A report published in 1960, "An Epidemic of Inhalation Anthrax, the First in the Twentieth Century," records the brutal, swift actions of this nastiest of diseases. Not only does it offer a rare, detailed portrait of what happens to people who inhale anthrax spores, these case histories also illustrate how difficult it is for physicians to accurately diagnose the disease.

Consider T.T., the first patient to succumb. On a Tuesday morning, this 60-year-old man complained of a backache and headache, and he left work at noon. A doctor who visited him at home that afternoon recorded that he had a temperature of 102 degrees. When the doctor put his stethoscope to the man's chest, he noted that his breathing tube sounded as though it had narrowed a bit. Diagnosis: influenza. The doctor prescribed aspirin and codeine. The next day, T.T. had a persistent cough, but he had improved, his temperature dropping to 100. He still stayed home from work. That Thursday, T.T.'s neck suddenly became "considerably swollen," but he ate normally and seemed fine. In the evening, however, the swelling spread to his neck and chest, and he began to sweat so profusely that his bedding was changed five times before his family summoned the doctor at 11 p.m. His pulse had become irregular, his hands cold and tremulous. He fainted twice, and at 4:45 a.m., the doctor admitted him to a local hospital. They attempted to X-ray his chest, but he went into such severe respiratory distress that they put him into an oxygen tent instead. At 6 a.m., he refused to use a bedpan and walked to the bathroom, whereupon his skin turned blue and T.T. collapsed and died.

Steven Wolinsky, chief of infectious diseases at Northwestern University, points out that in addition to physicians having no experience diagnosing anthrax, a terrorist attack with this bioweapon would cause further confusion for doctors because affected people most likely would disperse from the site of the invisible attack. Wolinsky offers the example of terrorists releasing anthrax in a downtown shopping mall, with the affected people then returning to their suburban homes. "How would you link those people to the attack?" asks Wolinsky. "We're woefully unprepared for anthrax."