Book Review.

Spores, Plagues, and History: The Story of Anthrax by Chris Holmes, M.D., Durban House Publishing, Dallas, Texas, 2003.

Spores, Plagues, and History: The Story of Anthrax provides a well-researched, historical perspective on the origin and use not only of anthrax (Bacillus anthracis) but other biological pathogens that have afflicted humans and animals over the centuries, both as an act of nature and as a deliberate act of man. Dr. Holmes presents interesting new theories on the causation of devastating plagues throughout history and the deaths of prominent historical figures that may be attributable to anthrax. He also documents the lives and work of both ancient and modern-day doctors and scientists--some obscure, others well known--whose efforts have led to the discovery, development, prevention, and even weaponization of these pathogens.

Dr. Holmes begins by examining the October 2, 2001, "Index Case" of a Florida man infected with inhalation anthrax at his place of work. He then follows with the exposures and infections resulting from letters mailed to Senators Daschle and Leahy, Tom Brokaw, and other media corporate offices. He describes the ensuing panic and alterations of daily routine caused by thousands of hoax anthrax letters received throughout the nation during the months of October and early November 2001 and the FBI's ongoing investigation. Then, the attacks stopped. Why?

To fully understand its effects on the body and use as a biological weapon, Dr. Holmes dedicates one chapter, aptly titled "The View from the Petri Dish," to explain the anthrax development process, from animal disease to human disease, along with diagnosis, treatment, and prevention. From the present-day medical, veterinary, and scientific knowledge of anthrax and other pathogens and with a forensic epidemiologist's eye, Dr Holmes looks back to the time of Moses then moves forward through recorded history to provide new possible theories to long-ago plagues and mysterious deaths.

Dr. Holmes uses his unique novelist skills to create a narrative and dialogue in "The Plague of Athens, 430 B.C." via a fictional Macedonian physician who discusses the real plague of Athens with fellow citizens, religious leaders, and a general and head of the Athenian state. This introduces the teachings of the cult of Aesclepius and of Hippocrates, the "Father of Medicine," whose Hippocratic Oath every medical school graduate repeats to this day.

He discusses developing technologies of the industrial revolution that caused new out-breaks of anthrax and other occupational diseases, creating the need for a true public health care system. He documents the work of many notable scientists, such as John Henry Bell, Robert Koch, and Louis Pasteur, whose research (sometimes scientific, sometimes fortuitous), findings, and experiments have created worker health standards, manufacturing processes, laboratory procedures, and life-saving vaccines still in use today.

Finally, coming full circle, Dr. Holmes presents the use of anthrax and other pathogens as biological weapons, starting with the Assyrians poisoning their enemies' wells in the ninth century B.C., the medieval practice of catapulting infected human and animal bodies over walled cities under siege, and the Japanese biological experiments on both humans and animals during World War II. These experiments and ensuing research data captured by both the United States and the Soviet Union lead Dr. Holmes to his detailed discussion of the bioweapons of today.

Dr. Holmes completes this history of biological pathogens and their devastating results with a simple yet ongoing question that titles his final chapter, "Are We Prepared for the Next One?" He looks at personal, community, and national preparedness, not to scare but to educate and understand. Only by proper understanding of the biologic, both its capabilities and weaknesses, can an appropriate public health response be mounted and mass prophylaxis be considered.

This book provides historic and scientific perspectives of anthrax and its likewise devastating sister pathogens. It could benefit all professionals in the law enforcement, hazardous materials, scientific, forensic, veterinary, and medical communities.

Reviewed by John A. Sylvester

Retired FBI special agent

President of Executive Response Solutions

San Diego, California