History of Bioterrorism

History of Bioterrorism
History of Bioterrorism
Nineteenth Century (1800s)
Twentieth Century (1900s)
Twenty First Century / Bioterrorism Today
From the beginning of history, records are replete with examples of biological or chemical materials being used in warfare.

Chemical and biological warfare can be loosely defined as the tactical use of chemicals, pathogens, or toxins during military operations to harm (kill, injure, incapacitate, damage) an adversary (personnel, animals, or plants).

Biological warfare is also distinguished from other biological factors affecting combatants in war by a single characteristic: Those who use biological and chemical agents have consciously and deliberately chosen to use them as weapons because of their potentially injurious or lethal effects.

So for example, the conquest of Mexico by Cortez's small, ragtag band of Spanish mercenaries might never have succeeded had the Aztecs not lacked natural immunity to the smallpox virus carried by the Spaniards. The disease spread rapidly through the population of Native Americans and killed, at a minimum, hundreds of thousands. However, since Cortez's soldiers were largely unaware that the microbes they carried would prove harmful to the native population, this was not biological warfare, according to the definition. Cortez and his men did not deliberately use the biological agent (i.e., smallpox) as a weapon.

In modern times, this deliberate effort to engage in biological warfare is called bioterrorism. Chemical and biological terrorism can be defined as the overt or covert use of chemicals, pathogens, or toxins by individuals, groups, or governments to cause harm for ideological, political, or financial gain.

Biological warfare dates back to ancient times, and has changed from crude use of agents to more sophisticated use as science evolved. Before modern times, biological materials were utilized as weapons in warfare in three ways:

•  Using infectious materials in an attempt to poison or render toxic an enemy's food or water supplies

•  Attempting to expose the enemy to infectious organisms or toxins, by delivering the material to the enemy via catapults, arrows, etc.

•  Distributing biologically infected fomites to transmit disease (i.e., clothing, blankets, etc. previously used by infected persons)

In modern times, both crude and sophisticated methods of biological warfare exist.

There are a number of examples of biological agents used in warfare in the historical period before the Common Era (BC).

Although people in ancient cultures did not understand ”germ theory”, they did seem to connect dead or decaying biological materials with initiation of illness. Perhaps they may have simply seen the flinging of rotting corpses or smelly materials onto their enemies as a way of terrorizing their opponents. Whichever effect was intended, ancient armies used crude biological agents as weapons on several noted occasions.

Examples include the following specific reported incidents. Where known, especially as it affected the military outcome, the results of the use of the biological materials as weapons are noted.

Ancient Times Timeline
600 BC
590 BC
400 BC
400 BC
300-100 BC
190 BC

Timeline Events

•   600 BC: Assyrians poisoned the wells of their enemies with rye ergot, which affected those ingesting it with sickness or death. The fungus that causes ergot produces ergotamine, a hallucinogen similar in chemistry and effects to LSD. Ergot poisoning causes delusions, paranoia, myoclonic twitches, seizures, and cardiovascular problems that can lead to death. Those affected seemed to go mad, which added the terror element and served to demoralize their comrades.

•   590 BC: During the siege of Cirrha, Solon of Athens is said to have used hellebore roots (a purgative) to poison the water in an aqueduct leading from the Pleistrus River. In that same era and area, Sparta used toxic smoke generated by burning wood dipped in a mixture of tar and sulfur during one of its wars with Athens.

•   400 BC: Sythian warriors reportedly dipped their arrows into decomposing bodies or in blood mixed with feces from diseased persons in the attempt to make even glancing wounds fester.

•   400 BC: Writings of the Mohist sect in China tell of the use of ox-hide bellows to pump smoke from furnaces in which balls of mustard and other toxic vegetable matter were being burnt into tunnels to discourage the besieging army from digging. The use of a toxic cacodyl (arsenic trioxide) smoke is also mentioned in early Chinese manuscripts. The Chinese may have developed smoke-type weapons for use in war as a result of their practice of fumigation of dwellings to eliminate fleas (know to have been practiced by the Chinese as long ago as the Seventh Century BC); or, according to other speculations, from the Chinese philosophy that all matter faded into an insubstantial form, which may have led them to study the effects and properties of vapors. Chinese writings contain hundreds of recipes for the production of poisonous or irritating smokes for use in wars, and many reports of their actual use. For example, they created and used an irritating "five-league fog" made out of slow-burning gunpowder to which a variety of ingredients –including, notably, the excrement of wolves – was added.

•  300-100 BC: The Romans used bees and hornets as weapons by catapulting them at their enemies. Some historians blame this practice for a shortage of hives during the waning years of the Roman Empire.

•  190 BC: In the Battle of Eurymedon, the Carthaginian General Hannibal won a naval victory over King Eumenes II of Pergamum by catapulting pottery jars containing poisonous snakes onto the decks of his enemy's ships. This imaginative tactic apparently actually worked. According to a Roman historian:

"At first these projectiles excited the laughter of the combatants [King Eumenes' sailors], and they could not understand what it meant. But as soon as they saw their ships filled with snakes, terrified by the strange weapons and not knowing how to avoid them, they turned their ships about and retreated to their naval camp. Thus Hannibal overcame the arms of Pergamum by strategy." [From "Hannibal," a section of Vitae Excellentium Imperatorum ("Lives of Excellent Men") by Cornelius Nepos]

From the 1100s to the late 1600s, the actual spread of disease by means of germs was still not understood. Medieval medical belief was that the foul smell of rotting bodies (described as "bad air," or mal aria) was the mechanism that spread disease. They might not have completely understood the details of disease transmission, but their crude tactics frequently worked.

During the 17 th century there was still little or no systematic thinking about the use of biological weapons. The possible impact of biological weapons had always been obvious to military leaders, who usually found disease to kill more men in the course of a campaign than enemy fire. However, in the 17 th century, the existing lack of knowledge about how disease was transmitted, coupled with the lack of knowledge about how to direct a disease so that it only affected the enemy, made the use of disease as a weapon seem improbable.

Nevertheless, many reports survive of biological agents being used to infect an enemy during this era. When medieval forces used human or animal corpses as weapons, they had the intention of using biological weapons to harm their enemies. Thus, this falls under the definition of biological warfare.

1100s to 1600s Timeline

Timeline Events

•  1155, Italy: In Italy, during the battle of Tortona, the Roman Emperor Frederick Barbarossa used the bodies of dead enemy soldiers to contaminate the enemies' wells.

•  1340, France: During the Hundred Years War, siege engines were used as platforms to fling putrefying animal carcasses into the besieged castle in Thun l'Eveque, northern France. No disease seems to have broken out, but the defenders were so affected by "the stynke," which was so "abominable," that they eventually "could not longer endure" it. The defenders negotiated a truce.

•   1346, Russia: In the Russian Crimean peninsula on the Black Sea, Khan Janibeg, the Tartar commander in the siege of Kaffa, catapulted corpses of some of his own men who had died of bubonic plague into the city, apparently initiating an epidemic. After the city surrendered, refugees unwittingly carried plague germs with them to Genoa, Italy, which some historians speculate was the cause of the "Black Death" epidemic in Europe.

•  1422, Bohemia: During the Holy Roman Empire, at Karlstein, Bohemia, attackers catapulted the corpses of dead soldiers killed in battle into the walled city. In addition, some 2,000 cartloads of excrement were piled up near the walls in the attempt to spread illness. However, no disease broke out and the city held firm. The siege was abandoned after five months.

•   1495, Italy: In Italy, near Naples, the Spanish provided their French enemies with wine tainted with the blood of lepers.

•   1528, Peru: During the conquest of the Incan Empire in Peru, Pizarro was said to have given South American natives some clothing contaminated with smallpox.

•   1672, Groningen: During his siege of the city of Groningen, the Bishop of Münster. Christoph Bernhard van Galen acquired the nickname "Bommen Berend" (or "Bombing Berend") because of his extravagant use of artillery. Among the explosive and incendiary devices he used were some filled with belladonna, intended to produce toxic fumes. The use of these weapons proved indecisive, in part because the bombardiers failed to take into account the direction of the wind. The Bishop's troops eventually had to withdraw, lifting the siege on the 28th of August. This event is still celebrated in the city traditions of Groningen.

During this century, more was understood in medical science about disease processes. In Europe, experiments began into ways to prevent diseases.

In the early 18th century, a number of things occurred that enabled strategic thinking about biological weapons. Some military strategists began to explore the possibilities of using preventive measures to protect their own troops while simultaneously using disease organisms to inflict harm on their opponents.

This strategic military thinking began to address one major problem in the effective tactical use of biological weapons: Biological weapons kill indiscriminately. They are potential weapons of mass population destruction, but if they are sufficiently deadly to strike decisively at intended enemy populations they are just as likely to inflict the same damage on the attackers as well.

Eighteenth Century (1700s) Timeline
Crude Use
Smallpox Variolation
Variolation in Military Strategy
American French and Indian War
American Revolution

Timeline Events

•   1700s, Crude Use of Biological Agents. In the eighteenth century, combatants continued their crude use of biological agents. For example:

•  In 1710, Russian attackers catapulted plague cadavers into the city at the city of Reval, Estonia, which was held by soldiers of King Charles XII of Sweden.

•  In 1785, Tunisian Moslem forces catapulted plague-infested clothing into the city during the siege of the city of La Calle, held by Christian forces.

•  In 1797, Napoleon attempted to infect the inhabitants of Mantua, Italy with swamp fever.

•  1718, Smallpox Variolation in England. In 1714, an article appeared in the (English) Royal Society's Philosophical Transactions that laid the foundation for a different view of the possibilities of biological warfare. The article contained a description of a technique used by a physician in Smyrna (now Izmir, present-day Turkey), Giacomo Pylarini, to confer some degree of protection from smallpox. The technique, variolation, involved taking some of the liquid from a person with a mild case of smallpox and rubbing it into a small scratch made on the person to be protected. The variolated individual would usually suffer a mild case of the disease and would then, be immune to further infection on recovery. The risk of death from variolation (estimated at 2 to 3%) was seen as acceptable when compared to mortality rates of the disease among unprotected populations.

Variolation became popular in England because of the actions of Lady Mary Wortley Montague , who, in her youth, survived a case of smallpox that killed her brother. Lady Mary was the wife of Lord Edward Wortley Montague, the British ambassador to the Ottoman Empire in Istanbul. There, Lady Montague observed the practice of variolation as the Turks practiced it since 1670.

Determined not to allow her family suffer as she had, Lady Montague directed the Embassy's surgeon, Dr. Charles Maitland, to learn the technique. In March 1718, Dr. Maitland variolated the Montague's four-year-old daughter in the presence of several respected British physicians, including the king's. With royal interest being aroused, Dr. Maitland was given permission to perform what came to be called the Royal Experiment . Six condemned prisoners were variolated and promised full pardons if they survived. When the prisoners did, indeed, survive (and received their pardons), further experiments were done on charity children. The safety of the procedure thus being deemed adequately established, two of the king's grandchildren were treated on April 17, 1722. After this, the practice of variolation spread rapidly, reaching even rural areas of England by the 1740s.

True smallpox vaccination efforts, however, began with Edward Jenner's discovery during his medical practice that patients who came to him with the mild discomfort and pustules caused by cowpox appeared to be protected from getting smallpox. He began documenting cases of subjects who had contracted cowpox and were subsequently immune to smallpox and then tested his hypothesis by inoculating healthy subjects with fluid from the pustules of cowpox-infected patients.

With variolation, the severity of the patient's reaction was difficult to control or predict. Subjects often suffered debilitating disease at worst and at best still became carriers of disease in the community. By contrast, Jenner's results indicated that vaccination with cowpox conferred immunity to smallpox without the adverse effects seen with variolation.

Following two unsuccessful attempts to get his findings published, Jenner finally published Origin of the Vaccine Inoculation in 1801. Jenner reported that, by 1801, over 100,000 persons in England had been vaccinated and that cowpox vaccination had been introduced into many other countries, including the United States, France, Spain, and Canada. This landmark contribution to medical science was the foundation of preventive medicine and immunology; it was the precursor Pasteur's work on rabies and anthrax immunity around 75 years later.

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•   Variolation in Military Strategy. Those familiar with the practice of variolation were cognizant of the following:

•   Smallpox in a previously unexposed population could be devastating,

•  Smallpox could be reliably produced by exposing healthy individuals to materials obtained from smallpox victims,

•  Individuals who had a case of smallpox, but survived, did not become infected again, and

•  The dangers of smallpox could be significantly reduced by variolation.

Operationally speaking, the commander of an army made up of individuals already exposed to smallpox – either naturally occurring or through variolation – would stand to gain if smallpox could be introduced to an opposing army which was not similarly protected. Additionally, having access to persons afflicted with smallpox, the commander could thus acquire materials that could be used to expose an immunologically naive enemy to the ravages of the disease.


•  1763, American French and Indian War. Apparently such a situation occurred in 1763, at Fort Pitt, in western Pennsylvania, during the French and Indian Wars. The commanding officer of Fort Pitt found himself in a difficult situation. The Indians were pressing the attack all along the Ohio River valley frontier. Three British forts in the area had already been lost. Many colonial settlers had come to Fort Pitt seeking safety. Smallpox appeared among the refugees. On June 23, two Delaware Indians appeared at the fort, asking for a parley. On the 24th, a delegation including William Trent, commander of a local colonial civilian militia met with the Indians. The Indians offered the British an opportunity to surrender the fort. They promised safe conduct for the fort's inhabitants, an offer that previous experience led the British to distrust. At this point, according to Mr. Trent's journal, "Out of our regard for them, we gave them two Blankets and a Handkerchief out of the Small Pox Hospital. I hope it will have the desired effect." The Delaware Indians did suffer greatly from an epidemic of smallpox, which contributed to the British victory at Fort Carillion. The operation significance of the incident at Fort Pitt is hard to determine. The materials given to the Indians may not have been the only source of infection among them. For example, smallpox cases had occurred among the three other forts in the Ohio River valley area that the Indians had subsequently overrun and ransacked. This is the best-documented incident of biological warfare in the New World in the 18th century, but it was not the only one.

•   1775, American Revolution. Other significant incidents of biological warfare occurred during the American Revolution:

•   In April 1775, the British in Boston found themselves facing both the Continental Army and a smallpox epidemic. The British began to variolate their troops. However, they also began to variolate colonial civilians who were fleeing the city. There is no documentation surviving that demonstrates the British intention in this instance, but it was well known that persons who were variolated could become infectious to others. General George Washington, commander-in-chief of the Continental Army, believed that "... the enemy intended spreading the Small pox amongst us." Washington delayed his attack on Boston until he felt the danger was past.

•   Later, in 1776, Washington saw his attack on Quebec fail, in large part because many of his soldiers were affected by an outbreak of smallpox. Washington regarded smallpox as "the greatest enemy of the Continental Army." On January 6, 1777, he issued orders to Dr. William Shippen, Jr., Director General of hospitals and Chief Physician to the Continental Army, to inoculate all Continental troops and the new recruits. Washington advised him to keep "the matter as secret as possible."

For the first time in history, measures had been taken to secure an army against a very real risk of a deliberate biological attack. Furthermore, these measures worked. After 1777, the operations of the Continental Army were never again hampered by smallpox.

By the 1800s, uses of biohazardous materials as weapons of war attracted far less attention than the development, improvement, and use of heavy artillery. Still, there were reports of biological agents being used for tactical purposes during the American Civil War.

Nineteenth Century (1800s) Timeline
American Civil War

Timeline Events

•  1860-1863, American Civil War. Records show the use of biological warfare by confederate troops.

•   In 1860-1863, W.T. Sherman's memoirs describe Confederates' poisoning of ponds by tossing carcasses of dead animals in them.

•   In 1863, confederate soldiers under General Johnson, retreating in Mississippi, placed animal carcasses in Union wells.

•   In 1863, Dr. Luke Blackburn attempted to use smallpox against Union troops. He arranged the sale of smallpox-contaminated clothing to unsuspecting Union officers. Although records indicate that there were numerous deaths from smallpox among Union troops during the Civil War, whether any of these can be attributed to the machinations of Dr. Blackburn is unknown – although friends and relatives of some Union officers who died claimed that Dr. Blackburn was to blame. Dr. Blackburn attempted to use the contaminated clothing scheme to spread yellow fever to Union troops, but without success. Until 1900, no one knew that yellow fever could be transmitted only through mosquito bites.

In 1863, the Union side officially banned this type of action. U.S. Army General Order No. 100 stated: "The use of poison in any manner, be it to poison wells, or food, or arms, is wholly excluded from modern warfare."

•  Germ Identification

Early in the 20th century, bacteriological warfare became more sophisticated. As microbiology developed, the etiologic agents of many diseases were identified, and many of these were grown and studied in laboratories.

Before and during the two World Wars, the more developed nations experimented with, refined, created, and sometimes used biological agents against their enemies, overtly or covertly. Because the knowledge, research, and equipment needed to develop biological agents into weapons were initially scarce or expensive, during the first half of the century the use of biological warfare was generally practiced only at the state-sponsored level.

During the latter portion of the 20th century, the use or attempted use of biological agents increased. However, people or groups without ideologies most often used biological agents for criminal purposes.

•  Biological Toxin Weapons Convention

In 1972, the US along with 100 other nations signed the Biological Toxin Weapons Convention. This was the world's first treaty banning an entire class of weapons. The treaty prohibits possession of deadly biological agents except for defensive research. However, the treaty contained no clear mechanisms to enforce the ban.

W. Seth Carus of the National Defense University compiled a list of incidents during the past century involving biological agents. Of these, most were criminal rather than terrorist in nature and involved attempts to poison or infect relatives, spouses, or associates. Agents involved in such attacks ranged from ricin to HIV.

According to the Monterey Weapons of Mass Destruction Terrorism Database, there were 175 reports in 1999 involving biological weapon incidents. This represents over 25% of the incidents that have been reported since 1900 and 35% of the incidents that have occurred since 1990. Of the 175 incidents in 1999, 104 occurred in the US (81 involved anthrax threats). The vast majority were hoaxes. However, in light of the terrorist attacks on the US in 2001, the US now remains under heightened alertness relative to bioterrorism.

•  Crude Use versus Scientific Advances

From about 1950 until 2000, there were two main "branches" of biological weapons-related developments:

1. Crude or terrorist use: In the latter part of the century, use of biological agents primarily occurred among rogue nations or desperate rebel groups. At times the use of biological agents was as crude as when first used thousands of years ago. In other incidents, militant rebels, terrorists, or criminals used some degree of scientific knowledge in an attempt to "weaponize" these biological agents.

2. Scientifically advanced biological weapons development: The advancement of scientific knowledge about infectious agents and disease vectors, as well as the wide availability of requisite equipment, meant that biological agents could be developed using relatively inexpensive means and with potentially devastating effects. In the 1970s, the developed nations began negotiating treaties with other nations to prevent the use these weapons and to destroy stockpiles of biological warfare supplies.

Historical incidents of biological warfare or biological agent use with the intent of causing harm in the 20th century are roughly grouped on the timeline.

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Twentieth Century (1900s) Timeline
1914 - 1918
World War I Incidents
1939 - 1945
World War II Incidents
Crude Terrorism
Cold War Incidents
Crude Terrorism

Timeline Events

•  1914-1918, World War I Incidents

Biological weapons were developed and used during World War I, although these attacks were primarily directed at animals, such as the horses and mules used to move heavy artillery pieces into position, rather than human combatants.

A German-American, Dr. Anton Dilger, allegedly grew cultures of Bacillus anthracis (anthrax) and Pseudomonas mallei (glanders), supplied by the German government, in his Washington, D.C. laboratory. The resulting biological agents and an inoculation device were given to sympathetic dockworkers in Baltimore, Maryland with the goal of infecting some 3000 horses, mules, and cattle being shipped to the Allied troops in Europe. German secret agents reported to their superiors that several hundred troops were affected along with the animals.

Other German secret agents carried out similar campaigns in Romania and the US (1915-1916), Argentina (1916-1918) and Spain and Norway (exact dates and details are vague). Despite the claims of some of the German undercover agents, these schemes had little impact on the war.

The Germans are also alleged, during World War I, to have attempted to spread cholera in Italy, plague in St. Petersburg, and drop biological bombs over Britain.

Geneva Protocol
In 1925, the United States was one of the nations that signed the Geneva Protocol, prohibiting the use of chemical or biological agents. The Geneva Protocol did not prohibit research or development of these agents. At the time, Japan refused to ratify it. Even though the United States signed this agreement, the U.S. Senate did not ratify it for 50 years.

•  1939-1945, World War II Incidents

In the years preceding World War II, the Japanese military practiced biological warfare against China. A notorious division of the Imperial Army, Unit 731, spearheaded this effort. This division was established in occupied Manchuria around 1936 and used scores of human subjects to test the lethality of various disease agents, including anthrax, cholera, typhoid, and plague. It is estimated that as many as 10,000 people were killed there. Another biological warfare site, named Unit 100, was developed near Changchun.

In active military campaigns during World War II, an estimated several hundred thousand people, primarily Chinese civilians, fell victim to biological attacks by the Japanese. In October 1940, the Japanese dropped paper bags filed with plague-infested fleas and grain over the cities of Ningbo and Quzhou in Zhejiang province. The grain attracted rats, which became infected from the fleas, and subsequently spread the disease further into the nearby human population.

Other Japanese attacks on the Chinese involved contaminating wells and distributing poisoned foods. During the war, the Japanese allegedly used over 3000 American, Korean, British, Australian, Soviet, and Mongolian POWs as guinea pigs. The Japanese army also unsuccessfully attempted to produce advanced biological munitions, such as pathogen-laced bombs.

As the leaders of Unit 731 saw Japan heading for defeat, they burned their records, destroyed their facilities, and fled to Tokyo. Later, in the hands of occupying US forces, they brokered a deal, offering details of their work in exchange for immunity to war crimes prosecution.

Allied scientists also experimented with biological agents. For example, in 1941 the British experimented with anthrax off the Scottish coast.

United States
The United States launched its own studies into use of and defense from biological agents. The US Army developed Camp Dietrick (now Ft. Dietrick), Maryland, into a site for biological research and development.

•  1950s-1970s. Crude Terrorist Use

These events are considered crude use of agents by terrorists during this period.

1950: The Mau Mau in Africa used plant toxins to kill livestock.

1960s: The Viet Cong used fecally contaminated spear traps during the Vietnam War.

1970: The Weathermen, a group opposed to American imperialism and the Vietnam War, allegedly attempted to obtain biological weapons from Fort Detrick, Maryland to contaminate the water supply systems of US cities.

1972: Members of the right-wing “Order of the Rising Sun” were arrested in Chicago. They had in their possession 30 to 40 kg of typhoid cultures they planned to use to poison the water supply in Chicago, St. Louis, and other western cities. It was felt that, had the detailed plan succeeded, it would have caused no problem due to chlorination of the water supplies.

1972: Police arrested two teenagers, who had started a small militant group that had visions of eliminating humanity so that the group's members could start a new master race. New recruits to the group tipped off police, who discovered that these teens actually had biological agents, including the typhus bacillus.

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•  1950s-1970s, Cold War Incidents

United States and USSR
By the end of World War II, Americans and Soviets were far along their own paths in developing biological weapons.

During the Cold War years, biological weapons programs in the United States and the Soviet Union explored the use of hundreds of different bacteria, viruses, and biological toxins. Each country devised sophisticated ways to disperse these biological agents in fine-mist aerosols, to package them in bombs, and to launch them on missiles.

In 1969, the US military held a massive field test of biological warfare agents, involving a fleet of ships, caged animals, and the release of lethal biological weapons. Soviet spies were lurking in nearby waters and collected samples of the agents tested.

1969, US Ban
That same year, the World Health Organization issued a report that described the unpredictability of biological warfare weapons and the associated risks due to the impossibility of complete control. At the end of 1969, possibly prompted by Vietnam War protests, President Richard Nixon ended the US offensive biological warfare program and ordered all stockpiled weapons destroyed. From that point on, US researchers changed their focus to defensive measures, such as developing "air-sniffing" detectors. In 1972, all US biological warfare agents and supplies were destroyed.

1978, Bulgaria
The first example of state-supported bioterrorism in recent history occurred in 1978. On September 7, Bulgarian exile Georgi Markov, in London, was injected in the leg with a steel ball impregnated with ricin via a specially constructed umbrella. He felt immediate pain at the injection site and within 5 hours became weak and dizzy. Fifteen to 24 hours later, Markov was febrile, nauseated and vomiting. He was admitted into a hospital 36 hours after the attack where he was found to be febrile, tachycardic, and with swollen lymph glands near the injection site. Two days after the attack, he suddenly became hypotensive. By the third day he was anuric and began vomiting blood. He was in complete heart block and eventually succumbed. The reason for the area of induration and redness on his leg was unknown until the necropsy. The communist Bulgarian government carried out the assassination with technology supplied by the Soviet Union. Only 10 days earlier, a similar assassination attempt was made against Vladimir Kostov in Paris. Only heavy clothing prevented the steel ball from entering any farther than Kostov's subcutaneous tissue. After he learned of Markov's death, Kostov went in for an examination and the pellet was found before the toxin was absorbed.

1979, USSR
In April 1979, in the city of Sverdlovsk, USSR, an explosion from Military Compound 19 resulted in a toxic release. Over the next several days, citizens downwind from the facility were stricken with high fevers, difficulty breathing, and death. While local doctors announced an outbreak of inhalation anthrax, the government blamed the situation on anthrax-contaminated beef. The military took over a hospital to attend to these victims exclusively. The official cause was made known by President Boris Yeltsin in 1992 when he stated that it was an accidental release of anthrax spores in a biological weapons program.

1985, Iraq
Iraq launched its own biological weapons program around 1985, but initially lacked the expertise to develop sophisticated arms. As the Soviet Union's program began to crumble in the 1990s and scientists' salaries dwindled, some biological weapons experts may have been lured to Iraq. By the time of the Gulf War cease-fire in 1991, however, Iraq had weaponized anthrax, botulism toxin, and aflatoxin and had several other lethal agents in development. Inspectors from the U.N. Special Commission (UNSCOM) spent frustrating years chasing down evidence of the program, while Iraq repeatedly denied its existence. The UNSCOM team found that Iraq's stockpile included Scud missiles loaded to deliver disease.

Iraq is known to have unleashed chemical weapons in the 1980s, both during the Iran-Iraq War and against rebellious Kurds in northern Iraq. However, there is no evidence that the Iraqi state has ever used its biological arsenal. It is believed, however, that with the aid of Soviet experts and with the UNSCOM inspectors kept at bay, the Iraqi arsenal is likely growing.

By 1989, the CIA Director, William Webster, announced that at least 10 countries were developing biological weapons.

•  1980s-1990s, Crude Terrorism

Terrorist or criminal crude use of biological agents during this time include the following events:

1980: A primitive laboratory said to have contained a bathtub filled with flasks of Clostridium botulinum was reportedly discovered in a Red Army Faction "safe house" in Paris. The German government later repudiated the report.

1984: In Oregon, Rajneeshee religious cultists contaminated restaurant salad bars with Salmonella typhimurium to prevent townspeople from participating in local elections. Over 750 were poisoned and 40 hospitalized, although no one died. Two cultists were eventually arrested.

1991: Members of the Minnesota Patriots Council , a right-wing extremist militia group, allegedly attempted to harm an Internal Revenue Service official, local law enforcement, and a US deputy marshal with ricin. They reportedly extracted the toxin from castor beans they received from a mail order house. Four members were arrested when the Federal Bureau of Investigation infiltrated the group.

1992: In October, Soko Asahra, 40 followers of the Japanese Aum Shinrikyo cult traveled to Zaire to assist victims of the Ebola virus. According to an October 31, 1995 report by the US Senate's Permanent Subcommittee on Investigations, the cult's real motive was to obtain virus samples to be used for biological attacks.

1995: It is reported that on at least ten occasions over the preceding five years, members of the Aum Shinrikyo cult attempted to disperse anthrax, botulinum toxin, Q fever, and Ebola in Japan. No reported infections occurred. These incidents include the following notable episodes:

•   In April 1990, cult members outfitted a car to disperse botulinum toxin through an exhaust system and drove the car around the Japanese parliament building.

•   In June 1993, Aum Shinrikyo cult members attempted, over a 4-day period, to spread anthrax in Tokyo via a sprayer system from the roof of a downtown building.

•   In March 1995, cult members planted 3 briefcases designed to release botulinum toxin in a Tokyo subway. The attack was averted when a cult member substituted a nontoxic agent instead.

For more than two decades, bioterrorism experts have warned that the United States might be vulnerable to attack with biological weapons.

In the Fall of 2001, anthrax-contaminated letters were sent through the United States Postal Service. The first anthrax case of this attack was reported on October 4 by the Palm Beach County Health Department. As of December 5, a total of 22 cases of anthrax had been identified; 11 were confirmed as inhalation anthrax and 11 (seven confirmed and four suspected) were cutaneous. 14 Six fatalities occurred due to inhalation anthrax. It is still not known whether state-sponsored terrorists carried out the anthrax-letter attacks in 2001. Many experts believe that the perpetrators are more likely homegrown extremists.

After the anthrax-letter attacks in late 2001, these warnings take on a new urgency. Considering the possible exposure, and the possible consequences, the 2001 anthrax attacks were more disruptive than destructive of human life. However, these attacks have certainly served as a wake-up call to those charged with protecting the public health.

The 2001 Anthrax incident has caused many in the health care field to look again at the exposure to risk and the history of biological weapons use. Just as the widespread knowledge of how biological weapons work has allowed some to use these readily available organisms to cause harm, medical professionals must now familiarize themselves with the history and types of attacks that have taken place. They must be prepared to recognize, treat, and report possible biological weapon effects to the appropriate authorities to quickly divert a large-scale disaster.


Anthrax Letters: http://www.cdc.gov/ncidod/EID/vol7no6/jernigan.htm

•  Physician Preparedness

Some of the roles required of individual physicians in response to disasters require knowledge or skills that few possess. However, most of the necessary skills and knowledge are simply extensions of the physician's daily working tools, such as forming a differential diagnosis for an infectious process or caring for acute trauma patients. The challenge, therefore, is to "fill in the blanks" for practicing physicians, whose needs will vary depending on their practice specialty and setting.

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Last updated March 11, 2015