The Demon in the Freezer

BMJ 2002; 325 doi: (Published 07 December 2002) Cite this as: BMJ 2002;325:1367
  1. Fred Charatan, retired geriatric physician (fredcharatan{at}
  1. Boynton Beach, Florida

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    Richard Preston

    Random House, $24.95, pp 233

    ISBN 0375508562

    Due to be published in the UK in January 2003 by Headline Books, £16.99, ISBN 0 7553 1217 1

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    Richard Preston, a writer for the New Yorker since 1985 and the only non-doctor ever to have received the US Centers for Disease Control's Champion of Prevention award, tells the riveting story of the current threat of biological weapons. He begins with the anthrax attacks, the first largescale bioterror event in the United States, and he describes the death last year from pulmonary anthrax of Robert Stevens, a British born photographer, who worked at the American Media Building in Boca Raton, Florida. The receipt of anthrax-laced letters at the US Senate a month after the September 11 terrorist attack led to the activation of the FBI's Hazardous Materials Response Unit, and efforts, so far unsuccessful, to track down the perpetrators.

    Smallpox, however, is the main focus of the book. Dr Peter Jahrling, senior scientist at the United States Army Medical Research Institute of Infectious Diseases (USAMRIID), says, “Epidemiologists think smallpox killed roughly one billion people during its last 100 years of activity on earth.” Dr Jahrling regards smallpox “as the greatest biological threat to human safety.” The Central Intelligence Agency believes a number of countries either have clandestine stocks of smallpox or are trying actively to get the virus. Likely countries include Iraq, North Korea, Iran, and Pakistan.

    An epidemic of smallpox occurred in 1970 in the small city of Meschede in northern Germany, begun by a man returning from Karachi, where he had contracted the disease. The outbreak resulted in 19 cases and four deaths, which Preston describes in painful detail.

    On 27 October 1977, a hospital cook in Somalia developed the world's final natural case of smallpox. Ring vaccination of 57 000 people around him finally eradicated the virus.

    Much of this book deals with the efforts to contain the two remaining stores of smallpox virus—at the CDC in Atlanta and in the former Soviet Union in Moscow.

    This is the third book in Preston's Dark Biology series. After reading Preston's second book, The Cobra Event, then US president Bill Clinton convened a meeting to discuss its implications, and altered the federal budget to buttress America's defences against bioterror attacks. The Demon in the Freezer should be read by all those working to defend theirfellow citizens against biological attacks.

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