A system of surgery . nner till the carbuncle reaches a considerable size,the same swelling and oedema preceding its enlargement. At the sametime, the poison is taken up by the lymphatics, the glands enlarge;and if a limb be affected, the whole extent may become swollen andoedematous. The appearance of the oedematous part varies in differentregions: thus in the eyelid a semi-transparent bladder-like swellingis not uncommon, while the lips become thickened and rigid, thenormal folds of the face being obliterated. Malignant pustules ofthe neck offer a special danger in the spread of the oedema t
A system of surgery . nner till the carbuncle reaches a considerable size,the same swelling and oedema preceding its enlargement. At the sametime, the poison is taken up by the lymphatics, the glands enlarge;and if a limb be affected, the whole extent may become swollen andoedematous. The appearance of the oedematous part varies in differentregions: thus in the eyelid a semi-transparent bladder-like swellingis not uncommon, while the lips become thickened and rigid, thenormal folds of the face being obliterated. Malignant pustules ofthe neck offer a special danger in the spread of the oedema to thelarynx, tongue, and floor of the mouth. Of 1,077 cases collected byW. Koch, 490 affected the head and face, 45 the neck, and 370 theupper extremity. In some instances the process may closely re-semble an ordinary cellulitis, highly oedematous, but without thedevelopment of vesicles. For a period of about two days—in fact, prior to the entrance ofthe bacilb and their products in any large amount into the general. Fig. 54—Malignant Pustule of Face. The en-largement of the submaxillary glands andthe surrounding oedema are well shown. 314 SURGICAL DISEASES DUE TO MICROBIC INFECTION. circulation—the patient suffers little, except from a feeling ofgeneral malaise. The temperature then rises to 102 to 104° F.,gradually falling intermittently; and if the case be treated byearly excision, reaches normal in a few days. The malignant pustuleitself is the seat of remarkably little pain, but acute pains may beexperienced in the limbs. In fatal cases, sweating and diarrhoea setin, accompanied by delirium, fall of temperature, often below normal,great prostration, and eventual collapse. Malignant pustule may serve as a local centre from whichembolic secondary deposits are furnished, or it may occur secon-darily to anthrax of internal organs. Diagnosis.—The recognition of malignant pustule is usuallyeasy, by observing the special appearances and carefully inquiringinto the histor
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