An American text-book of surgery : for practitioners and students / By Phineas S. Conner, M.D., Frederic S. Dennis, M.D., William W. Keen, M.D., Charles B. Nancrede, M.D., Roswell Park, M.D., Lewis S. Pilcher, M.D., Nicholas Senn, M.D., Francis J. Shepherd, M.D., Lewis A. Stimson, M.D., J. Collins Warren, M.D., and J. William White, M.D. Ed. by William W. Keen and J. William White.
- William Williams Keen
- Date:
- 1899
Licence: Public Domain Mark
Credit: An American text-book of surgery : for practitioners and students / By Phineas S. Conner, M.D., Frederic S. Dennis, M.D., William W. Keen, M.D., Charles B. Nancrede, M.D., Roswell Park, M.D., Lewis S. Pilcher, M.D., Nicholas Senn, M.D., Francis J. Shepherd, M.D., Lewis A. Stimson, M.D., J. Collins Warren, M.D., and J. William White, M.D. Ed. by William W. Keen and J. William White. Source: Wellcome Collection.
Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.
![i;JO ^i.v j.]//;A'/r.i.v rKxr-iiooK of surgery. formation of blehs upon tin- surface, filltMl wiili Itloodv scrum. In rare instanee8 spontaneous recoverv from this variety of antliiax takes ])lace. The local pain is slight, and, sis long as the diseased process is limited, there is but little general elevation of temperature, the patient often continuing to bo about and manifesting simply slight chills and mild fever, (ieneral infection is shown by well-marked rigors, high fever, with great weakness, delirium, feel)le ])ulse, sweating, diarrhea, and acute pains in many jiortions of the body. Cough, rapid respiration, and cyanosis indicate pulmonary disturb- ance. Collapse, often sudden in its development, closes the scene. Pathology.—The tissue-changes wiiich are discernible in cases of anthrax are de])endent upon the multiplication and diffusion of the bacilli in the capil- laries and lymphatics. The local changes of cedema aiul necrosis are due to the blocking uj) of the caj)illaries by the bacilli and to their irritating eflect upon the capillary walls, Avliich produces such abundant intlammatory exuda- tion into the paravascular and connective-tissue spaces that acute ischemia results. When general infection has taken place, the capillaries in every part of the body teem with bacilli, which accumulate in largest numbers at points where the blood-current is slowest. In the most vascular organs, like the spleen, liver, and kidneys, the bacilli especially abound. They form thrombi in the capillaries and lymphatics, from which multiple and more or less exten- sive extravasations into all the tissues result, and transudations into the various serous cavities are produced. Diagnosis.—The typical anthrax carbuncle is not likely to be confounded with any other aftection. The early superficial depressed eschar, the tough slough closely attached to the surrounding tissues, the lack of sensitiveness of the swelling, the widely-extending infiltration, the absence of suppuration, and the general symptoms Avhich attend its later course form a picture distinct from that which characterizes simple inflammatory carbuncle with its prominent cen- ter, its multiple soft, suppurating, sloughing foci, its local pain, and indolent inflammatory course. The nmltiple small carbuncles of glanders have little in common with the carbuncle of anthrax. Anthrax oedema at its outset may be confounded with acute })hlegmonous inflammation or with malignant oedema. Phlegmonous inflammation is characterized by its tendency to suppuration, which at once distinguishes it from anthrax. In malignant oedema the necrosis is attended with rapid disintegration and liquefiiction of the dead tissue, in marked contrast with the tough and adherent sloughs of anthrax. In all cases of suspected anthrax microscojjic examimition of the fluids of the aff'ected part should be made. The anthrax l)acillus can be readily stained and identified under the microscope. ]Microscopic findings may be made still more positive by inoculation experiments. Prognosis.—External anthrax which is allowed to take its own course, or in which the treatment is too long delayed, is very grave, but when an early diagnosis is made and energetic, rational treatment is at once instituted, the prognosis is usually favorable. When general infection of the system has occurred, the result is uniformly fatal. The prognosis of the oedcmatous vari- ety is more grave than that of the carbuncular, in consequence of the greater liability to general infection which attends the former. In either case the fatal termination is due, probably, as indicated by the most recent researches of bacteriologists (Bollinger), to toxic ptomaines formed in the body by the bacilli as the products of their growth. Treatment.—All treatment must be conducted ujion antiseptic lines, and should be energetic, and instituted at the earliest possible moment. Excision of the infected area should, if possible, be done, the incisions being carried](https://iiif.wellcomecollection.org/image/b21217014_0166.jp2/full/800%2C/0/default.jpg)
