Book Excerpt: 'Anthrax'

Once believed to be a manifestation of "unholy fire" that consumed infected animals, anthrax is now being seen as a potentially devastating weapon of terror. Medical anthropologist Jeanne Guillemin's book "Anthrax: The Investigation of a Deadly Outbreak" looks into the effects an anthrax outbreak can have on survivors and analyzes the prospects of biological warfare in the not-too-distant future. Read an excerpt from her book here.


Tuesday, June 2, 1992. After a long transatlantic flight from New York, our research team arrives in the new post-Soviet Russia, a nation that six months before did not exist. We are in the first stage of a trip to investigate the cause of the worst anthrax epidemic recorded in a modern industrial nation. The outbreak occurred in April and May 1979 in Sverdlovsk, an industrial city in the Ural Mountains, nine hundred miles east of Moscow. According to Soviet reports, by the time it was over, at least sixty-four people had died from this rare disease.

Leading the team is Matthew Meselson, a Harvard University biologist. I am the expedition's anthropologist, from Boston College, a Jesuit university that has unblinkingly supported my research for nearly twenty years. Matthew and I are also husband and wife. Doing research with a spouse can be problematic, especially when both are strong-minded individuals. Working on a politically charged issue in a foreign country can compound the difficulties, particularly when that country is the former Soviet Union, where censorship and political repression were the norm. But we have researched and written together before, on the "Yellow Rain" controversy. That investigation, during the 1980s, involved clarifying whether or not a dangerous mycotoxin had, with Soviet assistance, been used by Laos against its Hmong minority. By 1991, when Matthew began recruiting the Sverdlovsk team, I was well immersed in the details of this new problem and had made several trips to the Soviet Union, although none with the purpose and potential of this foray.

Matthew's commitment to discovering the Sverdlovsk epidemic's cause goes back to 1980, when he was consulted by the CIA after news of the event leaked to the West. In the years that followed, the world learned little about the outbreak, though speculations and suspicions abounded. Claims by a few Soviet dissidents that an explosion in a secret biological weapons laboratory caused thousands of deaths were countered by the Soviet government's contention that a much smaller number of people died from eating anthrax-infected meat sold on the black market. For years, Matthew, who has long been an advocate for the prohibition of chemical and biological weapons, has requested permission from the USSR for impartial experts to investigate the outbreak firsthand, but these requests have been denied. After the dissolution of the Soviet Union, however, the political doors have opened for our travel to Sverdlovsk, which has reclaimed its prerevolutionary name, Yekaterinburg. We have allowed ourselves only two weeks to attempt to discover conclusive evidence about the source of the 1979 anthrax deaths.

My part of the assignment is to interview the victims' families, if I can find them. We have no record of names or addresses. Yekaterinburg, an industrial city with a population of 1.2 million, as yet has no public telephone directory. Nonetheless, I optimistically carry in my suitcase a hundred copies of a brief questionnaire that I have prepared and tested in translation. Our team brings other expertise to the expedition. The congenial Dr. Alexis Shelokov, who speaks fluent Russian, is a vaccine expert from the Salk Institute with a long career in public health. The more reserved Dr. David Walker is chief of pathology at the University of Texas Medical Branch in Galveston. We are hoping that reports in the Russian press will prove true, that autopsy samples have been preserved by two pathologists who worked during the 1979 outbreak.

The fifth member of our team is veterinarian Martin Hugh-Jones from Louisiana State University, a member of the World Health Organization's Anthrax Research and Control Working Group, and an avid world traveler. The veterinary perspective is essential. Anthrax is a zoonosis, a disease that can travel from animals to humans. It is almost always associated with grazing animals, especially sheep, cows, goats, and horses, that pick it up from contaminated soil, by either eating or inhaling the tough spores that are the dormant form of its deadly bacteria.

Anthrax is as old as pastoralism and the origins of civilization. It might be the Sixth Plague, the sooty "morain," in the Book of Exodus that kills livestock and affects people with black spots. It is probably Apollo's "burning wind of plague" that begins Homer's Iliad.

Pack animals were his target first, and dogs but soldiers, too, soon felt transfixing pain from his hard shots, and pyres burned night and day.

In ancient Roman times, Virgil's Georgics lamented the shortage of animals caused by what again was most likely anthrax.

Ghastly Tisphone rages, and … drives before her Disease and Dread… The rivers and thirsty banks and sloping hills echo to the bleating of flocks and incessant lowing of kine. And now in droves she deals out death, and in the very stalls piles up the bodies, rotting with putrid foulness, till men learn to cover them in earth and bury them in pits.

Virgil also noted the other hazard of anthrax, that it spreads to humans, not by human-to-human contact, but by human contact with infected animals:

For neither might the hides be used, nor could one cleanse the flesh by water or master it by fire. They could not even sheer the fleeces, eaten up with sores and filth, nor touch the rotten web. Nay, if any man donned the loathsome garb, feverish blisters and foul sweat would run along his fetid limbs, and not long had he to wait ere the accursed fire was feeding on his stricken limbs.

Veterinarians can often tell an animal has died from anthrax by its sudden death and by the blood and bloody fluid that have oozed from its orifices. Anthrax bacteria in the decaying carcass are likely to be killed off by the bacteria of putrefaction; anaerobes (bacteria that can multiply without free oxygen) from the intestines do the clean-up work. The greater danger of anthrax lies in the blood that spills from the animal and drains into the soil, where the bacteria can then assume a protective spore form. (In a real sense, then, anthrax needs its host to die so that the disease may continue.) Relative temperature, along with varying blood and soil conditions, determines whether spores actually will form. Once formed, though, they can be devilishly hard to eliminate.

Burying dead animals in pits, as Virgil suggested, never really disposed of anthrax. In spore form, its bacteria have been known to persist in soil for as long as seventy years, well after the memory of the site is lost. When an old site is disturbed — as new fields are plowed, new gravel pits dug, or new roads laid — or when a spring flood brings spores to the surface, animal outbreaks can flare as if from nowhere. Animal and human anthrax ravaged Europe and Asia throughout history, with major outbreaks in Germany in the fourteenth century and in central Europe and Russia in the seventeenth century, and these epidemics most likely originated from old reservoirs where diseased animals had been buried.

Attacking anthrax contamination has its problems, especially when attempted on a large scale. It takes three hours at 140 degrees centigrade to sterilize a five-ton load of bones in an industrial digester. Four decades after the World War II testing of anthrax weapons at Gruinard Island off the coast of Scotland, the British used formaldehyde to the depth of six inches to ensure the soil was rid of spores.

In humans, an anthrax infection can begin in one of three ways. Infection through the skin (cutaneous anthrax) is what Virgil described and is the most common and obvious form. It begins with a tiny pimple. In a few hours this eruption becomes a reddish-brown irritation and swelling that turns into an ulcer, the "feverish blister" that splits the skin. The black scablike crust that the lesion develops gives the disease its name, anthracis, the Latin transliteration of the Greek word for coal. In Russian, anthrax is also called "Siberian ulcer" (Siberskaya yazva), because of the prevalence of the disease in that region. Indeed, czarist Russia and the former Soviet Union, with their huge rural area, had among the world's highest levels of recorded anthrax outbreaks. Without treatment, the fatality rate for cutaneous anthrax can be 20 percent. In this century, sulfamides, penicillin, tetracycline, and other relatively accessible drugs have reduced fatality to 5 percent and less.

As noted, there are two other ways of contracting anthrax in humans: Over the years, a distinction has been drawn between gastrointestinal anthrax, acquired by eating tainted meat, and inhalation anthrax, acquired by breathing in the deadly spores. This distinction immediately raises the issue of "portal of entry," of whether the spores enter the body through the mouth and digestive system or through the respiratory system, an issue central to the Sverdlovsk outbreak.

Outbreaks of gastrointestinal anthrax, rare and dangerous, usually afflict villages in developing countries, where animal vaccination and meat inspection programs are not in place or simply fail. They can occur when undercooked infected meat from local livestock or from wild animals makes it to the table. Depending on the outbreak, 25 to 100 percent of gastrointestinal anthrax victims are likely to die. Medical research (autopsy and tissue analysis) on the process of infection in authentic gastrointestinal anthrax is almost nonexistent.

Inhalation anthrax results from inhaling microscopic anthrax spores (one to five microns in diameter) deep into the lungs. Untreated inhalation anthrax is almost always fatal, but even in textile factory settings, where it has been best documented, it has proved exceptionally rare. For example, in one report of 117 cases of "woolsorter's disease" (as anthrax has been called since early industrial times), strung out over more than two decades, from 1933 to 1955, there was only one (fatal) case of inhalation anthrax; the rest were cutaneous. Other scattered fatal cases of inhalation anthrax were reported in the United States during this same time period: a football player who may have contracted the disease from playing-field soil, a San Francisco woman who beat bongo drums made of infected skin, a construction worker who handled contaminated felt, and several gardeners whose infection was traced to contaminated bone meal fertilizer. In the best-researched incident, in Manchester, New Hampshire, in 1957, inhalation anthrax killed four woolen-mill workers. In the same year, a man and woman living near a Philadelphia tannery also died of inhalation anthrax.

The terms gastrointestinal and inhalation, as noted, refer to the portal of entry, how the pathogen entered the body, not necessarily to specific clinical manifestations. According to the few published reports of cases, fatal gastrointestinal anthrax and inhalation anthrax are characterized by similar initial symptoms. At first the patient may experience the aches, chills, mild fever, and nausea characteristic of influenza. In many cases, there is a brief respite from the symptoms, a "false recovery." Then, as the infection progresses, there may be high fever, severe pain in either the abdomen or chest or both, congested breathing, dizziness, bloody vomiting, and diarrhea.

Regardless of the portal of entry, if the anthrax infection is internal, not merely cutaneous, it is termed systemic, and its treatment is highly problematic. Antibiotics are the first line of defense and can kill the anthrax bacteria or halt its growth. But because the bacteria produce a toxin that rapidly floods the blood and lymph system, sending the patient into shock, no remedy may be possible once serious symptoms begin. An unchecked anthrax infection sweeps rapidly through the body, causing massive toxic shock and internal ulceration and bleeding. During this process, a secondary pneumonia infection can develop, possibly in both patients who have eaten infected meat and patients who have inhaled anthrax spores.

Until World War II scientific interest in human anthrax cases was relatively minor compared to the focus on animal disease. Bacillus anthracis was discovered in 1850 by the French parasitologist Casimir-Joseph Davaine, who examined the blood of infected sheep under the microscope. Subsequent work, especially by Robert Koch, the famous German biologist, and the legendary Louis Pasteur in France, proved beyond doubt that this bacterium caused anthrax. It was with anthrax, in fact, that the germ theory of disease was firmly established. In 1876, Koch employed his pure culture techniques to discover the life cycle of anthrax (from the bacterium, with its bamboo-like rods, to its hardy spore form and back to bacterium again). At the time, though, he was much less concerned with the victims of "ragpicker's disease" (the colloquial German term for anthrax) than with the hundreds of thousands of grazing animals his native country was losing each year to anthrax. These repeated epizootics, common also in France and other European countries, damaged the food, textile, and leather industries dependent on animal products. In 1881 Pasteur followed up his successful development of a vaccine against chicken cholera with one for animal anthrax. In May of that year, he was pressured into an early public demonstration of the vaccine at a farm in Pouilly-le-Fort, forty kilometers outside Paris. The risk paid off. On June 2, with twenty-five vaccinated sheep alive and twenty-five unvaccinated ones dead, Pasteur was proclaimed a hero in the press and by his scientific colleagues.

Since World War II, the potential of anthrax as a biological weapon has focused national and international attention on its lethality for humans. Anthrax spores, tough enough to withstand bomb detonation and small enough to aerosolize, have been a preferred agent for every nation that has sought to develop and produce biological weapons. But the primary attribute of biological weapons, including anthrax, is that they have been experimented with but almost never deployed. Some restraints are a matter of international norms. Born of a repugnance for chemical weapons used in World War I, the Geneva Protocol of 1925, for example, prohibits the use in war of both chemical and biological weapons. Although several nations, including the United States and the USSR, formally reserved the right to use such weapons in reprisal if first used against them — and thus implicitly maintained the right to develop and stockpile them — only very rarely do the norms against using biological or chemical weapons break down. In modern times, the only significant use of biological weapons, including anthrax and plague, was in the late 1930s and early 1940s, when the Japanese Imperial Army undertook covert experiments on humans (which included vivisection) and deployed biological weapons against Chinese troops and civilians in Manchuria. The details of this historical anomaly have only recently been revealed.

During World War II, American, British, and Canadian laboratories moved far along in developing and producing biological weapons, especially anthrax, which had the code name "N." By 1944, thousands of anthrax bombs were ready for use by Allied Forces, but intelligence sources could find no indication that Nazi Germany had any investment in biological weapons (BW) capability. Indeed, directives from Hitler forbade BW offensive research. Late in the war some subordinates, notably Reich Marshall Hermann Göring, supported research at a small, secret facility outside the city of Posen (Poznan) in Poland, where anthrax was the most seriously considered BW agent against both humans and animals. The war ended before the effort produced any results.

After the war, the United States and Britain continued BW research and testing, with the U. S. program (centered at Fort Detrick, Maryland) at times having more money than it could spend. In 1969, after reviewing the extensive U.S. investment in offensive BW, President Richard Nixon categorically renounced biological weapons. "Mankind already carries in its own hands too many of the seeds of its own destruction" was his public statement. Nixon limited U.S. BW activities to strictly defined defensive purposes: "techniques of immunization, safety measures, and the control and prevention of the spread of disease." All U.S. programs were then dismantled or converted to protective or other peaceful defensive uses.

At the same time, President Nixon declared U.S. support for a British proposal for an international treaty banning biological weapons. With the concurrence of the United States, Great Britain, and the Soviet Union, the Biological Weapons Convention (BWC) was completed in 1972, and some 140 states are now party to it. The BWC forbids development, production, stockpiling, or otherwise retaining biological agents or toxins "of types or in quantities that have no justification for prophylactic, protective or other peaceful purposes." It also forbids "weapons, equipment or means of delivery designed to use such agents or toxins for hostile purposes or in armed conflict." Lacking investigatory or punitive powers, the convention eventually came to rely on "confidence-building measures," such as good-faith revelations by those states party to it of past offensive and current defensive BW activities and review sessions every five years, starting in 1980. It also allows one state party to lodge a complaint against another with the United Nations Security Council, in order to begin a formal investigation that all states party to the convention would support.

The BWC has remained largely a good-faith pact among nations, but it is because of it that our research team has become involved with investigating the 1979 anthrax outbreak in Sverdlovsk. In March 1980, during the first review session of the BWC in Geneva, the U.S. State Department raised its initial concern that the Sverdlovsk outbreak signaled a Soviet violation of the convention. Soviet invasion of Afghanistan the previous December had already ruptured relations between the two superpowers and precipitated a long list of U.S. economic and political sanctions against the Soviets. U.S. suspicions about Sverdlovsk were based on satellite photographs of the city's military Compound 19, on covert intelligence reports, and on an anonymous article published in January 1980 in West Germany, in the Russian dissident broadside Posev (Sowing). This account of the outbreak was translated by the CIA and made available to American reporters just in time to rock the BWC review session. The article's author described hearing about a tremendous "explosion" of anthrax in Sverdlovsk and laid the blame on the military. "During a month or so an average of 30-40 people died each day," the author wrote. "The total number of deaths can be estimated at about 1000." The report described the removal of contaminated topsoil and the paving of streets in a nearby village to cover the contaminated earth. "One would imagine this is the only asphalted village in the Urals," the anonymous author commented. The article also added that no animal cases occurred, although within the city stray dogs were reportedly destroyed to control the spread of the disease.

Taken by surprise, the Soviet Foreign Ministry in Moscow at first denied the outbreak. Then it followed up with a statement that an anthrax epidemic in the Urals had occurred but had been caused by "improper handling of meat products." On March 21, the last day of the BWC review meetings, Viktor Israelyan, the head of the Soviet delegation, stood and delivered a final response to the U.S. suspicions of forbidden work in biological weapons and a leak of deadly anthrax:

In March-April 1979 in the area of Sverdlovsk there did in fact occur an ordinary outbreak of anthrax among animals, which arose from natural causes, and there were cases where people contracted an intestinal form of this infection as a result of eating meat from cattle which was sold against the regulations established by the veterinary inspectorate. In this connection an appropriate warning appeared in the press. However, this incident has no bearing on the question of compliance by the USSR with the Convention on the Prohibition of Bacteriological and Toxin Weapons. In this connection there are no grounds whatsoever for the question which was raised by the U.S. delegation.

U.S. intelligence analysts believed otherwise. Rumors of hundreds, even thousands of people killed in the 1979 outbreak continued to come in from Moscow, from emigrés in Western Europe, and from Soviet Jews newly settled in Israel, although no firsthand witnesses ever emerged. Calculations of the anthrax dose by some U.S. intelligence experts further inflamed the issue. A single gram of anthrax contains around a trillion potentially lethal spores. In a briefing on Sverdlovsk for President Jimmy Carter by Central Intelligence Director Stansfield Turner, the amount of anthrax released in the outbreak was estimated at seventy kilograms, an amount that could seriously infect tens of thousands of square miles. Matthew Meselson and U. S. government BW experts at the army's Dugway Proving Ground, who better understood the basic aerodynamics involved in such estimates, reckoned that as little as a gram of aerosolized anthrax, with its trillion spores, could have caused the Sverdlovsk outbreak. The figure settled on in Defense Intelligence Agency reports was ten kilograms.

The Soviet response to these suspicions was to adamantly stand by its tainted-meat explanation. In the spring of 1980 the U.S. government formed a working group on the Sverdlovsk outbreak, consisting of representatives from the Joint Chiefs of Staff, the National Security Council, the State Department, the CIA, and other agencies, to consider the incident. The group called on several outside experts: Philip Brachman from the Centers for Disease Control, Nobel Laureate microbiologist Joshua Lederberg at Rockefeller University in New York, Paul Doty, professor of biochemistry at Harvard, and Matthew Meselson. After some months, the majority judgment of the group was that an accidental explosion at the Sverdlovsk military factory caused an aerosol emission of virulent anthrax spores and that this emission resulted in many deaths from inhalation anthrax. The group also surmised that the emission caused an epizootic that brought infected meat to the black market. This inclusion of infected meat in the scenario (meat that could have been stored and eaten over a period of weeks) would account for the epidemic's reported long duration into early May, with people still falling ill and dying long after the initial explosion.

During the 1980s, as Cold War tensions heightened, the U.S. investment in weapons systems (including renewed production of chemical weapons) quadrupled, and American press reports about alleged Soviet treaty violations, in Sverdlovsk and elsewhere, filled the news. Yet during this time no formal complaint about the 1979 epidemic was lodged against the Soviet Union at the United Nations Security Council by the United States or any other nation. Meanwhile, throughout these years, Matthew kept pressing for a full on-site investigation of the Sverdlovsk incident and sent numerous missives to Soviet officials and fellow scientists, asking for research cooperation. In August 1986, after Mikhail Gorbachev began to liberalize contact with the West, Matthew was invited to Moscow for a private meeting with the three principal public health physicians who had been sent from Moscow to Sverdlovsk in the 1979 epidemic and who now offered their evidence for the Soviet infected-meat explanation of the outbreak. Later, in October of that year, a delegation to Moscow from the U.S. National Academy of Sciences, chaired by Joshua Lederberg, heard the physicians' case, in both a formal presentation and informal discussion. Following that, in 1988, with Matthew handling the arrangements, two of those Soviet physicians came to the United States to present and defend their government's explanation of the 1979 anthrax outbreak. They spoke to professional audiences at the National Academy of Sciences in Washington, the Johns Hopkins School of Public Health in Baltimore, and the American Academy of Arts and Sciences in Cambridge. Their detailed presentation of the infected-meat scenario was judged plausible, even persuasive, although it lacked substantive clinical and epidemiological evidence.

Following that 1988 visit, Matthew persisted in expressing the need for a scientific investigation of the outbreak — in Congressional testimony, in print, and on the radio. In 1990, he wrote, "On the Soviet side there needs to be a political decision to allow qualified US officials freely to examine what remains of the relevant evidence and to meet with surviving patients and local medical, public health, and veterinary personnel in Sverdlovsk. In addition, US experts should be invited to visit, on a suitable reciprocal basis, the facility described in the allegations."

As the Cold War came to an end, the question remained whether all trust in the Soviet Union's adherence to the BWC had been misplaced. More to the point now perhaps was whether the new Russia was capable of fully revealing any violations at Soviet facilities. And if not, could the world trust this new government? In 1992, as we begin our investigation, the two explanations for the cause of the 1979 anthrax outbreak — a meat-borne infection or an aerosol biological weapons leak — continue to rest on conflicting assertions, neither as yet proven by facts. But now the doors to Russia are open so wide that even an unofficial group like ours can walk in and start asking questions. Will they be answered?

-- From "Anthrax: The Investigation of a Deadly Outbreak," by Jeanne Guillemin. © Dec. 14, 1999, University of California Press. Used by permission.