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Anthrax, an ancient disease, was well known to the Greeks and Romans and was widespread in Europe for thousands of years. In the first chapter of this book, Guillemin cites Virgil, who describes in the Georgics how the disease spreads from animals to humans. This was the only mode of transmission until the dramatic airborne epidemic and epizootic of anthrax in 1979 in Sverdlovsk, a Russian city in the foothills of the Ural Mountains.
The amazing explanation Russian public health leaders gave for this episode will appall the reader, as it did those of us who heard their story when they visited the United States in 1988. These Russian officials fabricated a story of a foodborne epidemic brought on by faulty inspections by public health veterinarians. Veterinary inspectors are well versed in the clinical signs of anthrax and usually reject for slaughter animals with these signs; if an infected animal should reach the killing floor, the signs of disease are overt. The Russians have reported episodes of foodborne anthrax that followed ingestion of anthrax-infected meat. The largest foodborne epidemic ever reported occurred in Rhodesia (now Zimbabwe) during the civil war there in the 1970s. More than 8000 human cases of cutaneous anthrax were recorded and treated successfully. There was no intestinal disease. All the human cases resulted from eating animals that had died of anthrax. The salvage of dead animals is a common practice in southern Africa.
The American pathologist David Walker proved the Russian explanation for the anthrax epidemic in Sverdlovsk to be false as soon as he examined the thoracic and mediastinal lymph nodes of the victims; the findings were consistent with airborne spread of the disease. Walker had no doubt that the 64 persons whose tissues he examined were victims of a release of anthrax aerosol that occurred for a few hours on April 2, 1979, near a military production facility in Sverdlovsk.
The investigation of the epidemic by Matthew Meselson and Jeanne Guillemin, with assistance from Alexis Shelokov and Martin Hugh-Jones, is the focus of this interesting book. Meselson had suspected that the epidemic was unusual and of great relevance to the prevention of biologic warfare. Through his determined efforts he was first able to visit Sverdlovsk in 1988, almost 10 years after the accident, and then again after the opening of Russia to the West in the 1990s. Guillemin, a sociologist, weaves a story that holds the reader's attention. One feels the tragedy of the loss of a mother, a father, a wife, a husband, a son or daughter. Old-fashioned "shoe-leather" epidemiology reveals the impact of the disaster.
How did the accident happen? Did it occur in the military facility? Was a broken pipe, an exhaust fan, or a mis-set control lever responsible? The answers are not known. But the fact remains that an accidental emission of airborne anthrax spores did occur.
Meselson's persistence in seeking information about the occurrence of any cases of anthrax in animals paid off when he found that sheep had died of the disease, 30 km downwind from the epicenter two days before any human cases occurred. Highly susceptible herbivorous animals, such as sheep and cattle, can serve as sentinels. It was unusual that so many dogs supposedly died of anthrax during this epidemic — or were they shot by the sanitation police? The failure to recover any viable anthrax organisms in and around the area in which human or animal disease occurred is also difficult to understand. But others have tried to recover Bacillus anthracis from sites where disease has occurred and have not always met with success.
Toward the end of the book, Guillemin raises the moral issue of biologic warfare. She has demonstrated how terrible a small epidemic (one involving fewer than 100 cases) can be to society and how it can overwhelm medical resources. Readers can easily imagine the ramifications of a larger episode. Biologic warfare has no place in modern civilization. The only legitimate way to consider it was expressed by Albert Sabin in a toast to Russian and American scientists during a visit by Americans in the 1950s: "A toast to biological warfare — against all disease." Anthrax is a well-written report of an epidemiologic investigation that will hold the attention of the medical community, especially public health scientists and veterinarians.
James H. Steele, D.V.M., M.P.H.
University of Texas School of Public Health
Houston, TX 77030
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