XLVI.

Case of Anthrax of the Face.

By F. L. VINCENT, m. d.

Mrs. T., of Geneva, N. Y., occupation that of a milliner, aged forty-eight, dark hair and eyes, with marked cachexia; debilitated by close confinement and unusual care and anxiety, left her home, and, en route for New York, visited in our city.

Soon after her arrival, the patient experienced a burning, sore pain in the center of the left cheek, which was supposed to be an incipient boil; which she pinched and finally pricked with a needle. This treatment aggravating it, at the suggestion of friends, climax salve was applied, which, though it mitigated the pain somewhat, did not prevent the increase of swelling; and on the third day of its development I was summoned.

Its carbuncular character was clearly indicated; the line of demarcation was about two inches in diameter, and from its many openings there exuded the peculiar, dirty pus. Guided by my experience in previous cases, I made deep, crucial incisions from the line of demarcation on one side to the corresponding line on the other, and applied, as a stimulant to the sloughing process, the yeast poultice, giving internally arsenicum alb., one powder every two hours.

On the fourth day the slough exhibited gratifying evidences of rapid dissolution, although the tumidity of the cheek had increased and infiltrated the cellular tissue about the eye, closing it, and giving to the entire surface an erysipelatous appearance. I continued the poultice, and gave rhus tox. in conjunction with the arsenicum. On the fifth day the slough had so much detached itself that with forceps and scissors the greater portion was removed.

The sixth day I removed the poultice and substituted hot calendula fomentations, as suggested by Dr. Helmuth, which treatment was attended with favorable symptoms; the tumidity was lessened, and a few distinct points of granulation were visible, and for two days more all the symptoms, constitutional and local, indicated a rapid recovery, when from some cause, to me unknown (unless by inoculation with my scalpel), a secondary inflammation ensued, with a "new departure" extending from the slough line to the limits represented in plate I. These local symptoms were

attended by great prostration, diarrhoea, and night sweats, changing the prospective convalescence to that of imminent danger and alarm.

I administered the arsenicum in the first decimal trituration, giving the remedy at intervals of one hour, and although contrary to cravings, gave copious draughts of milk punch and beef juice, resuming the yeast poultices, hoping to sustain the system while the process of suppuration and sloughing progressed. This treatment was continued up to the thirteenth day, at which time the boggy mass was so firmly adherent, and the discharges so offensive, that at the suggestion of Dr. Campbell I applied a paste of pix liquida and beer, he having had some previous knowledge of its valuable stimulant and antiseptic properties. In a few hours it had purified the discharge and greatly increased its amount, so that each succeeding day large masses of slough were readily removed. The local application was aided by the internal administration of silicea3, one powder every three hours. By the twentieth day the slough had been entirely detached, and presented the granulated surface represented by plate II.

The tar was discontinued, and dressings of lint, saturated with calendula lotion, substituted. The granulating process became rapid; the granules coalescing, formed planes of healthy tissue, which, gradually closing in its borders, has secured to my patient almost as fully a developed cheek as the sound one, while the cicatris promises to be, in comparison with the extent of tissue involved, almost nothing.

This case presents a few interesting features; first in the locality. I can find no record of a similar case. Again in the vascularity of the tissue involved and the possible inoculation by means of the incisions, and finally, the decided results attending the application of tar and beer, which would certainly tend to revolutionize my treatment of succeeding cases.

Our journals and text-books are rich with cases treated successfully, all, possibly, based upon the experience of one individual case, and with the confidence of Grauvogl, with his arnica, utter the one common assertion, "these are my specifics."

I must acknowledge my faltering faith in the knife and my convietion that I possibly, inoculated, with the passage of my scalpel through the diseased mass, the healthy tissue beyond. My final success I attribute to the constitutional deliverance afforded by arsenicum alb., rhus, and silicea, aided by nourishment bountifully supplied, and the producing of rapid sloughing; indolence in which threatened the patient with septæmia and death.