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INTRODUCTION

Background. Anthrax, caused by the bacterium Bacillus anthracis, has been recognized as an infectious disease of both humans and animals for many centuries. While no longer causing substantial disease in the United States, it occurs in multiple countries worldwide and is a major bioterrorist threat. The name of the disease, “anthrax,” is derived from the Greek word anthrakos, meaning charcoal or carbuncle, and refers to the black skin lesions commonly seen with cutaneous anthrax infection.1 Anthrax is likely to have originated over 6000 years ago in ancient Mesopotamia and Egypt, where it may have caused the fifth plague of Egypt in which the “horses, donkeys, and camels and cattle, sheep, and goats” of the Egyptians died the same day.2 However it may have existed as long as 12,000 years ago, when livestock were first domesticated.1,3 The Roman poet Virgil described an anthrax epizootic, observing that eating meat or wearing clothes made from the wool or hides of infected animals resulted in human anthrax.4 Devastating epizootics of anthrax were described in the middle ages, and an outbreak of anthrax referred to as the “black bain” is reported to have killed 60,000 people in Europe in 1613.5 A number of notable historical6–8 as well as recent9,10 outbreaks have occurred in the wake of famines or food shortages.

In nineteenth century Europe, anthrax outbreaks resulted in significant loss of livestock. In France, at least 20–30% of the sheep and cattle died of anthrax each year.3 This devastating effect of anthrax stimulated microbiological studies of the disease in the mid-1800s. Delafond, Rayer, Daviane, and others described “bodies” or “little rods” in the blood of animals, which died of the disease, and in the 1860s Davaine demonstrated that anthrax could be transmitted to healthy animals through the inoculation of blood from anthrax-affected sick or dead animals.3,11 Robert Koch was able to grow the anthrax bacillus in a sterile medium outside of an animal host and then infect mice with the resulting spores—thus first demonstrating in 1877 what have become known as Koch’s postulates, and making anthrax the first disease for which a single microorganism was proven to be the etiological agent. Louis Pasteur was the first to develop an effective vaccine for a bacterial disease, demonstrating his anthrax vaccine in 1881.3

In the middle of the nineteenth century, inhalation anthrax, or “woolsorter’s disease,” was recognized as an occupationally acquired disease of textile workers in England who sorted imported mohair and alpaca hair. It was not until 1879, over 30 years after the disease was first recognized, that John Bell determined that woolsorter’s disease was what we now refer to as inhalation anthrax. Recommendations were made the following year for the cleaning of imported mohair, and later these “Bradford Rules,” named for the English city, which was the center of the mohair wool industry, were improved by calling for ...

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