Correspondence

Anthrax

N Engl J Med 2000; 342:61-62January 6, 2000

Article

To the Editor:

In their excellent review of anthrax infection, Dixon et al. (Sept. 9 issue)1 state that the only known use of anthrax in war was by the Japanese in China in the 1940s. Two other instances have been reported, however, one of which is well documented and the other alleged and highly controversial. Both have special importance for American physicians.

In World War I, Germany undertook a widespread covert program of biologic warfare, using anthrax and glanders, directed against horses and mules. In the United States from 1915 to 1917 the program was operated by Anton Dilger, an American-born graduate of Johns Hopkins Medical School, who had brought cultures from Berlin and grew them in an improvised bacteriology laboratory in his suburban Washington, D.C., dwelling.2 Although humans were not directly targeted, reported cases of anthrax in humans increased to such a degree during this period that the Public Health Service began epidemiologic investigations.3

During the Korean War the Communist Bloc alleged that the United States had engaged in biologic warfare against North Korea and China using anthrax and other agents. The United States categorically denied these allegations and dismissed them as propaganda. Recent reevaluation by scholars, however, reveals that the Chinese leadership firmly believed the allegations then and continues to believe them today.4,5 Paramount in cementing this conviction was the Chinese experience of Japanese biologic warfare during World War II and the subsequent U.S. protection of the Japanese war criminals involved in biologic warfare in exchange for their expertise.5 Indeed, as more has been learned about the activities of the U.S. covert-intelligence community and of U.S. biologic-warfare technology in the early Cold War era, the political and scientific aspects of the Communist allegations that appeared ridiculous and impossible in the early 1950s seem considerably more plausible and practicable. Although some scholars remain firmly skeptical of the Communist claims,6 others are convinced that the claims are valid.4 The consensus is that resolution of this question must await the declassification of secret documents in both the United States and China.5

Biologic warfare must represent the ultimate obscenity to an ethical physician. It is sobering to reflect that an American physician was central in the first incident and that in the second, regardless of the validity of the allegations, American physicians were instrumental in creating a climate in which such allegations could be believed by the most populous state on earth.

Martin Furmanski, M.D.
333 E. Bayfront, Newport Beach, CA 92662

6 References

1
Dixon TC, Meselson M, Guillemin J, Hanna PC. Anthrax. N Engl J Med 1999;341:815-826
Full Text | Web of Science | Medline

2
Landau H. The enemy within. New York: G.P. Putnam's Sons, 1937.

3
Anthrax in man. In: Annual report of the Surgeon General of the Public Health Service of the United States. Washington, D.C.: Government Printing Office, 1917:259-60.

4
Endicott S, Hagerman E. The United States and biological warfare. Bloomington: Indiana University Press, 1998.

5
Harris SH. Factories of death: Japanese secret biological warfare, 1932–1945, and the American cover-up. New York: Routledge, 1994.

6
Moon JE. Biological warfare allegations: the Korean War case. Ann N Y Acad Sci 1992;666:53-83
CrossRef | Web of Science | Medline

Author/Editor Response

The authors reply:

To the Editor: The two instances described by Dr. Furmanski are notable additions to our review of anthrax. His letter also serves to remind us that it is not only humans that are susceptible to infectious agents such as anthrax. The animals and plants1 on which people depend also constitute potential targets for those capable of using biologic agents as weapons. In particular, livestock (which are natural hosts for Bacillus anthracis) are believed to be far more vulnerable to anthrax infection than are people.2 Contamination of our food supply could potentially affect both military and civilian public health severely. We appreciate Dr. Furmanski's informative comments as well as his repugnance, which we share, of any use of infectious agents as weapons of war or terrorism.

Philip C. Hanna, Ph.D.
Terry C. Dixon, B.S.
University of Michigan Medical School, Ann Arbor, MI 48109-0620

2 References