ANTHRAX TREATMENT

Anthrax is an infection which is classed as an occupational risk, and in man is more or less confined to workers with animals or in wool, hair or hides. The importance of artificial fertilizers containing bone-meal must be borne in mind for this may explain the infection of individuals with no obvious occupational or other contact. The disease is seen principally in animal husbandmen and infection usually enters through minute wounds or abrasions on the exposed skin, giving rise after an incubation period of about 24 to 36 hours to a cutaneous lesion, the " malignant pustule ".
Anthrax is not a notifiable disease, but information regarding cases occurring in factories and workshops must be forwarded to the Chief Inspector of Factories at the Home Office.
Preventive Treatment.—Although there is a considerable animal reservoir of infection in this country the disease is so well diagnosed by veterinarians that human anthrax from indigenous sources is very uncommon. By law, carcasses of infected animals must be either burned or deeply buried in lime and the area of ground fenced for some years. Thus, in the British Isles most cases arise from imported material—hides or bones being principally involved. As a result of legislation regarding the proper ventilation of factories, human cases of gastro-intestinal or respiratory anthrax—invariably fatal in the past— are never seen in Britain. Factory legislation also ensures that protective clothing is worn and that workers are made familiar—by means of posters and individual cards—with the clinical appearances of the malignant pustule.
So far as the individual is concerned, great care must be taken in handling infected material. Workers with skin lesions should be excluded. Nurses or attendants must take all necessary precautions when handling infective dis­charges from the " pustule " or the respiratory and intestinal tracts. Con­taminated dressings should be promptly burnt and discharges disinfected. Bedclothes, mattresses and bed linen must be subjected to steam disinfection.
Curative Treatment.—Penicillin alone proves adequate for practically all cases. Anti-anthrax serum (supplies of which are available in each hospital region) is not highly refined so that its administration is almost always followed by a serum reaction. It should not be used.
Large doses of benzylpenicillin are given, 0-5 to ro mega units four-hourly during the initial stages of treatment. The patient's temperature is not a reliable guide to the severity of the infection for it will often be normal. The best criterion is the amount of cedema. Further, in infections of the face and neck oedema has an additional significance as it may extend into the larynx and produce partial obstruction of the air way. As clinical improvement becomes obvious the dose of penicillin may be reduced but treatment should continue for 10 days.
Dressings are used because they reduce contamination of the bed linen. Instructions should be given for burning the scab when it separates. In the most severe cases there may be considerable sloughing so that skin grafting may be required.