BACILLUS ANTHRACIS. 557 
except that the duodenum is usually less affected; but in 
all cases metastasis occurs in various parts of the body, 
brought about, no doubt, by previous hemorrhages. 
Occurrence in Man. The disease does not occur 
spontaneously in man, but always results from infec- 
tion, either through the skin, the intestines, or occasion- 
ally by inhalation through the lungs. It is usually 
produced by cutaneous infection through inoculation of 
exposed surfaces—the hands, arms, or face. Infection 
of the face or neck would seem to be the most danger- 
ous, the mortality in such cases being 26 per cent.; 
while infection of the extremities is very rarely fatal— 
in only 5 per cent. of cases (Nassarow and Miiller). 
External anthrax in man is similar to this form of 
the disease in animals. There are two forms: Malig- 
nant pustule or carbuncle, and, less commonly, malig- 
nant anthrax cedema. 
In malignant pustule, at the site of inoculations, a small 
papule develops, which becomes vesicular. Inflamma- 
tory induration extends around this, and within thirty- 
six hours there is a dark brownish eschar in the centre, 
at a little distance from which there may be a series of 
small vesicles. The brawny induration may be extreme. 
There may also be considerable cedema of the parts. In 
most cases there is no fever; or the temperature at first 
rises rapidly and the febrile phenomena are marked. 
Death may take place in from three to five days. In 
cases which recover the symptoms are slighter. In the 
mildest form there may be only slight swelling. 
Malignant anthrax oedema occurs in the eyelids, and 
also in the head and neck, sometimes the hand and arm. 
It is characterized by the absence of the papule and 
vesicle forms, and by the most extensive edema. The 
