A letter sent to a Salem, Mass. hospital this week contained a small white powder, setting off fears of an anthrax attack within the building.

England has seen its first death from anthrax infected heroin and second reported infection, bringing the total deaths from the current outbreak to 11 in the United Kingdom and Germany.

It was revealed last week that a female addict from London was being treated for an anthrax infection and a currently unnamed Blackpool addict, England's second reported case, has died from the infection.

The Blackpool death comes on the heels of nine reported deaths in Central Scotland since the outbreak began in Glasgow in December. Additionally, there have been 19 confirmed cases of anthrax infections and deaths in Glasgow, Lanarkshire, Dundee, Fife and Stirling.

The infections in England and the recent death in Germany have no known link to the Scottish outbreak, which has fueled anxieties that the anthrax contamination is wider spread than originally thought.

Police and health experts remain puzzled about the cause of the outbreak, which is the most serious anthrax outbreak in the United Kingdom in recent times. Investigations are currently underway to determine if the infected heroin was contaminated in Afghanistan, its likely source of origin, from soils or contact with infected animal skins. Other theories center on an infected cutting agent used by drug dealers or traffickers in Europe.

The only previous case of an anthrax death from heroin was recorded in Norway in 2000.