cutaneous tissue and
altered blood, forms (Fig. 29). Meanwhile the induration extends, fresh
vesicles form and in turn burst, and the eschar increases in size. The
neighbouring lymph glands soon become swollen and tender. The affected
part is hot and itchy, but the patient does not complain of great pain.
There is a moderate degree of constitutional disturbance, with headache,
nausea, and sometimes shivering.

If the infection becomes generalised--_anthracaemia_--the temperature
rises to 103 or 104 F., the pulse becomes feeble and rapid, and other
signs of severe blood-poisoning appear: vomiting, diarrhoea, pains in the
limbs, headache and delirium, and the condition proves fatal in from
five to eight days.

_Differential Diagnosis._--When the malignant pustule is fully
developed, the central slough with the surrounding vesicles and the
widespread oedema are characteristic. The bacillus can be obtained from
the peripheral portion of the slough, from the blisters, and from the
adjacent lymph vessels and glands. The occupation of the patient may
suggest the possibility of anthrax infection.

[Illustration: FIG. 28.--Malignant Pustule, third day after infection
with Anthrax, showing great oedema of upper extremity and pectoral region
(cf. Fig. 29).]

[Illustration: FIG. 29.--Malignant Pustule, fourteen days after
infection, showing black eschar in process of separation. The oedema has
largely disappeared. Treated by Sclavo's serum (cf. Fig. 28).]

_Prophylaxis._--Any wound suspected of being infected with anthrax
should at once be cauterised with caustic potash, the actual cautery, or
pure carbolic acid.

_Treatment._--The best results hitherto obtained have followed the use
of the anti-anthrax serum introduced by Sclavo. The initial dose is 40
c.c., and if the serum is given early in the disease, the beneficial
effects are manifest in a few hours. Favourable results have also
followed the use of pyocyanase, a vaccine prepared from the bacillus
pyocyaneus.

By some it is recommended that the local lesion should be freely
excised; others advocate cauterisation of the affected part with solid
caustic potash till all the indurated area is softened. Graf has had
excellent results by the latter method in a large series of cases, the
oedema subsiding in about twenty-four hours and the constitutional
symptoms rapidly improving. Wolff and Wiewiorowski, on the other hand,
have had equally good results by simply protecting