Remember Tokyo in 1995. Chemical weapons as well as nuclear weapons do harm.
There is no room to disagree that nuclear weapons are the greatest artificial means to destroy mankind and make the earth ruin1. Besides nuclear weapons, chemical weapons can also be a means to destroy mankind2. Organophosphorus compounds used in agriculture can also function as weapons3. If they are mounted on a rocket and dropped or scattered on hostile destinations in an accurate orbit, they have enough power to damage the human race in the area. In order to protect ourselves from such weapons installed in rockets, it is recommended to evacuate to the basement and protect ourselves from them. Subway station and underpass can function as nuclear shelters.
However, the circumstances were different in the Tokyo subway incident in Japan in 1995. The Tokyo subway sarin attack in 1995 was the first large-scale disaster caused by the nerve gas sarin3, which causes the clinical syndrome of cholinergic hyper-stimulation by inhibition of the crucial enzyme acetylcholinesterase. A religious cult released sarin gas into subway commuter trains during the morning rush hour. On that day, the patient was getting on the vehicle of the subway where the incident occurred, heading for the company of his office. Liquid was spilling on the floor of the vehicle, which caused a pungent odor. His arms and feet trembled with wiggles and he could not stand. He could not breathe and his consciousness went away. He noticed that he himself was on the bed of the emergency and life center intensive care unit. Both of his both pupils were constricted to 1.5 mm like pinpoints. He was vomiting and profusely sweating, and he had increased oral and nasal secretion. Because of these characteristic signs of organophosphorus intoxication4, amount of atropine sulfate and pralidoxime iodide were intravenously administered5. Both prominent ST elevation of V3-6 on the 12 lead electrocardiogram and protrusion out of the apical ventricle on the echocardiogram at the first visit to the emergency unit, returned normal within 10 days of treatment. During the treatment, no rise in cardiogenic enzymes such as creatine phosphokinase was observed, no lethal arrhythmia was seen, and blood pressure was maintained. He was diagnosed as Takotsubo cardiomyopathy, which has a character of transient, reversible left ventricular dysfunction with normal coronary arteries6,7. Acute physical or emotional distress, such as unexpected sarin attack, is thought to play a role in the development of Takotsubo cardiomyopathy through sudden vigorous sympathetic stimulation. We also have reported a case of combination with Takotsubo cardiomyopathy and amnesia7,8. Takotsubo cardiomyopathy and transient global amnesia are sometimes reversible but sometimes irreversible disorders that can occur concurrently partially due to catecholamine excess, leading to pathophysiological changes within the brain and the myocardium.
It is terrorism itself, such as spreading highly toxic organic phosphorus compound like sarin in the subway on which an unspecified number of passengers are on board. Even now that more than 20 years have elapsed, we must not forget that the subway station premises in Tokyo, which is expected as a shelter for nuclear attacks, were used in the crime scene.
References
1 Margaret M. Nuclear weapons do harm, even if never used. BMJ. 2017 Sep 6;358:j3978. doi: 10.1136/bmj.j3978.
2 Green ST, Cladi L, Morris P, Forde D. Undergraduate teaching on biological weapons and bioterrorism at medical schools in the UK and the Republic of Ireland: results of a cross-sectional study. BMJ Open. 2013 Jun 20;3(6). pii: e002744. doi: 10.1136/bmjopen-2013-002744.
3 Okumura T1, Takasu N, Ishimatsu S, Miyanoki S, Mitsuhashi A, Kumada K, Tanaka K, Hinohara S. Report on 640 victims of the Tokyo subway sarin attack. Ann Emerg Med. 1996 Aug;28(2):129-35.
4 Michael E, Surjit S, Nick B. Organophosphorus poisoning (acute) BMJ Clin Evid. 2007; 2007: 2102.
5 Gulland A. Lack of atropine in Syria hampers treatment after gas attacks. BMJ. 2013 Sep 3;347:f5413. doi: 10.1136/bmj.f5413.
6 Banning AP, Cuculi F, Lim CC. Takotsubo cardiomyopathy. BMJ. 2010 Mar 25;340:c1272. doi: 10.1136/bmj.c1272.
7 Kato T, Yoshimoto N, Sawano M, Hamabe Y. Coronary vasospasm in a patient suffering from sarin poisoning.Am J Emerg Med. 2000 Jan;18(1):113-4.
8 Hatta K, Miura Y, Asukai N, Hamabe Y. Amnesia from sarin poisoning. Lancet. 1996 May 11;347(9011):1343.
Competing interests:
No competing interests
25 January 2018
Kato Toru
MD, PhD
National Hospital Organization, Tochigi Medical Center
1-10-37 Nata-Tomatsuri, Utsunomiya, 320-8580 Japan
Rapid Response:
Remember Tokyo in 1995. Chemical weapons as well as nuclear weapons do harm.
There is no room to disagree that nuclear weapons are the greatest artificial means to destroy mankind and make the earth ruin1. Besides nuclear weapons, chemical weapons can also be a means to destroy mankind2. Organophosphorus compounds used in agriculture can also function as weapons3. If they are mounted on a rocket and dropped or scattered on hostile destinations in an accurate orbit, they have enough power to damage the human race in the area. In order to protect ourselves from such weapons installed in rockets, it is recommended to evacuate to the basement and protect ourselves from them. Subway station and underpass can function as nuclear shelters.
However, the circumstances were different in the Tokyo subway incident in Japan in 1995. The Tokyo subway sarin attack in 1995 was the first large-scale disaster caused by the nerve gas sarin3, which causes the clinical syndrome of cholinergic hyper-stimulation by inhibition of the crucial enzyme acetylcholinesterase. A religious cult released sarin gas into subway commuter trains during the morning rush hour. On that day, the patient was getting on the vehicle of the subway where the incident occurred, heading for the company of his office. Liquid was spilling on the floor of the vehicle, which caused a pungent odor. His arms and feet trembled with wiggles and he could not stand. He could not breathe and his consciousness went away. He noticed that he himself was on the bed of the emergency and life center intensive care unit. Both of his both pupils were constricted to 1.5 mm like pinpoints. He was vomiting and profusely sweating, and he had increased oral and nasal secretion. Because of these characteristic signs of organophosphorus intoxication4, amount of atropine sulfate and pralidoxime iodide were intravenously administered5. Both prominent ST elevation of V3-6 on the 12 lead electrocardiogram and protrusion out of the apical ventricle on the echocardiogram at the first visit to the emergency unit, returned normal within 10 days of treatment. During the treatment, no rise in cardiogenic enzymes such as creatine phosphokinase was observed, no lethal arrhythmia was seen, and blood pressure was maintained. He was diagnosed as Takotsubo cardiomyopathy, which has a character of transient, reversible left ventricular dysfunction with normal coronary arteries6,7. Acute physical or emotional distress, such as unexpected sarin attack, is thought to play a role in the development of Takotsubo cardiomyopathy through sudden vigorous sympathetic stimulation. We also have reported a case of combination with Takotsubo cardiomyopathy and amnesia7,8. Takotsubo cardiomyopathy and transient global amnesia are sometimes reversible but sometimes irreversible disorders that can occur concurrently partially due to catecholamine excess, leading to pathophysiological changes within the brain and the myocardium.
It is terrorism itself, such as spreading highly toxic organic phosphorus compound like sarin in the subway on which an unspecified number of passengers are on board. Even now that more than 20 years have elapsed, we must not forget that the subway station premises in Tokyo, which is expected as a shelter for nuclear attacks, were used in the crime scene.
References
1 Margaret M. Nuclear weapons do harm, even if never used. BMJ. 2017 Sep 6;358:j3978. doi: 10.1136/bmj.j3978.
2 Green ST, Cladi L, Morris P, Forde D. Undergraduate teaching on biological weapons and bioterrorism at medical schools in the UK and the Republic of Ireland: results of a cross-sectional study. BMJ Open. 2013 Jun 20;3(6). pii: e002744. doi: 10.1136/bmjopen-2013-002744.
3 Okumura T1, Takasu N, Ishimatsu S, Miyanoki S, Mitsuhashi A, Kumada K, Tanaka K, Hinohara S. Report on 640 victims of the Tokyo subway sarin attack. Ann Emerg Med. 1996 Aug;28(2):129-35.
4 Michael E, Surjit S, Nick B. Organophosphorus poisoning (acute) BMJ Clin Evid. 2007; 2007: 2102.
5 Gulland A. Lack of atropine in Syria hampers treatment after gas attacks. BMJ. 2013 Sep 3;347:f5413. doi: 10.1136/bmj.f5413.
6 Banning AP, Cuculi F, Lim CC. Takotsubo cardiomyopathy. BMJ. 2010 Mar 25;340:c1272. doi: 10.1136/bmj.c1272.
7 Kato T, Yoshimoto N, Sawano M, Hamabe Y. Coronary vasospasm in a patient suffering from sarin poisoning.Am J Emerg Med. 2000 Jan;18(1):113-4.
8 Hatta K, Miura Y, Asukai N, Hamabe Y. Amnesia from sarin poisoning. Lancet. 1996 May 11;347(9011):1343.
Competing interests: No competing interests