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Synonyms.—Malignant Pustule; Splenic Fever; Wool-sorter's Disease; Carbuncle; Bloody Murrain.

Definition.—An acute infectious disease, caused by the bacillus anthracis, and characterized by the formation of a boil with a circumscribed, infiltrated base and dark center, and a systemic infection of a severe type, the toxemia being of the gravest character.

Etiology.—The bacillus anthracis, the recognized specific cause of anthrax, is the oldest known and most widely studied of all the micro-organisms. It was the first bacillus ever credited as being the cause of an infectious disease, and was first recognized by Pollender in 1855. It is an elongated, motionless, rod-shaped bacillus, from two to ten times the length of a red-blood corpuscle; the rods are often united, giving them the appearance of "bamboo-cane."

They multiply by fission, reproducing themselves with great rapidity. They can be grown easily on various culture media. The spores possess remarkable vitality, freezing having no effect upon them, and they survive for some minutes at a temperature of 212°, the boiling point. While the bacilli are destroyed in ten seconds in a one-per-cent solution of carbolic acid, the spores will live for thirty-seven days in a five-per-cent solution of the same, and while desiccation destroys the bacilli in a few days, the spores remain active for years.

They infect cattle and sheep principally, and man occasionally, and are introduced into the system through a wound, or by the bite and sting of insects, through digestion, and also by inhalation.

Occupation is a predisposing cause, and workers who come in direct contact with infected animals or their products are most liable to the disease; as butchers, tanners, herders, hostlers, and those who handle hair and hides. It prevails in Europe, Asia, and South America, but only to a slight extent in this country.

Pathology.—The usual lesions that are found in severe infectious diseases—viz., degeneration of the liver, spleen, and kidneys—are found in anthrax. In addition to the local lesions, ulceration, and edematous infiltration, the most marked and most constant lesion is splenic enlargement, it sometimes being three or four times its natural size. The blood is dark, thick, diffluent, arid rich in spores.

Symptoms.—Two principal forms occur, external and internal.

External.—Malignant Pustule.—After an incubating period of from one to four days, the patient experiences a smarting, pricking, burning, or stinging sensation at the seat of inoculation, usually the hands, face, or neck, and soon a papule appears, which rapidly changes to a vesicle, the contents of which are bloody. On rupturing, a brown or black scab forms—anthrax.

Encircling the primary pustule, are seen a number of smaller pustules giving it the appearance of a carbuncle. The base of the primary ulcer becomes infiltrated and swollen, often involving quite an extensive area. The neighboring lymphatics soon become involved, and lymphangitis is quite common.

For the first twenty-four or forty-eight hours, the disease is of a local character, but soon systemic symptoms appear, the temperature rising rapidly; there is nausea, vomiting, diarrhea, profuse sweating, and finally collapse, which may terminate fatally in from five to ten days. In more favorable cases, the temperature begins to decline by the fifth or sixth day; the scab sloughs off, the ulcer healing by granulation.

Anthrax Edema.—In this form there is an absence of the local pustule or eschar. The infectious poison invades the deeper tissues, and is followed by swelling and edema, which in some cases is extreme. The usual seat of the edema are the eyelids, lips, tongue, and upper extremities.

Internal Anthrax.—Intestinal Mycosis.—This form is the result of eating diseased meat, or drinking milk from infected animals, and resembles ptomain poisoning from other sources. It may begin with a chill, nausea, vomiting, and diarrhea following quickly.

There is pain in the head and back, and great restlessness, sometimes accompanied by delirium and convulsions. There is dyspnea, and sometimes the patient becomes cyanotic. Hemorrhage is likely to occur from the stomach, bowels, and mucous surfaces. In some cases, small phlegmonous, carbuncular inflammation, or petechia, appears upon the skin. The fever is moderate in character. When it terminates in death, a frequent occurrence, it is usually preceded by heart-failure and collapse.

Wool-sorter's Disease.—This form occurs among workers in factories where wool and hair are assorted, especially the product from Russia and South America, where the disease prevails to such an alarming extent. The separation of the wool, and hair creates more or less dust, and this, either swallowed or inhaled, produces the disease.

There are but few premonitory symptoms, the patient being seized with a chill, attended by great prostration, the pulse being small, quick, and feeble. The temperature reaches 102° or 103°.

The general symptoms may be those of a respiratory or gastro-intestinal infection, or both. The breathing is hurried, there is a sense of constriction of the chest, with cough, and symptoms of a bronchitis or pneumonia follow. Vomiting and diarrhea may accompany the above, while the cerebral symptoms may be scarcely perceptible, or of the most intense character.

The disease usually terminates fatally in from three to five days. Ball states that if the patient survives a week he will recover.

Rag-picker's Disease.—Eppinger has identified this as anthrax, the same as wool-sorter's disease, and it is found among rag-sorters working in the large paper-mills where infected rags are found. The symptoms are similar to those just described, and need not be repeated.

Diagnosis.—The fact that the patient is a worker among animals or their products, together with the appearance of a papule, rapidly changing to a vesicle, its rupture of bloody material followed by a black scab and great edema of surrounding tissue, makes the diagnosis comparatively easy.

The internal form, however, is not so easily recognized, and if we overlook the occupation of the patient, a mistaken diagnosis is very apt to occur, the symptoms being similar to ptomain poisoning from other sources, such as canned goods, mushrooms, milk and its products, etc.

Prognosis.—The prognosis may be favorable in external anthrax, when occurring in strong, healthy individuals, and when seen early, but the internal form is very grave, and the prognosis should be guarded. If the patient lives over the first week, he will most likely recover.

Treatment.—Eclectic remedies have not been tried in this disease, and we are able to say but little as to their effect; but, judging this by other infectious diseases where there is rapid infection, we would expect good results from echinacea, baptisia, the sulphites, chlorates, and mineral acids, as they might be indicated. The system should have all of these remedies that it will bear, and the local disease washed with the same.

Extirpation, probably, has served a better purpose than the cautery, though we are to remember that the patient dies from the systemic poisoning, rather than as a result of the local lesion. Cleanliness, antiseptic measures internally and locally, quiet in bed, and good nutrition will form the most successful line of treatment.

The Eclectic Practice of Medicine, 1907, was written by Rolla L. Thomas, M. S., M. D.

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