Anthrax

Anthrax (the Greek for “coal,” or “carbuncle,” so called by the ancients because they regarded it as burning like coal; cf. the French equivalent charbon; also known as fièvre charbonneuse, Milzbrand, splenic fever, and malignant pustule), an acute, specific, infectious, virulent disease, caused by the Bacillus anthracis, in animals, chiefly cattle, sheep and horses, and frequently occurring in workers in the wool or hair, as well as in those handling the hides or carcases, of beasts which have been affected.

Animals.—As affecting wild as well as domesticated animals and man, anthrax has been widely diffused in one or more of its forms, over the surface of the globe. It at times decimates the reindeer herds in Lapland and the Polar regions, and is only too well known in the tropics and in temperate latitudes. It has been observed and described in Russia, Siberia, Central Asia, China, Cochin-China, Egypt, West Indies, Peru, Paraguay, Brazil, Mexico, and other parts of North and South America, in Australia, and on different parts of the African continent, while for other European countries the writings which have been published with regard to its nature, its peculiar characteristics, and the injury it inflicts are innumerable. Countries in which are extensive marshes, or the subsoil of which is tenacious or impermeable, are usually those most frequently and seriously visited. Thus there have been regions notorious for its prevalence, such as the marshes of Sologne, Dombes and Bresse in France; certain parts of Germany, Hungary and Poland; in Spain the half-submerged valleys and the maritime coasts of Catalonia, as well as the Romagna and other marshy districts of Italy; while it is epizootic, and even panzootic, in the swampy regions of Esthonia, Livonia, Courland, and especially of Siberia, where it is known as the Sibirskaja jaswa (Siberian boil-plague). The records of anthrax go back to a very ancient date. It is supposed to be the murrain of Exodus. Classical writers allude to anthrax as if it were the only cattle disease worthy of mention (see Virgil, Georg. iii.). It figures largely in the history of the early and middle ages as a devastating pestilence attacking animals, and through them mankind; the oldest Anglo-Saxon manuscripts contain many fantastic recipes, leechdoms, charms and incantations for the prevention or cure of the “blacan blezene” (black blain) and the relief of the “elfshot” creatures. In the 18th and 19th centuries it sometimes spread like an epizootic over the whole of Europe, from Siberia to France. It was in this malady that disease-producing germs (bacteria) were first discovered, in 1840, by Pollender of Wipperfürth, and, independently, by veterinary surgeon Brauell of Dorpat, and their real character afterwards verified by C.J. Davaine (1812-1882) of Alfort in 1863; and it was in their experiments with this disease that Toussaint, Pasteur and J.B. Chauveau first showed how to make the morbific poison its own antidote. (See Vivisection.)

The symptoms vary with the species of animal, the mode of infection, and the seat of the primary lesion, internal or external. In all its forms anthrax is an inoculable disease, transmission being surely and promptly effected by this means, and it may be conveyed to nearly all animals by inoculation of a wound of the skin or through the digestive organs. Cattle, sheep and horses nearly always owe their infection to spores or bacilli ingested with their food or water, and pigs usually contract the disease by eating the flesh of animals dead of anthrax.

Internal anthrax, of cattle and sheep, exhibits no premonitory symptoms that can be relied on. Generally the first indication of an outbreak is the sudden death of one or more of the herd or flock. Animals which do not die at once may be noticed to stagger and tremble; the breathing becomes hurried and the pulse very rapid, while the heart beats violently; the internal temperature of the body is high, 104° to 106° F.; blood oozes from the nose, mouth and anus, the visible mucous membranes are dusky or almost black. The animal becomes weak and listless, the temperature falls and death supervenes in a few hours, being immediately preceded by delirium, convulsions or coma. While death is usually rapid or sudden when the malady is general, constituting what is designated splenic apoplexy, internal anthrax in cattle is not invariably fatal. In some cases the animal rallies from a first attack and gradually recovers.

In the external or localized form, marked by the formation of carbuncles before general infection takes place, death may not occur for several days. The carbuncles may appear in any part of the body, being preceded or accompanied by fever. They are developed in the subcutaneous connective tissue where this is loose and plentiful, in the interstices of the muscles, lymphatic glands, in the mucous membranes of the mouth and tongue (glossanthrax of cattle), pharynx and larynx (anthrax angina of horses and pigs), and the rectum. They begin as small circumscribed swellings which are warm, slightly painful and oedematous. In from two to eight hours they attain a considerable size, are cold, painless and gangrenous, and when they are incised a quantity of a blood-stained gelatinous exudate escapes. When the swellings have attained certain proportions symptoms of general infection appear, and, running their course with great rapidity, cause death in a few hours. Anthrax of the horse usually begins as an affection of the throat or bowel. In the former there is rapid obstructive oedema of the mucous membrane of the pharynx and larynx with swelling of the throat and neck, fever, salivation, difficulty in swallowing, noisy breathing, frothy discharge from the nose and threatening suffocation. General invasion soon ensues, and the horse may die in from four to sixteen hours. The intestinal form is marked by high temperature, great prostration, small thready pulse, tumultuous action of the heart, laboured breathing and symptoms of abdominal pain with straining and diarrhoea. When moved the horse staggers and trembles. Profuse sweating, a falling temperature and cyanotic mucous membranes indicate the approach of a fatal termination.

In splenic fever or splenic apoplexy, the most marked alterations observed after death are—the effects of rapid decomposition, evidenced by the foul odour, disengagement of gas beneath the skin and in the tissues and cavities of the body, yellow or yellowish-red gelatinous exudation into and between the muscles, effusion of citron or rust-coloured fluid in various cavities, extravasations of blood and local congestions throughout the body, the blood in the vessels generally being very dark and tar-like. The most notable feature, however, in the majority of cases is the enormous enlargement of the spleen, which is engorged with blood to such an extent that it often ruptures, while its tissue is changed into a violet or black fluid mass.

The bacillus of anthrax, under certain conditions, retains its vitality for a long time, and rapidly grows when it finds a suitable field in which to develop, its mode of multiplication being by scission and the formation of spores, and depending, to a great extent at least, on the presence of oxygen. The morbid action of the bacillus is indeed said to be due to its affinity for oxygen; by depriving the red corpuscles of the blood of that most essential gas, it renders the vital fluid unfit to sustain life. Albert Hoffa and others assert that the fatal lesions are produced by the poisonous action of the toxins formed by the bacilli and not by the blocking up of the minute blood-vessels, or the abstraction of oxygen from the blood by the bacilli.

It was by the cultivation of this micro-organism, or attenuation of the virus, that Pasteur was enabled to produce a prophylactic remedy for anthrax. His discovery was first made with regard to the cholera of fowls, a most destructive disorder which annually carries off great numbers of poultry. Pasteur produced his inoculation material by the cultivation of the bacilli at a temperature of 42° C. in oxygen. Two vaccines are required. The first or weak vaccine is obtained by incubating a bouillon culture for twenty-four days at 42° C., and the second or less attenuated vaccine by incubating a bouillon culture, at the same temperature, for twelve days. Pasteur’s method of protective inoculation comprises two inoculations with an interval of twelve days between them. Immunity, established in about fifteen days after the injection of the second vaccine, lasts from nine months to a year.

Toussaint had, previous to Pasteur, attenuated the virus of anthrax by the action of heat; and Chauveau subsequently corroborated by numerous experiments the value of Toussaint’s method, demonstrating that, according to the degree of heat to which the virus is subjected, so is its inocuousness when transferred to a healthy creature. In outbreaks of anthrax on farms where many animals are exposed to infection immediate temporary protection can be conferred by the injection of anthrax serum.

Human Beings.—For many years cases of sudden death had been observed to occur from time to time among healthy men engaged in woollen manufactories, particularly in the work of sorting or combing wool. In some instances death appeared to be due to the direct inoculation of some poisonous material into the body, for a form of malignant pustule was observed upon the skin; but, on the other hand, in not a few cases without any external manifestation, symptoms of blood-poisoning, often proving rapidly fatal, suggested the probability of other channels for the introduction of the disease. In 1880 the occurrence of several such cases among woolsorters at Bradford, reported by Dr J.H. Bell of that town, led to an official inquiry in England by the Local Government Board, and an elaborate investigation into the pathology of what was then called “woolsorters’ disease” was at the same time conducted at the Brown Institution, London, by Professor W.S. Greenfield. Among the results of this inquiry it was ascertained: (1) that the disease appeared to be identical with that occurring among sheep and cattle; (2) that in the blood and tissues of the body was found in abundance, as in the disease in animals, the Bacillus anthracis, and (3) that the skins, hair, wool, &c., of animals dying of anthrax retain this infecting organism, which, under certain conditions, finds ready access to the bodies of the workers.

Two well-marked forms of this disease in man are recognized, “external anthrax” and “internal anthrax.” In external anthrax the infecting agent is accidentally inoculated into some portion of skin, the seat of a slight abrasion, often the hand, arm or face. A minute swelling soon appears at the part, and develops into a vesicle containing serum or bloody matter, and varying in size, but seldom larger than a shilling. This vesicle speedily bursts and leaves an ulcerated or sloughing surface, round about which are numerous smaller vesicles which undergo similar changes, and the whole affected part becomes hard and tender, while the surrounding surface participates in the inflammatory action, and the neighbouring lymphatic glands are also inflamed. This condition, termed “malignant pustule,” is frequently accompanied with severe constitutional disturbance, in the form of fever, delirium, perspirations, together with great prostration and a tendency to death from septicaemia, although on the other hand recovery is not uncommon. It was repeatedly found that the matter taken from the vesicle during the progress of the disease, as well as the blood in the body after death, contained the Bacillus anthracis, and when inoculated into small animals produced rapid death, with all the symptoms and post-mortem appearances characteristic of che disease as known to affect them.

In internal anthrax there is no visible local manifestation of the disease, and the spores or bacilli appear to gain access to the system from the air charged with them, as in rooms where the contaminated wool or hair is unpacked, or again during the process of sorting. The symptoms usually observed are those of rapid physical prostration, with a small pulse, somewhat lowered temperature (rarely fever), and quickened breathing. Examination of the chest reveals inflammation of the lungs and pleura. In some cases death takes place by collapse in less than one day, while in others the fatal issue is postponed for three or four days, and is preceded by symptoms of blood-poisoning, including rigors, perspirations, extreme exhaustion, &c. In some cases of internal anthrax the symptoms are more intestinal than pulmonary, and consist in severe exhausting diarrhoea, with vomiting and rapid sinking. Recovery from the internal variety, although not unknown, is more rare than from the external, and its most striking phenomena are its sudden onset in the midst of apparent health, the rapid development of physical prostration, and its tendency to a fatal termination despite treatment. The post-mortem appearances in internal anthrax are such as are usually observed in septicaemia, but in addition evidence of extensive inflammation of the lungs, pleura and bronchial glands has in most cases been met with. The blood and other fluids and the diseased tissues are found loaded with the Bacillus anthracis.

Treatment in this disease appears to be of but little avail, except as regards the external form, where the malignant pustule may be excised or dealt with early by strong caustics to destroy the affected textures. For the relief of the general constitutional symptoms, quinine, stimulants and strong nourishment appear to be the only available means. An anti-anthrax serum has also been tried. As preventive measures in woollen manufactories, the disinfection of suspicious material, or the wetting of it before handling, is recommended as lessening the risk to the workers.

(J. Mac.)

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