most DOD installations. A number of classified documents were discovered in the course of the research and those with unclassified titles are listed with the appropriate security classification at the end of the entry.
Questions concerning the bibliography should be directed to the Combat Studies Institute, Attn: ATZL-SWI-R, Command and General Staff College, Fort Leavenworth, Kansas 66027, Autovon 552-2840.
http://www-cgsc.army.mil/carl/resources ... eller2.asp
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