BA CILL US AN THE A CIS. 557 



except that the duodenum is usually less affected; but in 

 all cases metastasis occurs in various parts of the body, 

 brought about, no doubt, by previous hemorrhages. 



Occurrence in Man. The disease does not occur 

 spontaneously in man, but always results from infec- 

 tion, either through the skin, the intestines, or occasion- 

 ally by inhalation through the lungs. It is usually 

 produced by cutaneous infection through inoculation of 

 exposed surfaces the hands, arms, or face. Infection 

 of the face or neck would seem to be the most danger- 

 ous, the mortality in such cases being 26 per cent.; 

 while infection of the extremities is very rarely fatal 

 in only 5 per cent, of cases (Nassarow and Miiller). 



External anthrax in man is similar to this form of 

 the disease in animals. There are two forms : Malig- 

 nant pustule or carbuncle, and, less commonly, malig- 

 nant anthrax oedema. 



In malignant pustule, at the site of inoculations, a small 

 papule develops, which becomes vesicular. Inflamma- 

 tory induration extends around this, and within thirty- 

 six hours there is a dark brownish eschar in the centre, 

 at a little distance from which there may be a series of 

 small vesicles. The brawny induration may be extreme. 

 There may also be considerable oedema of the parts. In 

 most cases there is no fever; or the temperature at first 

 rises rapidly and the febrile phenomena are marked. 

 Death may take place in from three to five days. In 

 cases which recover the symptoms are slighter. In the 

 mildest form there may be only slight swelling. 



Malignant anthrax cedema occurs in the eyelids, and 

 also in the head and neck, sometimes the hand and arm. 

 It is characterized by the absence of the papule and 

 vesicle forms, and by the most extensive oedema. The 



