By Dr Neil Metcalfe BMedSc (Hons) MBChB DRCOG DCH MRCGP (dist)GP and Police Surgeon

What is Woolsorter’s disease?Historical timeline of scientific

developments relevant to Woolsorter’s disease

The potential link to bioterrorism

•Working life in mid-nineteenth century•Woolsorting

The Effects of Arts Trades and Professions on Health and Longevity, published 1831: Suggested woolsorters were healthy despite “hot, headache-inducing conditions” Found 1 in 5 to die from consumption or ‘decline’

West Yorkshire main area for woolsorting

Local cases of bronchitis, pneumonia and blood poisoning termed maladie de Bradford phrase

Other areas known as chambon, malignant pustules, splenic fever

First reported 1838

Dr John Henry Bell (d.1906) wrote a death certificate stating “contracted owing to the owner’s neglect in taking adequate precautions” without knowing what precautions exactly

1878, Bradford Observer: “Three woolsorters had died from blood poisoning contracted in the same shed of the same factory”

1878 Dr J.E. Eddison: could it be linked to anthrax, common infectious disease of animals?

1879 – Link confirmed by Bell

Bacillus anthracis One of oldest

recorded diseases of animals

Believed to be the Sixth Plague in Book of Exodus

Still regularly occurs in ruminants e.g. cattle, sheep, goats, camels, buffalos, antelopes; in hind-gut fermenters such as zebras and rhinos

Found to have 2 forms of disease

Inhalational anthrax

Cutaneous anthrax

Mr Byles, MP Salford North: “a terrible disease, and if a man contracted it two days sufficed to kill him. A man went to work perfectly well and came home with a headache and in 48 hours he was dead”

Bradford conference draws up Bradford Rules in 1884, later adopted nationally

Contagious Diseases (Animals) Act 1886 Human anthrax made a notifiable disease

under S39 of the Factory and Workshop Act 1895

Bradford Rules adopted into Departmental Committee Report of 1897

Seen in combers and carders

Wife’s start being infected from husband’s clothes (6 deaths in 1914)

Sir Thomas Legge (1863-1932, right), the first Medical Inspector of Factories gets involved Blames air currents Blames certain wool especially

Persian, mohair and van mohair

Regulations in 1905 extending those of 1897 to include woolcombers and all handlers of goat and camel hair

However, no mention regard quality of imports: Mr Jowett, MP for Bradford West “respectfully

submitted that the line of action taken by the Home Office Department in regard to this disease of anthrax started at the wrong end. It started when the disease entered the factory, instead of preventing it entering the factory”

Chambers of Commerce of Bradford, Halifax and Kidderminster wrote a circular to consignors of Persian wool Keep extraneous matter out of exported

bales Pack locks, fallen wool and skin in

separate bales Prepared for higher costs

Formed 1905 Aimed to study all cases of the disease and

devise means of total prevention Dr Fritz Eurich (1867-1945) in charge of £300

budget Used teaching laboratory at Bradford Technical

College 5g mohair colonised 130 000 colonies bacteria

but if washed clean no change in anthrax spore number

96 Persian wool fleeces with dried blood found to have 90 positive cases of anthrax

Uneconomical to throw away blood stained wool but heat treatments would ruin the wool. Lower temperatures would increase anthrax spread

Departmental Committee of Inquiry 1913 Commissioned Eurich to devise method of

disinfection Timing crucial: Peak in anthrax 1916-1918

Advised a 2% solution of formaldehyde in water at 102-105⁰F

Disinfection Sub-Committee highlights Karachi, Bombay, Basra and Cairo

Accepted as part of Anthrax Prevention Act of 1919

Governmental Wool Disinfection Station at Liverpool sanctioned in 1920, opens 1921 Capacity for 5-6 million pounds of wool a year Low amount, only Indian goat hair and all hair

from Egypt scheduled first

Number of cases of inhalation anthrax in wool and hair industry from 1920-1996 was 430, 46 deaths

Reduction due to: disinfection station Decline in wool industry Improvements in health, nutrition,

clothing, housing Required carrying of anthrax warning

cards

•Exploited by British biological war programme during WW2•Tests performed at Gruinard Island off coast of Ross and Cromarty in Scotland

•Anthrax hundreds more times potent than any chemical agent at the time•22 April 1943, 5million anthrax-laced cakes ready to be dropped over Germany by air

•War brought about treatment•Penicillin reduced case fatality rates for 1944-1955 less than 4%•Vaccine also introduced•Just 14 cases occupational anthrax between 1981-2000

1970s – home-craftsman died of anthrax using infected goat-camel hair yarn from Pakistan

Soviet accidentBioterrorism

Bioterrorism (continued)

Woolsorters disease now a rare condition

Lessons can be learned from its history

Continued vigilance is neededThank local people for local disease