MEDICAL SERVICE IN MASS ATTACK USSR

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP81-01043R003800050002-9
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 114
• Document Creation Date: December 23, 2016
• Document Release Date: April 7, 2014
• Sequence Number: 2
• Publication Date: September 8, 1959
• Content Type: REPORT

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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
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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.
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?MED ICAL SERVICE'
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Obespechaniya.pri MassovyAch,_ _
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_Radioactive Substanets -
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, 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: -,- ?
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?*--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.
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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,..in.high.:explosive 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
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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
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Toxicologyf7'LI), of _ba
tanoes ?.7:ies
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A G.e, ..3.2t:royntiP, 0,o iosfoi to
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and ssifica-tion',0f 10 .7? Them ,
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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.
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? 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?..si?:. 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:, t.tp)rtjieci 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
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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.
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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-
,
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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
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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
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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
to.an- 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
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--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
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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 seen-.as 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
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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 needs.to 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..
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-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,kidneys.is
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
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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-
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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 whefeby.it 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- ,
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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
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AP
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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.
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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;
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_ ' 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
with-antiseptic.solutions 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 penicillin.group 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.
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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 in_tfie-ordi.cd-vity
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
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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
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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-
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??-?:
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
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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
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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
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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 no.data 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
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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
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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
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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.
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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
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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
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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
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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
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-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-
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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
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_
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
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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
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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
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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
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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
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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).
?.,
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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.
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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
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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
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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
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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
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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
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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
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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
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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
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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.
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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-
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isms of .disease'.
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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.
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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
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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
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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-
pated.in 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.
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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 densitive.to
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 disease.as 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.)
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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-
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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-
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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-
panied.by 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
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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
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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
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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
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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 organism.as'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
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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 lAibonic.farm 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 previlent.as 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 nutritive.media 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
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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
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equal.to 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 u.se 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 of.persons.in 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),
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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
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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
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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
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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
used.as:a 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.
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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-
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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.
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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 waterand.food 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
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?
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).
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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 of..protection
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
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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
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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 the.se 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
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-
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
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is unconditionally erroneous: the severity of the course
of the disease dependsjess_on the species of causal organ-
..ism than.is 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 from_an.open 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
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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
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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 only.at 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.
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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
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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.
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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-
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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
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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
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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 infection.in 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
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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.
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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 virus.is 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-
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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-
alitis.is 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 cannbt.be
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
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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.
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_
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).
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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 first.it'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
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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 uBed.as 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
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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
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infect'peeple When-it entere.'the reepiratory-passages, be--'
invtransmitted only,-byribitee,of,Aedes
s--. ? 4 ?
-ITHence itfolIow3lthat,the,yellow,,f6verL:Virus may beeX-
pected-.:to.be 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'fif.th&-ddY:the.lvirus,
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 when.an'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
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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 weakensrantdly.li 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 and:lwhich.is '
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
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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,:whighIcan.be,: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,diaeate.tasikl.to-been,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,ba.pid.ofthespractical 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
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.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
may.be 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,pregnancy.in.the 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
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:,; -
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, then:the-impossibility:ofcreating.an 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
repearch.in-the field of manufacture,of vaccines:i_etc.),,it
is'neCesSary.to 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 becategorized.as 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
about.by?the,fact ithey,deatrovpnly those microbes to which
they have been adapted., Bacteriophagy is essentially a virus
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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
bacteriophage.is 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
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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. Thereforel.it is impor-
ta.ntto know what can substitute for them if they are not
at hand:,
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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 I.is 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 protected.by 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) 15.parts 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 difficult.to 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
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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'it.is 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
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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'the.food 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 supplemented.by 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 ..is the mechanization
and automatization of all elements,:of food processing: The
entire technological process, of processing food should be
carried.out.in such.a..!way that not (only.is,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
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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 not.be,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
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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 should.be carried-out.in 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,
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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.
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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 inoculations.in 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
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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 put.tn-charge 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
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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
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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
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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
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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 biological.at-
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
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'
the occurrence of cases of disease produced.by 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 work.to 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
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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
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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
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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
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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,
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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 oflpersons.in 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
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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 shoUld.be 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 to.be 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
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4 ?
of diseases on a large sale and particularly those Which
are unusual for .the given Ideality gives us an adequate '
basis for.an 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 medidal.education. 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) '
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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. -
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_ .
This period is_rd.ckoried:Trom.tbe.timp_of hospitalization
of the last patient.
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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.
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- 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 begun.by 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-
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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 casualties.so 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;
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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
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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
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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 of.an 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
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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:
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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.
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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
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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. This.equipment 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
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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
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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.
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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.
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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
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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.
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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 advanced.training 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
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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
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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 -
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.UlA-RDP81-0104pnft
.
4.