Although human anthrax has become rare, endemic outbreaks still occur in tropical countries, parts of South America and Europe. We report 23 cases of cutaneous anthrax due to an endemic outbreak of animal and human anthrax in South India. These patients were admitted to our hospital between July 1998 and July 2001. Children outnumbered adults and most of them had lesions on the exposed sites. The majority of patients reported the death of infected animals in the neighbourhood without any direct contact with dead animals. Hence, vector borne transmission was suspected in most of the cases. Diagnosis was confirmed by the presence of a typical ulcer with eschar, Gram-stained smears from ulcers and epidemiological evidence. Except for one fatal case, all patients responded to treatment.