NATIONAL LIBRARY OF MEDICINE Washington Founded 1836 U. S. Department of Health, Education, and Welfare Public Health Service } J /CASE OF ANTHRAX: tf5 ^ SUCCESSFULLY TREATED. j/ David Hosack, il/. D- Professor of Materia Medicu and Botany, in Columbia College. New-York, July 31, 1809. ALTHOUGH the disease, which is the subject of the following case, was well known to the Ancients,* and has been well described by modern writers,']' and is of so frequent occurrence as to fall under the notice of most practitioners; it is no less true, that there is at this day great difference of opinion, as to the mode of treating it. It will be recollected, that but a few years since, it was the subject of a public controversy in this city ; and in Europe, surgeons are no less divided in their treatment of this dis- ease, than they are in this country. In 1794 I attended a case of Carbuncle, in consultation with two of our eldest and most respectable practitioners. The inflammation exhibited by the tumour appeared so ac- tive, that we unanftnously agreed on the application of lead- water ; poultices of bread and milk|; an abstemious diet, with the internal use of depleting remedies. Under this treatment, the febrile symptoms increased ; the tumour ex- tended ; sphacelus ensued ; and, in a few days, terminated in the death of the patient. The appearances, progress, and termination of this case, led me to the resolution to employ a very different treatment in those cases which might afterwards fall under my notice. Since that period, it has been my practice to support the strength of my patient by a nutri- tious and stimulant diet, and the free use of bark and wine ; at the same time preserving the tone and action of the part itself, by frequently washing the tumour with spirits or bran- dy, and by the constant application of a poultice composed of bark and yeast. Finding these remedies successful in many • See Galen, Celsus, Fabricius. f See Wiseman, Bromfield, Kirkland, David, Prix de I.' Academie Roy- ale de Chirurgie.---Tom. iv. Pouteau ffiuvres posthumf. Pearson's Surgery.—Cooper's Surgery. 2 Treatment of Carbuncle. instances which have fallen under my care, I enclose to you the following case, in which this practice was pursued, under the most unpromising circumstances, and therefore is better calculated to establish the principles upon which the cure of this disease is to be conducted; especially when it occurs in advanced life, and is preceded by, or accompanied with, a scorbutic or vitiated habit of body, as I believe, is most usually the case. If you consider the enclosed to be deserving of public record, it is at your service. I am, with great regard, yours, DAVID HOSACK. Dr. Edward Miller. On the 5th March, 1808,1 was called to Elizabeth-Town, in New-Jersey, to see Mr. John Hartshorne, aged 84, then on a visit to the family of Mr. Thomas Eddy. He was extremely debilitated, and suffering much dis- tress, from a tumour on the small of the back, which had been of several days continuance. Upon enquiring into the history of the case, I was in- formed that the tumour, in the first instance, appeared like a common boil; but having been preceded by several small- er ones, and an eruption on the skin, it excited very little attention on the part of his friends. It, however, very soon was attended with an acute burning pain, and began to spread, the adjacent part assuming a deep red or purple co- lour. The family physician was called, who, at that time, was not acquainted with the peculiar character of this dis- ease, having never met with it before in his practice, and therefore very naturally treated it as a common phlegmon ; applying the common cataplasm of bread and milk, lor the purpose of inducing suppuration, together with the internal use of those remedies that are usually prescribed lor the re- moval of simple inflammatory tumours. The inflammation continued to extend, attended with severe pain in the part, fever, restlessness, loss of sleep, and occasional delirium. In this state I found him. The tumour appeared about six inches in diameter; of a dark purple, livid colour; extremely painful, and sensible to the touch; in the centre of the swelling the colour was still darker, and was attended with a discharge of a thin acrid humour, as is usual in erysipelatous inflammation, altoge- ther exhibiting the symptoms of approaching sphacelus : his pulses were small and frequent; his "skin preternaturalk Treatment of Carbuncle. 3 heated, and attended with a sense of itching, over the whole surface of the body : his tongue was moist, but foul: his bowels were costive, except when relieved by injections, which were occasionally administered : his urine was spar- ing in quantity, and high coloured. Under these circumstances of a typhoid state of fever, attended with a gangrenous appearance of the tumour, we advised the part affected to be washed with a strong solu- tion of soap and water, rendered more stimulant by the ad- dition of a small quantity of rum or brandy, and afterwards a cataplasm of bark and yeast, to be applied over the whole surface of the tumour ; the same to be renewed every four hours, making use of fresh yeast at each application : a wine- glassful of a decoction of bark and Virginia snake-root, was also directed to be taken every two hours, together with the free use of porter, panado made strong with wine, and soup, as his nourishments. As he suffered a great deal of pain, he was also directed to take occasionally, throughout the day, about twenty-five drops of laudanum, and at night an anodyne draught, if otherwise he was unable to sleep. These directions were faithfully complied with. Upon visiting him on the 7th, his symptoms were much changed for the better. The appearance of the tumour was more healthy, and assumed a brighter colour, but was some- what increased in size, and in the extent of the inflammation : his pulses were more full, and less frequent : his strength was, also improved : he suffered less pain, and discovered a greater inclination for nourishment than he had before done. As he was fond of eggs and oysters, they were also allowed him. All the other remedies were directed to be continued. I did not see him again until the 12th : in the mean time the bark and yeast poultice had been steadily continued, with his decoction of snake-root, a generous diet, the liberal use of wine, and anodynes whenever he suffered much pain, or was deprived of his rest. At this time the tumour began to discharge, at different parts of its surface, a very healthy* * I am not a little surprised at the observation of John Pearson, [sec i'rinciples of Surgery] and the Editors of the Edinburgh Practice of Physic ;:nd Surgery, when they remark, that " an Anthrax never evacuates a lau- dable pus." Wiseman also observes, " that he never saw a true Carbuncle suppurate." On the contrary, I am inclined to believe that the wound ne- ver heals without this change in the quality of the discharge. 4 Treatment of Carbuncle. pus: the apertures were small, but numerous, resembling the cells of a sponge, or honey-comb. It continued,, thus to discharge for several days. We did not think it necessary to enlarge the openings, through which the matter was evacuated, as directed by Mr. Kirkland, David,* Mr. Cooper,"f and the Editors of the Edinburgh Practice of Physic and Surgery. In cases where the ulceration may be of greater extent than in the present instance, and the quantity of matter very great, this practice may be adviseable and necessary. About the 22d, we directed the poultice to be omitted, and the wound to be dressed with simple cerate. Within twenty-four hours after this gchange in the application, the quality of the discharge was sensibly altered. Instead of a healthy pus, a thin sanies, as in the beginning of the disease, was again poured out. The complexion of the tumour also assumed a darker appearance; and his friends again became alarmed for his safety. Finding these changes, we again advised the tumour and neighbouring parts to be bathed with brandy, and the poul- tice of bark and yeast to be renewed. From this time the wound recovered its healthy aspect, and continued to heal, without an unpleasant symptom. When the discharge totally ceased, and the wound had be- come cicatrized, a light compress of linen, wet with rum or brandy, was directed to be applied to the yet tender sur- face of the part affected. As he still continued to complain of an itching over the whole surface of the body, we put him on the use of the decoction of Sarsaparilla and Guiac. On the 7th April he was discharged cured, and returned to his family, in Monmouth. If it were necessary, I could here add the history of ano- ther very formidable instance of this disease, as it occurred in the family of the British Consul, Col. Barclay; in which precisely the same treatment was pursued, and with the same happy result. * See a very valuable memoir on abscess, by this writer, in the Memoires de 1' Acad, de Chir. torn. iv. f See First lanes of the Practice of Surgery. [Medical Repository.] ViX HS^Sccx, 1209