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Biological Warfare Support & Information

Anthrax/splenic fever/woolsorters' disease/murrain/malignant pustule

Transmission

The bacillus anthracis can be transmitted to men through contact with infected animals, through their hides, hair or meat, or water contaminated by them. The disease has two forms: the external, in which the bacillus enters a man through cracks and abrasions in his skin; and the internal, usually caused by dust from the infected animals or their hides or wool being inhaled. If contracted in the internal form, and untreated, it is almost always fatal within three days.

Precautions

Vaccination. Though this is safe it is not widely used but gives 90% protection. It is received by four intramuscular injections of 0.5ml each, the first three at intervals of three weeks and the fourth after a further six months. Booster doses of 0.5ml are required annually.

Infected areas should be shunned, especially on dry and windy days and where the ground is usually damp or marshy. Where feasible they may be disinfected by powerful disinfectants such as a 5% solution of chlorine or a 10% solution of carbolic.

Untreated hides should be kept damp.

Infected livestock should be slaughtered in deep, ready-dug holes which should then be filled in immediately though even this may not suffice because earth-worms are believed to carry the spores to the surface again, even years later. Suspect hides should be burned and the ashes buried. Human fatalities should also be buried in deep graves.

If burial cannot be immediate, carcasses should be covered, or be drenched in disinfectant or fly repellent to prevent spread of the disease by the horsefly or housefly.
If an animal which may have been exposed to anthrax is noticed to be standing alone, or to be staggering drinkenly, sweating, having difficulty in breathing, or to have cold ears, feet or horns, or blood-shot eyes or nostrils, or blood-stained diarrhoea, it should be shunned. Similarly to be avoided are carcasses with swollen abdomens, pustules, swellings around the neck or lower chest, or which are decomposing unusually quickly or accompanied by watery, blood-stained diarrhoea.

Infected persons should be treated by strict isolation. Their clothes and bedding should afterwards be burnt, and also be buried deeply and far away from any water supply. These precautions should also be applied to those nursing the sick of this disease.

Breaks in the skin should be covered by sticking-plaster, or by gloves.

In the presence of anthrax discharged as a weapon, a gas mask or other filter should be worn over the mouth and nostrils. Clothing should include rubber boots and gloves, and readily lend itself to decontamination. It should be changed, and the hands and face be washed thoroughly, before meals.

Symptoms

External Form. Several hours or days after infection a red swelling appears at the site of entry of the bacillus into the body. This grows to cover an area about the size of a hand. From this a pustule rises which, when it bursts, leaves a blue or black scab about the size of a new halfpenny piece but which increases in area.

This is accompanied by fever and prostration, and the spleen becomes swollen. Where this does not lead to complete collapse and death, in about ten days from the first appearance of symptoms and with a slow disappearance of inflammation, convalescence begins.

Internal Form. This is four times as lethal as the external form. The incubation period is one day. The symptoms vary, in part according to whether the disease has been contracted by swallowing infected meat or water, or whether inhaled. They include listlessness and headache, intestinal or stomach ulcers and enlargement or gangrene of the spleen, with bloody diarrhoea. There is also pneumonia and internal bleeding. Convulsions may occur before final collapse.

Treatment

The pustule should not be cut or cauterised, but be kept clean.

The antiserum should be received.

Benzyl penicillin by intramuscular injection of 600mg. twice to four times a day for twelve days.

Chlortetracycline or oxytetracycline orally at 1 gram three times a day for adults. For children, less according to age.

Botulism

This poisoning is very rare, but of all those occurring in nature it is perhaps the most dangerous to both men and animals. An ounce could kill close on forty-three million people. There is no immunity to it. There is no effective treatment. Because of its rapid action and the small amount of fatal dose it readily lends itself to use as a weapon.

When it occurs naturally, and there is normal access to professional medical care, the mortality rate is between 50% and 70%. That is when it is swallowed. Entering through an abrasion in the skin is a thousand times more lethal. Acting upon the nerves and muscles of the respiratory system it is thought that if released as an aerosol cloud it would quickly kill all who inhaled it.

Transmission

Clostridium botulinum exists in the soil or may appear in decomposing meat. It also exists in mud at the bottom of the sea and can be taken up by fish. It survives for short periods in our atmosphere as a spore and, when reaching an oxygen-free environment, can multiply and produce soluble poisons. Though it could enter the body though a cut in the skin, in peacetime it almost always enters with faultily preserved or prepared food. It has appeared in wild and domestic fowls, hare, rabbit, salmon and other fish, in tinned vegetables, and in soups, brawns, pate and other dishes made from these. It has been known to appear in cheese and also in water.

Refrigeration only prevents bacteria from multiplying; it does not kill them. Clostridium botulinum spores can also survive six hours of boiling. Neither preserving processes at home - including pickling - nor commercial canning procedures therefore ensure safety. And due to the speed of action of this poisoning, its positive diagnosis may have to await laboratory tests after death.

Precautions

Botulism from food is not caused by the bacterium itself; only by the poison it produces. Precautions therefore depend on a clear idea of the steps leading to this. Clostridium botulinum requires freedom from oxygen in order to breed. The poisons will be destroyed if the food is heated thoroughly shortly before it is eaten.

Where possible, foods should be kept dry.

Water may be purified of type A botulinum by the use of 0.6mg. of chlorine per litre. This treatment is more effective with water from a tap than when it is straight from a well.

Symptoms

Botulinum interferes with the working of the nerves and muscles. Its symptoms being within a few hours of swallowing or inhaling it. They may include stomach pains, though more often the abdomen is distended without any pain, vomiting and giddiness. There is a heaviness of the eyelids and dilation of the pupils, with blurred and double vision. This is accompanied by paralysis of the legs and respiratory system and facial muscles, producing dribbling and choking. Finally comes asphyxiation. There may be no rise in the body's temperature.

Treatment

Particularly when the onset of symptoms follows closely upon the consumption of food, this should include the encouraging or vomiting by the drinking of a strong saline solution or by other means.

At least 10,000 units of each of types A and B and 1,000 units of type E Immunoserum antibotulinicum should be received by intramuscular or subcutaneous injection as soon as poisoning is suspected to have occurred. As soon as poisoning is confirmed by appearance of symptoms a further 50,000 units of each of types A and B and 5,000 units of type E should be received by intravenous or intramuscular injection, and this treatment should be repeated every four to twelve hours as necessary.

Antibiotics may also be tried.

Brucellosis/levant fever/undulant fever

The spores are fairly hardy, able to survive for two months in dry soil. The vaccine is not readily available in Britain, nor is it very effective. It is a disease affecting both livestock and men, and is especially incapacitating due to its tendency to recur. Its mortality rate is low, only 6%. Though not contagious it would be suitable as a weapon meant not specifically to kill but to reduce a country's ability to wage effective war.

Transmission

Brucellosis occurs in pigs, goats, cattle and some other animals including house-mice. It may be contracted by men through wounds, or by swallowing or inhaling it. But in the several hundred cases requiring treatment each year in Britain it usually occurs through contaminated milk in which brucella abortus can live for several weeks, or through meat. It rarely occurs in pasteurised milk.

Precautions

Infected animals should be avoided, and suspect meat destroyed.

Suspect milk should be pasteurised or boiled.

During an epidemic, mice infestations should be eradicated.

Vaccination should be received.

Symptoms

The incubation period is three weeks from infection. Symptoms include headache, tiredness, poor appetite, constipation, sweating, coughing, vomiting, and a tenderness of the liver and spleen which may both be swollen. The severe fever accompanying these symptoms with temperatures up to 104 degrees F. usually lasts for about three months, during which the body becomes very weak. Relapses after recovery had apparently begun are common.

Treatment

Initially by the use of tetracycline hydrochloride by mouth in 250 to 500 mg. doses every six hours until two or more days after the temperature returns to normal; by intramuscular injection of 200 to 400 mg. daily in divided doses.

Others of the tetracycline group of drugs may be used.

If no other treatment is available, curled dock/yellow dock/rumex crispus may ease symptoms. This is prepared by decoction of the dried roots, and taken in 3.5 ml. doses three times daily. This plant is easily found almost anywhere, even by the seashore. It groes up to three feet tall, has curling edges to its leaves, and flowers in green between June and September.

Cholera

This internationally quarantined bacterial disease was a serious hazard in nineteenth-century Britain. It is suited to use as a weapon for the following reasons.

An intestinal infection, most dangerous to children and the elderly, its severity varies from not obliging the infected person to go to bed, to death within one day. Where medical treatment is available the mortality rate may exceed 50% in epidemics. The deathrate in some untreated epidemics soars to 90%.

Factors encouraging its spread include warmth, low-lying places especially near lakes and pools, and the absence of direct sunlight or rain.

Transmission

The vibrio* cholera is usually introduced into a community by infected human excrement in the water supply in which the bacteria survive for up to a week, or are settled upon by flies which then move onto food or drink. Cholera may also be spread in milk.

Precautions

Haffkine's vaccine of up to eight million attenuated (i.e. reduced in strength) vibrios, given by two subcutaneous or intramuscular injections of 0.5 and 1 ml. respectively between a week and a month apart. Provided that doses of 1 ml. boost this every three to six months, this reduces the chance of catching cholera, and its severity if one does. It gives better protection to adults than to children, but is ineffective for one person in five. In epidemics the heaf gun is sometimes used for mass vaccination.

The main route of cholera being the water supply, every effort should be made to ensure the purity of this, by boiling, chlorination or other means.

Strong disinfectants should be added to body-wastes, and insecticides should be used in and around latrines.

Before they become dry - in which state the bacteria die, but before doing which they may be blown about - body-wastes should be disposed of by burial at least fifty feet from any water supply.

Fly papers and relatively safe insecticides should be kept in and around places in which food, drink or their utensils are stored, used or eaten, and extreme hygiene should be exercised there. Hands should always be washed thoroughly before preparing or eating meals. Teeth should not be picked, or fingernails bitten.

Garbage should be burned or buried before it attracts insects. Houses should be fly-proofed.

Crowded or insanitary conditions should be shunned.

All those infected - and their nurses too for five days after they last had contact with the disease - should be kept in isolation.

All food and drink other than straight from tins or preserving jars, including fresh fruit and vegetables, should be kept covered and be boiled or at least scalded before being eaten.

Symptoms

The incubation period varies from hours to about five days. Symptoms begin suddenly with acute but painless diarrhoea which is sometimes accompanied by vomiting. This first stage, which lasts up to twelve hours, usually begins to include extremely painful cramp in the limbs and then the stomach, a great thirst, an inability to urinate, and an appearance which may be deathlike as the body becomes waster through loss of its liquids. The temperature drops to as low as 75°F./23.9°C., the face becomes pinched with the eyes deep-sunk and the skin takes on a bluish pallor.

The faeces of the infected person, from soon after start of the diarrhoea, will have been of characteristically 'rice-water' consistency.

The stage which follows may be of almost complete collapse. The body becomes dry and wrinkled, and of a darker blue or brownish shade. The pulse may be weak and rapid or imperceptible; the temperature drops even further and the person is unable to speak above a whisper. Remarkably, however, he may still be aware of both his condition and his surroundings, with his mental faculties unimpaired other than by a marked apathy. It is at this stage, and often within a day of the onset of symptoms, that cholera usually kills.

The third stage of cholera - if reached, - is basically one of recovery. In it the temperature rises towards normal, the body loses is unnatural hue, the vomiting and cramps reduce and stop, and the diarrhoea becomes less acute. Within the first three weeks, however, relapses which take the form of fever are not uncommon and may rapidly end in death. Unless urination can be begun again, death may also result from uremia, ie, keeping the body-wastes in the blood and organs.

Treatment

The first thirty-six hours survived, an infected person will probably recover. But surviving cholera in the presence of widespread damage and disruption may primarily be a case of not contracting it in the first place.

Of next importance is recognising it in time for action to be effective. Medicines may be of little if any direct use in actually saving life. Cholera kills through dehydration, by passing liquids out of the body, which is about 60% water. Treatment involves replacing the fluids almost as quickly as they are being lost. What life may really depend on is the drinking of water - not cups of it, but pints, or gallons, which itself will be a problem unless plentiful supplies of pure water can be made available.

From the onset of symptoms absolute rest is essential and, apart from pure water, only barley water should be taken.

Medicines may not act quickly enough to save many lives in cholera. But for their longer-term action against the causative bacteria any of the following drugs should be given if available.

Sulphaguanidine orally for three days in doses of 3 grams up to four times a day; followed by a further four days in which 3 grams are taken twice a day, as treatment for mild cases. In more severe cases 5 grams twice a day may be the continuing dose.

Chlortetracycline or oxytetracycline orally by up to 3 grams daily in divided doses.

For the diarrhoea kaolin may be taken, and up to 4 mls. of geum three times a day. The latter is prepared by infusion or decoction of the dried root of avens/colewort/geum urbanum L., common in woods and hedgerows throughout Britain except in northern Scotland. Up to two feet tall, its stem is thin, hollow, and reddish brown up one side. Its leaves are finely hairy, dark green on top, lighter underneath. It flowers in yellow from June to November. The roots, yellow-brown outside and purplish within, should be collected in Spring, dried and powdered.

In case of difficulty in urination, 4 mls. of milfoil should be taken three times a day. Milfoil/achillea millefolium/devil's nettle/yarrow grows up to eighteen inches tall, is furry and is common in pastures, gardens and by roadsides in Britain. Between June and September it flowers in white, pink and lilac. Its upper parts, which should be gathered while flowering, are dried and prepared by infusion.

Smallpox

Transmission

The poxvirus variolae can be directly transmitted by being swallowed or inhaled. It can also be spread indirectly, upon clothing or other articles passing from an infected person through third or more parties. It is thought that a dry atmosphere favours its spread. Insanitary or crowded conditions certainly do so.

Precautions

The vaccine (Vaccinium Variolae fluidum dermicum), given in an 0.02ml. dose pressed or scratched into the skin, is mass-produced, readily available and very effective. To afford real protection though, vaccination needs to be renewed every three years.

Methisazone also gives protection. The dose is 3 grams orally, morning and evening. The dose for children is a half or quarter of this, according to age.

During an outbreak of smallpox all crowded places should be avoided, especially those which are poorly ventilated. A thick filter should be worn across nose and mouth.

All bedding and clothing which has been used by an infected person should be burnt.

Extreme hygiene should be practised in enclosed places, especially around cooking and eating areas.

Symptoms

The incubation period is about twelve days.

Days 1 and 2: Chill, a rapid pulse and fever with temperatures which may rise above 104°F./40°C. Stiffness and pain, particularly in the back. A redness round the lower stomach and inside the thighs. Headache, vomiting and constipation. More rarely, these symptoms follow or accompany convulsions.

Day 3: The fever drops. The forehead, especially round the roots of the hair, becomes red. Beneath this rash 'pimples' may be felt.

Days 4 and 5: The 'pimples' have now spread, grown to pea size, and are filled with clear liquid.

Days 8 and 9: The skin eruption has spread, including to the mouth and throat, and its clear liquid contents have turned to yellow pus. The tips of the pustules are now convex. The fever returns, and brings raving or coma.

Days 11 and 12: The fever drops again, and the pustules begin to dry up.

Treatment

Complete rest in an airy, darkened room. Soup and milk diet.

Other agents coming soon!

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