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eci-ive Sto~
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Leonarc! A. Cole
Joseph Henry Press
Washington, D.C.
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Joseph Henry Press · 500 Fifth Street, NW · Washington, DC 20001
The Joseph Henry Press, an imprint of the National Academies Press, was
created with the goal of making books on science, technology, and health
more widely available to professionals and the public. Joseph Henry was one
of the founders of the National Academy of Sciences and a leader in early
· . .
American science.
Any opinions, findings, conclusions, or recommendations expressed in
this volume are those of the author and do not necessarily reflect the views of
the National Academy of Sciences or its affiliated institutions.
Library of Congress Cataloging-in-Publication Data
Cole, Leonard A., 1933-
The anthrax letters: a medical detective story / Leonard A. Cole.
p. cm.
Includes bibliographical references and index.
ISBN 0-309-08881-X ISBN 0-309-52584-5 (PDF)
1. Bioterrorism United States. 2. Anthrax United States. 3. Postal
service United States. 4. Victims of terrorism United States. I.
Title.
HV6432.C63 2003
364.152'3 dc22
2003015149
Copyright 2003 by Leonard A. Cole. All rights reserved.
Printed in the United States of America.
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CONl[NlS
Prologue
1 Deadly Diagnosis
American Media
The Nation at Risk
4 Ultimate Delivery: The U.S. Hail
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be Orbits
D.A. Henderson. the CDC. and the Beg Hind-Set
A Scientists Race to Protection
8 Terror by Hoax
9 Dirty
10 Loose Ends
flogs
Biblio~-
Ackno~ledgments
Index
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233
239
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PROLOGUE
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When Pat Hallengren arriver! at work on August 10, 2002, she
notices! that the micicIle mailbox was missing. It was the one
she hac! always usecI. For as long as she conic! remember, it
had stood between two other receptacles outside her window in the
American Express travel office in Princeton, New Jersey.
But cluring the late hours of the previous night, postal authori-
ties hac! remover! the box. Before long, wore! spreac! about the rea-
son, ant! local curiosity turner! to horror. The mailbox was fount!
to have container! anthrax spores. When Pat heart! this, her first
thoughts were about her mailman, Mario. "I really wasn't con-
cernec! for myself. I mean, I just put mad! in the box, but Mario hac!
to take it out." Her worry was unclerstanciable.
Anthrax bacteria are as murderous as South American flesh-
eating ants. An army of ants, traveling in the millions, can decimate
an immobilizecl incliviclual by devouring his flesh layer by layer.
Death is gradual ant! agonizing. Anthrax bacilli clo to the bocly
from within what the ants clo from without. They attack every-
where, shutting clown ant! destroying the bocly's functions from
top to bottom. The organisms continue to multiply and swarm un-
ti! there is nothing left for them to feed on. In 2 or 3 clays a few
thousanc! bacilli may become trillions. At the time of cleath, as much
as 30 percent of a person's Hood weight may be live bacilli. A
microscopic cross section of a blooc! vessel looks as though it is
teeming with worms.
. .
v''
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. . .
vail
THE ANTHRAX LETTERS
The anthrax bioterrorism attacks the previous fall, in 2001,
hac! been concluctec! by mail. On October 4, three weeks after the
terror of September 11, a Florida man was cliagnosec! with inhala-
tion anthrax. His cleath the next clay became the first known fatal-
ity ever causer! by bioterrorism in the Uniter! States. During the
following weeks, more people were cliagnosec! with inhalation an-
thrax as well as with the less dangerous cutaneous, or skin, form of
the disease.
Almost all the cases were tracer! to spores of Bacillus anthracis
that hac! been placer! in letters. Perhaps a half clozen letters contain-
ing a quantity of powder equivalent in volume to a handful of aspi-
rin tablets paralyzer! much of America. During the fall 2001 scare,
congressional sessions were suspenclec! ant! the U.S. Supreme Court
was evacuated. Infectec! mad! clisruptec! television studios ant! news-
paper offices. People everywhere were afraic! to open mail.
Four of the anthrax letters were later founcI, ant! all were post-
markocl "Trenton, NJ." That was the imprint made at the large
postal sorting ant! distribution center on Route 130 in Hamilton
Township, 10 miles from Princeton. Ten months after the attacks,
when Pat Hallengren's favorite mailbox hac! been removed, mail-
boxes that server! the Hamilton facility were belatecIly being tester!
for anthrax. In the first week of August, investigators swabber! 561
drop boxes and cleliverecl the cotton tips to state laboratories. Only
that one mailbox, on Nassau Street near the corner of Bank Street
In Princeton, tester! positive for anthrax. Could that box, not 30
feet from Pat Hallengren's clesk, have been where the poison letters
were clepositecl?
The mailer of the anthrax letters hac! not yet been founcI. But 6
weeks before the discovery of anthrax spores in the Princeton mail-
box, the Fecleral Bureau of Investigation hac! iclentifiec! a microbi-
ologist namer! Steven Hatfi~l as a "person of interest."
Days after the micicIle mailbox was removed, fecleral agents
fanned out through the neighborhoocl. They showocl a picture of a
steely, thick-neckoc! man to merchants ant! patrons up ant! clown
Nassau Street. It was Hatfield. "Do you remember seeing this per-
son?" they askocI. "I clon't recognize him," Pat Hallengren an-
swerecl, "but I see so many people on this corner." Four doors up
from the corner, Shalom Levin, the bearclec! owner of the Rec! On-
ion clelicatessen, was ambivalent. "I might have seen him walking
around here," he toicl an FBI official. But perhaps Hatfi~l's face
seemec! familiar, he acknowlecigecI, because he hac! seen it on TV. In
2003, long after the discovery of anthrax in the Princeton mailbox,
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PROLOGUE
IX
the FBI was still searching for the mailer ant! still consiclerec! Hatfi~l
a person of interest.
Between October 4 ant! November 21, 2001, 22 people were
cliagnosec! with anthrax. Eleven contracted! the cutaneous form ant!
all survived. But among the 11 who became ill from inhaling spores,
five flied. In subsequent months, with no new cases, national anxi-
ety eased. But the discovery of the contaminates! mailbox almost a
year later in Princeton drew a torrent of television ant! newspaper
coverage from arounc! the woricI. Fear hac! been rekincIlecI.
Concern about anthrax is as oic! as the Bible. Primarily a clis-
ease of animals, it is thought to have been the fifth of the 10 bibli-
cal plagues visitec! by Got! on the ancient Egyptians for refusing
freedom to the Jews. As recounted! in Exodus, horses, donkeys,
camels, cattle, and sheep were struck "with a very severe pesti-
lence." After their carcasses were burned, the virulence of the an-
thrax germs persisted, for the soot causer! "boils on man ant! beast
throughout the lancl of Egypt."
In recent years, anthrax spores have been cleemec! among the
most likely of biological weapons because they are harcly, long
livecl, ancl, if inhalecl, utterly clestructive. A victim is unlikely to
know he is uncler attack. As with other biological agents, anthrax
germs are ocloriess ant! tasteless, ant! lethal quantities can be so
tiny as to go unseen.
Every 3 seconds or so, a human being inhales ant! exhales about
a pint of air. Each cycle ciraws in oxygen to fuel the bocly ant!
releases carbon clioxicle, the gaseous waste product. The inhaler! air
commonly carries with it floating inciclentals such as crust, bacteria,
ant! other microscopic particles. If a particle is larger than 5 mi-
crons, it is likely to be blocker! from reaching creep into the lungs by
the respiratory tract's mucus ant! filtration hairs. If smaller than 1
micron, a particle is too small to be retained and is blown out
cluring exhalation. An anthrax spore may be 1 micron wicle ant! 2
or 3 microns long, just the right size to reach creep into the respira-
tory pathway.
A spore is so tiny that a cluster of thousands, which would be
enough to kill someone, is scarcely visible to the naked! eye. A
thousanc! spores sicle by sicle would barely reach across the thin
edge of a clime. Once inhalecI, the spores are drawn into the bron-
chial tree where they travel through numerous branches creep in
the lungs. Near the tips of the branches are microscopic sacs caller!
alveoli. It is in these sacs that inhalecl oxygen is exchanged with
carbon clioxicle.
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XTHE ANTHRAX LETTERS
Stationer! among the alveoli are armies of clefencler cells caller!
macrophages. These cells sense foreign microinvaclers ant! engulf
them. A pulmonary macrophage normally destroys its inhalecl cap-
tive ant! taxis it to the lymph nocles in the mecliastinum, the area
between the lungs. But in the case of anthrax, spores may trans-
form into active, germinating organisms before the macrophage
can affect them. The bacteria then can reproduce ant! release toxin
that destroys the macrophage. Thus, in a perverse turnabout, the
anthrax bacteria, like soicliers in the Trojan horse, can burst out of
their encirclement, into the lymph ant! blooc! systems.
An infectec! person at first is unaware that a gruesome cascade
is under way. Although the onslaught is relentless, symptoms do
not appear immecliately. Fluids that have begun to accumulate in
the mecliastinum graclually pry the lungs apart. Breathing becomes
increasingly clifficult, ant! after a few clays a person feels as if his
head is being helcl unclerwater, permitted to bob up for a quick gulp
of air ant! then pusher! uncler again.
The agony works its way through the bocly. Nausea gives way
to violent, bloocly vomiting. Joints are so inflames! that flexing an
arm or leg becomes an act of torment. Bloocly fluids squeeze be-
tween the brain ant! skull, ant! the victim's face may balloon out
beyonc! recognition. The tightening vice arounc! the brain causes
excruciating pain ant! clelirium. Survival clepencis on being proviclec!
appropriate antibiotics before the bacteria have releaser! so much
toxin that the bocly cannot recover. If inhalation anthrax is not
treater! in time, almost all victims suffer a torturer! cleath. One or-
gan after another is clecimatec! the lungs, the kidneys, the heart-
unti! life is sucker! away.
It is because of such ghastly effects that anthrax and other bio-
logical agents have been prohibited! as weapons by international
agreement. The treaty that bans their clevelopment or possession
by nations, the 1972 Biological Weapons Convention, uniquely cle-
scribes their use as "repugnant to the conscience of mankincl." Yet
despite this wiclely acceptec! moral precept, a germ weapon is seen
by some not as a shameful blight but as a preferred instrument of
terror.
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