_Malignant Vesicle_ (_pustule_). Symptoms may vary somewhat but are in
the main as follows: An itching papule appears in the seat of
inoculation, which might be mistaken for an insect bite but for the dark
red color of the centre. Occurring on an uncovered portion of the skin,
in an anthrax district, or near a factory where anthrax products are
likely to be used, this should at once create suspicion. Soon the dark
centre is covered by a small vesicle with clear contents which later
become bloody. Within 24 or 48 hours the vesicle dries up, becoming
firm, resistant and brownish red or blackish gray, and apparently
gangrenous. The swelling has meanwhile extended to ½ or ¾ inch in
diameter and a row of fresh vesicles may appear which in their turn give
place to a necrotic slough. In this way extension may take place, the
sore retaining a more or less rounded form, and necrosis extending from
the centre in every direction. The necrotic mass, however, remains
firmly adherent to the adjacent tissues until separated by the work of
suppuration which ensues in favorable cases. The disease is attended
with more or less fever, chill, hyperthermia, nausea, diarrhœa, with
aching of head, back, and limbs and unfavorable cases may merge into
acute and fatal general anthrax. The mortality is about 20 per cent.,
though in special epidemics it has reached 80 per cent. (With the
pustule on the face 25 per cent.; on the lower limb 5 per cent.,
Norris). The prognosis is favorable with a free concentration of
leucocytes, a moist condition of the wound and above all a liberal
invasion of pus cocci. It is unfavorable when the wound is dry, when the
drying slough remains firmly adherent and when the adjacent lymph glands
become implicated. In non-fatal cases it may be difficult to find the
bacillus.
_Anthrax Œdema._ This is less easily diagnosed than malignant vesicle,
and appears where the connective tissue is loose, abundant and little
vascular, from direct local inoculation, or as a concomitant of internal
anthrax. It is a flat, rapidly extending swelling, with the skin
comparatively unaltered, though at points yellowish or reddish
discoloration indicates congestion and extravasation. Not being limited
by firm tissues nor aggregations of accumulating leucocytes it tends to
a speedy general infection with all the febrile manifestations of that
condition. Thus chills, nausea, hyperthermia, dusky reddish or brownish
mucosæ, cephalalgia, rachialgia and profound prostration assist in
diagnosis. The bacilli in the blood and exudate would serve to confirm
the conclusion.
_Intestinal Anthrax._ Here again the ingestion of anthrax products, and
the simultaneous attack of a number of people who have taken such
materials will often assist in diagnosis. There may have been for some
days indications of local bowel lesions, such as chilliness, elevation
of temperature, nausea, headache, and giddiness. Suddenly these become
more violent, there is vomiting and sanguineous diarrhœa, extreme
anxiety and debility, cyanosis, dyspnœa, and it may be the appearance of
petechiæ on the skin and mucosæ or even of local swellings. In some
cases there are convulsions or other symptoms of nervous disorder and in
others extreme prostration and collapse. The bacillus is not always to
be found in the circulating blood, but may be detected in sanguineous
excretions, or by cultures.
_Pulmonary Anthrax._ (Woolsorter’s disease). Here again the occupation
of the patient assists in diagnosis. For two to five days prodromata
similar to those of intestinal anthrax may be noted. The difficulty in
breathing, dyspnœa, cough, cyanosis and sense of constriction of the
chest are especially diagnostic. Suddenly all these symptoms are
aggravated, respirations become 30 to 40 per minute, the pulse 120 to
150, the temperature 104° to 106°, and there is a frothy bloody
expectoration in which the bacilli may be detached. There may be
indications of intestinal, cerebral or nephritic lesions, and bloody
discharges. Death usually occurs in 12 to 48 hours from collapse, or
coma, from asphyxia or in convulsions. The few recoveries are tardy and
tremors and spasms persist for a length of time. In the most favorable
cases the disease does not proceed beyond the initial stage.