98 PUSTULE ering. Causes. It is the general conclusion of those who have investigated the nature of malignant pustule, that the germ of the disease consists in an animal poison, usually contracted by man from cattle or their remains. In sup- port of this view, it is found that the disease most frequently occurs among knackers, tan- ners, veterinarians, persons engaged in the removal of offal, and stevedores, particularly those employed in handling hides from dis- tricts and countries where the diseases of cattle most prevail. In other cases it has been at- tributed to eating diseased animal food. Yet, strange as it may appear, in the whole scope of veterinary medicine no disease is known which accurately resembles the malignant pus- tule of man. Certain herbivorous animals, especially beasts of pasture, are subject to a disease called malignant carbuncle, character- ized by the occurrence of a large uncircum- I scribed emphysematous tumor, which yields to ' pressure and crepitates under the fingers, and [ exhales a peculiar putrid odor. In its progress it turns black in the centre, and appears as if burned or charred ; it is infiltrated with a yel- lowish colored fluid, and distended with a fetid gas. This disease may be transmitted from j one animal to another by inoculation, and by absorption to man, in whom it runs a violent and dangerous course. MM. Salmon and Ma- noury of France have vainly attempted to limit the term malignant pustule to this disease only. Malignant carbuncle and other ulcers which occur in cattle are the eruptive symptoms of grave febrile disorders depending upon a dis- eased state of the blood, and always consecu- tive to the febrile symptoms ; and the inocula- lation of man with matter from such an ulcer is only equally dangerous with the blood, and possibly the milk, of the same animal in the febrile state before the ulcer appeared. In- deed, cases have occurred where the blood of animals not previously known to have been diseased has caused malignant pustules in man by absorption. It is the opinion of some ob- servers that malignant pustule may occur spon- taneously, without any contact with poisonous animal matter. But from the fact that dis- eased animal matter is known to cause the great majority of cases, many ways will read- ily suggest themselves by which inoculation might take place without any knowledge of the circumstance on the part of the person affected. As a general rule, cattle which feed on prairie meadows are exempt from malignant disease ; while those which are fed upon dried clover, lucern, and vetch are peculiarly liable to carbuncle. The same may be said of cattle that are fed upon semi-decomposed grain, the refuse of distilleries and breweries. All such things are actively predisposing agents to the blood diseases of cattle, and liable to engender malignant pustule in man. Treatment. Pro- mote suppuration in the pustule as rapidly as possible, and sustain the constitution. To this end, as soon as the nature of the disease is as- certained, the vesication formed on its surface should be opened, the fluid contents removed, and the denuded part covered with a dossil of lint dipped in a strong solution of muriate of ammonia or other caustic. Six hours after- ward this may be removed and a poultice ap- plied ; and 24 hours after this, if pain and burning heat have nearly or quite ceased, and no areola has formed, it may be safely con- cluded that the caustic has effectually perme- ated the whole of the diseased tissue, and that it will proceed to a healthy suppuration by the continued application of poultice. But if, on the contrary, a hard and deep-seated painful tumor has formed around the primary seat of the vesicle, we may take it for granted that the disease is extending itself. The tumor should be forthwith divided through the whole width and depth by a crucial incision, the gan- grenous parts removed if any have formed, and the nitrate of silver or fused potassa thor- oughly applied to the freshly divided surfaces. This proceeding is equally requisite when the slough which forms on the centre quickly be- comes hard and impermeable, like a piece of dry hide; this must be removed to admit of the unimpeded action of the caustic. Scarifi- cations and cauterizations, with the continued application of poultice, should be repeated daily until suppuration is established, or until the extent of the pustule as clearly defined. Internally, the bowels being first cleared by a mild cathartic, quinia (four or five grains every three or four hours), with wine or brandy, and as much food as the patient can be induced to take (there being generally disinclination to take food), and opiates with camphor, as much as may be necessary to allay pain and pro- duce sleep, constitute the basis of treatment. In spite of everything, the peculiar contagion of malignant pustule, being in the blood, fre- quently proceeds straight on to a fatal termina- tion ; and this is sometimes the case even when the pustule seems to have been checked. On recovery from malignant pustule, the deform- ities consequent upon its ravages sometimes require surgical operations for their relief. History. Malignant pustule was known to the ancients. Celsns and Paulus ^Egineta both described it under the head of carbuncle. Am- broise Pare, in the 16th century, distinguished it from plague. Yet it was not until the lat- ter part of the 18th century that physicians began to appreciate its nature. Thomassin, Boyer, Fournier, Montfiels, Veson, Sancerotte, Chambon, and especially naux and Chaussier, contributed to make the medical world acquaint- ed with the nature of malignant pustule. Du- ring the present century, Bayle, Bidault, Vil- liers, Reynier, Raver, Branell, Wagner, Raim- bert, Manoury, and Salmon, and more recently Bourgeois and Gaujot, have given valuable mo- nographs of cases and epidemics. In the United States, it has at least twice prevailed epidem- ically : in the vicinity of Philadelphia in 1834 -'6, and in Louisiana in 1837-'9. It is also
