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endeavour to obtain the adoption of the practice of exhibiting notices by all persons engaged in trades
in which there is risk of anthrax infection.
I desire to express my thanks to Dr. Perry, of Guy's Hospital, for searching the records of that
institution, and supplying notes for Dr. Hamer's use of the cases of anthrax occurring there.
Shirley F. Murphy,
Medical Officer of Health.
The first question which demands consideration in connection with this subject is the extent of
prevalence of anthrax in London. This is a matter upon which considerable diversity of opinion
exists among those who are brought into relation with the disease, and attention requires to be directed
to such facts bearing upon this point as are available. For due appreciation of the extent to which the
recorded cases approximate to an exact account of the manifestations of the disease in man, it is moreover
necessary to have regard to the comparatively recent development of knowledge respecting anthrax,
and to recognise that the lines upon which that development has occurred have materially influenced
the probability of the disease being recognised in one and another quarter.
The attempt to estimate with as much precision as possible the entent of anthrax prevalence in
London was made rather more than ten years ago by Mr. Spear. A table had been already prepared
by Mr. Davies-Colley, giving the record of cases observed during a number of years at Guy's Hospital.
This table was brought up to date and added to by Mr. Spear, who succeeded in obtaining information
concerning 39 cases of the disease occurring between 1873 and 1883. The help generously afforded by
gentlemen connected with the various London hospitals* has made it possible to obtain particulars
concerning a number of cases of anthrax occurring in the last ten years. Upwards of 60 medical men
practising in south-east London, in the neighbourhood of the seat of the hide and skin industry, have
been communicated with and have kindly rendered assistance, and in a few instances, cases have been
heard of from other sources and have been followed up.
It has thus been possible to collect information concerning 119 cases of anthrax (27 fatal) which
have occurred in London during the last 21 years. These cases are tabulated in Appendix I. It will
be seen that they date back to 1873, and though the record is certainly incomplete (other cases having
been heard of concerning which full particulars could not be obtained) it probably fairly represents
the extent to which anthrax has been recognised in London in the human subject. The important
question then arises as to how far recognition of the disease corresponds with its occurrence, and to
form any judgment on this matter it is necessary to realise the way in which knowledge concerning
the clinical manifestations of anthrax has grown up. It is therefore proposed to give, in the first
instance, an outline of the history of anthrax with a view to illustrating more particularly the degree of
reliability to be placed upon the record in the appendix; that record may then be more particularly
discussed, attention being especially devoted to the subject of the suspected source of infection in the
different cases ; it will then be necessary to note the changes that have occurred in the London hide
and skin industry since the time of Mr. Spear's inquiry; and then, finally, it will be possible to discuss
in the light of more recent events the remedial measures suggested by him, and to come to a conclusion
as to the value and practicability of those or of other methods.
A.—Outline of the history of the disease known as anthrax.
There is no doubt that the anthrax bacillus produced disease in animals and in man long before
it was discovered by the eye of the investigator. The recognition of the role played by the bacillus,
however, greatly stimulated the collection of exact knowledge on the subject, and it is probable that
prior to the demonstration of the cause of the disease, the effects produced by it were not always
grouped together and classed in the same category. In animals the malady appears to have frequently
manifested itself on the continent, and even in the last century it was well recognised that malignant
carbuncle (French "charbon") was apt to effect human beings who manipulated certain animal
products. The term anthrax signifies literally carbuncle, and seems to have been applied in this
country to any severe form of carbuncle. When the peculiar features of the local lesion, which is now
known to be caused by the anthrax bacillus, became recognised, the term malignant pustule was used
to designate the condition, and it is under this head that the first records of human anthrax in this
country appear.
Cases of malignant pustule were described by Mr. Lawrence in 1847; a series of cases was
collected and published in 1852 by Mr. Harvey Ludlow, and in 1862 a paper on the subject was read
before the British Medical Association in London by Dr. William Budd.
Dr. Budd in this paper (Observations on the occurrence of malignant pustule in England,
illustrated by numerous fatal cases) noted that malignant pustule had long been known in France,
Germany, Russia, Lapland, Sweden, Italy, and other parts of Europe. He wrote " Malignant pustule
in man is identical with and derived from the eminently contagious disease which under the name of
charbon (germanice, milz-brand, spleen-gangrene), or in sheep 'sang,' has prevailed from time
immemorial in various countries in oxen, sheep, horses and other animals." Dr. Budd gave the
histories of some thirty cases, but relying as he did upon the naked eye appearances of the pustule to
establish the diagnosis, it is possible that some of the cases investigated by him were not truly examples
of anthrax. It is noteworthy, however, that in one instance the patient was a tanner, and that another
patient had been employed in unloading hides.
In 1863, the year after that in which Dr. Budd read his paper, Davaine's researches on the
* To Dr. Perry, of Guy's Hospital, thanks are especially due for the kind interest he has taken in the matter.