Chemical warfare during the Cold War

In a work of fiction, a Yale psychiatrist describes how the Army tested agents for use in war.

By Cathy Shufro

Pfc. Don Wheatland sits on his bed babbling, pulse racing, occasionally swatting imaginary flies. Capt. Martin Baker, M.D., knows what has gone wrong. The soldier is a guinea pig in a test of VX; a single drop of this lethal neurotoxin can kill a man in 15 minutes by overstimulating the nervous system. The year is 1961, and the soldier is one of the “volunteers” undergoing tests of potential chemical warfare agents at Edgewood Arsenal in Maryland. Wheatland has been vomiting, and an Army medical officer has been treating the soldier by injecting him with atropine—too much, as it turns out. The private is delirious from atropine poisoning.

But the real problem will not emerge until later, when medical officer Baker gets a 10 p.m. phone call: “Wheatland has disappeared.”

This scene comes from Men and Poisons: The Edgewood Volunteers and the Army Chemical Warfare Research Program, a fictionalized account of life at Edgewood Arsenal in Maryland by Malcolm Baker Bowers Jr., M.D., HS ’65 (Baker in the book). Bowers, now professor emeritus of psychiatry, spent three years as a medical officer at Edgewood beginning in 1959. Bowers said he was inspired to write and self-publish the book to provide an account of chemical warfare research of the era. About 650 men were exposed to these nerve agents as part of Army research at Edgewood, according to the U.S. Army Medical Research Institute of Chemical Defense.

In one scene that illustrates the vision of chemical warfare held at the time, a general tells the research staff: “Think of it: LSD-impregnated toilet paper gets delivered to the Kremlin.”

In an interview at his office at 300 George Street, where he still sees patients, Bowers described his commanding officer, who tested the poisons on himself first. “His approach to the feasibility of testing was to insist that he take at least twice the dose proposed for a volunteer.”

Looking back, Bowers was struck by the lack of informed consent in that era. The 30 soldiers recruited for monthlong rotations had no idea what they were getting into, said Bowers, who provided them with medical care. “They came to get a break from their bases and to check out the infamous bars along the harbor in Baltimore.”

Before being exposed to nerve gases and hallucinogens, the soldiers got only brief verbal explanations of what was to happen. They did not really consent, either. They signed no forms and, Bowers noted, “There was no question that they would participate.”

Bowers recounted in his book how a seemingly healthy volunteer given LSD became psychotic and had to be sent to a psychiatric hospital. He was later diagnosed with paranoid schizophrenia. Bowers said that seeing such catastrophic drug reactions sparked his interest in how drugs can trigger psychiatric illness—the subject of another self-published book, Abetting Madness: The Role of Illicit and Prescribed Drugs in Promoting Psychotic and Manic Disorders.

Bowers’ account rings true to his colleague George K. Aghajanian, M.D. ’58, the Foundations Fund Professor of Psychiatry and Pharmacology, who served in the Army at Edgewood beginning a year after Bowers left. “It’s not fiction,” he said, “Just the names are fictional.”

Before Bowers and Aghajanian arrived at Edgewood, the work there had led to a therapeutic breakthrough: the first cancer chemotherapy agent. Two Yale pharmacologists, Louis S. Goodman, M.D., and Alfred Gilman, Ph.D., showed that the World War I gas nitrogen mustard could shrink lymphatic tumors. Their study was published in The Journal of the American Medical Association in 1946.

As for the soldier on whom Wheatland was based, he was found in New York City two days after he disappeared, when he asked a police officer what city he was in. The resulting newspaper headlines embarrassed the Army, but the soldier recovered.

Bookshelf is a column in Yale Medicine focusing on matters related to books and authors at the School of Medicine. Send ideas to Cathy Shufro at cathy.shufro@yale.edu.

Book notes

Developmental Psychopathology: Volume 1, Theory and Method, 2nd ed.
edited by Dante Cicchetti, Ph.D., and the late Donald J. Cohen, M.D. ’66 (Wiley) The topics addressed in this volume derive from current research on developmental psychopathology and include cross-cultural perspectives, developmental epidemiology, self-determination theory and gender issues.

Heart Care for Life: Developing the Program That Works Best for You
by Barry L. Zaret, M.D., the Robert W. Berliner Professor of Medicine, and Genell J. Subak-Sharpe, M.S. (Yale University Press) This book outlines characteristics common to each form of heart disease, from angina and heart attacks to high blood pressure and cardiac arrhythmias. The authors include instructional case histories and guide the reader in assessing personal variables to develop an individual treatment and life style program. The authors also provide quizzes to assess risk factors and suggest questions that readers can ask their doctors.

Doctor, Can I Ask You a Question? Your Health Care Questions Answered
by Arthur E. Baue, M.D., former chair and Donald Guthrie Professor of Surgery (XLibris Corp.) This book provides information that patients need in order to be informed about their health care. Baue discusses finding a qualified doctor; patient-doctor relationships and patient rights; disease prevention; and senior health care.

Another Day in the Frontal Lobe: A Brain Surgeon Exposes Life on the Inside
by Katrina S. Firlik, M.D., assistant clinical professor of neurosurgery (Random House) Firlik provides an inside look at the work of a brain surgeon, from the basic tools used in brain surgery to the ethical dilemmas that neurosurgeons face. She describes some of her more bizarre cases—such as a man with a three-inch nail shot into his brain—and the process of speedy decision making after a patient has suffered a head injury or stroke, when time is critically important. She also predicts what she believes to be the future of brain surgery—“brainlift” procedures that promise cognitive enhancement.

Life Is With Others: Selected Writings on Child Psychiatry
by the late Donald J. Cohen, M.D. ’66, edited by Andrés Martin, M.D., M.P.H., and Robert A. King, M.D. (Yale University Press) Cohen, former director of the Child Study Center, made groundbreaking contributions to the study of autism and developmental disabilities, Tourette syndrome, developmental psycho- pathology, child psychoanalysis and children’s adaptation to trauma. This book addresses topics including childhood psychiatric disorders; research ethics; mentorship; and the role of play fantasy, aggression and violence in childhood. Selections also include autobiographical writings.

Oasis in the Overwhelm: 60-Second Strategies for Balance in a Busy World
by Millie Grenough, M.S.W., clinical instructor in psychiatry (social work) (Beaver Hill Press) The author shares strategies that she designed to balance her work and personal life. She has developed a process to reduce stress and improve productivity; manage distractions and sharpen focus; and create a way of life that increases both personal and professional satisfaction.

Out of the Woods: Tales of Resilient Teens
by Stuart T. Hauser, M.D. ’66, Joseph P. Allen, Ph.D., and Eve Golden, M.D. (Harvard University Press) Through interviews with 70 people who had been institutionalized in a psychiatric facility during their adolescence, the authors investigate why some teens bounce back from a troubled adolescence while others don’t. The authors observe that the subjects who fared best had an interest in and capacity for reflection, responsibility and relationships, as well as a positive attitude and the desire to change.

Principles and Practice of Geriatric Psychiatry
edited by Marc E. Agronin, M.D., and Gabe J. Maletta, M.D., Ph.D. (Lippincott Williams & Wilkins) This textbook combines the insights of psychiatry, medicine and neurology by using scientific principles of geriatric psychiatry and clinical practice to provide evidence-based guidelines for care of the elderly. Contributors use case studies to illustrate these principles.

The Medical Interview: Mastering Skills for Clinical Practice, 5th ed.
by John L. Coulehan and Marian R. Block, M.D. ’71 (F.A. Davis) This updated text helps medical students and other health-professions students learn good communication skills, including basic history-taking, conveying bad news and communicating unanticipated adverse outcomes. The authors also address ethical and legal issues relating to medical interviews.

The Secrets of Happily Married Men: Eight Ways to Win Your Wife’s Heart Forever
by Scott Haltzman, M.D., HS ’89, and Theresa Foy DiGeronimo (Jossey-Bass) This book lists eight common sense strategies for men committed to building happy marriages. Among these suggestions are: learn to listen, make your marriage your job, know your wife and aim to please. The authors supply to-do lists and examples of successful interactions.

Home Long-Term Oxygen Treatment in Italy: The Additional Value of Telemedicine
by Allen I. Goldberg, M.D., HS ’70 (Springer) This book describes the evolution in the home management of severe chronic respiratory insufficiency over the last two decades in Italy. Goldberg covers epidemiological aspects, complicating events, current systems for oxygen delivery, changing approaches to the patient-caregiver relationship, the economic burden of home management and the potential of telemedicine.

Evidence-Based Psychotherapy: Where Practice and Research Meet
edited by Carol D. Goodheart, Alan E. Kazdin, Ph.D., professor of psychology and director of and professor in the Child Study Center, and Robert J. Sternberg, Ph.D. (APA Books) The authors acknowledge differences between the fundamental purposes of research and clinical practice in psychology and present varying viewpoints on the contributions and limitations of evidence-based practice. The book provides perspectives on how to improve psychotherapy from leading figures in both clinical practice and research.

Brain and Culture: Neurobiology, Ideology, and Social Change
by Bruce E. Wexler, M.D., professor of psychology (The MIT Press) Wexler explores the social implications of the close relationship between an individual’s neural and psychological make-up and how the individual interacts with the social and cultural environment. He integrates recent neurobiological research with major experimental findings in cognitive and developmental psychology, making reference to psychoanalysis, literature, anthropology, history and politics.

Rethinking Substance Abuse: What the Science Shows, and What We Should Do About It
edited by William R. Miller and Kathleen M. Carroll, Ph.D., professor of psychiatry (The Guilford Press) Leading experts describe what substance-abuse treatment and prevention would look like if they were based on the best science available. The writers summarize current thinking about the nature and causes of alcohol abuse and other drug problems; what works at the individual, family and societal levels; and how to develop more effective, humane treatments and services. The book incorporates developmental, neurobiological, genetic, behavioral and social-environmental perspectives.

Understanding Depression in Women: Applying Empirical Research to Practice and Policy
edited by Carolyn M. Mazure, Ph.D., professor of psychiatry, and Gwendolyn Puryear Keita (American Psychological Association) Women are more likely to suffer from depression than are men, and depression is the leading cause of disability for women throughout the world. The editors survey the findings of over 40 experts on depression and explore the latest strategies for treatment, prevention and service delivery.

The descriptions are based on information from the publishers.

Send notices of new books by alumni and faculty to Cheryl Violante, Yale Medicine, 300 George Street, Suite 773, New Haven, CT 06511, or via e-mail to cheryl.violante@yale.edu.

In circulation

New library software helps find the needle in the haystack

Some researchers and clinicians may feel joy when they consider that the database PubMed contains 16 million citations for journal articles. But for others, the possibilities of the information superhighway are overwhelming. Fortunately, Charles J. Greenberg, M.L.S., M.Ed., can offer strategies for finding what’s useful.

“You have to learn how to confront the large quantity of information and make it manageable,” said Greenberg, head of Curriculum and Research Support at the Cushing/Whitney Medical Library.

One useful approach is to use automated systems to tailor the flow of information to one’s interests.

PubCrawler (http://pubcrawler.gen.tcd.ie/), My NCBI (http://www.ncbi.nlm.nih.gov/) and BioMail (http://biomail. sourceforge.net/biomail/) all automatically search for newly indexed articles in PubMed. The user creates search parameters and then receives citation alerts about new articles via e-mail. Alternatively, PubCrawler and My NCBI can save articles in a user’s account on the application website.

For best-practices, one-stop shopping, Greenberg recommends UpToDate (www.uptodate.com), which, he says, “replaces a shelf of textbooks” and is more current. This online compendium supplies regularly revised information for 13 clinical specialties and can keep clinicians informed about new treatment recommendations. It can also remind or update clinicians about ways to treat a problem they rarely see—say, when a surgeon gets a question about an ear infection.

Greenberg believes that all computer sophisticates need to use RSS, or really simple syndication, an alternative to e-mail. Users can obtain grant announcements, FDA alerts and even check their Netflix DVD account queue using RSS. Users can sign up for an RSS “feed” by finding the orange XML or similar button on any Web page that offers RSS feeds. To view the content, one needs an RSS reader that automatically checks feeds. Examples of readers are available at www.bloglines.com and www.feedmaker.com. All Yale faculty, staff and students have an RSS-reading portal account at www.yale.edu/yaleinfo.

—Cathy Shufro

In Circulation is a column focusing on activities at the Cushing/Whitney Medical Library. Send ideas to Cathy Shufro at cathy.shufro@yale.edu.



Lurie		Kellert



Rozett		Fineberg

On campus

Public health plans lacking, although stakes are high

Despite the 9/11 attacks and the subsequent anthrax scare, the United States, said Nicole Lurie, M.D., M.S.P.H., has become complacent about public health. “Just when we were in danger of going back to sleep we had SARS and then the nightmare of Hurricane Katrina,” said Lurie, a former official in the U.S. Department of Health and Human Services, and now an analyst at the RAND Corp.

In the 9th annual Samuel O. Thier Lecture at medical grand rounds in January, Lurie said public health preparedness lacks consistent standards, often has insufficient emergency plans and has flawed communications between health departments and providers. To assess local responses, Lurie and her colleagues phoned in feigned emergencies, such as plague symptoms, only to be told to call back later. They also conducted more than 30 table top exercises around the country. While some responders were “absolutely terrific,” Lurie said, “you see things that are really terrifying.”

Local responses are critical, she said. “A weak link is going to have major consequences for the country and the world.” Lurie called on the faculty and students to make personal preparedness plans, and to become involved with their state and local health departments in preparing for public health emergencies.

—John Curtis

Contact with nature can be therapeutic

Bringing flowers to a sick friend does more than fulfill a social convention, according to Stephen R. Kellert, Ph.D., the Tweedy/Ordway Professor of Social Ecology at the School of Forestry and Environmental Studies. The fact that nearly every hospitalized patient has a bedside bouquet reflects “a deep-held need” for contact with nature, said Kellert in a March talk sponsored by the Program for the Humanities in Medicine.

Studies have shown that proximity to nature, including contact with pets, can be therapeutic, said Kellert. Until humans established the first cities 5,000 years ago, survival depended solely on paying close attention to predators, weather and sources of food and water, Kellert noted, and so humans are evolutionarily programmed to feel drawn to “the organized complexity” of nature.

Kellert said the absence of nature and the sterility of most of the modern urban built environment, including hospitals, can be remedied by incorporating nature into the built environment. This, in turn, promotes both health and productivity. “It’s a design failure that we can remediate through good design.”

—C.S.

A champion of health insurance for all

During his lifetime, Isidore S. Falk, Ph.D., professor emeritus of public health at Yale, was a towering figure in public health, championing universal health insurance as early as the 1930s. Now, 20 years after his death, although Falk’s work is largely forgotten, it remains relevant, Ronald T. Rozett, M.D., M.P.H., told his audience at the April meeting of the Beaumont Medical Club.

“Falk wanted minimum medical insurance for all Americans, not just the old and the sick,” said Rozett, director of the Master of Health Administration Program at Quinnipiac University in Hamden, Conn.

Among the staunchest opponents of publicly funded health insurance was the American Medical Association (AMA), whose members resented government intrusion in their medical practice. When Falk worked with President Franklin D. Roosevelt to include health insurance in the Social Security Act, the AMA undermined the proposal. Roosevelt ultimately focused on old age insurance alone, eliminating health insurance from the Social Security legislation.

Rozett said the Bush administration’s recent social security proposal would have horrified Falk. “The idea of allowing people to opt out of the social security system undermines the concept of social insurance, where people who are healthy subsidize those who are not,” said Rozett.

—Lori Ann Brass

Lessons from a pandemic that never was

In planning for a possible avian flu pandemic, said Harvey Fineberg, M.D., president of the Institute of Medicine, it is instructive to look at the recent past. Thirty years ago, Fineberg noted, the federal government began planning for a pandemic that never happened. Several people died of complications from a vaccine for swine flu, and that incident, coupled with a flawed outreach plan, bred mistrust of the program.

“That program was considered a fiasco,” Fineberg said, addressing the annual meeting in April of the Associates of the Cushing/Whitney Medical Library. The plan had an unrealistic goal of immunizing 95 percent of the American public, and the inability to attain this target obscured the unprecedented achievement of vaccinating 40 million people, twice as many as in any previous year.

Flu epidemics occur about three times a century, Fineberg said, denying scientists frequent chances to observe them. He called such events “low-likelihood, high-consequence” occurrences.

“They are seriously difficult for experts and for policy-makers,” he said. “If you are a naysayer and you scoff at the prospect of preparation, more often than not you are going to be proved correct. That doesn’t mean it is wise or prudent if you fail to prepare.”

—J.C.


			Originally published in Yale Medicine, Autumn 2006. Copyright © 2006 Yale University School of Medicine. All rights reserved.