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showed mediastinal enlargement, and all showed meningitis. These re-
sults must have been from real human inhalation anthrax cases, since the
information did not exist in 1952 to have allowed fabrication using text-
book or medical literature sources.
Further evidence against fabrication of the data lies in the apparent in-
cubation periods. The intervals between US overflights and the onset of
disease ranged from 3 to 35 days. In 1952 there were no reports of incu-
bation periods for inhalational anthrax, and it is unlikely that the Chinese
would have fabricated values with such an unusually wide range. It was
not until the 1994 publication of data from the 1979 Sverdlovsk outbreak
that a wide range of incubation periods became known as characteristic
of this disease. 48
There is nothing inconsistent between the Chinese contention that the
ISC anthrax cases were US BW attacks, and known US capabilities. US
aircraft did overfly the alleged target area. Anthrax had been developed
as a BW agent at Camp Detrick during World War II, 49 and the pilot plant
for anthrax production, concentration, and drying had been reactivated
in late 1950, 50 almost certainly to supply the Special Operations Division.
The use of feathers as a carrier for cereal rust spores was already a feature
of a standardized US BW munition, 51 and it had been successfully tested
with two animal pathogens as well. 52 Tests of flies as carriers for animal
pathogens had also been successful. In 1952 externally contaminated in-
sects were considered an effective dispersal method for BW agents. 53
Furthermore, inhalation anthrax has been reported only after readily
identifiable occupational environmental exposures or as the result of
BW. 54 No suitable environmental sources were described in northeastern
China in 1952, and the wide geographic separation of cases would have
required multiple sources. Only one of the victims (a farmer) had an oc-
cupational risk factor, and this would have been to cutaneous, not inha-
lation, anthrax. In the entire Chinese medical literature there were no
reports of inhalation anthrax, and only three case reports of isolated an-
thrax meningitis, 55 none with autopsy examination.
Despite the highly suspicious nature of this outbreak and the coinci-
dence of US capabilities and the alleged attack method, it appears to us
that this outbreak was natural after all, and not a result of BW use. More
than a dozen isolates of B. anthracis obtained in northeastern China in
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