ANTHRAX IN MAN 311 



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 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 the absorption of toxins. It 

 may here be said that 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 hemorrhage into them, The 

 tissues are cedematous, and the cellular elements are separated, 

 but there is usually little or no necrosis. There is enormous 

 enlargement of the mediastinal and bronchial glands, and 

 haemorrhagic infiltration of the cellular tissue in the region. 

 There are pleural and pericardial effusions, and hsemorrhagic 

 spots occur beneath the serous membranes. The lungs show 

 collapse and oedema. There may be cutaneous oedema over the 

 chest and neck, with enlargement of glands, and the patient 

 rapidly dies with symptoms of pulmonary embarrassment, and 

 with a varying degree of pyrexia. It is to be noted that in such 

 cases, though numerous bacilli are present in the bronchial 

 lesions, in the lymphatic glands and affected tissues in the 

 thorax, comparatively few may be present in the various organs, 

 such as the kidney, spleen, etc., and sometimes it may be im- 

 possible to find any. 



(3) Infection occasionally takes place through the intestine, 

 probably by ingestion of spores as in the case of animals ; 

 but this condition is rare. In such cases there is a local lesion 

 in the intestinal mucous membrane, of similar nature to that in 

 the bronchial form, the central parts of the hsemorrhagic areas 

 being, however, sometimes necrotic and yellowish, and there is a 

 corresponding affection of the mesenteric glands. In a case of 

 this kind, recently recorded by Teacher hsemorrhagic meningitis, 



