ANTHRAX IN MAN. 287 



intense congestion. Central necrosis occurs and leads to 

 the malignant pustule proper, which in its typical form 

 appears as a black eschar often surrounded by a ring of 

 vesicles, which in turn are surrounded by a congested area. 

 From this pustule as a centre, subcutaneous oedema spreads, 

 especially in the direction of the lymphatics ; the neighbour- 

 ing glands are enlarged. There is fever and a general 

 feeling of illness. On microscopic section of the typical 

 pustule, the central eschar is noticed to be composed of 

 necrosed tissue and altered blood ; the vesicles are formed 

 by the raising of the stratum corneum from the rete 

 Malpighi. Beneath them and in their neighbourhood the 

 cells of the latter are swollen and cedematous, the papillae 

 being flattened out and infiltrated with inflammatory exuda- 

 tion. The cells become necrosed, and go to form the 

 eschar. The subcutaneous tissue is also cedematous, and 

 often infiltrated with leucocytes. The bacilli exist in the peri- 

 pherse of the eschar and in the neighbouring lymphatics, 

 and, to a certain extent, in the vesicles. It is very important 

 to note that widespread cedema of a limb, enlargement of 

 neighbouring glands, and fever may occur while the bacilli 

 are still confined to the immediate neighbourhood of the 

 pustule. Sometimes the pathological process goes no 

 further, the eschar becomes a scab, the inflammation sub- 

 sides, and recovery takes place. In the majority of cases, 

 however, if the pustule be not excised, the oedema spreads, 

 invasion of the blood stream may occur, and the patient dies 

 with, in a modified degree, the pathological changes detailed 

 with regard to the acute disease in cattle. In man the 

 spleen is usually not much enlarged, and the organs gener- 

 ally may contain few bacilli. It may here be said that 

 early excision of an anthrax pustule, especially when the 

 latter is situated in the extremities, is followed, in a large 

 proportion of cases, by recovery. 



(2) Woohorters Disease. The pathology of this affection 

 was worked out in this country especially by Greenfield. 

 The local lesion is usually situated in the lower part of the 

 trachea or in the large bronchi, and is in the form of swollen 



