The principles and practice of modern surgeryPark, Roswell
Science
The principles and practice of modern surgery
Park, Roswell
Surgery
In _man_ the disease occurs usually as the so-called _malignant
pustule_, or _woolsorters’ disease_, the latter name being given
because of the liability of those individuals who come in contact
with the carcasses and hides of diseased animals or their immediate
products. The _period of incubation is brief_--on the average two
or three days. The first lesion appears usually on the face, hands,
or arms, and is characterized by local discomfort with formation
of a small papule, which rapidly becomes a vesicle with an areola
of cellulitis about it. This is rapidly followed by induration and
infiltration, and these by local gangrene, the result being the
separation of a core-like mass, similar to that of carbuncle. The
affected area is usually discolored, often quite black. The process
is not usually accompanied by suppuration, nor is there the pain of
true carbuncle. The lesions tend to spread peripherally, but there is
more or less vesication of the surrounding skin. On account of the
local ischemia there will always be edema of the affected region,
and sometimes the swelling and local disturbance become extreme.
These peculiar lesions have given rise to the common name _malignant
pustule_, which is well deserved. At last a line of demarcation becomes
manifest, and if the disease progresses favorably the included area
is sloughed out, leaving a surface which it is hoped will soon become
covered with reasonably healthy granulations.
Absence of pain, and usually of pus, are significant features of
anthrax. Should mixed infection occur, however, we are likely to see
pus formation. When the disease partakes less of the characteristics of
malignant pustule and more of a general infection, the local symptoms
may not predominate, but, on the contrary, septic indications may
become serious and even fatal. The evidence of more or less toxemia
is usually at hand, however, and the toxin of anthrax is almost as
destructive of muscle cell integrity as is that of diphtheria.
The local lesions may be single or multiple, but will be met with
almost always upon exposed areas of the body.
=Postmortem Appearances.=--These will depend upon the clinical course
of the disease. In the sloughing tissues the bacilli are very numerous,
while around the margin more than one bacterial form will probably be
met--_i. e._, mixed infection. Should saprophytic organisms complicate
the case, they may have replaced the anthrax bacilli by the time the
examination is made. The latter abound, however, in the blood, and
may usually be found occluding the capillaries of the liver, spleen,
kidney, etc. In intestinal infection, particularly in animals, the
mesenteric nodes are involved. Inasmuch as septic features accompany
all fatal cases, putrefaction will be found to begin early, and the
changes in the blood and the gross changes in the other organs will
resemble sepsis rather than anthrax.
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