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hardened doctor would have been startled by what lay beneath. After all, who would expect to encounter that rarity of all rarities— the so-called cardinal’s cap?
    The top of the victim’s brain had turned to blood.

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    INHALATIONAL anthrax places a bloody cap upon its vic- tim’s head like the cap a British judge wore when pronounc- ing a death sentence. As parts of Stevens’s body had turned blue from lack of oxygen, the brain tissue had swollen. It had bled horribly, hemorrhaging in the small blood vessels of the brain membrane as badly as the blood had filled Ste- vens’s chest. Though ghastly, the “cardinal’s cap” serves a
    purpose: it gives absolute confirmation of the most fatal kind of anthrax—inhalational anthrax, the most infrequent of the three forms of anthrax.
    In the meantime, where had the spores come from? So far the investigation had revealed no obvious exposure to B. anthracis. At first Florida and federal health officials be- lieved that Stevens’s infection was a fluke, the result of nat- ural or accidental exposure. Federal officials speculated that he had been contaminated by the deadly spores while drink- ing out of a tainted stream in North Carolina. But tests at specialized labs all confirmed his inhalational anthrax re- sulted from exposure to dust containing airborne spores. It was possible to distinguish anthrax contracted from airborne spores from the intestinal variety.
    Perhaps Stevens, while fishing, breathed in death from some animal that had lain moldering in the soil for a half- century. Just what were the occurrences of natural anthrax in that region? They would have to check. And what about Duke University where Stevens had visited on Sunday? Spores might have strayed accidentally from bioresearch labs at Duke, though that was unlikely. Frantic tests and lab work spanning the weekend would determine if he had con- tracted the disease on vacation. “No one has any idea where this came from,” said Martin Hugh-Jones of Louisiana State University and head of the World Health Organization’s group on anthrax.
    While flu kills twenty thousand Americans every year, anthrax had never been reported in the soil or in animals in the U.S. east of the Mississippi River. In fact, there was only one fatal case of inhalational anthrax between 1933 and 1955 in a study of 117 cases. The nation had recorded only 18 cases of inhalation anthrax in the twentieth century and none since 1978. The last Florida case occurred back in 1956. How could Bob Stevens have developed such a re- markable form of a rare disease?
    Anthrax cannot be transferred from one person to an- other, although the bacterium is communicable from animals to humans. Butchers, tanners, farmers—those processing goat hair or goat skins or shearing wool were most at risk. Historically, those who have come into contact with the con-
    taminated wool, hides, leather, and hair products of tainted animals have been those most infected. Spores can enter the human body through the lungs when people inhale spores flecked off an animal hide. Perhaps Stevens’s spores had come from imported wool.
    Inhalational anthrax was first identified in the nineteenth century when a handful of laborers in a textile mill fell ill. They had been exposed to spores released into the air by the new industrial processes developed to make wool. Mill workers were so frequently exposed to imported animal fi- bers contaminated with B. anthracis spores that anthrax be- came known as “wool-sorters’ disease” in England and “ragpickers’ disease” in Austria and Germany. In the early 1900s, human cases of inhalational anthrax began showing up in the U.S. in conjunction with the flourishing domestic textile and tanning industries.
    In the last part of the twentieth century, with improved industrial hygiene practices and restrictions on imported an- imal products, the number of cases dropped dramatically. In goat hair mills, goat