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September 8, 1959
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Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 PPrice: 53.50 8 Septembcr 1959 NTOICAL arVICOfT wss ATTACK USSR JFRS: L-973?i' OFFICE OF TEC:TIC/1 S3RVIC2,'S U. S. DEPOTEENT 0 e CCE.M.CE IiiiiSidlIGTOIT 25, D. C. U. S. JOIPT P BLICATX0FS "riiBAPC!I SERVICE 205 EAST 42nd STREET, SUITE 3(X) Fag YORK 17, Y. Y. STAT C TAT S TAT STAT Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 Declassified in Part- Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 ? .F W piR p * This publication.wris prepared under nontract by the UNITED STATES JOINT PUBLICATIONS RESEARCH SERVICE, a federal government organization established to, service. the translation and :Jr . ;,15.13 researchmesds tef the; -various government departments. 4 t. ?MED ICAL SERVICE' _ 4 'Vs!! 9 .1 ? ? : r 71! ?;5.7ft.trti, 111 VR:l. :1/41 'I ? !vit!'.-2' -? Orginizatai:yi'MailitaftiikOf61.!-af ' -- qrq 1 Obespechaniya.pri MassovyAch,_ _ Porazhenykh tr"" " . ? Z!..-11" " 214., 2,115?L'3 (1,1:1?i v - N1-1. "-jj.r-?? ? ,? ? 4. "CP ? 13i " 41J7 i? FtnFl!:!..1r. Ar ? - , , - ? 7 Ti-- _Radioactive Substanets - ? - ?- nenkO (froia' Chapthr14)- , r. a , Together with atomic and hydrogen:beinbs!and chemical and bacteriolegical--weapons,? military radioactive,-,zubstances ,(BRV) are litawise considered.' as a ;weapon' of mads There have been published in the foreign literatureitt, - number of works dealing with problems of the production, effective- ness and methods of utilizing m'ilitaryx:ad.1.,9Eletper17bstanoes. ? . . In the book "The. Effect' orAiorn?ip Veapone DonaldSons.E.'.Oiliille'aaryA; othei;;.9utheral, obtained by tl?re methoda.- Ths first 11)ethodli8 -obtaining radioadtive;substances in nuelearlrethetors' (boilers),-as?-by-products-iintthelfrocestheffpro-. clueing' plutonium !for i atomic bttniss.'t?-Thescr,,bry-predilots rare com- plex radioactive mixture of various ehemicalIsubstances: -,- ? Declassified in Part- Sanitized Copy Approved for Release @ 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 _ Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 ?*--t-qiehelseeagemethcd - obtaining radioactive isotopes by irre-''- dijatihg certain chemical substances-with neutrons., Such radio- - acti14107subisfinCes include strontium, yttrium, zirconium, niobium, rubidium, praseodymium, cerium, etc. The half-life of these substances is measured in tens of days, and their radiation has peat penetrating capacity. ???? A characterisAfffeature,pf-AWnis that :they have no specific odor, cOl'ory46e -Othhiiiarti---characteristics. The presence of BRV is determined by special instruments; termed dosimeters. BRV are desighed to contaminate localities, water, food and air with the purpose of destrpyincpe.ople and, animals. Foreign specialiete ad is evident-'frsin-the,.0ti'cle,,by Jack de Merit published in the journal "Ltilitiirkghgiiider1(14a.roh- April 1952), divide BRV into two groups f rii?st nces which act through radioactive radiations, and teband grioifp - substances acting not only through radioactive radiation, but also by toxic action of the chemical substances themselves. The author includes among such substances ordinary chemical poisons to which radioaptiv4ty,is imparted artificially or which are mixed with BRV??In-addition----BRV-oah-be-tUeed-in incendiary bombs as a smoke or fpg, splinter bombs, torpedoes, _ mortar shells, rand- 1-1d sea mines. . The foreign press states that BRV can be used in the form of-radioa6tive Msand'ylihichswould be sore substance carrying upon'it.- .Such "sand" can be given-adhesive or magnetic!properties, which will enable it to be'retained on clothing, motor vehicles, various objects, etc., and to affect people., LI r r ?I` ? f American authors include among the disadvantages of BRV as a weapon of ns destruction, relatiNdly rapid reduction 1,.n.desti-uaiion.aalOri-(raaibicti*i-ddiatiOn) anCthe consequent extra? difiibilltf o'kfsVakialiiig sitahlereserves' of V ii peace-time. (1. BRV are(l'unquettionithly p.-.:dangeroue: type ' of weapon, but ne verthele ssothey1 are cnot sb dangerous', as ?foreign.# authors -attempt .to.nrepresenVthemv-Ilieresexist3ciuite-,reliable-Imeans_ooft.defense` against, thislttpeizofrweapori. 1_ -2 ???? Declassified in Part - Sanitized Copy Approved for Release ? Toxicologyf7'LI), of _ba tanoes ?.7:ies s 37:31; eo rfzh j es A G.e, ..3.2t:royntiP, 0,o iosfoi to ra , and ssifica-tion',0f 10 .7? Them , r !Ift; fi Mid it ary poijpu1431) s p dric elf-trotta fc he nitosaltwar ars!, ?agent ti ) are chemical c ompound hichi& kftftid),vti,tht (the* ...p.itm,rof:'de.7-- ' pleting enemy personnel; and ciiiideVeCertain.c.cpnd,it,ioils can put m considerable Timber. of ..persons out of action at the front .and .).; ? - 1,14 ? it: , ? Dependingfion. ttie;b1iYsip,oLIC`liemic a 2. 'oharacteistOB an tin- fluences-of i.puyirc#1.enta),_ ?a?iiditionst these .1p0.?01:1R0 sub- stances tviliereztutiedr.?for,-, a short. , irfieCith; 'Stable7_,.war gasetsi) 'dk-,-fb14 timee,c exerting 7.,,a tpx1:9 : effect for a.-) longs period " of (persistentiyaz,.! gases ) ' :10 - These poi,sonpilsfilibs-:p*nc.e'd-'LdreL solid , gaseous.' Therefore, t:can act '0RJ:the' Orga:hisrd in droplet, fog, or smoke, - or ovappr-r.:or, -..stafets " -Even the direct 'contact of th-ese, ? poispne,,with J-tissues;? can !lead -to the devel-: -cipment fof ?,in.jury,.Penetration of -the substance into the organism occurs throligh 'the skin,-' ? wound surfaces, mucous membranes of -the eyes, respiratory, 'gastro-intestinal. tract, genitourinary passageg -and Others. . ) "7JJ? ? After they' enter, tile._ organism, the- toxic.. substances pene- trate' into varibuS." bigiti16: and t'issu&S and: produce , pathologi- cal changes -in --,tfieln.''';.,4f,teriAtard13, ' they, usually-, undergo,,various 1-117;10. ?..11 I c:?1?1', ?, r- - transformations in the 6rganism, "-in-iconsequence of 34hibh they are partially detoxified and lose thetr! itoxic prbp'erties. The Antepsity, s3ev.eloppi,entliof' the toxiaL ?process de- pend a -.7,on;-mari.y .2env,iiilonrilent a I '-`e.ond it i dna, and e .onc,31iti.ons? of the organism. .character of the injury :is deterr Mined Jto.i..a gertainas degr,e.e' by.*:thd'.4uantityand;:logalit.,4ticin of ithei.pchemig t warfare agent [thenceforth lt o be ?.abbrlOtiated .0WA14.1.the., gro' exposure' time 5.::.,,and,?.a? the 3troutest of entran.?:41Of:,:it'''irito. the-organism.Ttiq. c OrOP.6ibr ofthewrgan2sm at they t*:tc.of injury'l and also tile:, ind141.7 dual7zensitivy of:, OWA fare% noi le stz3-,e ifinporpan... jThusT) for exanple,,in isers9:41iiith...'pribnounded physical and mental overstrain, *diminished reactivity of , the; orga.niapi;', or various diseases the toxic process occure:in a,:moye.:severe 50-Yr 2014/04/07 ? CIA-RDP81-01043R003800050002 q 3. Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 form than incompletely healthy people. In its turn, injury by CWA can render manifeet al-latent-disease- _ It should be noted that quite frequently reports are encountered in the literature concerning a distinction be- tween the local_and general .effects of the CWA. However, from the point of view or-1, P. Pavlovts',teaching of_the integrity of the ors-aril-66 dUdh-a-divisionit not correct, because even in the case ot a slight "local" involvement phenomena of general charadter can be observed on the part of the nervous system, cardio-vascular System, etc. as .a result of nerve-reflex reactions: In the general characteriZation of the CWA the speed of- their action on the organism is of definite importance. :A whole series of chemical compounds exerts a toxic effect quickly, and sometimes only a brief contact with air con- taining the CWA is enough to cause a,pathological process to develop. These are so-called rapid-acting agents. At-the same time, there are CWA which act sloWly, which do not show their toxic effects immediately. The pathological ,process develops gradually thereby. Such chemical compounds are spoken of as CWA having a definite latent period of action. The duration of the latter is quite variable and depends on many conditions. It would be incorrect to think that during the period of latency of the CWA no definite changes are occurring in the organism. Even during this period a series of disturbances of physiological equilibrium can be detected, but the pathological changes are expressed only slightly, and a determination of them through objective examination is difficult. Nevertheless, the diagnosis of injury during the latent period of the CWA (early diagnosis) is exceptionally important, because the giving of timely first-aid measures and, therefore, the course and outcome of the toxic process, depends on this. The excretion or elimination of CWA from the organism occurs by various routes: through the skin, respiratory organs, kidneys, intestine, etc. The rate of elimination of chemical agents from the organism deoends on their phy- sico-chemical characteristics as well as on the functional state of the organs of excretion.. it' should be taken into consideration that o stain CWA are capable of accumulating. This accumulation can be chemical (accumulation- in the organ- ism) or functional, when each successiiie entrance of the chemical agent into the organism leaves a definite trace in the form of a partial disturbande of the functional capacity of individual organs. it r- ?040 The Use of CWA. -CWA can 'Ile used by 'various methods.. The simplest is the spraying of the CWA by special devices from an altitude, and -also by apparatuses on the ground. The use of chemidal bombs, mines, shells ,containing various CWA arid . also smoke pots is' pogsible.- : I ? t ? Modern technids of using chemidal-_weapons-providet,the possibility of simultaneous utilization of large quantities of CWA and in various mixtures, for example, yprite and lewisite, diphosgene.Witb:YP e-1(mustard'gas, so-called because it was first used at Ypres]. This essentially com- plicates the nature of the.:injury, the diagnosis and the treatment-of it. In its turn; the use of-CWA 4.n various, mixtures confrdnts phYsicians with new 'problems in the matter oP'diagnosing the injury'and in the treatment 9f,the.patient. at'the present tithe the possibility,arises of the-simultaneous use of atothic and'chemical weapons by an:, enemy. The possibility oftsudh,combined-fforms places a -? serious 'responsibilityon-the-shoulders of medical workers, --the solution of new problems in the matter of prophylaxis, diagnosis, evacuation and therapy of injuries produced by radiation and chemical factors. Classification of CWA. There have been many diverse attempts at---d-rviding the CWA in accordance with their phy- sico-chemical properties, physiological effects and other characteristics. However, to date none of the proposed classifications is perfect or fulfills all the requirements. Below, the most convenient and accepted classification of CWA is presented, the basis of which is constituted by certain general symptoms occurring as the result of the effect of the individual CWA. According to this classification, the CWA are divisible into the following groups: 1. General-toxic: hydrocyanic acid, carbon monoxide, arsine, tabun Isee below for description], and others. 2. Vesicant: mustard gas, lewisite, trichlortriethyl- amine and others. 3. Asphyxiant: phosgene, diphosgene, chlorpicrin, chlor- ine, phosgenoxime, etc. 4. 'Irritant: a) lachrymatory:-chloracetophenone,,brombenzylcyanide, chloracetone, and others. - b) sternutatory: diphenylchlorarsine, diphenylcyan- , 5 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07 ? CIA-RDP81-01043R003800050002-9 Declassified in Part - Sanitized Co.y Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 arsine, phenarsazine hydrochloride, etc. _ In the present chapter, 'in' addition to a-description (4 the CWA listed above, the clinic, pathology and therapy are given of intoxications by certain technical fluids (methyl alcohol, antifreeze, tetraethyl lead) and also of injuries froth phos- phorus, which may be encountered in peace,and wartime. ? CWA of General-Toxic Effect - y ? Among the CWA posseesing pronounced general-toxic effects are hydrocyanic acid, carbon Monoxide, arsine and also or- ganic phosphorub Compounds (tabun)., The characteristic fea- ture of all,the CWA listed above is their capaCity of exert- ing a toxic effect only when they penetrate into the.organism. Direct contact of them with the skin and mucous membranes, that is, with the routes through whdch they are absorbed into the blood, do not lead to the development of significant local reactions in the majority.of cases. ? The CWA of general-toxic effect injure.the vital organs and systems (blood, cardio-vascular, nervous system and others). As a result ofcthis, the oxidative processes in the tissues are disturbed (hydrocyanic acid), the transpor- tation of oxygen by the blood is blocked, (carbon monoxide), marked changes develop in the nervous system characterized by a convulsive-paralytic syndrome (tabun and others). The fact deserves attention that timely, early therapeutic meas- ures can prevent the further development of the pathological process and, by the same token, save the life of the patient. Therefore, the pathological phenomena produced by the effect of these CWA are, for the most part, reversible. Hydrocyanic acid. Hydrocyanic acid (HON) is a trans- parent fluid which has a specific almond odor. At a temper- ature of 10? its specific gravity is 0.7; its boiling point is 26?, and freezing point is 150. It dissolves rapidly and completely in chloroform, ether and other organic solvents, mixes readily with water. The vapors of HON also dissolve readily in water. Hydrocyanic acid and its compounds.(cyanogen-chloride and cyanogen bromide) are very toxic substances. During the First World War they were given special attention. How- ever, in-view of the low stability of. hydrocyanic acid it did not become prevalent as a war.gas. An attempt was made to use hydrocyanic acid with weighting compounds (stannic 6 Declassified in Part- Sanitized C .y Approved ease ? chloride, arsenic tetrachloride:_and Others)/ but no particu- lar result were achieved. In any case, hydrocyanic acid, being a yery toxic compound, cthlsprobably be-used as a.CWA , under certain:tphditicins. Hydro4yariTeatid,intoxications *are possible also in peacetime,_ partidularly,in childreni through' the excessive consumption of pits? o: apricots, cherries, plUms,?peaches, ? which .contain.,hydrOCyanic:acid in the form bf!glUcosides: In view of the,quite extensive use of hydrocyanic acid in a number of industries (gaIvanoplastios, dyeing) and also in view of-the utilization of cyanideLtontaining compounds in agriculture (rat-elitination) the occurrence of accidental intoxications is pobsible. . Hydrocyanic acid and its compounds can penetrate into the organism by varibus routes': through the _lungs on-inhala- tion of air containing this CWA, the gastro-intestinal tract and also through the; intact skin in cases of the effect of high HON concentrations. The penetration of the hydrocyanio acid through the mucous membranes of the respiratory passages is of thezreatest importance. Mechanism of Action"of Hydrocyanic Acid. Hydrocyanic acid is readily absorbed and penetrates very rapidly into the blood, and, thanks to its great soldbility in lipoids:, it enters the tissues, disturbing the normal 'course of the oxidative processes. As a result of this, the tissues lose the capacity of assimilating oxygen, in consequence of which anoxia develops, even though a cOnsiderable quantity of oxygen is contained in the blood. - Up to the present time, the essence-of the effect of ? hydrocyanic acid has, not been completely elucidated. The opinion exists that HON exerts an'influence on the system of hemin-containing enzymes, and reacts'with the oxidized form of the enzyme cytochromoxidase, forming complex compounds with it, whereby cytOchromoxidase is deprived of its catalytic function in the reaction between oxygen and the reduced form of cytochrome C. In consequence of this-? the course of the main mechanism of cellular oxidation Is disturbed. ? Hydro- cyanic acid exerts a blocking'effect on other enzymes also. As a result of, such an inhibitory effect of hydrocyanic acid on the oxidative processes in the tissues anoxia devel- ops (tissue anoxia). The dent'ral nervous system, as the?most sensitive, suffers primarily. This pertains, mainly, to-such 7 5 - r 2014/04/07: CIA-RDPFH-ninztqpnms:trmrlanrw-, Declassified in Part - Sanitized Cop Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 centers askthe, respiratory, vasomotor, and vagus nerves. The disturbance of activity of the vitally important centers7 is expressed in a certain excitation of them, and then by ? depression and paralysis of them. Also, changes occur in ' the blood. The arterial and venous blood are almost equally saturated with blood, in consequence of which the arterio- venous difference is slight. With the development Of the toxic process .the carbon dioxide_content in the blood id re- duced.. As .the result of the anoxia, the' metabolic processes are also disturbed, and the adidbase equilibrium is changed'.' Hydrocyanic acid in the organism'is subjected to a partial detoxification because-of the fact that it combine e with sulfur-containing substances (Cystine, cysteine, glutathione and others), thereby forming slightly toxic sulfocyanide com- pounds (HCNS) which are excreted through'the kidneys. - ? Clinical Picture,of Hydrocyanic Acid Injury. The degree of development of the toxic process in inhalation intoxica= tion with vapors of hydrocyanic acid is determined by the concentration of the CWA in the environment, the duration of contact and the,individual characteristics Of the organ- ism. In those cases where a person is exposed to the effect of hydrocyanic acid vapors in a concentration of 0.3 milli- grams per liter, a severe degree of anoxia develops, which in the majority of cases 'leads to a fatal outcome in the course of the next few minutes. Death occurs as the result of failure of respiration and the cessation of cardiac activity. The effect_of lower concentrations of hydrocyanic acid vapors leads to the development of a characteristic clinical picture in which several successive periods may be arbi- trarily distinguished. The initial period (prodromal) Is characterized by sudden malaise, headache, general weakness, taste of almonds In the mouth, salivation, decreased sensitivity of the oral mucosa, nausea, retching, shortness of breath and palpitation. ? Elimination ,of, the contact of the patient with the vapors _ of hydrocyanic acid during this period of iatoxication leads eliminatico of the pathdlogical phenomena *Id to com- plete recovery of the organism in short order. - af the effect of this substance continues, more pro- nounced-signs develop characterietic of the given'intoxica- tion(dyspneic period). In this stage of intoXication con- 8 ? siderable respiratory 'disturbances are. added to the signs listed. At the beginning; the' respiration is frequent, deep; afterwarda,:it Is 'slow, assuming a superficial, irregular character. Consciousness' 'is also gradually lost. The mucous membranes, ailc3. the skir.1 are'bright'because of the saturation of the blood with -oxygen. - _ With the dovelopmen't of intoxication convulsions of clonic and tonic character (eoriyulsive period) appear; the . patient loses consciousness. '-Scion; paralytic signs develops usually, the intoxicated pereon is completely prostrate and unconscious'; the respiration and cardiac activity are severely impaired; involuntary urination and defection are noted. During this peridd,. a fatal outcome usually occurs. First, a failure of respiatiOn is noted with subsequent stoppage of 'the Cardiac activity.' ' The death of the patient may occur during the hour follow- ing intoxication, and'in some bases even much later. Pathologidalthanses From Hydrocyanic Acid Intoxication-- On external examination of the cadaver a scarlet coloration of ,the cadaveric mottling,of'the mucous membranes and of the skin is found. 'On dissecting the cadaver, no particular changes are found in the individual organs and systems, just as in the case of carbon monoxide intoxication. The tissues are bright red,'the blood is scarlet, and an odor of bitter almonds is perceived. Solitary hemorrhages are observed, In various organs: in the pleura, endocardium, kidneys, liver, spleen. Somewhat greater changes are noted in the central nervous system. This is expressed in edema of the meninges as well as in solitary punctate hemorrhages. In addition, individual areas of degeneration may be seen in the brain. Diagnosis of Hydrocyanic Acid Intoxication. The diagnosis of intoxication by hydrocyanic acid vapors usually presents no difficulties. However, sometimes such an intoxication has to be differentiated from the intoxication produced by carbon monoxide, tabun and arsine. However, considering the data of interrogation of the patient's, "reconnaissance" findings, and the characteristics of the clinical picture of the intoxica- tion the diagnosis may be made with confidence. In doubtful cases, the decisive factor in excluding carbon monoxide in- toxication is-the'examination of the blood for'carboxyhemo- globin. It is not hard to exclude tabunand arsine intoxi- cations, which are accompanied by 017C67?,characteristic signs. First-Aid and Treatment in Hydrocyanic Acid Intoxication Declassified in Part - Sanitized Cop Approved for Release ? 50.-Yr 2014/04/07 ? CIA-RDP81-01043R003800050007 9 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 ..? --The outcome of hydrocyanic acid intoxication depends on timely and proper rendering of first aid. , In cases of even , more severe intoxication, properly organized therapeutid, - measures can save the patient's life.- First ,of al1, the patient should be removed from the contaminated area,.af_ter first putting on a gas mask. In cases where respiration has stopped, artificial respiration is indicated. Without losing time, a wad containing amyl nitrite (0.5 cubic centimeter) is put under the gas mask for the purpose, of forming,methemo- globib rapidly in the blood this ,combines with the poisons Care should be taken that the wad or tampon placed under the mask does not slip down into the respiratory passages,. In parallel with the inhalation of amyl nitrdte, an intravenous injection of one percent methylene blue and 25 percent glUcose solution (50 cubic centimeters) are.giVen.with=the:alm of forming methemoglobin and binding the toxic substance: .Here, the injected glucose also reacts with the hydrocyanic acid, as a' result of which almost non-toxic compounds are formed (cyanhydrins).which are rapidly eliminated by the organism. Sodium hyposulfite (50 cubic centimeters) in'the form of the 30 percent_.aqueous.solution is also used. Harmless sulfo- cyanide compounds are formed through the hyposuIfite injec- tion; they are eliminated in_the urine,-whereby the organism Is detoxified. Therefore,jthe therapeutic agehts listed may . . be regarded as antidotes. Giving of this treatment does not exclude the use of agents which stimulate the respiratory center, cardiac agents, oxygen, etc. Afterwards; in case_of.need, ;yarious symptomatic measures are -used. Carbon monoxide (C0)--A gaseous substance without an odor, taste or color. Its specific gravity is 0.97. CO burns with a bluish flame. Carbon monoxide may be formed in con- sequence of, the partial combustion of carbon-containing sub- stances in the presence of a-limited-supply-of o*ygen-.- -A gas mask without special adaptations does not 4eep out the carbon monoxide. . ? e ? Carbon monoxide was not used as a war gas in-conse'quenee of its physico-chemical characteristics. .However, during - war carbon monoxide intoxications are possible, especially during mass firing from semi-enclosed positions (blindages, tanks, bilges), during artillery fire, etc._ Carbon monoxide intoxications are possible also in peacetime, fOr example, as ,the result of lack of-observance,of the rules of utilization of gas apparatus, premature closure of flues and also in in- dustry.from improper ventilation systems. 10 Mechanism of Action of Carbon Monoxide-Carbon monoxide intoxification develops only when it enters the-organidt through the respiratory organs,) whereby the patient, May be exposed to the effect of carbon monoxide gas, without being aware of it. After penetrating through the pulmonary mem- brane into the blood stream, the carbon monoxide readily comb- bines with the hemoglobin, which-leads to the formation of_ carboxyhemoglobin4 In connection with this,, the blood loses the capacity of carrying oxygen from the lungs into the tissues in the quantity needed by the organism; an anoxic syndrome develops with its consequences. It ,should be ern7 phasized that the fortation of carboxyhemoglobin occurs very actively by virtue of the great activity of carbon monoxide. However, even after breathing air with the usual oxygen con- tent the carbon monoxide quite readily, separates from the, hemoglobin, which leads to the recovery of the normal blood functions. Therefore, carboxyhemoglobin-is not a-stable' compound and dissociates readily. Carbon monoxide .i6 excre= ted through the respiratory passages. The quantity of car- boxyhemoglobin formed in the blood determines the intensity of the' anoxic syndrome. If the content of carboxyhemeglobip, in the blood does not exceed 25-30 percent, the signs of ' intoxication are not pronouneed: With increase in the car- boxyhemoglobin content the severity of the pathological signs increases. The formation of 60-70 percent carboxyhemoglobin can lead to the development of a severe toxic process with pronounced changes on the part of the central nervous system. In such eases the blood usually contains a.much reduced oxygen content; the level of carbon dioxide is also reduced, which has an unfavorable influence on the activity of the respiratory and vasomotor centers. A disorder ,of the meta- bolic processes occurs; with the development of pathological changes in the blood various insufficiently oxidized products accumulate, and the acid-base equilibrium is disturbed. ' Clinical Picture of Carbon Monoxide Intoxication. The character of development of the clinical picture of carbon monoxide intoxication is determined by its. concentration in the surrounding air, by the intensity of formation of car- boxyhemoglobin in-the blood and, by the state of the' organism. Such a concentration of the gas as 0.15-0.2 milligrams per liter does not cause the development of any special patho- logical symptoms. The increase in the-concentration of. CO to four' to five milligrams per liter and more leads to, the development of serious toxic reactions. The acute form of carbon monoxide intoxication is charac- terized by the appearance of a whole series of symptoms Declassified in Part - Sanitized Copy Approved for Release ? 50 Yr 2014/04/07' CIA-RDP8 Declassified in Part- Sanitized.Co?yApprovedforRelease ? 50-Yr2014/04/07:CIA-RDP81-01043R003800050002-9 - attesting to the developing anoxia. These symptoms are the following: dizziness, headache,.ringing in the ears, sensa- tion-of.puIsatibn of the temporal and cervical vessels, in- crease in frequency of the pulse and respiration, general weakness, sometimes nausea and vomiting. If the patient is brought-out of the area into the fresh air, that is, if the contact with the carbon monoxide is removed, all the patho- logical signs gradually decrease and disappear without leav- ing any sequelae. In those cases where the person is exposed to the con- tinuing effect of carbon monoxide, the pathological signs progress. The patients show sleepiness, adynamia develops with marked muscular weakness, chiefly in the legs. Afterwards, consciousness is impaired up to the development of a coma- tose state. The blood pressure is reduced very sharply at times, and the respiration and cardiac activity are consid- erably imPaired (Cheyne-Syokes respiration develops). The pulse is usually of poor quality and hardly perceptible. As a result of sphincter paralysis spontaneous defection and urination are often seen. In some of the patients clonic and tonic convulsions occur. The patients may remain in such a condition for deveral hours, and at times two or three days. Death of the patients usually occurs as the result of failure of respiration and cessation of cardiac activity. However, even in a serious condition the patient's life not uncommonly can be saved through proper organization of aid and treatment. Recovery, particularly after severe intoxication, occurs gradually. The convalescents suffer from headache, general weakness, palpitation and an unsteady gait for a relatively long time. The course of carbon monoxide intoxication is not always of.the character described above. Atypical cases are pos- sible where the development of the toxic process is accom- panied by a sharp drop in blood pressure, rapid onset of a syncopal state, pallor of the visible skin and mucous mem- branes, and pronounced respiratory disorders. Here, the clinical picture of intoxication is reminiscent of the state of gray anoxia which develops in the severe forms of intoxi- cation with the asphyxiant CWA. There are also other atypical cases of intoxidation (euphoric form). 12 In mild cases of c'arbon-Monoxide.intoxication the.prog- nosis is usually favorabl&. In the more severe cases corn- plications may be. obseriied: hemiparezes, paralyses, psychic didturbances in the form of hallucinations, depression, maniacal 'stateas vieil as-changes in other-organs.- . ? PatholOgical ChangesA.ri CarbOn-Monoxide Intoxication., On examination of the cadaver a bright'aoloration of the , cadaveric spots and.of,thd skin is the result og, intoxication by'barbon-mbn6Xide. ,On-autOpsy of the cadaver, only solitary heMorrhages,bre-found in:the pleura; endo-, cardiuth, gastro-intestiAal.tract,'-congestion.of ihe brain and spinal cord. The-blood is-tisually bright in -color. .If the patient's death-occurs,at later; period's, degenerative changes are Possible in the internal organs and in the cen- tral nervous system. ." e Diagnosis of Carbon Monoxide Intoxication. The diagnosis of carbon monoxide intoxication does not present any aignifi- cant difficulty, particulany ih those cases where there is a possibility of examining the blood for the presence, of carboxyhemoglobin. There are several methods of determining the presence of carboxyhemoglobin. The simplest of them is the qualitative method: formalin is added to blood taken from the patient; if carboxyhemoglobin is present, a' raspberry-redcolor develops; in the control sample (blood of a healthy person) the addition of formalin gives a brown color. Carboxyhemoglobin may be determined-by means of the addi- tion of a mixture consisting of two percent tannin and pyro- gallic acid solution which, after interacting with the blood containing carbon monoxide, contributes to the formation of a bright red color; control blood taken from a healthy per- son and diluted with the mixture indicated takes on a grayish-brown color. A better method for determining .carboxyhemoglobin;is the spectroscopic method: carboxyhemoglobin, like oxyhemo- globin, gives two absorption bands in 'the spectrum. However, when added to blood 'containing oxyhemoglobin and ammonium .polysulfide, the two absOrption'bands fuse into one; this dOes not occur in the paient's blood. First Aid and"'freatment in Carbon Monoxide intoxications. First of all, contact of the patient with the contamfRaIed atmosphere should be eliminated. In the mild cases' of in- 13 Declassified in Part - Sanitized C .y A ease ? 5 - r 2014/04/07: CIA-RDPRi-ninaqpnn/Qnnnarvw, Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 volvement this measure leads to the quite rapid recovery of the inioaired functions.. With the more severe forms it is necessary to prescribe oxygen, best with an admixture of five percent carbon monoxide (carbogen). The carbon dioxide contributes to the stimulation of the respiratory center and to the improvement of respiration, Which leads to a more rapid 'elimination of the carbon-monoxide from the organism (Fig 80). The patieiN-shailli be-given rest. In very severe cases of intoxication, when a marked-depression ,of the respiratory center occurs, artificiai.respiration should be used according to the Sylvester, Schaeffer or Howard methods. Artificial respiration sometimes be car- ried out for several hours. For the-Ourpose of stimulation of the-respiratory center intravenous injections-of lobeline solution or of cytitone in the usual doses are recommended. When there are disturbances of the heart the.. use of cardiac agents is indicated (caffeine, corasole [pentylenetetrazole]. In caseswhere the patients are in a state of coma for a long time, bleeding (150-300 'cubic centimeters) may be recom- mended with the subsequent administration of blood-substitute fluids. Treatment of the complications or sequelaeof in- toxication is carried out according to general rules of therapy. Fig 80. Dissociation of Carboxyhemoglobin of Blood of Animals Exposed to CO Where Oxygen Therapy is Used (accord- ing to A. I. Cherkes). Arsine (AsH-1)--gaseous compound with indistinct garlic odor, combustible, much heavier than air. Its boiling point is -550. Arsine dissolves slightly in water and alcohol; better, in fats. This may be obtained readily under labora- tory conditions through the interaction of hydrogen with compounds containing arsenic. Arsine, being a very toxic substance, has for a long time been attracting the attention of military chemists. However, arsine has not been used under military circumstances in consequence of its inadequate stability and of the difficulty- in liquefying it. At the same time, arsine is of importance as an industrial poison, because it is encountered in many branches of industry (chemical, metal working and others). ' Essence of the Effect of Arsine. In its toxic properties AsH3 belongs-to the group of toxins which possess a hemo- lytic effect. Arsine penetrates into the organism through the respira- tor-organs; without producing any kind of signs of irrita- tion. Arsine, readily,abserbed by_the respiratory mucosa enters the blood stream, is adsorbed by erythrocytes and leads to a hemozsis_of them after a certain-time (latent period-6f action). -1As.a. resiat,ofthi-t1;7, fffVeixligen cap-acity of the:blood is reduced and_ah..oxygen.deficiency develops in the organism (anoxia)..The possibility has not been excluded of a toxic effect of the arsenic itself on-the organism; the arsenic is formed at a result of the decomposition of.arsine. ? Clinical Picture of tIntoxication-. -Arsine even in intigni- ficant concentrations can lead to the development of a severe toxic 'process. Thus,-the Inhalation of arsinvin a concen-, tratiOn of 0i05 milligrams.per.liter for 30 minutes leads to the:occurrence of-a severe form.of intoxication. It -should. be kept in'mindthat arsine possesses_a definite latent. . periad-bf.action, which can last from several hours to days or more. Only at-the-end of the latent, period does a more or-lett- intense intoxication .develop. In the initial period of that intoxication the patients offer Complaints of-dizziness, headache, sluggishness, nausea, retching, epigastric paing, eta. 'With the develop- ment of the toxic process blood appears in the urine,, the patients develop an icteric color of the skin, a rapid weak pulse, dyspnea, cyanosis, persistant vomiting with an ad- mixture of bile, and sometimes also of blood. Changes in the peripheral blood (Fig 81), which are ex- pressed in the development of anemia with a reduction-in the number of erythrocytes to 1,000,000 per cubic millimeter or less as well as neutrophilic leucocytosis, acceleration of the sedimentation rate, and the occurrence of biochemical changes in the blood (increase in bilirubin, .sugar, NPN and others) are characteristic of all the forms of arsine intoxi- cation. With a favorable course of the toxic process the symptoms of intoxication slowly and gradually disappear, and recovery of -the patient-occurs. In the severe cases of in- toxication serious complications may develop-on.the part of the kidneys (oliguria, anuria, uremia), of the nervous system (disturbance of consciousness, delirium, comatose state), of etlie-liver-and--atbar_organs. Fig 81. Content of Erythrocytes,and Hemoglobin at Various Periods of Intoxication of Animals by Arsine.. 15 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 -Fatal outcomes in arsine intoxication are observed. chiefly during the first two to four days, but death of the patient_is possible even at later periods. ? . - Pathological -Changes in Arsine Intoxication. ,,On autopsy of the cadaver the icteric coloration of the tissues,-the . hemolyzedillobd,-hemorithages?under'the'pleura, solitary hemorrhages in the heart4 muscle attract.attention; The liver is enlarged and icteric?. Thegall bladder?contains a considerable quantity of thick brown bile 4 the,spleen is ; enlarged, edematous, soft to the,touch. Changes in the kid- neys are quite'marked, and.they?appeir/ScitheWhat enlarged, of daek=brown color,- with differen-t:hue6:-"The'capsUle-is - readily rethoVed.- On section, the surface of the, of dark brown color, and the.markings-are somewhat Indistinctl The strbma of. the kidneys is swollen; Hemorrhages into the mucou membrane of the kidneys andlbladder.are pos- sible: Solitary hemorrhages are. found In 'the mucosa of the gastro-intestinal tract. In the central nervous;.system, edema is noted in the meninges' and solitary hemorrhages in various parts of the brain substance. First Aid and Treatment of Arsine Intoxications'. The patient should be removed from the contaminated area Imme- diately. With the aim of the quickest possible elimlnation of arsine from the body, early bleeding (200-400 cubic centi- meters) is recommended with the subsequent administration of physiological solution, glucose, and also of other blood- substitute fluids. In the presence of the appropriate indi- cations cardiac agents (camphor, caffeine and others) are used; for combatting developing anoxia oxygen is used, and frequent drinkingand diuretic agents are used for acceler- Et-in--g?th-e?elimina-tion of arsent-c:---Afterwards, symptomatic treatment is V.I./en directed at restoration of the kidney function and stimulation of hematopoiesis. With this aim in view, the patient should be given intravenous glucose (up to 50 cubic centimeters), liver preparations, iron and other agents. In cases of uremia, bleedings are indicated with simultaneous administration of blood-substitutes. Also the use ofigeneral-tonic measures, vitamin and diet-therapy are recommended, and in the absence of the signs of hemolysis, blood transfusions. Tabun--Considerable attention has been given in the post- war years to the study of organic phosphorus compounds which are highly toxic substances. A whole series of -compounds have found application as active insecticides (parathion, tetraethylpyrophosphate and others), and certain substances 16 I t`.. of this group (tabun and others) are potential CWA--- Sartory; Holmstedt and Others. In its chemical -structure tabun is the ethyl dimethylam4cIanphosphoiiC acid ' '. - . ' _a 0 N(CH3)2 \ / P 1: ? NC' . OC H ? 2 5s: , ether of.. , Tabun dissolves readily in a number of organic solvents (acetone, benzol and others)? ' In-Water its sOlubilityls slight. The reaction-of hydrolysis proceeds slowly: Tabun is an 'excePtionally toxic-dUbstance-with a consid- erable absorPtiVe-effeCt.. it'6hoUid be nOted that such Com- pounds as tabun) Parathione,and others do 'not cause any pro- nounded inflammatory:readtions,after direct.pontact with the skin or mucosae and,-after being absorbed, lead to the.devel- opment of severe general'SmPtoma.. The effect bf tabun in considerable concentrations and .doses can lead to the death of the organism in the course of a few minutes. Problems of pathology, clinic and therapy of the intoxi- cations and also the-mechanism of action of the organic.phoa- phorus compounds have been presented in quite some detail in the foreign literature--Grob, Holmstedt, Rohwer and Heller, Koelle and Gilman, Krop and co-authors, and many others. The intensity of the development of the toxic process in intoxication by organic phosphorus cotpounds depends on the dose or concentration of the CWA, the exposure time and also the individual characteristics of the organism. In the mild form of intoxication with organic phosphorus compounds (tabun, parathione) the following are observed: dizziness, headache, restlessness, nausea, vomiting. How- ever, the characteristic feature of the intoxication is the pupillary constriction (miosis). In addition, a disturbance of respiration is possible in connection with developing bronchospasm. In the case of'a mild degree of intoxication the prognosis is favorable,'and the pathological signs may disappear without trace in the course of the next few days. ? . ? In the more severe forth of intoxication, aside 'from the pathological signs and symptoms- listed above, which. may be 17 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 - - - expressed to a much greater degree, the involvement of the central nervous system is most important. . This is manifested in excitation, restlessness, disturb-once in coordination, notable changes in the state of consciousness, -up to loss of it as well as the occurrence of solitary muscular twitchings which may pass into a convulsive state; In such patients, the attacks of dyspnea,are Intensified, the cardiac and gastro-intestinal disturbances develop progressively, and glandular secretion increases (salivation, etc.). However, even in the severe cases of intoxication, with timely organ- ization of first aid and treatment of the patients a favor- able outcome is possible. As"has already been mentioned, a seriai_W&Ighs is ob- served in the-clinical picture of intoxication,by organic phosphorus compounds which give evidence of the involvement of the central nervous,system.4n the toxic process. This is confirmed by the data of pathological-examinations. In the cadavers-an ,edema of the meninges, congestion of the cerebral vessels.and hemorrhages'are found. In addition?.congestion andAlemorrhages-are noted .in many-organs.. Spasd of the smooth musculature of the bronchi, Intestine, and pupillary_con- _ striction is constantly noted. Certain Problems in the Mechanism of Action--The problems of the mechanism of -action of organic phosphorus compounds have not ,been completely studied to date. Many research workers adhere to the view that the organic phosphorus compounds possess an anticholinesterase effect, that is, the basis of the toxic effect of the substances in- dicated is their capacity of blocking cholinesterase (an enzyme which destroys acetylcholine), In-consequence of this, the acetylcholine content in the organism is increased, which to a considerable degree determines-the characteristics of the toxic effect of the substances indicated on the organ- ism. The fact that the application of such cholinolytic preparations as atropine eliminates the-signs of broncho- spasm and.other symptoms associated with the disturbance of parasympathetic Innervation of a number of organs may be used as proof of the correctness of this,position. At the sade time, not all the-:aspects,of the.toxiC process developing in intoxication-by organic-phosphorus compounds can be explained simply by ,their anticholinesterase effect. Prophylaxis and Treatment in Tabun Intoxications. Tabun intoxication can be preven.ed by he use of ordinary indi- vidual (gas mask, special suits and others) and group 18 (shelter) means of protection. In cases where tabun gets on the clothes or skin, imme- diate processing of the area with alkaline solutions (10-15, percent ammonia solution), the 'liquid of the gas casualty . first aid kit, organic solvents (dichlorethane, acetone, benzol and others) should be used. An active therapeutic measure for tabun intoxication is atropine--an acetylcholine antagonist. The use of-atropine (one to two milligrams or more) in the early period of the intoxication reduces the bronchospasm and the miosis. The therapeutic activity of atropine also effects an improvement In the general condition of those intoxicated. Therefore, atropine may be, regarded as a specific Measure to a certain degree. Atropine should be used along with symptomatic measures (in the case of considerable depression of respira- tion--lobeline or cytitone;-with dtspnea--oxygen, cardiac agents; in the case of convulsions--barbiturates, magnesium salts, etc.). In cases of need, artificial respiration is indicated. Rest and proper diet are important in therapy. VESICANT CWA The group of chemical compounds of so-called vesicant nature is comprised by dichlordiethylsulfide (mustard gas), trichlortriethylamine (nitrogen mustard) and chlorvinyldi- chlorarsine (lewisite). Despite the fact that the substances named are called vesicants, their effects are not limited to the skin. Therefore, "local" signs which are noted during the effect of the CWA of this group should not be regarded as isolated from the considerable general-absorptive effects occurring as the result of their absorption by the organism. CH2CH2C1 Mustard gas--dichlordiethYlsulfide S'r has not \CH2CH2C1 lost its military significance up to the present time be- cause of certain properties and military-tactical character- .. As is well known, under battle conditions tephnical mustard gas was used, a-dark fluid TosseSsing.the odor of, garlic, mustard or onions. 'Purified mustard gad' is an oily, almost transparent fluid with a slight odor. The specific gravity of mustard gas is 1.3; its boiling point, ' 2199. Vapors of mustard gas are much heavier than air. Must- 19 Declassified in Part - Sanitized Copy Approved for Release @ 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 tard gas dissolves slightly in water, but gradually under- goes hydrolysis. On heating the water and adding a small quantity of- alkali,-hydrolysis of the mustard gas proceeds more-rapidly, as a result of which hydrochloric acid and thiodiglycol are formed; the latter has no toxic properties and dissolves readily in water. . CH2CH0C1 CH2CH2C1 CH2CH2OH ? 2H20-12HC1 ? S ,s ? .:6112u1,120H -Mustard gas 4issolves readily in orgahic solvents (alco- hold gasoline, kerosine, carbon tetrachloride, etc..); the good solubility of mustard gas in fats and lipoids assures it a free penetration into the organism through the skin and particularly through the mucosae. Mustard gas enters actively into a reaction with oxidants, like potassium permanganate, nitric acid, hydrogen peroxide, thereby forming compounds (dichlordiethylsulfoxide and others) which are less toxic. After reacting with chlorine and chlorine-containing substances (chloramine, hypochlorites), mustard gas loses its toxic properties. Mustard gas possesses a high degree of toxicity and can act on the organism in droplet, vapor or fog states. Thus, inhalation of its vapors in a concentration not exceeding 0.05-0.07 milligrams per liter leads to the development of a severe toxic process in 30-40 minutes which terminates in a fatal outcome. However, the intensity of the toxic process depends not only on the concentration of mustard gas enter- ing the body and the exposure time but also on the individual characteristics of the body (condition of the nervous system, individual sensitivity to mustard gas, etc.). In its effect on the organism mustard gas has a number of characteristic features is distinguished from other CWA of this group. Among,s4ch characteristics are a quite prolonged latent period, the gradual development of the toxic process and a prolonged course of it. Clinical Picture of Mustard Gas Intoxication. Depending on a number of conditions (sensitivity, concentration, ex- posure ,time and other's), various forms of mustard gas intoxi- cation are observed. ? Iri Mild cases of intoxication with vapors of-mustard gas 20 ? the duration of.the latent-period reaches two to eight hours, during the course of which the .11catient does not offer any particular-comgaints. Only at the end of this period of ? time do general weakness, headache, nausea, sometimes vomit- ing develop as well as a number of other pathological ,signs on the part of the eyes, respiratory passages-and skin. This is expressed in a slight lachrytation, photophobia and blepharospasm, the, occurrence of a tickling sensation in the throat, a non-productive cough, hoarseness of the voice, and the excretion of mucus frot the nose. Afterwards, signs of skin inmolvement_develop: hyperemia of the.face, particularly of the neck,'in'the axillary and inguinal areas, that is, in places which are exceptionally . sensitive to this substance. r Mild degrees of intoxication usually end favorably in the course of the next seven to 15 days without leaving' any sequelae except for a skin pigmentation which gradually . disappears. ? After the action of higher concentrations of mustard gas, a severe form of toxic process is observed.'. In such cases the latent period is not so prolonged. All the pathological signs are r.ore pronounced. Thus, in the eyes there are ob- served not only considerable degrees of conjunctivitis but also an involvement of the other membranes of the eye. In , the lungs there is noted an inflammatory-necrotic process, bronchitis, broncho-pneumonia, and pulmonary edema is pos- sible. The body temperature is elevated. Considerable skin afflictions-develop: erythema and blisters (Fig 82) (Page 201 of Source]. The general-absorptive effect of mustard gas is expressed in pronounced fashion and is manifested in an involvement of the central nervous system, in blood changes, metabolic changes, etc. (see below). Fig 82. Mustard-Gas Blisters Formed on the Skin After the Effect of High Concentrations of the CWA. In severe cases of intoxication with mustard gas vapors death may occur at the end of the first or beginning of the second week against the background of pronounced general- toxic signs and a number of pulmonary complications. In the event of death during the acute period of intoxi- cation the greatest pathological changes of inflammatory- , 21 " Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07 ? CIA-RDP81-01043R003800050002-9 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 necrotic character are found in the respiratory passages. The lungs are somewhat enlarged, mottled in appearance be- cause of the presence of emphysema, atelectasis and pneu- monia. Abscesses and pulmonary edema are possible. The heart 'muscle is flabby. _Degeneration of muscle fibers is ob- served. The parenchymatous organs are congested with blood and show changes of stasis; hemorrhages are found in some of them. Changes in the central nervbus system are also pro- nounced (congestion of cerebral vessels, hemorrhages into the brain matter and other organic changes). Involvement of. the Skin by Mustard. Gas., ,Mustard gas, after fa ling-on the skin in the droplet state, leadS-to the development of erythema, blisters and ulcers after a latent period the average duration of which Is equal to two to eight hours. The formation of erythema May not be' limited to the site of localization 9T-the mustard gas, and, become con- fluent, may spread along the 9eriPhery accompanied by an itch and a prickly, feeling in the skin. Fifteen to twenty hours after mustard-gas intoxication small blisters develop along the borders of the erythema. Afterwards, they become confluent and are .converted into a massive blister at first filled with a serous and then with an opalescent fluid which does not contain mustar.d gas. In the milder cases of involvement of the skin the blister fluid is usually resorbed, and the blister shrivels up, forms a crust which later falls off, leaving only a pigmented spot. The effect of large quantities of mustard gas on the skin leads to the development of a pronounced inflammatory-necrotic process as the result of which indolent ulcers ate formed (Fig 83 [Page 202 of Source)). In such cases, secondary in- fection is readily superimposed, and this is in a good soil for its development, which complicates the course of the skin injury. As a result of marked pathobiosos of the tissues, the healing is extremely sluggish (one to three months) and terminates in the formation of a quite vulnerable scar sur- rounded by pigmentation. Fig 83. Mustard-Gas Ulcer. The effect of mustard gas in the vapor state also leads to the development of dermatitis; however, the latent period in such cases is more prolonged, and the signs of skin in- volvement are expressed to a lesser degree. 22 ..? After the mustard gas falls on the wound surface it is rapidly absorbed into the blood and leads to the development of general intoxication (combined injury), The healing times of such wounds are considerably prolonged. In diagnosiiig':the mUgtard=rtas skin inyolvements'it should be kt.-1-5t: in mind that-other-members of the persistent chemical agent group (lewisite and trichlortriethylamine) give very similar skin changes. .Mustard-gas injuries of the skin sometimes have to be differentiated- from Certain conditibns, like burns, frost-bites, erysipelas and others. - Involvement o_f_hkilesirats.x..,....blf_kr_L"4:-.The inhalatioh of musT-E73--g-E-VE5R7F-Iib.-31?tb-qUAte,considerable involvement of the respiratory organs, particularly the upper sections of the respiratory'passages. Clinically, this is manifested'(after a latent period of two to six hours or more) by the appearance of a frequent . cough, scratching in the throat, the excret,ion 9f mucus from the nose, hoarseness of the voice, and then by the develop- ment of aphonia. The involvement is not limited to signs of laryngitis and pharyngitTs;-the-pulmonary-parenchyma is also involved in the process- .Pathological changes extend throughout the entire respiratory appaiiatus. ,Afterwards; the involvement acquires an inflammatory-necrotic character with the development of.pseudoCroup and the exfoliation of necrotic membranes. The possibility exists of the develop- ment of bronchopneumonia, absce6ses.and even of toxic pul- monary edema. Mustard-gas involvement of the respiratory organs is almost always accompanied by pronounced symptoms of general intoxication. Mustard-Gas Involvement of the Eyes--may occur in various forms. The mild forms are usually observed after the effect of mustard gas in the vapor state and are most often limited to the signs of conjunctivitis, which disappear without trace in the next few days. Considerable mustard-gas concentra- tions can lead to serious afflictions of other eye tissues. A particularly severe eye condition is observed in the case of contact with .13--11-f the. form of Orops. Here, the direct contact not produce any unpleasant_subj--;tive seri.Ju.. Zpatt7- logical signs develop only after two-three' hours, 'Not only the conjunctiva but also the cornea, lriti-and ciliary, body are involved in the process. Superimposed infection often aggravates the condition. In extremely severe cases the de- velopment of panophthalmia Is' possible, which terminates in 23 Declassified in Part - Sanitized Copy Approved for Release @ 50-Yr 2014/04/07 ? CIA-RDP81-01043R003800050002 q AP Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07 : CIA-RDP81-01043R003800050002-9 perforation of the cornea. Mustard gas is readily absorbed into the blood from the ocular mucosa and leads to the oc- currence of general toxic sighs. Mustard-Gas Involvement of the Gastro-Intestinal Tract. The ingestion of food products or water containing mustard gas causes involvement of the digestive apparatus. The de- velOpment of a toxic process is also possible as the result of ,swallowing saliva containing a mustard-gas admixture. As in the preceding cases, 'a latent period is observed, but here it is not so lOng (15-120 minutes).- Afterwards, gastritis, salivation, nausea and vomiting develop._ Sometimes, signs of enteritis and colitis are added.. However,:most often the process is limited to the esophagus and stomach. In the severe forms of intoxication the inflammatory process assumes a suppurative-necrotic character; sometimes, the development of ulcers and even perforation of them. Death of the patients has been noted in the next two or three days, and' sometimes later as the result of a developing general intoxication of the organism. General-Toxic Effect of Mustard Gas. Mustard gas possesses an absorptive effect. Hereby, a series of pathological changes is found in the blood, cardio-vascular and nervous systems, of metabolism, of the kidneys, liver and other organs. The signs on the part of the nervous system are expressed as headaches, marked depression, indifference to events occurring in the immediate area, and, in severe cases of intoxication, considerable excitation, impairment of memory, of sleep, and the development of hallucatinations and convulsions are possible. Blood changes are observed chiefly in the more severe forms of intoxication and are expressed in a certain concen- tration of it with the subsequent development of anemia, which remains for a long time after recovery. A neutrophilia is almost noted with simultaneous eosinopenia. With the development of the toxic process the leucocyte count falls, leucopenia develops with the presence of toxic granulation In the leucocytes and degenerative changes in their nuclei. A sign which indicates a favorable turn in the course is the occurrence of eosinophiles, etc. in the peripheral blood. Severe mustard-gas intoxication usually is accompanied by a considerable drop in the blood pressure, up to the develop- ment,of collapse. - - In the milder cases of intoxication the cardio-vascular symptoms are limited to a certain drop in blood pressure, a 211 12; disturbance in the cardiac rhythm and muffling of the, heart sound. The kidneys are also involved in the process; albumen and blood appear in the urine with casts-and_other.pathological, elements; diuresis is markedly reduced.- Metabolism is significantly impaired, chiefly protein metabolism. There'is'an increased ammonia, total nitrogen, phosphorus, creatinine, etc. contentin the urine.- The body weight drops, and a caCheetic Condition .develops. Insufficiently oxidized products accumulate in and acidosis develops. These involv.effients are usually associated with disturbances in heat-regulation. the blood, pronounced Certain Problems in the Mechanism of Action of Mustard Gas. The mechanism of action of mustard.' gas cannot be con- sidered completely clear at the present time. Several theories exist, according to which the toxic effect of the mustard gas is associated with the effect of the entire molecule of it, or else primary significance is given to the hydrochloric acid formed in the body as the result of hy- drolysis in explaining the toxic effect. However, these theories, like many others, cannot be completely accepted, because they do not reflect the many and various changes in the body which are observed under the influence of mustard gas. Certain authors ascribe importance in the mechanism of action of mustard gas to its reaction with sulfhydryl groups of proteins, because of which the functional capacity of the latter is impaired. Works indicating the specific reactions of mustard gas with nucleoproteins occupy a definite place. Also, a similarity is noted between the biological effect of mustard gas and that of radiant energy, which indicates cer- tain common features in the mechanism of action of both factors. Prophylaxis, First Aid and Treatment of Mustard Gas In- toxications. Modern medicine has at its disposal a number of reliable agents for individual and group protection which can prevent the occurrence of large-scale intoxication under conditions of a chemical attack. Among them are gas masks, anti-mustard-gas suits, capes, impregnated underwear, rubber boots, gloves, stockings, and also the organization of special shelters. 25 Declassified in Part - Sanitized Copy Approved for Release @ 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 kr, The adcomplishment of emergency measures should be begun with the evacuation of those affected from the contaminated area, after first putting gas masks on the patients. How- ever, here 'it should be, kept in mind that mustard gas is quite rapidly absorbed by the body. Therefore, the CWA should be removed from the surface of the skin or from the mucous mem- branes as soon as possible. If circumstances permit, the surface on which the CWA has fallen should be treated while still in the area of intoxicationwith agents capable of de- toxifying the mustard gas; at least partially. As.soon as possible, after carrying out the emergency measures, the patients should be treated in a medical processing station, and his clothes should be changed. First aid consists basically of the neutralization and removal of the mustard,gas which has fallen cnto the skin and mucosae of the visual organs, organs of respiration, gastro-intestinal tract, etc. In those cases Where the dustar-d-gas in the form of drop- lets or vapors has fallen simultaneouslyonto the mucous " membrane of the eye and the surface of the skin, the eyes should be treated first by mans of irrigating with a 0.5 percent aqueous solution of chloramine, with a weak (0.05 percent) solution of potassium permanganate, boric acid or sodium carbonate (twa percent solution) and also water. Then, the skin is treated. Detoxification of the skin and removal of the mustard gas from its surface are accomplished in the following manner: if there are visible drops of mustard gas present, they should be removed mechanically (by pinching movements from the periphery toward the center) without rub- bing them in or smearing them. Then, the contaminated surface of the skin is treated with solutions of neutralizers (con- tents of the gas casualty first aid kit, chloramine, calcium hypochlorite, chloride of lime, potassium permanganate or with a mixture of neutralizer and solvent--chloramine with carbon tetrachloride and others) for five to ten or more minutes. In the absence of neutralizers the affected skin is treated with solvents (kerosene, gasoline, alcohol, etc.) with subsequent careful washing around it with warm water and soap. Timely decontamination of the skin can prevent the de- velopment of a serious toxic process. In cases where the mustard gas falls onto the mucous mem- branes of-respiratory organs or enters. the gastro-intestinal tract, the accomplishment of prompt measures is also neces- sary; these consist of the treatment of the,oral cavity and pharynx with a weak aqueous chloramine solution. Careful 26 gargling with neutralizers and also'irftgat'ion of the-nasal cavities with them at least partly'prevents-the absorption of mustard gas. Penetration of the CWA into the 'stomach.requires an immediate washing of the stomach with-a solution ofasodium bicarbonate and potassium permanganate and also the use of adsorbentscarbolene (actiVated charcoal). .k Through the timely use of prophylactic-measures the de- velopment of local and general signs occurring .from the effect of mustard gas may be prevented. Inadequately organized and conducted prophylactic Measures and first aid as well as the use of the latter in later periods lead to the development of a toxic process. Medical practice does not as yet have any agents which can heutralize mistard gas absorbed by the body; however, a series of therapeutic measures is taken the timely accom- plishment of which can considerably reduce the toxic effect of the CWA and prevent the develotment of complications. Among such measures are: bleeding, with the subsequent admin- istration of blood-substitute solutions, the use of 30-40 percent glucose solution, 10 percent potassium chloride, 30 percent sodium hyposulfite solution and also cardiac agents. In the presence of symptoms indicating the development of a process of central nervous system stimulation, agents such aa veronal, medinal and luminal should be prescribed in the usual doses. Oxygen therapy iQ of more than a little im- portance in the treatment of muStard gas intoxications. In cases where the activity of the respiratory center is im- paired (marked depression), oxygen is uSed in a mixture with five percent carbon dioxide. With considerable depression of the respiratory center, lobeline or'cytitone is recom- mended. For the prevention of the development of infectious complications the early use of sulfonamidea,and antibiotics (penicillin, streptomycin) is recoMmended. 4 DIA:?ing the recovery period efforts should be directed at incrcasing the immunobiological forces of the organism by means of the use of blood transfusions -small portions, protein therapy, autohemotherapy and general-tonic measures. Properly organized dietary and vitamin therapy contribute to the enhancement of the recovery process.' - Treatment of various types of intoxication is carried out in the following way: in the initial stage of the development of the process on the-skin (erythema) antiseptic Solutions (chloramine, potassium'perminganate, -etc.) should be used; for Itching, a two to five Percent alCohorsolutionrof menthol; 27 Declassified in Part - Sanitized Copy Approved for Release @ 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 _ ' r for various large blisters following the preliminary anti- septic treatment their contents are absorbed with a sterile syringe, after which an antibiotic dressing is applied (peni- cillin, gramicidin) or antiseptic solutions. In the case of diffuse involvement the open method of treatment is indicated. In order to avoid secondary infec- tion it is recommended that the affected surface be irrigated and that antibiotics and sulfona- mides be widely used. For superficial bulloUs forms and the presence of ero- sions the creation of a coagulation film is indicated by means of treatment of the affected area with three to five percent tannin solution, 0.5 percent silver nitrate solution or three to five percent potassium permanganate solution. In the case of indolent ulcers and also in the stage of epithelialization thermoparaffin therapy gives good results. During the period of healing, ointments consisting of. vitamins and also physiotherapeutic measures, protein- and autohemotherapy and other measures stimulating the defensive reactions of the body should be used. Pathological changes of the eye occurring as the result of the effect of mustard gas require special treatment. During the initial period treatment of the eyes with a weak aqueous solution of chloramine or with two to three percent sodium carbonate solution is recommended. If the patient is troubled by the pain, eye drops consisting of 0.5 percent dicaine solution or novocaine solution (two percent) with adrenalin is used. -If ,the cornea is involved in the patho- logic process, atropine treatment is necessary (one percent solution, one to two drops twice a day). In the event of photophobia, protective glasses should be used. The presence of a secondary infection requires the use of albucide [sulfa- cetamide] and penicillin.. Afterwards, the patients need specialized treatment. In caso:of.involvement of the respiratory organs, as in diseases of the resplratory apparatus of other etiologies, symptomatic measures are used. In the case of signs of laryn- gopharyngitis, sodium carbonate or menthol inhalations are indicated, or gargling with emollient solutions. In cases where a diffuse tracheitis, bronchitis, bronchopneumonia or pulmonary abscess develops, streptomycin, penicillin and other antibiotics need to be prescribed, and in the presence 28 of the appropriate indications--oxygen, cardiac agents, mustard plasters, compresses, etc. In the stage of resolution of the process, agents are recommended which contribute to the excretion of phlegm. With the aid of producing a better separation of the false membranes of the respiratory passages, such agents as men- thol or guaiacol in oil shopld be introduced into the trachea. Further treatment of the patients is conducted according to the general rules of symptomatic therapy. Treatment of gastro-intebtinal involvements is also accomplished according to.the rulesiof symptomatic therapy. Here, the observance of a diet is ,of great importance:- Medi- cinal agents used are alkalis, bismuth and kaolin. To avoid the development of infections preparations of the sulfona- mide, syntomycin and the may be recommended. Trichlortriethylamine--nitrogen mustard (N(CH2CH2C1)3) is a representative of the group of persistent CWA. Chemi- cally pure trichlortriethylamine is an oily, liquid, almost transparent substance with a yellowish hue and a very slight odor. Its specific gravity is 1.23. It dissolves readily in alcohol, acetone, benzol, and slightly in water; on re- action with the latter, trichlortriethylamine gradually undergoes partial hydrolysis. According to the data in the literature--A. I. Cherkes, Sartory, Anslow and Karnofsky, Friedenwald and co-authors, Gilman and Philips, Leder and others--trichlortriethylamine is a great deal similar to mustard gas in its toxic effect but has a whole series of distinguishing characteristics which will be brought out below. Trichlortriethylamine possesses a toxic effect in different states of aggregation: liquid and vapor. Just like the other representatives of the persistent CWA group, trichlortri- ethylamine can penetrate into the organism through the skin, mucous membranes of the visual, respiratory, digestive and other organs. In case of--direct contact with living tissues trichlortriethylamine produces more or less pronounced patho- logical reactions similar to those of mustard gas and lewis- ite, and absorption of it into the blood leads to .the devel- opment of signs of general intoxication. It she id be noted that trichlortriethylamine compared with mustard gas pro- duces somewhat less pronounced changes in the skin and in other organs. However, the general-toxic phenomena are greater in the case of trichlortriethylamine intoxication. 29 Declassified in Part - Sanitized Copy Approved for Release @ 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 The intensity of the development of the toxic process. In case of the effect of trichlortriethylamine is determined by a number of conditions (dose, concentration, exposure time, condition of the' body.; etc.). The apPearance of signs of intoxication at a certain latent interval after contact-with the CWA rather than imme- diately is characteristic of trichlortriethylamine, just as it is of mustard' gas. ? Clinical Picture of Trichlortriethylamine Intoxication ? . Skin involvement. Irfthe event trichlortriethylamine falls on the skin in.-the form of drops, hyperemia occurs after two or three or sometimes more hOurs,-and then, edema od the skin. Also, unpleasant :subjective sensations in the form of burning and itching appear. Further development of the toxic process depends on the quantity of the CWA which has fallen onto the skin'and'the reactivity of the organism. In cases of mild involvements the process is limited to the erythema stage. In the case of more severe forms, solitary vesicles may develop. In favorable cases the contents of the blisters are resorbed, their membrane degenerates, and at the end of a week a crust is formed; after this falls off pigmentation remains. In the presence of infection the development of an ulcero-necrotic process is possible; however, it does not reach the intensity of that occurring from mustard gas. The intoxication occurring after entrance of trichlortriethyl- amine into a wound is much more severe. Here, the phenomena occurring as the result of absorption of the CWA are particu- larly pronounced. The effect of trichlortriethylamine in the form of vapors usually does not lead to the development of any considerable, reaction on the part of the skin. Involvement of the eyes. Trichlortriethylamine, after falling on the mucosa of the eye, produces an involvement of It and leads to the development of a general toxic process. The latent period of the effect thereby equals an average of two to three hours. At the end of this period the signs of conjunctivitis develop; lachrymation, photophobia and ble- pharospasm. Afterwards, keratitis occurs. In the more serious cases, particularly with the superimposition of a secondary infection,,the other eye membranes are involved In the-pathological process.. The involvement occurs accord- ing to the type of suppurative-necrotic ,keratitis, which in a number of cases can terminate in-atrophy of tfie eyeball. 30 ? *"""1 ?-? v.?ex ? ? ? , . _ _ Involvement of the Reipiratory Organs. In.its_action on the respiratory-organs, trichlortriethylamine, just like. mustard gas, produces a series df pathological changes after a certain latent Period. Mterwards'?stgns of rhinitis, laryngitis and"tracheitis develop.I In the more_severe_fOrms of intoxieation the -processspreads,te the bronchi and the pulmonary parenchyma. The possibility exists .of the devel- opment of bronchopneumonia and other complications. The' general toxic symptomS-resulting.from-the absorption of the CWA Intothe organism ate quite pronounced. i. Involvement of the Gastro-Intestinal Tract. Trichlortri- ethylamine involvements of the gastro-intestinal tract are in principle little different from the changes' which are observed after the effect of mustard gas. Usually, after- a latent period signs of gastroenteritis are observed:, nausea, sali- vation, loss of appetite, Vomiting, intestinal disorders. When the:-CWA=enters_in:a larger quantity the occurrence of an ulcerative' processis possible not or.11y but also on the mucosae of other sections of.the gastro- intestinal tract. All these signs are accompanied by cpn- siderable general intoxication and by marked emaciation. General-Toxic Effect of Trichlortriethylamine. Regardless of how trichlortriethylamine enters the organism, it can lead to the development of pronounced symptoms of general intoxication greater than after the action of mustard gas. Signs of general intoxication are characterized by involve- ment of the central nervous system, namely: the development of clonic and tonic convulsions and a disturbance in con- sciousness. In severe cases a comatose state develops. The circulation and respiration suffer considerably. Changes in the composition of the peripheral blood are characteristic: the occurrence of neutrophilic leucocytosis which is replaced by a marked reduction in the white blood corpuscles up to the development of aleukia with qualitative changes in the cytoplasm and nuclei of the cells. These changes resemble changes in the peripheral blood which are observed after the effect of ionizing radiation. In trichlortriethylamine in- toxication, very frequently other organs and systems (heart, kidneys, liver) are involved in the 'pathologic process, and cachexia and marked general weakness develop. A fatal out- come occurs against the background of pronounced signs of a disturbance in the nervous system, hematopoiesis, circulation and respiration: Mechanism of Action of Trichlortriethylamine. The mechan- ism of action of trichlortriethylamine is very complex and is 31 Declassified in Part - Sanitized Copy Approved for Release @ 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 not sufficiently clear at the present.time. The viewpoint which has been most addepted'is-7that trtchlortriethylamine affects the nucleoproteins, particularly,desoxyribonocic acid, which is manifested by a disintegration of the nucleus and disturbances in the process of cell division, that is, of mitotic activity: These changes are particularly pro- nounced in cells-with a high level of mitotic activity, par- ticularly the formed elements of the blood, splenic cells, and cells of the bone marrow. At the same time, it is known that trichlortriethylamine is an enzyme poison with a broad range of action, which is manifested in the capacity of tri- chlortriethylamine of inaotivating a series of vitally im- portant enzyme systems (bliolinesterase, etc.)-.. It is pos- sible that the disturbance ,in the nucleoprotein metabolism is conditioned by the enzymatic influence of trichlortriethyl- amine. However, this idea requires further corifirmationi , Prophylaxis, First Aid and Treatment of Intoxications Produced IT-TrichlortriethyIamine? The same measures recom- mended for /he prophylaxis of muatard gas intoxidation can be used for the prevention of trichlortriethylamine intoxi- cations: the measures of individual and group protection (gas mask, protective clothing, shelters, etc.). The methods OT giving emergency aid-and the subsequent treatment of skin involvements, involvements of the organs of respiration, vision, etc. which develop after direct con- tact with trichlortriethYlamine are similar to those which are used in case of mustard gas involvement. COncerning the measures directed at the fight against the signs of general intoxication produced by trichlortriethYl- amine, it should be kept in mind that the given CWA is an exceptionally toxic compound which affects many organs and systems, and therefore therapy should be combined, that is, directed at the recovery of the impaired physiological equilibrium of the organism as a whole. Thus, for example, for pronounced convulsions the use of soporific and sedative agents is recommended (barbiturates--luminal, amytal, etc,). Further, where necessary cardio-vascular agents should be used --camphor, caffeine, corasole [pentylenetetrazole], ephedrin, adrenaline, as well as glucose and other symptomatic methods of treatment. In cases of weakening of the respiration, sub- stances should be prescribed which stimulate the respiratory center (carbogen [CO2-02 mixture], cytitone). Treatment. of hematopoetic system changes deserves special attention. With this dim in view, blood transfusions and 32 Other methods-of stimulative therapy should be.used.- Proper attehtion should be given to hygienic conditions properly arranged diet, provision of the affected organism with'an adequate quantity of vitamins; . - LewIbite. .Lewisite, 'chlorvinyldichlorarsine (C1CHCHAsCl2) is transparent liquid with a yellowiah:hue (chemically pure)..' Its 'specific graytty-is '1.9;. its boiling' paint 'is 190?. ? Lewisite posse6ee3, a charateiiistic?geranitYM odor. The sol- ubility of,'Iewisite in Ilate is slight; it dissolves much better' in alcoholvbenzlhe, benzol' arid other, organic solvents; dissoaves readily in fats and liicth. As a resialt of the reaction with water, it hydrolyses with the formation of chlorvinylarsinoxide, which like lewisite itself, is a very toxic compound:. C1CH.CHAse12 + H20 ------(C1CH=CH)As0 2H0a. 0 - ? Under the influence of such oxidants as potassium perman- gate, nitric acid and hydrogen peroxide, the arsenic atom is changed from 'd trivalent to a pentavalent condition; the: compound formed is-les toxic. Lewisite reacts-' actively . with substancea containing dhlorine and-also with strong bases, in consequence of which-its,toxlcity'is redubed. ?! , ' , ' ? ' ' In past wars.lewisitemas not used as a CWA; however, it is an exceptionally tokic compound, and in its toxicity it considerably exceeds the majority of the CWA previously used (with the exception of tabun and other CWA of similar type of action). - Lewisite is toxic for the organism in any state of aggre- gation: droplet, vapor, fog. Lewisite can penetrate into the body through the skin, gastro-int.)stinal tract, organs of respiration and others. An important characteristic of the effect of lewisite In contrast to other representatives of the group of persistent war gases is the particularly rapid aosorption of it into the organism and the development of a general-toxic process, which under certain conditions can quite rapidly lead to a- fatal outcome. It should be empha- sized particularly that in the process of occurrence and de- velopment-of toxic signs produced by lewisite the pathologi- cal changes occurring at the site of direct contact with the CWA (skin, mucosa of 'the respiratory -tract, gastro-intestinal tract, eye) and the 'general-absorptive reactions of many,or- gans and systems are interwoven. The Effect of Absorption of Lewisite. An important char- 33 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07 ? CIA-RDP81-01043R003800050002-9 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 not sufficiently clear at the present time. The viewpoint which has been most decepted iS-7that trichlortriethylamine affects the nucleoproteins, particularly,desoxyribonocleic acid,-which is manifested-by a disintegration of the nucleus. and disturbances in the process of cell division, that is, of mitotic activity: These changes are particularly pro- nounced in cells With a high level of mitotic activity, par- ticularly the formed elements of the blood, splenic cells, and cells of the bone marrow. At the same time, it is known that trichlortriethylamine is ap enzyme poison with a broad range of action, which is manifested in the capacity of tri- chlottriethylamine of inaotivating a series of vitally im- portant enzyme systems (cholinesterase, etc.)... It is pos- sible that the disturbance,in the nucleoprotein metabolism is conditioned by the enzymatic influence of ttichlortriethyl- amine. However, this idea requires further confirmation. Prophylaxis, First Aid and Treatment of Intoxications Produces:fly Trichlort-riethylamine. The same measures recom- mended for heprophyfaxis of muatard gas intoxication can be used for the .prevention of trichlortriethYlamine intoxi- cations: the measures of individual and group protection (gas mask, protective clothing, shelters, etc.). The methods "ogivinit emergency aid arid the subsequent treatment of skin involvements, involvements of the organs of respiration, vision, etc, which develop after direct con- tact with trichlortriethYlamine are similar to those which are used in case of mustard gas involvement. Concerning the measures directed at the fight against the signs of general intoxication produced by trichlortriethyl- amine, it should be kept in mind that the given CWA is an exceptionally toxic compound which affects many organs and systems, and therefore therapy should be combined, that is, directed at the recovery of the impaired physiological equilibrium-of the organism as a whole. Thus, for example, for pronounced convulsions the use of soporific and sedative agents is recommended (barbiturates--luminal, amytal, etc,). Further, where necessary cardio-vascular agents should be used --camphor, caffeine, corasole [pentylenetetrazole], ephedrin, adrenaline, as well as glucose and other symptomatic methods of treatment. In cases of weakening of the respiration, sub- stances should be prescribed which stimulate the respiratory center (carbogen [CO2-02 mixture], cytitone). Treatment.of.hematopoetic system changes deserves special attention. With this aim in view, blood transfusions and 32 other Methods-of- stimulative therapy should be-used.- _ , Proper attention should be given to hygienic conditions, properly arranged diet, provision of the affected organism with,' an adequate quantity" of vitamins.- ' - ? ? Lewisite. ,Lewisite, Chlorvinyldichlorarsine (01CH.CHAsCl2) is transparent liquid with a yellowiSh:hue (chemiCally pure) Its rspeelfic gravity-is a.9. its'boiling-point.ib 190'. - Lewisite posseSSea a chargateiiistic,geraniiiin odor: The sol- ubility pf-lewisite in Water is slight; it dissolves much . better,in alcohol, tenzlhel benzol.and other organic Solvents; dissolves readily in fats and As a result of.' the reaction with water, it hydrolyses with the formation of chlorvinylarsinoxide, which like lewisite itself, is a very toxic Compound: C1CH.CHAsC12 + 1120 L----*(C1CH.CH)AsO 2HCl. Under the influence of such oxidants as potassium perman- gate, nitric acid and hydrogen peroxide, the arsenic atom is changed from g trivalent to a pentavalent condition; thel compound- formed is aebs toxic. Lewisite reacts'actively with substances containing Chlorine and-also with strong bases, in contequence of which.its-toxicity is reduced. In past wars lewisite was not used as a CWA; however, it is an exceptionally tokic compound, and in its' toxicity it considerably exceeds the majority of the CWA previously used (with the exception of tabun and other CWA of similar type of action). - Lewisite is toxic for the organism in any state of aggre- gation: droplet, vapor, fog. Lewisite can penetrate into the body through the skin, gastro-intestinal tract, organs of respiration and others. An important characteristic of the effect of lewisite 'in contrast to other representatives of the group of persistent war gases is the particularly rapid absorption of it into the organism and the development of a general-toxic process, which under certain conditions can quite rapidly lead to a- fatal outcome. It should be empha- sized particularly that in the process of occurrence and de- velopment-of toxic signs produced by lewisite the'pathologi- cal changes ocourring at the site of direct contact with the CWA (skin,-, mucosa of the respiratory tract, gastro-intestinal tract, eye) and the 'general-absorptive reactions of mahy,or- gans and systems are interwOven.' The Effect of Absorption of Lewisite. An important char- 33 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07 ? CIA-RDP81-01043R003800050002-9 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 ??-?: acteristip, of lewisite is its capacity of penetrating rapidly from the site of application (skin, mucous membranes) into the blood and of exerting a general-toxic effect. L ? . The intensity and rapidity of development of the general-, toxic signs depend on a number of conditions (quantity of :the .CWA absorbed, the condition of the organism, etc.).. - Pathological changes of the central nervous system expressed in brief excitation with subseqUent depression usual1y de- velop soon after thejewisite intoxication. The invo1vement of tho cardio7;vasculansystem with the gractual..Orop in blood ,pressure and the development of a pronounced,etate of Col- lapse (Fig. $y) (Page 2,12 of Source] are charateristic. B1094'Peseure in a Dog Exposed tp the Effect 'of Arsenic. 2 h The respiratory disorders are also considerable:, at first, the respiratory ,rate is increased, and' respiration remains - quite deep for a certain time; afterwards, it assumes an ir- regular superTicial character. In lewisite intoxication there are regular changes in the blood which are expressed in an increase in the number of erythrocytes and the quantity of hemoglobin (thickening of the blood), in leucocytosis which is replaced by leucopenia (Fig. 85) [Page 213 of Source]. Also, biochemical changes in the blood are observed, an in- crease in the content of lactic and pyruvic acids and of sugar; the excretion of considerable quantities of total ni- trogen and urea nitrogen attests to the disturbances in the metabolic processes. Fig. 85. Certain Indices of the Blood Composition in Lewisite Intoxication. In the case of lewisite involvement a number of morphologi- cal changes,occur in the internal organs: a dilatation of the cerebral vessels, marked congestion, hemorrhages.particu- 1arly under the endocardium and in different parts of. the cardiac,muscle;.degenerative changes are noted in the-liver,. kidneys and other organs4 The-picture of the general-toxic effect of lewisite is very similar to that of arsenic intoxi- cation. 34 agle J Lewisite Involvement of the Skin. Lewisite in the drop- let form very rapidly produces a sensation of pain and burn- ing when acting on the skin. After this, hyperemia appears (first stage of involvement), which is not confined to the, site of contact with the CWA. Then, edema of the subcutan- eous tissue develops, the pain increases, and itching occurs. With small quantities of lewisite the signs-of inflammation are not pronounced arid gradually disappear. With more severe skin'involvements blisters develOp (second stage of involve- ment). First, the blisters are eolitary and small; after- wards (after 10-15 hOUrs) they become' confluent, and their serous contents adquirp an opalescent chatacter. At the end of approximately two day's the edema begills to decrease, the contents of the blister are resorbed, crusts form; after these drop off there is no pigmentation. In cases where infection is superimposed the inflammatory process acquires an exten- sive ulcerative-necrotic character (third stage of involvement) with a considerable number of hemorrhages. The process of regeneration proceeds quite slowly and terminates in the for- mation of a scar. The vapors of lewisite produce similar involvements on the skin; however, the intensity cf their development is not so great. The latent period is also more prolonged (two to six hours). Penetration of the CWA into a wound surface markedly aggravates the course of the main process. The skin changes described above which are observed after the effect of lewisite are similar to the involvements from mustard gas but have distinguishing features, specifically, a more vigorous development and a more rapid course of the reparative processes in the absence of infection. Lewisite Involvement of the Respiratory Organs. With the penetration of lewisite into the respiratory passages the development of the pathological process considerably resembles the course of the similar process which occurs after the ef- fect of lewisite and partly that following asphyxiant CWA. Lewisite vapors produce an irritation of the mucosa of the upper respiratory passages; which is accompanied by a number of symptoms (salivation, raspiness in the throat, cough, elm.), which appear as early as the period of inhalation of the CWA vapors in air. Soon the toxic process spreads to other parts of the res- piratory organs. After the inhalation of lewisite in high concentrations, and also in consequence of its absorption 35 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 from the surface of the skin, more or less pronounced pulmon- ary edema may develop. During the late periods of intoxica- tion.the'development of bronchopneumonia, pulmonary abscess, etc. is possible as the result of the superimposition of infection. - Lewisite Involvement of the Eyes. The direct contact of lewisite in vapor or'liquid states with the sensory nerve .endings of the ocular mucosa produces considerable' pain. Then, inflammation develops, which with low concentrations may be limited to the signs of conjunctivitis. % When large doses of. lewisite enter into the pathological process; all the eye membraneS are inVolved, and p-anophthalRia develops. With involvement of the eyes by lewisite in a vapor form, the pathological signs are usually limited to conjunc- tivitis (lachrymation, photophobia, blepharospasm, etc.). Under these conditions, keratitis rarely. develops.' Contact with a considerable quantity of lewisite in droplet form leads to the development of conjunctivitis, keratitis, iridocyclitis, and other tissues of the eye suffer as well. The development of a severe toxic process compli- cated by infection can lead to complete loss of vision. Lewisite Involvement of the Gastro-Intestinal Tract. Lewisice can penetrate into the stomach in contaminated water, food products, or by means of the swallowing of saliva and phlegm containing the CWA. Here, the signs of gastritis usually develop promptly. Afterwards, enterocolitis is added. The intensity of the development of the pathological signs will depend on the quantity of lewisite entering the stomach. Intoxication with large doses of lewisite is accompanied not only by changes on the part of the gastro-intestinal tract but also by the development of general-toxic signs (disorder of circulation, hemoconcentration, disturbance of metabolic processes). Mechanism of Action of Lewisite. ? Regardless of how lewisite enters the organism, it is absorbed rapidly into the general circulation and spreads throughout the organs and?tissues. On coming into contact with the tissue fluids, lewisite undergoes hydrolysis with the formation of hydro- chloric acid and chlorvinylarsinoxide (C1CH.CHAs0), which is a very toxic substance. The toxic properties of lewisite and of its conversion products (arsinoxide) are produced by the effect of the trivalent arsenic in their structure. 36 Prrt - ???????? According to modem concepts, the basis of the toxic effect of arsenic is its blocking effect on the sulfhydryl groups (SH) of a number of enzymes which carry out the most important physiological functions of the organism.. There are reports that arsenic compounds act selectively on the sulfhydryl groups of the protein component of the pyruvate-oxidase system which carries out the oxidationof pyruvic acid in the blood and tissues of animals. The latter leads to deep-seated disorders of carbohydrate metabolism as a whole. The reaction of trivalent arsenic with the thiol groups of enzymes can occur in the following direCtion: R-As=0 + (arsenic- containing CWA) HS S? N, R1 R-As R 1 (protein) (protein- arsenic complex) +H20 Such a concept of the mechanism of action of arsenic- containing compounds was the theoretical basis for the search for active antidote-therapeutic agents containing sulfhydryl groups, the therapeutic effect of which was based on competi- tive relations with the toxin. The dithiols (BAL, unithiol), compounds containing active sulfhydryl groups proved to be such substances. Prophylaxis, First Aid and Treatment of Lewisite Intoxica- tions. Eldergency therapy and also measures 9f chealical protection used for chlorvinyldichlorarsine (lewisite) into- xication are similar to those which are recommended for mus- tard as and nitrogen mustard. After lewisite falls on the skin, the skin should be treated with a solution of the gas casualty first aid kit. Tincture of iodine (five percent solution) and a number )f oxidizing agents (potassium permanganate), hydrogen peroxide and others others) also possess gas-decontaminating proper- ties. Urea peroxide (hydroperite) is one of the agents which detoxify lewisite. Usually, a 40 percent aqueous solution of this preparation is used; the skin is treated with it no less than five minutes. Timely treatment (five to 15 minutes after the contact 37 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 with lewisite) lewisite) with the substances named can completely pre- vent the absorption of the CWA. Particularly prompt intervention is required for the en- trance of lewisite into the respiratory organs,.mucosa of the eye, etc. In such cases, the CWA should be removed as quickly as possible by irrigation of the eye or upper res- piratory passages with aqueous solutions of soda and boric acid (two percent), potassium permanganate (0.05 perdent)i chloramine (0.5 percent) or simply with water. Penetration of lewisite into the digestive tract requires the use of adsorbents, emetics, irrigation and also antidoti arsenici in a'dose of one tablespoon repeatedly every 10-20 minutes. Subsequent therapy of the involved skin, eyes, respiratory organs and gastro-intestinal tract is very little different from the therapeutic measures used for mustard gas intoxica- tions. In combatting the general-toxic signs resulting from lewi- site intoxication, the antidotes of arsenic and of heavy metals may be recommended--preparations containing active sulfhydryl groups. The detoxification of arsenic and the most rapid elimination of it from the body are achieved by these substances. The antidotes used do not exclude the use of other meas- ures of pathogenetic and symptomatic therapy. Among them are suostances which stimulate the function of the cardio- vascular system (mesaton [meta-oxyphenyl methylaminoethanol hydrochloride: sympathominetic], ephedrin, adrenaline with blucose, corasole, etc.). In the event of developing hemo- concentrations, bleeding with the administration of a hyper- tonic solution of glucose is recommended. Magnesium prepa- rations exert a favorable effect on the central nervous sys- tem. The creation of good hygienic conditions, rest, appropri- ate diet and the administration of oxygen also contribute to recovery. ASPHYXIANT CWA Asphyxiant CWA (phosgene, diphosgene, chlorine, chlorpic- rin, nitrous oxide and others) are characterized by the cap- 38 44 4444...444,44 4-44 r404.417.44 acity of producing patnological changes in the respiratory organs, as a result of which toxic pulmonary edema may de- velop. Certain of these substances (chlorine, phlorpicrin and others) produce considerable irritative phenomena on direct contact with the mucosa of the upper respiratory pas- sages and of the eye. Chlorine and chlorpicrin lead to the development of a pronounced toxic process quite rapidly after contact with them;, phosgene and diphosgene do not pro- duce the whole complex of pathological signs characteristic of asphyxiant CWA immediately but rather have a definite la- tent period of action; Phosgene and diphosgene are of the greatest toxicological interest. 21.12!Elne and Dlphosgene. Physico-Chemieal Properties and Toxicity Phosgene (carbon chloroxide, carbonyl chloride--COC12) is a colorless, volatile liguid.. Its -specific gravity is 1.4; its, boiling point is 8.2?.. With increase in the temperature, phosgene is converted into a gaseous substance which is more than 3.5 times as heavy as,air. Phosgene,possesses an odor of rotten hay or.of moldy leaves. It, dissolves slightly in water, .but gradually hydrolyses on contact with it, as a re-. suit of which hydrogen chloride and carbon dioxide are g:i.ven off. Phosgene dissolves readily in certain organic solvents, reacts actively with alkalis, thereby losing its toxicity. Diphosf;ene (trichlormethyl ether of chlorocarbonic acid)-- ,OCC13 CO' in chemically pure form is a colorless liquid. Its \C1 specific gravity is 1.65. Diphosgene boils at a temperature :X 1280, and its temperature of fusion is -57?._ In compar- ison with phosgene diphosgene is a more persistent substance, and its vapors are almost seven times heavier than air. On reacting with water disphosgene undergoes hydrolysis, but the reaction proceeds more sluggishly than with phosgene. Diphos- gene is readily soluble in certain organic solvents, and like phosgene it reacts actively with bases and thereby loses its toxic properties. Phosgene and diphosgene are very toxic substances. Inhal- ation of air containing 0.2-0.3 milligrams per liter of phos- gene or diphosgene for a period of half an hour and in cer- tain cases even for 15-20 minutes can produce a severe toxic process with a fatal outcome. The intensity of the involve- ment is, determined, not only by the concentration of CWA and 39 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 by the exposure time but also by the condition of the body. Mild, moderate and severe clinical forms of intoxication are distinguished. Clinical Picture of Intoxication. The effect of slight concentrations of phosgene and diphosgene can be unnoticed or can be detected in the form of slight and very transitory signs of irritation (dyspnea, mild lachrymation, slight sali- vation). After the effect of higher concentrations the symptoms indicated appear in much more. marked form; in adaition, the development of malaise, general weakness, the occurrence of pain in the chest, sometimes headache, nausea, irritation of the mucous membrane of the eye are possible. Taking the patients out of the contaminated area leads to the disappear- ance of the signs of intoxication. For a certain time the patients usually do not offer any complaints--the latent period of action of the CWA occurs, However, the apparent state of well-being is only relative, because changes de- velop in the organism which are diagnosed with difficulty. On objective examination a certain increase in frequency of respiration and slowing of the pulse is observed. Many au- thors ascribe important diagnostic significance to this symp- tom. In a number of patients a slight reduction in arterial pressure, in temperature, and a hemodilution are noted. The duration of the latent period equals approximately four to seven hours; however, it can be much shorter, or, conversely, longer. At tfie end of the latent period of the CWA suddenly, as though right during a state of complete. well-being, the con- dition of those intoxicated by phosgene (diphosgene) deteri- orates considerably; the respiration increases in frequency, becomes superficial, the dyspnea becomes progressively more intense, and cyanosis of the lips, nose and ears appears; marked general weakness, cough, at first dry and then with the expectoration of a frothy fluid (pulmonary edema) develop. With the development of the toxic pulmonary edema the quan- tity of sputum in individual patients reaches two liters a day. On examination of the lungs, considerable changes are found. On percussion, the lower borders of the lungs are found in a lower position with 4 considerable impairment of mobility, and a pronounced amphoric or tympanitic sound is noted which attests to the occurrence of emphysema and atel- ectasis of the lungs. On auscultation, a considerable number of moist rales of the most diverse calibers are noted. The 140 or?????-? ? ;4 iv ???? ??? ????? ? ? ? ? heart .sounds are muffled; however, there are as yet indicating the considerable disturbance of function of the cardio-vascular system. On the part of'the blood there is noted a.neutrophilic-leucocytosis with a simultaneous lympho- penia-and eosinopenia: !,.In consequence of the hemoconcentra- tion the red blood'cotkit reaches seven to eight million, ? and the hemoglobin content, 100 percent o'r more. At the same time, the viscocity an coagulability of the blood are in- creased., In certain patients a-state of depression, distur- bance of consciousness,' sighs of enteritis, oliguria, etc. are observed. The picture of phosgene (or diphosgene) intoxication pre- sented above is characteristic of the cyanotic form of anox- emia, that is, of the condition in which seVereAyspneal cyanosis of-the mucous membranes and skin predominate, but in which pronounced cardio-Vaseular disorders are absent. This condition may change into an even more threatening one (gray form of anoxemia) which is characterized not only by marked dyspnea but also by 'a considerable disorder of activ- ity of the cardio-vascular system (drop in blood pressure, thready', arrhythmic pulse; etc.). The oxygen content drops markedly both in-the arterial and in the venous blood. Here, the patients usually lose consciousness; and the color of the face and skin acquire an ocherous hue.. This form of anoxemia is very dangerous and requires emergency measures. The development of toxic pulmonary edema reaches a maximum after approximately 15-20 liours. If the patient does not die at the climax of the pulmonary edema with considerable signs of anoxia and a disorder of the cardio-vascular activity, then the process of.resolution (recovery stage) occurs begin- ning with the third or fourth day. The pulmonary edema grad- ually decreases, the imparied gas exchange returns to normal, the cardiac activity improves as do also the functions of the other organs. At the same time, in certain patients an ag- gravation of the process may occur as a result of the super- imposition of infection (development of bronchopneumonia, pleurisy and other complications). At later periods after the occurrence of the intoxication remote sequelae are pos- sible in the form of bronchiectasis, bronchial stenosis, and pulmonary fibrosis which can lead to a loss of the ability to work. Certain Problems in the Pathogenesis of Intoxication by Phosgene and Diphosgene 14l Declassified in Part - Sanitized Copy Approved for Release @ 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 fIn the general complex of pathological phenomena occur- ring in phosgene or diphosgene intoxication chief importance is ascribed to the development of toxic pulmonary edema with all its sequelae (disturbance of gas exchange, hemoconcentra- tion, cardio-vascular disorders, etc.).. The mechanisms of development of these phenomena have not been finally clari- fied at the present time. The majority of research workers regard the toxic pulmonary edema as the result of a change in the regulation of the water balance between the blood and the tissues, of a disturbance in the permeability of the pul- monary capillaries as a result of which the liquid part of the blood exudes and fills the pulmonary alveoli. . With the development of the toxic pulmonary edema the normal gas-exchange conditions between the blood and the al- veolar air are disturbed. With the filling of the alveoli with edema flu-id the diffusion of alveolar oxygen becomes progressively more difficult, which leads to anoxemia. This is expressed in a progressive reduction in the oxygen satura- tion of the arterial and venous blood. Thus, the oxygen con- tent in the arterial blood can reach 10 volumes. percent or less compared with the normal of 17-20 volumes percent, while in venous blood it ,can go. down still further. Because of this, the.arterio-venous difference is increased. Signs of anoxemia can be increased in connection with the disorders of the cardio-vascular system which occur, stasis phenomena, etc.). With the progression of the process the content of carbon dioxide in the blood can increase, while in the term- inal period it can decrease notably (Fig. 85 [Page 220 of Source]). Fig. 86. Gas Content of Blood of Dog in Diphosgene Intoxi- cation (according to A. I. Cherkes). - Certain Characteristics of the Effect of Chid/wine and Chlor icrin. The clinical picture which is observed from the e feet of' other asphyxiant CWA on the body, particularly of chlorine and chlorpicrin, .to a great extent resembles the picture of the intoxication produced by phosgene (diphosgene). However, there.are also a number of distinguishing features. First of all, chlorine and chlorpicrin possess more pronoun- ced irritant effects on the sensory nerve endings of the res- piratory passages. In.addition, chlorpicrin,produces a marked irritation of the eyes and can lead to the developmentof ker- atitis. 42 Chlorine and chlorpicrin intoxication very rapidly lead to the development of toiic pulmonary edema, but the intensity of it is less than after phosgene or-diphosgene intoxication (Fig. 87 (Page 221 of Source)). It should be emphasized that the process here usually proceeds without any stage of false well being (latent period). -Just as'in'the case of phosgene and diphosgene intoxication, chlorine and chlorpicrin produce acute anoxia and other 'pathological signs characteristic of the effect of this group of substances. Fig. 87. Pulmonary Edema and Cardiac,Dilatation in ,a pog Exposed to the Effect of Chlorpicrin, (According to N. A. Soshestvenp.kiY). Pathological Picture of Intoxication with Asphyaln1_211..A... The most characteristic pathological changes after intoxica- tion with asphyxiant CWA- are-observed in cases of death occurring during the ,course of the first two days. These changes are localized chiefly 'to the'respiratory tract; in cases of phosgene.or.diphosgene) intoxication they are chiefly in the lower sections of the respiratory tract (pulmonary edema -- Fig.,88 (Page 222 of Source)). Here, the.lungs are usually three to five times larger than their normal volume. Their surfaces are mottled as a result of the presence of edema, atelectasis, emphysema and hemorrhages. On section, a large quantity of bloody-foamy fluid exudes from the parenchyma. No other changes are found in the upper and middle sections of the respiratory tract aside from hyperemia of the mucosa and solitary punctate hemorrhages. Fig. 88. Toxic Pulmonary Edema in Diphosgene Intoxication. (According to M. I. Nemenov). Significant inflammatory as well as necrotic changes in the trachea and bronchi are characteristic of chlorine and chlorpicrin. In cases of rapid death from chlorine intoxica- tion, no pulmonary edema is found,- but signs are observed which indicate a chemical burn of the lungs. The mucosa of the respiratory tract is usually necrotic, and the lung tis- sue is dry and friable. In intoxication by asphyxiant CWA changes are observed in the heart (dilatation, particularly on the right), in'the Declassified in Part - Sanitized Cop Approved for Release ? 50-Yr 2014/04/07 ? CIA-RDP81-01043R003800050007 '1 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 cardiac muscle (solitary hemorrhages), in th', :Aver, kidney and spleen (congestion). On dissecting the skull, edema of the meninges is noted and a marked congestion of the cerebral vessels and possible hemorrhages. On autopsy of cadavers of persons who died in the later periods of intoxication (10-14 days), pneumonia, pleurisy and other complications are found in the lungs. Prophylaxis, First Aidand Treatment of Those Affected by Asphyxiant CWA. An important prophylactic measure which can prevent the entrance of dWA into the body is the use of a gp.s mask or 'refuge in a shelter. The rendering of first aid in cases involved by as?hyxiant CWA amounts to the folloWing: the patient should be removed (on a litter!) from the con- tawinated area, after first putting a gas mask on him; the patient should be given complete rest, because even slight physical strAin contributes to,an increase in the consumption of oxygen, a deficit of which already exists in the body in the initial stAge of intoxication. Those intoxicated should be kept warm with hot water bottles, covered warmly, and given a hot drink at the first opportunity. The CWA can settle on the patient's clothing; therefore, it should be changed as quickly as possible. Rinsing with soda solution is recommended for reducing the signs of irritation of the respiratory passages and the ocular mucosa; in,case-of pro- nounced signs of irritation of the eyes, novocaine with adrenalin and other sedatives are indicated. The administra- tion of oxygen by means of various apparatus -- oxygen inhaler (Fig. 89 [Page 223 of Source]) and others -- is indicated even in early periods of intoxication. Fig. 89. Oxygen Inhaler (KN-3): 1--tank with compressed oxygen; 2--shut-off valve; 3--reducing valve con- nected to tank by means of a stem with a slip-over nut (4); 5--finimeter [?]; 6--injector screwed into the body of the reducer; 7--regulating disc; 8-- breathing bag;. 9--cross piece connected with the injector of the reducer by means of a rubber tube (10); 11--two corrugated hoses connected to the limbs (12) of the cross piece; 13--two masks connected with the free ends, of the hoses. After first aid is given, the patients should be sent to the hospital for further treatment. 44 _Medical practice has at its,disposal a number of measures for pathogenetic' therapy which are effective,-to a certain degree, imcombatting toxic pulmonary edema, circulatory_dis- tUrbances and other pathological changes. developing in cases of asphyxiant CWA involvement. The patient should be given maximum rest, he should be kept warm and supplied with oxy- gen in order to combat the developing anoxia. Usually, in- halations of pure Dxygen or air oxygen mixtures (40 to 60 percent)' are use and incases of pronounced signs of the gray form of anoxia the oxygen should be giVen with five to seven percent carbon dioxide (carbogen)., The duration of the use of oxygen depehds on the condition of the patient. Properly organized oxygen therapy contributes to the restor- ation of respiration to normal and to An improvement in car- diac activity, and also. eliminates a number of disturbances caused by the CWA asphyxiant effect. In parallel with the measures directed at the elimination of signs of anoxia agents are used for preventing and combat- ting developing toxic edema of the lunge. Ten percent cal- cium chloride and 10 percent calcium gluconate solution are such agents. Intravenous injections of these solutions dur- ing.the pre-edema period contribute to a condensation of the tissue colloids and reduce the permeability of the pulmonary vessels. Among the measures directed at preventing and cembatting toxic pulmonary edema mention may be made of bleeding with the subsequent administration of a hypertonic solution of glucose (25 percent, 50-100 cubic centimeters). In the ini- tial stage of the intoxication the bleeding (up to 500 cubic centimeters depending on the condition) may readily be per- formed by means of venipuncture. With the development of pulmonary edema the removal of blood is usually accomplished by means of venesection. During the bleedim process the condition of the cardio-vascular system should be watched, and where needed one cubic centimeter of 20,percent camphor solution, caffeine or one cubic. centimeter of 10 percent corasole solution should be injected subcutaneously. With conaiderable deterioration in the function of the heart ac- tive agents are prescribed which tonicize the cardiac activ- ity. _ Bleeding performed in time usually gives a good thera- peutic effect, because itcontributes'to bringing tissue fluid back into the circulation in consequence of which the quantity of circulating blood is increased, and its viscocity is reduced. Also, toxic products formed in the body are el- iminated in the blood which is removed. Bleeding can not be 45 Declassified in Part - Sanitized Copy Approved for Rel ? 50-Yr2014/04/07. - 8 -0104:1RnmRn Declassified in Part - Sanitized Cop Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 used in all the periods of.development of intoxication. Thus, in the stage of gray anoxemia, when, in addition to the toxic pulmonary edemal.there are pronounced signs of cardio-vascu- lar insufficiency (shock),..bleeding cannot be performed. In such cases the intravenous administration of strophanthin ' needs to be used in addition to the cardiac agents mentioned above. Glucose, which) by increasing the osmotic.pressure-of the blood, contributes to. the return of fluid from the tissues to the blood strdam,,occupies a special place in the treat- ment of those affected by asphyxiant CWA. Glucose also im- proves-metabolism, increases the blood pressure-and diuresis. In the ,event of the development of complications (broncho- pneumonia, pleurisy), the use of antibiotics, sulfonamides, mustard plasters, and cardiac agents is recommended. During the period of resolution of the process, expectorant'agents Are prescribed. Treatment of other complications of the lungs as well as of. the pathological signs of the nervous system and gastrointestinal tract is carried out according to the general rules of therapy. Properly organized hygienic conditions, general routine and diet are of importance in the success of treatment. Phosgenoxime. In looking for new CWA, foreign military specialists have directed their attention to the oximes, which possess a certain toxic effect on the body. The ad- dition of one of the halides (chlorine) to the oximes in- creases their toxic properties considerably. Phosgenoxime (C12.C.N.OH) is a white crystalline compound with quite an unpleasant, irritating odor; its boiling point is 129?. It dissolves in water without any particularly dif- ficulty. Phosgenoxime possesses a many-sided effect, uniting cer- tain qualities of the asphyxiants, vesicants and general- toxic CWA; however, its toxic effect on the body is less pro- nounced than the effect of the CWA previously described. 'Clinical Picture of Phosgenoxime Intoxication. Phosgenox- ime exerts atoxic effect in the droplet and vapor states. After entering the body through the skin and mticosae, phos- genoxime produces a number of pathological changes in various organs and systems. 46 ' .? Direct contact of phosgenoxime drops with the skin leads to the development of an erythematous and sometimes also to, a bullous form of dermatitis. The development, of superficial necrosis is possible. The regeneration of the affected tis- sues proceeds sluggishly. Phosgenoxime does not possess any latent period of action: direct contact of it with the skin produces first pain and then itching. The development of a superficial necrosis is possible: The effect of phosgenoxime in the vapor state does not usually lead to any significant skin changes. Even after a prolonged exposure the process, as a rule, is of a superfi- cial nature; less often, a more deep-seated inflammation de- velops. In such cases, 'healing proceeds much more actively than after involvement with .the liquid form of phosgenoxime. At the same time, the inhalation of phosgenoxime vapors markedly irritates the mucosa and can lead to the develop- ment of inflammatory signs not only in the upper parts of the respiratory passages but also in the lower parts. Not uncommonly, toxic pulmonary edema can develop. The eye is very sensitive to phosgenoxime. The penetration of phosgenoxime into the gastro-intest.inal tract is possible. In such cases gastroenteritis develops. In the very severe forms of involvement an ulcerative-necro- tic process occurs. Phosgenoxime is readily and rapidly absorbed into the body from the surface of the skin and mucosae and leads to the development of general-toxic signs: involvement of the nervous and cardio-vascular systems, kidneys and other organs. Pr2phylaxis, First Aid and Treatment. Prophylaxis of phos- genoxime intoxications consists of the use of a gas mask and other known measures of protection. Contact of phosgenoxime with the mucosa of the eye, res- piratory organs or entrance into the gastro-intestinal tract, just as in the case of the other CWA, requires prompt inte- vention (see mustard gas). In the case of developing pulmonary edema, bleeding is in- dicated with the subsequent administration of hypertonic glucose solution (25-40 percent, 50-100 'cubic centimeters), rest, oxygen, active cardiac agents and other measures suc- cessfully used for intoxication by asphyxiant CWA. 147 Declassified in Part - Sanitized Cop Approved for Rel ? 5 -Yr 04/07, - P81-01(14f1RnnqR Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 In the event of contact of phosgenoxime in the form of drops with the skin the prompt treatment of the skin surface is necessary. For this purpose, chloramine and the contents of the gas casualty first-aid kit may be used. Ammonia t1.0 percent solution) is an active gas-decontaminating agent. When the treatment is not timely and not sufficiently accu- rate skin involvements may develop which should be given treatment like that used for intoxication by other persistent CWA. Various symptomatic agents are used for combatting the signs of general intoxication. IRRITANT CWA , The toxic effect of the irritant CWA consists principally of their influence on the sensory nerve endings of the ocular and respiratory tract mucosae. After being absorbed into the body, the .irritants are capable of producing signs of general intoxication under certain conditions. Usually, the irritant CWA in low concentrations which are, nevertheless, adequate to put an enemy out of commission, do not lead to any considerable changes in the body, and the process is limited to a reflex effect without pronounced organic disturbances. Nevertheless, the chemical compounds belonging in this group have not lost their significance as CWA in view of their capacity of rendering a considerable number of personnel unfit for duty. Most often, the irri- tant CWA are used in smoke or fog states. Irritant CWA are customarily divided into two groups: chemical compounds which affect the nerve endings of the oscular--lachrymators--and substances which affect the nerve endings of the upper respiratory mucosa--the irritant arsines (sternutators). Lacrimators Among the CWA with a lacrimatory effect are chloraceto- phenone, brombenzylcyanide, bromacetone, chloracetone, benzyl bromide and benzyl chloride, etc. In their chemical struc- ture they belong to the groups of the halide-substituted ali- phatic hydrocarbons and of the halide-substituted aromatic hydrocarbons. The compounds named are solid or liquid. Their slight solubility in organic solvents and poor solu- bility in water are common to them. Brombenzylcyanide and chloracetophenone chiefly are of considerable practical in- terest. 48 Both substances lead to irrfAative signs in negligible concentrations (0.003 milligrams per liter). psa!?Itaalsy2121d2 (C6Hp,CHBreN) in the pure form is a , colorless crystalline subttance. It has a special almond odor. Its specific gravity is 1.52. Brombenzylcyanide is a stable compound which can maintain its capacity of produc- ing an irritating effect for many days. Chloracetophenone (C6H5COCH2C1) in its purified form is a crystalline compound which possesses the odor of Violets. Its boiling point is higher than that of brombenzylcyanide and is equal to 245?. Just as the other representatives of the group of lacrimators, brombenzylcyanide and chloraceto- phenone specifically dissolve poorly in water, and slightly in many organic solvents. Clinical Picture of Intoxication. The lacrimators do not have any latent period. After entering the eye they lead to considerable signs of irritation of the nerve endings (Fig. 90) located in the conjunctival and corneal membranes, which is expressed in marked pain and tearing, blepharospasm and other signs. When the effect of the lacrimators is brief and in low concentrations the pathological signs disappear after removal of the patients from the area of contamination; in the case of the more severe intoxications the signs of con- junctivitis may persist for several days, after which they gradually become quiescent. In particularly serious cases considerable changes are observed in the other ocular mem- branes also--the development of keratitis, etc., which can lead to a reduction in vision and invalidism of those affec- ted. In the presence of high concentrations of the CWA in the air a number of pathological changes of the respiratory organs, skin and nervous system are added to the eye involve- ments. In individual cases, the development of pulmonary edema can be observed. Fig. 90. Diagram of Winking Reflexes of Lids and of Lacrim- ation in Involvement by Lacrimators (according to Eder and Easton): - - - -sensory pathways; motor pathways. First Aid and Treatment of Those Affected. Patients who 49 Declassified in Part - Sanitized Copy Approved for Release ? 50 -Yr 2014/0 /0 : - -01 . pflfl Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 have, been exposed to the effect of lacrimators should be re- moved rapidly from the contaminated area, after first putting a gas mask on them. Emergency care consists of the immediate repeated treatment of the eyes with two percent aqueous soda solution, boric acid or pure water. In order to reduce the unpleasant subjective sensations (photophobia, lacrimation, pain) the patients should use. protective glasses and also should use various symptomatic agents:- drops of atropine (one percent solution), dionine, dicaine (one percent solution) and others. ? In-:cases .where there is a.superimposed infection antibiotics,' aluid [sul- facetamide], and systematic treatment of the eyes with anti- septic solutions are recommended. Further' treatment is given by the oculist. Irritant CWA (Sternutators) This group of CWA includes a number of chemical compounds which contain chiefly trivalent arsenic. Depending on the chemical structure, the CWA of this group usually are di- vided into arsine derivatives of the aromatic series'(diphenyl- chlorarsine, diphenylcyanarsine, phenarsazinehydrochloride) and of the aliphatic series (ethyldichlorarsine, methyldich- lorarsine). After falling on the mucosa of the upper respiratory tract in the form of vapors or smoke, the compounds mentioned pro- duce a series of reflex changes (pain in the chest, cough, obstinate sneezing, etc.). In addition, these CWA, like other arsenic-containing substances, are capable of exerting a general absorptive effect. The arsines of the aromatic series possess the greatest irritant effects. Diphenylchlorarsine--(C6H5)2AsC1 consists of white cry- stals; its specific gravity is 1.4; its boiling point is over 3200. Like the other CWA of irritant effect it dissolves to an insignificant extent in water; on reacting with it, it gradually undergoes hydrolysis. Diphenylchlorarsine is soluble in many organic solvents. Diphenylcyanarsine--(C6H5)AsCN--a crystalline compound possessing an almond odor. Its specific gravity is 1.45; its boiling point, 340?. The solubility of diphenylcyanar- sine in water is negligible. It undergoes hydrolysis very slowly. The reaction of diphenylcyanarsine with active oxi- dizing agents leads to a considerable reduction in its toxic 50 Declassified in Part - Sanitized Copy Approved for Release properties. Phenarsazinehydrochloride--NH(C04)2AsC1--adamsite, con- sists of yellow crystals; its specific gravity is 1.65; its boiling point is over 400?. In water it is practically in- soluble, and dissolves poorly even in organic solvents. In its effect on the living.organism it_resembles diphenyl- chlorarsine but-possesses a more pronounced.irritant effect. Clinical Pictuk=eof Intoxieation--The intensity of,the-de- velopment of the toxicprocf_?:ss from the effect of irritaht arsines on the body, like that of the other CWA, depends on the concentration of the substahce, the time of its action and the condition of the body. Arsines, after coming into contact with the respiratory organs in the form of a smoke or fog, very rapidly lead to oppressive signs of irritation. This is expressed in raspiness in the -throat, sneezing, the excretion of mucus from the nose, dry cough, headache and also in painful sensations in the retrosternal area, in the jaws and teeth. Therefore, both secretory and motor reflexes occur. These signs may be intensified even a certain time . (half-hour) after removal of the patients from the contamin- ated atmosphere. Reflex respiratory changes in the form of slowing of respiration as well as disturbances of the cardio- vascular system (Fig. 91 [Page 229 of Source]) are observed from the irritation of nerve endings of the upper respiratory tract and, particularly, of the trigeminal nerve. Afterwards, All the signs mentioned decrease, without leaving any after- effects. In the severe forms of intoxication the signs of stimulation are more pronounced, and the process may also ex- tend to the ldwer sections of the respiratory tract, leading to severe complications up to the development of pulmonary edema. Also, changes are observed in the central nervous system which are expressed in disorders of the psyche and df consciousness, in a disturbance of coordination of movement, development of anesthesia and others. The manifestations of intoxication enumerated above are of a reversible character in the majority of cases. It should be'kept in mind that the arsines possess the capacity of exerting a toxic effect not only after coming into contact with the respiratory organs but also through their effect on the skin, eye and gastro- intestinal tract. However, most often the pathological signs of the organs mentioned are limited to hyperemia, edema and skin,itchingilacrimation as well as dyspeptic symptoms. Fig. 91; Sensory-Motor Reflexes After Entrance of CWA into 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 51 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 Respiratory Passages (according to Eder and Easton): - ,-sensory pathways; _motor pathways First Aid and*Treatment of Patients. In the case of in- toxication by sternutators first aid amounts primarily to an evacuation of the patient from the contaminated area, For the purpose of reducing the symptoms of .irritation of,, the up- per sections of the respiratory tract repeated gargling with soda or water solutions is required, With *thiCaim in. view, the inhalation dr the anti-smoke mixture of the "following composition is recommended: ? Rx Chloroformii Spiritvi vini reCtificati aa 40.0 Aetheris aethylici 20.0 Liq. Ammoniii caustici gtt V The anti-smoke mixture should be inhaled for two to four minutes; if needed the inhalation of it may be repeated. In halations of menthol, eucalyptus, etc. are not uncom- monly used for pronounced signs of irritation. Irritation of the respiratory tract is often accompanied by quite severe headaches, unpleasant sensations in the chest, etc. These signs can be eliminated by analgesic agents--pyramidon, anti- pyrine, phenacetin and analgine [1-pheny1-2,3-dimethy1-5- pYrazolone-4-methylaminoethylene sodium sulfate). Pathologi- cal signs produced by the absorptive effect of the CWA re- quire special treatment, which is not much different from the therapy of intoxications with the arsenicals of the lewisite type. TECHNICAL FLUIDS Among the technical fluids are chemical compounds (methyl- alcohol, ethylene glycol, petraethyl lead and others), which are used very extensively both in war and peace time in var- ious branches of industry and for various purposes. The technical fluids which are utilized in the capacity of agents possessing the capacity of lowering the temperature of the freezing of refrigerant mixtures in airplane radiators, tank radiators, etc., deserves special attention as does also the application of some of them as antiknock compounds. In view of the fact that alcohol is included in the composition of a 52 Declassified in Part - Sanitized Copy Approved for Release ? -number of technical fluids (antifreezes and others), people have tried to use them instead of alcohol for drinking. As a result .of this a more or less pronounced intoxication may develop which frequently terminates in a fatal outcome or in invalidism of the patient. Methylalcohol (Alcohol methylicus)--CH,OH (wood alcohol, methanol, carbinol). In pure. form isa tansparent colorless slightly volatile liquid with the specific odor of alcohol. Unpurified methylalcohol is distinguished by an unpleasant od)r, which is produCed by its content of by-products. Methyl- alcohol is inflammable and burns. Its boiling point is +64.70; it solidifies at a temperature of -97.80. Methylalcohol can be mixed readily with water, ethylalcohol, acetone and other organic solvents. It serves as a solvent for oils resins, rubber and dyes. Methylalcohol has attained extensive application in various branches of ind,.stry. It is .utilized as a solvent in the pro- duction of lacs, organic dyes, gum mastic, drying Oils and is often used also. to keep water from freezing in the radi- ators of internal combustion motors, because it is included in a nber of antifreezes. Pure ii.ethylalcohol is of no less imprtance in the preparation of certain chemical-pharmacevti- cal preparations. Tie toxicity Di' methylalcohol extends over a broad ranr.e and to a considerable degree depends on the indlvichial sensi- tivity of the body. In certain people the constmption of even several ,Ailliliters (less than 10 ml.) of nethylalcohol can lead tu development of intoxication. The minimutu quaittity of iJethylalcohol which can produce death of a person is cfn- sidered to be 1u0 milliliters. However, the use of an even greater portiun of methylalcohol (400 to 500 ml.) in indivi- dual cases can be tolerated without serious toxic signs. Methylalcohol can enter the body through the various routes: through the gastro-intestinal tract, respiratory organs and skin. Most frequently methylalcohol intoxications are obser- ved,when it is used in the capacity of an alcoholic beverage. Clinical Picture of Acute Intoxication. Very shortly af- ter the consumption of even a small portion of the poison nausea and vomiting can appear a& well as signs characteris- tic of alcoholic intoiication. In the majority of cases the clinical signs of intoxication are found after a certain per- iod of time (period of the latent effect; on the averages 10- 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 gq 4 16 hours). During the period of the latent effect of methyl- alcohol the patient feels relatively good, but on objective examination a dilatation of the-pupils, increase in frequency of the heart, etc., are noted. At the end of the latent per- iod the patients' complaint usually amount to headache, diz- ziness, General weakness, sleepyness, nausea, vomiting, etc. Changes referable to the eye are particularly characteristic of methylalcohol intoxication. In mild cases of intoxication the eye involvement amounts to the sensation that everything around is seen through a fog or screen. Objectively only a certain dilatation of the pupils is found. The mild form of intoxication with methylalcchol usually ends favorably. In the more serious cases of intoxication the same clini- cal signs are seen but manifested to a greater degree: Eye changes are particularly significant. Therefore, certain authors call this form of intoxication ophthalmic. Patho- logical signs of the eyes develop either gradually or in a stormy fashion; however, in both cases a marked decrease in visual acuity or a complete loss of it is observed as a re- sult of atrophy of the optic nerve (Figs. 92, 93 [Page 233 of Source]}. . Fi:L. 92. Inflammation of the Optic Nerve in Methylalcohol Intoxication. Fig. 93. Atrophy of the Optic Nerve in Methylalcohol Intoxi- cation. In cases of severe intoxication with methylalcohol the in- itial clinical signs are similar to those described above. Then, signs of visual disturbance as well as data indicating the involvement of various organs and systems in the toxic process are superimposed. This pertains primarily to the in- volvement of the central nervous system, which is manifested as excitation and subsequent depression. Most often, the in- toxication is accompanied by sleepyness, an unconscious state, a disorder of the respiratory function and of that of the cardio-vascular system. Gastro-intestinal symptoms are also possible (diarrhea or constipation, distention and unpleasant sensations in the abdomen); renal signs are also possible (albumen, erythrocytes, hyaline cast* as are also blood signs (neutrophilia, lymphopenia). In a prognostic sense the first three days are the most threatening. In subsequent days the 54 number of fatal results decrease considerably. Pathological Changes. On external examination a pink cdlor of the cadaveric spot and dilatation of the pupils are noted; at autopsy, congestion and edema of the meninges and brain matter as well as solitary hemorrhages in the pons, medulla, and other parts are 11:oted in the central nervous system. At the same time there can be degenerative changes in various parts of the brain t Congestion and small punctate hemorrhages are observed in the lUngb, heart, stomack and other organs. In all cases pathological changes are found in the eye: edema of the vascular layer of the retina, degenerative changes in the neural fioers of the optic nerve, hemorrhages, etc. Mechanism of Action. Regardless of the routes of entrance of methylalcohol-into the- body, it is slowly oxidized, and forms toxic products (formaldehyde and formic acid) which are also considered to have decisive importance in the develop- ment of the pathology. It is .believed that the toxic effect of formic acid is brought about by its very pronounced reduc- ing properties; as a result of which the normal course of oxi- dative-reductive processes in the body are disturbed. It has also been established -that under the influence of formaldehyde the course of enzymatic processes is disturbed, as a result of which formic acid cannot be oxidized to its end products (I. I. Kazas). Considering that methylalcohol circulates in the body for a certain time in a practically unchanged or ul- changed condition while its toxic effect is obvious, certain authors have attempted to explain the mechanism of action of methylalcohol by the effect of its entire molecule. The works of V. M. Rozhkov and A. T. Suprunov, which have expanded the existing concepts of the mechanism of action of methylalcohol, deserves special attention. They have shown that under conditions of oxidation of methylalcohol there is a disturbance in the metabolism of those vitamins which play an important part in the course of the toxidative pro- cesses (development of anoxia). Acidotic changes and a dis- turbance in the course of the oxidative processes in a di- rection of a decrease in their intensity are also found (Rozhkov). Prophylaxis, First Aid and Treatment of the Intoxication. An essential condition for preventing the development of in- toxication is the strict observance of rules and instructions concerning the keeping and the utilization of methylalcohol. The elimination of methylalcohol from a number of industries 55 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07 ? CIA-RDP81-01043R003800050002-9 Declassified in Part - Sanitized Co.y Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 _ and the replacement of it by other, less toxic compounds also is of important prophylactic significance. One of the important measures in rendering first aid is washing out of the stomach which is indicated not only imme- diately after the intoxication but also subsequently. Adsor- bent (activated charcoal-carbolene), emetics, laxatives, and also siphon enemas may be used. Bleeding With the subsequent administration of glucose or of physiological solution con- tribute to the elimination of the toxic substance and its conversion products from the body. When necessary the bleed- ing may be repeated. In the treatment of those intoxicated by methylalcohol definite attention should be given to the matter of combat- ting possible acidosis and anoxia. With this aim in view. the intravenous administration of alkali (sodium bicarbonate) and the use of oxygen therapy are indicated. It is also re- commended that carbogen (oxygen-carbondioxide mixture) be used not only with the aim of stimulating the respiratory center in the event of its depression but also for the pur- pose of excellerating the elimination of methylalcohol through the lungs. An important place in the treatment of patients should be given to vitamin therapy (B1 and C). There are reports in the literature concerning the favorable effect of tissue therapy in cases where there are still optic nerve fibers which have not atrophied. Various symptomatic agents are used for combating individual manifestations of intoxi- cation. Antifreezes. This group of compounds is constituted by chemical substances which freeze at a very low temperature and which are used chiefly as measures for preventing the freezing of liquid in the refrigeration system of internal combustion motors. In their chemical composition antifreezes are different. They are usually mixtures of ethyline glycol with glycerine or without it, or of methylalcohol with gly- cerine. Because of its properties ethyline glycol has an advantage over antifreezes of other compositions. Ethyline Glycol (CH20H-CH2OH) is a colorless, somewhat viscous liquid without any odor but which possesses a sweet taste. It dissolves readily in water, glycerine, alcohol, but poorly in ether, benzol and fats; specific gravity-1,130 (at 00); temperature of fusion, -15.60. It undergoes oxi- dation readily. 56 Acute intoxication is possible as a result of the inges- tion of ethyline glycole; inhilation of its vapors uSually present no danger.. The majority of authors (S. Ya. Arbuzov, A, P. Astakhov and others) believe that 100-200 milliliters of ethyline. glycol is the dose which can produce fatal in- toxication. However, the development of_ serious intoxicaion is also possible after the ingestion of smaller quantities of ethyline glycol. ? Clinical Picture or Intoxication. A _brief euphoria is d)- served immediately atter the ingestion of ethyline glycol. In the majority of cases the initial symptoms of intoxication develop after a certain asymptomatic period (2 to 13 or more hours) during the course of which the patients sometimes con- tinue to engage in their usual, occupations. Afterwards, de- pending on the degree of intoxication, the intoxication can be limited to an anesthetic effect of the toxic substance or else signs develop which attest to .the involvement of the central nervous system, kidneys and Other organs in the toxic process. In mild cases of intoxication headache, dizziness, general weakness, nausea, repeated vomiting, as well as an excited state are observed. This form of intoxication usually ends in complete recovery of the patient. In the more serious cases of intoxication a symptom-complex develops which is characteristic of central nervous system intoxication. Therefore, certain authors call this state of intoxication the stage cerebral signs. It is characterized ey considerable headache, dizziness, sleepyness or excitation, by a decrease in auditory perception, dilatation of the pu- pils and a sluggish reaction of them to light, and shakiness of the gait. In favorable cases the signs noted pass in the course of several days without leaving any after effects. In the severe forms of intoxication a more pronounced dis- order of the nervous system is added to the signs described above. The memory suffers, poor orientation to the environ- ment is noted, and from time to time consciousness is clouded. A considerable excitation or depression is observed. In extremely severe intoxication the patients are uncon- scious, the pupils are dilated, pathological reflexes appear, spontaneous urination and suffOcation and sometimes convul- sions are possible. In addition to the characteristic signs of the nervous system, changes are also observed in the 57 Declassified in Part - Sanitized C .y A ease ? 5 - r 2014/04/07: CIA-RDPRi-ninaqpnmszrinriannr, Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 cardiO-Vascular system in respiration, in the gastro-intes- tinal tract, and others. In this form of intoxication the patientidie during the first 24-48 hours. The outcome of the intoxication depends a great deal on the intensity of kidney. involvement (stage of renal involvement). The dis- orders of the renal function are observed even in the stage of cerebral signs. Afterwards, oliguria develops, the urine acquires the color of gravy $ In the very severe cases uremia is possible. During this period encephalopathy, bradycardia and other pathological signs in various organs are_also_ob- served. Death of the patients during thiS stage of intoxi- cation occurs in the Second to third week against the back- ground of progressive signs of uremia and coma& In the pro- cess of recovery of the intoxicated patients the return to normal of the markedly 'impaired physiological equilibrium of the body occuts exceptionally slowly. Pathological Changes. The following changes are charac- teristic of the central nervous system: considerable edema and congestion of the tia mater and dura meter and of the brain matter and punctate hemorrhages. Histological examin- ation shows signs of stasis, considerable number of hemor- rhages, destruction of the vascular walls, and also of, the brain matter. In other organs, in the event of an early death, only hemorrhages in the serous membranes, congestion and a certain degeneration of the parenchymatous organs, catarrhal gastroenteris, pulmonary emphysema, and a serous myocarditous in the heart are found. In the case of death occurring in later periods (10-15 days) pronounced changes are usually found in the kidneys: hydropic degeneration of the epithelium of the tubules with subsequent necrosis, the deposition of lime in them, etc. During this period changes in the liver--degeneration and necrosis--are quite characteristic. Certain Problems in the Mechanism of Action of Ethyline Glycol. The mechanism of action of ethyline glycol has not as yet been completely studied. Considering that ethyline glycol is oxidized in the body with the formation of such atoxic substance as oxalic acid, the majority of research workers ascribe first-rate importance to it in the develop- ment of the pathological process. However, the entire symptom-complex characteristic of ethyline glycol intoxica- tion cannot be explained merely by the toxic influence of the oxalic acid formed in the body. B. .S. Fridlib disting- uishes two phases in the toxic effect of ethyline glycol. 58 During the first phase changes are observed in the gaseous content of the blood, which leads to the development of anoxia and, therefore, also to a whole series of disorders associ- ated with the anoxic syndrome. Serious disturbances of metabolism have also been established. jThe author' explains the occurrence of the phenomena mentioned as an effect of the undissociated ethyline glycol molecule. In the second phase, organic changes are expressed in a number of organs and systems, primarily, in the central nervous system and kidneys. These disturbances are brought about, according to the data of B. SI PriOlib, through the effect of conversion products of ethyline glycol. N. V. Lazarev notes a definite effect of ethyline glycol as a vascular and protoplasmic poison, as a result of which edema, cloudy swelling and necrosis of the vessels develops. A. B.,Reznikov and other authors, noting the disturbances in kidney function, attempt to explain these changes by the specific effect of the anti- freeze on the vascular apparatus of the kidneys, thereby as- cribing definite significance to the toxic effect of oxalic acid. Prophylaxis, First Aid and Treatment of Intoxication. In order to eliminate ethyline glycol intoxication extensive educational work should be carried on with persons who deal with antifreezes. V. M. Rozhkov recommends adding substances to the antifreezes which possess unpleasant odors and tastes, making them unsuitable for internal use. Of the first aid measures for ethyline glycol intoxication early irrigation of the stomach, emetics, bleeding with subsequent adminis- tration of glucose or preserved blood may be recommended. Based on the fact that great importance is ascribed to oxalic acid in the toxic effect of ethyline glycol, a number of authors recommend using calcium salts, which are almost always used in cases of oxalic acid intoxication, for thera- peutic purposes. B. G. Motylyev recommends using calcium chloride, accompanying this treatment with the use of alka- lies. As a measure capable of accelerating the detoxifica- tion of ethyline glycol in the body, certain authors use the intravenous administration of sodium sulfate in the form of 15-30 percent solution, in a dose of 50-60 milliliters. Lumbar puncture, the administration of glucose (30-40 per- cent, 30-50 milliliters), the use of cardiac agents and sub- stances stimulating respiration are indicated in addition to bleeding for a developing comatose state and uremia. In the treatment of ethyline glycol intoxications oxygen therapy (oxygen, carbogen) deserves special attention. Diet (no salt 59 - Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07 ? CIA-RDP81-01043R003800050002-9 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 and no-protein diet) and vitamin therapy are of great impor- tance in the treatment of ethyline glycol intoxications. Tetraethyl Lead. (TEL), Pb(c211)4 is an organic lead com- pound, being a colorless oily liquid which possesses'an odor which is not very characteristic and a sweetish taste. At a temperature of 20? its sRecific gravity is equal to 1.65; its boiling -point is 200'. Tetraethyl lead is very volatile, can evaporate at a temp- erature below 00 is resistant to alkalis, insoluble in water, but readily soluble in ether, chloroform, and fats; it readily combines with halides and concentrated acids. As a result of. this reaction tetraethyl lead is decomposed in air and in the light it changes to lead oxide and triethyl lead. The latter compound is very toxic and is a dangerous indus- trial poison. Tetraethyl lead has been well known for a longtime; how- ever, it began to be used extensively in industry only in connection with the discovery of its antiknock properties. It was established that the addition of tetraethyl lead to gasoline, even in very small quantities, contributes to a marked reduction in detonation in internal combustion motors. In addition, the addition of tetraethyl lead to gasoline creates conditions for the more prolonged operation of the motor and reduces the quantity of fuel used. Usually, tetra- ethyl lead is introduced into the fuel in the form of an ethyl" fluid [TEL, ethylene bromide and chloride] of which it forms a part. Through the use of this "ethyl" fluid a lead gasoline is prepared, which is also used in internal com- bustion motors. Tetraethyl lead intoxication is possible in all cases where there is direct contact with it (under conditions of tetraethyl lead production, in the preparation of theibthyl" fluid and of lead gasoline, etc.). The use of food products contaminated with tetraethyl lead and also the ingestion of it as an alcoholic beverage can produce a seV-ere toxicosis. The data which have been presented by far do not exhaust the number of conditions in which the development of tetraethyl lead intoxication is possible. Tetraethyl lead, "ethyl" fluid and lead gasoline can pene- trate into the body through the unbroken skin, through the respiratory organs (vapors) and also by means of ingestion of them as a drink. Being an exceptionally strong poison, 60 I tetraethyl lead produces a severe toxic process in the body which often..terminates in'a fatal outcome. Clinical Picture of the Acute and Chronic IntoxicatiOn. The effect of tetraethyl lead on the human body is charac- terized-primarily by.its specific effect on the central nervoUs system, .regardless of the physical condition of the substance (liquid, Vapor) or of the route of its penetration into the body-(resOitatory organs, gastro-intestinal tract, According to the nature of its course, the intoxication_ can be acute,_under the conditions of large doses of sub- stances. containing tetraethyl lead) or chronic, from the prolonged effect of insignificant concentrations (cumula- tive effect). Some authors (B. I. Martsinkovskiy, Bogdanova and others) also distinguish,a subacute form of intoxication. The clinical signs of acute intoxication with.tetraethyl lead usually develop, a certain time after its entrance in- to the body. TheLexistence. of a latent period 'is chara0? teristic of. all cases of%acute intoxication. The duration of this period is,from several hours to ten' or more days. Under conditions of penetration of tetraethyl lead per' os the intoxication develops moreirapidly. :Forerunners of the state of intoxication are the following: nausea and' vomit- ing, general weakness, rapid fatigability, loss of appetite, sleep disturbance, dizziness, weakening of the sexual cap- acity, etc: _ Of the early signs of intoxication with tetraethyl lead. note should be made of the 'vegetative disorders which are expressed in the.occurrence,of an increased tendency to . perspiration, salivation, hypotension, hypothermia; bradi- cardia, and dermographia. i Quite often the patients feel as though there is lafor- eign body in the mouth and attempt to remove it by a movement of the tongue or by.means Of the hands. Data.indicating psychopathological phenomena are particularly dangerous: the occurrence of anxiety, bad .mood and fitful sleep with nite- mares, and psychomotor excitation. In the very severe forms of intoxication with tetraethyl lead the signs of intoxication assume a.very pronounced character, which indicates organic involvement of the central 61 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 Declassified in Part - Sanitized Copy Approved for Release 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 1 nervous system: speech disorders, an unsteady gait, euphoria, an uncritical attitude .toward one's own behavior, dysarthria, etc. are observed. ? The toxic process .which develops as a result of the-action of tetraethyl lead can be limited merely to the initial stage of the intoxication. In the majority of case -s of acute in- toxication the proCess progresses rapidly assuming the char- acter offs. malignant course. Here, persistent central ner- vous system changes are particularly pronounced, leading to the development of an exogenous psychosis; The Malignant forms of tetraethyl lead psychoses usually lead to.the pa- tients death in the: course of the first few days. Intoxica- tions with.overt psychoses sometimes assume a prolonged course arid in a certain percentage of cases can end in re-. covery.but with.residual signs of.a more or less. consider? able psychic incompetency. . Chronic tetraethyl lead intoxication usually occurring as a result of the repeated effect of the poison or.mixtures of it, develops slowly, the pathological signs increase gradually, the toxic process lasts for a long time (several months). The symptomatology of,chronic intoxication is not much different from the signs which are observed in acute intoxication. In the chronic form of intoxication the most frequent complaints are general weakness, rapid fatigability, loss of appetite; salivation, tendency to perspiration, sleep disorder, weakening of sexual capacity. Objective examina- tion shows a hypotension (90 over 60), hypothermia (35 to 36?) bradicardia (45-50 per minute), loss of weight, pallor of the skin, a slight inemia, slight leucopenia, lympho- and mono- cytosis are found in the blood (-11. N. Vol'fovskaya)., In some of the intoxicated patients psychosensory disturbances are observed and 'sometimes also hallucinations. Afterviards, slight euphoria, dysarthia; disorders of sleep, memory and even of the intellect may be aUded; 1n contrast to the acute intoxication the signs indicated show no tendency to pro- gression and remain unchanged for a long time. Pathological. Picture of Intoxication. The most significant pathological changes are observed in the central nervous sys- tem. Usually, edema of the brain, hyperemia of the meninges and punctate hemorrhages are found. On. microscopic examina- tion small hemorrhages are found in the brain around the dilated blood vessels, and hemorrhages also exist in the cor- tex and white matter. Quite often., leucocytic stases are found in the blood vessels with perivascular hemorrhages in 62 3 E._ ? - "1t.t.**1 - - _ _ . _ - the workers should take a shower, and the clothes should be given in for decontamination.. An important condition for assuring the prevention of chronic intoxication is the giv- ing of periodic medical examinations. Sanitary-education work is of great importance in the system of prophylactic measures. Definite success of therapeutic measures in tetraethyl lead intoxication and intoxication by its mixtures depends on the early diagnosis of the intoxication and timely render- ing of first aid. In these cases contact of the patient with tetraethyl lead should be eliminated first of all. When tetraethyl lead or its mixtures fall on the skin it should be treated with kerosene, gasoline or alcohol im- mediately. After such treatment an alcoholic soap solution contain- ing cupric acetate is applied to the affected area (O. I. Glazova) or the contaminated site is washed with hot water and soap.- Tetraethyl lead decontaminators consist of sub- stances which contain chlorine in their molecules: chlorine water, chloride of lime, chloramines and the liquid from the gas castalty first aid kit. After the ingestion of tetraethyl lead vomiting should be induced, the stomach should be washed out with soda solution or by means of the administration of copious quantities of warm water, Bleeding is also indica- ted (N. V. Lazarev) with the aim of binding the lead in the body the intravenous administration of sodium hyposulfite together with glucose is recommended. It is believed that as a result of the reaction of sodium hyposulfite with in- organic lead circulating the body insoluble lead sulfide is formed. In addition, the capacity of sodium hyposulfite of increasing the antitoxic function of the liver and of favor- ably influencing the oxidative and metabolic processes is taken into account (V. M. Chernov). In the cases where sympathetic nervous system symptoms are manifested to a considerable degree, stimulants are used (corasole, caffeine, phenamine [amphetamine sulfate)). Vita- min therapy is also indicated (ascorbic acid and vitamin B1). In all stages of this condition the restoration of regular sleep (protective inhibition) is of special importance. With this aim in view, various members of the barbiturate group affecting chiefly the subcortical area (luminal, medinal [sodium barbital], nembutal, hexobarbital and sodium amytal) can be used. Magnesium sulfate (intravenously in a dose of 614 Declassified in Part - Sanitized Copy Approvedf Rel ? -Yr /04/07: - P81-0104.f1PnnqR Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 the area of the third yentrical and basal ganglia. De- structive changes of necrobiotic character are possible. Perivascular hemorrhages are observed also An the area of the cerebral peduncles and pons. Similar changes are noted in the cerebellum and medulla. Considerable changes of des- tructive nature lead to a disturbance of the cortical con- nections with various parts of the central nervous system, which is responsible for the unusual nature of the symptom- atology, (A. A. Kevorkiyan). In addition, morphological changes are noted in the myo- cardium, kidneys and other organs. Mechanism of Action of Tetraethyl Lead. The fate of tetraethyl lead in the body remains unclear at the present time. It is well known.that.tetraethyl lead circulates in the body in an unchanged condition for a very long time, and then can undergo a transformation with the formation of in- organic lead. The greatest quantity of lead is found in various parts of the central nervous system: in the medulla, thalamus, red nucleus, cerebellum, etc. Such a specificity in the distribution of tetraethyl lead is probably induced by its lipotrophic nature. I. G. Ravkin notes that tetraethyl lead penetrates readily through the hematoencephalic barrier and involves primarily the cells of the brain. Somatic disturbances observed after the intoxication are considered by the author to be secon- dary and he associates them with a functional disorder of the central regulatory mechanisms. Disturbances in the cerebral cortical functions in various stages of the toxic process produced by tetraethyl lead have also been found by L. S. Gorshyelyeda. Prophylaxis, Fist Aid and Treatment. Prophylactic meas- ures and properly organized working conditions are of great importance in the prevention of tetraethyl, lead intoxication. With this aim in view defects in the operation of apparatus used in the produption of tetraethyl 7,ead should not be per- mitted, the air conditioning system of the working rooms should be operated continuously, and all workers should be supplied with overalls and special clothing (gas mask, rubber gloves, ,bpots, etc.) and with solvents (gasoline, alcahol, kerosene, .and others) for washing their hands. After work ???? ? 2 to 10 ml in the form of the 10-25 percent solution) exerts a favorable effect in the sense of reducing the excitability of the central nervous system. The use of glucose in com- bination with magnesium 'sulfate is desirable. Treatment of patients who are in -a state of pronounced psychomotor exci- tation requires special attention, because they frequently refuse medicine and food. It is recommended that such patients be given hexobarbitol intramuscularly .10 percent, 10 milliliters, which produces sleep, during which the patients should be given magnesium sulfate, glucose, ascor- bic acid and other symptomatic agents intravenously. When the patient awakens he should be fed; if he Will not take food .he should receive sodium chlOride intravenously (10 percent, 10 milliliters) which increases the appetite and the thirst. With the aim of increasing the appetite and also of reducing the excitation insulin (5-10 units) may be given subcutaneously with the subsequent administration of glucose. A properly organized routine and diet are of great importance Amthe treatment of the patient. PHOSPHORUS INTOXICATION- In military-chemical practice phoRphorus is used as a smoke-forming and incendiary agent rather than as a CWA. Two varieties of phosphorus exist in nature, yellow and red. The yellow (white) phosphorus is of practical importance. Red phosphorus is sometimes simply added to the yellow phos- phorus for the purpose of a more prolonged and uniform com- bustion. Yellow Phosphorus, is a waxy substance of yellowish Color, a specific gravity of 1.83, a boiling point of 2800, and a temperature of fusion of 44.5?. It is practically insoluble in water, but readily dissolves in carbon disulfide; it dissolves somewhat lesser extent in fats and lipoids and also in gasoline, In air phosphorus reacts with oxygen, as a result of which it ignites, forming a yellowish-white smoke on burn- ing (phosphorus pentoxide--P20+ Later, the phosphorus pentoxide (phosphoric anhydride is converted to phosphoric acid (H3PO4) through its combination with the moist atmos- phere. Since it possesses the capacity of absorbing mois- ture, phosphoric acid gradually dissolves, as a result of which a fog is formed which consists of droplets of the acid in water (Yu. V. Drugov). This smoke does not exert any toxic effect on the body; only high concentrations of 6 5 Declassified in Part - Sanitized Copy A ease ? 5 - r 2014/04/07: CIA-RDP81-n nztqpnmsznnngnnr, Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 it can produce irritation of the respiratory tract. In the vapor form.phosphorus can exert a certain toxic effect on the body. However, the chief danger of the toxic effect of phosphorus is the possibility of its contact with open surfaces of the body or with the clothes in the form of hot particles, which leads to the development of thermal burns and for a general toxic effect; ? . When it comes into contact with the skin in the molten form on in a state of oombustion.phosphorus leads to char- ring of the skin. The effected area continues to smoke for a certain period of time (the oxidation of the still not entirely burned phosphorus). Afterwards, separation of the eschar occurs with the exposure of an ulcer which does not form a scar for a ,long time. Penetration of phosphorus in- to a wound surface complicates the course of the process and lengthens the 'healingperiods of the wound. A fatal outcome can occur ,soon after involvement as a result of a burn of a considerable surface of the body and as a result of develop- ing signs of general. intoxication.. The possibility of death exists even at a later time as a result of involvement of the liver, kidneys and other organs. In the mild forms'of'involvement,.the toxic effect of phosphorus is manifested. in the occurrence of headache, diz- ziness, malaise and other disturbances. The symptoms men- tioned disappear shortly. In the severe cases of involvement, general intoxication is expressed to a much greater degree: pathological symp- toms develop in the central nervous system (unconsciousness), in the cardio-vascular system (dilatation of cardiac borders, muffled heart sounds, arrhythmia, drop in blood pres- sure). ?., 66 Declassified in Part - Sanitized Copy Approved for R le General Information on the Biological Weapon and Principles of Anti-Epidemic Defence of the Population I N. Morgunov Basic Information on the Biological Weapon and Methods of Using It The problem of the possibility of using a new measure for mass attack agaimst the population--the biological .'weapon-- is being developed on progressively greater scales in the military plans of aggressive circles of certain foreign governments. The term "biological weapon" is not new. Hitherto re- ference was made to the bacterialogical weapon, assuming that only pathogenic bacteria--the causal agents of infec- tious diseases of men and animals--would be used. With the development of the techniques of culturing various viruses and rackettsiae in massive quantities the more or less real possibility of utilizing these biological agents as instru- ments of attack has also arisen. Apart from man and ani- mals, crops have been included among objects to be attacked with the aim of inflicting economic damage to the country under attack. In its turn this has involved the extension of attack measures to include the use of insect tests, (for example, the Colorado Beetle) fungi, etc. Naturally, the old terms--bacteriological weapon and bacteriological warfare-- are no linger suitable and have been replaced by broader concepts: biological warfare and biological weapon. The idea of artificial spread of infectious diseases among troups and population of an enemy for the purpose of -ailitary results arose long ago, in the pre-bacter- iological period, when nothing was known of the existence of causal auents of diseases out when the main property of the infectious diseases themselves was well known: that of spreadinc, extensively and rapidly among the population. Thus, fron the history of wars it is known thatin 134b dur- ing the siege of Kaffa oy the Tagars the latter through the Cadcvers of plague patients into the besieged city with the aim of causing a plague epidemic in the fortress and thereby brea'cing the resistance of its defenders. Plague which oe6an in the city actually forced the besieged fortress to lay down its arms. ? 50-Yr 0 4/ . - i-olo43Rnrnpn 67 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 A similar example may be presented from the history of colonization of the territory which-is now Mexico and Bolivia. In the year 1520 the Governor of Cuba, Diego Velksquez outfit- ted twelve ships With troops under the command of Panflio Norveza. There were cases of smallpox among the troops. The troops hung the infected clothes' out in the woods which were stolen by the Indians and thereby an outbreak of Smallpox was provoked. According to the data of contemporaries about three million persons died from Smallpox. The data concern- ing the number of those who died can hardly be considered 'reliable. However, from the point of view of the,possibil- ity of provocation of ,an epidemic this fact is undoubtedly interesting. The discovery of the causal agents of infectious diseases did not prevent attempt to spread epidemic diseases among enemy troops. Thus, during the Boer War the English troops during their retreat through the bodies of those who died from Cholera into wells dug along the main travel routes and which frequently were the only sources of water, with the aim of contaminating the water. During the First World War the use of chemical warfare agents was tested for military purposes. Along with the um of gasses attempts were made also to use a bacteriological weapon mainly for diversionary purposes (the infection of forces of the Rumanian Cavalry and the infection of chocolate with botulism toxsin). In 1915, the German spy Gragersen imported a culture of plague bacillus from the United States into Russia. This culture was brought from Arkhangeltsk to Saratov, where it was to multiply and then be used in Petrograd. This diver- sionary act was not completed, because the German spy Bler who had been put in charge of this operation was simultan- eously working for Russian Intelligence. In general, the use of the bacteriological weapon during the years of the First World Var did not give any percept- able results because "the bacteriological experiments ex- istina. at that time were undertaken with insufficient means", as the G.:rman military theoretician, Klotz, appraised these attempts. As a result of these unsuccessful attempts it became obvious that the utilization of biological agents as weapons requires the development of methods of'using them and of 68 AIL establishing the conditions under which this tYpe of - weapon is most effective. At the same time it was neces- sary to find new methods for the mass preparation (culti- vation) of various species of pathogenic microbes. During the period between the two orld Wars many reports appeared in the foreign press concerning the study of various problems in the application of bacteria in the bac- terial weapon. It was reported that microbes survive on the surface of a bullet when it is fired and in a shell after it explodes. German intelligence workers established the possibility of spreading microbes by spraying them in the air of the Paris subway, etc. The fact attradted'attention that there were no reports concerning works in'this direction in the Japanese press. However, as the Khabarovsk trial of Japanese war crimes showed, the' various aspects of waginE, bacteriological warfare were being studied most extensively in the Quangtung Army during these years. Two detachments were created in this army--number 731 (medical) and number 100 (veterinary). There were about 3,000 servicemen in detachment number 731 in addition to the various production rooms it had a special range for the purpose of testing various types of weapons, etc. As the investigation showed this detachment tried out the possibility of producing a plague epidemic in China among the population by dropping in- fected animals and fleas from airoplanes. An outbreak of plague confirmed the possibility of the mass artificial in- fection )f people as a result of "the research work" of these detachments many technical problems were worked out: accel- erated ,Iethods were proposed for the mass cultivation of microbes, multiplication of insects (particularly fleas) various rodents, and the most suitable types of bacteriolog- ical bombs, etc., were proposed. The rapid onslaught of tha Soviet Army prevented the use of pathogenic microbes during the Second World War and saved mankind from the terrors of biological warfare. Reports of the American Press attest to the exception- ally extensive scale which has 5een assumed for-preparation for biological warfare in the United States. Thus, apart from a special large bacteriological institution in C mp Dietrich, structures have been built which require the con- struction and production of special equipment, namely: 1) a nursery and research station in the State of Maryland (April, 1943); 2) a field research station in the State of Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07 ? CIA-RDP81-01043R003800050002-9 69 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 Mississippi (summer 1943); 3) experimental seats for prac- tical research in the field of mass production in the State )f,Indianna (beginning of 1944) and 4) a field research station in the Stateof Utah (summer 1944). Therefore, at least five special institutions were organized design- ed for the development of new measures of mass attack against the population. The application of biological weapons in Korea and in the northeastern regions of China are evidence of the extent of the work of these institutions. In a report of the International Scientific Commission on the Investigation of the Facts of Bacteriological Warfare in?Korea and China published in 1952, information is contained to the effect that causal agents of plague, anthrax, cholera, typhoid and dysentery were attested in these regions. Many inhabited places were subjected to attack: attacks investigated by the Commission were described in which the plague microbe was used in seven inhabited places of Korea and four inhab- ited places in China; oojects infected where the causal agent of anthrax were dropped on three inhabited places. In addition oention is made of the dropping of fleas and infected articles in the vicinity of military positions. The causal agents of intestinal infections were used for contaminating water supply sources; in Dai-dong Molluscs infected with the cholera bibrio were used for infecting the water; these were thrown into the river at the water-intake area of the waterworks. The water-purification structures (but not the waterworks) were destroyed by preliminary bombardment with demolition combs at this time. Material concerning the use of bacteriological weapons in Korea and China show that the most effective methods of attack were not used in a single case. Conversely, the bacteriological weapons were used under unfavorable condi- tions, by means of infecting unusual objects, etc. This gave us the basis for the belief that the bacteriological weapon in Korea and China was used in the form of "an experiment" which was masked by the unusual methods of application. Such an appraisal of the events in Korea and China is confirmed by the reports of Prisoner-of-War Colonel Schwebl, who was in charge of problems of bacterio- logical warfare in the American Army Staff. In his report he wrote: "The fundamental aim at that time (October 1951, the beginning of bacteriological warfare--i.m.) consisted in trying out various elements of bacteriological warfare 70 under military oonditions and then gradually eXpanding these military tests so that they might become a part of the regular military operations depending on the results obtained and on the situation in Korea". Such an appraisal of events in Korea is alse confirmed by a comparison with a research program in the .field of bacteriological war- fare given in a'large special article by Roseverry, former director of the Bacteriological Institution in Cump Dietrich. The problems whidh.were unclear to him were solved in practice in Norea, The movement of various peoples for peace has not stopped the preparation for biJloaical warfare, but has only con- cealed it further. Thus it is mentioned in a United Press report of November 1955: "A considerable part of the activity of the Chemical Corps (in charge of the development In problems of chemical and bacteriological warfare--i.m.) is considered hordble in its character and therefore does not find any support... Military circles have usually avoided discussing the question of chemical and bacteriological weapons in every possible way, partly for fear of interna- tional and internal psychological reaction". Nevertheless accordint, to a report of the Associated Press Agency, the Secretary of War of the United States, Bracker, ordered the Chemical Corps to carry on work in the field of creat- ing "new types of bacteriological and chemical weapons which only the human mind can devise". Evidently the moral evaluation of the idea of biological warfare expressed by the peoples of the world has not yet exerted a reliable effect on certain aggressive circles which want to make use of the characteristics and advan- tages of biological agents of warfare. Characteristics and Advantages of the 'Biological Weapon The biological and, particularly, the bacteriological weapon possesses the following characteristics which, at the same time, constitute its advantages. ? 1. The epidemic nature and the capacity of spread from a person directly affected to persons unaffected at the time of the attack. This chareceristic is associated with the infectivity of microbes and tne property of being trans- mitted from sick persons to healthy persons in the presence of conditions corresponding to the natural mechanisms of the transmission of the infection. Here, it is necessary Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07 ? CIA-RDP81-01043R003800050002-9 71 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 ZE;i4 to distinguish the time of infection during the attack, the time of artificial provocation of the epidemic outbreak from the further spread of the infection and the development of the epidemic itself. Artificial infection can be accomplish- ed through routes not characteristic of the given cause of organism under natural conditions. Thus a number of viruses and ricl:ettsiae can produce disease by entering the body through the lungs, although under natural conditions they are transmitted by blood-sucking insects. The development of the epidemic as such after a biological attack can be accomplished only in the presence of conditions correspond- ing to the mechanism of transmission of the given infection. Thus, in intestinal infection conditions are necessary which would contribute to the entrance of the infective material into the mouth (water, food, etc., factors); in the case of blood-borne infections, blood sucking insects--the natural vectors, etc.--should be present. As an example of the fact that it is necessary to dis- tinguish involvement at the time of the attack to further spread of the infection, one of the cases in North Korea may be related which was presented in the report of Interne- tional_Scientific Commission: One inhabited place with about 600 inhabitants was attacked at night. Animals in- fected with plague, on which fleas had fed which usually parasitize man (pulex irritants), were dropped. The nature of the attack was surmissed and prompt measures were taken in full volume. Only persons infected directly after the attack (50 persons) fell ill. As the result of the measures taken there was no further extension of plague. Therefore, there was an immediate infection but no further spread of the plague. In a similar case in the Province of Han'man (Northeast China) the nature of the attack was guessed almost immediate- ly and at midday the populati3n had aanilated all the field mice scattered over a territory of five by fifteen kilometers and also the dogs and cats which had caught the infected field mice. The attack was carried out in the winter and the animals dropped were either dead or half dead. This inter- fered with the rapid migration both of animals and insects. Under these conditions the measures taken rendered the' attack unsuccessful. In both these cases the mechanisms of natural transmission of bubonic plague could not be realized, and the artificially provoked plague outbreak in one case did not spread, and in the other even the infection did not occur. It should be noted that in both cases a complex mechanism 72 of transmission of the infection was used for the bio7 logical attack. It is natural that the effectiveness of such methods of attack dependto a large extent on the alertness and the operational efficiency of the sanitar.y- epidemiological institutions, the medical community and. the population which lives on the territory under attack. It may be supposed that other methods of attack (which will be dealt with in detail below) particularly the use of infection through the respiratory track, will oe able to produce a great direct effect: the number of those infected at the time Of the attack would be considerable. However, further spread requires the participation of natural mechanisms of transmission for the majority of in- fections. The tremendous experience of laboratory work with various infections (viruses, rickettsia and others) shows that the infection of animals through the lungs leads to the infection of a specific pneumonia. By analogy, this may be also expected in man. In this case the artificially produced infection in man would proceed in a distorted manner: Involvement of the lungs would be added to the usual course of the infection. Apart from the difficulties in clinical diagnosis, the super imposition of the air-droplet the route of transmission may be expected, which is not inherent to this infection under natural conditions. The epidemic nature of the biological weapon has been appraised by foreign authors as an indisputable advantage of it. Other forms uf weapons are designed for their direct effect on man. All types of firearms have no effect im- mediately after the attainment of their goal. The biolog- ical weapon esseatially just begins its effect after the primary infecting act: Further spread of the infection in the form of an epidemic may be added to the direct effect, which in itself can oe considerable. 2. The Opportunity of ,Rapidly Obtaining Large Numbers of Microbes. This feature is associated with the property of microbeo of the rapid multiplication. The capacity for rapid multi- plication is expressed in the bacteria. It is believed that division of the microbial cell occurs every thirty min- utes. Therefore, theoretically, 4 ? 1014. Individuals may be obtained from one..microbial cell in the course Jf twenty four hours. In practice, far fewer are obtained, which is associated with the particular rules and regulations of Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 73 Declassified in Part - Sanitized Cop Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 multiplication of microbes. Multiplication of microbes in a test tube proceeds irregularly. During the first few hours multiplication proceeds slowly (lag phase) and then a period of vigorous multiplication (logarthmic phase) occurs. After several hours of rapid increase in the number of cells a period occurs in which the number of microbial bodies in the nutritive medium remains at the same level (stationary phase), and then may even decrease somewhat, It has been shown that the relative equilibrium in the stationary phase occurs because of. the dying-off of cells, by.virtue of.con- ditions unfavorable for microbes which are. created in the culture fluid, Under ordinary cultural conditions accepted in laboratories (culture in test-tubes, flasks), microbes of the typhoid-paratyphoid and dysentery groups produce the suspensions containing concentrations of about two billion microbial bodies per milliliter of the nutritive medium. However, by changing the cultural conditions of the microbes it is possible to increase considerably the number of mi- cr)bial bodies per milliliter of. the medium (the so-called microbial mass yield). Thus, for example, by blowing air through the nutritive medium during multiplication of microbes in it, it is possible to shorten the time of the lag phase, and to lengthen the phase of logarithmic multiplication, and, by the same token, to establish the level of the statlnn- ary phase at a much higher point (30,000,000,000 to 6o,000, 000,000 microbial bodies per milliliter of medium). Here the total duration of the growth period of the bacteria may be short. It is not hard to imagine what figures may be obtained for the microbial mass. In very short periods of time under mass production conditions, it is known from the war crimes trial of the Quangtung Army that the produc- tive capacity of detachment 731 made it possible to culture 30,000,000,000,000,000 plague of microbes in one cycle, and these microbes grow more slowly then microbes of the colln group. In practice, it,may be considered that an unlimited number of microbes can be obtained in the course of a day or two. The situation is somewhat different tith regard to virus- es and rickettsiae. By virtue of their purely parasitic nature they can be grown only in living cells, which is attained by infecting animals or chick embryos. This to a certain degrae has limited the possibility of obtaining viruses on en masse. However, recently the technique of growing viruses and rick- ettsiae has been simplified considerably. Methods of grow- ing them in tissue cultures in rotating vessels have been developed. This improves the growth conditions of the 7)4 tissues, as a result of which the multiplication of viruses proceeds much more rapidly (two to four days), and there is no difficulty in obtaining them in large numbers. As an example of this we may cite the practice of mass preparation of the vacine against poliomyelitis, the virus of which is one of those requiring the greatest exactions and which are most difficult to culture. In relatively short periods of time such numbers of it were obtained that the vacihe prepared sufficed for the immunization of hundreds of thousands of children. Here it should be taken into con- sideration that the quantity of virus used for a prepara- tion ,f the vacine for a single person exceeds by many times the known infective dose of it. In other words, far fewer virus bodies would be needed for infecting a person then for immunization. Therefore, it is technically easy to obtain quickly the infectious material of viruses rickettsiae and particularly bacteria. This is not only a characteristic but is also an advantage of the biological weapon. Thus, as has been mentioned above, during one production cycle (maximum of three to four days) detachment 731 obtained 30,000,000,000, 000,000 plague microbes. Theoretically this quantity can suffice for infecting a population of 15,000 planets like ours, if we assume that the infective dose is 1,000 plague baccilli, (actually,to be sure, a smaller number is re- quired) 3. Cheapness of the Biological Weapon This characteristic, although of econimic nature, is still associated with the biological property of the causal organisms of multiplying on comparatively simple and cheap nutritive media. The cost of the dearest nutritive media (meat media) amounts in practice to the cost of meat, be- cause the remaining expenditures are exceedingly small. At the same time, it is possible that the nutritive media made be made even cheaper by the application of plant pro- teins, etc. Thus, for example, the cost of a single produc- tive cycle of detachment 731 obviously did not exceed 100,000 rubles. The cost of viruses can hardly be'much more, particularly if the growth is accomplished in tissue cultures. Thus, a total of about 2,000 eggs is required for obtaining one million doses of smallpox vacine from a chick embryos. Cultivation in tissue culture still further reduces the cost 75 Declassified in Part - Sanitized Cop Approved for Rel ? 5 -Yr 04/07. - P81-0104f1PnnqR Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 of such a quantity of vaccine virus. The cheapness of the biological weapon from the point of view uf certain foreign military workers is an excep- tionally important advantage of it. Thus, the American newspaper "Stars and Stripes" (dated 27 January 1952) in an article with a characteristic title, "Bacteria and Gas--the Cheapest Weapon" reported that the Chief of the Research Division of the Chema1 Corps of the Army of the United States, General Crissy had astated that this Weapon, which can be created, makes it possible td sohiev,e the greater effect with less expense then any otherof its forms. 4. Difficulties of Immediate Detection uf the Type of Biological Weapon Modern methods of laboratory diagnosis of infectious diseases are quite sufficiently developed so as to determine the type ,f causal organism of almost all diseases. However, they possess very essential short comings: First, compara- tively considerable time is required to make a laboratory analysis, even an orientative one, and, secondly, the major- ity of methods provides for the examination )f material taken from a patient and are unsuited to determining bac- terial contamination of environmental objects (air, water, various articles, etc.). It is sufficient to point out only these two shortcomings in the modern methods of labor- atory diagnosis in order to render obvious the difficul- ties in timely determination of the type of causal agent which has been used by an enemy. If we take into consider- ation the variety of species of causal agents of disease and differences in the methods of determining them, it becomes clear that the problem of the laboratory worker is a compli- cated one. This fundamentally distinguishes the biolog- ical weapon from the chemical and radiological weapons, the nature of which can be determined in a few minutes. The quickest methods uf diagnosis of causal agents of disease require several hours, that is, a time more then sufficient for the purpose of infecting a person with certain methods of application of the causal agent as a weapon. (For example, in the form )f an aerosol). Even in the case of a diver- sionary infection of iter of a time required for the in- fection would be less then that required for making a bacteriological analysis. This characteristic of the biological weapon is consid- ered a great advantage. 76 F '4L* not very strong and, i.n addition, is brief. There are no vacines against these infections. Therefore, the causal agents of two types of infections maybe used as a weapon: l) those against,which specific prophylactic agents exist and may be obtained; ana 2) those against which it is impos- sible to-immunize-people beforehand. ? As an example of the first type mentlon-may be-made of practically a whole group of particularly' dangerous infections (tularemia, brucellosis, plague, that is, abide from the pulmonary form, etc.)b AS an example of- the- secondtype of infection Roseberry men- tions the virus of dengue fever and others: It is important to consider this property of the biologi- cal weapon from the-point of view that it expands the pos- sibilities for.using it by an enemy who knows what type of causal agent is going-to be used and can therefore immunize the troops beforehand which are-designed for occupation of the infeated area. On the other hand, through the use of the biological 'weapon in the far rear or during a retreat, the enemy ban'utilize such-infections for which it is im- possible to create' an inoculation immunity, which consider- ably complicates the matter of combatting them. The pos- sibilitied of regulating the species of causal agents used constitute an -important- advantage of the biological weapon. 7. The Possibility of- Combined Application of Various Causal Agents Existing classifications of pathogenic microbes group them according to definite biological features (morphologi- cal, cultural, biochemical and others) which are common to various numbers of the different species. Epidemiological classifications of infectious diseases at the same time croup the causal agent in accordance with features important in an epidemiological connection. Thus, L. V. Gromashevskiy has made the mechanism of transmission of infection the basis for the most generally accepted epidemiological classification; this feature is closely associated with the localization of the infection. Here, in the same group there may be causal agents which are biologically completely unrelated to one another (for example, the diphtheria bacilus and the measles virus), but which are transmitted from person to person in the same way by the air-droplet route. The classification of microbes is extremely important and is necessary for prac- tical work. It facilitates the identification of microbes or the determination of the nature of the anti-epidemib mea- sures of general character (in connection with all the causal 78 Declassified in Part - Sanitized Copy Approved for Release 50-Yr 2014/04/07 ? CIA-RDP81-01043R003800050002 q Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 ^ 5. The Presence of an Incubation Period Diseases on a large scale and even individual.cases,,do not appear immediately after .the application of the weapon but rather a certain time Interval later, which .is equal to the average incubation period and loWer limits of the incubation period characteristic of tile causal agent used... This also, applies to characteristics, of the tdological, weapon.. De- pending on the problems pursued by the enemy:, causal agents of diseases can be used Which haye various Incubation per- iods. This charcteristic of the biolo.gicaI.weapon,is.the basis of two important facts: 1) in certain infectious dis- eases man, is contagious even in the incubation period and can contribute to the spread of the infection if no isola-, ting measures are taken and 2) during,the,incubation period, particularly with a long (several days). latent period,. _con- siderable movement and ,"mixing" of.individual,persons and even of groups,from the area of contamination may oecur , with the healthy population which had not, been exposed to the attack, and this. may be included in the enemies plans. In other words, the presence' of an incubation period can, contribute to the manifestation of a fundamental characteris- tic of the biological weapon--its property of spreading among the population, its epidemic nature. In this sense, the pre- sence of an incubation period is an advantage of the biologi- cal weapon. This fact should be kept in mind in determining the anti-epidemic measures to be taken 'in inhabited places where an attack has occurred. It should not be overlooked that in many infections, the causal agents of which .may be used, the incubation period may be shorter during infection en masse than it is when the disease occurs naturally. This possibility is particu- larly probable with the use of biological agents in the form of an aerosol thereby the causal agent will enter the body, missing the most powerful defensive barrier adaptations. 6. Possibility of Creation ,of Artificial Immunity As the result of having had many-ipfeCtiou's diseases a resistance (imMunity) to a given causal agent occurs in the body. This protects against having the disease a second . time. Immunity of greater qr lesser duration can be created artificially by means, of immunizing people with vacines or toxoids. A number of. infections, including those the causal agents of which can be-applied in biological,warfare, either do, not leave any immunity after them or else the latter is 77 Even though far from all of the causal agents can be utilized for the purpose of an attack, the advantage of the biological weapon is obvious in this connection. 8. As One of the Characteristics of the Biological Weapon associated with biological properties of the causal agent mention is made ,of retroactivity, that is-, the capacity of spreading to Involve 'the troops of the side which used the biological weapon. It was ,believed that this limitiapplica- tion of the Weapon. What has been .said above, is 'sufficient to make clear how litt:le this characteriaqc ?can influence the decision to' use biological agents aa weapons. Possibil.ity, of preliminary immunization of troops, the existence.of powerful disinfection technique, and the adop- tion of general preventive measures for the protection, of troops in accordance with tha type of causal agent which, to be sure, is well known to the side which used it consider- ably decreased the significance of this characteristic of the biological weapon. 9. The Biological Weal3on Affects Only Persona who are Sensitive to it, Without involving those who are resistant and without inflict-ing any damage on structures, Industrial enterprises, routes of communications or on the means of communication,. which can be utilized immediately oy an enemy. This characteristic to a certain degree is inherent in poison gases and radioactive agents also if the use of the latter is not connected with the application of explosive bombs (atom, hydrogen). Great importance is ascribed to the absence of damage to the means of production in the agressive plans of certain circles. Thus, according to a report of the United Press Agency mentioned above, General Crisy "ex- plained" that weapons containing pathogenic bacteria, poison gases or radioactive agents would make it possible to des- troy enemy without destroying his economy. In a report of the Associated Press Agency it is mentioned that United States Secretary of War tracker called for emphasis on the investigation "of the ,problem of how to suppress an enemy without destroying ?equipment which the victor might wish to keep". 10: The Powerful Psychological .Effect Exerted on the Population by an Attack using Biological Weapons is also Highly, Evaluated, ,According to an enemy's calculations, fear of,infectious diseases leads to panic, to mass flight, which,not.only complicates the task of eliminating the after Declassified in Part - Sanitized Copy Approved for Release ? 50 -Yr 2014/04/07 ? C 80 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 agents of variout groups): Howeverrvarious groupings of diseases do not mean that the individual speciet of microbes do not have their own specific characteristics which require special measures to be directed against them specifically. If we .exclude the most 4,,eneral_measures 'directed,.against some group of microbes' in the 'epidemiological classification, it follOws that a person can._essentiallcr. be affected by . any representative of, this grOup even in the- event protective measures are taken against one of them'. For example such a general measure for air-droplet' infections is the orotection of 'the' respirator/ 0114am-from ehtrance,of.the-lnfective nidus into them (mask, gas masks, shelters). However, in the absence of this measure a person is guaranteed against only those diseases to which he hs an immunity. In some cases, there are varieties (serologic types) within the limits of the-same:specie& or microbe,- 'anti iMmunity has to be created to each of these in order to prevent the disease completely. This characteristic oP biological aliens brings about an extensive possibility Of changing their sequence and combining them, substituting one species by another, one microbial association by another. Only the method of ap- plication can serve as -a factor limiting the frequency of replacements and combinations of agents:: Thus, there are certain causal agents with which it is impossible under any conditions to produce disease when used by mouth (for example, typhus). Evidently, the infection of food products or water with these causal agents would have no sense. We must con- sider that infection through the respiratory passages is not possiJle with all microbes either. In this case, spray- in 6 them into the air does not always achieve its purpose either. Therefore, each route of infection and every method of application will have its own group of causal agents within the limits of which changes in sequence and combin- ations can be accomplished. Such a grouping of causal agents cannot coincide with the 'usual epidemiological group- ing in the form which has been adopted, for example, in L. V. Gromashevskiy's classification': Organisms which can pro- duce infection after entering the body throligh various routes (for example, the organisms 'of tularemia, anthrax) constitute exceptions, and therefore-, they can be used in combination with microbes of several groups. -In order_to imagine what possibilitiesThlay beobtained from this characteridtic of_the_biological,weapon_it is..,, enough to say-that in his expanded'-grouping L V.'Gromashev- Skiy lists more than 100 infectiohs[andN. M. Zhdanov has listed 1,340 infectious diseases'as:nosologic entities. 79 - The morbidity rate from the direct infection will be more or less depending on which of the objects mentioned is in- fected. Thus, when water-supply-line water'is infected cases of 'disease will be found in larger numbers on teriiitory which is supplied by water from water mains from the site of infection to the terminal water network. A number of factors would limit the scale of involvement of the population when water is infected'. Thus, the exis- tence of residual- bhlorine in the water would to a certain degree. disinfect-the Water, and in the event- of infection of open water sourcesthe'normal operation of:water7purifica- tion equipment would apparently completely: prevent the en- trance of infected water into the water-distributing net- work. Infection of the water in the. large main lines (water conduits) with a small number of microbes would hardly giye any significant effect by virtue of the great dilution of the. The infection'of food products can also lead-to a con- siderable morbidity rate, particularly in a system of com- munity nutrition,when mass consumption.products are infec- ted. However, the outbreaks from food infection are usually smaller (compared with those from water) for a number of reasons: difficulties in infecting a very large quantity of food products, death of the microbes in acid products, after thermal processing etc. Naturally an enemy would take into consideration the con- ditions which would reduce the effectiveness of the attack. Particularly, utilizing the property of variability and ready adaptability of microbes, those microbes can be used in which an increased resistance to chlorine or to food product preservatives, etc., has been elaborated. Therefore, it is very important that under exceptional circumstances the population resort as much as possible to thermal proces- sing of all food products and water used. The possibility of infecting the air as a diversion method has been proved experimentally: German intelligence agents used the Bacillus prodigiotus for infecting the air of the Paris subway, through the currents of which the microbe was carried to neighboring subway stations. However, the impossibility of :using large-volume apparatus, the danger of immediate detection, the comparatively small concentra- tion of people in public buildings, where the air infection may be anticipated, limit the number of primary cases of 82 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07 CIA RDP81 01043R00380nonnn9 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 effects'of the attack and..not only renders difficult the giving of aid to patients (administration of sera, antibi- otics, etc.) but.would also 'contribute to the spread of in- fection on-the territory which'had not been exposed,to,at7 tack. From the point of view of the proponents of biological warfare, the exceptional variety of means of using biological weapons; practically without the aid .of explosive agent,.. and the possibility of spreading them among the popillation long after the attack determine the, advantage of this method not only over the USual forms of weapons but,alse,put it in first place compared with other forms of mass-attack weapons. This is the evaluation of biological weapons given by,ag- gressive' circles of certain countries., Methods of Attack and Methods of Application of the Bio- logical Weapon. Of the characteristics of the biological weapon mentioned we are particularly interested in those pro- perties which should be taken into consideration in the or- ganization of defense of the population against attack. Since these measures are of different character, depending on the methods-of use of biological weapons a description of the latter needs to be given if only in its general features. Up to this point it has been useful to throw light on the probable methods of infecting a locality, that is, the methods of attack. These two concepts are not identical-although they are often used as equivalent. As methods of attack should be understood those technical measures and methods which an enemy can utilize for effect- ing a locality or individual objects on the territory of the side being exposed to attack. The probable methods of attack may be judged on the basis of the history of bacteriological warfare, taking into con- sideration the sparse information which has penetrated into the general press concerning the "research" work in this field. During the First World War the onIyiwthed of bacteriolog- ical attack was diversionary. Evidently the application of this method will exist in the future. The diversion maybe accomplished by infecting either the water or the food pro- ducts- and fodder, or the air. Declassified in Part - Sanitized Copy Approved for Release ? J? infection. Taking into consideration that.for.the.purpose - of the subsequent spread the air-droplet mechanism of in- fection is the most favorable one, the fact that only a small number of persons are initially infected does not exclude the possibility of application of this method of diversion. During the period between the First and Second World Wars it was shown experimentally that.even microbes that do not form resistant spores readily tolerate the zonditiona which are created from the use of firearms. Microbes have survived in an artillery shell, particularly of .the shrapnel type, and even on the surface of a bullet. This has-given' us.the basis for the expectation that biological agents can 'also be carried by artillery shells, At a comparatively short distance the ejection of mibrobes is'passible:by means of mortars. Recently long-range rockets .have also been designed for this purpose. It should be considered that only local'and focal,areas of infection can be created by this method. To be sure, with planned firing the number eft-these areas,.can be great and can extend over a comparatively large distance. The use of special artillery shells, etc., very much com- plicates the rapid recognition of the fact of an attack, because these shells can constitute only. a.certain small portion of- the shells ordinarily used which would mask the use of the biological weapon. However, with adequate alert- ness on the part of the observation service these shells can be detected rapidly by the character of their explosions, etc. The application of artillery weapons can be combined with such species of microbes-the independent uae of:which would be senseless. Among these microbes are the entire group of causal agents of the wound infections. .The infec- tion of fragments formed from the explosion of shells con- taining the causal organisms of gas gangrene makes the lat- ter suitable for application as a weapon. At least, such a combination has been considered in Japanese military circles to be completely acceptable, as was shown during the trials of the former Japanese soldiers (khabarovskiy trial). Because of their large volume and other features, long- range rockets can be utilized for the carriage.of any species of causal organism. The use of artillery shells makes it. possible also to combine chemical warfare agents with various causal organ- 50-Yr 2014/04/07: CIA-RDP81-01043R0MFinnnnnn9_a 83 Declassified in Part - Sanitized Copy Approved for Release 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 - isms of .disease'. ? ? As the events in Korea and North China have shown, the moat "Common method of attack would Obviously be from air- craft. The use of airplanes as means of attack. has many advantages. First, the airplane can reach inhabited places which are located in the far rear. Secondly the airplane can transport any kit-0 of.causal agents. Thirdly, the carrying capacity of airplanes makes it possible to trans- port' the infectious material in a quantity sufficient for in- fecting large areas, Fourthly, various methods of applica- tion of biological weapons can be realized by: the use of an airplane, which: will be considered below. In principle, any bombing plane can be adapted for trans- porting biological weapons. However) by virtue of .the char- acteristics of design, certain types of airplanes can be more convenient, and they would be used more often for these purposes, According to the American prisoner of war, Colonel Schwebel, during the war in Korea various types of airplanes were tasted (VMF=5131 B-26, All;? F4US, F7F, F9F, Panther, etc.) with the aim of .determining those most. suited to biological attack. Therefore, taking into consideration the types of enemy airplanes during an attack may very quickly reveal which of them are being used chiefly for purposes of bio- logical warfare. Afterwards, these data may prove to be very useful as one of the features of application of bio- logical warfare. Airplanes may be utilized either for the direct spraying of infectious material from reservoirs, or for dropping var- ious types of bombs and containers. The possibilities of spraying an infectious mass from air- planes can be evaluated only by analogy with the practice of using toxic chemicals for combatting agricultural pests and the use of mineral fertilizers in agriculture. It is well known that this method .has been widely used for combatting malarial mosquitoes where their breeding areas (marshes) were large. Up to one ton of infectious material can be sprayed during a single airplane flight. -It is hard to say which types of bombs and containers would be used. Undoubtedly there would, be several of them depending on the nature_ of the infectious material. Inci- dentally, the possibility of application of biological weapons. by means of the most diverse bombs and containers, 84 including those which have been designed for other purposes, has been appraised-as one of "theadvantages p,f)-biologidal, weapons in the foreign press.. Thus, tor ,example, containars used for carrying propaganda leaflets have proved to be (late suitable. Therefore, biological warfare in Korea has been designated by the terml"super propaganda". A list issued according to the data of.the International Scientific Commis- sion on the investigation of the facts 'of warfare in Korea and China gives us an, idea of the variety of bombs and dontainers. From the description of eye-wit- nesses from preserVad evidence and from the reports of 'cap- tive fliers informatioh is available concerning the follov. ing types of bombs and containers, , ? 1. Air-burst bomb for leaflets with -a time fuze. It has a length of 1.4-meters and a diameter.of 40 centimeters. The shell casing la made of steel,-three millimeters in thickness; the volume is 72 liters. Therefore, its dimen- sions are approximately the same as those of the 250'-kilogram bomb, but its weight is equal to,75 kilograms. On explosion it covers an area of 200 x 100, meters. 2. Air-burst bomb for leaflets supplied with a propeller. After a definite number of revolutions of the latter an ex- plosion occurs. !this type of bomb was described by the cap- tive fliers. 3. Glazed-porcelain bombs 50-80 centimeters in length. This type of bomb was developed in detachment No 731 of the Japanese army. They were designed for filling with microbe cultures. U. The bomb known by the name of "egg shell" is a variety of the preceding type. It has very thin walls which after an explosion or even simply from the shock of hitting the ground smash into very small pieces which leave practically no trace at the site of hitting the ground. 5. Bomb (container) for leaflets which has little doors and a propeller. The latter actuates a mechanism which opens the doors. It was used for dropping insects. When supplied with a parachute it is suitable for dropping rodents. 6. Bomb (container) for leaflets which opens from the shock of hitting the ground. It is supplied with a para- chute. Suitable for dropping, insects and rodents. 85 Declassified in Part - Sanitized Copy Approvedf Rel ? -Yr2014/04/07: - P81-0104.f1PnnqR Lr. 71 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 7. .14on-teilosive,articles and paper containers of cylin- drical shape length 20 centimeters, diameter-10 centimeters) or in the form of packages (10.x 10 x 3 centimeters) for pack- ing insects. 8. Paper or ,cardboard cylinder-with a parachute: In its external,appearance it is similar to. an illuminating flare. Its'Yength is 36 Chtimetersiits diameter is _13 centimeters. Diameter of the parachute is 70 centimeters. A container of this type has been-used.for dropping insects which cannot tolerate a strong impact (mosquitoes, etc.): 9. Paper container with pa_per.parachute. It has ballast and a fuze which burns the container at the proper moment. 10, Other types'of containers:-Cylindrical containers made of wire netting, wooden boxes, etc. supplied with para- chutes. Designed for dropping rodents. It may be considered that this list does not exhaust the types of containers. .However, it does give us an idea of their great variety, which should be taken into consideration in intelligence work. Evidently, balloons can be used for carrying out an air attack; the movement of them is not regulated but their lo- cation is established by means of radio. The carrying cap- acity of the balloons is quite great (up to 600 kilograms), and they can be utilized for the transportation of bombs, containers, etc. It is not hard technically to drop these bombs on inhabited places over which the balloon is travel- ing. This method of attack is essentially no different from the use of airplanes, except for its lesser degree of accuracy in dropping the bombs. The methods of application of the biological weapon can be various. They are determined by which route of infection is being used for attacking the population: the respiratory organs, gastro-intestinal tract or skin. Infection through the respiratory organs is possible only by infecting the-air:' Infection of the air can be accom- plished by spraying infectious material. In practice this can be achieved by .the use of aerosols of .a microbial mass. The spraying of a bacterial culture in large droplets, like rain, cannot produce any great effect, because these drop- lets rapidly settle. The characteristic feature of aerosols 86 -11 is-their comparatively long stay in the air. The stability of aerosols depends on the size of their particles. The maximum size-of the aerosol particles does not exceed ten microns (one-hundredth of a millimeter). Larger .particles rapidly settle, partiOles smaller than ten microns stay in the air the smaller they are. The size of the pathogenic microbes of various species ranges from 0.3 to 3 microns. Viruses-conatitute an exception; their maximum size is equal to 0.2 to 0.25 microns; the majority of viruses are much smaller. . Therefore, if aerosol particles consist of solitary microbes they will remain in the air for a long time. Particles containing virus are practically of the same size, because their mass includes tissues on which the virus has been grown. Many other factors exert an influence on the length of stay of the aerosol in the air. Thus, movement of the air (wind) retards the settling of the aerosols. Air currents from heated ground also prevent sedimentation of the aerosols; if the air currents are great, for example, on a warm day,the particles of the aerosol can be carried upward. With a marked drop in the temperature, water vapor can condense on the aerosol particles on account of which an increase occurs in the size of the particles with a rapid sedimentation of them. In the absence of the effect of high temperature, movement of the air or condensation of moisture, the aerosol particles settle at a speed of several meters per second, depending on their size and the density of the mass, that is, on their weight. A concentrated suspension of microbes and liquids (liquid nutritive media, buffer solutions, etc.) or desiccated microb- ial masses can be used for spraying the infectious material. In the former case, the aerosols have the appearance of a fog; in the latter case, of a smoke. Each of these materials has its own shortcomings and advantages. Thus, in the liquid culture the number of viable microbes is greater than in the desicaated material; however, the period of viability of it is limited. On the other hand, the.desiocated microbial mass can be preserved for a_comparatively long time and does not require sUPh strict ' maintenance conditions 'as does the liquid culture, beaausd?in the desiccated state.the.microbes are much more resistant to- the harmful effect of external factors (temperature, light, etc.) which is important also for the preservation of them in the environment after the attack. The 87 Declassified in Part -Sanitized Copy Approved for Release ? 50-Yr 2014/04/07 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 tnt fact that infection is more readily accomplished by droplets then by dust particles is one of the.advantages of the liquid culture aerosols. This is very important.. H wever, this advantage can be smoothed over by fine grinding of the dry mats; because the aerosol particles which are equal in size to microbes practically.reach the alveoli With the inhaled air, and there infection occurs. The fact mentioned above can be of importance for larger particles (five,to'ten micrones or more) which settle in the bronchi and upper respiratory passages: Large particles of the drST mass would irritate the tissues, producing a cough, sneezing or would be expelled by the ciliated epithelium. The desicated microbial mass, hoWever, which -can readily be converted into a powder has still another advantage: In this form the biological weapon can be used in all three methods, of attack, whereas the use of an artillery weapon is obviously impossible for a liquid culture. The use of the 'biological weapon in the form of aerosol would perhaps be most prevalent for a whole series of reasons. First, infection through pulminary tissue is a:ccomplished much more readily not only by causal agents which affect the respiratory organs naturally but also by the causal organisms of other infections. Thus, under experimental conditions mice are readily infected with a Rickettsia prowazeki through this route. Roseberry and Cabot, on the basis of an analysis of thirty-four laboratory cases of yellow fever infection (fatal in five cases) came to the conclusion that infection was accomplished most probably through the inhalation of desi- cated and pulverized virus. Mosquitoes could have partici- no more then a few cases. Secondly through the use of aerosol it is possible simul- taneously to infect the maximum number of persons who are in the area of infection. Practically everybody who doesn't Use :one of the various methods of protection whb has breathed infected air can be infected. Thirdly, infection through respiratory organs in 'certain infections is accomplished also in those .cases where there is a considerable degree of immunity manifested to the other routes of infection. Thus, innoculations,against 'plague protect against its 'bubonic form, are inaffective for an in- fection through the respiratory organd. 88 ? .e . 4 Fourthly not only the direct infedtion of people but also of everything which _surrounds people i8 achieved by the ' use of aeroso?ls. _Thus, .even if through the Use, o'f a mask a person has avoided direct ingection, he is 8till,threatened by infection from clothes on which aerosol pa'rticles has settled while he was in the contaminated area, and which - were not disinfected in time; he is threEvtened by infection from objects in his apartment if the latter'was.ncet sealed off and if disinfective.measures were not taken in it;. and from food products and watei; which were 'not protected against the entrance, of infectous.materihl.into .,them and which were' - not destroyed afterwards,,etc.. .. ? , Fifthly, not only people,but'alSo animals the causal ?agent,used?can.lpe affected by, the aer:pstiis and, these latter can be, additional sburCes,of-infection. In, the cases of certain infections (plague', tularemia) such animals may be rodents (rats,- mide, etc.) which are reservoirs of the infection under natural conditions.. If measures are not taken on time for their annihllatloh ('complete deratiza- tion) the population of the involved locality will constant- ly be under a threat of-occurrence of the result of the previous attack. Therefore, the use of the biological weapon in the form of an aerosol can activate additional sourdes of infectionof people which are characteristic of other methods of applica- tion of this form of weapon. Infection through the gastonal.intestinal tract.may be accomplished first of all through the-,use'of'food products and water contaminated by pathogenic microbes for food or for drink. Other situations are possible: Swallowing ? sprayed infectious material with the saliva, that is, mater- ial which has settled on the nose and in the throat. Swallow- ing microbes which are on toys, niters, etc., and which have been taken into the.mouth. However, the latter cases would either be of exceptional rarity' or else would be characteristic of special categories of the population, with respect to which an enemy would hardly, orientate himself. , For example, in order that infection Occur hy beans of 'swallowing particles which, have settled on the upper respiratory passages a 'causal agent would have to be used of one of thea intestinal infections in the form of an aerosol with very large particles. Other- wise an infection would not occur Vy this route'. The use 'of such aerosols is not expedient (rapid settling, poor penetra- tion into quarters, etc.) 89 Declassified in Part - Sanitized Copy Approved for Release ? 50 -Yr 2014 .UlA-RDP81-0104pnft . r- Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 In contrast to what has been mentioned for the respir- atory organs, infection may be accomplished through the diges- tive tract only in the event causal agents are used which naturally affect man by this route. ' It is impossible to produce a disease through the enteral route by other causal agents All these constderdtions permit us to expect that the use of the biological'weapon for infecting the population with.iptestinal infections is possible only by means of contaminating water ahd food productwith pathogenic microbes. Evidently this method of applicati:On of'. the biological weapon is most readily conbined with the diversiOnary?method of attack. The use qf them in,the form of aerosols might be expected in the case of 'certain infections, like, for example, tularemia, anthrax, Q-fever', that is, 'those whiah affect man by seVeral routes. The existence of reports in the litera- ture of the possibility of utilization of aerosols for infec- ting food products and water with microbes of the colon group causes us to take this method of attack into consideration also with the aim of infection through. the digestive tract. Naturally, such a' situation obliges us-to protect the water, provisions and fodder not only against a diversionist but also against possible contamination of them by aerosol particles of infectious material (sealing of storehouses, food enterprises, means of transportation, etc.). This pertains particularly to food products which are not subjected to thermo- processing at home (bread, sugar, non-alcoholic beverages, etc.). The skin is the most powerful human barrier. Evidently the methods of application of the biological weapon described above would be inadequate for producing infection by this route. Infection through the skin occurs in two groups of infec- tions (according to the L. V. Gromashevskiy classification): In blood infections and infections of the skin. In the former case if the integrity of the skin is violated by blood sucking insects which are vectors of the infection, and the infective nidus enters the blood or lymph. In the latter case, the inte- grity of the ship is 'violated either mechanically (wounds) or as a result of animal bites, because of which the causal organ- isms 'miss the' barrier and the further course of tha infection can, be most varied (is enough to compare the caurse of rabies, sodoku arfq.gas.gangarene). ' The mechanisms orf infection indicated above obviously pro- 90 vide methods of application of the 'biological weapon in the case of infecting people through the skin. At least, the information which has broken into the press concerning methods of waging biological warfare which are being developed give evidence of this specifically. Thus; it may be seen from the material of the Khabarobesk Trial -that dn Detachments No 731 and No 100, methods were being actively developed for artificial multiplication of fleas and'dnfection of them under laboratory conditions t 'After that, an outbreak of plague in China was provoked by scattering infected fleas. In Detachment No 731 "experimente-were carried out in which people were'infected through the-Combined use of fragmentation bombs and various causal organisms of disease. These."experT. iments" confirmed, so to speak, the possibility of combining artificial infection with mechanical injury of the akin. . According to the data of the Internationational Scientific Commission on Investigation of Facts of Bacteriological War- fare on the territory of the Korean People's Democracy, a number of inhabited places were exposed to.biological attack with the use of infected fleas or infected rats, and in which there were many human fleas (Pulex irritans), obvious- ly with the aim of excelerating a transfer'of the ecto-para- sites to their natural biological host-, man. The possibility also exists of mass infection of the soil with spore-forming microbes and primarily'with anthrax spores. Hereby, a double aim may be pursued: Infection of animals in pastures and infection of people duringthe performance of various agricultural duties associated with a large number of --ell treomata (thorn bricks, abrasions, etc.) which as a rule remain unnoticed. Therefore, it may be supposed that both mechanisms of transmisaion of infection have been taken into considera- tion in the development of methods of application of the biological weapon. They would obviously be combined in a certain way with the methods of attack. Thus, the use of causal agents of infections of skin capable of producing di- sease after entering injured tissues (tetanus, gas gangrene, etc.) is readily conceived of only 1n combination with artil- lary fire. It would be senseless in an airplane attack.. On the other hand, the use of infected insects'is-conceivable only from airplanes and then in special containers, but is impossible through artillary fire. The infection of large areas of earth in which the grass on it and the crops are to be preserved also determines the method of attack.,. Obser- 91 Declassified in Part Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 vance of these conditions is possible only through the use of airplanes. In analyzing the question of the methods of applica- tion of the biological weapon the fact should not be over- looked that the use of combined methods of attack may be ex- pected. The biological weapon permits the most varied combina- tions. First of all, combinations of various biological agerts. are possible, and these in combination can produce infections with a more severe Course and tith a greater mortality rate. In addition, the use of causal agents of infections using various mechanisms of transmission is:possible,:which makes the success of the attack more probable. Finally, the com- bined use of causal agents can be .carried out .for the purpose of deceiving the country being attacked, which leads to an incompletness of the measures taken on account of the complex- ities of etc. The effectiveness of the attack, therefore, can be'sharply increased thereby. The combined application of various species of micro organisms should apparently be kept in mind always. This by far does not exhaustthe possibilities for the combined use of the biological weapon, however. Combinations of biological agents with various chemical warfare agents and radioactive subPtances are possible, that is, the com- bination of two or three various mass-attack agents. A combination with chemical warfare agents can pursue the purpose of facilitating the penetration of microbes into the organism through the tissues entered thereby. To be sure, the course of infection would be complexified, there- by, which always occurs in a more severe form in persons who suffer from some other disease. Naturally, the combina- tion of various microbes with chemical warfare agents is pos- sible only under conditions where the latter do not destroy the microbes themselves. The combination of biological agents with radioactive sub- stances is no less probable. Radioactive emination, as inves- tigations of recent years have shown, does not affect the growth, multiplication, or pathogenic properties of causal organisms of various infections. Microbes grow just as readily on media containing radioactive substances as on ordinary nutritive media.. It has been shown that radioac- tive isotopes of chemical element are assimilated by the micro- bial cell and are included in the composition of the substance 92 of which the microbial body is constructed without stop- ping or altering its activity. At the same time, the radio- active emination has an essential influence on the bodies of animals and of man. Regardless of the manner in which the body is'exposed to the affective radioactive substances, through external irradiation or through the entrance of these substances intd the-bddy, a marked decrease in the activity of the natural defence mechanisms is noted in both cases and 'obviously to the greatest extent with respect to their barrier functions. It has teen 'noted that the most threatening com- plication of radiation sidkness is the development of infec- tion. As the rebult'ef involvement of barrier and appar- ently of the phagocytic mechanisms the disease .can be pro- duced even by ordinary microflora of the intestine which are not pathogenic to the adult person. When the pathogenic microbes are present in the surrounding medium, it may be expected that the infection would occur more rapidly. It is possible that a comparatively slight degree of involvement of the body by radiation is sufficient for making penetra- tion of pathogenic microbes into the body easier. In additioAo the fact that radiation sickness is accom- involvement of the natural barrier mechanisms pre- venting the penetration of microbes into the internal milieu of the body, it almost completely paralyzes the immunological reactivity, as a result of which the body is deprived of the ability to elaborate,an immunity. It has been shown experimen- tally that introduction of vaccines into animals affected by radiation sickness does not cause them to produce antibodies in full measure or to create a state of immunity. The pos- sibility of disease in man through the penetration of sapro- phytic flora and a more severe cause of infection by a patho- genic microbe come about specifically for these reasons. Such an effect of radioactive emanation on the body obviously excludes active immunization (vaccination) as a prophylactic measure in a focus which has been affected by the combined action of biological and radioactive weapons. Therefore, the combined application of pathogenic microbes and of radioactive agent's increases the affectiveness of both types of mass-attack agents. Radioactive emanation facilitates the infection of people, aggravates the course of the disease and eliminates the practicality of specific prophylaxis against the infections. The pathogenic biolog- ical agent complicates the course of the radiation sickness and thereby increases the effectiveness of the radioactive 93 Declassified in Part - Sanitized Copy Approved for Rel ? 50-Yr2014/04/07. - 8 -01 04'.1Rnn'IR Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 weapon. Biological Warfare Agents By biological warfare agents we mean the causal organisms. of those infectious disease by which a, population can be inten- tionally infected with-the aim of mass-attack against it. At the present time, we can speak only conjuctuallY about the species of causal organisms which can be used by an. enemy. In the description of infectious diseases which can be spread intentionally by mass artificial infection we have to orient ourselves first .by the foreign literature, beeause the most probable warfare agents are named in it, and secondly, by the data concerning the properties of microbes, ,routes of spread of infection, etc., in comparison with the conditions under which the causal agent may enter the body when used by various methods. The infections presented below do not exhaust the list of causal agents, which are regarded as the most probable bio- logical warfare agents. Thus, such organisms as the influenza virus, the virus of Riff Valley Fever, the mumps virus, the vengue fever virus, the leptospiras, etc., have not been mentiOned, the possibility of using which has been assumed by foreign workers. The description of these infections has been omitted, because the grounds for the possibility of using them are either inadequately convincing or else are simply doubtful. However, to be sure, in the future the list of infections may be changed. In the description of causal agents and corresponding di- seases we have not attempted to give complete information about them. Therefore, this chapter does not in any way claim to substitute for special textbooks on microbiology, epidem- iology for infectious diseases in which the reader will find much more detailed information on the problems concerned. In this chapter they are being presented only in order to bring to mind certain properties of the causal organ, the clinic and epidemiology of diseases fundamentally for the purpose of laying a foundation under the ideas of methods of appli- cation of the given causal organism and also for the purpose of grounding certain measures of general and special nature in the focus of infection. Undoubtedly, a deeper study of the ediology, clinic, diagnosis and epidemiology of infections will require studying them according to the special liter- ature. The order of presentation of various infections is not 94 Declassified in Part - Sanitized Copy Approved for Release ? 50 -Yr 2014 connected with any classification of infectious diseases. A grouping of them according to the method of artificial infection of the population (through the air, through water and food products, by means-of insects, of vectors of infec- tions, etc. (Would be most correct,, because definite measures would correspond to each group. However, such a grouping is as yet impossible, because the most frequent and effective methods of application for various infections would be demon- strated only in practical work with the biological weapon. At our present level Of knowledge of this problem we may assume the possibility of application of several methods for the same species of causal organism, which complicates any kind of rational grouping which would be convenient for pre- sentation and suitable for practical needs. Based on this, we are describing first the bacterial infections and then 'the rickettsial diseases followed by virus infections and conaluding with a solitary representative of the group of bacterial exotoxins: Plague is an acute infectious disease occurring most often in two forms: The bubonic and the pulmonic. The great 'in- fectivity and the high mortality rate among the patients has aaused us to refer plague to the group of the particularly dangerous infections. The causal organism of plague B. pestis, is seen micro- scopically as a small bacillus with pointed ends having an oval shape (coccobacterium). The same morpnology is preserved in bouillon, but the formation of short chains is observed. In smears taken from agricultures of the bacillus-like shape of the microbe is more pronounced. The plague bacillus is readily stained by all aniline dyes and is gram-negative. The ends of the bacillus are intensely stained; the central portion is practically not stained (bi- polar staining), which is characteristic of the entire Pasteur- elle group to which the plague organism belongs. The microbe of plague grows well on ordinary nutritive media. Growth is improved by the addition of sodium sulfite to the blood media, which permits the detection of the plague bacillus when there is only a small number of them in the material under examination. In bouillon it grow? in the form of a film, producing a flocculent sediment at the bottom of .lA-RDP81-0104pnn . 95 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 the test-tube leaving the bouillon clear. On agar it grows after twenty-four hours in the form of.delicate colonies which are greyish-white with'an azure hue. In the presence of a sparse growth of colonies they are of considerable size, round in shape, rough with a prominent center and a flat lacelike. area along the periphery. The consistency of the colonies is viscous when cultured at 370 centigrade and dry when cultured in an auto-clave at a low temperatUre (28 to 300 C). Under environmental conditions the plague microbe possesses a considerable resistance compared with other vegetative forms. It is no different from others in its resistance to the effect of high temperature or to disinfectants. On environmental objects the resistance of the plague bacillus fluctuates depending on the temperature, humidity, light, etc. The following data give an idea as to its re- sistance. In sputum the plague microbe can be preserved ten to thirty days; in darkness, up to 165 days; in dried sputum, 4 to 7 days. In puss from buboes it is preserved 20 to 30 days. In the desicated state on a towel the plague rlicrobe remains viable at a temperature of 12 to 180 for 67 days. In human and animal cadavers, the plague microbe can ,icserved at a very long time at temperatures below 00 C.: From several months to a year. At higher temperatures the plague bacillus dies more quickly. In decaying cadavers the microbe disappears in 4 to 5 days, being preserved for this period of time only in the bone marrow. The microbe is preserved up to three weeks at room temperature in the skin of rodents which died from plague. In food products the plague bacillus is preserved for a long time: In black bread, for four days; in salted butter, 130 days; in-fruits and vegetables, 6 to 11 days; in grain, 12 to 54 days. The possibility of infection from food pro- ducts is confirmed by the fact that plague outbreaks have been observed among persons cutting up the meat of camela afflicted with plague. Therefore, we are dealing here with a peroral infection but rather with a mechanism similar to the natural one (through the shin). By analogy, infection may be expected through the respiratory tract in the reprocessing of grain. The plague bacillus lives in water for 75 days. It is well preserved in the soil at low temperature (one month), 06 1,1 and at high temperature it ales .quite quickly. ". t?"f.: A sealesd Culture of plaguebacilitis 'at'a-temperature , of 100 C preserves its viability and virulenze for nine years, which permits it to accumulate for a long time. ? 1? - Various species of'-rodents:are iiedel.vbirs'of Plague ii-" fection. Rats, silsliks,,salid-eelanTtarabagans play the greatest part In the epidemiology of.10.gue.-:- However, the number of species of *a4mals bUsceptible-to'plague is very great. More then !150 spe&ies of iio6ents ai,e known which are sensitive to the yaagUe'infeCtAC41P, Of the dbMestic animals, cats and' camels are SuiCeOlble. It is possible' to give pigs, goats, sheep a.d dogs plague only by artificial infection with large doses of the culture. Horses and long- horned cattle are not susceptible'-th Plague. ,Carnivora' (except for skunks and weasels)-arid'birds 'are hot susceptible to the 'infection. Insects and ar'aChnibes are slightly , susceptible but can preserve the-Microbes in their bodies for a long time: Bedbugs, 147 days; ticks, -10 or 11 days (Tumanskiy). ' A characteristic feature of the 'epidemiology of plague Is the fact that the development of epizootics among rodents precedes the outbreak of cases among people, ?and from this the infection is transferred to people. Therefore, plague is a typical zoonotic infection. The transmission of the in- fection to man is accomplished, as a rule, by ectoparasites of the rodents. Cases are possible from contact with infected animals (hunting tarabagans, stripping the cadavers of camels, etc.) The bubonic form of plague always develops with this kind of mechanism of transmission. Further development of an epidemic can assume a more threatening course. A specific pneumonia can develop in a patient with the bubonic form of plague. The sputum excreted thereby contains a large number of plague microbes. Transmission of the plague infection in this case is accomplished by the droplet route, which in view of the absolute susceptibility of man leads to an ex- ceptionally rapid spread of its most severe form. The pulmi- nary form of plague 'oetermines the great epidemic tendency of the plague-causal'an agent of bio1ogicd1 attack. This fact determined the most probable application of the plague bacillus in the form of ':a bacterial aerosol. How- ever, this does not exclude?the use of-infected insects, because each patient with the bubonic?form of plague is a potential puliminary form patient (secondary pneumonia), which, when it begins in one person, spreads rapidly to those 97 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07 ? CIA-RDP81-01043R003800050002 q Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 around if appropriate meuures have not been taken beforehand (separate-hospitalizationllobseryance of the .routine of care of plague patients by,.thjmedicai-personnel; etc.); The onset Of the disease is. acute in all forms (after in- cubation of one to threg,andvlesa often?more days) with a marked riserin temppratUreacilill, headadhe and Other signs of: genera). -intoxicatiane The patients are restless, excited and delirium-with.traalcinagsns is possible. The phase is hyperemic; the conjlAnctiVae. Are injected. Later,.cyahasis is noted, and the faOia): features,are_sharpened. The pulse in- creases ,in rate -is arrhytbdic anil thready. The heart sounds are 'muffled-. : . ? The chief,symptomsOf.tpe of plague is the development, of plague lymphadenitis .which includes a group of lymph glands with the super,impOsition of a periadenitis cal- led -a bubo. The first signs of this farm of plague are pains at the, site of development of thefuture bubo. The first bubo is usually associated regionally with the portals of .entry, of the infection. Afterwards, the appearance of buboes is asso- ciated with. the spread of the plague bacillus in the body. The buboes can be of different sizeS; most often are the size of a hen's egg.. Buboes are frequently observed in the ingui- nal areas, associated with infection through the lower ex- tremities, and then most frequently in, the axillery cervical and other areas. The latter are prognostically more danger- ous and are complicated by the pulmonary form. The climax of the disease is noted on the fourth or fifth day, after which resolution of the infection occurs 1f phenumonia has not been superimposed (which occurs in 5-10 percent of the cases) or unless plague meningitis (rare) or non specific complications have occurred. In the pulmonary form of plague, cutting pains in the chest, marked tachycardia, dyspnia, delirium with hallucinations and marked excitation (violence) are soon superimposed on the acute onset. Later, prostration is observed and prior to death, coma. A,lobular phneumonia is established through oscultation-and on precussion. A lack of correlation of ob- jective signs to the severity of the course is characteristic of pulmonary plague. At first the ,sputum is foamy and clear (glassy),,and then it becomes blood-tinged and even consists of pure blood. ,Microscopically, it is-easy to-find large numbers of plague bacilli in it. The total duration of the disease is ,five 98 The introduction of specific serum therapy into practice has markedly reduced-the mortality rate from the bubonic form of plague, having practically no effect on the -pulmonary form which usually ends in the death of the patient. ,:Treatment with antibiotics (streptomycin and others) in combination with serum has reduced the mortality rate in pulmonary plague also. The disease is followed by a strong;immunity. A strong immunity also occurs after inoculations. Therefore, inocu- lations of live plagUe Vacoine have -become a prophylactic measure. Vaccination is carried out in the focus of involvement even in the event cases of the disease have al- ready occurred', because post-vaccinal immunity increases the effectiveness of treatment. . Laboratory diagnosis is made by culturing suspected mater- ial on and?by infecting laboratory animals (biological tests).' If the material contains considerable foreign flora (from thebodies of rodents),-guinea pigs are 'infected by rubbing an emulsion of the material under examin- ation into the skin (Austrian method). The animals are in- fected thereby and die from the more pathogenic-plague bacil- lus. The results-of the biological test are controlled by cultures on media. - The collection and delivery of material for examination is a responsible-matter. The collection of material is accom- plished by forceps or, in an extreme case, using rubber gloves which should be disinfected immediately after finish- ing the operation. The material is placed in a bipartite ves- sel, between the walls of which there is a thick layer of gauze moistened with five percent lysol. . The bipartite ves- sel is also wrapped around with some kind of material moistened with disinfectant solution. Then, all this is put into a metal container or a tightly sealed box. Clinical-epidemio- logical data are given in an attached statement, and the pre- sumptive diagnosis is indicated. The principle of general anti-epidemic measures amounts, first, to complete individual isolation of all patients and persons who have in any way been in contact with them or with infected objects; secondly to combatting the source of in- fection and vectors of it (deratization and disinfection); and, thirdly, to the decontamination of-..the patient's surroun- dings (disinfection). In the event of the existence of large foci Of infection, when the possibility of,Anfections on a 99 Declassified in Part - Sanitized Copy A df ease ? 5 - r 2014/04/07: CIA-R DP8 1-ni nztqpnmcznnngr. Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 A large scale has not been.excluded, the measures indicated above are supplemented by the imposition of a quarantine on the entire affected area. In cases where plague badillus has-been used for the attack the quarantine is imposed immed- iately after the establishment of the species of organism; regardless of the number of cases or of the form of plague. All kinds of work in the focus of plague and having to do with communication with patient, regardless of their duration, should be carried Gut in a special protective suite which as- sures protection of the body surface, respiratory organs (mask) and eyes (goggles). Tularemia is an acute infectious disease which. has several forms of clinical course (bubonic, generalized and pulmonary) and which is transmitted by all the possible routes. The 'causal agent of tularemia, B. tularense, belongs to the Pasteurella-group, like the causal organism of plague, al- though in its antigenic structure it is similar to the brucel- lae. The microbe of tularemia is a very small size (0.270.7 -micron) often has.the!appearance of a coccus or coccobacterium, and is non-motile; it does not form spores, stains well with analine dyes; is gram-negative; is exclusiye with respect to nutritive media and grows only on MacConnely's coagulated egg- yolk medium on blood agar containing cystine. Growth appears on the second to seventh day in the form of a delicate shagreen- like film or of delicate individual colonies. Although the tularemic microbe does not form spores, still it possesses great resistance under environmental conditions. Direct sunlight kills it in 30 minutes; diffuse sunlight kills it in three days. It is not sensitive to low temperatures. Alternate freezing and thawing have little effect on its via- bility. It is preserved in frozen meat for 93 days; in salted meat, for a month; in cadavers undergoing incipient decay it dies in four to five days. The microbe of tularemia is resistant to desiccation. In pelts taken from infected rodents it is preserved for 45 days. In rapidly desiccated pieces of tissue from sick animals the microbe can be preserved for a year. In the dry excrement of insects it is preserved for 20-25 days. In grain the tularemic microbe is preserved for 133 days; in baked bread, about -three weeks; in water, three months. The tularemic microbe is very sensitive to the effect of 100 ordinary disinfectants. In .the usualli accepted dosages they kill it very quickly-within selieral minutes. Like plague, tularemia belongs to-the group of zoonoses. The chief reservoir and source of infection are rodents. In varioua'-countries "differenttspecieS of rodents?are sources of f.he infection (ground squirrels, bares,)beavers,.lemmings, etc.).--In the'Soviet'Union-mouse-like rodent's', water rats and hares play the main part in the infection',.. The infection of cats is possible but under 'ordinary conditions they are not of epidemiological significance4 , ; -? A characteristic of tularemia is the variety-of routes of infection of men. Infection-occurs through direct contact with infected material (the stripping of pelts, cutting of meat, etc.); through the consumption of infected water for drinking and domestic needs-(washing,-bathing) and the.con- sumption of contaminated food products;-as food?bread, etc.);'through the bite of ectoparasites and certain flying blood-sucking insects (horseflys,- mosquitoes, etc.); of rodents, by rubbing dust into the ocular mucosa or by in- haling dust -1.n which the causal organisms?of tularemia are present. The' latter method of natural- infection' doubted by some authors. However, in' principle, no one disputes the possibility of tularemia infection through the respiratory passages. In contrast to plague no transfer'of the.infection is ob- served in tularemia from ome person to another. Therefore, the-tularemic microbe as an agent of biological attack does not posSess great epidemic qualities. However, this means that it is also without retroactivity, which in certain , cases can be a very important fact. The great infectivity of it for man and variety of the methods' of infection com- pensate for its lack of an epidemic nature. Incidently, if a biological attack leads to the infection of rodents tula- remia?tan also assume this property. ' In accordance with the methods of infection (localization of the portals of entry of the infection) various kinds of clinical forms of tularemia develop.. The incubation period lasts from several hours to three weeks; .on the average it equals three to seven days. The onset of the disease is acute, with a chill, high temperature, headache, muscular pains, etc. The 'temperature curve is most -often remittent or irregularly intermittent and sometimes undulant (two or more waves). The duration of the fever, on the average,- is 101 Declassified in Part - Sanitized Copy Approved for Release ? 50 -Yr 2014/04/07- C 42 Declassified in Part - Sanitized Co .y Ap roved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 4 2-3 'weeks (5-30, days). The fall in temperature is lytic with a long.period of-low-grade fever. Clinical forms of 'tularemia (according to Rudnev): 1) bu- bonic (ulcerative-bubonic, pure bubonic, bubonic angina o hthalmic-bubonic and abdominal,with.mesenteric buboes); 2) ; ) generalized (synonyms-typhoid, pseudotyphoid, septic).; 3) pulmonary (bronchitic and phneumonic). The mortality rate .in tularemia is,low.'. Recovery proceeds slowly Thith loss of the ability to work for a long time. Antibiotics (streptomycin) have recently been used success- fully for treatment. .In addition,- serum is being used for therapeutic%purposes; Therrest of the treatment. is symptom- atic.' . , ? f Laboratory diagnosis, is made on the basis of the biologi- -cal test (Mainly for envilionmental objects, rodents and others), the agglutination tests with the patient's serum and thelallergic test with tularin. , . . The collection of the infectious material and the del- ivery of it to the laboratory and the examination itself are carried on with observance of the same. rules which ap- ply to plague.) . The comparatively high resistance of the causal organism and the variety of routes of infection of man makes its use possible by, any means. However, not all the methods of at- tack can be equally effective, because the infection of a small number of persons does not lead to the occurrence of any great epidemic outbreak (absence of an epidemic quality). Apparently of all the methods of application of the organ- ism of tularemia the one may be selected which leads either to. a direct infection of a large number of persons or to the infection_of rodents with the aim of creating an enzo- otic focus and an epidemic threat associated with it. The second method (infection of rodents) can constitute a hazard in a definite locality for a long time, but it can hardly lead to a single large-scale outpreak of the disease; this makes it possible to sufficiently effective preventive measures in time. , , Therefore, the application of those methods which lead to the large scale infection of the population .would be most probable. This can be attained either by spraying cultures or .by infecting the principle water mains of the water supply 102 1:2 system (pipelines and reservoirs). Through the use of the aerosol not only the infection of the population but also that of susceptible animals can be achieved (rodents). A definite impediment to the use of the organism of tula- remia as a biological weapon is the comparatively great, selectiveness.of the microbe with regard to nutritive media and the sparsity of its growth. However, these technical difficulties can hardly be insurmountable. .They cpn be. over- come through the expanded production of the microbial mass and, by the accumulatioh of it in the desiccated state, be- cause in this form the viability of the microbe is .well ? preserved. Tularemia leaves a strong immunity after it. Post-vaccinal immunity is also of adequate strength and therefore, vacdine- prophylaxis has an important part,in the system of, anti-epi- demic measures. General anti-epidemic measures are very similar;to.imeas- ures used in plague. They amount to hospitalization of pa7 tients with terminal disinfection of articles and of the room, of the observation he, environment and of measures for the annihilation of rodents and vectors (deratization and insect elimination). When there is suspicion ,that the causal agent of tula- remia has been usPd in the form of an aerosol it is essen- tial to resort to measures of individual protection (masks, goggles and clothes which cover the surface of the skin as much as possible). Anthrax. The causal agent of anthrax, B. anthracis, is a large bacillus (five to seven microns), non-motile, forms a capsule and spores.(pseudoanthrax bacilli are motile and do not form a capsule). In size the spores are much smaller than the vegetative forms. The ends,of the bacilli, which have the appearance of being squared off, represent a mor- phological characteristic of the anthrax microbe. The existence of soores for this microbe accounts for its very high degree of resistance to the effect of environmental conditions. In water, and in the earth the spores may re- main viable for scores.of years, Direct sunlight kills the spores in no less than four hours.. Dry heat at a. temperature of 120? kills them in. two J101.1r_s. Boiling,kills the spores. in 10-15 minutes, Solutions of chloride of, lime (20 percent), 103 Declassified in Part - Sanitized Co.y Ap?roved for Release ? 50-Yr 2014/04/07 ? CIA-RDP81 01043R0038000sonn? Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 formaldehyde (two percent), mercuric' chloride (one percent) kill the spores in one to two hours. Salting, drying, tan- ning leather, etc. do not contribute to the death of the spores. The vegetatiVe forms of the microbe are much less resis- tant to the effects 'of physical and chemical factors. The causal organi'm of anthrax does not possess any epidemic qualities 'in the literal sense of the word." Anthrax is a threat to personnel taking care of patients only when they do not observe therule the precautionary' measures ih giving med- ical aid. The group- cases of anthrax which are Obterved are usually associated with-a common source of infection (for example, the cutting and consumption of'meat of a sick animal, etc.). Sporatic cases are often associated with occupational factors (infection of veterinary workers, shephards, workers in slaughter houses, persons engaged in the processing of lea- ther, of bristles, etc.) and less often, with infection of the soil and transfer of the infection by blood sucking in- sects (horseflies and gadflies). The lack of an epidemic quality in the case of the anthrax organism is completely compensated for by its unusually great resistance under natural conditions. In the opinion of Roseberry, herein lies its importance as an agent of bio- logical attack. A locality once infected can continue to present a danger for a long time if account is taken of the difficulties of disinfecting the soil and the great resistance of anthrax spores. The portalsof entry of the anthrax infection can be the skin, intestine and organs of respiration. Therefore, methods of using the causal organism can be different. The possibil- ity of using the spores of the microbe exists in the form of an aerosol (6n account of their size the spores furnish stable aerosols) as a method which attains several purposes at once (direct infection of people, of the locality, of food pro- ducts, etc.) and also as a diversionary infection of certain -food products. The clinical fbril?of anthrax, is determined by the portals of entry of the infection: Cutaneous, pulmonary, intestinal and septic ;forms are distinguished. The incubation period, : on the average, is equal to two to three days with a range of one'to seven days. In the case of the cutaneous form, a reddish spot first appeirrs' at the site of the portal of entry of the infection which changes into a papule and then into a,vesicle containing a serous and thema dark bloody content';' Burning and itching at the site of the vesicle ,and of the-pidtuld lead to scrat8hing of them by. the patient, black' eschar appears, it is surrounded by secondary vesicles which undergo the _same development. Oh account of the secon- dary mistuleslyrowth,of the black eschar occurs. The hard eschar is surrounded by an elevated blood-red infiltrate; the surrounding tissue's are often edematous, particularly in places with' d loose subcutaneods tissue-and*particularly in the area of the face. The sites involVed are not painful in contrast to the' cutaneous involvement in plague and tularemia. The following general features are noted: malaise, headache, fever (temperature of 39 to239.5-degrees and higher). The drop in the temperature coincides with improvement of the local-process.' The cutaneous form can be complicated by a septic process with the appearance of secondary metastatic foci in the lungs, intestine and on the skin.- The intestinal form of anthrax begins' witha chill and with sharp,- cutting pains in the abdomen. Then, nausea and vomiting are added with the throwing up of bile and blood and also bloody diarrhea. The paresisoof the intestine which sometimes develops produces a picture of acute obstruction. Intoxica- tion is accompanied by a high fever, weakness of cardiac activity and progressive edema of the lungs. The primary pulmonary form of anthrax is characterized by a short incubation period, pains in the chest, cough and the excretion of a foamy,' liquid, bloody sputum in which many characteristic bacilli are found microscopically. Aspirates of a'pustule or ulcer, the contents of a car- buncle, vomitus, stool, urine, and .sputum are subjected to laboratory examination. Pieces of the spleen are taken-for autopsy. A final diagnosis is made on the basis of the bio- logical'test. Recourse,is had to the thermoprecipitation test according to the Ascoli method for the examination of infected tissues, whether, etc. ,.Specific prophylaxis is accomplished by means of a vaccine. In the presence' of a known infection, the prophylactic admini- stration of anthrax therapeutic antiserum is possible. General anti-epidemic measures should provide for the 105 Declassified in Part - Sanitized Copy A ease ? 5 - r 2014/04/07: CIA-R DP8 1-ni nztqpnn-4pnrmgrv-v-, Declassified in Part - Sanitized Co.y Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 :OM isolation of patients and the realization of measures of disinfection in the facus of involvement. The observance of rules of burying Of caadvers is of importance. Cadavers should be buried at a ,depth of no less than' two meters and disinfectant solutions should .15e.poured over them copiously. The burial sites should be fenced off. An infected locality should be carefully disinfected and plowed under (depending, on their conditions). ? . The use of anthrakspores may involve not only the infec- tion.of people but also that of cattle ? This Pact should be taken into consideration, and anti-epidemic measures should be supplemented by ,anti-etiozootic measures, for the perform- ance of which the veterinary service is recruited. ? ?,, , Glanders is an infectious disease involving solid-ungulate animals (particularly horses) which are the Sources of infec- tion for man. The causal agent of glanders, B. mallei,. is a bacillus of comparatively large size (one to five microns),, non-motile and non-spore-forming. Certain of its strains are polyniorphic. It stains well with aniline dyes, particularly on the addition of phenol or alkali to the latter; it is decolorized by the Gram method. On staining with Loeffler's methyline blue, granulation is demonstrated in the body of the bacterial cell. The bacillus of glanders grows well on potatoes, agar, and bouillon to which one to five percent glycerine has been added. On agar it produces greyish-White colonies with a mother-of.-pearl sheen, slimy and viscous. Growth on potatoes is particularly characteristic: on the third day, a Slimy film of amber-brown color resembling a copper film is formed which is dull or shiny; on the sixth to eighth day the amber color assumes a reddish hue. In bouillon containing two to four percent glycerine, .the bacillus of glanders grows produc- ing first a uniform turbidity, and then a slimy greyish-white sediment. The causal agent of glanders possesses slight proteolytic properties, ,coagulqtes milk on the sixth to eighth day, With an acid reaction, gives off hydrogen sulfide and ammonia, ferments glucose and lactose without the formation of gas, and possesses reducing and catalasic properties. The resistance of the glanders bacillus is comparatively 106 - Declassified in Part - Sanitized C .y A ease ? slight, like that of other vegetative forms of microbes, but is sufficient for infecting healthy animals from infected troughs, water, etc. Thus, the:glanders organism is preserved 12 to 15 days in dung; it dies on the 7th to 15th day in the suppurative exudateof ulcers.and in nasal mucus;. it tolerates low temperature well. 'Direct sunlight kills the microbes in 24 hours. The causal agent .of, glanders has a higivsensitivity to -disinfectants. A man-is susceptible to glanders'. Infection occurs under ordinary conditions dUring the care of sick animals and as a result of contact with objects contaminated by sick animals (straw, hay, harness, horse blanket, etc.); therefore, the cases show a pronbunced_occupational nature .Infaction of man, occurs through injured skin and mucosae. Certain research workers believe that cases of:infection are possible through the respiratory passages,- The course of 'glanders 'in man can be acute or chronic.. In acute glanders the incubation period last for two to- five days. The onset of the disease is acute, with a chill, heat, headache and muscular aches; later, pains in the joints and swelling' of them are superimposed. An Ulcer develops gradually at the site of penetration of infection with undermined edges and a greasy base. 'In the process, the'regional lymphatic vessels are involved (lymphangitisVand sometimes the lymph glands (lymphadenitis). After five to seven days, the fever shows an exacerbation. The appearance of secondary nodes is observed which change into ulcers in the muscles, in the nose and in the lungs. The ulcers are associated with greenish purulent exudates. Later, a suppurative involvement of the joints is added. The person dies with signs of pro- gressive cardiac weakness. In the acute form death is practically inevitable. In the chronic form, the inflammatory processes develop slowly and at times increase and at times slacken. In this form multiple ulcers and abscesses (like cold abscesses) are characteristic; these localize in the skin, in the muscles, in the lungs, andTfil?fffe?Tios-e-;--Th-e? ? I 4 GC is prolonged, up to several years. About 50 percent of those afflicted die. The laboratory diagnosis of glanders amounts to the.per- formance of a biological test, because,cultures from the pus are rarely successful. The biological test is performed on male guinea pigs. After three to' five days atypical 5 - r 2014/04/07: CIA-RDPRi-ninaqpnmszrinriannr, 107 "44 tow, Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 orchitis (Strauss reaction) develops in intraperitoneally-in- fected animals. The glanders bacillus can be isolated very easily from.the inflamed testicle. For the purpose of'making the diagnosis in chronic glan- ders in animals the' complement fixation and the cutaneous tests (the eye test in animals), the latter being an aller- gic test with mallein are being used very successfulY. There are no agents for the. specific therapy and prophy- laxis of glanders. The causal agent of glanders was one of 'the ;first microbes baCteriological.weapon for the infection of horses. For these purposes the feed of the -horses was infected in cavelry. units. No great damage was inflicted on the fighting capacity of these military. units.' Evidently, such diversions are completely senseless under modern conditions where the army is mechanized and the cavelry has lost its former signi- ficance.: The great severity of the infection (regardless of the form) and the high mortality ..rate in glanders, however, are attrac- ting the attention:of certain "pheoretichians" of biological warfare. In connection with this the problem is being dis- cussed of the methods of producing a glanders infection. Since infection with this disease is. possible only through damaged skin or mucosa, there is no particular sense in using the glanders bacillus, because it is impossible to carry out such a method of mass involvement of the population, and the disease itself does not possess any great epidemic quality. Roseberry, in discussing this problem, expresses doubt as to whether glanders can be :transmitted by the air-droplet route under natural conditions. At the same time, he allows such a possibility in the case of artificial infection under con- ditions of biological warfare. Moreover, he believes that primary infection of the respiratory passages can give this infection an epidemic quality. TMs-g4Ne-s-u-s- ! or c_, cti s th ganism of glanders in the form of aerosols. For animals glanders is essentially an intestinal infec- tion. The infection of people through the skin is used not because the alimentary method of introducing the causal agent cannot infect man, but rather because this mechanism of trans- mission of glanders.corresponds to the form of contact which ZOO of the 108 man has, with the sick animal (L. V. Gromashevskiy). There- fore, with Any nie'thod of application of the glanders lus as a bacteriOlogicdi kaeapon all measures bcnould be taken 'for the protection of fooa.'products,and 'water because un'der certain'coYiditi*ons they can 'play a part of a.factor tran6- ." mitting the infection.. What has 'been-said is' sufficient to determine the sys= te4,of measures to be 'used for 'the protection of the popu- lation against this incection in its general outlines. -These measures-ahould-provide fdr'the Utilization of individUal and group measures for bbe protection of respratory organs and.mucosae,of the eyes (maks'with protective goggles, shelters). . in the event of use of aerosols' of the causal agent's of glanders, 'the protection of provisions and fodder from their coritamination by particles of aerosol and from the diversionary infeotion of ,them. , . Disinfe,..tiOn measures should be taken in the zone of in- fection. In the event of the presenCe of horses' veterinary supervision should be established. The measures :with respect to sick horses are regulated by veterinary legislation. , With the occurrence of caseamong,peOple, hospitalize- tion, and the establishment of Medical supervision of the popu- lation of the affected area must be established for a two- week period. Melioidosis, or pseudoglanders is an acute infectious disease of animals from which man can be infected. Therefore, melioidosis is a zoonosis.- In its clinical picture it re- sembles glanders. Melioidosis is found in the Malayan archi- pelaeo in the southern part of Indo-China, in Burma and in southeastern India. The causal agent of melioidosis, B. whitmori, is motile, large (2-6 microns) bacillus with rounded ends. It is dr= ra66eif, in pair-ft_rmaticn nn smears: it forms capsules; it is aerobic. The bacillus of melioidosis stains well with all analine dyes; it is gram-negative. In,impressions taken from organs it stains well by the Romanowsky-Giemsa method. Staining is bipolar (the ends Of thelpacilli take the stain more inten- sely than the body of the microbe). The bipolar staining'and the motility can be lost when it is cultivated on nutritive media. - 109 Declassified in Part - Sanitized Copy Approved for Rel ? 50-Yr2014/04/07, - 8 -0104:1RnmRn Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 The bacillus of melioidosis-,not selective with regard to nutritiVp media.. It.grdws well on ordinary nutritive media at-a temperature Of 57 degrees Centigrade. The optimum pH=7, although the bacillus is. not very sensitive to the reaction of the medium. The growth on.five percent glycerine agar).s most characteristic; on this, after 48 hours, it produces cream-colored rough colonies with a pinkish hue which 'somewhat resemble the colonies of the tubercle bacillus; ,On this medium the causal agent of melioidosis grows more rapidly than the glanders bacillus"; Rough'colonies of the microbe corr6spond to the more virulent,form of the causal-agent of pseudoglandersi, On simple plate agar he colonies are round, slightly raised,-opaque, ,cream-colered with irregular edges. The melioidosib bacillus Can grow, forming slimy'colonies ,which are larger than the typical ones. They are transparent or opalescent, have irregular contours and are surrounded by a slimy border. In :cultures of sputum, the slimy colonies predominate (60 to 90 percent) over the typical ones. Bio- chemically, these colonies are no different ,from the typical ones. In bouillon they produce a uniform turbidity, and then a film can appear. On potatothe melioidosis bacillus grows well producing a cream colored film. It possesses proteoly- tic enzymes: it decomposes gelatine moderately; and de- composes coagulated blood serum slowly. ,The melioidosis bacillus does not form indole. It'fermentS glucose, lactose, maltose, sucrose, mannitol and dulcite without the formation of gas. Cultures of the pseudoglanders bacillus have a dis- tinctive odor. The resistance of the pseudoglanders bacillus compared with other microbes which do not form spores is very great. A culture grown on glycerine agar preserves its pathogenicity for guinea pigs for eight years., It tolerates desiccation well even under conditions which as much as possible approach natural conditions. Thus, a freshly-isolated culture of pseudoglanders bacillusomixed with earth can put in a drier (at a temperature of*27 centigrade for 27 days) can infect au ea 0 as b means of intranasal_administrAtion,__In_wate the causal agent of melioidosis is preserved for 44 days; in stool for 27 days; urine, for 17 days; in a decaying cad- aver, 8 days. effect of penicillin, streptmycin or bacitracin even in th,) presence 'of highconcentrati6ns of them in the neutra- tive medium. Aureomycin, terramycin, neomycin and chlormy- cetine check the growth of the microbe, particularly the last- mentioned-antibiotic.- A combination of antibiotics does not increase' their effect on the mellioidosis microbes; .There- fore, although 'there are as-yet no reports as to the testing oflantibiotics on patientS with melioidosis. The.treatment of thew is very-promising. The pseudoglandes: bacillus produces the disease in guinea pigs,'rabbits, rats, mice, cats, dog, sheep, goats and mon- keys. Guinea pigs, rabbits, and puppies are most susceptable to mellioidosis; Guinea pigs may be tifected'by any route er by any method; The most-reliable method is the subcutaneous injection-of the-material. 'However, the disease occurs also from intranasai infection;-through moistening-the oral cavity with a culture-application'of the material on to the scari- fied skin, etc.r'In'the event of subcutaneous infection death occurs on'the.second to fourteenth day. ,At autopsy, solidary abscesses with regional lymphadenitis, splenolmegaly, hepati- zation of the lungs and the enlargement of the suprarendis are found. In-rats melioidosis has a prolonged coursel/' slowly.leading to death. Horses are more'resistant to nel- lioidosis.'than-to glanders'-Coldploodedanimais and birds are .not-at all suscePtable to melioidosis. Under natural conditions melioidosis afflict rats and mice. Epizootics have been observed among guinea pigs and rabbits in vivaria. Dogs and-cats are infee_ted through'eat- ing the cadavers of rats and horses. Hogs can be infected the same way, becoming chronic carriers. The environment is infected by excretions of sick animals: mucopurulent excretions from the nose, purulent excretions from the skin, urine and feces. Human sputum may be added to this. The pseudoglanders bacillus is relatively resistant to die- infectant: one percent phenol, 0.1 percent formalin kill it in less`than,24 hours. The causal agent-of melioidosis is not sensitive to the 110 There are as yet no reliable data concerning the mechan- ism of transmission of melioidosis and the routes of spread of it. A peroral route of infection has been supposed, but Roseberry does not exclude the possibly of mellioidosis in- fection through the respiratory organs.. Probably, the trans- mission of melioidosis is possible through blood sucking insects, In this connection, the findings of spontaneously infected rat fleas-and mosquitoes (Aedes Aegypti) are inter- esting in this respect. The duration of the incubation per- 111 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07 ? CIA-RDP81-01043R003800050002-9 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 iod in melioidosis has not been established. The duration suggested is three or .fourteen days. The desease occurs in three forms: acute, subacute and chronic. The acute form of. melioidosis is characterized by sud- den onset, high temperature, severe headaehes, shertneas of breath, vomiting and diaTrhea and muscle .pains. In this form melioidosis has a.course resembling sepsis or septicemia. This similarity is enhanced'14 the appearande of abscesses in the muscles and (parenchymatous organs, abscesses in the skin, etc.). A leucocytosis (15,000 leucocytes,per cubic millimeter) are noted in the blood.- The-blood,formula shows a neutrophilia with a considerable shift to the left (young forms). In the majority of cases the disease in the acute form leads to a fatal outcome in 5-10 days. In certain cases it begins with severe diarrhea resembling cholera. The_dis- ease occurs also in a lightening-like form, terminating in death of the patient within a day. Differential diagnosis should be made from pulmonary and/septic plague, acute glan- ders, typhoid fever and the ,comatose form of malaria. In the case of a subacute course of melioidoisis multiple punalent foci are observed in the form of pulmonary abscesses, pura:e.nt orchitides, myositides, osteomyelitides, etc. The meninges can be involved (according to the tuberculous menin- gitis type). The course is prolonged (three to four weeks) and, if the patient does not die, it passes into the chronic form. Chronic melioidosis is characterized by the existence of multiple cutaneous ulcers and abscesses with fistulae par- ticularly in the area of the buttocks. The course is very prolonged and tei mates frequently in death from cachexia. This form can resemble tertary syphilis, cutaneous tubercu- losis, chronic glanders, brucellosis, mycoses of the skin and bones. There is a high mortality rate in melioidosis. Autopsy reveals cascous nodes surrounded by an area of acute inflammation which are characteristic of this disease in all organs. In the early periods these nodules are very small. The liver is.enlarged and also contains numerous cas- eous nodules of irregular shape. The nodules can become con- fluent and are of considerable size. The spleen is also en- larged, and on its surface numberous yellowish-white caseous nodules of various sizes are seen. On section the same nod- 112 ules are found as well as abscesses. The presence of the caseous nodules,and.abscesses is noted-also%in the kidneys, bladder, gall, bladder and lungs, in the subcutaneous tissue, muscles and bones. Histological examination shows that the nodule represents a granuloma with polynuclear and mononuclear cells with , necrotic centers. Small cellular element are arranged along the periphery of the granuloma. In the granuloma epithelioid cells are sometimes oberved. Giant cells are not' found in the granuloma. . . . ? ? The laboratory diagnosis is made by infecting guinea pigs with infected material and also b51 blood cultures and cul- tures of pus from abscesses of the patients and from pieces of: organs and tissues of the spleen,.liver,?lungsl lymph glands and blood taken at the time of autopsy.. A culture of the bacillus of pseudoglanders As most ,easily isolated from fresh pus taken from the dissection of abscesses. The culture culture isolated, is used, in addition to studying its cultural characteristics; for infecting guinea pigs. As has been mentioned_above the infection may be accomplished by any route. The application of the culture to the mucous membranes (eyes, nose, vagina) produces a suppurative pro- cess with the formation of ulcers and a high temperature. The regional lymph glands are involved in the process also. Death of the guinea pigs occurs approximately after a week. Subcutaneous injection of the culture produces first a dense Infiltrate, which becomes necrotic on the second to third day and which changes into an indolent ulcer with undermined edges. The regidnalaymph'nodes are enlarged and suppurate. Purulent foci are formed in various organs. ,The animals die at the end of the second to third week. Characteristic changes occur throughthe infection of guinea pigs (males) intraperitoneally. an addition to peritonitis with the.. formation of nodules(:o the omentut and internal ,organs, the-male guinea pigs develop orchitis after two days (Strauss phenomenon). The bacillus of pseudoglanders can be isolated from the testicular exudate. The melioidosis 'bacillus is agglutinated by the serum of'animals.which have been imunized against glanders and, vice versa, which speaksfor their great serological simi- larity. With patients' sera an agglutination test may be performed. .113 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 A dilution of 1:100 is considered a.. diagnostic titer. The complement-fixation tet is more sensitive and may be posi- tive while the agglutination test is negative. Fresh anti- gens possess great specificity. In-patients with melioidosis the cutaneous allergic test with mallein can be positive. - Since the routes of spread of, melioidosis are. not known it is hard to speak of the most probable methods of using the pseudoglanders bhcillus as agents of bacteriological at- tack. French authors, discussing problems of.lpacteriologi- cal warfare, believe the pseudoglanders bacilfus to be a very probable agent for attack, because melioidosis is ac- companied by a high mortality rate, and also 'because the physicians of European governments are not acquainted with this disease .(and its causal organism). Roseberry (United States of America) shares this opinion. ? The lack of information concerning the natural mechanisms of transmission of melioidosis cause us to suppose that the pseudoglanders bacillus, at least at first, would be used by all possible methods until the most effective of them is elucidated. Foreign research workers, discussing this prob- lem, actively emphasize the ability of the causal organism to produce the disease by any route of penetration into the organisms of animals. Roseberry adds that the lack of proof of the droplet method of transmission should not be taken into consideration, because even the pulmonary form of plague is not encountered in localities with a hot climate. The same thing can occur with melioidosis. Objections may be raised to this research workers' interpretation of the patho- genesis of the pulmonary form of plague. However, undoubtedly, this speaks for a possible application of the causal organism of me.lioidosis in the form of an aerosol as the most univer- sal method (inhalation of the causal organism, swallowing of microbes which have settled in the oral cavity, settling of the microbes on the muanrsmembranes of the nose and eyes). Although the Soviet Sanitary Epidemiological Service has no experience in combatting mellloidosis, nevertheless from what_has been said above the general, principles of prophylaxis of and combatting this disease can be marked _out.' .Apparently, general measures for the protection of pro- ducts against bacterial contamination as well as measures for individual and group protection from aerosols (regardless of the species of .causal organisms) should be extended to 114 melioidosis. Taking' into consideration" the role otrats and mice as possible sources of the infection generalipea-_ sures shouldqpe:aupplemented by the' accomplishment,of;de- ratieation'and the. protection of food products and water against the 'access of these rodents to them. .With the ap, Pearance of cases -the patients should of necessity _be.hos- pitelized, and their clothds and household objeets should be disinfected. 1 Brucellosis is a Mide-,spread zoonosis .which involves . short-and long- horned/cattle and hogs which are the sources of the Infection. BrUcellosts is one of the intestinal in- fections acbording to the mechanism of its,transmission. ?.. The properties of the causal agent of brucellosis, ac- cording to;the.prevalent opinion, are distinguished depend- ing on which species of animal it adapts itself-to. *There- fore, at the present time it is customary to distinguish three speeles of brucellae: 1) 'Brucella melitensis, which producess-a disease of sheep; goats, etc.,. 2j-Brucella -abortus bovis, which produces infectious abortion in IZTIE:horned cattle,. and 3) Brucella abortus suis, which produces abor- tion in hogs. All species of brucella?are very similar in their biological and serological characteristics. The dif- ferentiation of them presents considerable difficulties. This has given certain research workers the grounds for the belief that there is a single causal organism which changes certain of its properties when it passes from one species of animal to another. From this point of view, the greater in- fectivity of B. melitensis should be explained by the readier transmission of the infection rather than the properties of the causal organism. Brucellae are small cocco oacteria which stain readily with analine dyes, and are gram-negative; non-motile and do not form spores or a capsule; they do not possess proteolytic or saccharolytic properties; they do not form indole. Hydrogen- sulfide is given off during growth on bouillon. Brucellae are readily grown on ordinary.neutrative media, grow well on liver bouillon. Colonies of brucellae on Petri dishes containing agar are colorless,-convex, rounded, and with regular contours. In bouillon they produce a uniform turbidity.. - Brucellae possess great resistance to the effect of various environmental factors, although they do not form 115 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07 ? CIA-RDP81-01043R003800050002 q Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 ? spores. They are resistant to desication, to the effect' of light, to low temperatures, and are preserved for a long time in water and soil (2-2-1/2 months). In urine, the brucellae are preserved for six days. '.In food products they are preserved for a much longer period of time: in milk, for several *days, in butter and fresh cheese, for 15-45 days, in brynze (cheese made from ewe's milk) in the presence of high acidity (at 50? according to Turner), 7.2 days; with higher acidities, they die more quickly. In meat (salted or frozen) the brucellae are preserved forl5-30-days. Heating to. 58 or 600 kills the microbes in 30.thinUtes.?They:A"ft sensitive to generally used disinfectants in ordinary con- centrations to the same degree as other microbes which do not form spores. The fact that the culture of,brucellae in sealed contain- ers Preserves its viability for several .months is important. Brucellae are pathogenic tor.many_species of animals. All the.represelitatives the,alca-. and long-horned cattle, hogs, horses, camels,i.dogs, and cats can be infected by .them; ro- dents, including all laboratory animals, are susceptible to them. To be sure, the role of various animals as a reservoir of the infection is not the same. The part of rodents (sus- liks, mouse-like, and others) as sources of the infection under natural conditions is doubted by many research workers. All species (variants) of brucellae are pathogenic for man. Infection of man under natural conditions is accomplished by the peroral route. The incubation period lasts, on the aver- age from 12-20 days (from 7-30 days). The disease begins with a gradual rise in temperature. Fever is prolonged with periodic remissions (undulating fever), which is associated with a trenching sweat. Deviations from this typical form of fever are often observed along with it: brief tempera- ture rises, typhoid-like fevers with very long remissions, with low-grade fever. Sometimes, there is no rise in temper- ature at all, and only a poditive-agglutination reaction (Wright) and an allergic cutaneous reaction attest to the pre- vious infection. In febrile patients enlarged lymphnodes (polyadenitis), an enlarged spleen and liver are found. The pulse is of ncreased frequency (regardless of the tempera- ture). The blood pressure is lowered. Leucopenia and mono- cytosis are noted. Involvement of the nervous (neuralgia, neuritis, polyneuritis), synovial and bone-joint systems (bursitides and tendovaginitives, arthritides, and coxitides) are characteristic of brucellosis. 'Orchitides and epididy- 116 ? ? ? initides are observed. Not uncommonly; secondary involvements of the respiratory organs (bronchitides, relapsing bronchopneu- monia, etc.) are encountered'. The complications of brucel- losiS are very diverse. ? ' In brucellosis (not considering the ambulatory forms) the mortality rate'is equal to 'approximately eight percent. A. vaccine is used as a specific therapeutic measures. Recently, the use of chlordmycetiri, biomycin (aureomYcin) and ,strepto- mycin lave been recommended. As has been-mentiolied above man is infected by the peroral routet ? Therefore; it is very easy to imagine that the bru- cellae can'be-used for diversionary infection of food pro- ducts and possibly also of water. At least) the length of survival of the brucellae in them allows of such a possi- bility. The question of the possibility of producing a bru- cellosis infection through the 'respiratory organs under artificial Conditions remains discussionable. -Based on the great infectivity and'on reports of cases of laboratory in- fection (particularly by B:'Abortus bovis sUspended in air), Roseberry asserts that infection through the respiratory organs is quite probable. In this case it may be expected that the brucellae can be used in the form of aerosols. It is very difficult to form an opinion concerning the epi- demic quality of brucellae as agents of biological attack, because there are no reliable data concerning the infection of man by man. However, the morbidity rate for brucellosis is generally low compared with other intestinal infections. Therefore, this phenomenon may be explained by the relatively small number of patients as sources of infection. The pos- sibility exists that mass artificial infections of people during a biological attack can bring about an increased con- tamination df environmental elements by the brucellae (for example, as a result of the excretion of brucellae in the urine) with the subsequent spread of brucellosis from man tc, man, that is, an epidemic proper. In addition to this, the use of brucellae can lead to in- fection not only of man but also of animals which play a great part as sources of infection (sheep, goats, cows, hogs). Infection en masse of these animals undoubtedly would be ac- companied by an increase in morbidity among people, but through routes characteristic of brucellosis (consumption of milk and milk products, contact with sick animals). 117 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 Laboratory methods of determining brucellae permit iso- lation of them not only. from objects in, which a few brucel- lae exist (blood, amniotic fluid, pieces of organs are taken at autopsy) but also in the event these objects contain many other microbes, as, for example, in urine, feces, etc. This makes it possible to examine various environmental objects (washings of various articles, food products, etc.). Such an examination is based on the fadt that gentian violet-solu- tions (1:2000Q00) inhibit the growth.of the other microflora without involving the brucellae. In cases where a small-num- ber Of microbes may be expected in the fluid, concentration of them Is carried .out (serum agglutination, gentrifugation, filtration through membrane filters, etc.). Milk is centri- fuged or is left in the-cold and a culture is made from the cream which separates out. The laboratory diagnosis of brucellosis in man and animals is based on a bacteriological examination (of blood; urine, stool, spinal,fluid, pus, amniotic fluid, etc.), on serologi- cal analysis (Wright reaction) and on.the,intracUtaneous allergic test (Burnet reaction) 1 A very reliable method of detection of the causal,agent of brucellosis is the performance of the biological test. In the event the material being examined is contaminated with saprophy4c.flora or where the concentration of brucellae is small the infection of highly-susceptible laboratory animals (guinea pigs, white mice) should be accomplished along with the bacteriological method of examination. . A shortcoming of the methods of examination for brucello- sis is the length of time needed for them, because brucellae grow very slowly when separated from the body. The first generation of brucellae in a culture, for example, of blood is sometimes obtained after several weeks of keeping it in a thermostat. In subsequent generations the growth of the brucellae excelerates considerably. Under these conditions serological and allergic reactions assume particularly great importance for making the diagnosis of the disease. Howtver, they have no significance for the determination of the species of causal organism at the time of the attack. It may be con- sidered that bacteriological examination under conditions of an attack would not require a prolonged cultivation of bac- teria, because strains would be used inevitably which have already been grown for a long time on artificial neutrative media. Specific prophylaxis of brucellosis can be carried out with a live brucellosis vaccine. In the event of_an.attack by means of aerosols consisting of brucellae the population should use such individual and group measures as masks and shelters. General measures for the safeguarding and protection of water and food products prevents infection of them by any,patho- genic microbes, incltiding brucellae. . For the purpose of protecting the population against this infection measures should be provided directed against the infection of cattle; The z veterinary serVUe of the MPV0 - [Localartiaircraft defense], should carry: out a systematic observation for the existence of Drucellosissinfection in domestic animals. In the presence of Any kind of report to the effect that an attack has ,been made_ an.increase,in the number of cattle affected by brucellosis (according to sero- logic and allergic tests) requires the adoption of special measures (intensification of the sanitary-veterinary )'outine on farms, transfer of cattle to stalls-, etc.)-. In the event brucellae have been used in. the form of aerosols the :general system of sanitary-veterinary measures should be extended to include privately owned cattle.on the territory which l'Ias been exposed to attack (in the area of inspection). Naturally, disinfection measuresishould be carried., out in the area of infection with consideration of the stability of brucellae in the environment. There are reports that in a large scale infection by brucellae the requirements made on disinfection conditions should be extended. If the cattle pastures have been exposed to infection they should be fenced off, and cattle should not be permitted to graze on them for three to four months. If conditions permit, such fields should be plowed under. After the period of .time in- dicated it may be considered that the fields are free of brucellae as the result of their natural extinction. In connection with people who have become sick ordinary anti-epidemic measures are used (hospitalization, disinfection of the focus, etc.). With the suspicion of-a mass infection of people antibiotics may be used prophylactically. ? . _ r Cholera. The causal agent of cholera is the vibrio chblerae asiaticae, which has the shape of a comma, is a curved bacil- lus, possesses great motility, does not-form spores. The cau- sal agent of cholera is a strict aerobe, stains-well with all 119 118 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07 : CIA-RDP81-01043R003800050002-9 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 analine dyes, is gram-negative, is readily cultured on ordinary nutritive media'. Culture of it on one percent peptone,water, which is'the first step in the bacteriologi- cal examination,'is'based/on its consistent relationship to nutritive media and its pronounced aerobiosis. The resistance of the cholera vibrio to the effect of physical and chemical factors is not great'. On boiling,it dies in a moment; at a temperature of 800 centigrade it dies in five minutes, and at 560, in a half-hour. The cholera Vibrio is resistant to low pemperatures, On objects contaminated with feces it survives for several days; in food products it is readily preserved if they are not acid; in milk (before souring) it can even multiply; in' water it is preserved,for. a' lon.g:time 'It is very sensitive to acids: a solution of 'hydrochloric acid 1:10,000 kills it in several seonds. Chlorinating the water guarantees its safety. Only? man is a source of infection '(patient or vibrio car- rier). Infection of man is ?possible only by the oral route, that is, cholera is a typical intestinal infection. As in the case of the other intestinalinfections the routes of spread are numerous. , Water and food products can play an important epidemiological part. Large outbreaks can be produced by the consumption of contaiminated water, particularly when there is a central- ized water supply. The infection of local water sources leads to the predom- inance of the disease in regions in which these water sources are utilized. Infected rivers can lead to the infection of inhabited places along them, particularly of rural locali- ties, in which water is often, utilized directly from the rivers. Further spread of cholera is effected by the same variety of routes as in the other intestinal infections. The role of, the fly. factor is important in the seasonal rise of the disease incidents. The great epidemic tendency of cholera is determined by. this. The use of the cholera vibrio as an agent of biological attack is determined by what has been stated above. Evi- dently, an attack can be effective only through the infection of the water supply. The system of purification, and dis- infection of water.. at commuhity water supply centers com- pletely.eliminates the cholera vibrio from it. On this basis, Roseberry, in general, doubts the possibility of application 120 of it. -However, in Korea (in Dai-dung) the water-purifica- tion equipment was destroyed by bombing prior to infection of the water source but the waterworks itself was not touched [the term "waterworks" is used here in the sense of water- distributing'element in contrast to the water-purification element]. Under such conditions the infection of the water can lead to the occurrence of an outbreak if it is not re- cognized in time. Infection of the Water in the water. supply system (a^ uxil- iary reservoirs, etc.) is bossible if there is an insuffi- cient quantity of rdsidual chlorine in it. To be sure, this can be accomplished most readily by a diversionary method. The site of infection can be established by epi- demiological examination' with adequate accuracy: the great majority of cases will be in the area supplied by the in- fected water. ? The clinical picture of cholera is characterized by diar- rhea, vomiting, convulsions; hypothermia and in severe cases, by. cynosis. The incubation period lasts from several hours to six. days (on the average, one to three days). In con^ trast to other diarrheal diseases the cholera diar- rhea is not accompanied by tenesmus, the excretions are very copious, odorless and colorless, and are of a liquid con- sistency. Because of the desqumating epithelium of the in- testine.these stools resemble rice water. There are many vibrios in the excretions which are readily detectable on microscopy. The excretion of a large quantity of fluid with the vomi- ting and in the diarrhea leads to marked dehydration of the body and demineralization of it. The occurrence of other clinical features are associated with this: marked sharpen- ing of the facial features and cynosis of the face (facies cholerica), loss of the voice, intensification of convul- sions, loss of skin turgor, etc. There is no specific treatment. The use of antibiotics (streptomycin, terramycin and others) is possible. Laboratory confirmation ?the diagnosis of cholera is obligatory. A preliminary analysis is made on the basis of the microcopy of the excretion. At the same time, a culture is made on peptone water with subsequent plating out on alkaline agar, by' the isolation of a pure culture and the .1 I 121 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 Declassified in Part - Sanitized Copy Approved for Release 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 performance of the agglutination test. An important differ- ential feature is shown by culturing on blood agar. Shipping of the material for examination is carried out using the same precautions as for other particularly danger- ous infections. Specific prophylaxis is carried out by in- oculations of a cholera monovaccine or by combined prepara- tions in which the cholera lraocine constitutes a component part. Extensive phage prophylaxis, which includes the whole populhtion without exception, is carried out in the focus of infection. . ? The general anti-epidemic measures are the. same as for the other intestinal infections. The high degree of epidem- icity of cholera makes it essential that measures be conducted more carefully and in short order. Hospitaliza- tion of suspected patients should be carried out using iso- lation technique before clarification of the diagnosis; how- ever, known cholera patients can be placed in general wards. Persons (clinically healthy) who have been in contact with patients are isolated in special institutions for the purpose of constant observation. They are carefully examined bac- teriologically in order to detect vibrio carriers. The per- sons under observation are given bacteriophage (after mater- ial is taken for laboratory examination). Requirements for the condition of the water supply, clean- liness of cities and the sanitary routine at food industries are made stricter. Constant special bacteriological examin- ations of water for the cholera vibrio are made. The fight against flies should be carried out most vigor- ously. The observance of the rules of personal hygiene by the population plays a tremendous part in the prophylaxis of cholera. Therefore, sanitary propaganda among the population should be markedly increased. Typhoid and paratyphoid fevers. The causal agents of typhoid fpver and paratyphoid fevers A and B are biologically related microorganisms which produce unitypical, clinically indistinguishable diseases which have common epidemiological rules and regulations. Typhoid and paratyphoid fever microbes are bacilli of average size (1=3 microns). They do not form spores, are 122 - motile; they stain well with all ahaline dyes, are gram-nega- tivei grow well on ordinary media:, producing a uniform tur- bidity on liquid media, while on platelagar (in Petri dishes) their colonies are clear, 'round, s1ightl convex,-with billooth borders and. two to'three millimetersin- diai-peter. )They are biochemically active:. they decompose gluco86',-MaltOserman- nitol, and certain other carbohydrates (except for lactose and sucrose) forming-acid (the typhoid fever microbe), or acid and gas (the paratyphoid fever-microbes) .:"These properties of the typhoid-paratyphoid microbes are constant and can be used as.a differentiating characteristic: 'Microbes Of the typhoid-paratyphoid group are quite resis- tant in the environment. They survive up to four days in tap water; in stagnant water, for about two seeks; in el:A/age and in soil of irrigation fields they are'preserved for tl'Io AeekS; in cadavers, up to a month. In pasteUrized milk they live for four months; and in other food products, depending on the acidity, preservatives'and other conditions, from several days to several months: Desiccation on various ob- jects does not kill the microbes immediately: they survive for several days. When desiccated from the frozen state the microbes not only survive but also are well preserved. Under natural conditions, A disease corresponding to the clinical picture of typhoid fever (which is produced by all three species of microbes) exists only in man. Such a dis- ease cannot be produced in any species of animals even using experimental infection, although the administration of large enough doses of microbes causes the death of the animal from intoxication. Therefore, the only source of infection is man. The infection occurs by the oral route. The incubation period in typhoid lasts for one to three weeks; in the para- typhoid fevers, from two to three to-fourteen days. The clinical picture of typhoid fever is characterized by a very severe headache and depression during the first few days of the disease, by a slow increase in temperature (stadum mere- menti), by prolonged fever (acme), by a general serious con- dition (typhoidal state), by a roseolar rash on the abdomen and chest, by"a slow decrease in the temperature (stadium decrementi) and by a gradual improvement' in. the 'condition or the patient. Deviations from the typical clinical picture -are possible in the direction of a milder course, particu- larly in those who have been inoculated:' The idea that all cases of the disease with a mild course are paratyphoid fever 123 Declassified in Part - Sanitized Copy A d for Release ? 50-Yr 2014/04/07: CIA-RDP81-n1naRriflqs:tnnnannn Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 is unconditionally erroneous: the severity of the course of the disease dependsjess_on the species of causal organ- ..ism pustomarily,thought. Accurate diagnosis can be .established ;only by laboratory means. In recent years., levo- mycetin-2(chloromycetin) and biomycin (aureomycin) have been used successfully for the treatment of typhoid fever. , As has been mentioned above) the only source of infection can be'man, a patient or a bacterial carrier. Because the infection occurs through the oral route, the transmission . factors can be eitherfo0 products or water "(including non- alcoholic beverages), which can be infected by the most varied means (flies, dirty hands, the access of contaminated sewage to reservoirs, etc.)i The consumption of infected food products and drinks leads to the occurrence of new cases of the disease. The epidemic quality of typhoid fever, which under appropriate conditions can always become an epidemic outbreak, is determined by this factor. It exists when there is infection of water in watermains, of milk in dairy farms and creameries, of any dishes in large public dining rooms or factory kitahens, etc., that is, in those cases where in- fection of the water and food products occurs which are used on a large scale and which come from a single source. This determine the method of appllcation of typhoid-paratyphoid microbes as agents of attack. Evidently a diversionary in- fection of the water and food products would be most probable. Infection of water in reservoirs would hardly be effective in view of the existing system of purification and disinfec- tion (chlorination) of it at the main structures of the pub- lic water supply. The penetration of a sufficient number of typhoid-paratyphoid microbes into the water supply network is possible only in the event the established sanitary-hygi- enic norms, which can be guaranteed only by strict observance of generally accepted methods of water purification, are vio- lated. Naturally, under conditions of a possible attack the requirements for the observance of a routine of operation of the water supply systems should be made more rigid. One of the violations of the sanitary-hygienic standards which can devaluate all the efforts of workers in public water supply systems is.the.combination of a water supply network used for drinking with an industrial water supply. When water is taken reservoir it is not subjected to purifiaation, because it is designed for technical purposes. In certain cases, when for various reasons there is not enaagh water, the industrial water supply network is combined with 124 ttin' r- the public water supply. As a result of an asynchronous change in the water pressure in the two water supply net- works, the entrance of unpurified (so-called "crude") water possible into the network of the public water supply sys- tem. Naturally, in such a case infection of the water in the reservoir can be effective. Some industrial adminis- trators have been attempting to diverge.from the require- ments of the health agencies that the public water supply. be kept unconditionally separate from the industrial water supply on the grounds that chlorination of the water is car- ried out in the latter: ,Such digressions should be stop- ped most decisively, because chlorination of unpurified water is not very effective because of the large amount of organic substance which combines with the active chlorine. Increasing the quantity of chlorine added cannot be unlimi- ted, because it would have a marked effect on the quality of the water, which acquires the taste of phenol. In practice, this leads to the fact that chlorination is carried out with ordinary doses of chlorine, which does not assure the disin- fection of the water. The considerations presented above permit us to believe that strict observance of sanitary-hy- gienic standards developed .under ordinary conditions guaran- tees the disinfection of the water even under conditions of biological warfare. This is not a chance coincident. Sani- tary-hygienic standards have not been worked out through speculation, but rather through the process of assuring dis- infection of water from open reservoirs contaminated by sew- age. Therefore, a diversionary infection of open water sources cannot be effective if it is not combined with a destruction of the purification equipment. The infection of water can be accomplished, however, in the water conduits and in the water distributing system. De- pending on how the water distributing system branches off from the site of infection to its terminal points, the focus of involvement by the infection may be greater or smaller. The presumptive site of infection can be indicated with more or less accuracy by an epidemiological examination of the focus of Infection. Factors contributing to the infection are marked variations in the water pressure in the distribu- ting system. A fall in pressure in the system, up to a. vacuum, renders infection of the water technically easy to accomplish. Poor maintenance of water towers, access of in- spection pits to the water distributing network, and the ab- sence of protection for auxiliary water reservoirs etc. also 125 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 can contribute to this. A diversionary infection of food products with typhoid- paratyphoid microbes can be expected first of all at indus- tries the-products of which are not afterwards subjected to thermal processing (bread, ice cream, certain confectioneries, hors d'oeuvres, etc.) or'where thermal processing is not obligatory (milk). To a certain degree this also pertains to the large mercantile establishments,-which extends the assortment of food products which can be .exposed to infec- tion (sausages and siMilar meat products, fruits, certain vegetables, etc.). The question of the possibility of application of an aero- sol of typhoid-paratyphoid microbes is being discussed in the press.- It should be noted that there are no data in existence concerning the possibility of artificial infection by typhoid- paratyphoid microbes through the respiratory passages. How- ever, it may be assumed that the existence of microbes in the air will lead to a settling of them in the oral cavity and in the nasopharynx, and they will be swallowed together with the saliva. The disease occuring.thereby would be associa- ted with the natural mechanism of infection rather than with any portals of entry which are not characteristic of the typhoid-paratyphoid microbes. In addition, the application of aerosols can lead to contamination of environmental ob- jects (even aside from food products and water) with which man comes into contact, and then the microbes carried into the mouth by contaminated hands can be swallowed along with the food, etc. In other words, regardless of whether infec- tion can occur through the respiratory passages or not, the use of typhoid-paratyphoid microbes in the form of aerosols cannot be eliminated as a possibility, although a priori. It would be difficult to determine the effectiveness of this method of application. These considerations pertain to a certain degree also to the cholera vibrio. Everything stated above determins the system of preven- tive measures which need to be adopted before an attack oc- curs. Among them are a proper arrangement of the water sup- ply system of inhabited places (observance of the technology of water purification, proper maintenance of the waterworks, a continuous operation of the pumping stations etc.) and an appropriate routine for enterprises of the food industry and mercantile system (protection of food products from external contamination at all stages: from preparation to consumption) Diversionary acts can be prevented only through ineffective 126 S-77, t.;?_ protection of various objects. These measures should be supplemented by constant bacteriological .control of the water: by determination of bacterial contamination with pathogenic microbes. In the case of the Use of aerosols Protective individual and group measures should-be used (masks and shelters) for the prevention of direct infection of man and also all the numerous measures for the protection of food products and water not the factories and mercantile points (seal- ing of storehouSes, Covering food products, etc.) but also of the food products and water existing ailong the population. Food products which have not been covered, and therefore which are possibly contaminated, should either be destroyed or subjected to thermal processing. All the measures for the protection of water and food products should predeed the advent of the aerosol cloud, that is, practically they should be carried out continuously, because it is impossible to de- termine the moment of attack beforehand. After the attack, access to food products can be permitted 'only after disin- fection of all surrounding objects and rooms, etc. Mb been carried out. The food products should be unwrapped in such a way that they are not contaminated from the outside of the container or from the means of covering them before diFInfec- tion is carried out. Prophylactic measures can be supplemented by immunization of the population with a vaccine prepared from a combination of all three causal organisms (triple vaccine):' After the occurrence of cases of the disease the measures taken are no different from the measures for combatting ty- phoid fever which have proved themselves. In connection with the fact that careful systematic medical observation should be carried out in the area of infection constantly, the early detection of febrile patients will be facilitated. Early hospitalization of patients and careful disinfection along with other measures (the cleaning of rubbish in the yards, the fight against-flies, inoculations, etc.)' when ac- complished punctiliously and promptly can prevent the spread of. infection among the population." Bacterial dysentery. Dysentery is a general infectious disease with predominant involvement of the large intestine, which is manifested in frequent stool, usually with mucosan- guineous excretions. 127 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07 ? CIA-RDP81-01043R003800050002-9 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 Dysentery is caused by several species of microbes: by the Grigor'yev-Shiga, by the Stutzer-Schmiez bacillus, and by microbes of the Flexner group, by the Sonne-Cruzi bacil- lis, etc. The causal organisms of dysentery are non-motile, do not form spores, are gram-negative. The GrigorlYev-Shiga and Stutzer-Schmiez microbes form a toxin. They grow well on ordinary nutritive media.. The species listed are differ- ent in their biochemical and serological characteristics. . Under environmental conditions, the resistance of the causal agents of dysentery is less than that of microbes of the typhoid:paratyphOid group. In the stool of patients dysentery bacilli die in several hours. In impure water they die in two to four days, and in sunlight, in two and a half to three hours, The causal agents of dysentery sur- vive for two months in ice. In food products they survive for several days. - Bacterial dysentery is a human disease. Spontaneous cases of dysentery are also observed in monkey houses. The disease can be produced in cats under laboratory conditions. When mice and rabbits are injected with dysentery microbes they die from intoxication by endotoxins. Therefore, the only source of dysentery is man. The clinical course of dysentery has been discussed exten- sively in the special literature, and there is hardly any need to describe the entire well-known picture of dysentery. In this section mention should be made only of the great variability of the course of dysentery (from a severe toxi- cosis to the so-called "irritablenowl") which complicates its clinical diagnosis. In addition, the great frequency of the,, stool, whish is associated with the excretion of a large quantity of infected material into the environment is important in an epidemiological connection, and to a certain degree this compensates for the low resistance of the mi- crobe. The routes of spread of dysentery are the same as for typhoid fever. However, the low resistance of the dysentery microbes limits the importance of such a factor as water. This, to be sure, does not mean that water-borne outbreaks of dysentery do not occur at all. When the causal organisms enter the drinking water large outbreaks develop. However, water-borne epidemic outbreaks in dysentery are much less common, obviously because massive infection of water sources is relatively rare on account of the low resistance of the 128 e microbes' and as the result of the rapid extinction of the microbes. The coincidence Of a massive infection of'the water with errors in the Operation of-the water supply sys- tem,(inadequate purification- and chlorination), are-necessary for the-occurrence of an outbreak. However,-the effect of other epidemiological factors (flies, dirty hands, etc.)- is so active that spread-of dysentery proceeds very vigorously and generally involves more of the population than does' ty- phoid fever, - Taking into cohsideration the characteristics of dysen- tery microbes and the epidemiology of dysentery it may be assumed that causal agents of this type of disease can be used as an-agent of attack only by the diversionary method. Here the water supply network or rapidly-spoiling food pro- ducts which are not subjected to thermal processing can be exposed to infection. Roseberry considers that dysentery ? causal organisms can be used for the infection of water res- ervoirb', food., milk, etc. during a retreat, which also to ap- plies to the category of diversionary acts. . Therefore, the prophylaxis of infections amounts to the observance of the sanitary standards in the water supply system and possibly to an increase in the chlorine content in the water, and also to a protection of food products against infection. Sanitary propaganda among the population should play an important part (as in other cases): the con- sumption of boiled water and thermally' processed (boiling, waShing fruits and vegetables with hot water, etc.) of food products is a guarantee against infection by dysentery bacilli. With the occurrence of cases of the disease the same mea- sures are used which are taken in the fight against dysentery under ordinary conditions. These measures have been quite well worked out and are generally known. Typhus. The causal organism of typhus, is the Rickettsia prowazeki. In smears the Rickettsia prowazeki has the ap- pearance of cocci, bacilli, and sometimes of filaments which are often arranged in pairs and rarely in chains. Study by means of the electron microscope has shown that they possess a membrane and many inclusions in the cytoplasm. A bipolar structure is 'shown by means of the phase contrast microscope. After staining by the Romanowsky method brightly staining chromatin granules, which are arranged differently depe"nding on the morphology of the cells (P. F. Zvrodovskiy), are found in the bodies of the ilickettsiae. 129 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 Declassified in Part - Sanitized Copy Approved for Release The Rickettsia prowazeki is a microorganism with little resistance, like the majority of intracellular parasites. However, this does not mean that they die instantly after coming outinto the environment. Under some conditions, they are preserved for quite along time: Thus, in the stools of lice under low temperature and low humidity conditions the Rickettsia prowazcki remain viable for several months. Under artificially crea:ted conditions (desiccation in the frozen state) the rickettsiae can be preserved for seVeral years? This speaks for the possibility of prolonged preservation cC the rickettsiae in the capacity of an agent of biological at- tack. Modern methods of mass production of typhus rickettsiae have been quite well developed._ They can be grown in lice, in the yolk sacs oP chick embryos and in the lungs of rodents, maintaining their pathogenicity for map. Man is absolutely susceptible to typhus. The epidemiology of typhus is quite well known. The only vector of the infec- tion is the louse. In the complete absence of lice a patient does not constitute a danger to those around. However, this does not mean that a.person cannot be infected artificially by another route. Cases of laboratory infection with typhus during the preparation of typhus vaccine in mice speak on behalf of such a possibility. The intranasal infection of mice produces sneezing in them, even though it is carried out under light anesthesia. This, in its turn, produces a dissem- ination of the infectious material in the air. Laboratory workers who are in the same and sometimes in the next room are infected by breathing the air contaminated with the ric- kettsiae. Therefore, the portals of entry for the typhus infection may be the respiratory organs. By comparing this with the possibility described above of keeping the Ricket- tsia prowazeki in a desiccated condition for a long time, the conclusion may be reached that the possibility exists of using the causal organism of typhus in the form of an aerosol as an agent of biblogical attack. The clinical picture of typhus is characterized by an aoate onset, by a rapid temperature rise (for two to three days), by a typhoidal state, disorder of activity of the cardiovas- cular,zystem and by petechial rash which appears on the fourth or fifth day. The fever remains about two weeks, after which the temperature falls by crisis or by an ab- breviated' lysis. At the climax of the fever definite signs of intoxibation deveIovin_the central nervous 'system (typhoi- 130 Declassified in Part - Sanitized Copy Approved for Release 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 dal state, restlessness, delirium; hallucinations', etc.) and in the heart (degenerative changes-of the muscle, in- volvement of the vessels). The briefly deacribed'signs of tYphus infection can be preceded' by prodromal signs consisting of headaches and muscle, aches, poor'sleep, rapid fatigability, etc. The presence of such signs in cases-of-possible infection (in a. focus of infecti9n) should .attract attention and should be considered to be incipient typhus, arid the entire complex of anti-epideMid measures (hospitalization, insect elimination) should be taken with respect to the patient in the focus. There is no reliable information as to how rapidly after an' infection through the respiratory organs the- signs of the disease appear; It Is possible that the incubation period is of the usual duration (on the average, 14-15 days). The Rickettsiae prowazeki when used as an agent of attack would not possess any epidemic tendency if participation of the only vector of-the infection--the louse--iseliminated. Therefore,-anti-epidemic measures in the area of infection should primarily provide the careful accomplishment of in- sect elimination. When a locality with a large number of inhabitants is affected, the citizens themselves may be brought into the work of insect elimination, providing them with insecticidal soap. Correctly and carefully performed measures can completely prevent the spread of typhus, limi- ting the number of cases to those directly infected. Specific prophylaxis (vaccination) is possible but has not been adequately worked out as yet. "Q" Fever (pneumorickettsiosis). A particular species of rickettsiae, the Rickettsia burneti, is the causal organism of an unusual rickettsial disease which occurs in people in the form of an acute febrile disease, usually with the pre- sence of pneumonia but in the absence of a rash, and which has been given the name ne fever. Rickettsiae represent small coccoid bodies; they can have the appearance of small or of large bacilli, and sometimes form filaments. The for- mation of filtrable forms is a characteristic feature of them. The rickettsiae are readily Cultured in laboratory ani- mals. However, in mice the infection occurs asymptomatic- ally, but a fatal infection develops when they are infected 131 5 - r 2014/04/07: CIA-RDP8i-ninaflpnnqsznnnannn Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 with.a large dose. Guinea pigs are more.suseeptible.and,, therefore, more, suitable for isolation and culture of the rickettsias. Rabbits are not suited to these purposes. The causal agent. of "Q" fever is very resistant both in moist and in .dry. substrates. In butter made from the milk of infected cows-it remains very active for 41 days. It tolerates desiccation very well: it maintains its infectiv- ity in the feces of ticks for 566 days. Dried utine and blood of infected animals preserves its infectivity for several weeks. Pasteurization of milk reduces the number of ricket- tsias but does not lead to complete disinfection, On prolonged maintenance under laboratory conditions the causal agent of this disease preserves its infectivity for a long time. Thus, in blood of infected guinea pigs kept under a mixture of oil and vaseline the rickettsias preserve their infectivity for more than nine months. The causal agent of "Q" fever is pathogenic for many species of animals: rodents (mouse-like, susliks), wild artiodactyls (Persian gazelles), domestic animals (short- and long-horned cattle, horses, asses, dogs, etc.). Its pathogenicity for birds (for example, field sparrows) he's been established. Man is also highly susceptible to the infection. The incubation period in "Q" fever lasts from 19-20 days (14-26 days), on the average. The onset of the disease is acute, out is not severe. The fever begins with a chill, rapidly reaches a high level and lasts for four to 15 days. It is accompanied by headaches and muscle aches, and by gen- eral weakness. There is no rash, which distinguishes it from che majority of other rickettsial diseases. Pneumonia is very characteristic of "Q" fever, while it is comparativ- ely rare in the other rickettsfal diseases. Most often, the lower lobes of the lungs are affected. The pneumonia is accompanied by a dry cough, which is found on the fifth to sixth day of the disease, and by pains in the chest cor- responding to the affected part of the lungs. The pneumonia itself has an atypical course: it is not demonstrable by auscultation or by percussion; it is mainly diagnosed ro- entgenographically. In individual cases, it shows the course of a severe bronchopneumonia with the excretion of sputum, or proceeds subacutely; resembling tuberculosis. There is a tendency to bradycardia noted in the heart. The course of 132 the disease is benign, but the period of convalescence is protracted (several weeks). In addition to this typical.form, "Q" fever can occur with the most varied clinical picture. In accordance with this, grippe-like, septic, pseudobrucellosis, nervous, low- grade febrile, latent and other forms of this disease are distinguished. The :disease leaves a strong immunity in its wake. Successful treatment is given with aureomycin (biomycin) and levomycetin (chloromycetih], The epidemiology_of "Q" fever has not been adequately clarified.,, However, the main data concerning it are avail- able, Rodents and ticks are the natural reservoirs of the infection; in ticks the infection is transmitted transovar- ially. Evidently, domestic animals are infected by the ticks (goats, sheep, cows), 'and these are frequently sources of the infection for man. .Therefore; "Q" fever is a typical zoono- sis. It is believed that man can be infected by the oral route by consuming milk, and milk products from sick animals, through the skin, as a result of tick bites, through col- tact with infected articles, through the nucous membranes of the eyes, etc. and respiratory passages (inhalation of air containing infected particles). Particularly great signi- ficance is ascribed to the air-borne route of spread of the infection, particularly to the inhalation of dust (the cau- sal agent of "Q" fever is found in the dust of farms which have sick animals). There is no agreement on the question of whether or not the infection is transmitted from man to man. The majority of research, workers deny this possibility. It should be men- tioned that such an idea renders completely incomprehensible the assertion that the main route of infection of people is through the respiratory passages, on which many research workers insist. In all known infections the infection of man through the. respiratory. passages leads to the involvement of the latter and to the" spread of the infection by the air- droplet mechanism. It is, difficult to believe that "Q" fever is the only exception. Therefore, either we must accept the infectivity of man.for those around, with the participation of the air-droplet mechanism of transmission, or deny the chief 'importance of the. respiratory passages in the infection of man and regard the pneumonia which frequently develops as 133 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07 ? CIA RDP81 010 RO (-) 9_0 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 secondary. This problem is exceptionally important for unde'rstanding the natural spread of "0 fever; for an evaluation of the possible methods of using the causal agent of this disease and the spread of the an artificially.created epidemic focus (focus of infection). Therefore, this problem should be discussed in some detail. From.the recognition of rodents and ticks as natural re- servoirs of the infection it follows that he infection of people can occur either as the result of the conpumption of infected food products (with the possible participation of an additional epidemiological link--short- and long-horned cattle), or .as the result of the bite of ticks (with the pos- sible participation of them in the infection of, agricultural animals), In both cases, infection through the organs.of respiration is excluded, if we overlook, in general, the exquisite cases of the infection, for example, through dust from packing straw which had been sent into a locality where there were no other sources of the infection. Reports of the dust method of infection in foci of infection where other methods of infection are possible have, at least, not been proved. Therefore, the chief method of infection of people should be considered to be either transmissive or oral, dependinE, on the source of the infection. This is associated with the absence of infectivity of the sick persons, particularly those who are hospitalized, because in this case there are no conditions which would contribute to the transmission of the infection to those around. There are other relationships in the infection of man through the respiratory passages. The developing pneumonia is accompanied by the excretion of sputum which is copiously seeded with rickettsias. Under these conditions the patient can be infective for those around, although the conditions under which hospitalized persons are kept do not contribute to the expression of this property. Thus, German authors have described an intrahospital outbreak of "Q" fever among patients and medical personnel. A laboratory worker was the source of it; he had been infected in the process of work- ing with the causal organism of "Q'.. fever. In the course of two months he infected 38 persons in the hospital, evi- dently by the air-droplet route, because rickettsias were found in the sputum. Then, despite the fact that he contin- 134 ued-to' eibrete the cauPal cirganisms in the sputum for another three mOnthsi-the cases ,of the disease stoppe'd. Undoubtedly, this was preceded by a change in the measures taken for the patient. It is interesting to note that ,the source of the outbreak'-wa.'s-alman'-'whO had beeh -Infected in%the laboratory, that is, 416tVyl-then*atuilil'i"OUte. Itris-believed that in suchceses the infection Is brought about through the res- piratory 1)assage:s. Here, there is a grimary involvement of the flungs', accOmpaniea by -thee-eXcretion of a large number of rfckAtsids: Fi-om this exaiiiple it is' seen that under certain conditions a sick person is highly contagious. The conditions prePented above permit,us to suppose that under certain conditions (for example, .int the event of pri- mary involvement of the lungs, or in the-acute bronchopneu- monic form of the disease) a person can constitute an epi- .. demiolegical danger. J ? ? The most Probable method of using the causal organism of "Q" fever,- in -the'fbrm-of -an-aeroSol,lis determined by the possibility of:infeCtion'thrOugh the respiratory passages, by the great resistance of-the Causal agent, by the great probability -c)1C-'an inCrease in the epidemicity of this.fc?m of biological weapon in primary irivoivement of the lungt, and also by the fact that massiVen6as of infections can readily-be produced by this route. The use of infected ticks cannot oe very effective both because of their biological characteristics (number of blood-suckings, poor mobility, season of activity, etc.) and because of "the lengthiness" of the outbreak produced artificially by them, which permits the timely application of the entire system of measures for protection a6ainst attack. Food products (milk, etc.) can be infected for diversionary purposes. The establishment of the use of rickettsias by the labor- atory method can be based on the examinations of various en- vironmental objects and on material from patients. In the former case, washings Should be taken from articles onto which particles of the aerosol, suspected food products, anu ticks may settle (if there are any indications that they have peen dropped), etc. The examination proper should be car- ried out in the form of a biological test by the subcutaneous infection of guinea pigs in the area of the thigh. Disease of the latter (edema of the subcutaneous tissue and gangrene of the muscles) occurs on the third to tenth day; there are many rickettsias in the affected tissues.' Therefore, rein- oculations into fresh animals should be made at the height 135 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 Declassified in Part - Sanitized Copy Approved for Release of the fever in the infected guinea pigs. The rickettsias can be reinoculated into the yolk sacs of chick embryos Guinea pigs can be infected with material from patients by the method mentioned above or intratesti,dulatly; the maximum accumulation of rickettsias is Sound in the tissues of the testicles (in the cytoplasm of the histiocytes) on the seventh or eighth day in the' form of Co6coid or diploc- cal forms. Chick embryos can be infected dire'ctly with this material. Making the diagnosis in patien't's can be based on serolog- ical examinations (agglutin4ion i'eaction of rickettsias and complement-fixation reactioh) also. The prophylactic measures are determined by the method of application of the rickettsias as a weapon. Such group mea- sures of protection as shelters protect against rickettsias used in the form of an aerosol. Individual measures of pro- tection of the type of masks, respirators, etc. can be supple- mented by vaccination in this case. The vaccine which has been developed at the resent time does net: constitute a complete safeguard against the disease during 'an infection en masse. However, in immunized persons the course of the fever is incomparably milder, without complications, etc. Naturally, the immunization is effective also for other routes of infection. After an attack has been made, a careful supervision (no less than 21 days) is established of the inhabitants of the affected area. As a result of the high degree of resistance of the rickettsias, disinfection, insect elimination and deratization operations should be carried out extensively and very carefully. If it is established objectively that the rickettsias were used in the form of an aerosol, measures in the focus should be extended to include animals (sheep, goats, cows) in the form provided for by the veterinary- sanitary legislation for zoonotic infections. Milk of these animals should, of necessity, be boiled, because pasteuri- zation is inadequate. With the occurrence of cases of the disease, the same mea- sures should be taken as for other infections (hospitaliza- tion, terminal disinfection). The prophylactic use of anti- biotics is possible. 136 Declassified in Part - Sanitized Copy Approved for Release 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 In the hospitals the medical personnel should wear at - least masks. ? When the rickettsias are used by other.methods, appropri- ate-Measures are taken with respect to food products (when there is a dIversionary infection of them) or ticks (insect elimination)'; ' - Virus Encephalitides. Cerebral afflictions are caused by several-species of virusesi-:Hoigeveli, not all the viral en- cephalitides have been sufficiently studied. The epidemiol- ogy and etiology of soMe of them are not known to date. Among these are EcOnomOts encephalitis [encephalitis lethar- gica] and Australian encephalitis (X-disease). Among those which have been adequately studied are tick-borne spring- summer encephalitis, Japanese, or summer-autumn encephalitis, St. Louis encephalitis, and'equind encephalomyelitis. Tick-Borne Spring-Summer Encephalitis. The etiology' of this disease and 'theepidemiology 'of it have been studied by Soviet scientists. The causal agent is a virus which is pathogenic not only for man but also'for'thher species of ani- mals and birds, which are infected under natural conditions. The vector of the infection and chronic carriers of the .virus are ticks of the: genera Iibde's,..Dermacentor and Haemaphysalis. The virus concentrates chiefly in the salivary glands of the ticks arid enters the bodies :Of man and-animals with the sal- iva of the tick during a bite'. .Evidently,'-the virus enters the genital organs of the tick also, because it is 'transmit- ted to the tick Progeny transovariallY. ? The virus is cultured in susceptible animals (mice) and on chick embryos (on the chorioallantoic membrane). When dried from the frozen state the resistant. The virus can be preserved for 25 days in a suspension of brain in physiological solution. The' possibility of laboratory in- fections without the participationof vectors permits us to suspect infection by other routea, for example, by the air- borne route. Therefore, th6 possibility exists of applica- tion of the virus as a biological weapon, at least in the form of aerosols. The events in Korea have shown the attempts at using the biological weapon are possible by means of scattering insect vectors. However', the dropping-of ticks can create 'ideali- zed foci''of infection. We must consider also thattsticks aan be used during definite season 6 of the' year--during the per- 137 50-Yr 2014/04/07: CIA-RDP81-01043Rnrmnnncnnno_a Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 iod of their greatest activity. The season of the greatest activity of ticks is found from April to June. After a certain delay (incubation per- iod) the activity curve of, the tick factor is repeated by the tick-borne spring-summer ehcephalitis morbidity rate. In the western regions of the USSR the maximum number of cases are observed in June-Jul: - The incubation perio4,1asts two weeke;-on'the average (eight to 23 days) I The disease begins acutely, with a rapid temperature rise (to 400), very severe headache; nausea, vomiting and general hyperesthesia. The psyche is impaired. The disease affects the gray matter of the spinal cord, most often of the superior cervical segments, as a result of which flaccid, atrophic paralyses of the muscles of the neck and shoulder girdle develop. The paralyses are observed in more than 20 percent of cases. The recovery period is prolonged. A strong immunity remains after the disease. Therapeutic serum and convalescent 'serum 'can be used-for-treatment. The vaccine which has been proposed for purposes of spe- cific prophylaxis represents a suspension of the brains of infected mice, in which the virus has been killed by the prolonged effect of small doses of formalin. Anti-epidemic measures should be directed against the vectors of the infection (insect elimination). The indi- vidual measures of protection are appropriate clothes and insect repellents. Patients should be hospitalized immedi- ately, not so much because of their epidemiological threat as in the interests of the patient himself. Japanese, Summer-Autumn Encephalitis [Japanese "B" En- cephalitis]. Cases of this infection are observed in Japan, Korea, in the Philippines, in the western regions of China, in Manchuria, and in the southern regions of the Primorskiy Kray. The regions affected by encephalitis are strictly oub- lined, and cases have been observed in them for many years (natural focalization according to Pavlovskiy). The causal agent of Japanese encephalitis is a filtrable virus, to which, in addition to man, monkeys, certain species of rodents, sheep and goats are susceptible. Because the en- cephalitis has been observed for many years in poorly inhabi- ted localities it must be considered that certain species of animals (possibly also birds) are the reservoirs of the in- .138 nr77- t fection,,as in the case of tick sprpig.7summer encephalitis,T becoming sick from it under natural!,condions.. ,Therefore, Japanaseencephalitis should be regar-Odbas a zoonosis. _ ' 'Mosquitoes are the vectors of the.Japanese encephalitis virus:.Culex pipiens, Culex tritaeniorhynchusc,,,Aedes-togoi, Aedes albopticus and Aedes laponicus.-2-Culex.tritaenior-! hynchus and Aectes.togoi are infected spontaneously. The vi- rus reaches its maximum Oontentration in the bodies of the mosquitoes 15-20 days 'after the infection. In its remaining properties the virus of Japanese enceph- similar to the.yirus pf spring-summer encephalitis. The methods of using the virus of Japanse encephalitis as an agent-of attack can evidently bp_andlOgousito those described above. 'It should,be taken, into consideration .that mosquitoes are more active as vectors but they bred in many localities. Therefore, in many regions it is impossible to -create long-smoldering foci Of4aP4nafile enceph- alitis, the possibility of which,would:,compensate to some degree for the lack. of epidemicity. The clinical picture of Japanese encephalitis is charac- terized by an acute onset. The incubation period lasts 10- 12 days, and the prodromal signs are usually absent. The temperature.rapidlY reaches 39-410. Vomiting,occurs. Tonip and clonic convulsions develop which go into an epileptiform attack. The muscle tone is increased (fixed positions of the patients). kecovery is slow, with a prolonged mental impair- ment (weakening of memory, discrimination, etc.). There are no pareses, paralyses or similar phenomena. The, mortality rate is high (40-50 percent). The treatment and prophylactic measures are the same as , for tick-borne encephalitis. Anti-mosquito nets should De, added to the measures of individual.prptection. Naturally, in the focus of infection insect elimination should be widely used. (when insects are dropped) as well aa;processing of the pop44tiOn (in the event aeropols,are,used).,' 1 I ! St. Louis Encephalitis (American Encephalitis). Cakes have been obseriied in the United States (in St. Louis and its environs and, in he state of The causal agent of enCephalitis is ,a. filtrable virus, which is similar in its properties to the, virus.of,Japanese encephalitis. The'. virs is pathogenic for monkeys and,mice, isnot pathogenic Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 139 ? Declassified in Part - Sanitized Cop Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 for aheep,and dther anithals. The vectors are Several species of mosquitoes of the genera=Culex,-Aedes and Theobaldia. Culex. torsalis mosquitoes- have been found to-be spontaneously infected. The morbidity is observed in August-September. - I. . ? The-clinical.picturelOf Amerldan encephalitis is:the same as that eflTatanese encephalitisl.but it is milder. Treatment and prophylactic meaSureb arti the same as for Japanese encephalitis', ?( Equine Encephalomydlitisi- Cases have been-observed'in America, Germarly, and France. In the United States, two ' variants of the?virus are known--western and eastern equine encephalomyelitis/ which are capable of producing cases of the disease in-persons. Equine encephalomyelitis observed in the USSR is-obviously not transmitted to people, because no cases have been observed among people. ? Many ?species of rodents, calves, goats, certain birds (with experimental infection) are susceptible to the viruses of eastern and western encephalomyelitis. Under natural con- ditions, mules, horses and man become sick with it. The cases of eastern encephalomyelitis are more severe. The disease in people is characterized by a sudden onset (in the western variant prodromal signs are observed--head- ache, sleepiness, intestinal disorders). Fever with a temper- ature of 40-41 is accompanied by neurological symptoms: very severe headache, pronounced pain in the back muscles, sleepiness, confusion, speech disturbance, ataxia, nystagmus, convulsions. In eastern encephalomyelitis general rigidity of the muscles or opisthotonus, paralyses, pedal and facial edema and cyanosis are observed. In thaeastern variant the disease-passes through two phases: -the initial general signs, of the prodromal type, pass without? trace, And then", after a short period of apparent recovery, the complete, severe pictUre of the disease unfolds. 'Paralyses are observed in 15-20 percent of the Cases. The mortality rate is high: about 15 percent. in western and up to 74 percent in the eas- tern form of encephalomyelitis, Chiefly children are af- fected. - ''The virus of encePhalomyelitis is readily cultured by all the-methods.known In virology: in'tissue culture, on chick embryosc-on animals. Large'numbers of'the virus are readily'obtained by the infection of chick embryos. This 140 method; as 'well as passage through the brain of mice, is utilized for the purpose, of obtaining virus.during prepara- tion of,the vaccine' Vaccination creates a strong ,immunity to the disease. N , . In nature the reservoir of the virus is unknown. Eviden- tly, neither horses nor man play the important part in pre- serving-the-virus-in ?nature. The question of vectors,of ? the infection has not been finally solved .either. It is be- lieved that two blood-sucking artIlropods participate in the transmission.of.evOephalomyeltis; the .birdfmite, Which transmits the virus frOm bird to bird, maintaining it under natural conditions, and mosquitoes,' which transmit the Infec- tion from birds to vertebratesincluding horses and man. The absence of casesof equihe encephalomyelitis in the USSR can be explained either by_the lack of susceptibility of mar? to the local virus or to.the,absence Of an appropriate vector. Therefore, the use of the virus of American equine encephal- omyelitis-could have the aim only of directly infecting the population, which can be accomplished on a large scale only by means-of- aerosols.. The'use-of infected.vectors can produce a limited number-of cases of the disease'if there are no appropriate local vectors which are secondarily infected. In the event of the presence of vectors the infection can assume broader dimensions if we Judge by the analogy to malaria. It may be supposed that the second possibility is excluded in the USSR, because the presence of appropriate vectors would have led to an adaptation of the local equine en- cephalomyelitis virus to the human body, as occurred in the United States. These considerations, in accordance with the most probable method of attack (aerosols), permit us to recommend indivi- dual protective measures (masks and gogles for the protection of the mucosae of the eyes and respiratory organs) and Processing of the focus and of people with the aim of elimina- ting aerosol particles whickv,have settled in the event of an attack. If the attack is not recognized in time, there Is no need for these measures at the time cases of the disease occur, 'because by this time the virus would 1lave died out. This evidently applies to all viruses described above. Psittacosis is an infectious febrile disease produced by a filtrable virus and in the majority of cases it occurs with inflamation of the lungs. ? un- Declassified in Part - Sanitized Cop Approved for Release ? 50-Yr 2014/04/07 ? CIA-RDP81-01043R003800050007 Declassified in Part - Sanitized Copy Approved for Release _ The virus of Psittacosis is one of the representatives of a group of viruses very similar-to'one'another which cause diseases of birds and which are .combined under the group of ornithoses. In their properties the virus of lymphodranu," loma (a human of venereal disease) and viruses of various animal diseases .dre similar to the viruses of ornithoses; The virus of psittacosis is one of,the:large (280,to 380 millimicrons) VirUses-but it passes through a seitz filter, through the Berkefead'filters,and through large- pored Chamberlane cahdles-in,impressions:or,,in, sections from organs of the elementary bodies of the virus, can be found by staining in the Romanowsky or Morozov methods.. They , are found in cells or the reticulb-endotheliaI system or intra- cellularly after .rupture of the cells. In the event of an intraderebral infection the sections (smear-impressions) are made frOM the brain; in-the event of an intraperitoneal infection, from the'spleen and liver. The virus of psittacosis Is quite resistant.. Heating to a temperature of 560 for thirty-minutes does not inactivate it completely; it dies in ten minutesonly at 60?. At low temperatures (minus 700) it remains viable for one year and even for two years. When freed of tissue particles of the virus, suspended in a buffered physiological solution, is preserved for no less then three weeks: In sputum and in pieces of lungs placed in glycerine the virus is rapidly inac- tivated, which should be taken into consideration when collecting material for laboratory examinations. The virus is pathogenic for mice and they are utilized for the isolation of it. Mice may be infected by any parenter- al route. The virus can be isolated and cultured also by infecting chick embryos (in the Allantoic fluid or in the yolk sac). Under natural conditions the virus of psittacosis and other ornithoses effects about thirty species of parrots, domestic pigeons, ducks,, chickens, turkeys, egrets, etc. Guinea pigs and rabbits are susceptible to certain strains of the virus and are utilized for the isolation of it. Birds also may be utilized for the isolation of the virus if it can be ascertained that they were taken from healthy aviaries. Man is infected with psittacosis and other ornithoses from parrots and other birds. The incubation period in man lasts from seven to fourteen days (on the average ten days). 142 Declassified in Part - Sanitized Copy Approved for Release 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 The clinical course of-the disease fs differgpt. ...;11 some cases, the onsetAs'sudden, with a cht11, tever,:loss of appetite, paid-in the throat, malaise; photophobia and a severe'headache. In other cases the disease begins gradually and unnoticeably. The temperature at first Is somewhat less then 38 to 399 C., and then increases,? In severe cases, ? a high terriperature"of constant type persists for about two : weeks; in mild cases, it drops.on,the,seventh to eighth day; The temperature decreases gradually. Nasal hemmorhage is noted in 25,Pereent-ot the oases. A slight dry cough develops ih the patients for 60vbra1 days. The.sputun. is never abundant;-at'is mucous and then mucopurulent. The physical changes 'in the lungs are poorly expressed: Sections of bullness to percusaioh,are found at-the bases of both lungs; roles an be heard, beginning with the, fifth day,. The degree of development of pneumonia is established by X-ray examination; Recovery proceeds slowly, and there are often relapses. Residual signs in the form of "a network': of inter- stitial thickening with individual small foci are detected by roentgeno1ogfeS1 examination when' it is Impossible to detect any changes by ordinary' examination. .? The mortality rate in psittacosis is equal to nine to eleven percent, but in individual cases it can be higher. The mortality rate is reduced considerably by the use of anti biotics (penicillin, biomycin', etc.). )Blood is taken.from the patient for laboratory examination during the first few days of the disease and after two weeks. Blood.taken during the first few days is utilized for isolation of the virus' and for performing the compliment-fixation test. The compli- ment-fixation test is performed using two specimens of syrum taken during the first few days and after two weeks in order to ascertain the occurrence or increase in the antibody project. Befibrinated blood is used for isolation of the virus taking into consideration the fact that it is found in the blood during the first week of the disease. ,The virus may be isolated from the'sputum at later periods: After two to three weeks, and in certain cases, even later. Therefore, this material can also be taken fnr examination. If the patient does not excreet any sputum, a washing is made from the bharynx with sterile physiological solution. On autopsy of cadavers pieces of pulminary tissueri should be taken from areas showing changes, and also pieces of spleen, and exudate from the plural davity.. Each type of material is put individually into test tubes which are covered with 50-Yr 2014/04/07 .. 143 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 rubber stopper's'. The test-tubes are .put into metal case and during transportation the material is refrigerated (dry ice, by putting the cases into ice, etc.) A similar procedure As carried :out with material taken from the bodies of birds. If the bodies of birds are being shipped they.should be wrap- ped up in many7layered,gauze, moistened with five percent lysol or phendl and placed in a canvas bagb Refrigeration of the material is obligatory., The main source of psittacoals and ornithoees in general, as seen from the naM02.are birds, and 1*r-titularly parrots. However0'man'to man infection is possible. Reeen,t17,..more then twenty'cases of,infection of medical personnel.(thirty persons) have been described where contact with bird had been compTetely excluded. Infection obviously occurs' through the respiratory passagesl, Intrahospital and intralaboratpry infections attest to this. "The latter ,cases also speak for the great susceptibility of man because infection is contracted very readily. The infection .of laboratory animals,by'inhalation of the virus also indicates the fundamental importance of' the air-droplet mechanism in the spread of the infection. These' data speak for the fact the use of the virus of psittacoei's is possible only in the form of aerosols.' True, reports of the possibility of infection from articles-con- taminated from virus (feathers of birds which have died, excreta, nasal excretions, etc., permit us to assume the possibility that infected articles can be dropped. However, In the best case such a method can produce only-solitary cases of the 'disease. The application of aerosols makes it possible to infect not only people but also birds, creating, thereby, a powerful focus of infection with a long-lasting reservoir of infection in a given locality. Apart from the usual measures of protection to which recourse is had in places where the use of aerosols is suspected. Protective masks and goggles, gas masks, shelters) the prophylactic use' of antibiotics is possible if it has been established that the virus of psittacosis was chosen as the agent for the attack. Vaccines made of psittacosis virus have been obtained and have been tried outson volunteers; however' their epidemiological effectiveness has not, been established. - When casea:of the disease occur among people measures should be taken in, the area .of infection taking into con- . sideration also the possible infection.oT,birds. Continuous medical supermieion is established of the popu- lation in'vthe area, of infection for two)/pekp during which temperatures.are,takena. /At the firet: 'signs, of tie disease ' the 'patient is Tioepitalized and ,disinfection. is carried out of his personal-articles.? , ? - ? . Observation of,persons.who,have-,been in -eoptaet with patients is Cohtinued.Torvatwoyeeksxaftr 'hospitalization of the patient. A careful examination of 'birds is carried out by the veterinary service in the area of infection with the aim of ,stablishing,:theepresence.of-,cases of-disease among them:, On,large,Tarms'sickbirds and,thoee suspected of being sick.alceltilled and evisqerated on the spot. The meat'can be food,after,thermalprocessing the down and feathers -are .carefully collected arid burned. -In_indi-VidUal farms in which:cases-of,theAisease,are found the.?nically healthy birds are killed with consumption of the meat ab food. The feathers and down are burned. Sick birds'are destroyed (burn- ed). Careful,disinfectionjwith a clarified solution of chloride of lime) is carried out in the aviaries. The eggs maybe utilized as food iinthe cooked (hard,boiled) form. The sale of birds and eggs from ,the area'of infection ie prohibited. The quarantine. Is removedTrim farme six donths after the last case of disease among the ,birds. . . ? I a. 4 . The medical and veterihary.personnel carrying out the work on the.elimination of the after-effects of the attack should 'use measupes .of individual protection (ordinary overalls, cotton-gauze ,masks,. protective glasses). -medical supervision is established of them-also. ? Yellow Fever is an acute infectious disease of tropical and sub-tropical countries, of viral etiology, which is trans- mitted_by, mosquitpe bites. The causal organism of 'yellow fever belongs to the group of small?viruses (twelve to.nineteen millimicrons); it ' readily passes through all the bacterial filters. Depending on the tissues that it accumulates in chiefly (affecting them) two types,x, virus strains are considered:. Naurotropic and Viscerotropic,. However, different tropisms of the virus can be assosiated:vith,the method of Culturing it. The ori- ginally,strins are evidently pantrobic. lit 5 , Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07 CIA RDP81 010 RO sn 9_0 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 The virus ib readily cultured on animals (.usually on mice), in tissue cultures and on chidk embryos0.that:is, by all the methods kndWn tb;virolbgy; r. The virus-is sensitive to heat-and, ahtideptics. It is well preserved in 50 p&rceht glycerine solution, which is utilized' Or shippihg.the- material for-examination:. The fro- zen infectious Material'Preberves is Attivity:tor s lbng time. The virus desidcated in the Trdzen state when kept in the cold can _remain viable for several years. The blood of patients looses:ita infectivity'at-atemperature 30? centigrade in Spoximately'two days;? at 55?, inAen min- utes, 1 ?,,, r . ?. ? _ The virus of yelibw-fever is pathogenic,forAtide, guinea pigs, hedge'hogtil certain spedies%of :edentates Contesters and others)) certain Specied of rodentti?and all marsupials. Mon- keys are readily.irifected-by the.virus:of'yelloW fever. Rab- bits and ratb of'the=:laboratdrY animalsvcarnivOra) the maj- ority of rodehtsicold blbodedTanimals and 'birds are resis- tant to thevirus. ' : ? ? ? Man is very susceptible to-the:?yelloW.fever virus. 'The course of the,disease in man is variable: from very mild to very severe, terminatifig in death in several days. The incubation period' is equal -to two to seven days, some- times being drawn out to'12 days-.' The febrile period begins suddenly without any prodromal signs. The high temperature is accompanied by headache; pains in,the back; and in the feet. A lack of' correlation between the pulse and the tem- perature is characteristic of yellow fever, kremission is possible after which the temperature rises.again;?and jaun- dice develops. Hemorrhages are observed' in the skin and mucous membranes. Nausea and vomiting (of- changed blood) increases. In favorable cases, the temperature:dropA lyti- cally. The mortality rate is considered to be various ranging from 5-25 to 30 percent if it is not taken into consideration that during the severe outbreaks it reaches 70-75 or even 9k percent. PoSsiblY the-latter figures'4Der- tain only to the most severe cased, ..There is no ,specific treatment: ?. . At the very beginning of the pre6ent dentury-it was shown by experiments on volunteers that Ybllow.feverl:s transmit- ted only'by blood-sucking mosquitoes.' Attempts to infect people with underwear taken from patients or with underwear 146 4.. contaminatecl,w1th,,b1oo4_and vomitus of patients. did not,give anypositimPrPatilJts, ,Thus, the,opinionowas confirmed:.that, the only route-df-tfanbmibbion of the infection is by the mosquito in the-body,Ofwhich the-virus'is?capable of 'multi- plying and reaching ajligh,concentrationon,the twelfth dav after infection. From ,this point:oflyiew,the uselofIthe yellow fever Vitus as an agent of bigiogical attack is_possible only by'''dropping infected,.moiquitoes;,1Thib, to be .sures.cah.,limit the-effec- tiveness -of the 'attack;, because the. inclusion of.. the natural mechanism oftranamission,lof)infection reqUires the presence of, the,Aedes.aegypti-mOsquito in the givehglocslity; and it: is found only in a small section of the southern coast: of - the Caucasus (Batumi Poti, and Suahumi) where they were broughtfl:by ships, ,In, Other places of the Bilack-Sda-,'coast the mosquito of this species did,not take route.ibecause,of the unfavorable climatic conditions, since there is no basis for_the:lbelief that it was not imported into these frequently visited ports.:(0dessa'and others):: Therefore, onralmost'the entire.territory?of the,Soviet Union the useof,Ithe4ellow%- fever virus:-by dropping ,infected mosquitoes .can-be'considered only ,from the,point,,o1 view of the activity of thel.inbedts,,-' dropped. However, ,even in this case,an adequately high ?.? night temperature is an,obligatory condttion:', no less than 177209, at which the mosquitoes still attack,man: ? -' , In connection with the discussion of the problem of the ' possibility of using the yellow fever virus as an agent 'of biological warfare the opinion has been expressed that.arti- ficial infection by this causal organism can ,be carried out by the air-borne route. Roseberry adheres to this view, basing, his conclusion on.en-snalysis of intralaboratory in- fections. 01.34 cases :described (five cases fatal) only several of them were associated with mosquito-infection; and in the tremendous,:majorityof cases the work was being,: carried out without insects, and therefore, the infection was not accomplished by this method. Specifically, cases have ,been described where the. patients had been' .assisting' two laboratory, workers in their work with desiccated' and," pulverized yellow fever virus. The work lasted Sutotal of several minutes.-The possibility exists that:thevirus .; was sprayed. Two other, laboratory workers also.became,dick. Roseberry believes inhalation of the sprayed.virus_to'be the most probable method of, infection, in the giveh'caliie. Therein the, yellow fever virus is distinghished,frOm,the ? epidemiologically similar dengue feverwirus,jwhith does not 147 771.44111.0,1.1 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 1 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 infect'peeple When-it entere.'the reepiratory-passages, be--' invtransmitted only,-byribitee,of,Aedes s--. ? 4 ? -ITHence itfolIow3lthat,the,yellow,,f6verL:Virus may beeX- usedr:in-the form2off--an aercisol. - - - The laboratory diagnosis is based on the isolation of the ,vitUs.andlowithe%determination;bf,antibodiesAn the-,patients' ..seraywThe data of:.the-sihistopathlegidal,:eiamination,may-aibe' Such'exathi6tioha-2-can (virologidal) ,labOratoried.i Blodd,should'be taken-frOm the patients for isolatiorrOfJthe vtrusdurinethe firat'focc- daysiof the:disease;-because-afterthe', disappears.from-thePblood._ ? ? ;:?.'?! 1 ? , ? Thecsystemof,rdeasures for 'combattinglyellow fever isde- terminedr,bythe.method.:of apPlication -of-the infectivenidus. :i.PbophylactIc methods in ,the use of aerosols, , as in many - other,,casesiamounts%toa protection,ofrthe respiratory organs -(masksshelters). lin the given case, individual measures-ofq.protectionLcambe-supplemented by vacination, whichcreates an immunity of adequate' strength. In cohnec- tion with the trief.incubation period:of yellow fever the immunizationilof:persons.knownto-be infected doesnot have, any sense, because immunity.cannot be developed. Nor does the disinfection of objects on to which particles of the aerosol have fallenor of patients' excretions -have Any par- ticular zence, because during brief periods of time the virus is neutralized as-the result of natural extinction. The fact that in the desiccated state it possesses a high resistance is very important for, the accumulation and preservation of. it, but does not 'make it necessary-to carry out disinfection, because, desiccated and.pulverizedipiological preparations are vtery hygroscopic, and in the-presence of moisture and warm- weather Conditions the^Virus'is rapidlytinactiVated. If there.iffiduld.;.be any-danger that the,particies of'aeroWol which.have?eettledi:mial be 'carried upward into the air again, and .if. _conditions have-not contributed,tOtheir inactivation, pouring: watez!over thesoil,and over"tife-oUtsidesiall'Of buildings-sandxlamp_oleaning,in the house, etc.' are sUfficient. In practice,.disinfection!mill be used.intall ea-see of "at- tAck:by.faerosals.,:because, all the vrOtectirVe:theasureddhOuld. be taken imishOrt-order:during thobe..periode'of'time,Ah.which identificatiort,of.the-biological'agentfis improddible given' the present'state.of.:sciente..- lberefore-;:in infectjon will be;rcarried.:out'enethY-used. the 'yellow - 148 t feverWitus. The hospitalization of patients should be carried out-jn, the interest Of.;the-patierits themselves :rather than,becattSe.: of theepidetiologidal%threat ofthe:patiefitat ',The'abience, ofa vector !baked the'patientsafel' In Iocalitie3 where there is a.vector-hoepitilizatidn'!isan anti-epidemic-Ieaddr ?.:::-" . ? The use of-Modquitops infected with tWye110-ifeVer,v1rus reql.kired-the-aCcOmgiShment'of-measUres-With-reepect to-the-' vector (1nseelithinatiein)1 arid the measures, of protection againat,attadka by themusing netting,=danopies, anti=mosqUito net.$).'rePellenta. other'wordd,"the'same-'' measures-are taReiragainat modquitoes-ae--in-th6 case of malaria.. I ? ? 4 t ? 'f ? ?? ''? '; . ' .1' i'Bbtulinue.Toiiri- Among the-agents'-of bidlagical. warfare" mentionedAn'the.foreign literature (Rosebefty'aild Cabot) the toxin of the.bacillus Of botulism ts listed. ; The causal -organism of botulism is an anaerobic bacillus, which is quite large (four to six microns), forming highly resistant spores. It is stained by all the aniline dyes. Young cultures are gram-positive; in old cultures there are many gram-negative individuals. A subterminal location of large (greater than the width of the Cell) oval spores, which gives the bacillus the, appearance of a tennis racket, is characteristic of the botulinus bacillusJ The bacillus of botulism possesses great proteolythic and ? saccharolytic activity; however, the property of splitting carbohydrates is not constant and cannot be used in the iden- tification of the microbe or of its types. Five types of the microbe of botulism 'are distinguished which are designated by the letters' of the alphabet (A, B, C, D, E). They all-form antigenidally different toxins, that is, each of them 1s neutralized Only by its own anti- toxic serum. This property-hat-been made-the -basis of the serological differentiation-Of the bacillud of'botUlisM. ? The botulinus toXin is one 'o the. most actiVe.-'Its toxicity is exceptionaily,great. Thus', there Ete 220,,000;000 minimuM lethal doses for White"thideiper-milligrath of nitrbgeh. of tte' crystalline type. K botulisa-toxin. 'eThe toxicity of-t-Yper(B'' is approximatelythe'dame It is hard tb-"judge the activity of type E .toxin-,-becautefit- has not been isolated in the'. crystalline form; however, filtrates of cultures of type E 3.149 Declassified in Part - Sanitized Copy Approved for Release @ 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 bacilli are less toxic than filtrates of type B and-particw larly of type A. ? - , " ; ? The botulism toxin possesses a:TropertvwhkchAistinguishes itnfromother exotppiips:::,1tjs,not-idestroyed:An,theacid ,,medium,of the,stomaphx,and_itjpongt-split-ImAlgestive en- zymet30.%and,isreadiJiy absorbed-Srqmitbeidigestivetract. Therefore, in contrast to other, toxins it can cause a disease -after_entering the,bpdvin phe--food (enteplIv,route).;, In ad- dition; 1.t_ipjleat:tesiatant,,.compared;iiith',otheri toxins:, -com- plete,deStrUctibb-i, iachiempd,.by heat-Tat.._50,for-about-f30 0,Tinutes., Thestabt4ty of:the to*in,tsideterpitnedcbyjthe characperi.ofthe,rdedium iniwhiqh the to*in,id, .A high carbo- hydrate content increases thenresistanpei,ohe toxin to_the effect of high temperature. in liquid medium (desolved-,toxin) in the presence of air, and under the effect of light the botulinusrtoxin It is Inactivated Very,: rapidly when there is an alkaltne reac,fionTOT-theTmedtph:- In the desiccated state in sealed ampoules or in an exsicca- tor over calcium chloride, sulfuric acid (protection against moisture), it can be preserved for several years without zany significant changes tn,toxicity. Man is very sensitive to type A, B and E toxins. The data of authors who have observed outbreaks of botulism speak for the high degree of susceptibility of man. Cases have been described in which the patients merely tasted the food product and spit it out without swallowing it. Never- theless, this did not prevent the disease: negligible quan- tities of the toxin remaining in the mouth proved to be suf- ficient to cause a severe disease. The toxin may be absorbed from the ocular mucosae. The first signs of the disease are thirst, dryness in the mouth and in the throat, visual disorders (disturbance of accomodation, double vision, ptosis, etc.) which stem from paralyses of the oculomotor muscles. Then, disorders of swallowing and of speech are added, the voice becomes hoarse, and-there can be complete aphonia. The picture of botulism is also supplemented by a persistent constipation as the result, of aAisturbance of motor, function of the intestine 4n,c11.eteor1pm, ,Consciousness is: preserved until death. The mortalityyp. is high but is (Afferent in different outbreaks. It isOpelieved.that on.the,average it is, equal to-,6,,percentoweverl,at the tine of a, large outbreak in the, United,L4tatts:in 1936 it-reached-J=1,2 percent. 150 -11 .A specific=antitOitc-serum-as used-fo'r'treatthenP; ? , The content,ofAoxinAn foocrproductatindAn.material takemat the_time:-.of aUtolisylblood from-the heart--;'piecet- oftliver, spleen,,urine4,!oontents-of Various seotions--of:: theA.ntestinetaken:peparately-in--jars)7ia'determined by, a biological test-on animals:',-With-thie's-,aitivinView, ?- tracts from.organa,:fOod;-ettt are pouredrida into five test-tubes. 'Antitoxic"serum.(A;B, S)J'eaah-tyPe'ini ' ? single test-tube', idridded,to three'ttstltdbei, A' fourth-- tubeAs heated. ata temperature ofi1000?C-for tive to ten minutes. Test=tubes'containing a. mixture of'tht material , with serum are placed in a termostat for 20-30 minutes.' " Then, mice are injected With 0.5 milliliters of the liquid from-all the test-tubes. An extract which-was not subjected either to heating or'to serum neutralization ' in-the fifth:test-tube is injected into onemouse. 'The re-' sults of.the,test are correct if two'-mice'die which have received,the material-under examination' in a mixture with ' serum, and-the mouse which' received antiserum and' another,. which received the heated extract remain alive. The type-- of botulism corresponds to the type of antitoxin which . protects the mouse frop?death. To be surel.the coursel.of the disease in the animals should be characteristic of bot- ulism (flaccid', paralysis). However, frequently the death of the animals occurs in the morning and the-r6search worker doesn't have any opportunity' to watch the development of ' botulism. ,;J ? The properties of the botulinus toxin which have beehl' briefly described and, primarily its exceptionally great toxicity have made it possible for foreign authors to list it among 'the agents of attack. When botulinus toxin is used as a biological weapon' only the direct :involvement of the population can be taken into consideration, because for readily understandable reasons the toxin is completely devoid of epidemicity. American authors (Roseberry and Cabot) believe that the-toiin- can be ubeefor poisoning water, food products and in the fOrm of an aer0661. 11 ? / This determins the prophylaxis of cases'of botulism.. Water and food products designed for individual usage should be subjected to thermal processing. Food:products which-are not subjected to thermal-processing should bb' destidyed 'if' they are known. to 'be contaminated' by th'e 151 Declassified in Part - Sanitized Copy Approved for Release @ 50-Yr 2014/04/07 ? CIA-RDP81-01043R003800050002-9 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 j When the,toxin,isused:in,the,form,ofan.aerosol the pro- tection of organs of respiration and of the eyes (masks, gas masks,lprotective-glatses),andr:shelters%aretadequate for:the protectiontof-the:people againotthe disease. The clothes_ of peaple,who are ,in: the aero?1-1oud 5hould be-'moistened- witlwater and alkalis .Theuse ofdi,sinfectants:has no sense, because We.are,dealingherp-with,a-toxici.substance ancUnot with a,,livipgorganibm...-.,-Most practical i's?!the_use,of sub- stances yihich,destroy.the tokin. ,,As;far.:as:the soil is con- cernedypotsibil itiis $iAfil.cient,t0 pour ordinary.water cop- iously over,it..,Therfty,the solutimaf the toxin occurs. with absorption of ii:by the soil,and,acceleration of its., destruction.. - . . ? ' . , c ,, ??. . . , , , :With'the occurrence of cases of diSease-antitOxic serum-, Sho4d:beAnjected,,:usedtaldo prophylactically in ,the,event:of,e.,probablefentrance-of the- botulinustoxin into the body. Recently,,a botulinus.:-toxoid-!has.been ob-L, tained:.-with which peoPle_can be immunized., However, .its ef- fectiVeness*deilepidemic circumstances =has not been clarified:, Measures for,the,Individual and Group Anti-Bacterial ,./:,..-Protection of the Population, The fight:against:infectious diseases and primarily against those whichhave become prevalent and which have been associ- ated-With a 'high mortality rate (plague, cholera, small pox, leprosy, etc.) has been carried on for a long time, and the history of it is as old as;the history, of mankind r; Naturally, the lack of information concerning the cause of the diseases in previous, centuries lead to the fact that many of the mea- sures taken were naive from a modern point of view. (fumigation with letter incense during outbreaks of the plague etc.). However, certain of-the,measures in a modified, form have been preserved up;t0,he,present time. The practicality of them was determined.tvthe:fact that they were directed against the most important properties:of,infectipus diseases, viz., infectivity and a rapid diffution among the population. 'Thus, such .measures hayebeen preserved upto the present time as hotpitalization and isolation of patients, quarantine, pro- tective aAttsand maks, etc.L/The idea of immunization of healthy pepple,mith:the,aim of protecting ,them against a Spvere,,paed for several centuries:- The perfedtion of,ma#o.14p,prophylactAc measures and agents pro-- deeded on' the?deirelopmept ofLthescience of infectious-disea- ses (bacteriolOgy, immunology, virology, epidemiology, etc.) ?-* and2_on..the, testing of them in anti- epidemic practice._ ! . According to their character, prophylactic agents and meatures cap be directed against, any definite infection, such, for example, as immunization,against it, or in the-case of a group of infections by acting on the routes of spread which are common to them:.,:Inzconpection with the fact thatiin the former caseibacteriological preparations are most-,often used (vaccines, seta) whidh posses8 a great degree of spe- cificity (in the imilunological sense), ,the entire system,of inoculations for,proptirlactic or, therapeutic purposes has obtained the name%of,specificTrophy,laxis or therapy. In con- trast to this, measures taken against.the routes,of spread, etc., are called measures Of non-specific prophylaxis, al- though this is not altogether accurate in the epidemiological sense., ,? In,additiop to such a division of the various measures and agents of prophylaxis they are-sometimes grouped in ac- cordance with ,whether they are of an individual or group ? character.- This division to ,a certain degree is arbitrary, because, for example,oinoculationt, which are essentially measures,of.individual prophylaxis, when used extensively lead to a reduction in the morbidity rate among the popula- tion (group)_ not only because of those who have been, inocu- lated but also' among the .persons who have not been inocula-' ted. 'Thus, smallpox was eliminated on the territory of the USSR -before,ail of the population had been inoculated. In a description of measures taken against the spread of infectious diseases among the population under conditions of application of a biological weapon a second grouping of them is accepted. That is, a-differential consideration of individual and group measures of protection. Among the individual measures' of protection are the use of specific prophylaxis by means of vaccines and sera, the prophylactic use of antibiotics and various chemotherapeutic preparations,the utilization of protective clothing, gas masks or respirators, protective glasses, anti-mosquito nets, agents,which,.repel insects, ,observance of the rules of per- sonal.hygipne, etc. ? f ; Among_-the-Broup measures ,of protection: are shelters and, other structures,y4ch:may,be-utilized simultaneously by groupa,ofithe,population of-differeht sizes. Various measures .153 Declassified in Part - Sanitized Copy Approved for Release @ 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 go. Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 .V3 ??.* 4 ' - ???? directed at decontamination-of water, food prOducts'and soil or of the protection of them from contamination are also?-?, used for the protection of the group. In?our subsequent presentation each of these agente;and- ' measures will be examined individually: Specific Prophylaxis. Specific prophylaxis is carried out by means of vaccines, toxoids and immune sera. The vaccines dre biological preparationslin whiCh 61e antigen, that is, the 'substance which produce8-the elaborT. ation of immunity, is represented either-by the entire 14- crobe cell (bacteria, rickettsias, viruses) or by a substance extracted chemically from the whole microbial cell. ' ? f Vaccines may be living or killed. The liver vaccines are prepared from causal Organisms of the corresponding diseases and attenuated by various methods. A live Vaceinal strain is obtained as a result of various inflUences on-causal or- ganSms, which almost completely lose their virulence, pre- serving their immunogenic properties. The loss" of-the cap- acity of producing a general disease is.preserved,permariently by the vaccine strains, which assures their' complete safety. Plague, tulerimia, brucellosis, anthrax; tuberculosis (BOG vaacines)7 etc. may serve-as examples Of bacterial vac- cines. Of the live virus vaccines, smallpox, rabies, influ- enzal vaccines and vaccines against yellow fever, poliomyel- itis, etc. may be mentioned. The killed vaccines are represented?either by suspension of microbial bodies (bacteria, rickettsias, viruses) which have been killed by heat, formalin or phenol, etc. or are colloidal solutions of a glucide-protein-lipoid complex, the so-called complete antigen, extracted from bacterial cells by chemical means. Therefore, such vaccines are some- times called chemical. Of the killed vaccines mention may' be made of chofera, typhoid, paratyphoid and dysentery Vaccines. Complete anti- gens may be extracted from'-these microbes for the purpose ' of preparation of a chemical vaccine. An example. of the ? latter is the NIISI [Scientific Research Institute of Vac- cines and Sera] in which complete antigens of all-the-mi- crobes listed above and tetanus toxoid-are' represented. ' ? Vaccines against typhUs, "sr fever', spring-sUmmer encephalitis 1514 and othersNare examples of -chilled. vaccines'made of ricket- tsias ad Viruses1' ' I. u. Ja So ca11ed?tox6ids,whithltilay be:lobtained from,bacterial toxins throilgWthe-action of formalin otothem (013-106 per- cent) at a temperature7toV40? Clare iddely used as-agents of 5p-deifies Prop4Tlaxis. ?These-preparatiohs, therefore, are prepared froWthef,activityiproductslof thicrobes--toxint which on-entering.thebody i?rodUce dibease,-that is,- which'' are the?battc pAthOgenetic,faCtOrbi-136bause they postesa not only a.toxial-effettiblit alsotimmunogetic properties, . immuhization withftheiblit a:?priAeotiOn against the disease However, immunization with the toxins themselves is impOs- sible on account of their high degree of toxicity. As a result- Of the-prOcesaing of=the,-tOxihiwith formalin (at a temperature-' of-"140?---C) it coffiplet'ely 'loses- its toxicity, pie- ImmUnbgenicprOperties: TheJpracti'Ceoficom- batting-diphtheria'and tetanus attest--to'the'-g(56d prophy- lactic-:qUalities)Of.toxoida:1 -Diphtheria, tetanus, staphyloCo3cUs and botulinus- toxoids named-at!examples OftprOphylactic agent's of thissgroup - Not all-the causal'organitms of'infeotions which have been mentioned in connection of preparations of vaccines against them will be used directly in the capacity of bio- logical weapon's: Howeveri.under conditiont-of applicatiOn of radioactive:weapons=thejsiegnificance'of all causal Organ- ismsior:infection.cah berenhanced, and therefore, active im- munization of-the'population should provide for the use of all the'known:specific prophylactic agents. The giving of inoculations under ordinary conditions is limited by=established contraindications, among which are acute infectious,diseases, kidney diseases, afflictions of the cardio-vascular system, diabetes, second half,'etc-. When inoculations are given during.a threatening period and particularly in the area of infection, the number of contraindications should be reduced as much as possible, giving .the inoculation in:all cases where injection of the vaccine is notiw,threat to:the life of the person being in- oculated. ? c% _ Active immunt7ation of%the-population-should be carried out chiefly before'an-attaok by the enemy for twd reasons. First, quite a long time is required for the development -155 xeetar=etafaIllsan..aaromm.moroarma*rfnamier....1 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07 ? CIA-RDP81-01043R003800050002-9 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 :,; - of: an immunity after inoculation,of,the_vaccine,:wPichi-as_ a rule, exceeds the duration of the incubation:period. ,If, we take into consideration the fact that the use of vaccines after anattaCk-has;:been,accomplishedAinIthearea of_infec- tion) is popsible.only afterthe'.establishment:,of the Species of microbe used, im- munity in,directly,infected,,persons becpmeaqblii0.,117The use of vaccines injthe-,area of infection:.can./provideOnly a limitation of the. spread of. thelinfectibn'by a-natUral route and a certain-reducponiintlie mortality rate-lamong, those infeCted, 40nlYa:preliminary:;immunization7can reduce loses from direct?infection significantly, atthe:time%of the attack. , Seconcqyipreliminary?immunUation,(before.the)attadk), - off the population is more effective 'even=in,tileigie4t-a com47 binatipnof.radioactive and-biological agent.4-Qf Attack are used. :Reports appearing in .thb.JbPas to the erect, that active'imthunity elaborated before the,developmentiof radi- ation sickness is not weakened or is only slightly weakened by irradiation.make4t,pecessaryito,en0PMpass the,P0pUlat1on as extensiyely As possible_ with, active immunization,J)efore the attack. Active immunization of persons who have been exposed to the effect.of,radiological weapons would. obviously be of little effect. The need for preliminary itmunization of the population, therefore, is obvious. _However, there are a number of dif- ficulties of objective and technical order. Among,the lat- ter are difficulties associated with the need for large quantities of vaccines, etc., inoculating instruments, large staffs of vaccinators, etc. Among the objective difficul- ties are the brevity of the immunity which can be created by certain types-of vaccines, the inadequate scientific develop- ment of the preparation of effective combined vaccines for the immunization against a large number of infections simul- taneously and, finally, the absence of vaccines'against.cer- tain infections. . . Therefore, alOng with thef?preparation'foroovercoming,the difficulties mentioned:(by,increasing_the,productive capacity of institutions which manufacture vaccines, by the organiza- tion and training of inoculation detachments, by scientific field of manufacture,of vaccines:i_etc.),,it is' take into.-,consideration the ,use of other bio- logical preparations in the system of specific prophylaxis. 156 ??? ? --..Specific prophylaxis., as?hasbeen,mentioned_above, can be carried7out:by the-use. of:immune 5era:,i.The latter can be obtainedifrom-animals_which:have,been,immunized.either by, . microbial tella2(antimicrobia1:sera).or,,by?.their, activity products.(antitpxic:-sera). Blood:,serai_of immunized-animals contain:ready.limmunebodies.against thecausal-,;orgapisms withtwhich'Ithe-immunization was carried Out. -Antibodies in- troduced.into a-pon7immune.organism.assist the latter in over- coming-thepathogenic effect of.tPe causalorganisms. , . . In contrast to vaccine6,, the Injection ofantisera crea- tes an immunity rapidly, over the course of several hours, but the duration' of it,doesinot exceed two or three weeks, that4is,-the time necessary_for-eliminating-the foreign serum from' the body'. ? . ? ? J. ,) As'an example weshould, like to mention:the,serum against tetanus, diphtheriv,_bbtulism (types A B and, al anthrax, plague,- spring-summer encephalitis, gas gangrene, dysentery (Grigor'yev-Shiga)," etc. The majority of antisera in ordinary practice is used for . ? 4 therapeutic purposes (specific therapy). Tetanus antiserum, the use of which gives practically no effect in tetanus which has already developed, constitutes an exception. The remain- ing sera also can be used.for.prophylactic purposes--for passive immunization of the population in the area of infec- tion. To be sure, even in this case serum may be used only after the establishment of the species of the causal organ- ism used. The use of polyvalent sera (against several in- fections) or of a mixture of several monovalent (against a single infection) sera is possible only in the event this is dictated by objective necessity (the established or sus- pected use of several causal organisms by an enemy). Bacteriophage can also be used for prophylactic purposes. Bacteriophages are,viruses which affect bacteria in the bodies of which the bacteriophage is a parasite and multiplies. Bacteriophages affect,various species of microbes selectiv- ely. Thus, cholera, dysentery, typhoid,staphylqcoccic, pro- ., teus and other bacterial phages are known. Because of this ? they rnayi specific prophylactic ,agents. However., iticOntraSt..tO-Vabbines:and sea they 'are not 'in any sense connacted7With-tha dAtigenic btimulation and im- mune: reactio,n_of,--the,b6dy. Their specificity 4E) brought,fact ithey,deatrovpnly those microbes to which they have been adapted., Bacteriophagy is essentially a virus 157 Declassified in Part - Sanitized Copy Approved for Release @ 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 dieease of -microbes. Therefore,-for the effect of the bacter- iophage its encounter.14ith the microbe is_obligatory, into which it'Penettates and which it destroys; -Naturally_such an nencoiantee in the case ? of the prophylaotic:oral use of bacteriophage can exist'only in the case of those,infections the causal organisms of Which are localized in the intestine. Therefore, the prophylactic use of.. cholera and .dysentery the most likely. .Theprophylactic use of. bacteriophage parenterally- is completely:excluded., because_ it possesses antigenic properties, and antibodies which des- troy the bacteriophage are,elaborated against it: ' Still another type of biological preparation may be used as an agent of individual protection in the .area of infec- tion?antibiotics (penicillin, streptomycin, levomycetin. (chloromycetin), biomycin (aureomycin], etc.). The estab- lishment of the species of causal organism is also essential for their use, In addition,. the sensitivity of!the latter to various'antibiotics should be established and depending on the results of testing various preparations should be prescribed. The need for the determinations indicated is dictated, on the one hand, by properties of antibiotics of acting on definite species of microbe's (bactericidal or bac- .teriostatic action spectrum of antibiotics), and on the other hand, by the property of the microbes of increasing their re- sistance to the effect of antibiotics. The use of the lat- ter in cases of infection by a microbe resistant to anti- biotics can give no effect which can be anticipated. The dosage of antibiotics which may be used in the focus of infection should be the same as when they are used thera- peutically. The dosage of these preparations should not be reduced arbitrarely, because this may lead to the acquisi- tion of resistance by the causal organisms. In a completely similar way (to the antibiotics), chemo- therapeutic preparations may be used also. Their use should also be correlated with the species of causal organism. Their dosage and systems 'of application have been quite well worked out. Individual Measures of'Protection Against the Entrance of Causal Organisms of Infection into tht_113.21y. Individual mea- sures of protection which protect against the entrance of causal Organisms of-various infectious diseases into the body do not possess any specificity., Their character ,is deter- 'mined by:which of the-possible routes of: penetration of the 158 Declassified in Part - Sanitized Copy Approved for Release ? infection they protect. It-is well known that infectious diseasee-agents penetrate into the body through the skin, mucous membranee of the-iespiratory tract, mucous membranes of' the intestinal trabt.,- mucous membranes of the-eye 4nd mucous methbrands of the genitourinary organs. In accordance with thie various.teasuresOf individual protection are used. s' Protection of 'the (*in, respiratory organs 'and mucous mem- brane b of the eye-is ccomplished by means of special cloth- ingl'gas Masks (or itb substitutes) and goggles. These pro- tective measures against the acute' infectious diseases have been used for a'long-time. As an example mention may be made of,the anti-plague suit with a hood,Wormover the usual clothing, and the triangular-bandage-nightcaps;. The suit is supplemented by rubber boots and gloves. A medical gown of 'special style:is Worn Over this, suit. The respiratory organs are protected by gas mask or'by a respirator or by cotton-gauze bandage. The mucous membranes of the eye are protected by goggles. Such a suit protects against infection even upon entering a bacterial aerosol cloud. Anti-chemical suits which protect against the effect of chemical warfare vesicands also completely protect the skin against infection by causal organisms of the particularly dangerous infections which are used in the form of an aerosol. Other types of anti-chemical protective suits in combina- tion with a gas mask or respirator and protective glasses make it possible to carry on different kinds of work in the focus of infection: reconnaissance, disinfection, insect elimina- tion, neut..0alization of bombs and containers, the taking of samples for laboratory examination, etc. Gas masks of the modern type protect the respiratory or- gans against infection completely. The newly'actiVated MPVO [Local Antiaircraft Defence] units, which are to be in:the focus of infection for a long time, - conducting 'its de6ontamination, should be equipped with special'forms'of.prOtectiVe clothing. The population, on the other hand, cannot always take advantage of the protec- tive clothing and the gas:masks. is impor- ta.ntto know what can substitute for them if they are not at hand:, 159 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 A gas mask can be successfully .replaced by a respirator or even by-a cotton-gauze bandage The,laiter can be pre- pared by the general-population.. Yor.this purpose gauze, measuring 100 x 50 centimeters is used,and,absOrbent Cotton measuring 25 x.15 centimeters and a thickness of twO to three centimeters is placed in the middleof it1 recommended that a layer of gray cotton, which retains duet particles more effectively be placed on the layer of absorbent cotton which effectively checks droplets (14 N..Zhukoy7Verezhnikov). In folding, the gauze.the cotton is covered with. to layers of it, above and below. A long strip pf cotter' and gauze in three layers is obtained. The ends of,gaUze free of the,cotten are cut down to the.. cotton in order to-obtaintwo,strips of gauze on each size fOr the purpose of tying. This dressing (of_a fundiform type) is. applied to the mouth' and-nope:. The.lower ends of the cut gauze are:tied over_the.tep bf:fthe head,and the other ones, at the occiput. ;.The space between the alae of the nose and the dressing is covered with pieces of cotton. The eyes are protective glasses. If a cotton-gauze dressing .is not at hand any uninfected tissue may' be utilized (coat tails, towel, .shirt, kerchief, etc.). Such tissues should be folded:in pix to'eight"layers. Gauze (without cotton) should be folded in 10-12 layer's. In the absence of any special suit, any thick or sufficiently nappy fabric, sheets, coat, etc., may be. used for. the protec- tion of the skin. The trouser legs should be tucked, into the boots. If no boots are available the trouser legs should be tied around and a second pair of. socks should be worn above them. Sleeves, gloves, etc., are put on the hands. All articles which have been,used in an area.of infection by aerosol or sprayed microbes after the explosion of a shell should, of necessity, be disinfected. Of course, these mea- sures are not required if no air infection occurred during the attack. The use of,,clothes without respirators or gog- gles, etc., is required only when insects are dropped. Protection against insects and ticks is accomplished by clothing made of dense fabric, without any openings into which the insects or ticks might crawl. The clothes should be im- pregnated with insecticidal preparations (DDT, hexachlorane). _ ? In addition, anti-mosquito nets should be used against fly- ing insects, which cover parts of the face and neck. Protec- tive nets devised by the Academician Pavlovskiy can be made 160 from silk mesh, a fishing net of the dragHnettype, etc. - The net is dipped in repel),ents: 1) ten parts of pitch and' 90 parts .of five percent potassium hydroxide; 2) of lysol, eight parts of turpentine, 77 parts of water;. 3) 20 parts of naphtilalysol, 10 parts of turpentine, 70,_parta,of water; 4) 30 parts of lysol, 10 parts of turpentine, 5 parts of odorless, vegetable oil and 55 parts of water. The nets; are wetted with these solutions for to or three hours, and then are wrung out an driedt, The rebellent effect ,of these substances As maintained for 10-12 days....The.nets are put on over the head geal,.ho that the ends of the net hang down freely. It is fixed in. place by two ribbons"seOn to. it which are tied under the chin. Dimethylphthalate, with which clothing, netting, etc. are impregnated, is also used as a repellent. It is used either in the pure form or in ,the form of a 15 percent solution in glycerine, vaseline and Others.- Dimethylphthalate can be ,ap- plied directly onto the skin, which it does not irritate. However, contact of it with the mucous membranes of the eye should. be avoided, because it produces severe pain. The re- pellent effect of dimethylphthalate is. preserved, for three to five hours. DibUtylphthalate (a similar prepara,tion)preser- ves its effect for four to five hours. Observance of the rules of personal hygiene at home and at work is of great importance during the period of the threat. The biological weapon is insidious; the use of it may not be accompanied by any visible signs; it is recognize the use of it at the time it is applied; it may makes its ap- pearance at any moment and, infect a large number of persons. However, it is completely ineffective if its road into the internal milieu of the body is blocked. Protection of the skin and mucous membranes of the res- piratory organs and eyes has been spoken of above. Infection by the oral route can be effected either by water or by food products. Observance of personal hygiene, thermal processing of food products and water, careful covering of them (which will be dealt with below), protection against flies, etc., are the measures which completely protect against intestinal infections in the presence of any method of application of the causal agents of them. The rules of personal hygiene should,supplement all the measures of Individual, and group protection. Shelters as Measures of Group Protection. The construction 161 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 of shelters for the protection of the population against the effect of chemical-warfare agents was based on the idea, like individual 'meastires.of protection, of prbtecting man against an(attack against his' skirt respiratory 'organs, etc., by measures of chemicar,attac.,... Because the shelter ia badedlon tlie principle of complete isolation of a person froma con- taminated medium it can be utilized completely also for the protection of the population against a biolegical. weapon. - ,The shelters represent complete guarantees againat infec- tion only event they are properly utilized.. The rules of utilization df shelters are prebented in .a:spepial section. In general, they amount to the following directives (with respect to the biological weapon): 1) until special instruc- tions are received from the chief of the shelter service con- cerning their'utilization no one Should be permitted to enter 'the shelter '(with the aim or preventing a possible diversion- ary attack); 2) persons Who have entered the shelter after being in a cohtaminated atmosphere are kept in isolation from persons who took advantage of' the shelter before the contam- ination occurred. Articles of various fabrics which were utilized as substitutes for protective clothing (Sheets, ker- chiefs, etc.) should be handed in for disinfection upon eh- tering the shelter. Shoes should be wiped on mats moistened with disinfectant solution in sections (or in special shel- ters). Where persons are quartered who have been in a contam- inated atmosphere, the utilization of gas masks, respirators, etc. is obligatory; 3) in the event of a disturbance in the operation of the shelter's airconditioning-filtering system (nearby bomb explosions, etc.) the order is given immediately that individualimeasures of protection be used; 4) shelters or sections where persons are quartered who have been in a contaminated atmosphere should be carefully disinfected after the people leave; 5) exit from the shelter may be allowed only by special permission. Leaving the shelter is accomp- lished along special walks covered with disinfectant solu- tions and with observance of the orders established by per- sons directing the operation of disinfection and decontamin- ation of the area of infection (chief of the medical service of the MPVO (Local Antiaricraft Defense), his deputy in the sanitary epidemiological service, by the chief epidemiologist, or by the chief of the mobile anti-epidemic detachment). Chemical agents possess a greater penetrating power than do microbes. If it were completely possible to guarantee the impermeability of cracks in windows and doors?to bacter- ial aerosols, it might be possible to use any room as a 162 ' shelter, because .filtration of the air through the wall (natural ventilation).would eliminate the infection of -sit. However,,it is,hard to guarantee suchtan tsolationo ThereI, fore; any room other: than a ahelter,type cannot:be considered suitable for complete' protection. Nevertheless; if for any.reason' impossible to uti17. ize-the shelters, the population may be quartered in any room or quarters which arg.isolated as much as possible. Thereby, the protection of,peopleadgainst the effect of or- dinary types of weapons tfragmentation.bombs, artillery, fire, etc.) is achteved as well as against%the effectof ' radioactive emanations. Undoubtedly, with sufficiently care- ful preparation of such rooms the penetration of bacterial aerosols 'into them-would be insignificant; that is, the con- centration of microbes would be considerably less than in., the outside air. .This makes the protective affect which may be achieved by individual measures *(respirators, cotton-gauze, bandages; etc.) more probable; these measures would have' to be utilized in such quarters. Taking shelter in_trenches,,,,- and in blindagescf the simplest type protects people only against ordinary weapons and external...radioactive emanation. It does not protect against,:biological weapons. Conversely; in some cases aerosol particles of .microbes may be retained in them longer than in the.surrounding,open area. Protection of-Provisions from Fodder and Water Against Contamination by Pathogenic Microbes. The significance of water and food products in epidemiology is well known. It has been mentioned repeatedly above that the causal agents of intestinal infections can infect man, entering through the mouth either with the food or with the water. The role of water and of food is not the same in different intestinal infections. Thus, in cholera water plays a more important part; but in dysentery, food products are more important. The greater part played by one factor or another, first of all, does not eliminate the participation of other fac- tors (for example, of water in dysentery) and, secondly, is associated not only with the biology of the causal organ- ism but also with the characteristics of transmission of the infection-from its source to a susceptible person. Other relations can be observed under conditions.of bio- logical warfare, where water or different kinds of food pro- ducts are infected artificially. In this case, the'part played by them will be determined not by ordinary routes of 163 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07 ? CIA-RDP81-01043R003800050002-9 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 infection, which havb already been quite well studied, but - rather..bY the availability and expediency of infecting them; taking into the-consideration the biology of the causal or- ganism (resistance in the-environment) and the character of the raw material, food products, etc. Thus, for example, there would hardly be any sense in infecting groats or pota- toes with'a typhoid bacillus, because.-under these-conditions there would,hard17;be any massive 'infection of the popula- tion produced: At.thelsame time, the infection of. sugar, . bread and other prodUcts with Anthrax-spores could evidently bring about the .infection of people,'although such a Method of transmiseion of infdction is not encountered under ordin= ary conditions.. / Under modern conditions, when there are no reliable data conderning thelmethods and.measUres of biological attack which would be utilized by an enemy, we must take the position that the measures to be elaborated for the protection of water, provisions and fodder should be as extensive and generally applicable as possible. in other words,' they should be ex- tended to all types of provisions without exception, and in their character they should not depend on the .individual pe- culiarities of.various objects'in,which the food product is being.manufactured or stored (food enterprise, store, etc.). This does not eliminate:the need for developing individual- ized measures not only with respect to various branches of the food industry but also .With respeetto various types of enterprises in one and the same branch of industry. However, the presentation of individual measures to be taken is not part of the problem of the present text, in which only the most general measures of protection of water and provisions are to be described. Measures for the protection of provisions should be based on the fact that the main'rethod of infection may be diver- sionary, whereby the culture is introduced directly into the food product. Infection of the latter can also occur indir- ectly--through aerosols of pathogenic microbes penetrating into .the processing site (site of manufacture) of the food raw materials, site of storage of the prepared products, etc. The protection of provisions against diversionary attack should provide for the protection of food enterprices, store- houses', etc. One of the measures for protecting tood-products against infection in' enterprises is the use of special cloth- 164 ing as a replacement for the,usual,clothing.. :Measures for preventing contact of .microbes sprayed into -the air with,food.produCts argmore complex.- Sealing,.off _ Of .rooms with the.simultaneous-use.of ventilaW,on,.which creates an-indreased pressure inpthe rooms; is the mot._ gendralmdasure; ,1t goes, mithout:saying.that such ventila- tion is permissible only in ttle,event-the filtration systems provide a complete elimination of microbes from the air sup- plied.,,Otherwise,the,yentilation should,be turned .off, and the airshaft hermetioillvsealed.- ,.It is very difficult-to achieve an adequate. sealing of the room. ?Moreover, it can be impaired readily-by bomb explo- sions. ir the,yacinity of the buildings-in question. There- fore,. sealing of-the rdoms,should be cover- ing,food.productsapd, apparatus with covers, mantles, thick paper in-two-layers; and canvas, The,food products and ap- paratus can be uncovered and work can be started again only after careful disinfection of the rooms. To be sure?:,,the,best method-offprotection of food products against aerosol infection (and also including by.the diver- sioriary method) at the food enterprises the mechanization and automatization of all elements,:of food processing: The entire technological process, of processing food should be such.a..!way that not (,the food untouched by .humari hands but,also that there is-no access,to it. How- ever, this measure, which is most expedient in every respect, would have to be accomplished gradually, with the perfection of the production processes at the food enterprises. Special attention needs to be given to the preservation of prepared food products and particularly, to those products which afterwards will not be subjected to thermal processing. Products such as bread, and sugar, prepared foods (particularly sausage-meat products, etc.) maybe' mentioned as examples. Even 'I.;hough sugar when used, as a rule, is dis- solved,in hot-water the resistance of microbes to the effect of the increased temperature in the sugar 'sblutions is mar- kedly Increased.. Puch:food.products should be protected by speCial preservation ,conditions, that. is, in a container (1)4-er-bag's, boxes, bins, etc.) or ,on refrigerator shelves covered .over with impermeable material '(cellophane, thick paper, Canvas). ,Food products which the population has on hand is protected 165 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 from infection in a similar way. Considerableattention should be-'gfveh'to the protection of food products.againet irifectionduftngthe processlof trans- portation. The-transpoitationof'-'breadlibakery and confec- tionary products should be accomfiliahed in bpafallk 4dapted, carefully sealed truckal-Trie dabwdoord sliouldbe covered with . ? , canvas in the form of a canopy :re- , - ' , ? Milk which is in a,rdOmlof whidh-the Omiiiete.,06aling is doubtful is best boiled beforeldeliVery. ' - Water-may 'serve 'as a "source Of ififectidri-of food products if pathogenic microbes haVentered,i15-2by'any*-meane. There- fore, it it is best-for food enterprises,' 15articularly those - which manufacture non-alcohdlic ibeVefages Or 'iihiah use a comparatively amall-quantfty of4Steri either-to Use boiled water or water which has been additiohallrchlorinated.' Certain problems in 'theprOtedtibb of water against in- fection by pathogenic microbes have been mentioned above. Measures for the prdtection of water are determined by the possible methods of infection. The latter amount to an in- fection of open water sources by the dropping of-bacterial bombs (it should be considered that they would be dropped simultaneously with-fragmentation bombs for the destruct-ion of purification equipment) and by diversionary infections of pure water reservoirs and of the-waterworks. The possi- bility also exists of infection through the penetration of bacterial aerosols into the pure water (particularly in re- servoirs). Measures for the protection of water against infection by the diversionary method in the area at the waterworks in which there is. adherence to a strict routine are the same as for food enterprises: However, they 'Should be supplemented by mobile security of water condites and waterworks. I The sealing of purification equipment and rooms for pure, water reservoirs ('if they are-open) should'be carried out with exceptional care.'--, Particularly thelventilation tubes over the auxiliary. water,TeserVoira should be dOvered over. At the time of an attack with bacterial aerosols, the Water, level in the reservoirs 'should not be permitted to drop, because thereby air is sucked in. Chlorination is the chief measures fbr the protection of 1.66 Map water.1 After an attack, hyperchlorinatioNis permissable_ Naturally, under exceptional _conditiops.,a--:deviation, from ,the GdSTIAll-bnion,State Standards] isjustified.. - ,..? _ ? ? A . n. . ! L . Despite the fact that disinfection of the mater. cam :be, insured, by these measures-the idea, of obligatory boiling .of water by the population, during .a period-:of threat needs. itcr be and:rnot onlyfof water .which .is used :for, drinking (this' should-be carried out constantly) but also of water hich is used for other purposes (for washing, cleaning the hands, etc.). Such a strict rout .11 should last for as much ,time as needed for gua'ranteeing*Ithe de- contamination of water in water conduits, or in wells. -. .Among the measures for the protection of water there is also ,the constant bacteriological control of its .quality.. Here, it should be taken ,into considerationIthat,artificial infec4on would,accompanied im any changes in the! B. coli titer.- Therefore, in theexamination of the water one would have to be oriented by a direct determination of the presence of pathogenic-microbes and-their. toxins in the water. The problem,of fodder is somewhat distinct. The infec- tion of fodder may lead to the infection of persons in con- tact with it according to their working conditions and mainly, to the infection of animals, which, in their turn, can serve as sources of infection for man. The protection of fodder should be carried out according to the same. rules that apply to the protection of food products. Finally various rodents (rats, mice), which can infect water (for example with the tularemia microbe) or food pro- ducts the consumption of which can lead to human infection, should have no access to water, food provisions, or fodder. Naturall, all food enterprises should be in rat-proof rooms. In addition, various deratization measures should be-car- ried out-with particular persistence. _Fundamental Principles of Organization_of:Anti-Epidemic Protection of the Population , The same measures which are carried out'in.the%event of the natural occurrence of epidemic outbreaks will underlie the anti-epidemic work in artificially produced foci'of-ace infectious diseases. Certain differences will be determined by the massiveness of the number, of primary cases and by the 167 Declassified in Part - Sanitized Copy Approved for Release @ 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07 : CIA-RDP81-01043R003800050002-9 unusual route of' spread of infection-at the time of the at- tack, or, more accurately,- by the route8 of primary infectien. However, even in this case the differences will be part of - a definite nosologic form rather than of principles of com- batting infectious diseases generally.- Thus', if the air-drop- let mechanism is not :inherent in a given nosologic form, and if it specifically has .been used in the attack, the usual , measures taken for- this infection will be supplemented by Jothers usually used for infeCtions of-the respiratory passa- ges. ? , ? r . The absence of' difterences in,princiPles'oP,c.ombatting' infection's evidently leads to the fadt-.that no 'changes are required in the prindiples of organization of anti-epidemic protectiOn.of thopopUlation, which' can be based' on the ex- isting network of sanitary epidemiological and therapeutic institutions with-active participation of the population it- self. This has .no bearing-on the fact that under conditions of-biological attack-the work of anti-epideinic, defense in all of its branches a more organized, more complete fashion and in a shorter period of time. Spe- cifically these factors determine the characteristics of work in protecting the population against a biological weapon, and, therefore, the preparation of medical institutions and of their personnel for work under conditions of an attack should be planned and executed beforehand. In the establishment of the duties of the chief special- ists in corresponding public health organs it has been pro- vided that the planning and organization of measures for in- creasing the quality of work of the existing network of med- ical institutions should be carried out by these specialists on the basis of an analysis of the results of their opera- tive activity. Therefore, the planning and organization of anti-epidemic defense of the population, by analogy, should be put in charge of the chief epidemiologist. The work of the chief epidemiologist is distinguished from the work of the chief specialists in other specialties to the same de- gree to which the sanitary-anti-epidemic work is disting- uished from therapeutic work.' Its .characteristics are de- termined primarily by its more pronounced prophylactic trend. For :understandable reasons, the work of the chief-epidemi- ologist will'be different under peacetime condition's, during a period of threat, and at the moment of attack'. Under peacetime conditions the chief epidemiologist plane the measureslfor.improving the work of the, sanitary epidemi- ological institutions .(improvement -in laboratory diagnosis, improving the 'quality of sanitary and anti-epidemic-work, increaaing the special qualification of sanitary epidemio- logical stations, etc'.), and for improving the water supply and feed products systems. Naturally the. sanitary requirements made on public admin- istrative organs and food enterprises should. be made stricter and should provide for the elinination of possibilities of. infection of water and food products by pathogenic microbes when utilized as a bidlogical weapon by. an enemy. Concretization of these requirements is possible on the basis of data obtained through an analysis of the infectious disease morbidity and. through a_study of individual epidemic outbreaks, which makes' It possible to' elucidate the routes of spread of various :infections under conditions of a speci- fic locality.. At the, same time, the epidemiologist also should studythe:potential,epidemiological factors which can play a part of the spread of an infection, absent at the present time but which can-be brought about Jay an attack. Rats,'. certain species of ticks, mosquitoes, for example, may be.such factors. Comparison of the cartograms of spread of possible vectors of infection on the .territory of various localities makes it possible*.to-evaluate the epidemiological situation quickly after an attack and during peacetime to initiate planned measures for the elimination and reduction of the possible effect of such factors. For e7.-.ample,' through deratization measures taken in an inhabited place from year to -year it is possible to reduce to a' minimum the importance of rodents in the spread of plague in the event the plague bacillus is used as a biological weapon. Under conditions of a biological attack the precise co- ordination of actions of all branches of the medical service of the affected population is of first-importance. The at- tainment of perfect agreement in the matter of service to the population in the area of infection is possible only after a profound study of policies and medical tactics in the area of :,.::fection; The chief ,epidemiologist should partici- pate in the planning and checking of the quality of prepa- ration-of medical workers for-carrying out their duties un- der conditions where an enemy uses a biological weapon. The particularly great importance assumed by the active ,use of measures of ,individual protection by the population, 169 168 Declassified in Part - Sanitized Copy Approved for Release @ 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 including punctilious observance of the rules of personal . hygiene, under conditions of a biological attack has been mentioned above, Therefore,, the chief epidemiologist should participate in the organization of training the population. in the rules of behavior in the area of an Attack. This training should be carried out by all medical workers. Specifically, the population should be informed ofthe methods of prophylaxis of infectious diseases (for each type of infection) and trained in the methods of group (rules of utilization of shelter) and individual" (utilization of gas masks, respirator, preparation of cotton-gauze 'bandages, elements of disinfection, etc.), protection, ,r ? . , 'During a period of danger, the chief epidemiologist'. ? should check on the degree of preparation of medical insti- tutions for the accomplishment of tasks with which they would be encharged in the event of an attack. With the aid of other sanitary epidemiological workers the degree of pre- paration of food enterprises, food storehouses, and fodder warehouses, stores, etc:, and also of water supply systems should' be determined with regard to the protection of food products and water from contamination by pathogenic microbes. At the same time,- the working order of technical protec- tive measures (disinfection technic, etc.) should be checked. After an attack, the chief epidemiologist, who is a-con- sultant or deputy to,the chief of the medical service of the DINO [Local Antiaircraft Defense],participatps in the organ- ization of measures for the elimination of the consequences of the attack. These measures will be discussed in the next section. In accordance with the functions entrusted to the chief epidemiologist he is given the right to check institutions and organizations directly engaged in carrying out measures planned for anti-epidemic defense. To the same degree to which the chief epidemiologist is the one who fundamentally plans the preparation of the popu- lation for anti-epidemic defense, the sanitary epidemiologi- cal stations are the main centers directing the accomplish- ment pf the planned measures. A.number of the most important measures axe taken by the members of the sanitary epidemiological station (SES) itself. 170 Thus; provides the' laboratory diagnosit and detection of the causal organisms of'infectious diseases. Anti-epidemic detachments and groups are created frbm its staff which are entrusted With the responsible task's in the accomplishment of sanitary-epidemiological reconnaissance, in determing the limits-of:the area of infection and in the direct leadership and accoMplishment of measures for elimination of the conse- quences of the attack 4 The potential epidemiological factors, which may be of tremendous importance in the event of an at- tack (species composition of rodents, ticks, etc.), are stu- died by the members' of the iiickettsial-virological labora- tories and departments of particularly dangerous infections, and laboratOry diagnobis of the corresponding diseases is carried out. The disinfection departments of the-SES organ- ize and control the systematic performance of disinfection, insect elimination and deratization measures on the spot. The departments ofipublic and food hygiene of the SES check on measures taken-for the' protection of water, provisions and-fodder. The role' of the sanitary-epidemiological stations becomes even more important. during a period of danger and 'under con- ditions where biological attack has been made. -From thea time of initiation "ofthe.threatening situation" the epidemiological' department of the SES organizes the giv- ing of inoculations on h. large scale with the he10-of inocu- lation'detachments created from the personnel of medical, , groups. First, the so-called organized population' is covered by inoculations, that is, laborers, white collar workers, students, children in kindergartens and nurseries (small pox). This makes it possible to include the major portion of the population in the minimum period of time. Under such condi- tions, a vaccinator can inoculate 200 persons during a work day. Then, inoculations are given to the non-working popu- lation. With good organization of the inoculation system and with active aid of the members of sanitary organs the vaccin- ation of the population can be carried out at the same rate. Good organization of the giving of inoculations should pro- vide for the equipping vaccinators with an adequate number of syringes and needles, of population groups at a single point, which reduces the loss of time in traveling, sterili- zation of material and instruments, etc. Selection of a person from the active members of a sanitary organ who is sufficiently literate for the purpose of recording inocula- tions increases the productivity of the vaccinator's work. Declassified in Part - Sanitized Copy Approved for Release @ 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 171 ta Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 However) the number,of those dhooplated in this case in practice rarely exceeds' 100 persons per vaccinator. The success in carrying out this, measure will .depend to consider- able degree on the educational work carried out among the _popula,tion. ,The inoculatiOn should be recorded carefully, because. Only iti_this way is it possible- to avoid _errors in. the future, when vaccination With other types or vaccines will be given. ,f The disinfection department organizes, the provision, of the population with disinfectants and directs the training of the population in their utilization.: During this period, the fight against rodents and insects should be sharply in- tensified. 'Disinfection technics are put in a.st4te of battle readiness. ? The sanitary groups of the SES, each in its own fields, checka the state of, preparedness of various objects for de- fense against biological attack: the existence of measures of concealment, sealing-off of rooms, reserve supplies of- - disinfectants) etc., and also the state of readiness of _san- itary units and posts of particularly important installations. Under the conditions of, the threatening situation, the sani- tary condition of cities should be markedly improved with the aim of eliminating the germination sites of flies, the mechanical vectors of infections. The cleaning up of cities also contributes to the fight against mouse-like rodents. The qualitative preparation of an inhabited place for a bio- logical attack and the systematic sanitary epidemiological supervision with the aim of timely detection of the fact that an enemy has used a biological weapon determine to a con- siderable degree the success of anti-epidemic defense of the population and elimination of the consequences of the attack. In the area of the attack, that is, during the period af- ter the attack, the members of the SES and institutions at- tached to it should carry out measures directed at the dis- infection of the focus and for preventing the spread of in- fection (these measures will be listed in the next section). Anti-epidemic defense of the population is accomplished not only by the members of the sanitary-epidemiological ser- vice. General medical care of the population, which is pro- vided by the medical. system, is an important element in it. - During the period following the beginning of "the threat- ening situation", additional infectious disease beds are set , 172 up in the existing hospitals at the order .of. he c4ef,qc the medical service of the MPVO,. Medical'ipersonnel brought in for care of persons in the additiqnal infectious disease .beds are carefully instructed as. to the; rules qf care of 'in- fectious disease patients (primarily, of patients with par- ticularly dangerous infeotions),--eoncerning the routine in the infectious disease' department, and theylare.provided with measures of individual protection. . The department should be provided with a sufficient _quantity_ of-',disinfectants and vessels for disinfecting linen, feces, etc. The polyclinic departments of medical institutions sel- ect a group of workers for inoculationdetaCshments and train them in the rulesend technic.of case of need and also supply them with material needed-for inoculations (syringes, needles, cotton, alcohol, sterilizers, ,etc.). The district physicians and the secondary school medical,person- nel attached to them should carry out the recqrding and ob- servation of all febrile patient 6 on the territory ,of the medical district, which would be very important if the dis- trict should be in an area of infection. Medical inStitutions should train-detachments of medical workers and Red Cross and Red 'Crescent workers for contin- uous,medical observation of the population in an area of in- fection in the event an observation or qtaranteen?routine Is established. The personnel of these detachments should be trained in the methods of individual protection and in the simplest methods of processing and disinfection in the focus of detection of the patient. Recruiting of the population (primarily of the Red Cross and Red Crescent groups) for observation and assistance in the elimination of consequences of the biological attack re- quires the obligatory creation of sanitary units in inhabited places, of sanitary posts at various industrial enterprises, in institutions and homes (or house committees) before their direct participation is needed. These elements of the popu- lation should be carefully trained in methods of individual and group protection for various methods in which the bio- logical weapon may be used, in the simplest methods of sani- tary processing and disinfection. The training of the per- sonnel of these groups should not be limited merely to-an acquaintance with the technic of carrying out the measures indicated. Sessions with them should include a populat pre- sentation of all the information concerning properties of the causal agents and their species; concerning the routes 173 Declassified in Part - Sanitized Copy Approved for Release @ 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 ofispread of'infection, methods of infection, etc. It should be kept i 'mind that only sufficiently trained persons, who are well 'acquainted with the rules of behavior in an area' of infection, can be enlisted for work in a focus of infection. ? The sanitary-anti-epidemic unit (SPED) created from the population in inhabited places of rural type and in cities, and -rayon centers' are of the sanitary-epidemio- logical stations at which they are organized: By means of them all the measures are carriecLout in an area of infec- tion for elimination of the consequences of an attack, super- vision of.the,observance of the established routine, dis- infection, insect ellMination and deratizati9fi. operations, etc. The sanitary-anti-epidemic team tarries out its work In.. the area:of infettion under the direct supervision of the mobile anti-peidemic detachment or of the group.(PPEO.Imo- bile anti-epidethic detachment] or PPEG [mobile anti-epidemic groupTh.darrying out in the technical division the same functions as these groups [PPEO and PPEG] in anti-epidemic defense. Measures for the Elimination of Consequences of the Biological Attack Announcement of a Biological Attack to the Population. In preceding sections a basis has been repeatedly made for the statement that timely application of individual and group measures of protection prevents the penetration of the causal agents of diseases into the human body. It has been mentioned that in contrast to specific prophylactic measures these very simple methods .protect against infection by any causal agents and because of their very simplicity they can be used on a very massive scale. In other words, the effectiveness of these measures of defense is assured by the timeliness of their application. The timely and at the same time massive application of individual measures of protection is possible only when the population is informed in time of a biological attack. This respon$ible function is carried out by a special service of the MPEO [Local Anti-aircraft Defense]. Warning of the population of the threat of an attack from the air is accomplished by. giving the "air alarm" signal, at which the population should' be prepared for the use of one or of several Mass attack agents simultaneously by an enemy, including the biological one. At the "air alarm" signal the population should take cover 174 ?????-.. in the shelters, having measures of individual protection with them. Persohs who have not suCceeded, in taking cover in the shelters for various reasons should take cover in specially adapted rooms which protect them 'primarily against the effect6 of powerful explosions (airwave, fr4ments of buildings, light and radioactive emanation) etc.). Sealing of such rooms as'muCh as possible iedupes the concentration of organisms in the air but doe not exclude the penetration of aerosols Into the room. Therefore, persons taking Cover in Such room6:should be prepared to use individual measures Of protection,immediately (gas mask, respirators) etc.). , The population should be informed bf the use of a biologi- cal weapon by the enemy through the "chemical attack" signal. A common signal has been introduced for chemical and biologi- cal,attack'becausethe indirect (visible) signs pf,a biologi- cal and'Of a chemical attack as well as the nonspecific mea- sures of protection and rules of behavior of the population in'them are the same to a considerable degree. Among the sins suspicious of the use of bacteriological or chemical weapons are the following: the appearance of a cloud in the form of a fog or smoke Coming from one of the airplanes or from a bomb which has been dropped, the faint sciund of an explosion, the occurrence of the wet ground or pulverized substances at the site where the bomb has fallen, the pre- sence of large bomb fragments from the weak explosion or parts of a container fragmented from impact, etc. In addi- tion, the appearance of a large number of insects, ticks or rodents orof containers which cannot be used for other types of weapons constitute evidence of a biological attack. At the "chemical attack" signal the airconditioning-fil- ter apparatus in the shelters is switched over to a "Kh N (chemical attack)" or 'bomplete isolation" routine. Exit from the shelter is forbidden until specifically indicated. Persons who are outside the shelter should immediately use measures of indiVidual protection (gas mask, respirators, cotton gauze .bandages). In the absence of specially: pre- Rared respirators, handy, measures are used. , ElAdemfological Redonnaissance. At the "chemical attack" signal the chief of the medical service of the MPVO at the Instructions. Of the chief of the MPV0.of'the cit-y, sends the mobile anti-epidethic detachment (PPEO) or group (PPE) to the presumptive -SIte of infection. ,The epidemiological branch of the PPEO (or PPEG) makes a ;175 ?.. Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 careful examination of the locality with the aim of detec- tion of sTgns of biological weapons (bomb Or container res- idues, an unusual collection of insects, ticks or rodents; unusual drops dr the unusual charaCter of the dust (*len.- vironmental objects, scattered food products and articles,,. etc.). Data of the examination are Compared 'With reports of eye-witnesses of groups' df, the observation service of the MPVO and of the population. All suspicious, material-16 col- lected in the form of samples for prompt laboratory examin- ation in Order to establibh the species of'causal organism used for the attack. The collection of samples and the per- formance of the bacteriological examination are accomplished by the laboratory brandh of the PPEO. If the reports of eye-witnesses and other. signs, (spraying of aerosol-from an airplane, residuals of bombs with' a spray- ing.device, etc.) attest to the use of a microbial aerosol, the detachment establishes the direction of the wind; and its speed, the humidity, air temperature and temperature of 'the upper layers' of the soil, nature of the locality (height of the buildings and density of construction, presence of vege- tation, etc.), conditions of the movement of the aerosol cloud in the given locality (for example, whether the direc- tion of the wind coincides with the direction of the streets, whether the formation of air eddies is possible) etc. In ad- dition, the detachment establishes the population census, the character and duration of measures of defense used, length of time the population has been in the aerosol cloud, and it collects other information which makes it possible to estab- lish the limits of the area of infection, the possibility of massiveness of involvement of the population under specific conditions of the focus of infection. Simultaneously, ac- cording to the data of public health organs and veterinary service organs they clarify which infectious diseases have been observed recently in thA Fiven locality among people and animals and their territorial distribution. On the basis of the epidemiological reconnaissance infor- mation obtained the limits of the area of infection are de- termined, and appropriate signs and protection posts are set up. In "certain cases (for example, when,dropped-rodents and fleas are 'found) the focus, 'is immediately surrounded (armed guard);, The armed guard of the boundaries" of the area of infectidn is put under the orders of the chief of the MFVO of the city. ? The disinfection branch of the PPEO determines the character 176 ? 7,1i. -"V vl and volume of disingection operations in the focus, the con- ditions under which: they are performed, the types of dis- infection technic needed for work in the given focus, the quantity of.,disinfection agents .which are needed for disin- fecting the focus. Also, the existence, of baths, sanitary Inspection stations, etc. which may be of use for sanitary processing of'the population is clarified. A specialist on infectious .diseases of the anti-epidemic detachment checks the conditioniof the system of hospitals within_the limit of the focus of infection and plans the set- ting up of temporary infectious disea,be,i)eds for the hospi- talization of patients and the isolation or Persons suspected of disease. On the basis, of all the reconnaissance data-,the chief of the PPEO or senior officials coming into the area (head phy- sician of the SES, chief epidemiologist) construct a speci- fic plan for the elimination of the consequences of the bio- logical attack. This plan should provide for the following: 1) the establishment of infectious disease beds; 2) census of medical personnel for the purpose of accomplishing a con- tinuous medical observation of the population;-3) the order and sequence of accomplishing disinfection operations; .4) the taking of the census of MPVO groups fort the performance of disinfection operations; 5) the accounting of technical mobile and hospital agencies and the location of them; 6) estimation of necessary therapeutic, inoculation and disinfection agents; 7) measures for the protection of the focus in accordance with the OPB: [?] service. In the plan to be constructed the fundamental measure be- fore the occurrence of cases of the disease should be con- sidered to be the performance of disinfection work. The lo- cation of temporary washing-disinfection stations at the lim- its of the .focus of infection should_be,particularly well planned so as not tp permit the spread of the infection be- ? yond its limits, and the order and sequence of performing the disinfection operations should be particularly carefully thought Evidently, the routes along which persons would be evacuated from shelters, that is, those known to be healthy, should be disinfected first. Then, the areas and routes which would be used in the process of supplying the population with food products and water in the event of a disturbance in the operation of the water supply system should be disinfected. Well shafts, which can be utilized for water supply existing on the territory of the focus of infection should also be 177 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 disinfected and appropriately outfitted. Also, placed where repair 1:lork of the water supply system and of the sewer sys- tem would be carried out should be disinfected. The rooms and yards adjacent to hospitals and buildings in which there are temporary infectious disease beds and other medical in- stitutibns should be carefully disinfected. The places . where the bomb, containers, etc. fell and nearby areas should be disinfected immediately. In other words, places and the routes to them whiCh provide for a normal way of. life in the focus of infection and which assure the .performance of anti- epidemic measures should be disinfected first.' After this, disinfection operation are carried out'on a broad scale . (complete-area disinfection, insect elimination or deratiza- tion). The'need for assuring the normal way of life of the popu- lation i dictated by the fact that an observation or quarantine routine may be imposed on the area of infection as a whole. By "observation" is understood-the system of measures which provide'intensified medical observation of the popula- tion in the fodus'of infection with the performance of thera- peutic-prophylactic and isolation-restriction measures for preventing the occuftence and spread of infectious diseases. Medical observation in the area under observation should have as its problem the detection of afflicted persons,- early detection and hospitalization of patients, isolation of persons who have been incontact with patients and obser- vation of them, the giving of inoculations and the use of anti-biotics (after establishing the species and the drug resistance of the causal organism used in the attack), the increase in health propaganda, particularly concerning the rules of behavior and personal hygiene in the specific given focus. Ingress,- egress and travel through the area of the focus of infection should, be restricted. By "quarantine" is understood the system of .anti-epidemic routine measures which provide for the complete isolation of the focus of infection from the surrounding .population. including people and animals which are onits territory and also the measures directed at limiting the size of an epi- demic outbreak and eliminating the cases' of disease in the focus itself. The imposition of a quarantine provides a prohibition of 178 ??? ingress, egress, and travel through the., territory of the focus of infection. With the exception.of the transporta- tion of special services (bringing in provisions, etc..) which, nevertheless, observe the rules made (disinfection.ce the means of.transportationi.sanitary processing of persons associated with it, etc.). An armed guard (surrounding) of the focus of infection. is established for-the purpose. of assuring the execution of this measure. _ - In the focus of infeCtion.tne population is divided into as ?mall groups as, possible (in houses; apartments) in,order to restrict, the contact of people:with. one another. In the event of an air-droplet mechanism of transmission' of the in- fection the population in the focus is provided with an ade- quate number of respirators, protective.glasses, etc.. A special service for the observation ,of order in the focus.: is organized for the purpose of insuring the execution of this measure, and extensive ,educational work_ is also con- ducted among the population. Anti-epidemic measures are' the same-during.quarantinwi-but should be more complete, extensive,and -more rapidly carried out. In certain cases (for example, in plague)Andividual hospitalization of patients and isolation' of persons suspec- ted of disease should be provided. As has been mentioned' above, in :ertain infections anti-epidemic measures should be supplemented by anti-epizootic measures. For example,. in the event of use of the psittacosis virus or some other. virus of an ornithosis it should-be forseen that not only' people but also birds will be affected. Because determination of the nature of restrictive mea- sures in the focus of infection (observation, quarantine) is possible only after establishing the species of causal organism by the laboratory method, which requires quite a' long time, strict restrictive measures (prohibition of egress, or of free movement of the population within the limits of the focus, etc.) should be provided for in the plan to be constructed before the accomplishment of. complete-area -dis- infection (if it is required by the circumstances). After disinfection of the environment, contaminated clothes, etc., observation is established temporarily, and this may be' prolonged or replaced by quarantine depending on the results of the laboratory analysis or of the clinical picture of diseases which occur. Regardless of which routine will be established in the 179 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07 : CIA-RDP81-01043R003800050002-9 focus of infection afterwards, the plan of eliminating the: focus of infection and of combatting diseases which occur should provide for the immediate performance of anti-epi- demic and sanitary measures of general nature, which are made,more specific after.the establishment of the species of causal organism. For the accomplishment of all the - necessary-operations'in the focus, in addition to workers of medical institutions-(including-scientific research in- stitutes) and students in medical colleges,, all other groups of .the MPVO, public organs and administrative organizations should be enlisted also, which "should find its-reflection iwthe operative plan construoted*for.the'elimination of the -consequences of the-biological attack". The operative plan'for the elimination of the focus of infection and measures providing for the prevention of a development of an epidemic outbreak should be approved by the chief of the city (or rayon) MPVO. ? Epidemiological reconnaissance and planning of measures for thef'elimination of the consequences of a tack., which have been presented in their general outlines, are orientedwith respect'to the use of a biological wealion in an air attack fundamentally in the form of aerosols. , Naturally, the nature of the reconnaissance and the contents of the-anti-epidemic measures being planned would be modi- fied in the case.of other methods of attack. For example, in a diversionary.attack of the water-supply-system water the fundamental reconnaissance information may be obtained on the basis of data of continuous laboratory checking of the water and an analysis of the development of the morbidity, its level and territorial distribution of patients in accor- dance with the ramifications of the water supply network. It should be considered that in the event continuous labor- atory control does not provide for the timely detection of infection of the water a probable biological attack would be established on the basis of the occurrence of cases of diseases en masse. In this case, anti-epidemic measures for the elimination of the focus would be no different from the ordinary ones. Certain characteristics of anti-epidemic measures in the focus of infection can be conditioned simply by the massiveness of a water outbreak, with which the major- ity of epidemiologists is acquainted only from the litera- ture. ? Disinfection Measures in the Focus and Sanitary Processing of the Population.' It has been mentioned above that prior to .180 ese.,cclic. I _ed Corn/ Aoorov ' the occurrence of cases of disease the Use of the ,biological weapon the fundamental prophylactic measure is the disinfection of the focus of infection, that is, dis- infection in the broad sense of the word": By disinfection is meant different-kinds of measures directed at the elimination of pathogenic microorganisms in man's environment. ipsually, when we speak of disinfec- tion measures 1n the focus we understand by them not only the disinfection proper but also insect elimination (elimin- ation,of insects_and ticks, the-vectors bf infections) and deratization (the extermination of rodents, the sources of infection). ? The disinfection may be-accomplished by the Use of-mech- anical, physical and chemical-agents. In 'acCtIrdance with this mechanical, physical and chemical methods of disinfec- tion are distinguished. In an artificially created focus, of all the methods of disinfection those which assure the reliability of disinfection with the simplest possible methods in the shortest periods of time are of practical' application when'there is a large volume of be car- ried out. Filtration of the air in shelters, through the canister of the gas mask, through the filtration device of the res- pirator, etc. are examples of mechanical methods of disin- fection. Drinking water maybe reliably disinfected by fil- tration through bacterial filters, but the no less reliable disinfection of the water by boiling (physical method of disinfection) would be used more often because of its greater simplicity. Of the physical methods of disinfection methods based on the application of nigh temperature are the most prevalent: boilinc in water, processing by steam or by dry hot air (in the latter case for the purpose of insect removal from per- sonal effects). If, for example, in an area of infection brucellae fall pasture grounds, then, after fencing off this area, we may count on the disinfection of the soil as a re- sult of the effect of physical factors such as sunlight and desiccation. However, in this case no less than two to two and a half months are required for eliminating the brucellae from the pasture grounds. To'be sure, this method is not ap- plicable to the inhabited portion of an era of infection. Chemical methods are applicable for the disinfection of 181 lease ? 50 Yr 2014/04/07 CIA-RDP81-01043R003800050002-9 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 underwear, linen, utensils and tablewear, furniture, rooms, outside walls, soil, etc. The application of various chemi- cal agents is determined by the species of causal organism and by the character of the object to be disinfected. Chem- ical means are utilized extensively also for insect elimin- ation and.ddratization. The main disinfectants which have been recommended'as highly effective are the following groups' of :agents I . I. ;Chlorine-containing preparations (chloride of-lime, chloramine, sodium and potassium hypochlorite,1ouseum ? hypochlorite, neopntocide, etc.). 1. Chloramine'is a white or yellowish crystaline powder with a-chlorine odor. It should contain no less than 25 per- cent of active chlorine. When kept properly (in a dry room, in 4 dark well stoppered container) c],oramine is quite staple. Chloramine solutions can be kept up to 15 days in a closed, dark vessel. Disinfection of'contaminated articles requireA'a high concentration of ,chloramine and a long ex- posure time. Chloramine is very suitable for disinfection of linen (one to three percent solution), tablewear.(one to three percent solution). By means of a 0.5 to 1 percent solution of chloramine it is possible to disinfect also ex- poded parts of the body (face, neck, hands). It is also used for the disinfection of excretions (urine, feces, pus, sputum). 2. Chloride of lime (bleaching powder, calcium hypochlor- ite).is a white powder with a yellowish hue with the odor of chlorine. When it has less than 15 percent active chlor- ine chloride of lime is not suitable for disinfection. Chlor- ide of lime, Particularly clarified solutions of it, can be Used for the same purposes as chloramine. However, it can also be used for the disinfection of soil (10-20 percent solu- tion) and In vertical plains (thick suspension of chloride of lime). If the objects to. be disinfected contain a suffi- cient quantity of water chloride of lime is used in the dry form. Metal articles should not be disinfected with chloride of lime because of it corrosive effect. Chloramine and chloride of lime can be used in the form of activated solutions. Amonium chloride, sulfate or nitrate in quantities equal to half of that of chloramine can be used as aativators. First, the chlorine-containing substances are dissolved and then the activator is added. Activated 182 ;?? solutions act more vigorously, but they are unstable and should be used immediately after preparation. II. Group of phenol and, cresols (phenol, cresol, lysol, creolin, etc.). 1. Phenol (crysta4ne.carbolic acid) in the pure fbrm consist-6-3Y-Yarge prismatic 'crystals with a characteristic odor. On adding 10 percent water to the crystals phenol is obtained which is convenient to use in practice. Because there is already Water in liquid phehol a little less of it should be taken/pi preparing solUtions. .For example, in the preparation of the five percent solution 550 grams of liquid phenol are,used per bucket of water (10 liters) in- stead of 500 grams of the crystalline form. Usually 3-5 per- cent solutions are used for disinfection and these rapidly kill the non-spore forming species of microbes. Phenol is not suitable for disinfection of objects contaminated with spore forms. Phenolated soap solutions are used for disin- fecting rooms (walls, windows, doors, etc.) and linen. Linen is moistened with the 1-2 percent solution and is kept in it for two hours. The odor of phenol is readily adsorbed by food products; therefore, it is recommended that it should not be used to disinfect a room in which food products are kept. 2. Lysol is a solution of cresols in a potassium soap prepared in the factory. Lysol possesses greater bacterici- dal properties than phenol. For the purpose of disinfecting rooms and furniture in the case of intestinal and droplet in- fections, 3-5 percent of solutions of lysol (900 milliliters per square meter). Other cresol preparations (sulfuric-cresol in mixtures, creolin, etc.) are used for rough disinfection (toilets, rboms for animals, etc.). III. Alkalis (sodium hydroxide, potassium hydroxide, unslaked lime, etc.). 1. Sodium hydroxide is a white crystalline substance which is readily soluble in water. For disinfection, 2-4 percent solutions of commercial sodium hydroxide (caustic soda) are used. For anthrax disinfection 10 percent hot (75?) solutions of sodium hydroxide are used. Sodium hydrox- ide is used for the processing of rooms of food enterprises, rooms for animals, storehouses of animal raw material, etc. 2. Unslaked lime is utilized in the form of 10-20 percent 183 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 solutions for the purpose of disenfectipg walls are treated. three times with paint using paint -brushes for the purpose of disinfecting soil, a 2o? percent solution of unslaked lime (5-10 leaders per square meter) _is used. For purposes of insect elimination chemical agents with different- mechanisms of action can be used (nerve .poisons, intestinal poisons, etc.) as well as substances of plant origin. Mist widely used at the present time are DDT.prepara- tions and hexachlorcyolohexanel DDT (4, 4-dichlordiPheilyltrichlormethylmethans) is a white chrystaline powder. Its good qualities are determined by its-great proxisity for very many Species of insects and its lack' of proxisity for men (coming into contact with the dry preparation of), it' prolonged retention of activity. (Stability to oxidation and slight evaporation), its lack of an odor or of a soiling tendency. In connectioli with the latter, it can be Used for the impregnation of fabrics. In practical work DDT is utilized in the form of dusts (10 per- cent DDT and 90 percent filler-talc kaolin, etc.), of emul- sions (20 to 30 percent DDT) aqueous suspensions (the prepara- tion is insoluble in water) and aerosols. DDT aerosols are particularly suitable for the insect elimination of large areas, and inadequate density are highly insecticidal with respect to all blood sucking insects (mosquitoes, fleas, ticis, etc.). Hexachlocyclohexane (hexachlorane, HXCH) is a chrystaline, white or whitish brown-colored powder which is oily to the touch. It dissolves well in organic solvents (acetone, gaso- line, kerosene, etc.) and does not dissolve in water. Hexachlor- ane is several times more toxic to insects then DDT, possesses an unpleasant odor, is used in the same way as DDT (dust, emulsions, aerosols). Hexachlorane, like DDT, can be added to soap. Laundering linen with hexachlorane soap can protect it for a long time against the settling of insects in it, (residual effect of hexachlorane). Gas disinfection of rooms is carried out with chlorpicrin or sulphur dioxide obtained from burning sulfur. For the purpose of exterminating rodents the mechanical trapping of them,'infection of baits with pathogenic microbes (biological methods) and various chemical toxic substances acting through the digestive tract (raticide [Cil H10 Np S]), barium carbonate; zinc phosphite, or by means of asphyxlapion (chlorpicrin, hydrogen sulphide, hydrogen cyanide), etc.) are 184 .e.c4, ? used in connection with the fact that very toxic substances arP used for the extermination of rodents this work is carried out by specially trained personnel. Physical methoCs of disinfection with the use of high temperature and steam provide the most reliable form of disinfection.:, Linen, clothing, bedclothes, etc., are dis- infected by these methods. The physical method of disin- fection is usually combined with sanitary probes ing of the. population, becaUse in both cases a special washing- disinfection technib is required. For the purpose of disinfection, of the articles mentioned above various systems of mobile and stationary steam and steam-formalin-chambers are used. Therefore, this method of disinfection is frequjntly called the chamber method. stationary chambers are set up in sanitary inspection sta- tions, bath houses, stationary washing points (SOP) and washing-disinfection departments (ODO) in medical first-, aid detachments (OPM). Disinfection,of underwear and bed linen can be carried out also in public 'sundries in bucking apparatus! Incidentally, the disinfection of linen by boiling it in a solution of washing powder can be cartied out by the population itself. This reduces the load on disinfection chambers, by the same token shortening the periods required for processing the focus, for ekiample, steam-formalin chPmbers mounted on a chassis (PPK), shower-disinfection truck (DDA), etc. Washing-disinfection mobile technic of this type makes it possible to carry out the processing of the p:ipulation in any place where it is necessary. There are special trucks and trailer arrangements for spraying disinfectent solutions, spraying dry disinfectents and insecticides, and also aerosol trucks available for the performance of chemical disinfection and insect elimination. Large-scale technic (irregation trucks,) can be successfully used for these purposes. The use of the technic for disin- fection by the chemical method makes it possible to process large areas in the z,..)ne of infection in very short periods of time. By means of the disinfection measures and technic listed above, various groups of the MPVO set about the plan that sanitary processing of affected persons and the disinfection of infected rooms and articles used by the population and also of environmental objects (soil, outside walls of buildings, 185 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 etc.) immediately after they carry out the primary disin- fection operations which were mentioned above (disinfec- tion of the roots of egress of persons known to be uninfec- ted of the supply routes of the population in the area, etc.) In the event of an enemy attack from the air (aerosol-use of the biological weapon) these measures are conducted on a large scale 1n the area through which the aerosol cloud passes. All persons in the focus are subjected to sanitary processing regardless of whether op not they use individual methods of protection. Naturally, other methods of attack do not require the total processing of the whole population. Thus, after the scattering of insects by an enemy, the population in the vicinity of the containers dropped is Subjected to process- ing (local processing of the population). When flying in sects are dropped the sanitary processing of the population is not conducted at all, and insect elimination in rooms be- comes most important (houses, sheds', outside toilets, etc.) Even if itis detected in times diversionary infection of the water and food products requires, first of all, a disinfection of the infected object cnd places of storage of them. Infected food products belonging to the population should be destroyed. Only persons who have been in contact with infected products are subjected to sanitary processing. When cases of disease occur in the area of infection, processing of posei should be 'carried out according to the type of terminal disinfection.throughout the entire work_in the focus the personnel of the working groups should undergo sanitary processing. systematically (at the end of a shift, during an interval period in the work, before taking food, etc. Epidemloldgl2a.l Observation of the Focus of Infection Simultaneously with the performance of preventive disinfec- tion measures, a systematic epedimiological observation is established in the zone of infection as a fundamental measure for the anti epidemic defense of the population before the occurrence of cases of the disease produced through the use of a biological weapon. Before the occurrence of cases of the disease and before the laboratory establishes the species of the causal agent used, epidemiological observation should be performed with the aim of clarifying the data of the epidemiological recon- naissance with respect to the infectious disease morbid-ity rate prior to the attack. The original figures for epidemio- logical reconnaissance based on official reports of patients 186 AD with infectious infectious diseases in whom the diagnosis was establish- ed will.always-be less because whom the' diagnosis ha's not been establIShed.:at'the .time of attack. ' The true number of patients (febrile)) is established by :? house-to-house rounds. eatientS detected are.Subjected-to 'I careful clinical examination by a specialist in infectious diseases, and-this'examination-is_combined?With an epidem- iological examination; in necessary cases they are hospital-' ized'immediately. N Epidemiologists shOUld-carefuliy plot cases of the -diseases detected on a-map of the locality:Iplanbf the city), which afterwards facilitates an evaluation of the source -oft the' infection for-new patients anA'alda.serves for the deter- .. mination of-the:territorial-distribution of new cases of disease. In certaincases,(for example, inwater infection) study of the territorial distribution.,of,the3cases of di- sease is a? clue to the determination 'of-the.characteraf the epidemiological oUtbreakiandthe-sites of infection. The map of the infectious disease morbidity rate-in t. inhabited places constructed by the'epidediologists irithe process of their usual work may-be of invaluable It Should be then made more precise through the addition of., newly detected patients. It gicies an idea as to the lnfec-, tious'dipease?morbidityPate through a-long period of time, which is very important in certain infections. House-to-house rounds, which are to be made by the medical workers enlisted, are continued with the aim of the earliest possible detection of infectious disease patients. Each new patient with an Infectious disease is examined ? by an infectious disease specialist, subjected to labora- tory examination and to an epidemiological analysis not only with the aim of the rapid establishment of the diagnosis and the source of infection but also for the purpose of early detection of new diseases which are either not charac- teristic of the given locality or which have not been observed for a-long time. The detection of the first cases of any unusual diseases, not only facilitates the fight against the further spread of infection but can serve as the earliest indication of the species of causal organism'used, which permits anoextezisiNon"and particularization of anti-epidemic measures,.and which makes it possible to direct them against a definite infection. An important epidemio;ogical measure, which should be 187 Declassified in Part - Sanitized Copy Approved for Release 50-Yr 2014/04/07 ? CIA-RDP81-01043R003800050002-9 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 carried out before the occurrence of cases of the diseases, is cleaning up of the affected locality. Cleaning up of the focus of infection is carried out by members of the public administrative organs: In the focus of infection the militia should make their requirements stricter with respect to public administrative organs. The order of cleaning the inhabited place, however:, can be changed, and in each specific case determined by the sanitary organization,: The problem will be solited most readily when rubbish-burning and blotherinal apparattis are presently in the affected area, whibh.makes it possible to avoid carrying the rubbish oUt of the footle of Infection if the latter has been caused by the .application of causal organisms which are -particularly dangerous infections. Ap- parently, in certain cases the preliminary disinfection is. nedessary of dirt which_is to be carried out and transpor- tation which is used. The possibility exists that recourse will be.needed to burning the rubbish in the boiler- rooms of enterprises on the territory of the focus of infec- tion when there is a need for destroying dry rubbish (feed- ing places_of rodents). Only the need for preventing an accumulation of rubbish is indisputable, sights of the, germination, habitation and feeding of insects and rodents which play an exceptionally important part in the spread of infection. Examinations of all enterprises and institutions having stores of provisions and fodder should be included in the system of measures of sanitary epidemiological observa- tion of the focus of infection. During the examination it Is essential to determine the timeliness and adequacy of measures taken at the time of the attack for the safeguarding of.provisions. In addition to this, a laboratory evaluation should be made of food products for contamination by patho- genic microflora. The order of carrying out the laboratory examinations is established by the sanitary service in cooper- ation with interested organizations. The sale of food products which are in the area of in- fection at the time of the attack is forbidden until the permission of the sanitary service for this is obtained, and the latter can determine the nature of the preliminary pro- cessing of these food products. This group of measures shouli completely eliminate the participation of the food factor In the infection and subsequent spread of the infection, the causal organism of which was used during the attack. The species of causal organism can be established most accurately by laboratory examination. However, the occurrence 188 ? ....11,11. I1. 4 ? of diseases on a large sale and particularly those Which are unusual for .the given Ideality gives us an adequate ' basis idea as to the species of the causal agent used and for the adoption of appropriate anti7.epidemic measures. In those cases where it is possible to Isolate the causal organs, bacteriologicaj anaIysis should be supplemented by a determination of the sensitivity of causal organisms to various-antibiotics. This ith accomplished by the application of circles of -filter paper dipped it ,various antibiotics to a continuous ihoculUm of the microbe in Petri dishes. Infor- mation as to the densiti.Viy of the microbe to the .antibiotics is needed for the purpose of including,ithe latter in the group of prophylactic agents! After obtaining information concerning the species of causal organism and certain of its properties vaccination is organized of the entire personnel of the MPVO groups and of the entire population in the focus of infection. :The occurrence of cases of disease Is not a contra indication to the accomplishment of active immunization of clinidally healthy persons. In cases of need (short .incubation period, contact with patients With, for example, the pulminary form of plague; etc.) specific serum can be used prophylactically for the purpose of passive immunization. If the use of the collarvibrio hasbeen established,--anti-cholera bacteriophase should be used along with immunization of the population.. The giving of innoculations can be entrusted only to persons with a The prophylactic application of anti-biotics can be carried out by distributing powders to the population for the purpose of internal consumption. With the occurrence of cases of the disease produced by artificial infection, anti-epidemic measures are directed at eliminating the source of infection from the group (hos- pitalization of the patient) and the performance of this infection in the focus of the disease. Persons who have been in contact with patients are either subjected to quarantine Or are put under an intensified observation at home. Hospitalization of patients is carried on only by a special ambulance. It is categorically forbidden to use just any chance,trucks., The patients are aCcompanied only by persons specially selected for this purpose from the groups or insti- tutions of the medical service of the MPVO (local ? anti-air- craft defence) ' 189 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 As a rule, hospitalization of patients should be carried out in rooms which are on the territory .of the focus of infection, particularly in case's 'where a quaraAtine has been imposed. This-eliminates the spread of the infection beyond the limits of the infected area. In certain cases (for examble) in the event of 'preceding use of atomic weapions), when it is impossible to organize a ho6pitalization _of patients in the infected area, the transportation of the patients out of this area becomes inevitable. Classification of'Patients in this case is carried out on the territory of the focus of infection. Trucks leaving the focus of irifection should be ,subjected to disin- fection on a special platform located at the border of the area of infection. After delivering of the patients, they are again subjected to disinfection4 The use of atomic and thermonuclear weapon undoubtedly considerably complicates conditions for carrying out anti- epidemic measures, without changing them in principle. Therefore, there is no particular need for a special description of them. However, it should not be overlooked that in a focus affected by atomic weapons there will evi- dently be all the conditions needed for the development of an epidemic outbreak eNien'without'the use of biological weapons (destruction of houses, water-supply systems, sewer- age systems, etc.). Therefore, a focus affected by atomic weapons should be regarded as a potential epidemic focus of any infection inherent to the given locality and it should be considered that this infection will obtain more favorable conditions for its spread. Anti-epidemic plans should be constructed in accordance with this. If infected animals or birds are the sources of infec- tion,measures should be taken with respect to them which are provided by the veterinary-sanitary legislation. Measures directed at cutting the routes of spread of the infection are exceptionally numerous. The most general of them have already been partially presented. Special measures apply to each infectious disease presented in de- tail in a course of specific epidemiology. ? , Epidemiological observation of the focusiquarantine-, observation) is stopped When no new cases have' been observed in it for the period of time which in the majority of cases is equal to the incubation period for the given infection. - 190 _ . This period is_rd.ckoried:Trom.tbe.timp_of hospitalization of the last patient. 191 Declassified in Part - Sanitized Copy A d for Release ? 5 - r 2014/04/07: CIA-RDP81-flinaflPnnqsznnnannn Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 The Or anization of the MO Medical Service and Its Basic Tasks A. Ye. Minenko (Chapter 11) The continuous armament race in capitalist countries is creating a constant threat of the outbreak of war i The peace-, lovinp countries together with the USSR are stubbornly striving to safeguard peace throughout the world. The Soviet Union is actively coming forward and persistently striving for prohibition of weapons of mass annihilation, for disarthament in conventional types of armament, and for peaceful coexistence of different states regardless of their social system4 Yet the imperialistiCally minded circles in capitalist states maintain their former positions of a "cold war", of con- tinutnee of the armament races and for the use of atomic weapons. Certain government officials?in capitalist countries con- tinue to preach the use of atomic, bacteriological and chemical weapons and are training their armiesfor the use of these types of weapon. Thus, for instance, according to a report in the newspaper Pravda (9 November 1955), the United States Secretary of Aviatio177;&ld Quarles, in his speech on 6 November 1955 claimed that the United Stales possesses atomic might "capable of annihilating communist Russia". According to a report of the Associated Press, the United States Secretary of the Army Brucker ordered the Chemical Corps to conduct work in the field of crea- ting "new types of bacteriological and chemical weapons, such as only the human mind could devise". On 6 November 1955 the United States Secretary of the Army-approved the report of the so-called "Civil"Advisory Committee, where it is noted that chemical and bacteriological methods of warfare are allotted an "appropriate place" in American military plans. It is also re- portadthat "in the past year (i.e. 1954) information has leaked out that the American Army is engaged in work on a fatal nerve gas "G", by means of which a person can be killed within a few minutes. Such speeches of government officials, the race in - atomic and other forms of armament in capitalist countries, and press reports, blurting out information concerning preparations in these countries for use of methods of mass destruction, gives reason to assume the possibility of use by an aggressor of 192 ???? methods of mass destruction. In the event thetpponlies of the Soviet Uniontattack the peaceful cities and village's Ok"OUrIfoinerand.:gith.atomicl" bacterio- logical or chemicl weapppFl.there ?ill be extensive centers of destruction with much devastanil'Oriesiduntialjdistricts, facto- ries, plants,,railwaY jupctions and other targets. All this will produce many victims among the aivilian population.s especially in the event of sudden atomic attack. a ? OOOOOO ? ? Ot.. ? The MFVO medighl acktlidgc.14,hich'is. a ,divVicrvA?tho local Anti-Aircraft Defense, must be ready at any inomen't'IO give medical aid to citizens injured by atomic, bacteriological or chemical weapons. In the event of use by the enemy of bacteriological wea- pons.) the medical service is obligated to promptly determine what .agent of infectieus disease has been employed, to take urgent pre- ventive measures against spread of the infection, and to provide _medical aid to the sick. In order to properly understand the problems of organization and tactics of the PIPV0 medical service, one must have a concept of possible casualties in the event of use by the enemy of methods of mass attack. It must be assumed that of all known methods of 'mass attack, atomic weapons with explosive action will cause maxi- mal casualties among the population of the cities subjected to air attack. World experience in military use of atomic bombs is limi- ted to the atomic atrack by the United States on the Japanoee cities Hiroshima and Nagasaki. This affords an opportunity to make use of the statistical information on number of victims in 'these cities. According to data of the American pressl, based on material of the reconnaissance service of the 4morican Bombing Command, on -6 and 9 August 1945 in the cities of Hiroshima and Nagasaki) 216,000 out of a tetal population in the two cities of 500,000 were victims of the atomic attack. It follows from those figures that 43.2 percent of the population in the two cities were victims of the explosion of two atomic bombs. The casualties in each city separately were as follows: 1T. Sears. The Role of the Physician in Anti-Atomic Defense 4The Physician in Atomic Defensg, Foreign Literature Press, Moscow, 1955. 193 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07 ? CIA-RDP81-01043R003800050002-9 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 - Hiroshima Nagasaki Total liop?aation (according to data , of,T. '306;000 ? 200,000 Population' denaAy:per km%. -'L .13,566 ' 25,193 ,- Area in whch deistrUction-oceUrrod (km2)-.i. .12.2' .- 446 , No, killed and missing..64,1 ,,i6..lil.t1....4i 701610 " 36,000 Wbunded.... e i 66:allook0444 . ' .70,000 %40,000 , - ? . ? ? .? % k Totarcasualties in Hiroshima were 46.6 percent and in Nagasaki 38 percent when both cities were bombed with atomic bombs of the same caliber, equivalent to 20,000. tons ofTNT,(LepP) 5app7. The relatively low casualties in. Nagasaki (almost one-half those in Hiroshima) is explained by the fact that the city was situated in a hilly. locality - the hills sheltered parts of the city from the effect o the shock wave, and destruction occurted over an area of 4.6 km' ? Hiroshima wasf,situated in flat country, and the area of destruction was 12.2 km'. Hence the considerable 'difference in number of victis? despite the fact that in 1"agasaki the population density per kra ,ps almost twice that in Hiroshima. This provides a basis for the collateral conclusion, that cities on plains suffer considerable destruction from atomic attack, less in hilly regions. According to data of an estimate by a British commission, total casualties in Hiroshima were 170,000 - 190,000, i.e. about 60-63 percent of the total population. All statistical data, published in the foreign press, on number of victims of the atomic explosions in the Japanese cities are distinguished by great inexactness and can serve only as 'very tentatibe indexes of the effect of an atomic bomb in military practise. 194 ??? However, recalling the complete unexpectedness of the use of an atomic bomb, the unpreparedness of the population fop an air attack, the absence of organized rescue work and medical, aid, one might :assume that the figure 50..60 percent caddalties'in Hiroshima somewhat approicisnatekthe truth4-- ? s, According to the same British and American statistical data, of the total number of-casualties in Hiroshima ,70,000 o. 90,000 were killed, which is 41647 percent::. If this figure is real and there actually was such a morta- lity-percentage), it wah 'a result of the complete unexpectedness of ute of so powerful a weapon as the atomic bombs The ,.explosion created panic and confusion amo,ng the population and Organa ,of authority in Hiroshima: Rescue work in the city was not begun until 30 hours after the atomic bomb explosion, and medical aid was 30 physicians and about 100 nurses, uninjured by the explosion, only after much time following the catastrophe. Of course under these circumstances a considerable number-of severely wounded perished as a result of-the lack_Of prompt medical aid, and many wounded could not without assistance get"obt of burn- ing buildings and perished in the fire. Well organized and rapid medical assistance and properly set up rescue work could have saved the livas- of a considerable number of inhabitants of Hiroshima; the percent mortalities could have been reduced to approximately 30.35 percent, and hospital casualties in this event would have been 65-70 percent. Such are the conclusions, highly tentative, that can be drawn from the ststittioal data published by the American, T. Sears, on the number of victims' in Hiroshima and Nagasaki. It should be noted that in the event of preparedness in anti-atomic defense, prompt notification of the population of the possibility of an atomic attacks and the people's knowledge of a behavior standard under attack, it may be assumed that casualties in Hiroshima could have been reduced to one-half or one-third, i.e. would not have exceeded 20-30 percent. Those injured from weapons of mass destruction are notable for a diversity of injuries. In an atomic destruction center one. can anticipate the most varied wounds of every degree a; severity, burns of all degrees up to charring, injury bY ionizing radiation and radioactive substances. A chemical attack necessitates assi- 195 Declassified in Part - Sanitized Copy Approved for Release ? 50 -Yr 2014 . - 1-01 . Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 stance to the injured against the chemical poisons: skin-blistering, suffocating, generally toxic and other effects. Use by, the enemy of bacteriological weapons requires preparedness for,struggle, in all probability, with especially dangerous infections and those ? causing severe illnesses and capable'ef rapid spreading. The presence in the hands of an aggressor of weapons of mass destrudtionpnd an opportunity of Using them will entail the appearance of mixed centers and will complicate still further the problems of organizing and giving medical aid to the injuredi The use by the enemy of weapons of mass destt4ction may re,.. suit in contaminetion of a locality and the buildingsi.raSr,sources, food (in stores, rarehouses, depots; etci) situated:therein', in con- tamination of clothing and footwear; which in turn can be an addi- tional agent of human injuryl Possibilities of enormous among the civilian population of cities and villages, the diversity of injuries, and all the after-effects resulting from use of weapons of mass destru- ction, confront the MPVO medical service with serious problems in organizingtand giving medical aid to the injured. ? The former MPVO medical service was designed chiefly for medical aid to the injured in centers of destruction caused by high- explosive, splinter and incendiary bombs, and for giving medical aid to the injured in chemical attack centers. This demanded a special network of MPVO medical service hospital installations (DPM, PPM, SPM, city MPVO hospitals, SKIL, etc.) and a relatively small number of field units (sanitation postal sanitation teams, sanitation brig- ades, OPM, reinforcement brigades). The appearance of new types of weapohs of mass destruction has confronted the MPVO medical service, in the event of air attack by an aggressor using weapons of mass destruction with different problems that consist essentially of the fallowing: Rapid premedical first aid to injured directly in the attack center, their removal to a safe place with subse- quent evacuation to MRVO medical service field units or installations giving medical aid; maximally rapid emergency medical aid in the immediate vicinity of the attack center; casualty clearing at all points and rapid evacuation of injured to their destination; 196 Declassified in Part - Sanitized Copy Approved for Release ? hospitalization of injured, and skilled, specialized ' medical aid in MPVO medical service hospital installations; determination of persons contaminated with radioactive substances among injured arriving at medical stations and hospital installations; organizing, and carrying out sanitary treatment for arri- vals in_NPV0 medical service installations, and special treatment for these injured by poisonous or radioactive substances (OV or RV); . organizing and cari.ying out inspection of water and food for bacteriological contamination and contamination with. OV and RV, and determination of fitness of water and food provisions for the population; carrying out sanitary and anti-epidemic control over the condition of collection stations for injured and of other population distribution points; carrying out necessary sanitary and anti-epidemic measures to prevent mass spreading of infectious diseases; ? ? sanitary and anti-epidemic supervision of the condition of the resources of collective defense; sanitary supervision of burial of bodies. This combination of measures represents essentially the tasks that the medical service must perform in the event of enemy attack upon our peaceful cities and villages. In order for the medical service to perform these tasks, it was necessary to considerably reinforce existing field units and to create new ones for work in the attack center. The new units must quickly reach the center, give premedical first aid to the injured and remove them from the attack center within a short time. The necessity of hospitalizing a considerable number of injured required, in addition to existing stationary installations, the formation of large-scale clearing and eva- cuation bases, in suburban and rural areas, able to accept and give skilled and specialized medical aid to the injured. Considerations were presented above concerning the like- lihood of occurrence of mixed attack centers and the possibility of mixed injuries. The occurrence of an atomic attack center may 197 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 ?m?IL Declassified in Part - Sanitized Co .y Ap roved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 be accompanied by additional' bacteriological attack, which will appreciably complicate the situation. Atcmic weapons with ex- plosive action produce a considerable number of combined in- juries (trauma and burns; trauma and radiation sickness; burns and radiation sickness; trauma, burns and radiation sickness). T. Sears reports the following concerning casualties in Hiroshima and Nagasaki: "On the basis of interpolated data obtained on relatively small groups of -injured) it has been estimated that 70 percent' of the in,lpred receiied me6hanical injuries, 75 per- cent burns) and 30 percent radiation injuries; this gives a total of 175 percent and indicates that the majority of, injured re- ceived simultaneously injuries of various types" ,Without going into a criticism of the methods and correctheas-of thl data cited by T. Sears2'it'can be concluded that mixed :injuries in Hiroshima and Nagasaki occupied a considerableplacei In .order to effectiNely provide medical aid' to of various"types'of weapons and in centers of combined attacks, the new organization of forces and resmirces of the MPVO medical service envisages .combined measures to aid the injured. Also altered is the ta-"--1 solution of problems in liquidating the attack center, The massiveness of population destruction in atomic attack (50-60 percent in Hiroshima acco- rding to preliminary conclusions) demands considerable numbers of medical personnel to give prompt medical aid to the injured. Under these conditions not a single city will be able ? to provide the required medical personnel by its awn efforts, much less so since somo field units and installations may be destroyed. Hence the' now organization envisages mutual assi- stance between cities, oblasts, regions, and republics with en- listment of their forces and resources to give medical aid to e center of large-scale attack. ? Medical aid to the injured during liquidation of the de- struction center will be carried out by the entire public health network, on whose base is organized a considerable nUMber of the MPVO medical service field units and installations.- , The health agencies are conducting this work jointly with the volunteer Red Cross and Red Crescent Society, which is forming a number of units from among its members. 198 The health agencies are organizing the medical service by utilizing the wide network of hospital, medical, anti-epidemic and other medical institutions of our country, irrespective of their institutional affiliation. With: these as a base, medical service field units and installations aro created, which are staffed with physicians, secondary and junior Medical personnel recruited from the base institutions. In order to eduip field units and installationt with stock medical and sanitation-administrative equipment, the medical service can utilize in full 4. in part the equipment of the base institution: The enormous and complex tasks confronting tho MPVO medical service have required the enlistment of a large number of physicians, seco- ndary and junior personnel from the public health network. But oven under circumstances the medical service will not be able to porferm the tasks confronting it without the assistance of broad masses of the population. Hence the health agencies are planning their work on giving medical aid to the injured jointly with the volunteer society, Red Cross and Red Crescent. The latter is performing much work among the population in self-help and mutual assistance, and is forming from the ranks of its members sanitation posts and teams, sanitation brigades, etc. By enlisting these units into the MPVO medical service staff, the Red Cross and Red Crescent Society is creating an enormous force capable of performing the most difficult tasks in giving first aid to the injuted in an attack center, in removing them from the attack center, of care for the wounded, etc. The health agencies through the Red Cross and Red Crescent Society will be able when necessary to enlist this national force in order to liquidate possible serious after-effects of an attack upon our cities and villages by an agres- sor using weapons of mass destruction. Hence the Red Cross and Red Crescent field units occupy an important place in the MPV0 medical service and are an integral 'part of it. The medical service, with the health agencies and network as a base, is drawn up on the succession principle. The Minister of Health USSR is the chief of the country's MPVO medical servicejministers-of Union republics are chiefs of the republics' MPVO medical services, directors of region, oblast, city, and rayon health departments are .0 the respective chiefs of the MPVO medical services. In region, oblast, and city health departments there aro formed, for operational leadership of the MPVO medical service, region, oblast, and city 1PV0 medical service staffs, headed by a chief of staff having advanced medical training. In health departments without 199 Declassified in Part - Sanitized Co.y Ap?roved for Release ? 50-Yr 2014/04/07 CIA-RDP81 01043R00380005onn7 q Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 regular posts of chief of staff, their duties are laid, by order of the health department director, upon a physician in the appa- ratus for holding multiple posts. Chiefs of region and oblast medical services appoint Consultants from among head specialists in the health department.. The principal consultants appointed are: head 'surgeon, head therapeutist (toxicologist), head radio- lopist, and head epidemiologist. In region and oblast health de- partments without a given staff specialist, his duties are laid upon a specialist in a region or oblast hospital. The chief of a region or oblast MPVO medical service appoints as staff members: - 1. The deputy director of the region or oblast health department on medical problems - as deputy chief of the Mn0 medical service on medical problems. ! 2i Assistants to the 'chief of the region or oblast MPV0 medical service; - y) the head physician of a region or oblast sani- tation-epidemiolbgical station - as assistant on sanitation-epidemiological problems; b) tho chairman of an oblast Red Cross and Red Crescent committee - as assistant on mass field units; c) the manager oblast pharmaceutical board - as assistant on medical supplies; d) the chief of region or oblast sanitation-admini- strative supplies - as assistant on sanitation- administrative supplies. The MPV0 medical service has a double subordination. The region, oblast, city, or rayon MPV0 medical service chief on special problems is subordinate to the higher ranking MPV0 medical service chief, from when he redoives necessary instructions and to whom he reports on work completed. On the other hand, ho is operationally subordinate to the correPs ending chief of the Local Anti-Aircraft Defense ZRPV07 . On this basis all city and rayon medical service chie7 s on special problems are subordinate to the region and oblast MPV0 medical service chief. To him also are fully subordinated the.Offices of clearing-evacuation bases - 200 placed on territory of the region or oblast. The forces and resources of the MPV0 medical service are made up of field units and installations formed by the Rod Cross and Red Crescent Society and the health agencies. The units formed by the Red Cross and Red Crescent Society include: sanitation posts (teams; sanitation and sanitation-anti-epidemic brigades; detachments for searching and carrying out wounded (ORVP); searching-Clearing groups (PSG). The units formed by the health agencies includc: detachments of medical first aid (OPM) with divisions' for washing and decontamination (degassing, disinfection), for receiving and clearing, for surgery and dressing, for hospi- tal evacuation, and a mobile laboratory (PL); detachments and groups of specialized medical aid (OSMO and GSMP); mobile anti-epidemic detachments and groups (PPEO and PPEG); mobile radiological laboratories (PRL); medical groups to accompany transport of wounded. In addition to field units, the health agencies form the following MPV0 medical service stationary installations: premedical stations for first aid (DPM); stations for medical first aid (PPM); hospital stations for medical aid (SPM); clearing-evacuation bases (SEB), comprising the clearing-evacuation base office (USSB), dlearineevacuation hospital (SEG), MPV0 medical service rural hospitals, and collection stations for the lightly wounded (PSLP). The 201 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 latter are formed by city executive committees; radiological stations; ititer-rayon and reserve laboratories of the MPVO medical .service. On instruction of MO city staffs, on the base of public baths, bath pavilions, sanitary inspection stations j etc., hospital washing stations (SOP) are organized. SOP formation is laid upon departments and ministries to whom the base in- stitutions are subordinated. The mobile forces or, in other Words, the NPVO medical service field units are designed to give medical aid to wounded in the attack center or its immediate vicinity. Despite a considerable number of such units, they nevertheless cannot perform tho tasks confronting them without assistance from other MPVO services, working in the attack center. The NPVO medical service units therefore work in close contact with other MPVO services, especially the disaster-equip- ment and fire-prevention services. These services give access to wounded in collapsed shelters or under debris of buildings and remove people from fire centers, whether sanitation field teams and medical personnel cannot penetrate without assista- nce; othor services provide information on limits of contami- nation with OV, RV, and BRV and on amount of radiation after an atomic explosion, report data on degassed or decontaminated passage-ways in tho destruction center, etc. Without good con- tact with the inits of other MPVO services, the medical service cannot rapidly and effectively organize its work in the destru- ction center, and consequently cannot give prompt aid to the wounded. All NINO units working in the destruction center should give every possible assistance to the medical service in its work of promptly aiding the wounded, and take measures to pre- serve life and health of the population suffering from weapons of mass destruction. Assuming that the target of a possible air attack using weapons of mass destruction will be primarily large indu- strial cities and important administrative centers, we will examine the structure'of the MO medical service of a city with a rayon division. 202 r\s .t.r The chief of a city NPV0 medical service has a service .staff, headed by a chief of staff - the physician who is first deputy director of the city health department for MPVO medical service. ?? , The chief of staff coordinates the work of assistants to'the MPVO medical service chief and of medical service chiefs of:oity rayons, directs compilation of staff documentation, and during liqui- dation of the destruction center:conducts operat.onal direction of the service on instruction of the MPVO medical sorv.Ice chief. The MPVO medical service chief appoints clonsU...tants on special medical problets4, There should be Without fail among the con- sultants: head epidemiolbgistsi head surgeonslioad radiologist, and head therapeutist- toxicologist: These persona'are appointed from among head speqialists in tho city health departwent. In caaos where there are no head staff specialists, the MPVO medico: service chief appoints head specialists from among qualified oily hospital physi- cians having MPVO training. A city MPVO medical service staff comprises: 1. The head physician of the city sanitatienepidomiolo- gical station (SES) - as assistant to the MPVO medical service chief on sanitation-epidemiological problems. To him are subordinated the following installations and units of the MPVO medical service: ? IMO medical service city laboratory; mobile anti?epidomic groups (PPEG); mobile anti-epidemic detachments (PPEO); disinfection (degassing) stations; mobile radiological laboratory (PRL); MPVO medical service inter-rayon laboratories ? In addition to the units and installations indicated, the assistant td the MPVO medical service chief on sanitation and anti-epidemic problems has under him all city SES divisions. 2. The deputy directOr of the city health department - as deputy chief of the city MPVO medical 11-xvice in medical work. To him are subordinated the following units and installa- tions: 203, ? Declassified in Part - Sanitized Copy Approved for Release ? 50 -Yr 2014/0 /0 : - -01 . Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 detachments and groups of specialized medical aid (OMP and GSMP); blood-transfusion stations (SPK); city radiological station; detachments of medical first aid (OPM); MPVO medical service city hospitalsi 3. The chairman of the city comhittee of the Red Cross and Red Crescent Society is a staff member as assistant to the city MPVO medical service dhief on Mass field units, and is in charge of the latter., 4; The head physician of the city first aid station is a staff member - as assistant to the city MPVO medical service chief on evacuation of wounded. The motor transport of the city first aid station and institutional transportation are at his disposal. 5. The manager of a large city pharmacy is a staff member - as assistant to the NINO medical service chief on medical and administrative supplies, under whom is the pharmaceutical supply base, and administrative supply base when such exists in the city health department. The staff personnel is appointed to posts and released from them by order of the city medical service chief. The MPVO medical service chief of a city rayon has: 1) a deputy in medical work; 2) an assistant on mass field units; 3) an assistant on sanitation-epidemic problems. TO the first are subordinated pre-medical stations of (first aid (DPM), medi- cal first aid stations (PPM), detachments of medical first aid (OPM), hospital stations of medical aid (SPM), and rayon hospi- tals. To the second are subordinated sanitation brigades; sani- tation posts, and sanitation teams. To the third are subordina- ted hospital washing stations and rayon HPV0 medical service laboratories, if the, latter exist in the rayon. As deputy chief' ofthe MPVO medical service of a city rayon in medical work, the deputy director of the rayon health department is appointed, If this post does not exists the rayon MPVO medical, service chief may appoint to this post the head physician of a rayon hospital. As his assistant on sanitation- 2014 ?.: epidemiological problems, he appoints the head physician of a rayon SES, as assistant on M2SS field units --.the chnirman of the KK and KP Lfied Cross and Red Crescen rayon committee. In addition an out- side chief of staff is appointed. Such is the organizational scheme of the_MPV0 service of-a city with a rayon divisiont If the city hae no rayon division, then . the MPVO medical service installations and unil,s, indicated in the scheme, are transferred to?the jurisdiction of the respdctive or deputy of the city MPVO medical service chief. ? ? ? y The large number of its and installations of the MPVO medical service, the responsible -tasks confronting them, and tho nocossity of being prepared at any Moment to aid the wounded, now require, of the MPVO medical service the training of installations and units for work under conditions of possible use by an aggressor of' the weapons of mass destruction. 205 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-ROPRi_ninaqpnnarvIncrww, V. Declassified in Part - Sanitized Cop Ap roved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 Ct Mobile Formations of the MFVO Medical Service A. Ye. Minenko (Chap 12) The new types of weapons of mass destruction, primarily atomic weapons with explosive action, have sharply changed the dimensions of attack centers and the extent of devasta- tion in them. Population'casualties have also risen immeasurably Human injury in atomic attadk is of great severity. A feature of the injury, in an atomic attack center is the fact that a considerable number of victims simultaneously, incur Al-ljuries of different types, such as burn and, trauma, burn and-radiation sickness,'trauma and radiation sickness, and possibly burn, trauma, and-radia- tion sickness4 The likelihood of occurrence Of combined attack centers gives reason to suppose that victimsmay also be injured by poisons or be subjected to bacterial infection. Upon explosion of an atomic bomb of medium caliber, a destruction center of up to 30-35 km2 in area is possible in which victims will have injuries from light to extra- ordinarily severe. Devastation and fires in the destruction center will greatly hamper search for wounded and evacuation outside the center. Data on destruction of buildings in an atomic attack center give reason to suppose that in the area of great destruction the city hospital institutions will be des- troyed, and in the area of intermediate destruction if not destroyed, will scarcely be able to operate. An enormous area of devastation with tens of thousands of injured caught in collapsed and demolished structures and in fire areas, loss of many medical personnel and hos- pital institutions, as well as difficulties in evacuating wounded from the devastated part of the city, are the conditions that the MPVO medical service will obviously have to face if an enemy makes an atomic attack upon any city of our country. Our medical experience in the Second World War, 1941- 1945, showed that the majority of wounded required early surgical treatment, and that surgical treatment given within a few hours after injury gave the best results. Hence conclusions were made on the necessity of maximally 206 rapid evacuation of wounded from the battle field to points where medical aid was available, and medical aid was brought maximally close to the wounded in battle. These two concept t are fully applicable-to the conditions of giving medical aid to wounded in an atomic attack center. On the basis of the principle of giving rapid premedical first aid, of bringing medical aid close to the wounded, and also of giving them maximally rapid skilled and specialized medical aid, WV? medical service field units and installa- tions were formed of types able to perform these tasks. Moreover, the possibWty of use by an aggressor of bacter- iological and chemical weapons required the MPVQ medical service to plan for units which could give the people the necessary medical ait4 in the event of use of any of the three types of weapons of mass destruction or combination of them. The necessity of organizing mutual aid among cities, regions, oblasts, and republics demanded in turn the forma- tion of mobile units, whose movement could give prompt aid to some other c-ity. The new structure of the .MPV0 medical service provides for units which fulfill the requirements for work under con- ditions of attack by an enemy using modern methods of mass destruction. Units Formed by the Red Cross and Red Crescent Society Sanitation posts(SP) are mass units formed by the Red Cross and Red Crescent Society at enterprises, in institutions and educational institutions, on railroad and water transport, in residential buildings, etc. In places where self-defence groups or unitary squads are formed, the sanitation posts belong to them as the medical teams or groups. If for any reason these groups or squads are not formed, sanitation posts remain independent units working under the direction of the local organizations of the Red Cross and Red Crescent Society. A sanitation post-staff consists of four persons,, one of whom is appointed 'chief and three are team members. For staffing of sanitation posts GS0 and BGSO badge-holders 16-55 years of age are selected. Persons are enlisted, in sanitation posts who live in residential buildings, if they 207 Declassified in Part - Sanitized Cop Ap. rovedor Release ? 50-Yr 2014/04/07: CIA-RnPR-Lninipz flr12 (-Inn c nt-sr." " Declassified in Part - Sanitized Copy Approved for Release 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 do not belong to MPVO units for local service, students, employees, kolkhoz workers, and auxiliary labor workers and employees in factories. As stock supplies of the sanitation post the following equipment has been planned: hospital stretcher - 1, kit for sanitation post chief - 1, stretcher straps indOidual antichemical packets - 4. is acquired from resources of the institutions on,whose base'the sanitation, post is formed. . ? ? Training of personnel is conducted by:the Red.Cross and Red Crescent Society with assistance of its medical groupe For guidance of their daily work and participation in pro- phylactic and sanitation-educational work of the health agencies, the sanitation posts are attached to hospital institutions by order of the respective'director of the medical institution. In ordtr to learn methods of work under conditions in mass attack centers, sanitation post personnel is enlisted in training courses of the MFVO medi- cal service, with release from work for five days per year. During participation in the training courses, average wages at their place of work afe maintained for persons working In factories, institutions, etc. Students are released from studies for the same period. Sanitation posts in peace-time, in order to assist medical personnel, inspect sanitary con- ditions in industrial enterprise workshops, kolkhoz field camps, public dining rooms, residential buildings, institutes, schools, etc. Sanitation posts conduct prophylactic work on reducing illness and injury among workers and kolkhoz farmers, give first aid in accidents, participate in organizing sanitation-educational work, inspect sanitary conditions of outside premises of plants, factories, residential buildings, educational institutions, etc. Sanitation posts are a great social force contributing to public health care in the matter of further improving sanitary conditions in our cities, villages, industrial enterprises, kolkhozes, and sovkhozes. Sanitation posts in the MFVO medical service during liquidation of attack centers are charged with the duties of searching for wounded, giving them first aid, and carry- ing them to the nearest medical station. In addition, they are charged with sanitary supervision of-refuges and shel- ters within the territory of activity of the sanitation post. 205 Sanitation brigades(SD) are the basic and permanent unit of the Red,Cross and Red'Crescent'Society. They are formed to assist the health agencles in carrying out prophylactic and-sanitation improvement measures among the people and to function in the MR/0 medical service. Sanitation brigades are formed by local, organizations of the Red Cross and Red Crescent Society in plants, factories, special secondary and higher educational institutions (sec- toral SD); on railroad and water transportation (transport SD); in kolkhozes; MTS, and sovkhozes (rural SD); in second- ary schools and educational institutions for labor reserves (school SD). In additi.on to the sanitation brigades enumer- ated, city and rayon sanitation brigades are formed. These brigades are recruited'essentially from persons not working in factories or institutions (housewives). Rayon sanitation brigades may also enroll institutional employees working and living in the same rayon where the unit is formed. In the sectoral, transport, and rural sanitation brigades are enrolled women aged 16-45 years, chiefly from among per- sons in auxilfary labor. Boys and girls in special secondary and higher educational institutions, in educational institu- tions for labor reserves, and in schools (classes 8, 9, and 10), are enrolled in sanitation brigades. A sanitation brigade staff consists of 23 persons, of which there are: brigade commander - one, brigade political instructor - one, communications-supplies agent - one, team commanders - five, and brigade workers - fifteen. To replace losses in-personnel.,_a reserve is formed of two persons per team, a total of ten per sanitation brigade. A sanitation brigade consists of five teams. Each team con- sists of four persons, including the team commander. The task of a sanitation brigade in the WV? medical ser- vice comprises searching, giving first aid, and carrying wounded from the destruction center, as well as participa- tion in carrying out sanitation and anti-epidemic measures under direction of the sanitation-epidemic station. Sanitation brigades in peacetime participate under direc- tion of medical workers in sanitation improvement and anti- epidemic work, organize sanitation education, and give first aid in accidents. Instruction of personnel in a special program is carried out by the Red Cross and Red Crescent Society with enlistment 299 Declassified in Part - Sanitized Copy Approvedf Release? -Yr2014/04/07: - P81-n1n2mRnnqp Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 of medical institution workers. For every-day guidance of .the work. of sanitation brigades, the latter are attached to hospital and medical institutions, which is formalized by order of the respective health department. The stock equipment of a sanitation' brigade provides for: medical assistant's sanitation kit - 1, team commanders' kits -.51.sub-kits - 17, hospital stretchers - 5, stretcher straps - 10, gasmasks -.23, -rubber boots - 9 pairs, rubber gloves . 9 pairs, protection suits (evacuation clothing) - 23, anti- chemical covers - 23, flash-lights - 7, individual:anti- chemical packets . 23, water canteens..., 7, berets.-,23, and sleeve-bands 23. 'Sanitation brigades are equipped from resources .of insti- tutions on whose base the brigades are formed. Exceptions are city and rayon sanitation brigades, which are equipped by the Red Cross and Red Crescent Society. In addition to the sanitation brigades described above, there are formed on special instructionsanitation- anti-epidemic brigades(SED). These brigades are formed by the Red Cross and Red Crescent Society at sanitation-epidemiological stations in a number of cities and rural rayon centers. Sanitation-anti-epidemic brigade.: are formed by rayon and city committees of the Red Cross and Red Crescent from the rayon center or city population and are instructed at the base sanitation-epidemiological stations. They are designed to aid sanitation-epidemiological stations in carrying out prophylactic measures and in liquidating epidemic centers. A sanitation-anti-epidemic brigade staff consists of 23 persons, of which there are: t.-..igade commander - one, poli- tical instructor - one, commun, a..ions-supplies agent - one, team commanders - four, brigade members - sixteen. The brigade has the four following teams: 1) reconnaisance, 2) disinfection, 3) quarantine, and 4) sanitation. Each team consists of five persons, including the team commander. It must be emphasized that a medical assistant should, as a rule; be appointed as sanitation-anti-epidemic brigade commander, whose appointment is approved by the sanitation- epidemiological station's head physician. Brigade members are enlisted from society members having at least seven 210 Declassified in Part - Sanitized Copy Approved for Release purpose of training ORVP at different times of year and day, not less than twice a year the detachment attends study assemblies, with release from lessons. Duration of these assemblies should, not exceed five days per year. In order to provide medical guidance the detachment is attached to a medical institution located nearby. The att- achmcnt is formalized by order of the respective health depa...,tment after approval by the Red Cross and Red Crescent Society. Detachments for searching and carrying mounded are equipped according to an approved list. For teaching pur- poses a special list provides for the following: medical assistants' kits - 5s sanitation team commanders' kits - 5, sanitati.on sub-kits - 17, hospital stretchers - 5, stretcher straps - 10, gas masks - 25, rubber boots - 25 pairs, rubber gloves - 25 pairs, protection suits - 25, individual anti- chemical packets - 25, water canteens 7, berets - 25, sleeve-bands - 25. The entire complex'of ORVP teaching equipment is acquired from resources of the educational institutions on whose base ORVP is formed. Searching-clearing groups (PSG) are formed by the Red Cross and Red Crescent Society jointly with hospital insti,...Aioa directors, PSG are staffed by nurses in conformity with an apprpved staff, providing for posts of PSG chief (preferably a medical assistant) and 11 nurses. Each nurse is equipped with a sanitation kit and contents, individual anti-chemical packets, gas mask, prctection clothing, lamp, canteen. PSG stock equipment is supplied by the Red Cross and Red Crescent Society. PSG personnel goes through special training and is sys- tematically trained under various conditions, in order to learn methods of searching for victims and giving them pre- medical first aid. The Red Cross and Red Crescent Society organizes these courses and conducts them together with the director of the medical institution on whose base the searching-clearing group is formed. In addition, PSG personnel attend study-training assemblies twice a year, with release from work not more than five days per year. Average wages are maintained for persons enlisted for study assemblies for duration of the assembly. 50-Yr 2014/04/07: 212 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 years of education. Sanitation-anti-epidemic brigades are equipped within limits of the approved list by the Red Cross and Red Crescent Society and partially by the sanitation-epidemiological sta- tion at which the brigade is formed. Detachments for searching and ca.:rying wounded(ORVP) are MPVO medical ser- vice field units. They are formed from students in the first three classes of all higher educational institutions, stud- ents in technical schools, and classes 8, 9 and 10 in secondary schools. Detachments for searching and carrying wounded are formed by the Red Cross and Red Crescent Society jointly with direc- tors of thecductional institutions, who approve by order the detachment personnel. Detachments for searching and carrying wounded are designed for work in an attack center. The basic tasks of ORVP in work in centers of atomic and chemical destruction comprise searching for wounded, giving them first aid, and removing them to temporary collection stations for wounded or directly to OPM. When necessary, ORVP can be employed in loading and unloading of wounded being evacuated by air, railroad, water, and motor transport. In peacetime, the detachment personnel is enlisted to carry out mass sanitation improvement measures within the school establishment. Detachments for searching and carrying wounded are incor- porated into the makeup of five sanitation brigaies, with total personnel of 125. The ORVP staff is planned to have: ORVP chief?- one, ORVP deputy chief for the political sec- tion - one, ORVP supplies agent - one, communications work- ers - two, sanitation brigade commanders - five, sanitation brigade political instructors - five, sanitation team com- manders - 25, sanitation brigade supplies-communications agents - five, team members - 75, reserve team members - five. Theoretical and practical training of ORVP personnel is organized by the Red Cross and Red Crescent Society jointly with the directors of the school establishment. With the 211 Searching-clearing groups are formed as independent units of the MO medical service and are attached to. detachments of medical first aid in which they are a structural subdi-. vision designed for work directly in the-attack center. D.Aring liquidation of a mass destruction center, the , follcwing tasks are laid upon the searching-clearing group: search for victims in the destruction center, joint parti.cipation with disaster-rescue and fire brigades in rescuing persons from collapsed structures, burning buildings, etc? and giving premedical first aid to the wounded; bicarrying out on the spot of initial medical clearing of wounded acOrding to severity of injuries, and determin- ing order of priority in removal and means of evacuation (on foot, independently or With escort, carrying on stretcher, by auxiliary means, etc.); c) direction of work in the attack center of sanitation posts, sanitation teams, sanitation brigades, detachments for searching and carrying wounded, and stretcher teams com- posed of inhabitants of the surviving part of the city and environs. Searching-clearing groups upon completing their work in the attack center may be employed in city or rural MPVO medical service hospitals. Searching-clearing groups work in the attack center in close contact with other MPVO service units, primarily with disaster-equipment, fire-prevention, anti-chemical, and other services. In addition to units formed directly by the Red Cross and Red Crescent Society, there exist local MIN? units con- taining medical teams and groups. These MPVO units include self-defense groups and unitary squads. A self-defense group contains a medical team that is formed, as is the self-defense group, in a city residential sector, in workers' settlements, educational institutions, kolkhozes, and sovkhozes on instruction of the respective MPV0 headquarters. The medical team consists of eight persons, one of whom is appointed team commander, and seven regulars. 213 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07 ? CIA RDP81 01043R00380nonnn9 Declassified in Part - Sanitized Cop Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 To equip the medical team, the self-defense group list provides for: sanitation kits and contents - 2, individual. bandage packets - 55 (12 are reserves), hospital stretchers - 2, sanitation sub-kits.- 20 individual anti-chemical packets - 55 (12 are reserves), sleeve-bands with red cross - 8, canteens - 8, lamps t. 20 water-hose 1, disinfection sprayer for powder - 1, pails - 2, lysol - 5 kg) hexachlbrane emulsion - 4 liters, and "DDT" dust - 10 kg & In addition, all medical team personnel should have means of individual anti-chemical protection. Unitary squads contain a medical group, which is formed together with the squad at industrial enterprises on order of the respective MPVO headquarters and in accordance with special specifications. The medical group consists of two medical teams, with total personnel of 17. Stock equipment of the medical group is almost the same as medical team equip- ment, but increased correspondingly. Stock equipment of medical teams and groups is acquired through the enterprise, residential building, kolkhoz, sov- khoz, educational institution, etc., on whose base the self- defense group or unitary squad is formed. In the event that there are sanitation posts in an enter- prise, establishment, kolkhoz, residential building, etc., and self-defense groups or unitary squads are formed, the sanitation posts are incorporated .into the medical team or group as a sanitation team. Instruction of medical teams and groups is carried out by the Red Cross and Red Crescent Society with enlistment of its medical group in this work. The medical teams and groups have the same purpose and functions as the sanitation posts. ,However, upon occurrence of a mass destruction center, these surviving units are not automatically included in the work of eliminating after- effects of an air attack beyond territorial limits of the industrial enterprise. The medical groups and teams may be enlisted in the work of liquidating large destruction centers upon special instruction of the respective MPVO headquarters or the city MPVO medical service chief. MPVO Medical Service Units Formed by the Health Agencies Detachments of medical first aid (OPM) are formed by the 21)4 health agencies on the base of medicaf institutions regard- less of their institutional affiliation, with the exception of Ministry of Defense medical institutions. A detachment of medical first aid consists of the follow- ing divisions and subdivisions: receving clearing division; S urgical; hospital evacuation; washing-degassing (decontamination, disinfection) division (0D0); mobile laboratory (PL); searching-clearing groups (PS0); sanitation brigades (SD). All these subdivisions, combined into a single formation under direction of the OPM chief, is a mighty mobile struc- tural unit of the MPVO medical service available for work in a destruction center or its immediate vicinity. The first three divisions ofa medical first aid detachmentare formed on the base of medical institutions of the health network (hospitals, their polyclinic divisions, dispensaries, maternity homes, children's clinics, etc.). In forming the OPM divisions indicated, -_ttempts should be made to staff them completely through a single medical institution. When this is impossible, then by virtue of necessity the basic OPM divisions may be formed on the base of a single medical institution, and the remaining personnel recruited through other institutions. The receiving-clearing, surgical, and hospital evacuation divisions when deployed form a medical station fulfilling the basic function of OPM. The OPM receiving-clearing division is designed to receive and clear the wounded arriving from an attack center, and to regulate the load of other divisions. The surgical and dressing division is designed to handle two groups: a) lightly wounded, b) seriously and intermed- iately wounded. In order to provide both groups with suit- able surgical aid, a dressing room for lightly wounded is formed and a separate one for seriously and intermediately wounded. In the surgical and dressing division one operat- ing room with several operating tables is organized. In 215 Declassified in Part - Sanitized Cop Approved for Rel ? 5 -Yr 04/ . - P81-0104nRnnqR Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 this division an anti-shock ward is set up. The hospital evacuation division is set up to handle three groups: aY lightly wounded; b) seriously and inter. mediately wounded, and c) ill (injured by radioactive radia- tion and RV), who are determined by the receivingLclearing division, as well as to deal with the group of non-trans- portable wounded. The OPM medical station is supplied in accordance with an approved list through central equipment and partially through equipment available for use in t,he base institutions. The OPM medical station equipment consists of specific out- fits of dressing materials, medicines, and assortnients of medical instruments for operating and dressing rooms; These outfits are packed in standard boxes convenient to transport and carry, which keep the equipment in strict order. The outfits are designed for first aid and emergency medi- cal aid to those injured by atomic and chemical weapons and in combined attack. In connection with the relatively wide range of OPM surgical aid, the equipment of the surgery and dressing division permits minor to highly complex surgical operations. Washing-degassing (decontamina- tion, disinfection) division(ODO) is formed on the bases of city hospital and sanitation-prophy- lactic'institutions and is designed to service wounded arriv- ing at OPM. However, ODO may also be employed as an independent unit in the event of occurrence of epidemic centers. The basic tasks laid upon ODO are: sanitation treatment of wounded contaminated with radio- active substances, decontamination of their clothing and foot-wear; sanitation-chemical treatment of wounded injured by stable toxic substances and degassing of their clothing; in the event of use of bacteriological weapons, ODO gives the population sanitation treatment and disinfects clothing. The washing-degassing division is supplied centrally with equipment according to a planned list. The stock 216 tr. equipment provides for thorough sanitation treatment of _ contingents arriving at ODO, including decontamination, degassing; or disinfection of thei-r clothing. ODO is equipped with a disinfection-shower bath installation' hauled by motor. 'ODO staff consists of secondary and ! junior medical personnel, 18 in all. Mobile rab'oratorie,s are formed as independent 1v1PV0 medical service units. Bases for forming mobile laboratories are hospital and medical ir%qitutions, regardless of their ipstitutional affiliation, A mobile laboratory staff consists of five persons, Including: laboratOry chief (medical assistant), one labora- tory worker, and three radiometric technicians. Personnel is recruited from the base institutions. Completed mobile laboratories are aysigned to OPM, one to each, and are a structural subdivision of it, but when necessary they may independently perform allotted tasks. Mobile laboratories are charged with: a) dosimetric inspection of rounded arriving at OPM; b) analyzing blood of wounded arriving at OPM, subjected to high doses of radioactive radiation; c) collecting water and food samples and .delivering them to the MPV0 medical service city and rayon laboratory to analyze qualitatively and quantitatively for contamination with chemical OV and radioactive substances; d) collecting water and food samples to be examined in the MPV0 medical service city or rayon laboratory for bacterial contamination. Mobile laboratories are equipped through the base insti- tutions and in part centrally. Searching-clearing groups(PSG) and sanitation brigades, incorporated into OPM, are essigned to it from Red Cross and Red Crescent units formed in a city and are OPM structural subdivisions. These.PSG and sanitation brigades are equipped by the Red Cross and Red Crescent Society. The searching-clearing groups incorporated into OPM ful- fill their immediate functions in the attack center, and sanitation brigades work in OPM divisions. Total OPM staff is 104 persons, of whom 33 are at the medical station. 217 Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 Declassified in Part - Sanitized Copy Approved for Release 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 '47 Nine trucks are assigned to OPM, of which eight are ZIS- 150 types adapted to transport wounded, and one is for work-, in ?DO; This motor transpert serves to transport OPM per- sonnel and equipment during deployment, disengagement, or transfer. Detachments of medical first aid, mighty MPVO Medical service units, play a fundamental and decisive part in liquidating an attack center. They fulfill the following basic tasks: giving first aid and emergency medical aid to wounded; medical clearing of wounded; temporary hospitalization of urgent cases (shock, hemor- rhage, etc.); dosimetric inspection and sanitation treatmentof wounded If contaminated with radioactive material or sanitation- chemical treatment if injured by stable toxic substances; partial decontamination of foot-wear and Clothing of wounded if injured by radioactive material, and degassing of foot-wear and clothing if injured by stable toxic sub-' stances; evacuation of wounded to MPV0 medical service stationary installations located in city or rural areas (SEB); direction of all medical units working in the attack center (ORVP, SD, SP, SZ) and those assigned to OPM (ODO, PL, SD, PSG); giving aid to special units (PPEO, PPEG) when carrying out anti-epidemic measures upon occurrence of epidemic attack centers and when liquidating them; compilation of initial medical documentation on wounded passing through the detachment of medical first aid. Detachments of specialized m-edical aid(OSMP) are formed by the health agen- cies on the base of certain medical institutes and insti- tutes for of physicians. Staff is recruited from skilled institute specialists. 218 -or A professorial-teaching group in various specialties (sur- geons, therapeutists, stomatologists, etc.) is enlisted for this purpose. Detachments of specialized medical aid are designed primarily for work in MPVO medical service' stationary installations. OSMP in its structure and principle of use has consider- able resemblance to the detached medical reinforcement companies (ORMU), which played a large part in the matter of giving specialized medieal aid in medioal-sanitation battalions and first line field hospitals. However, the resemblance of ORMU and OSMP is a relative one, for the latter have considerably greater group specialization than ORMU. OSMP is made up of three groups, each group of 14 brigades. An OSMP brigade is staffed by physicians, second- ary and junior medical personnel. Total number of psmP personnel is 259. A group of specialized medical aid is made up of the following brigades (according to specialties): neurosurgical, face and jaw, thorax and abdomen, traumatic, otorhino-laryngeal, ophthalmological, general surgery, burn, roentgenological, toxicology and therapeutics, radiological, and brigades of infection specialists, blood transfusion, and clearing. Groups of specialized medical a i d (GSMP) are formed not only in the make-up of OSMP, but also independently on the bases of medical institutes and institutes for advanced training of physicians (which do 'not form OSMP), and on bases of large kray, oblast, and city hospitals. The group structure and brigade types are identical to those in OSMP groups. Number of GSMP staff personnel is defined by staff order and consists of 86 persons. Detachments and groups of specialized medical aid are equipped in Conformity with listed standards through resources, when present, of the institutions on whose base OSMP and GSMP are formed. When the bases are medical institutes and institutes for advanced training of physicians, not having clinics, OSMP and GSMP are equipped by those hospitals and divisions hav- ing one or another of the departments, whence also the 219 Declassified in Part - Sanitized Copy A d for Release ? 5 - r 2014/04/07: CIA-RDP81-flinafIRnMSInflnannn Declassified in Part - Sanitized Co .y Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 specialized brigade. The maneuverability and tactical use of OSMP and GSMP require portable packing of supplies: Hence all surgical instruments and necessary equipment must be put in special packing boxes which keep in definite order the packed sur- gical instruments, sterile bandage material, medicines, and administrative inventory (sheets, towels, etc04 The necessity,of transporting, sometimes of carrying, equipment by group or brigade personnel requires that pack- ing boxes be convenient for carrying and the weight of each not exceed 16-20 kr. OSMP and GSMP brigades should have in packing boxes an amount of medicines and bandage sufficient for aiding 100-150 gounded. Upon,exhaustion of medicinal ald bandage Supplies, they are.replenished from pharmaceutical stores on request of directors of the installations where brigades or groups of specialized medical aid are working. OSMP and GSMP mob- ility and presence of highly skilled specialists allow ready movement of these units and rapid organization of specialized medical aid at various evacuation points. Detachments and groups of specialized medical aid are employed not only in MO medical service stationary instal- lations, but in specific cases may also work in OPM, depend- ing on requirements of the situation. Mobile anti-epidemic detach- ments(PPEO)and mobile anti-epide- mic groups(PPEG) are formed by the health agencies: the former on bases of oblast sanitation-epidemiological stations eld institutes of epidemiology and microbiology, and the latter on bases of city sanitation-epidemiological stations (SES). Mobile anti-epidemic detachments and groups are mobile MPV0 medical service forces which carry out anti-epidemic measures in the event of a flmenacing situation." At this time their activity consists of increased sanitation- epidemiological supervision, prophylactic inoculations of the population, sanitary inspection of refuges and shelters. In case of an air attack by an enemy using bacteriological weapons and occurrence of an attack center, PPEO and PPEG carry out anti-epidemic measures for liquidating the center, enlisting in this work all mobile forces and resources of 22a the MPVO medical service. In case of atomic attack these units take sanitation and anti-epidemic measures to prevent possible epidemics resulting from the great dislocation of population and its accumulation upon roads and in certain parts of the attacked city. In the event of occurrence of a chemical attack center, PPEO and PPEG take the same measures as in an atomic attack center. PPEO staff has three divisions - epidemiology, laboratory, and disinfection. Total PPEO personnel is 14. Specialists in epidemiology, laboratory, and disinfection are specified for the staff. These units are recruited from medical personnel of sanitation-epidemiological stations, in accordance with the approved staffs. PPEO and PPEG are equipped through the institutions on whose base they are formed. Trucks are assigned to these units from the sanitation-epidemiological stations, in accordance with staff order. In cases where city or oblast sanitation-epidemiological stations have no motor transport, machines are assigned PPEO and PPEG from other medical Institutions, Assignment of institutional motor transport Is carried out by order of city or oblast health department directors. Groups to accompany woundedare formed by the health agencies from medical personnel of hospital institutions of ministries of health and ways of communication. These groups are designed for medical service along the line of movement of _transports of wounded being evacuated from attacked cities tothe oblast interior or beyond its limits. To eacri hospital train or motor column is assigned an escort group of physician, nurse, and nurse's aide. The group may be enlarged, depending on number of escorted wounded and severity of their condition, from MFVO medical service units and installations. Mobile radiological laborator I e s (PRL) are formed in certain cities on sped-ti instruc- ??? 221 Declassified in Part- Sanitized C .y A ease ? 5 - r 2014/04/07: CIA-RDP8i-n-maqpnn-zQrmrlarw-w-,-, N.? Declassified in Part - Sanitized Copy Approved for Release ? 50-Yr 2014/04/07: CIA-RDP81-01043R003800050002-9 4 tion. The base for their formation are city sanitation- epidemiological stations, from which the personnel is selected. They are designed for analyzing water and food contaminated with RV or BRV in cases where the situation requires urgent decision of the question on the spot, or if for any reason the MO medical service laboratories cannot fulfill this task. PRL are equipped centrally with all necessary equipment. #1288 #1956 - END - 222 Declassified in Part - Sanitized Copy Approved for Release ? 50 -Yr 2014 .UlA-RDP81-0104pnft . 4.