Index

INDEX

A Aircrew uniform, integrated battlefield (AUIB), 373 Air delivery Aberdeen , , 398, 409–410 history, 28, 31, 34–35, 49–50 See also Edgewood Arsenal, Maryland See also Aerosol; Inhalational injury; specific agent ABG Airplane smoke tanks, 31 See Arterial blood gases (ABG) AIT Abortion See Aeromedical Team (AIT) septic, in , 516 Alarms, 377–383 Abrin, 610, 632 , 431 Abrus precatorius, 610, 632 history, 23, 53, 60–62, 66–67 AC LOPAIR, E33 Area Scanning, 53 See (AC) M8A1 Automatic Chemical Agent, 380–381 Acetaminophen, 627 M21 Remote Sensing Chemical Agent (RSCAAL), 381 (ACh), 132–134, 136, 159, 647 Portable Automatic Chemical Agent, 60–62 (AChE), 131–132, 134, 182–184 See also Detection Acetylene tetrachloride, 34 Alastrim, 543 Acid hydrolysis, 355 Alexander, Stewart, 103 Action potential, 133 Algal toxins, 457, 609, 617 Activated charcoal, 217, 362–363, 366, 370, 373, 670 Alimentary toxic aleukia (ATA), 659, 667 Alkaline hydrolysis, 355 See DM (diphenylaminearsine) Allergic contact sensitivity, 238–239, 249, 314, 316–317 Additives, 122 a -Naphthylthiourea (ANTU), 638 Adenine arabinoside (Ara-A), 553 Alphaviruses, 562 Adenosine triphosphate (ATP), 275, 383, 431 antigenic classification, 564–565 S-Adenosylhomocysteine hydrolase inhibitors, 552 structure and replication, 569–570 Adenoviridae, 575, 683 See also Viral encephalitides; specific virus Adrenaline, 132 Alphavirus virion, 569 Adrenergic nervous system, 132 Ambergard XE-555 Resin, 353 Adsorbent materials, 354, 363–364, 370 Ambulance exchange points, 331 Advanced trauma management (ATM), 326–327 AMEDD Aedes albopictus, 563, 566, 568 See U.S. Army Medical Department (AMEDD) Aedes dorsalis, 567 American Civil War, 11, 13, 88, 416, 540 Aeromedical Isolation Team (AIT), 432, 434 American Cyanamid Company, 38 Aeromonas, 609 American Type Culture Collection (ATCC), 463, 646 Aerosol American University, 94 definition, 248 Amherst, Sir Jeffery, 416 detection, 383, 448 Aminoglycosides, 518 LCt50 calculation, 606 Aminopyridines, 651 LD50 calculation, 606 2-Amino thiazoline 4-carboxylic acid, 276 particle size, for biological agents, 440 Amphetamines, 292 Aerosolization, 121 Amyl , 280 of biological agents, 440–442 Angola, 69 of toxins, 605–608, 612 Anguidine See also Inhalational injury; specific agent See 4,15-Diacetoxyscripenol (DAS) Aerosol vulnerability testing, 429 Animals AERP system that harbor disease, 487–488, 514, 524, 527–528 See Aircrew Eye/Respiratory Protection (AERP) system transgenic research involving, 683 Afghanistan, 3, 67–68, 102, 104, 656–658, 665 vaccines for, 434, 460, 464, 568, 576, 578 Aflatoxins, 656, 662 weapons directed against, 12, 16, 34–35, 37, 51, 60, 428– African swine fever, 459 429, 459–460 African viral hemorrhagic fever, 434 See also specific agent or animal , 105, 297, 419 Animal venom toxins, 610, 650 Agent Purple, 51 , 5, 467–475 Agent X in animals, 468–469 See Botulinum toxins clinical manifestations, 471–472 Aging, of organophosphoryl– bond, 162, 182– cutaneous, 471–473 183, 230 delivery, 442, 446 AHF diagnosis, 473 See Argentine hemorrhagic fever (AHF) epidemiology, 469 Airborne toxic material gastrointestinal, 472–473 definitions, 248 history, 10, 16, 32, 42–44, 50, 68, 417–418, 420, 427, 431–432, See also Aerosol; Inhalational injury; specific material 459, 468, 645 Aircraft masks, 74 inhalational, 469, 471–473 Aircrew Eye/Respiratory Protection (AERP) system, 369–370 lethality, 443–444, 456 Aircrew personal protective equipment, 368–370 occupational exposure, 468–469, 474

691 Medical Aspects of Chemical and

oropharyngeal, 472–473 Arterial blood gases (ABG), 252 pathogenesis, 469–471 Arthur, Stanley, 73 prophylaxis, 473–475 Artificial ventilation recent use, 4, 420–421, 452–453, 462, 464, 468 See Ventilatory support spore stability after production, 441 Artillery shells, 120 treatment, 473 Ascorbic acid, 671 vaccination, 73, 462, 468, 473–475 ASC Whetlerite charcoal, 363 See also Bacillus anthracis Ash, Charles A., 13 Anthraxin, 473 Aspartate aminotransferase (AST), 596 Antianimal weapons, 459–460 Aspergillus fumigatus, 429 history, 12, 16, 34–35, 37, 51, 60, 428–429 Asphyxiation, 249 See also specific agent or animal Aspirin, 597, 627 Antibiotics Assassinations for anthrax, 473 using biological weapons, 420–421, 446, 645 for brucellosis, 518 ASZ impregnated charcoal, 363–364 cream/ointment, 214 ATA for , 497–498 See Alimentary toxic aleukia (ATA) for , 531 ATCC resistance, 681–682 See American Type Culture Collection (ATCC) for , 507 Atelectasis, 252 See also specific antibiotic Ativan , 294–302 See Lorazepam See also specific agent ATM Anticonvulsants, 154–155, 165, 187, 191, 279 See Advanced trauma management (ATM) See also specific drug ATP kits, 73 See Adenosine triphosphate (ATP) AtroPen, 155, 159–160, 169 , 298–302 sulfate, 159–162 cyanide, 279–282 administered in absence of intoxication, 160 , 102, 218, 220 cardiovascular effects, 156, 160, 165 nerve agent, 158–159, 329 contraindications, 167 self-administration, 329–331 decrease in sweating caused by, 160 See also specific antidote for dermal exposure, 161–162 Antigens dosage and administration, 160–161, 169 detection, 383, 517 and endurance time in protective gear, 394 viral, 541–542 history, 47, 54, 60, 131, 291 Antihistamines, 627 ID50, 295 See also specific drug as , 294–295, 299 Antimaterial agents, 459, 461 for inhalational exposure, 161 Anti-O-polysaccharide antibody, 517 injectors, 54, 73, 155, 159–161, 169 Antiplant balloon bomb, 51–52 LD50, 295 Antiplant weapons, 460–461 for nausea and , 168 history, 44, 51–52, 60, 427–429, 431 and nerve agent cardiovascular effects, 156 See also Defoliants; specific agent or plant and nerve agent–induced seizures, 154–155 Antiricin antibody, 638–639 and nerve agent pretreatments, 184–187, 191 Antitoxins, 434, 632 pulmonary effects, 148–149, 158 Antitussives, 628 topical ocular administration, 147, 166–167, 215 Antiviral drugs, 434, 598–599 Attack measures See also specific drug for medical support, 328 ANTU AUIB See a -Naphthylthiourea (ANTU) See Aircrew uniform, integrated battlefield (AUIB) Anxiety reactions Aum Shinrikyo, 4, 75, 113, 118, 131, 169, 274, 342, 438, 463, 678 differential diagnosis, 297–298 Aura virus, 566 Apodemus agrarious, 594 Australia, 460 Ara-A Autoclaving, 358 See Adenine arabinoside (Ara-A) Autoinjectors, 54, 73, 155, 159–161, 163–165, 169, 252, 341 Arab–Israeli Six-Day War (1967), 57, 65 Autoinoculation Arab–Israeli War of 1973, 3 and vaccinia vaccination, 548–549 Ara-C Automatic Chemical Agent Alarm See Cytosine arabinoside (Ara-C) M8A1, 380–381 Arenaviridae, 575, 592–593 Automatic G-Agent Field Alarm, 53 Argentine hemorrhagic fever (AHF), 592–593, 595–596, 599 Automatic G-Agent Fixed Installation Alarm, 53 Armstrong, George E., 428 Autonomic nervous system Arrhythmias, 156, 165–166, 239, 253, 277 effects of cyanides on, 277 , 42, 198 Aviator’s masks, 74 See also specific agent Avipoxvirus, 542 Artane Azidothymidine (AZT), 639 See Trihexyphenidyl Azithromycin, 531

692 Index

B inhalational injury, 440 introduction to, 4–6 Bacillus anthracis, 383, 439, 468–469, 474 laboratory testing, 448–449 See also Anthrax lethality, 439–440, 444 Bacillus globigii, 43, 60, 429 nonmilitary sources, 5–6, 10 Bacillus subtilis, 428 nonreplicating, 4–5 Bacitracin, 214 occupational exposure, 398–399, 402–408, 432, 434 Bacteria patient isolation procedures, 432–433 possible biological warfare agents, 439 protective equipment against, 431, 447–448 See also Biological agents; specific agent replicating, 4–5 Bacterial toxins, 609, 647 risk of transmission to medical staff, 356 See also specific toxin stability after production, 441 Bacterium tularense susceptibility and nonsusceptibility, 441 See vaccines, 60–61, 73, 434, 441, 460, 462, 681–683 Badoglio, Pietro, 34 virulence, 681 Baker, Newton D., 25 See also specific agent BAL Biological bombs, 32–33, 44, 51–52, 59, 441–442, 444 See British anti-Lewisite (BAL) Biological defense equipment, 431 Baldwin Report, 427–428 Biological Defense Research Program, 434–435 “8-Ball,” 428 Biological Integrated Detection System (BIDS), 74, 377, 382– Bang, B., 514 384, 448 Barbiturates, 293, 302 Biological warfare Bari mustard disaster (Italy), 40, 103–104, 200 attempts to control, 13, 419–420, 678–679 Barmah Forest virus, 565 Cold War, 50–52, 55, 58–60, 420–422, 426, 430, 656 Barrier nursing procedures, 432–433, 598 definition, 10 Barton, Samuel, 13 early proposals and usage, 12, 88, 416–417 Base-ejection devices, 120–121 history, 9–75, 87–105, 415–422 Battalion aid station (BAS), 327, 329, 331, 335 indications of possible attack, 448–449 Battledress overgarment (BDO), 371, 373 and military healthcare provider, 6, 445, 447, 683–684 Battledress uniform (BDU), 373, 669 pre–World War I, 10–13, 88–90 Battlefield health service support, 326–328 psychological factors, 445 Bedbugs, 487 1920s, 28–29 Bell, Sir Charles, 105 1930s, 31–33 Belladonna, 289–290, 294–295, 297–299 1960s, 58–60, 104–105 Benactyzine, 159, 187 1970s, 64, 67–68, 104–105, 420–421 Benenson, Abram S., 428 1990s, 74–75, 104–105, 420–422 Benzilate, 295 strategic and tactical concerns, 445–446, 456–458 Benzodiazepines, 302 threat, 451–464, 683–684 Berlin Blockade, 47 unconventional/clandestine use, 442, 446–447, 458 Berthollet, Claude Louis, 10 World War I, 16, 21–22, 90–97, 417, 446, 459, 540 b-Propiolactone (BPL), 597 World War II, 36–37, 42–44, 103–104, 417–419, 426–427, 446, Bhopal disaster (India), 119 483–485, 540, 632, 644–645 Bicuculline, 154–155 Biological Warfare Convention, 64, 67 BIDS Biological weapons See Biological Integrated Detection System (BIDS) advantages and disadvantages, 442–445, 456–459, 684 BIGEYE bomb, 65–66, 71 demilitarization, 431–432, 525, 564 Binary weapons programs, 65–66, 70–72, 75, 104 nations with capability for use, 679 Biological agents nonhuman targets of attack, 434, 459–461 aerosolization, 440–442 versus nuclear and chemical weapons, 458–459 availability or ease of production, 438–439, 457, 678 proliferation, 456–459, 678 containment precautions, 430, 432–434 use, 437–449 decontamination, 357–358 Biological Weapons Anti-Terrorism Act, 75, 633 defense against, 1–6, 425–435, 438, 443–446, 677–684 Biological Weapons Convention, 419–420, 422 delivery systems, 121, 420–421, 429, 438–442, 446, 457, 656, compliance, 432, 435, 455, 458, 462–463, 679 658–659 and Soviet biological warfare program, 4, 452–453, 455–456 detection, 74, 377, 382–384, 431, 447–449 Third Review Conference, 453 differential diagnosis, 438, 448–449 and toxin definition, 604, 608 dispersal, 5 Trilateral Agreement, 455 dual use, 679 and U.S. biological warfare program, 426 ease of dissemination, 440, 457 , 454 enhanced pathogenicity, 680–681 Biosafety levels, 430, 432–434, 597 epidemiological surveillance, 448 Biotechnology, 678–683 field testing in U.S., 429 and nerve agent pretreatments, 192–193 genetic recombination, 681 Birds ideal, requirements for, 438–441 viral encephalitides carried by, 567, 573 incapacitation caused by, 292, 431, 439–440 Blackburn, Luke, 12 incubation periods, 439 Black Death, 481–482, 487, 495 infectivity, 680–681 Blackford, William W., 11

693 Medical Aspects of Chemical and Biological Warfare

Black Plague, 416 British anti-Lewisite (BAL), 102, 218, 220, 261 Black vinyl overboot (BVO), 374 British anti-Lewisite (BAL) Eye Ointment, 42 Bleach British smoke grenade, 262 See Hypochlorite solution Bromine, 273 Bleaching powder, 22–23, 33–34, 54 Bronchiectasis, 211–212, 215, 238 Bleeding Bronchitis, 211, 238, 253, 257 in viral hemorrhagic fevers, 597 Bronchoconstriction, 148–149, 158 Blood–brain barrier permeability Bronchodilators, 253, 257 and nerve agent pretreatments, 187, 191 Bronchospasm, 250, 253, 257 Blood cell counts, 497, 506, 530, 635 Brown, Frederic, 93, 96 Blood , 132, 136–139 Bruce, David, 10, 514 Blue-X, 3 Brucella, 383, 514–515 BN 52021, 670 See also Brucellosis Boer War, 11 Brucella abortus, 514, 516, 518 Bolivian hemorrhagic fever, 593, 595–596, 599 Brucella canis, 514–515, 517–518 Bombs Brucella endocarditis, 517–518 biological, 32–33, 44, 51–52, 59, 441–442, 444 Brucella melitensis, 514–518 chemical, 28, 40, 49–50, 59, 65–66, 71 Brucella neotomae, 514 See also specific type of bomb Brucella ovis, 514 Bone disease, 215–217, 517 Brucella suis, 51, 429, 514–515, 517 Boots Brucellosis, 5, 513–519 protective, 373–375 clinical manifestations, 516–517 Botulinum toxins, 5, 643–652 diagnosis, 517–518 and assassination of Reinhard Heydrich, 645 differential diagnosis, 574 crystalline, 644 epidemiology, 515 decontamination, 616 history, 10, 43–44, 417, 427, 429–430, 514 detection, 383 lethality, 444 dual use, 457 pathogenesis, 515–516 genetics, 647 prophylaxis, 518 history, 32, 43, 417, 421, 427, 644–645 treatment, 518 lethality, 608 See also Brucella mechanism of action, 609–611, 647–649 Bubo aspiration, 495 military significance, 644 , 480, 486, 491–492, 497 recent use, 462–463 BuChE relation to other bacterial toxins, 647 See Butyrocholinesterase (BuChE) serology, 646 Buddy-aid, 155, 159, 161, 165, 166 stages of toxicity, 648 and chemical workers, 407, 409–410 versus tetanus toxin, 646 Bulk-release munitions, 120–121 treatment, 611 Bullene, Egbert F., 48, 50 vaccination, 73, 462, 644, 651 Bunyaviridae, 575, 592–594 , 646 Burnet, MacFarlane, 525 clinical manifestations, 649–650 Burns diagnosis, 650 CS-induced, 313 differential diagnosis, 574, 613–614 mustard, 98–100, 202, 205–208, 214, 238, 342–343 infant, 644, 646 thermal, 343 inhalational, 647, 649–650 Burroughs Wellcome Co., 214, 552 pathogenesis, 647–649 Bush, George, 72, 74, 117, 455, 462 treatment, 616, 651–652 Butyl rubber aprons, 329, 332 wound, 644 Butyl rubber gloves, 356–357 Bouquet, Henry, 12 Butyl rubber masks, 364–365, 369–370 Boynton, E. C., 11 Butyl rubber overgarments, 370 BPL Butyrocholinesterase (BuChE), 132, 136–139, 192, 301 See b-Propiolactone (BPL) Butyrophenones, 293 Bradley, Tom, 461 Butyrylcholine, 132, 134 Bradycardia, 156–157 BVO Brain lesions See Black vinyl overboot (BVO) nerve agent–induced, 154–155, 187 BZ (3-Quinuclidinyl benzilate), 5, 119, 159, 294–296 Brazil anticholinergic delirium produced by, 296 hemorrhagic fever outbreak, 593 chemical structure, 295 Breathing difficulties clinical pharmacology, 295–296 with mask use, 365, 403 delivery systems, 121 nerve agent–induced, 145, 147–149, 158, 167–168, 170 history, 5, 57–59, 291 and toxic inhalational injury, 255 ID50, 295 See also Ventilatory support MED50, 296 The Breeders, 461 treatment, 298–302 Brefeldin-A, 639 Brevetoxins, 609 C Bristol-Myers Squibb Oncology Division, 237 CA (bromobenzylcyanide), 320

694 Index

Caffeine, 292 CDAE CAI See Chemical defense aircrew ensemble (CDAE) See Chemical (Surety Material) Accident or Incident (CAI) CDC CAIRA See Casualty Decontamination Center (CDC); Centers for See Chemical Accident or Incident Response and Assis- Disease Control and Prevention (CDC) tance (CAIRA) cDNA Calabar bean, 130, 298 See Complementary DNA (cDNA) Calamine, 670 CDTF Calcium ethylenediaminetetraacetic acid (CaEDTA), 261 See Chemical Decontamination Training Facility (CDTF) Calcium hypochlorite Cefazolin, 473 See Hypochlorite solution Ceftriaxone, 497 Calomys colosus, 592 Centers for Disease Control and Prevention (CDC), 540, 551– CAM 552, 596, 626, 651 See Chemical Agent Monitor (CAM) Central Intelligence Agency (CIA), 428, 454, 456–457, 461–462 Cambodia Central nervous system effects See Kampuchea of brucellosis, 517 Camp Detrick of cyanides, 277 See , Maryland of mustard, 212, 239 Camphor, 670 of nerve agents, 145, 149–155, 170, 233–234 Camp Terry, Plum Island, New York, 460 of Q fever, 529–530 Canada, 32, 427 in toxic inhalational injury, 254 Canister mask arrangement, 364, 366–369 of viral encephalitides, 571–574, 576 Cannabinoids, 297–298 Centro Chemico Militaire, 29 Canvas Trench Fan, 22–23 Cephalosporium, 656 Capripoxvirus, 542 Cephalothin, 473 Capsaicin, 316 Cerebrospinal fluid (CSF) examination, 576 , 130, 132, 134, 183–184 CF See also specific agent See Complement fixation (CF) Carbamoylation, 184 CG See (CG) See Sevin Chad, 69 Carbon tetrachloride, 199, 201, 310 CHAMP Carbonyl chloride See Chemically Hardened Air-Management Plant See Phosgene (CG) (CHAMP) Carcinogenesis Chancroid, 495–496 and mustard exposure, 217, 237–238 CHASE (Operation Cut Holes and Sink ’Em), 62–64 Cardiovascular effects CHATH of brucellosis, 517–518 See Chemically Hardened Air Transportable Hospital of cyanides, 277 (CHATH) of mustard, 217 ChE of nerve agents, 145, 155–157, 165–166, 169 See Cholinesterase (ChE) of Q fever, 528 Chemical accident/incident response and assistance, 409–411 of agents, 315, 321 Chemical (Surety Material) Accident of Incident (CAI), 409 of staphylococcal enterotoxin B, 626 Chemical Accident or Incident Response and Assistance of toxic inhalational injury, 252–253 (CAIRA), 409–411 of viral hemorrhagic fevers, 596 Chemical agent monitor (CAM), 70, 378–379 Carus, W. Seth, 458 decontamination certification with, 355–357 Cassava, 273–274 and medical management, 332, 335 Castor beans, 610, 632–633, 635 Chemical agents, 4–6, 10, 18–19, 22–24, 27, 29–31, 34–35, 37– Castor oil, 610, 632, 636 39, 41, 52–53, 57, 62–63, 66–69, 72–74, 118–119 Casualty arrival point, 331–332 defense against, 1–6, 677–684 Casualty decontamination, 329, 331–335, 340–341, 352, 386– definition, 398 387, 408–410 demilitarization, 115, 117, 411–412 Casualty Decontamination Center (CDC), 329 detection, 377–381 Casualty-receiving area, 331–335 deterrents to use, 6 Cats, 487–488 dispersal, 5 Cat scratch disease, 495–496 incapacitation caused by, 292 Cattle, 417, 459–460, 548 lethality, 607 Cavanaugh, Dan C., 483 nonmilitary uses, 5–6, 115–116, 679 CB Pressurized Pod, 67 nonpersistent, 5, 122–123 CBPS offensive use, 112–117 See Chemical and Biological Protected Shelter (CBPS) persistent, 5, 122–123, 157 C-CHF physical properties, 122–123 See Crimean-Congo hemorrhagic fever (C-CHF) release, See Delivery systems; specific system CCST review of effects, 341–344 See Chemical Casualty Site Team (CCST) storage, 411–412 CD volatility, 122–123 See Cluster of differentiation (CD) See also specific agent

695 Medical Aspects of Chemical and Biological Warfare

Chemical and Biological Protected Shelter (CBPS), 385 Chemical surety mission Chemical bombs, 28, 40, 49–50, 59, 65–66, 71 civil–military relations and, 408–411 Chemical casualties definition, 398 advising agencies for treatment, 398 duty positions, 399–402 with combined injuries, 340, 347–348 healthcare and, 397–412 decontamination, 329, 331–335, 340–341, 352 Chemical threat diagnosis, 112, 124 definition, 112 field management, 325–336 and enemy capability, 113–114 first aid for, 329–332 medical management, 124–125, 329 attempts to control, 13, 115, 117, 411–412, 678–679 World War I, 6, 24, 91–92, 100–101, 200, 205 capability for, 113–117 Chemical Casualty Site Team (CCST), 410 definition, 10 early proposals and usage, 11–12, 88 biological warfare programs, 430 future, 125–126 creation of, 45 history, 9–75, 87–105 post–World War II programs, 46–47 and military healthcare provider, 6, 111–126, 328–335, 683– 1950s programs, 47–55 684 1960s programs, 55, 57–62 pre–World War I, 10–13, 88–90 1970s programs, 64–68 1920s, 25–29, 101–102 1980s programs, 68–72 1930s, 29–36, 101–102 See also Chemical Warfare Service (CWS) 1950s, 47–55, 104–105 Chemical decontamination methods, 158, 354–355, 357–358, 1960s, 55–64, 104–105 363 1970s, 64–68, 104–105 Chemical Decontamination Training Facility (CDTF), 71 1980s, 68–72, 104–105 Chemical defense aircrew ensemble (CDAE), 373 1990s, 72–75, 104–105 Chemical defense equipment, 124 training, 48, 55–56, 71–72, 94, 124 aircrew, 368–370 World War I, 13–25, 90–97, 290 and chemical warfare capability, 113 World War II, 36–47, 103–104, 125, 131, 200, 290 Cold War, 52–53, 60–62, 67, 69–70 Chemical Warfare in Southeast Asia and Afghanistan (Haig), 68 developmental, 375 Chemical Warfare Review Commission, 70 early, 12–13 Chemical Warfare School, 26, 29, 35, 48, 71 ground crew, 365–368 Chemical Warfare Service (CWS) individual, 363–377 biological warfare programs, 426, 428, 632 joint service use, 362, 375 creation of, 18–19, 95 and medical personnel, 329, 331–332, 334, 338, 340–341 permanent establishment of, 25–27 post–World War II, 47 post–World War II demobilization, 45 1920s, 27–28, 101–102 1920s programs, 27–29 1930s, 33–34, 101–102 1930s programs, 29–31 1960s, 60–62 World War I programs, 19–22 1980s, 69–70 World War II programs, 37–44 1990s, 74 See also Chemical Corps World War I, 15–18, 22, 91–94, 363–364, 393 “Chemical warfare threshold,” 117 World War II, 37, 40–43, 103, 365, 394 Chemical weapons See also Collective protection; Masks; Mission-oriented nations with capability for use, 114, 116, 679 protective posture (MOPP); specific item versus nuclear and biological weapons, 458–459 Chemically Hardened Air-Management Plant (CHAMP), 385 proliferation, 114–118 Chemically Hardened Air Transportable Hospital (CHATH), reduction or elimination, 115, 117, 411–412 385 tactical and strategic use, 120–125 Chemically protected deployable medical system (CP versus toxin weapons, 605, 607 DEPMEDS), 384 Chemical Weapons Convention, 75, 115, 117, 679 Chemical Personnel Reliability Program (CPRP), 399–402 Chemical workers baseline data for future exposures, 404 health education for, 407–410 periodic medical examinations, 404–406 health surveillance for, 402–405 preplacement examination, 403–404, 406 Chest radiography screening/evaluation, 399–404 and inhalational injury, 252, 259–261, 264 termination examination, 405 and pneumonic plague, 494 Chemical protective footwear cover (CPFC), 374 and Q fever, 530 Chemical protective glove set, 374–375 and tularemia, 506 Chemical protective overgarment (CPOG), 373 Chickenpox Chemical rockets, 40, 58–59, 62, 71 versus , 546 Chemicals in War (Prentiss), 123 virus, 562, 578 Chemical Stockpile Emergency Preparedness Program Chile, 463 (CSEPP), 409 China Chemical Surety Inspection (CSI) biological warfare program, 461–462 documentation, 400–402 Japanese invasion of, 35–36, 200, 218, 417–418, 485 Chemical surety material Chipmunks, 487–488 definition, 399, 402 Chlamydia trachomatis, 496

696 Index

Chloramphenicol, 473, 497, 507 CMR Chloride of lime See Chloroform– extraction (CMR vaccine) See Hypochlorite solution CN (1-Chloroacetophenone), 27, 119, 292, 309–310, 316–321 (Cl), 118, 255–257 Cobalt salts, 281 clinical effects, 256 Cocaine, 292 history, 5, 11, 14–15, 27, 88–93, 95, 119, 248 Coccidioides immitis, 429 long-term health effects, 257 Coccidioidomycosis, 429, 431 physical properties, 255–256 Cochrane, Thomas, 88 treatment, 256–257 Codeine, 628 1-Chloroacetophenone Cold War, 47–64 See CN (1-Chloroacetophenone) binary weapons programs, 65–66, 70–71 2-Chlorobenzaldehyde, 315 biological warfare programs, 50–52, 55, 58–60, 420–422, Chlorobenzene, 201 426, 430, 656 o-Chlorobenzylidene malononitrile detection developments, 53–54, 60–62, 66–67, 70 See CS (o-Chlorobenzylidene malononitrile) nerve agent production and development, 49 Chloroform, 11 offensive chemical agent developments, 49–50, 57–59 Chloroform–methanol extraction (CMR vaccine), 532 protective device developments, 52–53, 60–62, 67, 69–70 (PS), 10, 12, 19, 27, 201 Soviet threat, 54–55 Chlorosulfonic acid Collective protection, 384–386 See Sulfur trioxide–chlorosulfonic acid (FS smoke) developmental, 386 Chlorpromazine, 280, 302 history, 33, 42, 60, 67, 70 Cholecalciferol, 498 medical systems, 384–385 Cholera, 10, 12, 16, 33, 37, 42, 417–419, 462 for military vehicles, 67 nervous system, 132–134 preattack measures, 328 Cholinesterase (ChE), 130–139, 159 Collective protection equipment (CPE) Cholinesterase (ChE) inhibitors, 130–142, 164, 236 M28, 384 See also Nerve agents; Organophosphorus compounds; Colorado beetles, 418 specific agent Combat lifesaver, 327, 339 Chromium, hexavalent (CrVI), 363 Combat medic, 327, 339 Chronic pulmonary disease, 237–238 Combat Service Mask, 41 Churchill, Winston, 14, 125, 418, 427 Combat Support Hospital (CSH), 328 CIA Combat vehicle filtration protection system, 368 See Central Intelligence Agency (CIA) Combat Vehicle Mask, 70, 74 Cigarettes Combined injuries, 340, 347–348 Teflon-contaminated, 265–266 See also Wounds Cigarette smoke ComboPen, 155, 163–165 cyanide content, 273 Committee on Biological Warfare, 427 Cigarette smoking Complementary DNA (cDNA), 569 and toxic inhalational injury, 250 Complement fixation (CF), 531, 573 Cimex lectularius, 487 Compound W Ciprofloxacin, 473 See toxin Civil defense program Conjunctivitis, 98–99, 208, 210, 214–215, 238, 314 and biological warfare, 434–435, 446 Contact lenses World War II, 41 and protective masks, 402–403 Civil disturbances Containment precautions, 430, 432–434 riot control agent use during, 309–310, 313 Contamination Civilian resources of medical equipment and facilities, 124–125, 157, 353, 357 training, 409–410 wound, 124, 347–348, 356 Civil–military relations Continental United States (CONUS), 326, 328 and biological defense program, 434–435 Convention on Prohibition of Bacteriological and Toxin and chemical surety mission, 408–411 Weapons CK See Biological Weapons Convention See chloride (CK) Convulsions, 154–155, 158, 165, 187, 239 Clean Air Act, 412 Copper oxide, 363 Clean treatment area, 331, 333, 335 Coquilletdia, 566 Cleghorn, G., 514 Corneal damage, 210, 238, 317 Clethrionomys glareolus, 594 Corticosteroids, 598 Clindamycin, 473 Corynebacterium diphtheriae, 647 Clinton, William, 455 Cotton lung disease, 659 Clostridium botulinum, 644, 646–647 Cough suppressants, 628 See also Botulinum toxins; Botulism Counterterrorism, 75 Clostridium difficile, 463 Cowpox, 548 Clostridium perfringens, 421 Cows, 417, 459–460, 548 Clostridium tetani, 644, 646–647 Cox, Herald, 525 See also Tetanus toxin Coxiella burnetii, 430, 524–526, 528–529 Clothing decontamination, 358, 408 See also Q fever Cluster of differentiation (CD), 542, 622 Coyotes, 488

697 Medical Aspects of Chemical and Biological Warfare

CP DEPMEDS food poisoning with, 463 See Chemically protected deployable medical system (CP food sources, 273–274 DEPMEDS) history, 5, 119, 273–274, 447 CPE laboratory findings, 278 See Collective protection equipment (CPE) military uses, 273 CPFC nonmilitary uses, 273–274 See Chemical protective footwear cover (CPFC) pharmacokinetics and pharmacodynamics, 276 CPOG poisoning presentation and management, 277–279, 342 See Chemical protective overgarment (CPOG) properties, 272 C protein, 570 prophylactic drugs, 281–282 CPRP toxicity, 276 See Chemical Personnel Reliability Program (CPRP) triage considerations, 342, 344–347 CR (dibenz(b,f)-1:4-oxazepine), 319–320 and wound decontamination, 355–356 Crackles, 251, 343–344 See also specific agent Crick, Francis, 679 , 273 Crimean-Congo hemorrhagic fever (C-CHF), 439, 593–596, (CK), 118, 272–282 599 detection, 380 Crimean War, 11, 13, 88 history, 10, 16, 38, 40, 273–274 Crimes Involving Poisons, 463 properties, 272 CRM-197, 648 toxicity, 276 Cross-neutralization tests, 573–574 Cyanohydrin-forming drugs, 282 Crotocin, 665 Cyanomethemoglobin (CNMetHb), 275, 280 CS (o-Chlorobenzylidene malononitrile), 119, 292, 310–316 Cyclohexyl , 185 cardiovascular effects, 315, 321 Cyclopentolate, 146 chemical structure, 310 Cyclophosphamide, 528 clinical effects, 310–316 Cynomys species, 487 delivery systems, 121 Cyprus, 524 dermatological effects, 312–314, 320–321 Cystathionase, 275 future use, 321 Cytochrome oxidase, 274, 280 gastrointestinal effects, 314–315 Cytokines, 681 history, 5, 310, 313 Cytolysins, 609 metabolic effects, 315 Cytosine arabinoside (Ara-C), 553 mutagenic effects, 315–316 Cytoxan, 237 nations with capability for use, 114 ocular effects, 314, 321 D physical characteristics, 310 DA (diphenylchlorarsine), 319 properties, 309 Dakin’s solution pulmonary effects, 311–312, 321 See Hypochlorite solution severe medical complications from, 317–318 Dalden Corp., 374 tolerance to exposure, 310–311 DANC CSEPP See Decontaminating Agent, Non-Corrosive (DANC) See Chemical Stockpile Emergency Preparedness Program DAS (CSEPP) See 4,15-Diacetoxyscripenol (DAS) CSF examination Davaine, Casimir-Joseph, 10 See Cerebrospinal fluid (CSF) examination da Vinci, Leonardo, 11–12 CSH Davis, Gordon, 525 See Combat Support Hospital (CSH) Davy, Humphry, 10 CSI DC (), 319 See Chemical Surety Inspection (CSI) DDT Ct See Dichlorodiphenyltrichloroethane (DDT) definition, 142, 202, 249–250 Dead-space ventilation, 364 Cuba, 657 Decontaminable litter, 389 Cui-xing-ning, 191 Decontaminating Agent, Non-Corrosive (DANC), 34, 62 Culex taeniopus, 567 Decontaminating Apparatus, 62, 70 Culex tarsalis, 563–564, 566 Decontaminating Solution 2 (DS2), 62, 374, 388 Culiseta melanura, 563, 566, 573 Decontamination, 351–358, 362 Cunningham, Roy, 461 biological agents, 357–358 Curare, 647 casualty, 329, 331–335, 340–341, 352, 386–387, 408–410 CWS certification, 355 See Chemical Warfare Service (CWS) chemical methods, 158, 354–355, 357–358, 363 Cyanate, 276 clothing, 358, 408 Cyanides, 118–119, 271–282 definition, 352, 357 antidotes, 279–282 equipment, 124–125, 353, 357, 387–388 biochemical basis for poisoning, 274–276 eyes, 352–353 and combined injuries, 348, 355 history, 22–24, 33–34, 42, 47, 54, 62, 70, 97–98 and CS-caused deaths, 315 importance, 157, 329 decontamination, 279 and inhalational injury, 252 detection, 380

698 Index

methods, 354–355 of trichothecene mycotoxins, 658, 665–666, 670 nerve agents, 47, 157–158, 168–169, 354–355, 387 of tularemia, 505 by oxidative chlorination, 354–355 of viral hemorrhagic fevers, 595–596 personal (self-), 157, 329–330, 352 Derrick, Edward, 525 personnel, 352, 386–387 , , , 430 personnel requirements for, 335 Detection, 124, 362, 377–383, 683 physical methods, 354, 358, 363–364, 370 aerosol, 383, 448 skin, 157–158, 333, 335, 352–353, 356, 386–387, 408, 669–670 biological agent, 74, 377, 382–384, 431, 447–449 spot, 333, 341, 353 chemical agent, 377–381 surgical instruments, 357 Cold War, 53–54, 60–62, 66–67, 70 time required for, 333, 335, 341 developmental, 381 toxins, 616, 660, 669–670 integrated mobile systems, 381–383 training, 352, 387, 408 and medical management, 329 vapor, 352, 356 point, 377–380 wounds, 352, 355–357, 387 post–World War II, 46 See also specific agent or method preattack measures, 328 Decontamination apparatus/systems, 62, 70, 97–98, 388 1960s, 60–62 Decontamination area, 332–333, 335, 409 1970s, 66–67 Decontamination equipment, 386–389 1980s, 70 Decontamination Kit, Individual Equipment (DKIE) 1990s, 74 M295, 387–388 standoff, 53–54, 74, 380–381, 447–448 Decontamination kits, 158, 335, 353–354, 387–388 toxins, 613 Deer mice, 487–488 World War I, 23 DEET (diethyltoluamide), 191 World War II, 42 Defense Research Establishment, Ottawa, Canada, 658 See also specific detector Defoliants, 119 Detection paper history, 44, 51, 56, 60, 62, 104, 419, 428 M8 Chemical Agent, 335, 355, 357, 377–379 Dehydration M9 Chemical Agent, 378 and protective clothing use, 370–371, 406–407 Detector crayon, 42 Deliriants, 294 Detector kits, 42, 46 See also specific agent M256A1 Chemical Agent, 379–380 Delirium Detector paint, 42, 46 anticholinergic-induced, 296, 298–301 Detector paper, 42, 46, 66–67, 70 Delivery systems, 120–122 Detoxification, 352 biological agents, 121, 420–421, 429, 438–442, 446, 457, 656, Dexamethasone, 670 658–659 Dextromethorphan, 628 and chemical warfare capability, 114, 116 DFA staining and choice of agent, 123 See Direct fluorescent antibody (DFA) staining history, 27, 31, 36–37, 39–40, 51–52, 58–59 DFP vapor, 121–122 See Diisopropyl fluorophosphate (DFP) weather conditions and, 122–123, 125 4,15-Diacetoxyscripenol (DAS), 660–661, 666 See also specific system Diamanus montanus, 487 de Mussis, Gabriel, 416 Dianisidine chlorosulfate, 14 Demustardizing Apparatus, Commercial Type, 33 Diaphragm masks, 33 Dendrochium toxicum, 659 Diarrhea, 212, 216, 314–315 Dengue hemorrhagic fever, 593–596, 598–599 Diatomaceous earth, 353 Deoxynivalenol (DON), 659–661, 668 , 154–155, 165–169, 191, 279, 347 Deoxyribonucleic acid (DNA), 515, 660–662, 679 Dibucaine numbers, 137 alkylation, 203, 239 DIC complementary, 569 See Disseminated intravascular coagulation (DIC) Deoxyribonucleic acid (DNA) viruses, 540–541 Dichlorodiphenyltrichloroethane (DDT), 483 Deoxyribonucleoproteids, 541 Dichloroformoxime Deoxyverrucarol (DOVE)–protein conjugate, 671 See Phosgene (CX) Department of Defense Appropriation Authorization Act, 66– 2,4-Dichlorophenoxyacetic acid (VKA), 44 67 Dicobalt edetate, 279, 281 Department of Defense Biological and Chemical Defense DIDS, 275 Planning Board, 430 Dihydrocodeinone, 628 Depressants, 293 Diisopropyl fluorophosphate (DFP), 132, 152–153, 233, 301 See also specific agent Dilger, Anton, 16 Dermal effects Dilger, Carl, 16 of anthrax, 471–473 , 138 of Lewisite, 219 of mustard, 201–202, 205–210, 214, 217, 238–239, 342–343 See British anti-Lewisite (BAL) of nerve agents, 143–145, 161–162, 167 Dimethylaminopheno (DMAP), 275 of , 221 4-Dimethylaminophenol (4-DMAP), 279–281 of plague, 494–495 Dinitropheno (DNP), 275 of riot control agents, 312–314, 316–317, 320–321 Diphenhydramine, 627, 670 of smallpox, 543–545, 548–550 Diphenylaminearsine

699 Medical Aspects of Chemical and Biological Warfare

See DM (diphenylaminearsine) definition, 326 (DP), 16, 118–119 I: Unit Level, 326–327, 340 Diphtheria toxin, 609, 647–648 II: Division Level, 327–328 Direct fluorescent antibody (DFA) staining, 495–496 III: Corps Level, 328 DISCOM IV: Echelon Above Corps (EAC), 328 See Division Support Command (DISCOM) V: Continental United States (CONUS), 328 Disinfection treatment emphasis at, 327 definition, 357 Ecstasy Disney, Walt, 41, 103 See 3,4-Methylenedioxymethylamphetamine (MDMA) Disseminated intravascular coagulation (DIC), 595–597 Eczema vaccinatum, 549–550 Distilled mustard agent (HD), 38–39, 198–200 ED50 Ditran, 298 See Effective dose (ED50) Diuretics, 253, 259–260 Edema toxin, 470 Division Support Command (DISCOM), 327 Edgewood Arsenal, Maryland, 19, 26, 30, 38–39, 49, 93, 101, DKIE 434, 460, 658 See Decontamination Kit, Individual Equipment (DKIE) EEE DM (diphenylaminearsine), 27, 119, 292, 309, 319 See Eastern equine encephalitis (EEE) 4-DMAP EEG See 4-Dimethylaminophenol (4-DMAP) See Electroencephalography (EEG) DNA Effective dose (ED50), 622 See Deoxyribonucleic acid (DNA) Eglin Air Force Base, Florida, 429 DON Egypt, 56, 104, 200, 418–419, 657 See Deoxynivalenol (DON) Ehrlich, Paul, 632 Dopamine, 132, 598 Electrocardiography (ECG), 156, 165–166 Doughty, John W., 11, 14, 88–89 Electroencephalography (EEG), 153, 235–236 Doxycycline, 473, 497–498, 518 Electron transport system (ETS), 275 DR1 emulsion, 33 ELISAs Drinking tubes, 60, 366–370 See Enzyme-linked immunosorbent assays (ELISAs) Drones Ember, L. R., 657 for agent delivery, 59 Emergency medical treatment (EMT) station, 331–335 Dry heat decontamination, 358 Emetics Dryvax, 551 See Nausea-producing agents; specific agent; Vomiting DS2 agents See Decontaminating Solution 2 (DS2) Emetine, 671 D-Stoff Encephalitis See Phosgene (CG) equine, 562–579 Dugout blanket, 22 lethality, 444 , Utah, 427, 429, 432, 457 postvaccinial, 549–550 Dugway sheep-kill incident, 62, 432 Encephalomyelitis Du Pont Advanced Fiber Systems, 373, 638 nonviral causes, 576 Du Pont Company, 33, 38 viral causes, 575 Du Pont Multi-Source Products, 302 Encephalomyelitis viruses Du Pont Polymers, 264, 617, 638 See Viral encephalitides; specific virus Dusts Endocarditis definition, 248 brucella, 517–518 Dutch Powder, 353 Q fever, 528, 530 Dyer, Rolla, 525 Endocrine system Dynamite, 89 effects of cyanides on, 277 Dysentery, 12, 42, 417–418 Endothelial-derived relaxing factor (EDRF), 275 Dyspnea Enterocolitis, 625–626 nerve agent–induced, 145, 147–149, 158, 167–168, 170 Entry point, 331–332 in toxic inhalational injury, 252, 255–256, 258–261, 265 Environmental concerns with sea dumping, 62–64 E Environmental conditions EAC and agent delivery, 122–123 See Echelon Above Corps (EAC) Environmental samples Eastern equine encephalitis (EEE), 570–574, 576–579 for toxin exposure diagnosis, 614, 617, 627, 668 Eastern equine encephalitis (EEE) virus, 562–564 Enzootics PE-6 strain vaccine, 579 definition, 480 Eastern equine encephalitis (EEE) virus complex, 564–566 genetic drift, 567–568 Ebola hemorrhagic fever, 432, 434–435, 439, 593–596 and plague, 487 Ebola viruses, 594 and viral encephalitides, 564, 567–568, 572 Ebola–Zaire strain, 594 Enzyme-linked immunosorbent assays (ELISAs) ECG in biological agent diagnosis, 448–449 See Electrocardiography (ECG) in toxin exposure diagnosis, 617 Echelon Above Corps (EAC), 328 See also specific agent diagnosis Echelons of care Epileptogenic substances, 292 Epinephrine

700 Index

See Adrenaline for chemical casualties, 329–332 Epiphytotics, 460 Fiske, Norman E., 34–35 Epizootics Fitness evaluations definition, 480 for Chemical Personnel Reliability Program, 402–403 genetic drift, 567–568 Flaccid paralysis, 149 and plague, 487, 491 Flame warfare agents, 90, 119 and viral encephalitides, 564, 567–568, 571–572 Flannel hoods, 91 Epoxide group, 656 Flaviviridae, 575, 592–594 Equine encephalitis, 562–579 Flavonoids, 671 Equipment decontamination, 124–125, 353, 357, 387–388 Fleas Erythema multiforme, 549 as bacterial agent vector, 33, 380, 482–489, 498 Erythrocyte cholinesterase (RBC-ChE), 132, 136–137 Flechettes, 439–440, 442 baseline and periodic measurements, 404–405 Flettner rotor, 441–442 inhibition, 138–139 FLOT as nerve agent pretreatment, 192 See Forward line of troops (FLOT) Erythromycin, 473, 507, 531 Flour , 609, 633, 682 decontamination with, 353–354 Eserine Fluoroquinolones, 507, 531 See FM Ethiopia, 34–35, 102, 200 See Titanium tetrachloride (FM) , 12–13, 308 FMC Ethylenediaminetetraacetic acid (EDTA) See Field medical card (FMC) cobalt salt, 279, 281 Food and Drug Administration (FDA), 188, 463 Ethyl iodoacetate, 13 Food Machinery and Chemical Company, 49 Evacuation categories, 340 Food poisoning, 463, 622, 644, 646, 649, 659 Evans, A. C., 514 Food supply contamination, 442, 446–447, 459, 469 Executive Order 11850, 308 Foot-and-mouth disease, 51, 460 Exertion Ford, Gerald R., 64, 308 and mask use, 365 Foreign material and toxic inhalational injury, 254–255 in wounds, 356 Explosive-release devices, 120–122 Formulation, 122 Export controls 2-Formyl-1-methylpyridinium chloride and chemical manufacturing, 116–117 See 2- chloride (2-PAM Cl) Eye decontamination, 352–353 Fort Detrick, Maryland, 43–44, 426–432, 434, 460, 616, 623– Eye irrigation 624, 651 for mustard injuries, 98 Fort Morgan virus, 566 Eye pain, 147, 166–167, 215 Forward line of troops (FLOT), 326 Eyes Forward Support Medical Company (FSMC), 329 protection from toxins, 612 Foster, John S., 431 See also under Ocular Fourier Transform Infrared (FTIR) spectrometer, 380 Fowl pest, 460 F Fox, Leon A., 31–32, 426 FOX Nuclear, Biological, Chemical Reconnaissance System Faceblank, 364 (NBCRS), 74, 377, 381–383 Fasciculations, 149, 168–170 France FDA biological warfare programs, 32 See Food and Drug Administration (FDA) chemical warfare programs, 114 FDECU See also World War I; World War II See Field deployable environmental control unit (FDECU) Francis, Edward, 504 Feather bombs, 51 Francisella tularensis, 383, 429, 504, 506–507 Federal Emergency Management Agency (FEMA), 411–412 See also Tularemia Federal Security Agency, 426 Freeze drying, 440–441 FH French and Indian War, 416 See Field Hospital (FH) Fries, Amos A., 18, 25–26, 28, 95 Field deployable environmental control unit (FDECU), 385 FSMC Field Hospital (FH), 328 See Forward Support Medical Company (FSMC) Field management FS smoke of chemical casualties, 325–336 See Sulfur trioxide-chlorosulfonic acid (FS smoke) Field manuals FTIR spectrometer for chemical surety inspection, 400 See Fourier Transform Infrared (FTIR) spectrometer Field Masks, 74 Fugu toxin Field medical card (FMC), 333, 335 See Field mouse, 592, 594 Fuller, J.F.C., 35 Fildes, Paul, 645 Fuller’s earth, 353 Filoviridae, 592–594 Fumes Filter mask layer, 364–368, 370 definition, 248 Finlay, Carlos, 10 Fumonisins, 656 First aid Fungal toxins, 609–610, 656

701 Medical Aspects of Chemical and Biological Warfare

See also specific toxin protective, 373–375 Fusarenon-X rubber/surgical, 356–357 See Monoacetylnivalenol Glucocorticosteroids, 670 Fusarium, 656, 658–659, 668 Glucose-6-phosphate, 203 Fusarium nivale, 659 (GSH), 203–204 Fusarium semitectum var semitectum, 658 Glycolates, 295–296, 298 See also specific agent G Glycoprotein synthesis, 570 Goats, 528 GA Goebbels, Joseph, 418 See (GA) Gorbachev, Mikhail, 453, 455 D-Galactose, 639 Grains g-Aminobutyric acid (GABA), 132 moldy, 659 Gangliosides, 648 See also Antiplant weapons; specific grain Gases Greek fire, 88 airway distribution, 248–249 Green cross definition, 248 See Phosgene (CG) historical war, 255–260 Green vinyl overboot (GVO), 374 See also specific gas Grenades “Gas Fright,” 95, 97, 343, 393 hydrocyanic acid, 40–42 Gas gangrene, 417 smoke, 262 Gas–liquid chromatography (GLC), 668–669 , 90 Gas mask phobia, 393–395 Ground crew personal protective equipment, 365–368 Gastrointestinal disturbances Ground squirrels, 487–488, 504 anthrax-induced, 472–473 Gruinard Island, Scotland, 418, 441 CS-induced, 314–315 GSH mustard-induced, 212, 216 See Glutathione (GSH) nerve agent–induced, 145, 168 Guanarito virus, 593 staphylococcal enterotoxin–induced, 622–627 Guanine, 239 See also Diarrhea; Nausea; Vomiting Guarnieri bodies, 546 Gas Warfare Service, 95 Gulf War syndrome, xvi, 73, 105, 190, 191, 195, 297 See also Chemical Warfare Service (CWS); Chemical Corps GVO Gates, Robert, 456–457 See Green vinyl overboot (GVO) GB See (GB) H GD See (GD) H Gel diffusion test, 546 See Impure mustard agent (H) General Hospital (GH), 328 Haber, Fritz, 14, 25, 89–91 General Ordnance Equipment Corp., 310 Haber’s law, 276 Genetic engineering, 452, 454, 680 Ha bomb, 33 Genetic recombination, 681 Haemophilus ducreyi, 496 Genetic weaponry, 682 Haffkine, Waldemar M. W., 498 Geneva Protocol Hague Convention of 1899, 89–90 history, 29, 34, 57, 64, 67, 69, 290, 427 Hague Peace Conferences, 13 and riot control agents, 308, 321 Haig, Alexander M., 68 and status of chemical proliferation, 114, 679 Haloperidol, 293 Genitourinary tract infection, 517 Hantaan virus, 593–594, 599 Gentamicin, 473, 497, 507 Hantavirus disease, 594, 598 Germany Hantaviruses, 593–596 biological warfare programs, 16, 32, 36–37, 418, 426, 459, Hantavirus pulmonary syndrome (HPS), 594–595 644 Harassing agents chemical warfare programs, 5, 14–15, 89, 130–131 See Riot control agents; specific agent post–World War II weapons disposal, 46 Harmine, 293 viral hemorrhagic fever outbreak, 594 Hart, B. H. Liddell, 35 See also World War I; World War II Haslett, Lewis P., 13 GF, 119, 130–131, 230 HC aging half-time, 183 See Hexachloroethane (HC); Zinc oxide (HC) decontamination, 354 HD Iraqi production, 185–186 See Distilled mustard agent (HD) and pretreatment, 185–186 Healthcare GH and biological warfare, 445, 447, 683–684 See General Hospital (GH) and chemical surety mission, 397–412 Gilchrist, Harry L., 93, 96–98 and chemical warfare, 111–126, 328–335, 683–684 , 10, 16, 427, 431, 459 Health education GLC for chemical workers, 407–408 See Gas–liquid chromatography (GLC) Health service support (HSS), 326–328 Gloves Heart block

702 Index

atrial–ventricular (A–V), 156 protective equipment for, 31, 91 Heart rate vaccination, 568, 576, 578 effects of CS on, 315 Hospitals effects of cyanides on, 277 Chemically Hardened Air Transportable (CHATH), 385 effects of nerve agents on, 156–157 combat support, 328 in toxic inhalational injury, 253 Echelon V (CONUS and ZOI), 328 Heat categories field, 328 and work/rest cycles, 329–330, 371, 403, 405 general, 328 Heat stress mobile surgical, 328 and protective gear, 125, 329–330, 367, 370–371, 394, 403, personnel needs, 331 405–407 Hotline Helminthosporium oryzae van Brede de Haan, 460 in casualty-receiving area, 331–333, 335, 340, 410 Hemagglutination assays, 497, 507, 517–518, 531 HPLC-MS Hemagglutination-inhibition (HI) tests, 566, 573 See High-performance liquid chromatography–mass Hemodialysis, 217 spectrometry (HPLC-MS) Hemolysins, 609 HPS Hemopoietic changes See Hantavirus pulmonary syndrome (HPS) mustard-induced, 215–217 HS Hemorrhagic fevers See Mustard (HS) See also Viral hemorrhagic fevers; specific virus HSS Hemorrhagic fever with renal syndrome (HFRS), 593–595, See Health service support (HSS) 597, 599 HTH solution Hemorrhagic meningitis, 471 See Hypochlorite solution Henbane, 294 HT-2 toxin, 660–661, 664, 666 HEPA filters Hughes, M. L., 514 See High-efficiency particulate air (HEPA) filters HUGO , 217, 597 See Human Genome Organization (HUGO) Hepatitis, 517 Human Genome Organization (HUGO), 682 Hepatitis A virus, 418 Human Genome Project, 682 Herbicides, 460 Human immune globulin preparations, 434 Herpesviridae, 575 Human immunodeficiency virus (HIV) infection, 550, 552 Hexachloroethane (HC), 27, 260 Humoral immunity, 505, 528, 542, 551, 683 Hexamethamine tetramine, 260 Hun Stoffe (Germany stuff) Hexamethyltetramine, 363 See Mustard (HS) Hexose monophosphate shunt, 203 Hussein, Saddam, 72–74, 113, 416, 421, 679 Heydrich, Reinhard, assassination of, 645 Hussein Kamal Hussein, 421 HFRS Hydrocodone, 628 See Hemorrhagic fever with renal syndrome (HFRS) Hydrogen cyanide (AC), 118, 272–282 High-efficiency particulate air (HEPA) filters, 430, 432, 434 detection, 380 Highlands J (HJ) virus, 566–567, 574 history, 10, 16, 37–38, 40–42, 104, 273–274 High-mobility, multipurpose, wheeled vehicle (HMMWV), physical properties, 122–123 382–385 properties, 272 High-performance liquid chromatography–mass spectrometry toxicity, 141, 276 (HPLC-MS), 669 Hydrolysis, 121, 354–355, 387 Hill, Edwin, 427 Hydroxamine, 162 Hinsch, Frederick, 16 Hydroxide HI tests dilute, 158 See Hemagglutination-inhibition (HI) tests (vitamin B12a), 279, 281 Hitler, Adolph, 103 Hyoscine HJ virus See Scopolamine See Highlands J (HJ) virus Hyoscyamine HL, 119 See Atropine sulfate HMMWV Hyoscyamus falezlez, 290 See High-mobility, multipurpose, wheeled vehicle Hypertension (HMMWV) pralidoxime chloride–induced, 163–164, 170 Hmong, 3, 67–68, 656–658 Hypochlorite solution, 352–358, 387, 408 HN-1/HN-2/HN-3 contraindications, 314, 353, 356, 358 See mustard for nerve agent decontamination, 158, 341 Hoffman, Theodore A., 12–13 preparation, 358 Hog cholera, 460 for riot control agent decontamination, 314 Homatropine, 147, 166–167, 215 spot decontamination with, 333, 335 Honest John rocket, 59 for toxin decontamination, 616, 660, 669 Hoods for vesicant decontamination, 214 M6A2, 366 World War I use, 22–23 Hoplopsyllus anomalus, 487 “Hypo helmet,” 363 Horses Hypotension, 170, 598 biological warfare involving, 417, 459 Hypoxia encephalitis viruses, 562–579 and inhalational injury, 252, 257

703 Medical Aspects of Chemical and Biological Warfare

I Influenza viruses, 680–681 Information-Telegraph Agency of Russia–Telegraph Agency Ibogaine, 293 of Soviet Union (ITAR-TASS), 455 ICAM Inhalational injury, 123, 247–267 See Improved Chemical agent monitor (ICAM) biological agents, 440 ICN Pharmaceuticals, 132 clinical effects, 249, 253 Idoxuridine, 550 and condition of exposed tissues, 250 IFA staining evaluation, 250–252 See Indirect fluorescent antibody (IFA) staining exertion and, 254–255 Ig and intensity of exposure, 249–250 See Immunoglobulin (Ig) laboratory measurements, 251–252 I. G. Farbenindustrie, 130 nerve agent–induced, 139–144, 157, 161, 167 IL-6 patient history, 250–251 See Interleukin-6 (IL-6) physical aspects, 248–249, 251 IMA physiology, 249–250 See Installation Medical Authority (IMA) pulmonary effects, 253, 256, 258–259, 265–266, 343 Imipenem, 473 therapeutic considerations, 252–253, 255 Immune response, 681, 683 See also specific agent to brucellosis, 515–516 Injectors to Q fever, 528 atropine, 54, 73, 155, 159–161, 169 to smallpox, 542, 551 diazepam, 165 to staphylococcal enterotoxins, 622–623 2-pralidoxime chloride (2-PAM Cl), 73, 155, 163, 169 to tularemia, 505 Insecticides to viral encephalitides, 573, 576–577 and plague prevention, 498 Immunization, 681–683 See also Organophosphorus compounds; Carbamates; against anthrax, 473–474 specific agent against botulinum toxins, 651 Insects against plague, 498 as bacterial agent vectors, 33, 50 against Q fever, 531–532 See also specific insect or agent against smallpox, 540, 546–551 Installation Medical Authority (IMA), 402–404, 406–407, 409 against staphylococcal enterotoxin B, 628 Installation Response Force (IRF), 410 against toxins, 615, 618–619 Institute of Especially Pure Biopreparations, 454–455 against trichothecene mycotoxins, 671 Integrated mobile systems, 381–383 against viral encephalitides, 564, 576–579 Interferon-alpha (IFN-a ), 599 against viral hemorrhagic fevers, 599 Interferon-gamma (IFN-g), 505, 516, 599 See also Vaccines Interleukin-6 (IL-6), 471 Immunoglobulin (Ig), 434, 516 Intermediate syndrome, 232–233 Immunology, 632, 681–683 International Declaration Concerning the Laws and Customs Immunotoxins, 632 of War, 13 Imperial Chemicals, Ltd., 49 Iran Improved Chemical agent monitor (ICAM), 378–379 biological warfare program, 679 Impure mustard agent (H), 199–200 Iran–Iraq War, 68–69, 321, 362 Incapacitating agents, 118–119, 287–302 chemical casualties death rate, 6 biological, 292, 431, 439–440 cyanide use during, 273 chemical, 292 mustard use during, 3–4, 104, 114, 116–117, 157, 198, 200– and combined injuries, 348 201, 205, 214–216, 230, 237–239 delivery systems, 121 nerve agent use during, 104, 114, 116–117, 122–123, 230, differential diagnosis, 297–298 290 historical precedents, 52, 57, 289–290 Iraq ideal, criteria for, 288–289 biological warfare program, 421–422, 462–463, 657, 679 medical management, 298–302 chemical warfare capability, 114–115, 117, 185–186 nonchemical, 291–292 Iraqi Kurds, 4, 69, 74, 104, 273, 679 toxin, 608, 622 IRF triage considerations, 344, 346 See Installation Response Force (IRF) use, 289–291 Irrigation solutions, 353, 357 See also specific agent Irritants Incapacitation See Riot control agents; specific agent definition, 288 Ishii, Shiro, 32–33, 483 possible approaches to, 291–294 Isolation procedures, 432–433, 497, 547, 598 Incineration Isolators Ltd., 432 of surplus chemical weapons, 72, 411–412 Israel, 190, 608 Indirect fluorescent antibody (IFA) staining, 531 Italian–Ethiopian War, 34–35, 102, 200 Individual Equipment Decontamination Kit, 70 ITAR-TASS Indoles, 297–298, 302 See Information-Telegraph Agency of Russia–Telegraph Industrial accidents, 119 Agency of Soviet Union (ITAR-TASS) Industrial hygienist, 399, 402 Ivanovskii Institute (Moscow), 562 Infant botulism, 644, 646

704 Index

J Lane, Benjamin I., 13 Laos, 3, 67–68, 421, 656–658, 665 JACADS Laser detection systems, 380 See Chemical Agent Destruction System , 592–593, 595, 598–599 (JACADS) Lassa virus, 592 Japan LCt50, 142, 183, 606 biological warfare programs, 32, 36–37, 417–418, 426–427, LD50, 142, 183, 606 446, 483–485, 540 LDS chemical warfare programs, 37 See Lightweight Decontamination System (LDS) Imperial Unit 100, 418 Le 100 Imperial Unit 731, 417–418, 427, 483, 540 See Tabun (GA) invasion of China, 35–36, 200, 218, 417–418, 485 League of Nations, 28–29, 34 sarin incidents in, 4, 75, 113, 118, 131, 169, 274, 342, 438, Lederle Laboratories, 191 463, 678 Legionella, 525 Jenner, Edward, 548 Legionnaire’s disease, 434 Jerks, 149, 158, 168–169 Leporipoxvirus, 542 Jimson weed, 294 Lethal factor, 470 Johnston Atoll, 64, 72, 411 Leukocytosis, 635 Johnston Atoll Chemical Agent Destruction System Leukopenia, 215–217, 667 (JACADS), 72, 411 Lewis, W. Lee, 19 Joint disease, 517 Lewisite (L), 118–119, 218–220 Joint Service Lightweight Integrated Suit Technology antidote, 102, 218, 220 (JSLIST), 375–376 biochemical mechanisms of injury, 218 Aviation Overgarment (AVOG), 375–376 chemical structure, 218 Duty Uniform (DU), 375–376 clinical effects, 218–219 Improved Chemical and Biological Protective Glove delivery systems, 121 (ICBPG), 376–377 dermatological effects, 219 Multipurpose Overboot (MULO), 377 detection, 42, 380–381 Overgarment (OG), 375–376 differential diagnosis, 200, 212, 219–220 Vapor-Protective, Flame-Resistant Undergarment history, 19, 36–38, 40, 46, 102, 198 (VPFRU), 375–377 laboratory tests, 220 Joint United States/United Kingdom/Russia Trilateral long-term health effects, 217, 220 Statement on Biological Weapons, 4 military use, 218 Junin virus, 592–593, 599 mixed with mustard, 201, 218 nations with capability for use, 114, 116 K ocular effects, 219 K-agents, 52 pharmacology, 199 Kampuchea, 3, 67–68, 421, 656, 666 physical properties, 122–123, 218 Kawasaki disease, 623, 628 pulmonary effects, 219 Kelocyanor, 281 toxicity, 218 Keratitis treatment, 220 vaccinia, 550 vapor, 218–219 Keratopathy Lewisite shock, 219 delayed, 238 Libya, 4, 69, 74, 321, 524 a -Ketoglutaric acid, 282 Lice, 487 Kevlar, 373, 638 Light reduction, 145–146 Khmer Rouge, 656, 666 Light sources, high intensity Kitchener, Field Marshal Lord, 13 incapacitation by means of, 291–292 Koch, Robert, 10, 468, 470 Lightweight Decontamination System (LDS) Kops Tissot Monro (KTM) mask, 22, 28, 92 M17, 388 Korea, North, 461–462, 679 Eli Lilly and Company, 280 Korean hemorrhagic fever, 594 Lilly Cyanide Antidote Kit, 280–281 , 47–48, 104, 394, 418–419, 429, 485, 594 Limitation of Arms Conference, 29 Kostov, Vladimir, 420–421 Line source Kuhn, Richard, 131 for aerosol delivery, 441–442 Kuntsevich, Anatoly, 453, 455 Lipid peroxidation, 204 Kyasanur Forest disease, 593–594 Lipopolysaccharide (LPS), 504, 515, 526, 528 Liston, W. G., 486 L Litter decontaminable, 389 L Litter decontamination station, 332–333, 410 See Lewisite (L) Litter-patient airlock LAC in chemical shelter, 385 See Operation Large Area Coverage (LAC) Little John rocket, 59 Lacrimators, 292, 308 Livens projector, 20–21, 31, 91 See also specific agent Live vaccine strain (LVS), 507 Lactic acidosis, 279 Loco weed, 294 Laetrile, 274 Loffler, F., 10

705 Medical Aspects of Chemical and Biological Warfare

LOPAIR ( long-path infrared) alarm, 53–54 function testing, 365–366, 403 Lorazepam, 302 for horses, 31, 91 LOST microphones in, 364, 366, 368–370 See Mustard (HS) M45 protective, 365 Lott, Joseph, 11 M1 Service, 28, 33 LPS M2 Service, 40 See Lipopolysaccharide (LPS) and nerve agent exposure, 157 LVS post–World War II, 46–47 See Live vaccine strain (LVS) psychological effects of wearing, 393–395 Lymphogranuloma venereum, 495–496 quality assurance concerns, 94 Lymphoid changes, 471, 495, 505–506, 571, 625 1920s, 28, 101 D-Lysergic acid diethylamide (LSD), 52, 293, 302 1930s, 33, 101 1960s, 60, 105 M 1980s, 69–70 1990s, 74 MacArthur, Douglas, 29 and toxin protection, 612, 669 training, 393–395 See CN (1-Chloroacetophenone) winterization kits, 366 Machupo virus, 593 work of breathing added by use of, 365 Macrocyclics, 660 World War I, 15–18, 22, 91–94, 363–364, 393 Macromolecules, 192 World War II, 37, 40–41, 43, 103, 365, 394 Macrophages, 515–516, 528 Mask-to-mouth resuscitator, 54 Mafenide acetate, 214 Mass casualty biological (toxin) weapon (MCBW), 605–606, Magnesium sulfate, 670 611 Mahan, Alfred T., 13 Mass hysteria, 124 Major, John, 455 Mass spectrometry (MS), 669 Major histocompatibility complex (MHC), 505, 622–623 Mastomys natilensis, 592 Malaria, 32, 418, 596–597 MAT , 132, 138 See Medical Augmentation Team (MAT) Malononitrile, 315 Material Manchuria, 418, 427, 483, 594 biological agents directed against, 459, 461 Mandrake root, 289 M256A1 ticket, 355 Manning, Van H., 17 Maximum credible event (MCE), 409 Marboran Mayan, Thayer, 89 See Methisazone Mayaro virus, 562 Marburg hemorrhagic fever, 439, 593–596 MCAT Marburg virus, 594–595 See Medical Chemical Advisory Team (MCAT) March, Peyton C., 25 McAuliffe, Anthony C., 47 Marijuana intoxication, 298 McBride, Lewis M., 27 Marine toxins, 609 MCBW See also specific toxin See Mass Casualty Biological (Toxin) Weapon (MCBW) MARK I kits, 252 McCarthy, Richard D., 431 atropine therapy, 161–162 McCoy, G. W., 504 and combined injuries, 347 MCE Persian Gulf War use, 73, 155 See Maximum credible event (MCE) pralidoxime chloride therapy, 164–170 McNamara, Robert S., 55 self-administration, 329–330, 341 McNeill Consumer Products Co., 274 Markov, Georgi, 420–421, 632 MD Marmots, 481–482, 488 See Methyldifluorarsine (MD) Marshall, John D., 483 MDMA Marston, J. A., 514 See 3,4-Methylenedioxymethylamphetamine (MDMA) MASH Meade, John, 34–35 See Mobile Army Surgical Hospital (MASH) MED , 295–296 Mask-Only Command, 371–372 50 MEDCEN Masks, 123, 362–370 See Medical Center (MEDCEN) Chemical–Biological: Aircraft, M43, 369 MEDDAC Chemical–Biological: Aircrew MBU-19/P, 369–370 See Medical Department Activity (MEDDAC) Chemical–Biological: Field, M40, 363–364, 366–368 Mediastinitis, 471–473 Chemical–Biological: Field, M42, 368 Medical Aspects of Chemical Warfare (Vedder), 102 Chemical–Biological: Field, M17A2, 363, 366–367 Medical assistance Chemical–Biological: MCU-2/P, 368 procedures for requesting, 407–408 Cold War, 53–54, 105 Medical Augmentation Team (MAT), 410 and contact lenses, 402–403 Medical Biological Defense Research Program, 615 design, 364–365 Medical care developmental, 370 levels of, 410 discipline in use, 94, 124, 393 safe environment for, 71, 124–125 drinking tubes in, 60, 366–370 Medical Center (MEDCEN), 398 early, 12–13 Medical Chemical Advisory Team (MCAT), 411

706 Index

Medical Collective Protection Systems, 384–385 Microphones Medical defense in masks, 364, 366, 368–370 history, 87–105 Microwave bombardment Medical Department Activity (MEDDAC), 398 incapacitation by means of, 291 Medical directives Midazolam, 154, 191 for chemical surety inspection, 401 Middelburg virus, 565 Medical Management of Chemical Casualties Course, 398, 409 Militarily significant weapon Medical Management of Chemical Casualties Handbook, 401 definition, 604 Medical record card, 333, 335 Military healthcare providers Medical Reengineering Initiative (MRI), 328 biological warfare threat and, 6, 445, 447, 683–684 Medical research chemical warfare threat and, 6, 111–126, 328–335, 683–684 on human volunteers, 52, 60–61 detection capability, 124 Medical Response Team (MRT), 410 safety from chemical contamination, 125, 157 Medical support Military installations in biological warfare environment, 445, 447, 683–684 plague on, 483–484 in chemical warfare environment, 111–126, 328–335, 683– Military medical facilities 684 contamination, 124–125, 157, 353, 357 Medical surveillance Military occupation specialty (MOS), 327 for chemical workers, 402–405 Military vehicles definition, 402 collective protection for, 67 Medical treatment facility (MTF), 328, 409 Mines, 31, 52, 58, 123 casualty-receiving area, 331–335 Minnesota Multiphasic Personality Inventory (MMPI), 311 contamination, 124–125, 353, 357 Minnesota Patriots Council, 463–464 Mediterranean fruit fly, 461 Miosis Melanoconion, 564, 567 nerve agent–induced, 144–147, 166–168, 170 , 431 Missile-control vans Membrane-damaging toxins collective protection for, 67 mechanism of action, 609, 611 Missiles, 120, 446 See also specific toxin Mission-oriented protective posture (MOPP) gear, 101, 123– Memorandum on Gas Poisoning in Warfare with Notes on its 125, 169–170, 362, 371 Pathology and Treatment (U.S. Army War College), 23–24 exchange procedure, 331, 334 Memorandums of Agreement (MOAs), 401, 408–409, 411 and heat stress, 125, 329–330, 367, 370–371, 394, 403, 405– Meningitic plague, 491, 494 407 Meningitis level of efficiency in, 329, 362 anthrax-induced, 471–473 and medical personnel, 329, 331–332, 334, 338, 340–341 hemorrhagic, 471 postattack measures, 329 Meningococcal infection, 417 preattack measures, 328 Meningoencephalitic syndrome, 574 psychological effects of wearing, 362, 393–395 Meningoencephalitis, 517 removal of, 333, 335, 355, 386, 669 Menthol, 670 training, 393–395 Mercaptopyruvate sulfurtransferase, 275 Mission-oriented protective posture (MOPP) levels, 328, 372 3-Mercaptopyruvate sulfurtransferase, 276 Mist Merck, George W., 43, 426–427 definition, 248 Merck Company, 43, 198 MK 4 suit, 123 Mescaline, 52 MLRS Metabolic disturbances, 277, 315 See Multiple Launch Rocket System (MLRS) Binary Metals Chemical Warhead contamination with biological agents, 459, 461 MOAs Methanesulfonate salt of pralidoxime (P2S), 163 See Memorandums of Agreement (MOAs) Methemoglobin, 275, 280 Mobile Army Surgical Hospital (MASH), 328 Methemoglobin-forming drugs, 280–282 Mobile decontamination facilities See also specific drug World War I, 97–98 Methisazone, 552 Molasses residuum, 37 Methyldifluorarsine (MD), 27 Molds, 656, 659 3,4-Methylenedioxymethylamphetamine (MDMA), 293 Molluscipoxvirus, 542 Methylisocyanate, 119 Monkeypox virus, 542, 547, 551 Methylthiazolidine-4-carboxylate, 670 Monoacetylnivalenol, 659 Metoclopramide, 670 Monoclonal antibodies Metrazole, 292 as nerve agent pretreatment, 192 , 138 in toxin prophylaxis, 615, 651, 671, 682–683 Meyer, Karl F., 498 MOPP Meyer, Victor, 10, 198 See Mission-oriented protective posture (MOPP) MHC gear,Mission-oriented protective See Major histocompatibility complex (MHC) posture (MOPP) levels Mice, 487–488, 592, 594 MOPP Ready, 371–372 Michigan Department of Public Health, 473 Morocco, 102 Mickey Mouse gas mask, 41, 103 Morphine, 293 Microcystin, 609, 611, 616–617 Mortars, 21, 27, 31, 39, 48

707 Medical Aspects of Chemical and Biological Warfare

MOS 210, 212–214, 216, 237–238, 393 See Military occupation specialty (MOS) and wound decontamination, 355–356 Mosquito, 418, 430 Mustard burns, 98–100, 202, 205–208, 214, 238, 342–343 as viral encephalitides vector, 562–564, 566–568, 573, 577 Mustard shell, 40 as viral hemorrhagic fever vector, 593–594, 596 Mustargen, 198 as vector, 50 Mutagenesis, 239, 315–316 Most probable event (MPE), 409–410 Mutual aid agreements Mouth-to-mouth ventilation, 159 for chemical surety inspection, 401 MRI Mycotoxicosis, 659, 670 See Medical Reengineering Initiative (MRI) Mycotoxins, 656 MRT See also Trichothecene mycotoxins; specific toxin See Medical Response Team (MRT) Myrotecium, 656 MS Myrothecium verrucaria, 659 See Mass spectrometry (MS) M9 tape, 355, 357 N MTF NAD+ (nicotinamide adenine dinucleotide), 203 See Medical treatment facility (MTF) Nairovirus, 593 Mucoid plugs, 148, 158 , 302, 670 Multiple Launch Rocket System (MLRS) Binary Chemical , 119 Warhead, 71 NAPP (nerve agent pyridostigmine pretreatment) Muscarine (mAChR), 132–133 See Pyridostigmine bromide Muscular system NAPPS effects of nerve agents on, 145, 149, 232 See Nerve agent pyridostigmine pretreatment set (NAPPS) Mussolini, Benito, 34 Narcan Mustard (H) See Naloxone impure, 199–200 Nasal effects Mustard (HD) of nerve agents, 145, 147, 167–168, 170 distilled, 38–39, 198–200 Nasal mucosal swabs Mustard (HS), 118–119, 198–217, 230–231 for toxin exposure diagnosis, 614, 617, 627, 638, 650 biochemical mechanisms of injury, 202–204 National Academy of Science, 43, 217, 220, 426 carcinogenic effects, 217, 237–238 National Research Council (NRC), 17, 43, 426 cardiovascular effects, 217 National Security Memoranda central nervous system effects, 212, 239 on use of biological weapons, 426, 431 clinical effects, 204–212, 342–343 NATO and combined injuries, 347–348, 355–356 See North Atlantic Treaty Organization (NATO) deaths related to, 205, 212 Natural killer (NK) cells, 505, 516, 528 decontamination, 22–24, 33–34, 54, 157–158, 213, 354–355, Nausea, 145, 168, 212, 216, 314–315 387 Nausea-producing agents, 292 dermatological effects, 98–100, 201–202, 205–210, 214, 217, See also specific agent; Vomiting agents 238–239, 342–343 NBC officer detection, 42, 66, 378, 380–381 See Nuclear, biological, and chemical (NBC) officer differential diagnosis, 200, 212–213, 219–220, 343 NBC-PC exposure categories, 213–214 See Nuclear, biological, chemical protective covers (NBC- gastrointestinal effects, 212, 216 PC) history, 5, 10, 27, 29–31, 34–40, 46, 56–57, 62–63, 102–104, NBCRS 198 See FOX Nuclear, Biological, Chemical Reconnaissance inhalation, 100 System (NBCRS) laboratory test for, 213 NBC Warning and Reporting System, 448 long-term health effects, 97–101, 217, 230, 236–239 Nduma virus, 565 , 204 Nebelwerfer launcher, 36 military use, 200–201 Neoprene masks, 41 mixed with Lewisite, 201, 218 Neosporin, 214 mutagenic effects, 239 , 132, 298 nations with capability for use, 114–116 Nernst, Walther, 14, 91 neuropsychiatric effects, 239 Nerve agent pretreatments, 132, 134, 181–193 ocular effects, 202, 208–211, 214–215, 238 biotechnological, 192–193 pharmacology, 199 and cardiopulmonary response, 156 physical properties, 122–123, 199, 201 centrally acting, 191–192 pulmonary effects, 211–212, 215–217, 237–238 and central nervous system effects, 154, 187 recent use, 3–4, 69, 198, 200–201, 205, 214–216, 230, 237–239 oxime, 164 reproductive toxicity, 239 and pulmonary response, 149 teratogenic effects, 239 See also Pyridostigmine; specific agent thickened, 356 Nerve agent pyridostigmine pretreatment set (NAPPS), 189 toxicity, 201–202, 276 Nerve agents, 118–119, 129–171, 230 treatment, 213–217 aging, 162, 182–183, 230 triage considerations, 342–343 antidotes, 158–159, 329 vapor, 201–202, 237 binary weapons, 65–66, 70–72, 75, 104 World War I use, 16, 19–24, 95–101, 119, 198, 200–201, 205,

708 Index

and blood cholinesterase activity, 138–139 Nightshade, 289, 294 cardiovascular effects, 145, 155–157, 165–166, 169 NIKE missile-control vans, 60 central nervous system effects, 145, 149–155, 170, 233–234 “Nine Mile Agent,” 525 and combined injuries, 347, 355–356 , 263 versus commonly used cholinesterase inhibitors, 139 , 280–281 in contemporary U.S. munitions inventory, 131 See also specific agent decontamination, 47, 157–158, 168–169, 354–355, 387 , 263 dermal exposure, 143–145, 161–162, 167 , 198, 200, 231 detection, 53, 66, 378, 380–381 history, 30, 36, 38, 46 differential diagnosis, 613–614, 638 See also Mustard (HS) effects on organs and organ systems, 144–157, 230, 341–342 Nitrogen oxides (NOX), 263–264 electrocardiographic (ECG) effects, 156, 165–166, 235–236 Nitrous oxide, 263 electroencephalographic (EEG) effects, 153 Nivalenol, 659–661 exposure categories, 166–170 Nixon, Richard M., 63–64, 431, 525 exposure routes, 142–144 NK cells gastrointestinal effects, 145, 168 See Natural killer (NK) cells “G” series, 130 Nobel, Adolph, 89 history, 5, 30, 36, 46, 49, 56–58, 62–63, 103–104, 130–131, Noguchi, Hideyo, 525 290 Noise inhalational injury, 139–144, 157, 161, 167 incapacitation by means of, 291 intermediate syndrome caused by, 232–233 Nomex, 373 long-term health effects, 153–154, 170, 230–236 Noradrenaline (norepinephrine), 132 mechanism of action, 132–136, 230 Norfolk Supply Center, Norfolk, Virginia, 429 mild exposure, 167–168 Noriega, Manuel, 291 minimal exposure, 167 North Atlantic Treaty Organization (NATO), 70, 74, 182, 185, moderate exposure, 168 354, 368 moderately severe exposure, 168–169 Nosecup, 364–365 muscular effects, 145, 149, 232 Nosocomial transmission nasal effects, 145, 147, 167–168, 170 of viral hemorrhagic fevers, 592–593, 595–596 nations with capability for use, 114, 116 NOx neuropsychiatric effects, 145, 149–155, 233–235 See Nitrogen oxides (NOx) occupational exposure, 136, 236 NRC ocular effects, 144–147, 166–168, 170 See National Research Council (NRC) oral effects, 145 Nuclear, biological, and chemical (NBC) officer, 362, 445 versus organophosphorus compounds, 231 Nuclear, biological, chemical protective covers (NBC-PC), 669 pharmacology, 139–142 Nuclear age, 36–47 physical properties, 123 Nuclear weapons polyneuropathy caused by, 231–232 versus chemical and biological weapons, 458–459 pulmonary effects, 145, 147–149, 167–168, 170 Number Facility (NF) performance, 296 and return to duty, 170 Nunn, Sam, 75 severe exposure, 169 Nursing care suspected exposure, 166 for biological agent–exposed patients, 432–433, 598 thickened, 356 toxicological studies, 236 O treatment, 54, 73, 154–155, 157–170, 230 Obidoxime triage considerations, 341–342, 344–346 See Toxogonin vapor exposure, 142–144, 157, 161, 167 Obscurants, 260–266 ventilatory support, 148, 158–159, 166–169 See also specific agent; Smokes “V” series, 130 Occupational exposure, 119 and wound decontamination, 355–356 to anthrax, 468–469, 474 See also specific agent and chemical surety mission, 398–399, 402–408 Neuromuscular conduction, 132–134, 647 to Q fever, 524, 532 Neuropsychiatric effects to ricin toxin, 636 of brucellosis, 516 and U.S. biological warfare program, 398–399, 432, 434 of mustard exposure, 239 Ochratoxins, 656 of nerve agents, 145, 149–155, 233–235 Ocular effects of Q fever, 529–530 of cyanides, 277 of viral encephalitides, 573–574 of Lewisite, 219 of mustard, 202, 208–211, 214–215, 238 clostridial, 644, 647 of nerve agents, 144–147, 166–168, 170 differential diagnosis, 650 of phosgene oxime, 221 mechanism of action, 609–611 of riot control agents, 314, 317, 321 See also specific toxin of trichothecene mycotoxins, 665–666 Neutrophils, 505 Ocular vaccinia, 549–550 Newcastle disease, 460 Oehler, Gordon, 462 New York State Psychiatric Institute, 52 Off-gassing, 356 Niacinamide, 203 Ofloxacin, 497 Nicotine (nAChR), 132–133, 292

709 Medical Aspects of Chemical and Biological Warfare

Okinawa accident, 63–64 See Pralidoxime chloride (2-PAM Cl) Olfactory assault p-Aminoheptanoylphenone (PAHP), 280–281 incapacitation by means of, 292 p-Aminooctanoylphenone (PAOP), 281 Olfactory nervous system p-Aminopropiophenone (PAPP), 275, 280–281 viral encephalitides infection through, 571–572 Panama, 291, 524 Oligonucleotide primers, 627 Paramyxoviridae, 575 Omsk hemorrhagic fever, 593–594 Parapoxvirus, 542 O’nyong-nyong virus, 562 Paraquat, 638 Open reading frame, 541 , 132, 138, 232 Operation Cut Holes and Sink ‘Em (CHASE), 62–64 Paratyphoid, 42 Operation Davy Jones Locker, 46 Parker, Ralph, 525 Operation Desert Shield, Operation Desert Storm Partial pressure of carbon dioxide (PCO2), 253, 264 See Persian Gulf War Partial pressure of oxygen (PO2), 252, 278 Operation Geranium, 46 Particles Operation Just Cause, 291 and toxic inhalational injury, 249, 260 Operation Large Area Coverage (LAC), 52 Pasechnik, Vladimir, 453–455 , 64 Passive hemagglutination assays (PHAs), 497 Operation Solid Shield 87, 71 Pasteur, Louis, 468–469 Operation Steel Box, 72 Pasteurella tularensis, 60 OPIDN Patient decontamination, 329, 331–335, 340–341, 352, 386–387, See Organophosphorus ester–induced delayed neurotoxic- 408–410 ity (OPIDN) Patient flow pattern Opioids, 293, 302 in chemical environment, 125 Opisochrostis hirsutus, 487 Patient-isolation procedures, 432–433, 497, 547, 598 Optical remote sensing (ORS), 380 Patient protection, 389 Oral exposure Patient protective wrap (PPW), 335, 389 to nerve agents, 145 Patient transport equipment, 389 to trichothecene mycotoxins, 665 PATS Orenburg, 659 See Protection Assessment Test System (PATS) Orf, 473 PB Organofluoride polymers, 264–266, 638 See Pyridostigmine bromide Organophosphorus compounds, 130, 132, 231, 233–234 PCP long-term health effects, 231–236 See Phencyclidine (PCP) mechanism of action, 134 PCR versus nerve agents, 231 See Polymerase chain reaction (PCR) treatment of exposure, 163 PDA See also Nerve agents; specific agent See Portable Decontamination Apparatus (PDA) Organophosphorus ester–induced delayed neurotoxicity PDDA (OPIDN), 231–232 See Power-Driven Decontamination Apparatus (PDDA) Oropharyngeal anthrax, 472–473 PEEP Oropsylla idahoensis, 487 See Positive end-expiratory pressure (PEEP) Oropsylla labis, 487 Pellets ORS biological agent delivery via, 420–421, 442 See Optical remote sensing (ORS) Penicillin, 473 Orthopoxvirus, 540–542 , 316 Overgarments, 363, 370–377 Perfluorocarbon rubber masks, 364 See also Mission-oriented protective posture (MOPP) gear Perfluoroethylpropylene, 264 Oxidation Perfluoroisobutylene (PFIB), 264–266 decontamination by, 354–355, 387 Permethrin, 191 , 162–165 Peromyscus species, 487 contraindications, 167 Pershing, John J., 6, 18, 25, 95 dosage and administration, 163–164, 169 Pershing missile, 59 mechanism of action, 162–163 Persian Gulf War for pretreatment use, 164, 183 anthrax vaccination during, 474 and pyridostigmine pretreatment, 184–187 biological warfare threat during, 2, 6, 72–74, 416, 421, 438, treatment, 164–165 444–445, 462, 608, 678–679 See also 2-Pralidoxime chloride (2-PAM Cl); specific drug botulinum vaccination during, 651 Oxygen supplementation, 253, 255, 257, 266, 279 chemical warfare threat during, 2, 6, 72–74, 117, 130–131, Oxytetracycline, 531 198, 230, 362, 394, 678–679 MARK I kits issued during, 73, 155 P medical aftermath of, xvi, 73, 105, 190, 191, 195, 297 pyridostigmine pretreatment use during, 185, 188–191 PADPRP Q fever cases during, 524 See Poly(ADP-ribose) polymerase (PADPRP) Personal decontamination, 157, 329–330, 352, 408 Palmer, John M., 55 Personnel decontamination, 352, 386–387 Palythoa tuberculosa, 609 Personnel decontamination kits, 386 Palytoxin, 609 Personnel documents 2-PAM Cl for chemical surety inspection, 401–402

710 Index

Petroleum products Pioneer Chemical Co., 62 biological agents directed against, 461 Plague, 479–499 PFIB as biological warfare agent, 482–485 See Perfluoroisobutylene (PFIB) bubonic, 480, 486, 491–492, 497 PG clinical manifestations, 491–495 See Staphylococcal enterotoxin B (SEB) cutaneous manifestations, 494–495 Pharyngeal plague, 494 cycles, 489 Pharyngitis, 506 diagnosis, 495–497 PHAs differential diagnosis, 574 See Passive hemagglutination assays (PHAs) epidemiology, 486–489 P helmet, 17 history, 10, 16, 32–33, 37, 42, 75, 416–417, 431, 454, 462–463, Phencyclidine (PCP), 293–294 480–482 Phenethylamine derivatives, 302 incidence, 489–491 Phenethylamines, 292 laboratory confirmation, 495–497 Phenothiazine derivatives, 627 lethality, 439 Phenoxybenzamine, 280 meningitic, 491, 494 Phentolamine, 163–164 pathogenesis, 491 PH helmet, 91 patient isolation procedures, 497 Phillips Duphar, 132 pharyngeal, 494 Phlebovirus, 593 pneumonic, 454, 489, 491, 494, 497 Phosgene (CG), 118–119, 257–260 prophylaxis, 498 clinical effects, 258, 343–344 septicemic, 480, 491–494, 497 and combined injuries, 348 treatment, 497 detection, 42 on U.S. military installations, 483–484 history, 5, 10, 27, 29–30, 36–38, 40, 248 vaccination, 498 long-term health effects, 260 See also Yersinia pestis physical properties, 123 Plants therapy, 258–260 transgenic research involving, 683 toxicity, 276 weapons directed against, 44, 51–52, 60, 427–429, 431, 460– triage considerations, 343–347 461 World War I use, 16, 19, 21, 91–93, 95, 119 See also Defoliants; specific agent or plant Phosgene oxime (CX), 220–222 Plant toxins, 610 biochemical mechanisms of injury, 221 See also specific toxin chemical structure, 220 Plaque reduction neutralization (PRN) antibodies, 573 clinical effects, 221 Plasma carboxylesterase, 192 dermatological effects, 221 Plasma cholinesterase differential diagnosis, 200, 219–220, 638 See Butyrocholinesterase (BuChE) history, 220 Plasminogen activator, 491 military use, 220 Playfair, Sir Lyon, 11, 88 ocular effects, 221 Pneumonia, 506, 623 pharmacology, 198–199 Pneumonic plague, 454, 489, 491, 494, 497 physical properties, 220–221 Pneumonitis, 253 pulmonary effects, 221 Point detectors, 377–380 treatment, 221–222 Point source Phospholipases, 609 for aerosol delivery, 442 Phosphoric acid, 262 Point-source explosives, 120 Phosphorus pentoxide, 262 The Poisoner’s Handbook, 463 Phosphorus smokes, 262 Polish Academy of Science, 419 Phosphorus trioxide, 262 Pollution control Phossy jaw, 262 and weapons disposal programs, 412 Photochemical smog, 263 Poly(ADP-ribose) polymerase (PADPRP), 203 Photostimulation, high intensity Poly- D-glutamic acid, 469 incapacitation by means of, 291–292 Polymerase chain reaction (PCR) p-Hydroxylaminopropiophenone, 281 in biological agent diagnosis, 448–449 Physical decontamination methods, 354, 358, 363–364, 370 in toxin exposure diagnosis, 617 Physical disturbances See also specific agent diagnosis incapacitation by means of, 291 Polymer fume fever, 264–265 Physical examinations Polyneuropathy, 231–232 for Chemical Personnel Reliability Program, 403–406 Polyparaphenyleneterephthalamide Physostigmine, 130, 132 See Kevlar as anticholinergic antidote, 298–302 Polytetrafluoroethylene chemical structure, 184 See Teflon dosage and administration, 299, 302 Portable Decontamination Apparatus (PDA), 62, 70, 388 mechanism of action, 134, 299 Porter, William N., 37–38, 45 as nerve agent pretreatment, 187, 191–192 Laboratory, England, 658 side effects, 191 Positive end-expiratory pressure (PEEP), 253, 257, 259, 266 Picornaviridae, 575 Positive-pressure total body suits, 432–434 , Arkansas, 429, 431 Postattack measures

711 Medical Aspects of Chemical and Biological Warfare

for medical support, 328–329 Pseudocholinesterase Postsynaptic potential, 133–134 See Butyrocholinesterase (BuChE) Potassium cyanide, 273 Pseudomonas, 609 Poultry, 460 Psilocybin, 293 Powders Psittacosis, 43–44, 427, 431 biological agent dispersal as, 441 Psychedelics, 293–294 decontamination with, 353–354 See also specific agent Powell, Colin, 74 Psychochemical agents, 292–294 Power-Driven Decontamination Apparatus (PDDA), 388 See also specific agent Poxviruses, 540–542 Psychochemical Agents project, 52 See also specific virus Psychological effects Poxvirus virions, 541 of wearing mission-oriented protective posture gear, 362, PPW 393–395 See Patient protective wrap (PPW) See also Neuropsychiatric effects Prairie dogs, 487–488 Public hostility, 62–63 2-Pralidoxime chloride (2-PAM Cl), 149, 162–165 Public Law 91-121, 63 dosage and administration, 163–165, 169 Public Law 91-672, 64 and endurance time in protective gear, 394 Public Law 92-532, 64 injectors, 73, 155, 163, 169 Public Law 99-145, 71–72 and nerve agent cardiovascular effects, 156 Public Law 102-484, 72 and nerve agent–induced seizures, 154–155 Public Law 607, 45 pharmacokinetics, 163 Public water systems and pyridostigmine pretreatment, 184–187 biological warfare testing involving, 428–429 side effects, 163–164, 170 Pulex irritans, 483, 487 Preattack measures Pulmonary effects for medical support, 328 of anthrax, 472 Prentiss, Augustin M., 123 of brucellosis, 517 Preplacement examination of cyanides, 277 for Chemical Personnel Reliability Program, 403–404, 406 of Lewisite, 219 Presidential Decision Directive 39, 6 of mustard, 211–212, 215–217, 237–238 Prison incidents of nerve agents, 145, 147–149, 167–168, 170 use of riot control agents during, 318 of phosgene oxime, 221 PRN antibodies of Q fever, 530 See Plaque reduction neutralization (PRN) antibodies of ricin toxicity, 636–637 Prochlorperazine, 627 of riot control agents, 311–312, 315–316, 321 Project 80, 55 of staphylococcal enterotoxin B, 624–627 , 55 of toxic inhalational injury, 253, 256, 258–259, 265–266, 343 Project CD-22, 430 of trichothecene mycotoxins, 666, 670 “Project Whitecoat,” 428 of tularemia, 506 Promazine, 280 Pulmonary function tests (PFT), 252, 265 Promethazine, 217, 280 Pulmonary toxicants, 118–119, 247–267 Propranolol, 165 See also Inhalational injury; specific agent Prostigmin Pungi sticks, 419 See Neostigmine Puumala virus, 594 Protection and Detection Sets, 54 Pyridine-2-aldoxime methyl chloride Protection Assessment Test System (PATS), 365–366 See 2-Pralidoxime chloride (2-PAM Cl) Protection factor (PF), 366 2-Pyridine aldoxime methyl chloride Protective antigen, 470 See 2-Pralidoxime chloride (2-PAM Cl) Protective boots, 373–375 Pyridostigmine, 124, 183–191, 298 Protective ensembles, 371–373 blister pack, 189 Protective equipment, 363, 370–377 blood–brain barrier permeability, 187 acclimatization period, 406 chemical structure, 184 biological, 431, 447–448 dosage and administration, 187–188, 191 factors that restrict wearing of, 402 drug interactions, 188 toxins, 612–613, 669 efficacy, 184–187 See also Chemical defense equipment; Masks; Mission- FDA informed consent waiver for, 188 oriented protective posture (MOPP) gear; specific item mechanism of action, 134 Protective gloves, 373–375 and nerve agent cardiovascular effects, 156 Protective Ointment Kit, 42 and nerve agent–induced pulmonary effects, 158 Protective ointment sets, 54 and nerve agent–induced seizures, 154–155, 165 Protective ratio (PR), 183, 186 as nerve agent pretreatment, 134, 149, 154–156, 158, 165, Protein exotoxins, 469–470 182 Protopam Chloride pharmacology, 183–184 See 2-Pralidoxime chloride (2-PAM Cl) precautions, 187 PS safety, 187–188 See Chloropicrin (PS) side effects, 187, 189–190 P2S wartime use, 185, 188–191 See Methanesulfonate salt of pralidoxime (P2S) Pyridostigmine bromide, 73, 132

712 Index

Pyrogenic toxins See Masks See Staphylococcal enterotoxin B; specific toxin Respiratory failure, 148, 252 Pyruvate dehydrogenase complex, 218 RESPO 21, 370 Resuscitation Q See Ventilatory support Return to duty, 170, 213, 331 QDH/SS Reverse transcriptase polymerase chain reaction (RT-PCR), See Quick Doff Hood/Second Skin (QDH/SS) 597 Q fever, 5, 523–532 Revolutionary War, 417 acute, 529–530 RFK mask chronic, 528, 530 See Richardson, Flory, and Kops (RFK) mask clinical manifestations, 528–530 RH-195, 33–34 diagnosis, 530–531 Rhabdoviridae, 575 differential diagnosis, 574 Rhinorrhea, 145, 147, 167–168, 170 in domestic animals, 528 Rhodanese, 275 epidemiology, 526–527 Rhonchi, 343–344 history, 52, 430–431, 525 RIAs lethality, 444 See Radioimmunoassays (RIAs) military relevance, 524–525 Ribavirin, 598–599 occupational exposure, 524, 532 Ribonucleic acid (RNA), 541, 569, 662 pathogenesis, 527–528 genomic, 569–570 prophylaxis, 531–532 Ribonucleic acid (RNA) viruses, 592 treatment, 531 Ribosomal ribonucleic acid (rRNA) analysis, 504, 525 vaccination, 430, 531–532 Rice, George S., 17 See also Coxiella burnetii Rice blast disease, 60, 460–461 Q fever endocarditis, 528, 530 Rice fungus, 44, 427, 460 QNB Richardson, Flory, and Kops (RFK) mask, 22 See BZ (3-Quinuclidinyl benzilate) Ricinis communis Quarpel-treated fabric, 373 See Castor beans Quayle, Dan, 73 Ricin toxin, 604, 631–639 Quick Doff Hood/Second Skin (QDH/SS), 74 anticancer effects, 632 3-Quinuclidinyl benzilate availability or ease of production, 438 See BZ (3-Quinuclidinyl benzilate) cause of death, 636–637 R clinical manifestations and pathology, 635–637 detection, 383 Rabbits, 504 diagnosis, 637–638 Radiation Detector history, 10, 420–421, 446, 463–464, 632–633 ANVDR2, 382 immunization, 638–639 Radiographic findings inhalation, 636–639 in brucellosis, 517 injection, 635 See also Chest radiography lethality, 608 Radioimmunoassays (RIAs), 448, 668 mechanism of action, 610–611 Rales, 343, 530 military significance, 632–633 Rapidity of action, 123 native, 632 Rats, 481–482, 486–488 occupational exposure, 636 Rattus norvegicus, 482, 487–488 oral intoxication, 635 Rattus rattus, 482, 487 pathogenesis, 634 RBC-ChE sample collection, 617 See Erythrocyte cholinesterase (RBC-ChE) structure, 633 RDIC (resuscitation device, individual, chemical), 159, 169 toxicity, 633–634 Reagan, Ronald, 68, 70–71 treatment, 611, 616, 638–639 Receptor-mediated endocytosis (RME), 648–649 Ricketts, Howard T., 10 Red mold disease, 659 Rickettsia mooseri, 418 Red phosphorus, 262 Rickettsia prowazeki, 418 Reed, Walter, 10 Rifampin, 518, 531, 552, 616 Remote sensing capability, 53–54, 74, 380–381, 447–448 (RVF), 434, 444, 593, 595–596, 599 Remote Sensing Chemical Agent Alarm (RSCAAL) Rift Valley fever (RVF) virus, 593, 595, 599 M21, 74, 381–382 , 51, 460 Reoviridae, 575 Riot control agents, 118–119, 292, 307–322 Replicating agents, 604 characteristics, 308–309 Reproductive toxicity decontamination, 320 and mustard exposure, 239 definition, 308 Resin kit future use, 321 M291, 353–354, 387 history, 5, 48, 56, 62, 75, 308–310 Respiration medical care, 320–321 depth and frequency of, and toxic inhalational injury, 250, nations with capability for use, 114 255 severe medical complications from, 317–318 types, 308

713 Medical Aspects of Chemical and Biological Warfare

See also Tear agents; specific agent dual use, 457 Ripley, James W., 11 lethality, 608 RME mechanism of action, 610 See Receptor-mediated endocytosis (RME) treatment, 610, 616 RNA SBR See Ribonucleic acid (RNA) See Small-box (SBR) Rockets Scarification, 548 chemical, 40, 58–59, 62, 71 Schäfer method of assisted ventilation, 159 Rock squirrels, 487 Scheele, Carl, 10 Rocky Mountain Arsenal, Denver, Colorado, 460–461 Schrader, Gerhard, 30, 130 Rocky Mountain spotted fever, 10, 525 Schutz, W., 10 Rodents Schwarzkopf, H. Norman, 73 that harbor plague, 480–482, 486–488, 498 Scopolamine, 191, 294–295, 298–299 that harbor viral encephalitides, 567 ID50, 295 that harbor viral hemorrhagic fevers, 592–594, 596 Scopolamine hydrochloride, 153 See also specific rodent Scopolamine methylbromide, 153 Roosevelt, Franklin D., 36, 43–44, 125, 426–427 SCPE Roridin A, 661 See Simplified Collective Protective Equipment (SCPE) Ross River virus, 562 Screening Royall, Kenneth C., 45 for Chemical Personnel Reliability Program, 399–404 RSCAAL Scrub , 495 See Remote Sensing Chemical Agent Alarm (RSCAAL) SDS polyacrylamide gel electrophoresis Rubratoxins, 656 See Sodium dodecyl sulfate (SDS) polyacrylamide gel Russia electrophoresis biological warfare programs, 420, 422, 453, 455, 679 SEA chemical warfare capability, 75, 115–116, 218, 679 See Staphylococcal enterotoxin A (SEA) Russo–Japanese War, 11 Sea dumping RVF of surplus chemical agents, 45–46, 62–64 See Rift Valley fever (RVF) SEB See Staphylococcal enterotoxin B (SEB) S Secobarbital, 293 Secondary inoculation Sabia virus, 593 and vaccinia vaccination, 548–549 Sacroiliitis, 517 Secretion precautions Sag Paste (Salve Antigas), 22 with biological agent–exposed patients, 433 Salmonella, 12, 447, 574, 683 SED Salt intake See Staphylococcal enterotoxin D (SED) and protective gear use, 407 SEE Sanders, Murray, 32 See Staphylococcal enterotoxin E (SEE) San Francisco Bay Seizures, 154–155, 165, 187, 279 biological agent testing, 429 Selassie, Haile, 34 Sarin (GB), 118–119, 130, 230 Selenium, 671 aging half-time, 162, 183 Self-aid and blood cholinesterase activity, 138 and chemical workers, 407, 409–410 cardiovascular effects, 156 Self-decontamination, 157, 329–330, 352, 408 case reports, 135–136, 147 Semliki Forest virus, 565, 569 decontamination, 354 Sensory stimulation detection, 378–381 incapacitation by means of, 291 electroencephalographic (EEG) effects, 153, 236 Seoul virus, 594 history, 30, 36, 46, 49–50, 58–59, 63–64, 66, 103, 130–131 Septic abortion, 516 LCt , 141 50 Septicemic plague, 480, 491–494, 497 long-term health effects, 154, 232, 235–236 Sergeant missile system, 59 molecular model, 140 Serotherapy nations with capability for use, 114–115 for viral encephalitides, 577 neuropsychiatric effects, 152–153, 235 Serratia marcescens, 32, 428–429 ocular effects, 144–147 Service Response Force (SRF), 410–411 pharmacology, 141 Sesquiterpenoids, 660 physical properties, 122–123 Sevin, 132 polyneuropathy caused by, 232 Shalikashvilli, John M., 104 pulmonary effects, 148 Shanty, Frank, 53 and pyridostigmine pretreatment, 184–186 Sheep, 528 recent use in Japan, 4, 75, 113, 118, 131, 169, 274, 342, 438, Shellfish toxins, 439 463, 678 See also specific toxin toxicological studies, 236 Shelter System, 67 treatment, 163, 165 Shepherd, Forrest, 11 Satratoxin, 659, 661 Sherman, W. T., 416 , 604, 609 Shigella availability or ease of production, 439

714 Index

See Dysentery history, 3, 103, 131 Shuffle pit, 333 LCt50, 141 Sibert, William L., 19, 25, 28 long-term health effects, 153–154, 232, 235 Silent Death (Uncle Fester), 463 molecular model, 140 Silicone rubber masks, 364–366 muscle necrosis caused by, 232 Silver nitrate solution, 320 nations with capability for use, 114, 116 Silver sulfadiazine, 214 neuropsychiatric effects, 153, 235 Simplified Collective Protective Equipment (SCPE), 385–386 pharmacology, 141 Sindbis virus, 562, 566–567, 577 physical properties, 122 Sin nombre virus, 594 polyneuropathy caused by, 232 Skin decontamination, 157–158, 333, 335, 352–353, 356, 386– pretreatments, 183–187, 192 387, 408, 669–670 pulmonary effects, 148–149 Skin Decontamination Kit toxicological studies, 236 M291, 387 treatment, 165 M238A1, 669 SOPs M258A1, 387, 669 See Standing operating procedures (SOPs) XM291, 669–670 Southeast Asia S-LOST trichothecene mycotoxin use, 419, 421, 609, 657–658 See Mustard (HS) See also specific country Small-box respirator (SBR), 18, 91, 93–94, 364, 393 Soviet Institute of Microbiology and Virology, 420 Smallpox, 539–553 Soviet PKhR-RM Chemical Agent Detector Kit for Medical and biological warfare, 540–541 and Veterinary Services, 65 chemoprophylaxis and chemotherapy, 552–553 Soviet Union versus chickenpox, 546 biological warfare program, 4, 29, 55, 67–68, 418, 429, 452– clinical manifestations, 542–546 455, 485, 656–658, 679 complications, 543–544 chemical warfare program, 47, 54–55, 67–68, 72, 104, 114– diagnosis, 546–547 117, 130–131, 679 eradication, 540, 543 SPE flat-type, 543, 545 See Streptococcal pyrogenic exotoxins (SPE) hemorrhagic-type, 543, 545 SPE-A history, 10, 12, 416–417, 462, 540 See Streptococcal enterotoxin A (SPE-A) immunoprophylaxis, 548–552 SPE-C modified-type, 546 See Streptococcal enterotoxin C (SPE-C) pathogenesis, 542–546 Spermophilus, 487 patient-isolation procedures, 547 Spermophilus beechyi, 487 treatment, 547–553 Spermophilus lateralis, 487 vaccination, 540, 546–551 Spermophilus richardsoni, 487 See also Variola virus; Vaccinia vaccines Spermophilus variegatus, 487 SmithKline Beecham Pharmaceuticals, 302 Spondylitis, 517 Smoke inhalation Spot decontamination, 333, 341, 353 and , 273–274, 280, 282 Spray delivery, 40, 120–121, 441–442 Smokes, 118, 260–266 Spray drying, 440–441 definition, 248 Squirrels, 487–488, 504 See also specific agent SRF Smoke tank See Service Response Force (SRF) airplane, 31 SS John Harvey, 40, 103–104, 200 Snake venom toxins, 610, 650 Stachybotryotoxicosis, 659 Soap and water Stachybotrys, 656 decontamination with, 353–354, 357–358, 388, 616, 669–670 Stachybotrys atra, 659 Sodium bicarbonate, 279, 670 Standing operating procedures (SOPs), 401, 407–408 Sodium carbonate, 408 Standoff detection, 53–54, 74, 380–381, 447–448 Sodium dodecyl sulfate (SDS) polyacrylamide gel electro- Stanton, Edwin, 88 phoresis, 647 Staphylococcal enterotoxin A (SEA), 622–623 Sodium hypochlorite Staphylococcal enterotoxin B (SEB), 621–628 See Hypochlorite solution clinical manifestations, 626–627 , 279–280 detection, 383, 627 Sodium phosphate, 670 diagnosis, 627 Sodium , 217, 279, 281, 363 differential diagnosis, 473, 613–614, 638 Solanaceae, 290, 294 immunotherapy, 628 Somalia, 525, 540 incapacitation caused by, 622 Soman (GD), 118–119, 130, 230 inhalational exposure, 623–626 aging half-time, 162, 183 mechanism of action, 609 blood–brain barrier permeability, 187 pathogenesis, 623–626 cardiovascular effects, 156 prophylaxis, 628 case report, 150–151 toxicity, 608, 622 decontamination, 354 treatment, 627–628 detection, 381 vaccines, 628

715 Medical Aspects of Chemical and Biological Warfare

Staphylococcal enterotoxin C1 (SEC1), 622 (TMB4) Staphylococcal enterotoxin C2 (SEC2), 622 Tabun (GA), 118–119, 130, 230 Staphylococcal enterotoxin C3 (SEC3), 622 aging half-time, 162, 183 Staphylococcal enterotoxin D (SED), 622–623 behavioral effects, 152 Staphylococcal enterotoxin E (SEE), 622 decontamination, 354 Staphylococcal enterotoxins, 5, 622–623 detection, 381 classification, 622 history, 30, 36, 46, 103, 130–131 decontamination, 616 LCt50, 141 diagnosis, 613 long-term health effects, 232 incapacitation caused by, 431 molecular model, 140 mechanism of action, 609 nations with capability for use, 114 sample collection, 617 pharmacology, 141 treatment, 616 physical properties, 122 Staphylococcus, 609 polyneuropathy caused by, 232 Staphylococcus aureus, 622–623, 626 pulmonary effects, 148–149 Status epilepticus, 155 and pyridostigmine pretreatment, 184–186 STB recent use, 69 See Super tropical bleach (STB) toxicological studies, 236 Steam heat, 358 Stenhouse, John, 10, 13 See Tetrahydroaminoacridine (THA) Sterilization Tactical Biological Standoff Detection System, 448 definition, 357 Tank Collective Protector, 53 Sternutators, 308 Tank masks, 53, 70, 74 Steroid therapy TAP ensemble contraindications, 597 See Toxicological agent protective (TAP) ensemble for riot control agent exposure, 320–321 T cells, 505, 577, 622–623, 628 for toxic inhalational injury, 253, 257, 264, 266 Tear agents, 118–119, 308 Stimson, Henry L., 29, 43, 426 delivery systems, 121 Stimulants, 292–293 history, 11, 13, 35–36, 56, 90, 104–105 See also specific agent See also Riot control agents; specific agent Stokes mortar, 21, 27, 31 Techne, 132 Strategic Biological Standoff Detection System, 448 Teflon, 264–266, 617, 638 Streptococcal adenitis, 495 Temperature Streptococcal disease, 473 and agent delivery, 122–123 Streptococcal enterotoxin A (SPE-A), 622–623 and protective gear use, 125, 329–330, 367, 370–371, 394, Streptococcal enterotoxin C (SPE-C), 622–623 403, 405–407 Streptococcal pneumonia, 623 TEMPER (tent, extendable, modular, personnel) system, 384 Streptococcal pyrogenic exotoxins (SPE), 622–623 TEPP Streptomycin, 497, 507, 518 See (TEPP) Stress testing, 254 Teratogenesis Strychnine, 292 and mustard exposure, 239 Stubbs, Marshall, 54–55 Terrorism, 6, 75, 117–118, 678, 683 Submarine mine, 52 and biological weapons, 117–118, 422, 438, 446–447, 461, Succinylcholine, 137 463–464, 604, 609, 611, 633, 678, 683 Sudan, 594 and toxin weapons, 604, 609, 611, 633 Suipoxvirus, 542 Terrorist weapon , 13–14 definition, 604 Sulfur donors, 281 Tetanus toxin, 609, 644, 646–647 Sulfur mustard Tetracycline, 473, 497–498, 507, 531–532 See Mustard (HS) Tetraethyl pyrophosphate (TEPP), 130 Sulfur trioxide-chlorosulfonic acid (FS smoke), 262–263 Tetrahydroaminoacridine (THA), 301 Superantigens, 622–623 (THC), 52, 298 Super tropical bleach (STB), 54, 388, 408 Tetrodotoxin, 417–418, 609–610 Surgical gloves, 356–357 Thermal burns, 343 Surgical instruments , 163 decontamination, 357 Thickeners, 122, 356 Surgical irrigation solutions, 353, 357 Thin-layer chromatography (TLC), 668 Survival Technology, 155 Thiocyanate, 276 Sverdlovsk accident, 4, 68, 420, 452–453, 468 Thiodiglycol, 213 Synaptotagmin, 648 Thiolcalcium hypothesis Systox, 138 of mustard injury, 203–204 Thiosulfate reductase, 275–276 T Third World nations biological weapons programs, 456–458, 461, 678–679 T-144 chemical warfare capabilities, 116–117 See Sarin (GB) See also specific nation TAB Thorazine See N,N’-Trimethylenebis-[pyridine-4-aldoxime bromide] See Chlorpromazine

716 Index

Thrassus bacchi, 487 Tracheobronchial destruction, 100 Threshold limit value (TLV), 250 Tracheobronchial stenosis, 215–217 Tick-born encephalitis, 444 Training Ticks chemical warfare, 48, 55–56, 71–72, 94, 124 as biological agent vector, 504, 525, 528, 593–594, 596 for chemical workers, 407–410 Titanium tetrachloride (FM), 27, 263 of civilian resources, 409–410 TLC decontamination, 352, 387, 408 See Thin-layer chromatography (TLC) protective gear, 393–395 TMB4 Training Mask, 40 See N,N’-Trimethylenebis-[pyridine-4-aldoxime bromide] Tranquilizers, 293 (TMB4) Transport equipment, 389 TNF Treaties See Tumor necrosis factor (TNF) chemical weapons, 4, 13, 72, 75, 104–105, 113, 115, 117, 411 TOCP verification of compliance, 117, 420 See Triorthocresyl phosphate (TOCP) See also specific treaty Togaviridae, 562, 575 Treaty of Versailles, 29 Tooele demilitarization plant (Utah), 72, 411 Trench fan, 22–23 Topical skin protectants Triage, 337–349 for chemical warfare agents, 669 definition, 338 Torsade de pointes, 156 objective, 338 Tourniquet test, positive, 596 Triage categories, 331, 334, 339–341, 344–347 Towelettes chemical intermediate, 339 decontamination, 158 delayed, 340, 344–346 Toxic Agent Training Course, 409 expectant, 340, 345–347 Toxic Chemical Training for Medical Support Personnel immediate, 340, 344–345 Course, 398 minimal, 340, 345–346 Toxicological agent protective (TAP) ensemble, 404 urgent, 339 Toxic shock syndrome, 623, 626–627 Triage officer, 331 Toxic shock syndrome toxin-1 (TSST-1), 622–623, 627–628 qualifications, 338 Toxins Triage station, 331–332 aerosolized, 605–608, 612 Trichloromethyl chloroformate analysis and identification, 617 See Diphosgene (DP) bacterial, 609, 647 Trichoderma, 656 bioengineered production, 682 Trichotecin, 665 chimeric, 632 Trichothecene mycotoxins, 655–671 countermeasures, 610–619 acute effects, 664–666 decontamination, 616, 660, 669–670 aerosolized, 658–659, 666–667, 670 definition, 604 anticancer potential, 667 detection, 613 chemical and physical properties, 660 diagnosis, 613–614 chronic toxicity, 667 ease of production, 605–608 clinical manifestations, 658, 664–667 fungal, 609–610, 656 decontamination, 616, 660, 669–670 immunization, 615, 618–619 dermal exposure, 665–666, 670 incapacitation caused by, 608, 622 diagnosis, 667–669 marine, 609 ease of production, 659 mechanisms of action, 608–611, 648–649 history, 655–659 physical protection, 612–613 lethality, 658–659 plant, 610 mechanism of action, 611, 660–662 prevention, 614–616 metabolism, 662–664 route of exposure, 604 military significance, 655–659 sample collection, 616–617 occurrence in nature, 659 shellfish, 439 ocular exposure, 666 sources, 608–610 prophylaxis, 670–671 stability, 605–608 protective equipment, 669 toxicity, 605–608, 612 recent use, 3, 68, 419, 421 treatment, 614–616 respiratory exposure, 666, 670 venom, 610, 650 structure, 659 water purification methods effective against, 617–618 toxicology and toxicokinetics, 660–664 See also Biological agents; specific agent treatment, 611, 669–671 Toxin weapons use in Southeast Asia, 419, 421, 609, 657–660, 665–666, 668 versus chemical weapons, 605, 607 See also specific toxin defense against, 603–619 Trichothecene ring, 656 populations at risk, 611–612 Trihexyphenidyl, 191 possible, 439 Trilateral Agreement, 455 terminology, 604 Trilon-46 Toxogonin, 163 See Sarin (GB) TPS1/TPS2 Trilon-83 See Topical skin protectants See Tabun (GA)

717 Medical Aspects of Chemical and Biological Warfare

Trimethoprim/sulfamethoxazole, 498, 518, 531 anticrop research programs, 460–461 N,N’-Trimethylenebis-[pyridine-4-aldoxime bromide] biological field testing in, 429 (TMB4), 159, 163 biological warfare and defense programs, 425–435, 455, Trinitrotoluene (TNT), 89 645 Triorthocresyl phosphate (TOCP), 232 chemical warfare agencies Truman, Harry S, 64 See Chemical Warfare Service (CWS); Chemical Corps T-Shell, 14 chemical warfare policies, 29, 36, 44–45, 48, 56, 63, 72, 75, TSST-1 89–90, 104–105, 112, 117 See Toxic shock syndrome toxin-1 (TSST-1) nerve agent inventory, 131 T-2 toxin, 608–610, 659 plague cycles in, 489 aerosolized, 658–659 Q fever epidemiology in, 527 chemical and physical properties, 660 See also Continental United States (CONUS) clinical manifestations, 658 UNSCOM decontamination, 670 United Nations Special Commission (UNSCOM) dermal exposure, 665–666 U.S. Army Chemical Research and Development Center, diagnosis, 668 Edgewood, Maryland, 658 ease of production, 659 U.S. Army General Order No. 100, 13 lethality, 658–659 U.S. Army Medical Department (AMEDD), 328, 428 mechanism of action, 660–662 U.S. Army Medical Research Institute of Chemical Defense metabolism, 662–664 (USAMRICD), 410, 434 ocular exposure, 666 U.S. Army Medical Research Institute of Infectious Diseases prophylaxis, 671 (USAMRIID), 431–434, 596, 599, 616, 623, 651 protective equipment, 669 U.S. Army Medical Unit, 430–431 toxicity, 661 See also U.S. Army Medical Research Institute of Infectious treatment, 670 Diseases (USAMRIID) Tuberculosis, 495 U.S. Army regulations/publications Tularemia, 5, 503–508 for chemical surety inspection, 400 clinical manifestations, 505–506 U.S. Biological Warfare Committee, 43 diagnosis, 506–507 U.S. Biological Warfare Program, 59–60 differential diagnosis, 473, 495–496 U.S. Biological Weapons Program, 44 epidemiology, 504 U.S. House of Representatives Committee on Armed Services, history, 10–11, 427, 429, 454, 504 114 lethality, 444 Defense Policy Panel, 456 pathogenesis, 504–505 Special Inquiry Into the Chemical and Biological Threat, prophylaxis, 507 461, 678–679 treatment, 507 U.S. Public Health Service, 411 typhoidal, 505–507 U.S. Senate Committee on Governmental Affairs, 114 ulceroglandular, 505–507 USAMRICD vaccination, 507 See U.S. Army Medical Research Institute of Chemical See also Francisella tularensis Defense (USAMRICD) Tumor necrosis factor (TNF), 471, 505 USAMRIID Twitches, 149, 158, 168–169 See U.S. Army Medical Research Institute of Infectious Tylenol, 274, 447 Diseases (USAMRIID) Typhus, 10, 33, 37, 42, 444, 495 Ustinov, D. F., 453 U Thant, 57 U V UJI bomb, 32–33 Ultraviolet radiation Vaccine interference, 578 decontamination with, 358 Vaccines Umbrella gun, 420–421 for animals, 434, 460, 464, 568, 576, 578 United Kingdom biological agent, 60–61, 73, 434, 441, 460, 462, 681–683 anticrop research programs, 460–461 live attenuated, 507, 683 biological warfare programs, 32, 418–419, 427, 455, 645 recombinant vector, 683 chemical warfare divisions verified clinical take, 547 See World War I; World War II See also specific agent or vaccine United Nations, 683 Vaccinia chemical/biological weapons reports/inspections, 63, 104– generalized, 549 105, 419–422, 444, 458, 461 ocular, 549–550 and Iraqi chemical weapons program, 69, 73–74, 114, 201, progressive, 549–550 462–463, 679 Vaccinia-immune globulin (VIG), 550–552 Resolution 687, 462–463, 679 Vaccinia keratitis, 550 Resolution 715, 462–463, 679 Vaccinia necrosum, 549–550 Security Council, 420, 462–463, 679 Vaccinia vaccines, 540, 548–551, 683 Yemen Civil War investigation, 56–57 Vancomycin, 473 United Nations Special Commission (UNSCOM), 421, 463, 679 V antigen, 486, 491 United States Vapor, 121–122 animals that harbor plague in, 487–488 airway distribution, 248–249

718 Index

decontamination, 352, 356 See Viral hemorrhagic fever (VHF) syndrome definition, 248 Vibrio cholerae delivery systems, 121–122 See Cholera Lewisite, 218–219 Vickers Medical Containment Stretcher Transit Isolator, 432 mustard, 201–202, 237 Victor, Joseph, 427 nerve agent, 142–144, 157, 161, 167 Vietnam, North, 656–657 off-gassing from contaminated wounds, 356 Vapor Detector Kit, 42 adaptation of biological warfare during, 419 Variable domain-b (Vb), 622 and biological defense program, 431 Varicella defoliant use during, 56, 62, 104–105, 297 versus variola, 546 mask use during, 124, 394 Variola major, 543–544, 547 plague outbreaks during, 480, 483 Variola minor, 543, 545, 547 riot control agent during, 56, 62, 104–105 Variola virus, 540–542 riot control agent use during, 308–309 See also Smallpox VIG Variolization, 548 See Vaccinia-immune globulin (VIG) Vector Laboratories (Russia), 540 Viral encephalitides, 561–579 Vectors aerosolized, 570–572 for bacterial agent dispersal, 33, 37, 50 alphavirus structure and replication, 569–570 See also specific vector or agent antigenicity, 564–567 Vedder, Edward B., 102 clinical manifestations, 572–576 VEE diagnosis, 572–576 See Venezuelan equine encephalitis (VEE) differential diagnosis, 574–576 Vegetable killer acid epidemiology, 567–568 See 2,4-Dichlorophenoxyacetic acid (VKA) history and significance, 563–564 Vegetable killer liquid (VKL), 44 immunoprophylaxis, 564, 576–579 “Veil” respirators, 91 pathogenesis, 570–572 Venezuela treatment, 576 hemorrhagic fever outbreak, 593 weaponization, 562–564 Venezuelan equine encephalitis (VEE) See also specific virus clinical manifestations, 572–573 Viral hemorrhagic fevers, 591–600 diagnosis, 573 aerosolized agents, 592 enzootic, 567–568, 572 antiviral therapy, 598–599 epizootic, 567–568, 571–572 classification, 593 history, 44, 431, 434 clinical manifestations, 594–595 immunization, 576–579 diagnosis, 596–597 incapacitation caused by, 439 epidemiology, 592–594 pathogenesis, 570–572 immunoprophylaxis and immunotherapy, 599 Venezuelan equine encephalitis (VEE) virus, 5, 562–564 infectivity, 592 C-84 strain vaccine, 578–579 isolation and containment procedures, 598 TC-83 strain vaccine, 577–578 nosocomial transmission, 592–593, 595–596 Trinidad donkey (TrD) strain, 571, 577–578 treatment, 597–599 Venezuelan equine encephalitis (VEE) virus complex, 564–566 See also specific virus Venom toxins, 610, 650 Viral hemorrhagic fever (VHF) syndrome, 592 See also specific toxin Viruses Ventilatory support modification, 680–681 for cyanide poisoning, 279 possible biological warfare agents, 439 for first interventions, 341 See also Biological agents; specific agent history, 54, 60 Virus particles for mustard-exposed patients, 215 progeny, budding and release, 570 for nerve agent–exposed patients, 148, 158–159, 166–169 Vitamin B12a for toxic inhalational injury, 252–253, 257, 259, 266 See Hydroxocobalamin for toxin exposure, 616 Vitamin E, 217, 671 for viral hemorrhagic fevers, 597 VKA Ventricular fibrillation, 156 See 2,4-Dichlorophenoxyacetic acid (VKA) Verrucarin A, 661 Voicemitters, 364, 366, 368–370 Verticimonosporium, 656 Volatility, 122–123 Vesicants, 118–119, 197–222 Voles, 594 clinical differences among, 200 Vomiting definition, 198 CS-induced, 314–315 detection, 378, 380–381 mustard-induced, 212, 216 incapacitation caused by, 292 nerve agent–induced, 145, 168 pharmacology, 199 relation of cholinesterase activity to, 139 triage considerations, 342–347 Vomiting agents, 119, 292, 308, 319 and wound decontamination, 355 See also specific agent See also specific agent von Deimling, General, 15 VHF syndrome von Liebig, Justus, 89

719 Medical Aspects of Chemical and Biological Warfare von Steinmetz, Erich, 16 treatment, 576 von Tappen, Hans, 14 Western equine encephalitis (WEE) virus, 562–564 VX, 118–119, 130, 230 B-11 strain vaccine, 579 aging half-time, 162, 183 CM-4884 strain vaccine, 579 as anticholinergic antidote, 301 Western equine encephalitis (WEE) virus complex, 565–567 and blood cholinesterase activity, 138–139 Wet bulb globe thermometer (WBGT) index, 329–330, 407 decontamination, 158, 354–355, 387 Wheat blast fungus, 460 delivery systems, 121 Wheat stem rust, 51, 60 detection, 378, 380 Wheezing, 251–252 history, 49–50, 57–58, 63, 70, 131 White phosphorus (WP), 27, 260, 262 LCt50, 141–142 Whole-body-protection equipment items, 375 long-term health effects, 234 Wilson, George, 13 molecular model, 140 Wilson, Woodrow, 16–17, 19 nations with capability for use, 114–116 Winter, Dennis, 92 neuropsychiatric effects, 152, 234 Winterization kits pharmacology, 141 for masks, 366 physical properties, 122–123 Wipedown mitts, 387 pulmonary effects, 148–149 Wisner, Frank, 455 and pyridostigmine pretreatment, 184–186 Woehler, Frederick, 89 treatment, 163 Work/rest cycles and wound decontamination, 356 heat categories and, 329–330, 371, 403, 405 World Health Organization, 419, 443, 456, 540, 542–543 W World Trade Center bombing (New York), 446 World War I, 5, 13–25, 90–97 Waco, Texas, 75, 291, 310 Allied chemical warfare program, 13–16, 93–94 Waitt, Alden H., 29–30, 45, 47 biological warfare programs, 16, 21–22, 90–97, 417, 446, Walcott, C. D., 17 459, 540 Walter Reed Army Medical Center, Washington, D. C., 432, chemical casualties, 6, 24, 91–92, 100–101, 200, 205 434 chemical warfare usage, 14–20, 96, 290 Ward, Kyle, Jr., 30 cyanide use during, 273 Warning systems decontamination facilities, 97–98 See Alarms; Detection; specific detector detection, 23 War Research Service (WRS), 43, 426–427 gas casualty treatments, 23–24, 95–101 Wart hog disease, 460 mustard use during, 16, 19–24, 95–101, 119, 198, 200–201, Washington, George, 417 205, 210, 212–214, 216, 237–238, 393 Washington Post, 114 protective devices, 15–18, 22, 91–94, 363–364, 393 Water riot control agent use during, 309–310, 320 decontamination with, 158, 353–354, 357–358, 388, 616, smokes used during, 260 669–670 toxic inhalational injury during, 248, 254–260, 343 Water intake World War II, 36–47, 103–104 and protective gear use, 370–371, 406–407 anticrop research programs, 460 Water solubility biological warfare programs, 36–37, 42–44, 103–104, 417– of toxic inhalants, 249 419, 426–427, 446, 483–485, 540, 632, 644–645 Water supply contamination, 442, 446, 459 chemical warfare preparations, 37–40, 125, 131, 200, 290 Water testing kit civil defense program, 41 M272 Chemical Agent, 380 cyanide use during, 273 Water treatment defensive equipment, 40–42 for toxin contamination, 617–618 demilitarization of captured weapons after, 45–46 Watson, Gerald G., 71 detection, 42 Watson, James D., 679 plague outbreaks during, 482 WBGT index protective devices, 37, 40–43, 103, 365, 394 See Wet bulb globe thermometer (WBGT) index Q fever outbreaks during, 524 W bomb, 632 smokes used during, 262 Weapons disposal programs, 45–46, 62–64, 72, 411–412, 431, tularemia outbreaks during, 504 525, 564 U.S. chemical warfare policy, 44–45 Weapons of mass destruction Wound botulism, 644 comparison, 458–459 Wound contamination, 124, 347–348, 356 Weather Wound decontamination, 352, 355–357, 387 and agent delivery, 122–123, 125 Wounds and protective gear use, 125, 329–330, 367, 370–371, 394, in casualties with combined injuries, 340, 347–348 403, 405–407 exploration and debridement, 356–357 Webster, William H., 73, 114, 117, 462 foreign material in, 356 Wedum, Arnold G., 430 off-gassing from, 356 Western equine encephalitis (WEE) thickened agents in, 356 clinical manifestations, 574 WP diagnosis, 574 See White phosphorus (WP) immunization, 576–579 Wyeth, 551 pathogenesis, 570–572 Wyeth-Ayerst Laboratories, 149, 163, 302

720 Index

Wyoming MOU, 72 outer-membrane proteins (Yops), 485–486, 491 staining for, 495–496 X virulence factors, 485–486 See also Plague Xenopsylla cheopis, 482–483, 486–487 Yersinia pseudotuberculosis, 482, 485 , 14 Yom Kippur War Y See Arab–Israeli War of 1973 Yperite Yatapoxvirus, 542 See Mustard (HS) Yellow cross Ypres, Belgium, 14–15, 90, 200, 248, 308 See Mustard (HS) Y 62-63 virus, 566–567 Yellow fever, 593–595, 599 history, 10, 12, 32, 37, 50, 418 Z Yellow rain, 419, 421, 609, 656–660, 665–666, 668 Zaire, 432, 435, 594 Yeltsin, Boris, 4, 68, 420, 422, 453–455 Zhukov, Georgi, 54 Yemen Civil War, 56, 104, 200, 657 Zinc, 363 Yersin, Alexandre J. E., 482 Zinc cadmium sulfide, 52 Yersinia enterocolitica, 485 Zinc oxide (HC), 260–262 Yersinia pestis, 75, 463, 482, 485–486, 491 Zone of Interior (ZOI), 326 detection, 383 , 273 lethality, 439

721