Anthrax in Man. 225 



Within 24 or 48 hours the vesicle dries up, becoming firm, 

 resistant and brownish red or blackish gray, and apparently gan- 

 grenous. The swelling has meanwhile extended to */£ or y^ inch 

 in diameter and a row of fresh vesicles may appear which in their 

 turn give place to a necrotic slough. In this way extension may 

 take place, the sore retaining a more or less rounded form, and 

 necrosis extending from the centre in every direction. The 

 necrotic mass, however, remains firmly adherent to the adjacent 

 tissues until separated by the work of suppuration which ensues 

 in favorable cases. The disease is attended with more or less 

 fever, chill, hyperthermia, nausea, diarrhoea, with aching of 

 head, back, and limbs and unfavorable cases may merge into 

 acute and fatal general anthrax. The mortality is about 20 per 

 cent., though in special epidemics it has reached 80 percent. 

 (With the pustule on the face 25 per cent. ; on the lower limb 5 

 percent., Norris). The prognosis is favorable with a free con- 

 centration of leucocytes, a moist condition of the wound and 

 above all a liberal invasion of pus cocci. It is unfavorable when 

 the wound is dry, when the drying slough remains firmly 

 adherent and when the adjacent lymph glands become implicated. 

 In nonfatal cases it may be difficult to find the bacillus. 



A?ithrax CEdema. This is less easily diagnosed than malig- 

 nant vesicle, and appears where the connective tissue is loose, 

 abundant and little vascular, from direct local inoculation, or as 

 a concomitant of internal anthrax. It is a flat, rapidly extending 

 swelling, with the skin comparatively unaltered, though at points 

 yellowish or reddish discoloration indicates congestion and ex- 

 travasation. Not being limited by firm tissues nor aggregations 

 of accumulating leucocytes it tends to a speedy general infection 

 with all the febrile manifestations of that condition. Thus chills, 

 nausea, hyperthermia, dusky reddish or brownish mucosae, 

 cephalalgia, rachialgia and profound prostration assist in diagno- 

 sis. The bacilli in the blood and exudate would serve to confirm 

 the conclusion. 



Intestinal Anthrax. Here again the ingestion of anthrax 

 products, and the simultaneous attack of a number of people 

 who have taken such materials will often assist in diagnosis, 

 There may have been for some days indications of local bowel 

 lesions, such as chilliness, elevation of temperature, nausea, 

 15 



