ANTHRAX IN THE HUMAN SUBJECT 353 



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 of irregular shape 

 often surrounded by a ring of vesicles, these in turn being 

 surrounded by a congested area. From this pustle 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, 

 which 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 

 neighbouring 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. 



(2) Woolsorter's 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 patches in 

 the mucous membrane, often with haemorrhage into them, small 

 ulcers may also be seen. The tissues are intensely inflamed, 

 oedematous, and the cellular elements are separated, but there 

 is usually little or no necrosis. There is enormous enlargement 



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