The disease generally attacks the hands, neck, face, or shoulders of
butchers and others, who carry, or in some way deal in carrion. It has
also taken place in consequence of the hand being introduced into the
rectum—a veterinary method of removing scybala—of an animal labouring
under putrescent disease. A pustule appears on the part affected,
containing a serous or a dark-coloured fluid; and the base ulcerates,
extending through the skin to the subjacent parts; at first it is
accompanied with a pricking sensation, afterwards the pustule enlarges
and becomes brown, and the pain is burning and itching. The vesicle
when opened, or when it has burst spontaneously, furnishes a few drops
of red serum, and the pain is thereby relieved for a few hours. A hard,
moveable, and circumscribed tubercle forms, without alteration of the
surrounding skin. The bottom of the sore is yellow, greenish, or livid,
and the sensation is that of acute heat and erosion. Phlyctenæ spread
around. The tubercle becomes black in the centre, and an eschar forms;
the patient becomes irritable and languid. The gangrenous point begins
to extend, and that alarmingly; great swelling takes place, elastic,
red, and shining, more emphysematous than inflammatory or œdematous.
The burning pain is aggravated; the patient has a feeling of weight
and stupor; great constitutional disturbance follows, there is slow
fever, with a small pulse, a dry and brown tongue, and unquenchable
thirst; a low muttering delirium ensues, and under these symptoms the
patient soon sinks. After death, the fetid body swells rapidly. The
disease sometimes terminates fatally in twenty-four hours or less;
but generally the patient’s sufferings are more protracted. In the
treatment, superficial scarifications are of little avail. The only
topical application which can be relied on is a powerful escharotic,
applied freely to the part, and at an early stage, before swelling
and constitutional affection have been added. By it the parts replete
with virus, being immediately deprived of vitality, are soon thrown
off. Thus the virulence of the poison is annihilated, it is rendered
inert, and is concentrated in the slough, and the surrounding parts are
stimulated, and receive vigour of action, which enables them to resist
any further inroad, and to detach quickly the mortified substance.
For this purpose, the most effectual and convenient escharotic is the
caustic potass, but the liquid muriate of ammonia may also be employed.
The vesicle is opened, and the caustic applied to the exposed surface;
and if necessary, the eschar may be afterwards divided, and the remedy
reapplied. In the absence of other escharotics, the actual cautery will
prove a valuable substitute. After the separation of the slough, the
sore is to be dressed with slightly stimulating applications. Bark,
camphor, and mineral acids, are given internally, and the patient is
enjoined a light diet, with a moderate allowance of wine.
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