—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.
Prognosis.
—Prognosis for man is not usually unfavorable, the majority of cases recovering with more or less local destruction of tissue. Should, however, infection become generalized, the case will probably terminate fatally. Cases assuming the type of splenic fever are of much more serious character, and their prognosis graver.
Treatment.
—This should be both local and constitutional. The former should consist of the most radical possible attack and include complete excision of the infected area, with the use of active caustics or the actual cautery. In fact, the latter instrument offers a most valuable means for combating the destructive tendency of the disease. Sloughing and separation of the cauterized mass may be hastened by warm antiseptic poultices. Subcutaneous injections of 5 per cent. carbolic solution have been given, with apparent benefit, in a number of cases, but should only be relied upon in the treatment of the milder manifestations.
Benefit will accrue from the use of the ichthyol-mercurial ointment whose formula was given under treatment of Erysipelas. It has been suggested to treat these cases by the employment of the bacillus pyocyaneus, since it is known that this organism when injected with the anthrax bacillus materially attenuates its effect.
Prophylaxis.
—Prophylaxis is most important. The bodies of all infected animals should be burned, not buried, since the resistant bacilli are often brought to the surface of the soil by earth-worms. Every discoverable source or medium of infection should be destroyed or sterilized.
MALIGNANT EDEMA.
This disease has been recognized for some time, mainly by French and Continental clinicians, and under such names as gangrène foudroyante, gangrène gazeuse, gangrenous septicemia, and gangrenous emphysema. The name malignant edema was given by Koch, who identified the infecting organism. It is one of the most dangerous forms of gangrenous inflammation, and occurs sometimes after serious injuries, and, again, after most trifling lesions, such as those inflicted by the dirty pointed implements of the gardener, etc., or even the stings of insects. Two cases are on record where the disease followed a puncture of the hypodermic needle for the administration of morphine. In one of these the organism was found in the solution; in the other it probably had been deposited upon the skin.