Strange as it may seem today anthrax is primarily a disease of animals. Man is infected from an animal, either by direct association or by exposure to infected animal parts such as contaminated meat, hides or wool.

Anthrax has been known down through time by a series of names, many of which have been lost as centuries came and went. Some of them are malignant pustule, splenic fever, carbuncle, charbon, murrain, black bain and wool sorters disease.

Man has upset nature’s apple cart during the last few years by developing strains of the anthrax bacilli which are highly refined as to their lethal capabilities and resistance to drug therapy. These refined strains were developed to contaminate vast areas of human and animal populations plus contaminate the air which we breathe to create the pulmonary form of the disease which is highly fatal. Enter into the world so-called “bacterial warfare or bioterrorism.” Man picked a good one to use when he settled on the anthrax bacilli.

The beginning of anthrax is lost in the fog of time. In 1491 B.C., Moses, the great biblical prophet, is said to have threatened the Pharaoh of Egypt with an epidemic which would destroy his horses, cattle and sheep. The quotation goes like this: “Behold the hand of the Lord is upon thy cattle which is in the field, upon thy horses, upon thy asses, upon thy camels, upon thy oxen, and upon thy sheep: there shall be a grievous murrain.”

Many students of the bible and historians believe this disease or plague was anthrax. All of the cattle in Egypt died along with vast numbers of horses, asses and sheep.

Many historical writers mention outbreaks of anthrax in animals. Homer and Virgil describe quite well epidemics in animals. Other writers such as Hippocrates, Galen, and Pliny describe carbuncles, which today’s authorities believe to be a form of anthrax in the human.

During the medieval ages writers describe many epidemics in animals which were absolutely devastating. Records reveal that in 1613 anthrax developed into such an epidemic that it killed 60,000 people plus vast numbers of sheep, goats, cattle and horses. It is interesting to note that Anglo-Saxon records of the time contain folk charms and remedies for the prevention and cure of anthrax, which at that period was known as “black bain.”

It was not until the end of the 16th century that the scholars suspected the disease was transmitted from animal to man.

Real scientific literature did not appear until 1769 when the Academy of Dijon produced a paper on the disease which gave quite accurate descriptions of anthrax in animals and as it occurred in man. This was followed closely by Chabert in 1780, who wrote about the different forms of anthrax in man and its differential diagnosis from other conditions or diseases of the skin. In 1823, a scientist named Barthelemy proved this contagious nature of anthrax in animals by his experiments.

Farming was almost at a standstill in Europe during the early 1800s. Anthrax was destroying vast numbers of the livestock. France alone was losing 25 to 50 percent of its sheep. Goats were hit much harder, up to 75% of the herds were decimated. It is thought by examination of old records that by 1850 in France alone, 50% of the cattle and 40% of the horses and asses had been destroyed by anthrax.

I can remember being taught in vet school that Koch discovered the anthrax bacillus in 1876 and Louis Pasteur produced a vaccine for the prevention of the disease by 1880. This all happened very timely to save the livestock industry in Europe.

Anthrax was historically important in that it was the first disease occurring in animals and man shown to be caused by a “germ” or micro-organism and it was the very first disease to be prevented by the production and use of a bacterial vaccine. So as not to confuse the reader, the very first vaccination against smallpox was done on May 14, 1796, by William Jenner in England on an eight year old lad named James Phipps. This vaccination differs from the anthrax vaccine in that smallpox is caused by a virus and when the vaccination first occurred, Jenner had no idea of the causative agent or the nature of it. He was flying in the dark, but by doing so he made an extremely important discovery for the health and welfare of mankind.

Now let’s take a look at the organism itself. Bacillus anthracia is a large rod-shaped single cell organism. It is relatively easy to grow and is one of the most resistant of the pathogen bacteria. In addition, it has the ability to form into a “spore.”

A colony of anthrax bacilli growing on an agar plate has a peculiar shape. The colony is curled and will have filaments around the margin which always return to the original colony mass. These colonies are aptly named as having a “medusa-head.” The filaments or “hairs” are actually chains of the rod-shaped bacteria growing out and continuing back to the center of the colony. Two types of colonies are seen, rough and smooth. The rough or “R” type colonies are more virulent than the “S” type or smooth. If the “R” type bacilli are propagated the virulence seems to increase while the “S” type bacilli, if propagated, seem to lose much of their virulence or disease producing capabilities.

The big deal is that these little buggers are “spore” formers. Round shaped bacteria, cocci, or the filamentous ones do not form spores. Only the rod shaped bacteria and possibly some spiral-shaped ones are spore formers.

Environmental factors will hasten the formation of spores within a cell. In the case of the anthrax bacillus, the presence of oxygen is a major factor. When the bacilli are grown on an agar plate, spores only form after a 24-hour period has passed.

The spore is a portion of the protoplasm in the cell, usually containing about 20 percent water while the cell itself may contain 80 to 90 percent water. It shrinks in size within the cell and is surrounded by a thick heavy wall. This spore is very resistant to drying, heat, light and chemical disinfectants. The anthrax bacillus will grow, as it does in animals and man, without an abundant supply of oxygen. However, as soon as it is exposed to a good supply of oxygen, it begins to form into spores.

The anthrax bacilles is a spore former in the soil where these spores will be exposed to a great variety of temperature and humidity changes as well as light. Under favorable conditions they will germinate or grow into the original cell structure of its kind.

These spores can exist for many years under very adverse conditions. One such test revealed that anthrax spores in a room environment exposed to sunlight at room temperature were 50 percent capable of germination after two months. Many were capable of life after ten years, and it took 23 years for them all to die. Another experiment revealed that spores taken from the ground, where an animal had died of anthrax, remained viable for 83 years, which was the last time a sample was taken.

At one time anthrax was prevalent throughout the world. For example, one researcher, Carpenter, traced the infection in Louisiana where it was a common disease of the deer in the area and soon became an annual problem in the cattle populations. In 1835 he reported a large number of human cases in the area. Anthrax later became quite prevalent in the lower Mississippi and the states bordering the Gulf.

The worst endemic areas of the world were Russia, Siberia, Iran, Iraq, China, India and Arabia. It occurred in South America, Africa and Australia. No area of the world was safe from the anthrax bacillus.

It is interesting to note, the first reported human case in the United States was in Philadelphia in 1834. Records show that cattle pastured in the area, on the commons, were dying of “Murrain” or anthrax.

One would probably be correct to say that all mammals are susceptible to anthrax. Grass eaters-herbivora, are the most vulnerable to natural infection. Sheep, goats, cattle, horses, asses and mules are probably the most susceptible of our domestic animals. Hogs, guinea pigs, rabbits, mice and others will succumb rapidly to the disease. Dogs, cats, man and other omnivera and carnivores will contract the disease and die as quickly as the herbivora, but many cases are confined to local infection and will recover. One report in the literature tells about an anthrax outbreak in Siam, in elephants, the cause of which was contaminated forage.

It is interesting that birds are immune to the disease. However they may contract it if their immune systems are impaired. Pasteur did some experiments with chickens in which he lowered their body temperature by immersing them in water while giving them the anthrax bacilli. They then came down with the disease.

Infection of the animals usually is a result of ingestion of the organism or the spores rather than by contact. This is especially true of the grass-eating animals. As we have noted, the ruminants are the most easily infected. This is an oddity since in the ruminants, cattle, sheep, goats, deer and etc., the infection probably takes place in one of their stomachs. The horse, mule and ass ferment the forage in the large intestine. These intestines are loaded with the colon bacillus, E Coli. When the anthrax bacillus and colon bacillus grow together, as in that large intestine, the anthrax organisms will decrease in number and virulence. So you can readily see the equine family has a good defense against contracting the disease if the bacteria and spore numbers are not too great.

Pastures, stables, corrals and yards where infected animals have died become contaminated with spores which are viable for years.

When the forage is abundant, especially when moisture has been plentiful, the disease is not as easy for the grass eaters to contract. However, when the weather becomes dry and forage is short the animals grazing will eat to the ground, and in the case of the horse, will actually pull up the grass and eat the roots and all. The spores in the ground get access to the intestinal tract and to any broken tissue in the animals mouth. The latter is often true of the horse as its mode of infection.

If the bacteria or spores, born on dust or dirt gets on an abraided area of the oral mucosa or a slight skin abrasion or wound, it goes to work immediately.

Pastures where infected cattle have died remain infective for years. Tannery wastes have been dumped on pastures and into streams, thus depositing the spores in areas where they are viable for years.

Anthrax spores have been found on the beaks and feet of buzzards who have fed on the dead carcasses and they will serve to spread the disease. Dogs, cats, opossums and chickens all have proven to harbor the anthrax spores for years and shed them in their feces. One case was reported where a dog harbored virulent anthrax spores in its feces for eight years after having been fed anthrax-contaminated meat. How would you like it to have licked your face as we see so many cats and dogs doing to people on T.V. and in the real world featuring pets today?

Feeding contaminated hay or other forage, which was grown on infected land, will spread the disease. Other feeds or feed additives which have been known to cause outbreaks of anthrax in Maryland, Great Britain and Holland were infected bone meal, blood meal and some imported forages and processed feeds.

Biting flies and mosquitoes may be another source in spreading the disease from animal to animal and from animal to man. One experiment found live anthrax spores in flies for as long as 20 days after they were ingested by the host fly.

In horses, the disease may appear in one of three forms.

The first form is known as the apoplectic or peracute phase. In this form the symptoms of anthrax develop rapidly and acutely. The horse will exhibit a very high temperature. He will show signs of cerebral dysfunction in that he will stagger, show profound depression, stupor and muscular tremors. He will exhibit colic pains and muscle weakness. The animal will fall and not be able to rise. The mucous membranes will be a bluish, red color. As the animal staggers and falls, bloody fluids will flow from its body openings and he soon will die.

The second or acute form in the horse develops more slowly in that it takes about 24 hours for symptoms to occur. As in the peracute case the fever will be high, 104 to 107 degrees Fahrenheit. At first, the stricken animal will be greatly excited. Later it will become drowsy and have a staggering, indolent gait. It will frequently pass bloody urine. The breathing will increase to 40 respirations per minute. Usually the death is preceded by convulsions and movements of all four legs.

The subacute form is the third form of anthrax in the horse. As in the other two forms, the fever is very high going to 107 degrees. A week may be required to bring on all of the symptoms. Colics are commonplace. The animal will develop swellings which are local anthrax tumors, or so called carbuncles, externally on the skin. They will appear first on the shoulders, then the neck and head. These tumors are, at first, hard and well contained. Later, they will become more diffuse, cold and insensitive. If one of these tumors should be cut open it will be very black in color and be filled with a dark bloody mass of necrotic tissue. Of course this tumor contains millions of the anthrax bacteria.

This form of anthrax is the one most commonly seen and can respond favorably to modern day treatment. In the peracute and acute phases of anthrax, the onset and duration of the disease is so fast that most treatments are of no use and the animal will die.

As far as cattle, sheep and bison are concerned, the peracute or apoplectic form of anthrax is what is most commonly seen when these animals are infected.

The number of human cases of anthrax which have occurred in the United States has steadily declined since the 1940s and these numbers are not large. As in the horse, the human form of anthrax is categorized according to the route of introduction of the infection as well as the tissues, which are involved. Generally, there are four classes of infection.

Up until the present time when terrorists are suspected of spreading the anthrax bacilli, the most common infection was local lesions called malignant pustules, carbuncles or charbons. These would occur at the site of infection, which were slight abrasions, scratches or small wounds in the skin. These external cases of anthrax are very easy to diagnose.

About two or three days after exposure, a small red blister will appear at the site of the infection on the skin. It is often mistaken for a bug bite. If the area around the blister is swollen and reddish in color, the serious fluid present in the blister and surrounding area should be examined bacteriologically. This examination would reveal the presence of the microorganism. Blood can also be tested from the patient for the presence of immune bodies against the anthrax organism. If they are present, it definitely shows exposure to the disease. An early diagnosis of the condition would lead to speedy treatment and recovery.

In another 24-48 hours the clinical diagnosis of the infection should be certain. The skin lesion develops rapidly in size. The center becomes red and will change to a black color. In fact, the term anthrax refers to this very black center. The lesion will expand rapidly at this time becoming two or more inches in diameter. It will be surrounded by an area of oedema. The lesion will become hard but is not painful unless probed or touched.

In those cases where the lesion has progressed the patient will show a high fever and prostration and the infection will spread rapidly through the lymphatic and circulatory systems and the patient will die of a massive septicemia.

The head, neck and arms are the most usual sites for the appearance of this type of anthrax in man. This form of anthrax would primarily occur in hide, skin and leather workers, as well as farmers and veterinarians. People who were involved with the transportation of hides, skins and leather could also be stricken. It is often known as the skin form of anthrax.

Internal anthrax as it appears in man is the second classification. One form of internal anthrax involves the intestines where the infection is present. This is called intestinal anthrax. It is generally thought this infection does occur from eating improperly cooked infected meat or by consuming any produce which had become exposed to numbers of anthrax spores and, in turn, was not adequately cleaned or washed before the produce was consumed.

This form of internal anthrax is not common and is rare in man.

The second form of internal anthrax in man occurs when the infection enters the upper respiratory tract and will produce a massive pneumonia in the victim. At the turn of the century, up until the 1950s, this form of anthrax was known as “wool-sorter’s disease.” From 1939 to 1943, there were 237 reported cases in the United States among those people who worked in the wool and hair industry.

The source of the infection was the importation of wool and hair from anthrax infected countries. This of course led to disinfection stations for these raw products not only in the United States but overseas as well. Great Britain was the first country to open such a station in Liverpool in 1921. At that time, much wool coming from anthrax infected areas was diverted to the United States where disinfection of the raw products was not mandatory.

Posters such as this were used by the U.S. Department of Labor to warn workers in the tanning industry about the skin form of anthrax.

The period, 1939-1943, also covered the war years when there developed a tremendous demand for wool clothing and other finished wool products and the demand for raw wool and hair was therefore very high. After the end of World War II, there were increased importations of goatskins for tanning purposes. These bales of skins had been stored for a long time and some contained enough anthrax bacilli and spores to cause a sharp increase in anthrax cases, both localized and pneumonia, in tannery employees.

People working in this type of industry were subject to the skin infection and to the pulmonary form of anthrax.

Pulmonary anthrax cases in humans is the desired effect when using anthrax spores as a biological warfare tool. To accomplish this end, terrorists would probably use highly refined anthrax spores mixed in an aerosol medium. These spores could be from bacilli which have been genetically altered to become resistant to antibiotics and disinfection. The product must be delivered in such a fashion that it is invisible and non-odorous. It could then be delivered anywhere into the air which people would breathe. No one would be the wiser until numbers of infected individuals, and perhaps animals, would develop high temperatures, pneumonia and septicemia and die in two to four days after exposure.

Of course, this is what the terrorists would like, but so far it has been very difficult to amass the amount of anthrax spores needed and to develop a good reliable delivery system. We have all seen, however, what havoc can be wrought upon government and business by the delivery of a few letters to offices with the resulting exposure to anthrax by a limited number of people. One could only imagine what could happen if a large amount of anthrax spores were used against a large number of people that were either housed or working in buildings. On the contrary, it would be much more difficult to disseminate this sort of weapon to individuals or livestock in the out-of-doors. Of course anything might be possible and only time will give us the answer.

Another, but not very common, form of anthrax in the human is a meningitis form. Some researchers have found the brain to be much more receptive to the anthrax bacilli than the skin. There are some cases on record which have been researched where anthrax meningitis was present without any evidence of an external lesion.

Although it is extremely rare, there are a few cases on record where anthrax has been passed from one human to another. One such case involved a three year old girl who contracted an anthrax infection in her eye while sleeping with her father who had an anthrax lesion.

The following are some cases of anthrax which will illustrate how it spreads and its ability to permeate the human population.

A family in Pennsylvania in 1930-31 on a small farm, where all seven developed the disease in two months with two deaths and five recoveries. One of the seven had a return case the following year with recovery.

There are many cases which are recorded of workmen in tanneries carrying the infection home on their clothes to their families without getting the disease themselves.

Shaving brushes after World War I were the cause of anthrax in man. The source of the contaminated horsehair, which was used in the brushes, was from Siberia and China. The first recorded death from this route was a British soldier on July 9, 1915. United States troops there during the war had 149 cases of anthrax with 22 deaths from shaving brushes. From 1919 to 1923 in New York City there were 32 cases of anthrax reported involving contaminated shaving brushes.

In the state of Illinois, one lot of 36 brushes was inspected at that time and all of them were contaminated with anthrax spores.

In 1938-39 another outbreak of anthrax was attributed to a shipment of 35,000 brushes from Japan. They were all supposedly sterilized. However, the state of North Dakota and the U.S. Public Health Service found many of them to be contaminated with anthrax spores and the whole consignment was destroyed.

Here’s an interesting case again involving shaving brushes: According to the London Letter of the Journal of The American Medical Association, a lot of 12 brushes was received in Lambeth, England and was tested and found infected. Eleven were removed but one had been sold and could not be traced. Two years later the twelfth brush turned up after its owner had died of anthrax. He was a boot maker who had used this infected brush until he inadvertently cut himself and became infected.

In 1864, in five communities in Russia, 10,000 horses and 1,000 people died of anthrax.

Bites of bloodsucking insects have been a factor in transferring the disease from an infected animal to man.

One girl in the state of Louisiana developed anthrax while carving small figures from horse bones.

One man is known to have gotten anthrax while caring for his dog, which had fed on a sheep after it died of anthrax.

And the lists of cases go on and on. Some are easy to understand as to the source of infection. Others have puzzled investigators and the source of the anthrax has never been known. One such is a dress clerk in an Ohio store who developed a skin case of anthrax and no source of the infection could be found. The same may be said at the present time for the seven month old baby girl who contracted the skin form of the disease apparently while present in an ABC News office.

The eradication and control of anthrax in animals depends largely upon the vaccination of cattle, sheep, horses and goats in infected areas. I believe any suspected or diagnosed case must be reported to the appropriate state and federal authorities. It is most important to burn the dead animal or bury it deep in the ground and cover the carcass with quicklime. Do not open the animal if it is dead and you know the cause of death. The act of opening the animal will cause spores to be formed and this, in turn, will contaminate for a very, very long time the ground on which the cadaver lays.

In dealing with animals, the case should be diagnosed as soon as possible and effective treatment undertaken as vigorously as one can do in order to save the patient.

As to human anthrax, eradication of the disease in animals is a big factor in preventing many cases. The elimination of industrial hazards has been largely accomplished through state and federal laws regarding the importation and sterilization of animal products such as skins, hides, wool and hair.

In the human, cases of anthrax should be diagnosed as early as possible. Nasal swabs should be taken and processed if there is any indication that exposure to anthrax spores has occurred. If these cultures are then positive, preventive treatment for the pneumonic form of internal anthrax can be instituted with excellent results.

There are a number of antibiotics available today which are excellent for the prevention and treatmnet of anthrax. They are: Doxycycline, penicillin, Cipro (made by Bayer) and Oxytetracycline.

The U.S. government has developed a human vaccine to be used to immunize people. So far it has been used only on military personnel.

A few years ago, before the advent of sulfa drugs and penicillin, an arsenical drug called neoarsphenamine was used to treat human cases of anthrax. It was an excellent drug to employ for the treatment of anthrax cases and many physicians preferred it over the sulfa and penicillin.

I would like to leave you with a few thoughts and facts about anthrax which I hope will answer some of your questions.

1. Anthrax is primarily a disease of animals.

2. The anthrax spore is among the most resistant of pathological spores and it can be genetically modified and refined in size and virulence to be delivered as an aerosol whereby the pneu- monia form of the disease in man is very deadly.

3. Promptness of diagnosis is extremely important. Nasal swabs and blood samples should be taken if anyone believes he or she has been exposed to the anthrax spores.

4. Infection of the skin cannot occur through unbroken skin.

5. Roccal-D, Nolvasan and com- mon household Clorox are very good disinfectants to use to disinfect an area suspected to be contaminated with anthrax.

6. During the period from 1944- ’74, 284 cases of the skin form of anthrax occurred in the U.S. in man. About 72 cases of the pneumonia form were reported and a very small or unknown number of intestinal cases of anthrax occurred.

7. It is a poor practice to store or take the antibiotics as a preven- tive for anthrax unless one has been exposed.

Last of all...do not become panicked over the thought of a massive anthrax aerosol strike on this country. It simply is quite impossible to pull off. Be vigilant, be aware of your surroundings, and report anything which may arouse your suspicions along these lines.

Remember-it is fear and mass hysteria which the terrorists hope to instill into the population, by the use of bioterrorism.

I believe in the next few weeks we will see improved treatments for the pneumonia form of anthrax in man as well as measures being adopted to prevent the spread of anthrax spores in our U.S. postal system.

The last cases of respiratory anthrax occurred in the United States 25 years ago and therefore, modern medicine had some catching up to do as far as diagnosis, treatment, prevention and decontaminating the exposed areas of anthrax.