Pathogenesis 



371 



III. The Skin. — The bacillus frequently enters the body through 

 wounds, cuts, scratches, and perhaps occasionally fly-bites, though 

 from the work of Nuttall* it is pretty clear that flies play little part 

 in the transmission of the disease. Under these conditions the organ- 

 isms at once find themselves in the lymphatics or capillaries, and 

 may cause immediate general infection. In human beings a " malig- 

 nant pustule" is apt to follow local infection, and may recover or 

 ultimately cause death by general infection. 



The malignant pustule usually makes its appearance upon the face, 

 hands or arms. The first symptom is a reddish papule that extends 

 and becomes vesicular. At the point of infection necrosis is rapid. 



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Fig. 130. — Anthrax bacilK in glomeruli of kidney. 



and within forty-eight hours there may be a brownish eschar sur- 

 rounded by a crop of secondary vesicles, beyond which there is edema 

 or brawny swelUng. According to the susceptibility of the patient 

 the disease may soon localize, the slough detach and recovery set in, 

 or the edema and swelling may continue, blood invasion occur and 

 death ensue. Heinemann,t in compiling statistics of the fatality of 

 malignant pustule, shows that the danger of the lesion is greatly miti- 

 gated by complete excision. Koch found the death-rate among 1473 

 cases to be 38.8 per cent., but Heinemann's statistics upon 2255 

 cases show the deaths to be only 5.8 per cent. 



Lesions. — The disease as seen in the laboratory is accompanied 

 by few marked lesions. The ordinary experimental inoculation is 



* "Johns Hopkins Hospital Reports/' 1899. 

 t"Deutsche Zeitschrift fiir Chirurgie," 1912, cxrx, 201. 



