(Anthrax maligna; Pustula maligna; Splenic fever carbuncle)
Definition. A rare, specific inflammatory disease of the skin, due to inoculation by the bacillus anthracis and characterized by gangrenous development.
Symptoms. The poison of splenic fever may be communicated to man from infected animals by the respiratory or digestive tract, and prove rapidly fatal. It is only the more usual infections of and through the skin which is considered here. Within twenty-four hours after accidental inoculation, generally on the exposed portions of the hands, face, or neck, a single painless macule appears, soon followed by an angry inching papule, which in its turn rapidly becomes a vesicle or vesicopustule filled with bloody serum. There is marked and often sharply defined induration and edema of the skin and subcutaneous tissues, covering an area from the size of a dime to the palm of the hand. There is a deep scarlet areola and the central portion rapidly forms a depressed gangrenous patch, which in the course of another day may be surrounded by a circle of newly formed vesicles. The lumphatics and glands enlarge, sometimes suppurate and the gangrenous patch spreads, general infection follows with a high fever, often assuming a typhoidal aspect. In severe cases, death occurs in from two to seven days from shock, systemic poisoning or exhaustion. The local process may be less rapid and the systemic disturbance less marked, the patient not even being confined to his home. In these mild cases, the local process is circumscribed and the gangrenous mass sloughs off in due time. Exceptionally, in the place of the lesion, the disease may take the shape of an extensive malignant tumor, spotted with gangrenous points and blebs filled with a bloody fluid. There are all degrees of this condition between the mildest described and the most malignant, but in all cases there exists the possibility of malignancy.
Etiology and Pathology. The disease is most common in Continental Erurope, where splenic fever in cattle prevails; while it is relatively rare in America, where that infection is infrequent. As has been stated, the causative factor is the bacillus anthracis which is conveyed through a slight abrasion or opening in the skin. In occurs almost exclusively in those whose occupations bring them in touch with live or, more often, dead animals such as tanners, cattle dealers, butchers, wool sorters, etc. It has been conveyed by flies or dust from the hair or hides of animals and it is even claimed that the milk or butter of diseased animals or imperfectly cooked flesh or recently slaughtered animals has produced it. The bacillus anthracis is the largest of the pathogenic bacteria and is found in great numbers through the affected tissue, including the fluid of the pustule and, after a few days, in the urine, sweat, or feces and at times in the blood. It may be found postmortemly in the capillaries especially of the liver, kidneys and spleen.
Diagnosis. Anthrax may be identified by the occupation of the patient and by the rapid development of papule, vesicle, pustule and gangrene situated on a deep, resistant, highly colored base surrounded by edema, and on the second or third day by the pathognomonic, sign, a depressed eschar encircled by vesicles. Carbuncle, furnuncle, poisoned wounds and chancre can be excluded by their more indolent course and onset, while the microscope may be used in cases in which there seems to be some doubt, as the bacillus is readily found in the fluids of the lesions. The form that is characterized by rapidly diffused edema might resemble in some degree erysipelas or malignant edema.
Prognosis and Treatment. The disease is fatal in about one-third of all patients. Cases of internal anthrax are nearly always fatal and the death rate is also very high in the edematous variety.
Prompt complete excision of the lesion and strict antiseptic precautions, followed by frequently renewed antiseptic dressing is to be preferred to the deep and thorough saturation of the affected tissues with antiseptics. However, the latter method which includes hypodermic injections of pure tincture of iodin, 5 per cent. or stronger solutions of carbolic acid, and 1 per cent. of potassium permanganate, has been satisfactory in reported cases. Good results have been observed from the use of an anthrax serum originally prepared by Scalvo of Siena, Italy. The serum is best introduced intravenously although it may be used subcutaneously and is well borne in large doses, with only slight destruction of tissue and rapid convalescence. A case of my own which promptly received a massive X-ray dose recovered rapidly. Supportive nutritious feeding, together with careful selection of the indicated drug would seem necessary in all cases. The snake poisons seem especially applicable. See Anthrac., Apis, Crotal., Kali phos., Secale, Tarent., Vipera.