A CASE OF PRIMARY INTESTINAL ANTHRAX IN MAN SEPTICÆMIA; HÆMORRHAGIC LEPTO-MENINGITIS
two cases of four millimetres, lasting from one to two seconds, and of 6 millimetres, lasting four seconds. Injection of muscle extract was practised twice ; in one there was a marked fall of 38 millimetres lasting four minutes 28 seconds, and in the other a fall of only four millimetres, lasting one minute 55 seconds. The observations on the kidney, the liver, and the brain were more numerous and are tabulated according to whether they caused a rise or fall (Tables V. and VI.). TABLE
... Rise of Pressure after Injection of Various Extracts. TABLE VI.— Showing Fall of Pressure after Injeoting Various Extracts. In Table3 V. and VI. the heading "Maximum " means the highest or lowest maximum point the blood pressure reached respectively during the interval in which rise or fall occurred. The duration in Table IV . is qualified in many cases by the words "at least" because it was necessary in these cases to stop the kvmograph and so economise tricing paper in order to get the whole series on one tracing. It is obvious that though other organs than the kidney occasionally show a rise of pressure on injection, yet the rise is small and of short duration; whereas the kidney effect of a rise, though varying within considerable limits, is a striking feature, and the same may be said of the duration in which such rise takes place ; no other organ has been noticed to have such an effect FO frequently. The liver and brain show a much greater tendency to cause a fall of blood pressure and even then such fall is generally of very brief duration. One point to which it is necessary to draw attention is that in none of these experiments was the kidney extract injected first ; the injection always succeeded that of some other organ and it may be objected that it is possible that the rise of pressure following the injection of renal extract is due to some interaction of renal extract with some previous extract. Moreover, it may be thought that the renal extract is of a different physical character and likely to cause a rise of pressure from some mechanical effect dependent upon the granules contained in the emulsion. As will be seen later, there is no reason to believe that either of these objections holds good. It is to be observed once again that these animals were simply under the influence of ether ; this was so carefully administered that the respiration was maintained regularly. In another experiment, 33B, with ether anesthesia and artificial respiration, the vagi were cut ; an injection of renal extract then produced the exceedingly small rise of only four or one millimetre, lasting one minute 40 seconds and 25 seconds respectively. So far as this. one experiment is concerned it must be stated that the second injection of an extract has on other occasions shown less marked reaction than the first one. The slight rise, such as it is, merely suggests that the rise of pressure on injecting renal extract is due to a peripheral effect whereby the arterial pressure is raised. THE following case of anthrax is of interest from several points of view. It appears to be an example of that form of the disease which is the most common in animals but the rarest in man-viz., that in which infection occurs through the alimentary canal. The infection was extremely virulent and the course of the disease was correspondingly rapid, the whole known duration of the illness being 20 hours. There was nothing in connexion with the occupation of the patient to suggest anthrax and the symptoms gave no clue to the nature of the disease. Until the hæmorrhagic condition of the meninges was revealed at the post-mortem examination anthrax was never suspected. Moreover, the case appears to have been completely isolated and all investigations subsequently undertaken have failed either to reveal the source of the mfection or to bring to light other cases of the disease in man or animals in the neighbourhood of the present one. Clinical history by Dr. ROBERT BELL.-A man, aged 36 years, was admitted to Ward 12 of the Western Infirmary, Glasgow, at 11.15 P.M. on Jan. 31st, 1905, in a semi-conscious and delirious state. According to the account of his friends he was to all appearance in perfect health until the morning of the day of his admission, when he rose with the intention of going to work but returned to bed because he felt giddy and had a headache. The headache he described as a pain beginning behind and shooting over to the forehead, while occasionally he complained of pain in the region of his right ear and right eye. He remained in bed all day and took a little light food, and he appeared to be not at all seriously ill. About 7 P.M., however, his friends heard him give a cry and went to the bedroom, where they found him out of bed, very restless and excited, and talking in an unintelligible manner. He would not reply to any questions but would rise suddenly, go and sit down by the fire, holding his head and moaning, and then as suddenly he would jump into his bed again and would lie huddled up. This restlessness and excitement he showed in an increasing degree up to the time of his admission. The patient worked at the making of white lead in a paint manufactory. The people with whom he lodged had known him for five years and he had been an exceptionally strong and healthy man. They stated that he had not been a heavy drinker but he occasionally had a bout of two or three days' duration, after which he would be steady for some weeks. When seen in the receiving room at 11.5 P.M. he was being held in a chair by three or four men so violent were his struggles. On admission to Ward 12 he seemed unconscious but if spoken to loudly he opened his eyes and looked about. If left to himself he lay huddled up with his legs and knees drawn tightly up and flexed upon the abdomen, his arms thrown across the chest, and his head bent with the chin on the sternum. But if any attempt were made to move him or rouse him he struggled violently and occasionally gave a low sighing moan. The pupils were moderately dilated and reacted sluggishly to light ; they were equal. The teeth were tightly closed and could not be opened. On the gums there seemed to be a suspicion of a blue line. Respiration was easy and quiet, 24 per minute. The pulse was small, wiry, 90 per minute. The temperature was 98' 40 F.