Presentation on theme: "“Elementis Regamus Proelium” An Overview of Chemical and Biological Warfare Presented by CPT Michael A. Ladd SGT Lisa Lyon United States Army Chemical."— Presentation transcript:
“Elementis Regamus Proelium” An Overview of Chemical and Biological Warfare Presented by CPT Michael A. Ladd SGT Lisa Lyon United States Army Chemical School
“Elementis Regamus Proelium” Agenda Chemical Warfare Biological Warfare Question and Answer Period
“Elementis Regamus Proelium” Brief History of Chemical Warfare 1915 Ypres, France (WWI) No major military use of chem in WWII, but research completed by Germans Some use of chem during Vietnam (Agent Orange, BZ, CS, etc.) Use of nerve agent during Iran/Iraq War Gulf War Tokyo Subway Attack
“Elementis Regamus Proelium” EXERPT FROM: THE HUMAN COST, The Aum Shinrikyo victims have their say By Kavitha Rao and Murakami Mutsuko / Tokyo Ohashi Kenji, 41: “When he boarded the train, he saw one male passenger slumped in his seat and a woman doubled over. He sensed a strange smell, "sweet as if something was rotten.” Ohashi took a seat and fell into a brief sleep. When he woke up, he was thirsty and started coughing. His legs began trembling. Everything was black around him and he could hardly breathe. He was rushed to hospital, where he stayed for 12 days.”
“Elementis Regamus Proelium” CHEMICAL AGENTS DEFINED: “Any chemical substance which is intended for use in Military and Civilian Operations to kill, seriously injure or incapacitate man because of its physiological effects.”
“Elementis Regamus Proelium” PERSISTENCY OF AGENTS General description of how long a chemical agent remains dangerous after it’s release / employment. Two categories: PERSISTANT (“P-Chem”) And NON-PERSISTANT (“NP-Chem”)
“Elementis Regamus Proelium” PERSISTENT CHEMICAL AGENTS Long-Duration Agents (hours or days) used to: Deny terrain (channelize attacking forces, protect flanks, defend avenues of approach) Contaminate terrain & material (roads, key terrain or facilities) Degrade efficiency (forcing extended operations in protective posture) Neutralize defending strong-points
“Elementis Regamus Proelium” PERSISTENT CHEMICAL AGENTS Usually appear as an oily, thick liquid in pools, scattered droplets, or puddles Collect in low-lying areas Mix with topsoil, mud & standing water, easily spread by traffic (“Gross Contamination”) High contact hazard Low to medium vapor hazard (depending on temperature)
“Elementis Regamus Proelium” NONPERSISTENT CHEMICAL AGENTS Short-duration agents (minutes or less than one hour in open air conditions) used to: Create favorable fighting conditions Produce casualties Degrade or suppress Occupy without need of decontamination
“Elementis Regamus Proelium” NONPERSISTENT CHEMICAL AGENTS Usually a colorless, odorless (or faint odor) gas or vapor Same physical behavior as smoke or fog- travel in clouds with prevailing wind currents, weather conditions will determine spread Weather away easily- not a source of Gross Contamination High vapor & contact hazard Blood, choking, psychochemical and nerve agents are stockpiled in the largest quantities, highest probability of acquisition by terrorist groups Present highest “payoff” in terms of mass casualties in population centers
“Elementis Regamus Proelium” CLASSIFICATION OF TOXIC MILITARY CHEMICAL AGENTS Blood Blister Nerve Choking Vomiting Incapacitating
“Elementis Regamus Proelium” BLOOD AGENTS
“Elementis Regamus Proelium” Blood BLOOD AGENTS: Poisons enzyme cytochrome oxidase thus blocking the use of oxygen in the cells.
“Elementis Regamus Proelium” Physiological Effects BLOOD AGENTS PREVENT CELL RESPIRATION AND THE TRANSFER OF OXYGEN FROM THE BLOOD. OVER- OXYGENATED BLOOD CAUSES CHANGE IN COLOR (Pale to Bluish-tinge visible on the skin).
“Elementis Regamus Proelium” Physiological Effects EYES Moderate toxicity RESPIRATORY SYS. ENTERS BODY AS VAPOR OR GAS SKIN Not readily absorbed
“Elementis Regamus Proelium” CATEGORIES OF BLOOD AGENTS AC HYDROGEN CYANIDE CK CYANOGEN CHLORIDE Absorbed primarily by breathing
“Elementis Regamus Proelium” AC CHARACTERISTICS Appearance: Colorless liquid or gas Odor: Bitter Almonds Protection: Protective Mask See Note:
“Elementis Regamus Proelium” Rate of Action…..Rapid. Death w/in 15 min. Persistency…..Short. Dissipates quickly in air. Use Designation: Quick acting casualty agent. AC CHARACTERISTICS
“Elementis Regamus Proelium” AC SYMPTOMS: HIGH CONCENTRATIONS Increased heart rate Violent convulsions Breathing stops 1 min Heart stops in 2 min.
“Elementis Regamus Proelium” AC SYMPTOMS LONG EXPOSURE LACK OF OXYGEN TO THE MUSCLES IRRATIONALITY COMA AND CONVULSIONS
“Elementis Regamus Proelium” CK CHARACTERISTICS Appearance: Colorless, highly volatile liquid or gas Odor: Pungent, biting; may go unnoticed Rate of Action: Very rapid. Immediate intense irritation Protection: Mask (may damage filters)
“Elementis Regamus Proelium” Persistency: Short (may persist in jungles) Use Designation: Quick acting CK
“Elementis Regamus Proelium” CK SYMPTOMS CK IS CONVERTED BY THE BODY TO AC WITH IRRITATING EFFECTS LIKE CS *Immediate intense irritation (nose/throat) *Coughing, tight chest,heavy water flow from the eyes *Dizziness and unconsciousness *Breathing may stop/Death *Convulsions, involuntary urination/defecate.
“Elementis Regamus Proelium” FIRST AID - BLOOD AGENTS Ô Continue Normal Activities ÔGeneral Rule of thumb- after 5 min of exposure, anyone still breathing / ambulatory requires no first aid Ô Seek Medical Attention – Oxygen therapy – Keep warm and rested
“Elementis Regamus Proelium” Blister BLISTER AGENTS: These agents cause inflammation, blisters and general destruction of tissues. Vulnerable areas include the eyes, mucous membranes and respiratory tract.
“Elementis Regamus Proelium” BLISTER AGENTS All Blister Agents are PERSISTENT MUSTARDS ARSENICALS URTICANTS
“Elementis Regamus Proelium” ACTION ON THE BODY PHYSIOLOGICAL Damage ANY TISSUE they come in contact with, specific damage to: EYES LUNGS and RESPIRATORY SYSTEM Causes Vomiting & Diarrhea
“Elementis Regamus Proelium” ACTION ON THE BODY Penetration of the body Eyes, skin, respiratory and digestive tracts. Symptoms: There are distinct differences among each type.
“Elementis Regamus Proelium” MUSTARD AGENT CHARACTERISTICS (H - HD - HN - HN1 - HN2 - HN3) APPEARANCE (20 deg C / 68 deg F) HD…colorless to pale yellow HN SERIES…dark liquid Freezing point of Mustard Agents is deg F
“Elementis Regamus Proelium” CHARACTERISTICS Vapor Density: 5 to 7 times heavier than air Body Effects…irritation to eyes, tissues, and respiratory tract. Rate of Effectiveness….Delayed Duration…..Several days under normal conditions
“Elementis Regamus Proelium” CHARACTERISTICS Protection LEVEL A OR MOPP IV Persistency Depends on quantity. Weeks to months in cold. Use Delayed acting First Aid Do not break blisters; if in eyes use water; decon with M258A1/M291
“Elementis Regamus Proelium” PHASES OF HD LATENT PHASE HOURS ERYTHEMA PHASE Red Skin with itching VESSICATION PHASE Blisters from hours NECROSIS Tissues die and decay
“Elementis Regamus Proelium” SYMPTOMS FOR MUSTARD AGENTS EYES- most susceptible. Immediate burning sensation, swelling of tissue 1-12 hours, burns & lacerations SKIN- affected more by hot, humid weather & direct contact (e.g., sitting / standing in agent) Lungs- delayed action (days to weeks), cumulative dose poison, increased respiratory infections
“Elementis Regamus Proelium” FIRST AID FOR MUSTARD AGENTS IMMEDIATE & Continuous Flushing of the Eyes IMMEDIATE & Continuous Flushing of the Eyes: 86% of all Blister Agent Casualties exhibit contamination in the eyes Triage- Triage- Note exposure possibility for evaluation at Treatment Center: 75% of all Blister Agent Casualties experience latent onset (18-36 hours)effects upon the respiratory tract
“Elementis Regamus Proelium” ARSENICALS L - HL - PD - ED - MD
“Elementis Regamus Proelium” CHARACTERISTICS L - HL - PD - ED - MD Persistency: Persistent Physical States: L - Colorless to brownish liquid HL - Dark oily liquid PD - Colorless liquid ED - Colorless liquid MD - Colorless liquid ODORS –L - Variable –HL - Garlic –PD - None –ED - Fruity / Biting (irritating) –MD- NONE
“Elementis Regamus Proelium” ARSENICAL AGENT SYMPTOMS Ô Immediate pain (within 30 seconds) Ô Irritation of eyes Ô Reddening of the skin (within 30 minutes) Ô Blisters appear (within 48 hours) Ô Systemic poisoning
“Elementis Regamus Proelium” ARSENICALS Ô Primary Hazard: – Eyes & respiratory tract (vapors) – Skin (direct contact) – Digestive system (ingestion) Rate of Action: Eye effects & stinging sensation (immediate) Prompt, burning redness within 30 minutes Blisters on 1st or 2nd day Pain / necrosis more severe than with mustards
“Elementis Regamus Proelium” URTICANTS Ô Rate of Action: – Immediate Ô Primary Hazards: – Eyes, nose & respiratory tract (vapors) – Skin (direct contact) – Digestive tract (digestion) SYMPTOMS SYMPTOMS Ô IMMEDIATE Ô Strong irritation of mucous membranes – Stinging sensation (bee sting) Ô Blanching of skin – Eyes, nose & skin – Surrounded by reddening (within 30 secs) – Wheal forms (in about 30 mins) – Blanched area turns brown (24 hrs) – Sloughs off (couple weeks)
“Elementis Regamus Proelium” NERVE AGENTS
“Elementis Regamus Proelium” Nerve NERVE AGENTS: Inhibits cholinesterase enzymes thus allowing acetylcholine (a neurotransmitter) to collect at its various sites of action. Can be inhaled, ingested or absorbed through the skin.
“Elementis Regamus Proelium” ACTION ON THE BODY (PHYSIOLOGICAL) Nerve Agents are potent inhibitors of the enzyme cholinesterase. This inhibition permits the build-up in the body of Acetylcholine, a muscle and nerve ending stimulator. The major effects will be on skeletal muscles, parasympathetic end organs, and the central nervous system.
“Elementis Regamus Proelium” ACTION ON THE BODY Penetration Eyes: Symptoms appear in 2-3 minutes. Kills nearly as rapidly as respiratory exposure. Respiratory System: Symptoms appear in 2-5 minutes, lethal dose kills in less than 15 minutes. Skin: Symptoms occur slowly; Lethal doses 1-2 hours; Sweating and tremors may occur.
“Elementis Regamus Proelium” NERVE AGENT SYMPTOMS (SEVERE) STRANGE/CONFUSED BEHAVIOR GURGLING SOUNDS WHEN BREATHING SEVERELY PINPOINTED PUPILS RED EYES WITH TEARING VOMITING SEVERE MUSCULAR TWITCHING LOSS OF BLADDER CONTROL CONVULSIONS UNCONSCIOUSNESS
“Elementis Regamus Proelium” TABUN - GA Non-Persistent Nerve Agent Appearance….. brownish to colorless liquid Odor…..faintly fruity; none when pure Vapor density: 5.63 times heavier than air.
“Elementis Regamus Proelium” GA Persistency…..depends on weather and munitions; 1-2 days for heavily splashed liquids. Use Designation: Quick acting casualty agent Rate of Action: Very rapid; w/in 15 min for lethal dose Protection LEVEL A OR MOPP IV LEVEL A OR MOPP IV ; clothing gives off vapor
“Elementis Regamus Proelium” SARIN - GB Non-Persistent Nerve Agent Appearance: colorless liquid Odor: almost none in pure state Vapor density: 4.86 times heavier than air
“Elementis Regamus Proelium” GB Persistency…..same as for GA Use Designation, Quick acting casualty agent Rate of Action, Very Rapid Protection Required: LEVEL A OR MOPP 4 - See GA
“Elementis Regamus Proelium” SOMAN - GD Non Persistent Nerve Agent Appearance…..colorless liquid Odor…..fruity; impurities give camphor Vapor density: 6.33 times heavier than air
“Elementis Regamus Proelium” GD Persistency: same as GA/GB only evaporates at slower rate Use Designation: Quick acting casualty agent Rate of Action Very Rapid. Protection Required: LEVEL A OR MOPP 4. See GA
“Elementis Regamus Proelium” VX VX is a PERSISTENT Nerve Agent Appearance: Colorless to Amber liquid Odor: NONE Vapor density: 9.2 times heavier than air
“Elementis Regamus Proelium” VX Persistency: Heavily Splashed Liquids May Last For Long Periods Use Designation, Quick acting casualty agent Rate of Action and Protection requirements are the same as the other nerve agents.
“Elementis Regamus Proelium” FIRST AID- NERVE AGENTS Convulsion Antidote for Nerve Agents (CANA). CANA is an auto-injector which contains 2ml of diazepam. It is to be used only as buddy-aid, never self injected Nerve Agent Antidote Kit (NAAK Mark 1). The NAAK Mark 1 contains the AtroPen auto-injector (2mg of atropine) and the Pralidoxime Chloride auto-injector (600mg of pralidoxime chloride) in a compact package which facilitates emergency use. 1 to 3 injections, depending on level of symptoms
“Elementis Regamus Proelium” Choking CHOKING AGENTS: Attack lung tissue (dry-land drowning). Choking sensation as a result of nose and throat irritation.
“Elementis Regamus Proelium” CHOKING AGENTS CG PHOSGENE Physiological Action: Symptomsthree to four hours after exposuredeath within 24 hours Effects are exerted on the lungs resulting in damage to small blood vessels. Anoxia is the cause of death due to flooded air sacs. Symptoms appear three to four hours after exposure and death within 24 hours.
“Elementis Regamus Proelium” PHOSGENE Odor: Green corn, grass, or new- mowed hay Protection: Protective Mask
“Elementis Regamus Proelium” PHOSGENE may collect in low areas Persistency: Short, but may collect in low areas. Rate of Action: Delayed. Immediate symptoms in high concentrations. Up to 3 hours for low levels. Symptoms: Tearing, soar throat, coughing, wheezing; Pulmonary Edema in 2-6 hours, nausea, vomiting and gastric pains are common
“Elementis Regamus Proelium” PHOSGENE First-Aid: SELF / BUDDY Aid : 1) Mask, 2) Continue with normal activities. 3) Keep personnel quiet, and casualties should be kept only comfortable warm. 4) Seek medical help.
“Elementis Regamus Proelium” CHOKING AGENTS Ô Protection Required: Tested & Approved Protective Mask Ô Decontamination: – Aeration (confined areas) – No decon in open air environment – Change contaminated clothing Dissemination – [Not Limited To]Aircraft spray
“Elementis Regamus Proelium” FIRST AID-CHOKING AGENT EMS: No standard first aid kit In the ambulance: ABC’s O 2 monitoring No exertion Advanced Providers IV Fluids Bronchodilators No Diuretics
“Elementis Regamus Proelium” CHARACTERISTICS OF INCAPACITATING TEARING AGENTS THEY CAUSE PHYSIOLOGICAL AND MENTAL EFFECTS THAT LEAD TO TEMPORARY DISABILITY. THE LETHAL DOSE IS MANY TIMES GREATER THAN THE INCAPACITATING DOSE.
“Elementis Regamus Proelium” TEARING AGENT CHARACTERISTICS (CA / CS / CN / CNB /CNC / CNS /CR / PS Ô Persistency: Short (CN Series), varies with others Ô Physical States: (20 deg C / 68 deg F) – Yellow or Colorless solid, liquid, or powder Ô Odors: – Soured fruit or pepper- like or apple blossoms
“Elementis Regamus Proelium” TEARING AGENTS Ô Primary Hazard: Respiratory Ô Rate of Action: Immediate Ô Symptoms: Effects last 5-10 minutes after removal from area – Immediate burning sensation of the eyes – Coughing – Difficulty breathing – Involuntary closing of eyes – Stinging sensation on moist skin
“Elementis Regamus Proelium” TEAR AGENTS Ô Protection Required: – Tested & approved protective mask – Secure normal clothing at neck, wrists and ankles Ô Decontamination: – Aeration (cool shower may help)
“Elementis Regamus Proelium” TEARING AGENTS Ô First Aid Ô First Aid: None required (aeration) Ô Exception: individuals wearing contact lenses at the time of exposure- remove them ASAP! Ô Medical Treatment: – Prompt irrigation of the eyes – Mechanical removal of agent – Erythmea (calamine / topical corticosteroid) – Blisters (treat as 2nd degree burns) – Secondary infections (treat with antibiotics)
“Elementis Regamus Proelium” Vomiting VOMITING AGENTS: produce strong pepper-like irritation of the eyes and lacrimation and violent uncontrollable sneezing, cough.
“Elementis Regamus Proelium” VOMITING AGENTS CHARACTERISTICS DA/DC/DM Ô Persistency: Non-persistent (aerosol) Ô Physical States: (at 20 deg C / 68 deg F) DA - White to brown solid DC - White to pink solid DM - Yellow to green
“Elementis Regamus Proelium” VOMITING AGENTS Ô Odors: – DA - None – DC - Bitter almonds / garlic mixture – DM - None Ô Primary Hazard: Respiratory Ô Rate of Action: Very rapid (30 sec - 2 mins)
“Elementis Regamus Proelium” VOMITING AGENTS Ô Symptoms: last from 30 minutes to several hours after removal from contaminated area – Irritation of eyes and mucuous membranes – Viscuous discharge – Sneezing & coughing – Acute pain & tightness in chest – Severe headache – Nausea – Vomiting
“Elementis Regamus Proelium” VOMITING AGENTS Ô First Aid: – Mask – Let agent take its course – Vigorous exercise / physical activity Ô Medical Treatment: – Few should require treatment – Symptomatic relief Pepto-Bismol / Maalox / etc – Aspirin (headaches / general discomfort)
“Elementis Regamus Proelium” DECONTAMINATION M291 Skin Decon Kit. Used for skin and equipment decontamination. Is non-toxic, eliminating the need for trainers. M295 Decon Kit, Individual Equipment (DKIE). The M295 employs sorptive resin technology; consists of a pouch containing four individual wipedown mitts each of which is within a soft, protective packet. The pouch assembly is designed to fit comfortably within a pocket. Used to decon personnel equipment
“Elementis Regamus Proelium” EXTINGUISHING MEDIA: Water, fog, foam, CO2. Avoid using extinguishing methods that will cause splashing or spreading. INCOMPATIBLES: Negligible on brass, steel, aluminum DECONTAMINATION
“Elementis Regamus Proelium” Chemical Detection and Sample Collection
“Elementis Regamus Proelium” Chemical Detection and Identification Suite
“Elementis Regamus Proelium” Chemical Detector Papers M9 and M8 chemical agent detector papers –Only for liquids/agents –Prone to false positives –Best for initial recon Other chemical detector papers V G H L
“Elementis Regamus Proelium” Chemical Identification Kits “Wet chemistry” chemical agent identification kits –Vapors only –Good specificity Colorimetric tube sets
“Elementis Regamus Proelium” M256A1 Kit Capabilities: –Detects nerve, blister, blood agents –Detects below IDLH for most agents Limitations: –Takes 15 minutes to use –Hand manipulations –Does not detect choking agents Best uses: –Initial recon –Verification of chemical detection
“Elementis Regamus Proelium” Colorimetric Tubes Capabilities: –Detect, identify family of chemicals: nerve and blister agents –Identify, quantify (ppm) choking and blood agents –Sampling unknown agents Limitations: –Hand manipulations –8 specific tubes required Best uses: –Industrial chemicals –Verification of chemical detection
“Elementis Regamus Proelium” Chemical Detection Instruments Hazardous chemical detectors - PID, FID, Multi-gas meter Chemical agent detectors -ICAM-APD2000 -AP2C -M-90 CAD -SAW MINICAD -ICAD Chemical agent alarms Laboratory instruments
“Elementis Regamus Proelium” Chemical Agent Monitor Capabilities: –Point detection of nerve, blister agents –Detects down to IDLH –Semi-quantitative indication Limitations: –Many false positive readings –Not a “survey” device –May become supersaturated Best uses: –Detection of contaminated areas –Check at decontamination corridor
“Elementis Regamus Proelium” Gas Chromatograph and Mass Spectrometer Portable gas chromatograph Portable GC/MS Laboratory analysis
“Elementis Regamus Proelium” Detect / Sample / Handle Proper procedures are of vital importance to: Protect Responders Treat Victims Prevent Spread of Contamination Alert Supporting Agencies Gather Evidence Throughout every step of the response cycle, from Initial Assessment to Transportation to Hospitals
“Elementis Regamus Proelium” Chemical Detection Process Observe signs and symptoms Don appropriate protection Initial entry (radiation; pH paper; O 2, LEL, CO; PID) Chemical agent detector papers (M8, M9) Chemical detector instruments (CAM) Detection kits (M256A1), colorimetric tubes Samples for GC/MS
“Elementis Regamus Proelium” Chemical Agent Sampling Air samples Liquid samples Solid samples Quality of sample
“Elementis Regamus Proelium” Proliferation Current Proliferation NuclearBiologicalChemical Number of Countries Source:
“Elementis Regamus Proelium”
Major Concerns Break up former Soviet Chemical Scientist Rogue nations procurement of chemical stores ICBM and delivery systems Willingness of radicals to use chemical (Tokyo, Iran/Iraq War)
“Elementis Regamus Proelium” What is Biological Warfare? Warfare involving the use of living organisms (as disease germs) or their toxic products against men, animals, or plants. “Webster’s” definition
“Elementis Regamus Proelium” What are Biological Agents? Biological agents are the living organisms, or the toxins derived from, causing disease in man, animals or plants. Bacteria Virus Toxins
“Elementis Regamus Proelium” How can they be disseminated? Biological agents can be disseminated in a variety of ways. Mail Clouds/Spray cans Food/water Sick people/animals
“Elementis Regamus Proelium” Factors in Making Effective Bio Agents Availability and ease of production in sufficient quantities. Lethal or incapacitating effects in humans at achievable and deliverable doses. Appropriate particle size. Ease of dissemination. Stability (storage, weapons, environment) Susceptibility of target.
“Elementis Regamus Proelium” Hemorrhagic Fevers Crimean-Congo, Hantavirus, Ebola, Yellow Fever Symptoms include fever, muscular pain, lack of strength. Full blown; shock and mucous membrane hemorrhage.
“Elementis Regamus Proelium”
Small Pox Variola virus –Small Pox : High transmissibility, globally eradicated in the 70’s. INCUBATION: 7-17 DAYS SYMPTOMS: After incubation include fever, headache, neck and backaches. 2-3 days rashes w/ lesions appear. 3-4 weeks scabs develop and fall off. –Treatment: Vaccine during first week of exposure, 30-35% mortality.
“Elementis Regamus Proelium”
Plague Yersinia pestis PLAGUE - Bacteria - Inhalation, Insect bite. 3 Clinical Manifestations SYMPTOMS : (Occur within 1-6 days) –Swelling of Lymph Nodes (bubonic) –Nausea, fever,chills, vomiting, diarrhea. –Respiratory Distress (pneumonic) –Appendages turn black (Septicemic) Mortality : Bubonic 23%, Pneumonic and Septcemic near 100% if untreated.
“Elementis Regamus Proelium”
Anthrax Bacillus anthracis ANTHRAX - Spore-forming bacteria. Causes infection and depresses the Central Nervous System. ROUTE OF ENTRY : Inhalation, Ingestion, or skin lesions. SYMPTOMS : (Occur within 2-7 days) –Cutaneous- boil like lesion forming into black ulcer. –Inhalation- common cold then respiratory difficulty and shock. –Gastrointestinal- inflammation of intestinal tract, nausea, vomiting, fever, abdominal pain. Mortality : % if untreated
“Elementis Regamus Proelium” Anthrax factory in Russia. Third world countries are more susceptible to Anthrax due to the mixing of human and animal populations.
“Elementis Regamus Proelium”
95% of all Anthrax cases are Cutaneous.
“Elementis Regamus Proelium”
Lungs of victim of Sverdlovsk incident.
“Elementis Regamus Proelium” Monkey infected with Anthrax
“Elementis Regamus Proelium” Want more Information? Centers for Disease Control (CDC) US Army Medical Research Institute of Infectious Diseases (USAMRIID) World Health Organization page/index.en.shtml
“Elementis Regamus Proelium” Questions and Answers Tartars at Caffa City