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Letter
Industry-Related Outbreak
of Human Anthrax, Massachusetts, 1868
Suggested citation for this article: Macher A.
An industry-related outbreak of human anthrax: Massachusetts, 1868.
Emerg Infect Dis [serial online] 2002 Oct [date cited];8. Available
from: URL: http://www.cdc.gov/ncidod/EID/vol8no10/01-0509.htm
To the Editor: In Bioterrorism-Related Inhalational Anthrax: The
First 10 Cases Reported in the United States, Jernigan et al. noted that
in the mid-1800s inhalational anthrax related to the textile industry
became known as woolsorters’ disease (in England) and ragpickers’ disease
(in Germany and Austria) because of the frequency of infection in mill
workers exposed to imported animal fibers contaminated with Bacillus
anthracis spores (1). During the 1800s, as in Europe,
industry-related human cases of anthrax also occurred in the United States.
In 1868, Silas Stone, a physician, reported that “an unusual number of
cases of a rather rare affection have come under my observation within
the past 14 months” (2). Stone described eight patients
with “malignant pustules” who worked in or were associated with an animal
hair factory in Massachusetts. The patients’ cutaneous lesions were described
as dark red, dark purple, purplish-black, and black; six of the patients
had “slough” lesions. Stone treated his patients with tincture of iodine,
iron, and quinine. Since antibiotics were not available, six of the eight
patients had severe clinical disease, and two died. Stone’s patients demonstrated
the full spectrum of anthrax, including gastrointestinal, mediastinal,
and meningeal involvement. Four patients had gastrointestinal symptoms,
including epigastric distress and pain, nausea, and vomiting. Three patients
had mediastinal involvement, manifested by chest distress and pain, dyspnea,
and tachypnea. In the two fatal cases, meningitis appeared to have been
the immediate cause of death; both of these patients were described as
delirious.
Among Stone’s eight patients, most remarkable was case 5, which was strikingly
similar to case 8 of Jernigan et al.; the signs and symptoms of both patients
included chills, headache, fatigue, vomiting, chest pain, tachypnea, tachycardia,
and cutaneous lesions. Stone’s description of the 7-day clinical course
of patient 5, a laborer at the hair factory, is as follows: “Called November
17. Had been sick since the Thursday previous (November 14). Was taken
with chills, pain in head and back, and suffered loss of strength. When
first seen, was in bed . . . had not slept well the previous night. Pain
and distress in epigastrium and back. Pulse 120 . . . breathing hurried.
Discovered a dark purple spot surrounded by yellow vesicles . . . pressure
on slough produced no pain. November 18: Slough doubled in size. November
19: Vomited . . . severe chill. November 20: Sleep restless . . . slough
one inch by half an inch, much raised above surrounding skin, with a red
areola about an inch in width. November 21: a.m.: Delirious part of night
. . . slept but little . . . pain in chest. 3 p.m.: Distress at epigastrium
great . . . delirium more violent. 8 p.m.: Distress and delirium greater
. . . pulse failing . . . sinking rapidly . . . died soon after visit.”
Stone perceptively noted that each of his patients was directly or indirectly
exposed to hair or dirt from the animal hair factory, and that in the
surrounding population not so exposed, no cases were seen. Stone realized
that he was dealing with an industry-related disease and hypothesized
that the cause was “a specific poison, and not simply putrescent animal
matter.” Nine years after Stone’s 1868 report, Robert Koch in Germany
reported isolation and cultivation of B. anthracis, the formation
of its spores, the production of anthrax disease with pure cultures, and
the recovery of B. anthracis from experimental infection (3).
Abe Macher
Health Resources and Services Administration
U.S. Public Health Service
Rockville, Maryland, USA
References
- Jernigan JA, Stephens DS, Ashford DA, Omenaca C, Topiel
MS, Galbraith M, et al. Bioterrorism-related
inhalational anthrax: The first 10 cases reported in the United States.
Emerg Infect Dis 2001;7:933–44.
- Stone SE. Cases of malignant pustule. Boston Medical and Surgical
Journal 1868;I:19–21.
- Jay V. The
legacy of Robert Koch. Arch Pathol Lab Med 2001;125:1148–9.
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