342 ANTHRAX 



taining the bacilli, these having afterwards formed spores. 

 This variety is often referred to as " woolsorter's disease," from 

 its occurring in the centres of the woolstapling trade .(in 

 England, chiefly in Yorkshire), but it also is found in places 

 where there are hair and brush factories. 



(1) Malignant Pustule. This usually occurs on the exposed 

 surfaces the face, hands, fore-arms, and back, the last being a 

 common site among hide-porters. One to three days after 

 inoculation a small red painful pimple appears, soon becoming a 

 vesicle, which may contain clear or blood-stained fluid, and is 

 rapidly surrounded by an area of 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 an irregular ring of vesicles, these in turn being surrounded 

 by a congested area. From this pustule as a centre subcutaneous 

 oedema spreads, especially in the direction of the lymphatics; 

 the neighbouring glands are enlarged. There is fever, with 

 general malaise. On microscopic section of the typical pustule, 

 the central eschar is noticed to be composed of necrosed tissue 

 and degenerating blood cells ; 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 oedematous, the papillae being enlarged and flattened 

 out and infiltrated with inflammatory exudation, w^hich also 

 extends beneath the centre of the pustule. In the tissue next 

 the eschar necrosis is commencing. The subcutaneous tissue is 

 also cedematous, and often infiltrated with leucocytes. The 

 bacilli exist in the periphery of the eschar and in the neigh- 

 bouring lymphatics, and, to a certain extent, in the vesicles. It 

 is very important to note that widespread oedema 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 bacilli gradually die out, the eschar becomes a scab, 

 the inflammation subsides, 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 

 generally contain few bacilli. The actual cause of death is 

 therefore a toxic effect. The early excision of an anthrax 

 pustule, especially when it is situated in the extremities, is 

 followed, in a large proportion of cases, by recovery. 



