Medical Aspects of Chemical Warfare (2008) - The Black Vault

Medical Aspects of Chemical Warfareseems to be in a “waking dream,” staring and muttering,sometimes shouting, as simple items in theenvironment are variably perceived as structures, animals,or people. These hallucinations may arise fromsome trivial aspect of the surroundings: a strip of floormolding has been called a strip of bacon; a bulky objectled one subject to yell for help for an injured woman;and another described a Lilliputian baseball game onthe rubber padding, evidently stimulated by unevenpatches or shadows. A total lack of insight generallysurrounds these misperceptions.A striking characteristic of delirium is its fluctuationfrom moment to moment, with occasional lucidintervals during which appropriate answers are unexpectedlygiven to questions. Sometimes the correctanswer gets temporarily shunted aside. An example ofthis unusual phenomenon was a subject who spoutedgibberish when asked “who wrote Hamlet?” Whenasked where he lived a short time later, he answered,“Shakespeare.” Phantom behaviors, such as pluckingor picking at the air or at garments, are also characteristic.This behavior was termed “carphologia” in the 19thcentury. Sometimes two delirious individuals play offeach other’s imaginings. In one study one subject wasobserved to mumble, “Gotta cigarette?” and when hiscompanion held out a nonexistent pack, he followedwith, “S’okay, don’t wanna take your last one.”Recovery from drug-induced delirium is gradual,the duration presumably paralleling the pharmacokineticpersistence of the causative agent. The morespectacular and florid hallucinations are graduallyreplaced by more modest distortions in perception.For example, illusions of large animals are replacedby those of smaller animals. As awareness of thetime and place and recognition of people graduallyreturns, the subject enters a transitional phase duringwhich he recognizes that his mental faculties are notwhat they should be, but suspects that somethingelse is wrong. This may produce temporary paranoiddelusions and withdrawal (or occasionally an attemptto escape from the room). A psychiatrist might bereminded of similar states observed in some schizophrenicpatients.During the period from onset of maximum effectsuntil partial recovery at between 24 and 48 hours, thevolunteers are completely unable to perform any taskrequiring comprehension and problem-solving. Duringthis time and even during their gradual recovery,they are generally docile. Aggressive or assaultivebehavior does not occur, except in the form of momentsof irritability, sometimes punctuated by an attemptedpunch or other expression of annoyance. “Berserk”behavior or attack with an object is absent, contraryto some descriptions by those unfamiliar with the BZdelirious syndrome. Confusion may give way to panicin a few subjects as they near recovery, but this is alwaysmotivated by fear of imagined harm, and neverby a desire to inflict severe bodily injury. Not once inseveral hundred drug-induced delirious states duringthe BZ studies was significant injury inflicted on theattending staff.A period of restorative sleep generally precedes thereturn to normal cognitive function, accompanied bycheerful emotions. Many of the BZ subjects describeda feeling of well-being following recovery. Initially, asreflected in their posttest write-ups, those who hadbeen delirious can recall some events, but, as withdreams, their recollection soon fades. Thereafter, thesefleeting memories are forgotten, in keeping with theclinical adage that delirium of all types is followedby amnesia.Other glycolates. At least a dozen synthetic glycolateswere provided to Edgewood Arsenal for testing involunteer subjects. John Biel, at Lakeside Laboratories,Milwaukee, Wisconsin, prepared many of these compounds,making it possible to compare belladonnoidstructures that differed only quantitatively in suchparameters as potency, duration, speed of onset, andrelative central potency. 96 His colleague, Leo Abood,was an early pioneer in the study of many of thesecompounds and formulated useful structure/activityrelationships showing that duration and potency,for example, could be predicted from the position ofparticular features of the structure, such as the locationof a hydroxyl moiety. Testing in volunteers validatedmany of these observations about structure. Abood’schapter in a National Academy of Sciences publicationon chemical agents also contains a useful compilationof the number of volunteers tested at Edgewood Arsenalwith each belladonnoid and a summary of theobserved effects. 97Abood adds his personal knowledge of three graduatestudents who surreptitiously ingested up to 10mg of BZ and were hospitalized. All three studentshad been in academic difficulty and had considereddropping out of school; however, after their recovery,their academic performance improved dramatically,and all went on to obtain PhDs and continue in gainfulemployment. In addition, several independentobservers thought the students seemed happier andbetter adjusted. These unexpected changes tend to corroborateprevious claims of psychiatric benefits frombelladonna-induced coma therapy. 98–100Many synthetic belladonnoids were tested in thevolunteers. Some of these were found to be more potentwith fewer side effects, such as no significant increasein heart rate. 101–105 Testing continued to find syntheticbelladonnoids with much shorter duration and withfull recovery occurring within 1 to 2 days, making aconvenient agent against which to test antidotes. 106–111424