Anthrax.
Synonyms:—Charbon; malignant pustule; carbuncle; splenic fever. These synonyms are apt to be confusing, as they confound this disease with better known diseases of the same name, not caused by this bacillus.
Definition:—A disease usually affecting herbivorous animals primarily, and conveyed from them directly to omnivorous animals or to man. It is very seldom conveyed by direct infection from man to man. It is caused by a specific bacillus, the bacillus anthracis.
Etiology:—This is a not uncommon infectious disease in animals; at one time it affected entire herds, but now it is early diagnosed, and it is stamped out by destroying the first infected animals. From animals the disease is not readily conveyed to man, but in the handling of hides and in working in wool infection is directly acquired. The micro-organism may be inhaled or taken in with the food and drink, in which cases there are acute constitutional phenomena. The entire group of symptoms constitutes wool sorters* disease. More commonly the infection takes place through abrasions of the skin of the face, neck, arms and hands, from contact with the infected wool or hides, and a local inflammation is the first result, followed after a few days by a general constitutional infection.
Constitutional infection has occurred from eating meat from diseased animals. In a number of cases epidemics have originated from this cause. Infection of a number of individuals from drinking water from a well that had been contaminated has been known to result.
Symptomatology:—The form known as wool sorters' disease is very uncommon. The symptoms appear suddenly after an indefinite period of incubation. Usually there is a general sense of distress and malaise for a short time, quickly culminating in a severe chill. Occurring almost simultaneously with the chill is a high fever and marked pain in the stomach, with rapidly increasing dyspnoea, which is usually easily diagnosed as other than cardiac dyspnoea. In severe cases the disease runs its entire course, and death occurs within a few hours after the first acute symptoms appear.
With dyspnoea there may be cough, labored respiration, cyanosis, rapid, irregular, feeble pulse, great prostration, collapse and death.
If the pain occurs first in the stomach or intestinal canal, developing the condition known as intestinal mycosis, sudden prostration, with nausea and vomiting, and choleraic diarrhea may be the first symptoms. The temperature falls, the pulse becomes feeble, evidences of rapidly failing heart action occur, and death quickly follows, usually within two, three or four days. Nervous symptoms, as convulsions, coma, various forms of delirium, may result in the severe cases, but death may occur with no mental derangement whatever.
When the infection occurs through the skin, external anthrax, or the condition known as malignant pustule results. At the point of infection, which is usually where there is a small scratch or wound, the skin being abraded or broken, a small papule first appears. This itches and burns and soon becomes angry and inflamed, with a red base. This increases in size, assumes the form of a vesicle and is filled with serum and blood. When the contents discharge a scab forms, bluish or black in color, which is characteristic of anthrax. Around the base of this primary vesicle a number of minute miliary vesicles now quickly develop, from which infection and acute local inflammation rapidly spreads. The tissues involved in this inflammation become dark colored after the vesicles discharge and sloughing occurs. There is no severe pain, and the itching and burning disappears with the discharge of the contents of the vesicle.
With the development of the local symptoms, fever, chill, languor, headache, nausea and other constitutional symptoms appear in varying degrees of severity. Symptoms of glandular infection quickly follow, often in the course of the lymphatics, with swelling and severe local inflammation. Other constitutional phenomena, as enlargement of the spleen, great prostration, prostating sweats and diarrhea, may follow.
Oedema occurs in a number of cases of anthrax at the seat of or contiguous to the local infection. It is malignant and virulent in character frequently and occurs without the eschar developing from the papule. The oedema and swelling develop and increase so rapidly in the tissues of the face, head, tongue and lips, and perhaps the neck, that the circulation is impaired and a slough is formed or gangrene results. Death has followed quickly in nearly all of these cases.
Diagnosis:—When the patient's occupation is not taken into consideration the diagnosis of this disease from the symptoms is exceedingly difficult. The occupation, the occurrence of associated cases and familiarity with its development are essential to its quick recognition. The conclusions must be confirmed by an examination of the pustule contents, or by the inoculation of a guinea pig. The germ will develop rapidly in the tissue of the animal and can be soon found. Death follows the inoculation in two or three days.
Diagnosis of the internal disorder is made by exclusion, by the rapid course of the disease and by the profound constitutional involvement, and finally by the presence of the micro-organism in the blood.
Prognosis:—In proportion to the severity of the original infection and the rapidity of the invasion is the danger of this disease in its external forms. Internal infection causes death in nearly all cases. One writer, Bell, claims that patients who live six days will probably recover. Those developing from pustule, if of excellent previous health, can throw off the disease. Those having poor vitality, or possessing a constitutional dyscrasia, are apt to succumb. The local treatment, if prompt and heroic, is productive of much good.
Treatment:—Extreme antiseptic measures must be adopted from the first. If the papule is recognized before the pustule develops the tissue at the base should be injected with a safe solution of carbolic acid and a wet carbolic acid dressing, covered with a rubber protective, should be applied and re-applied every twelve hours. Excision of the pustule may be practiced in many cases, and antiseptic dressings applied to the raw surface of the wound. We would have great confidence in the injection of echinacea into the surrounding tissues, and in its internal use in the carbuncular form or when gangrene is threatened, as it has not yet failed to antidote the most virulent organic infection to a greater or less degree and to stimulate the stagnating capillary circulation. It will be of great value from the first to antagonize the constitutional infection. It should be given in dram doses every two hours in every case, without regard to the mode of infection. Other of our specific remedies will facilitate the action of this. Phytolacca will be servicable where the glands are involved, and rhus tox will have its specific indications in some cases. Iodine in some quickly appropriable form will help in general restoration. Organic iodine—the Iodoneucleoid—will be of great service. Iron is important in anaemia, and to assist echinacea in antagonizing the formation of pus. In convalescence, echinacea should be continued, and the best of blood restoratives and nerve tonics should be given, with forced concentrated nutrition.
In individuals working among hides and wool, the use of a mild, harmless antiseptic solution, as a wash to the exposed parts, is advisable always. When the skin is abraded it should be treated antiseptically; and if of the fingers, it should be covered at once with a new rubber finger stall over a light gauze dressing. When handling dry wool or hides the mouth and throat should be washed and gargled with a similar solution and precautions taken to breathe the least possible amount of the dust. Fresh air should be continually circulated in the room by means of fans and ventilators.
