INFECTION IN MAN AND CLINICAL VAKIETIES. 203 



the bacillus of anthrax and the spirilli of recurrent fever, possess 

 this property. The tubercle bacillus and the bacillus of glanders 

 are no blood bacilli, but even in infective processes with these 

 microbes the disease can be produced by inhalation without primary 

 localization in the lungs. Entrance of these microbes into the blood 

 without alteration of the vessel wall has not been proved. Anthrax 

 on the external surface of the body is the result of direct inocula- 

 tion. The clinical forms vary according to the location of the dis- 

 ease, its extent, and the intensity of the infection. Most all authors 

 follow Bollinger's classification, according to which all cases are 

 brought under one of the following varieties: 1. Anthrax acutissi- 

 mus, or apoplectiformis. 2. Acutus ; and 3. Subacutus. The 

 primary location of the disease is in accordance with the manner in 

 which infection has taken place. W. Koch (" Milzbrand u. Rausch- 

 brand," Deutsche Chirurgie, Lieferung 9) states that in animals and 

 man the bacillus can enter the organism through one of the follow- 

 ing three routes : (a) Through the skin. (6) Gastro -intestinal 

 canal, (c) Respiratory passages. The microbe first multiplies at 

 the primary point of invasion, and from here by entering the blood- 

 vessels it is conveyed to distant parts and organs. The pathologico- 

 anatomical conditions vary according to the primary seat of invasion 

 and the structure of the organ the seat of the disease. The first 

 tissue-changes are observed at the primary seat of localization. 

 These local conditions, carbuncle and anthrax-oedema, give rise to 

 symptoms proportionate to the importance of the organ involved. 

 An anthrax oedema of the hand or arm is a less serious condition 

 than when the same affection involves the face or neck. The local 

 oedema at the point of infection is caused by vascular disturbances 

 due to the presence of the bacilli within the bloodvessels and the 

 interstitial inflammatory exudation caused by their presence. The 

 local affection always becomes dangerous when the bacillus enters 

 the bloodvessels and gives rise to general dissemination. When 

 the microorganism enters the body through the gastro-intestinal 

 canal with the food or drink, it gives rise to a primary anthrax of 

 the intestinal canal, which again may become general by metastatic 

 dissemination through the systemic circulation. 



Vierhoff ( Ueber Anthrax intestinalis beim Menschen, Dissertation, 

 Dorpat, 1885) has collected 41 cases of anthrax intestinalis, the 

 total number which were found reported up to 1885. The author 

 observed himself two cases of secondary intestinal anthrax in the 

 hospital at Liga. 



Cases of secondary intestinal anthrax that is, localization of the 

 bacillus of anthrax in the mucous membrane of the intestines after 

 external infection were known to the older authors, while obser- 



