ANTHRAX IN THE HUMAN SUBJECT 345 



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; it 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 pustule as a centre 

 subcutaneous oedema spreads, especially in the direction of the 

 lymphatics; the neighbouring glands are enlarged. There is 

 usually 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 

 Malpighii. Beneath them and in their neighbourhood the cells 

 of the latter are swollen and cedematous, 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 sub- 

 cutaneous tissue is also oedematous, 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 patho- 

 logical 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 



