ON THE CARBUNCLE IN CATTLE. 
117 
egg, or even sometimes of a man’s fist. The character of the sur- 
rounding swelling is in part oedematous, and in part erysipelatous. 
It has been usually at this stage that my patients have applied 
for advice, so that I have not often been able to use the caustic with 
the view of destroying the characteristic tubercle while it was yet 
small — apian of treatment which, on more than one occasion, has 
perfectly succeeded in my experience. I have never practised the 
excision of the part, as recommended and adopted with great ad- 
vantage, we are told, by Dr. Wetzer, of Bonn. 
The most dangerous seat of the malady is the face ; and, un- 
fortunately, this is of by no means rare occurrence. I have seen 
many patients die from the effects of the swelling extending in- 
wardly to the throat and causing suffocation, before any typhoid 
fever had supervened. Often, in those alarming cases, neither 
bleeding from the arm — which is frequently of the greatest ser- 
vice if resorted to sufficiently early — nor deep incisions in the 
swollen parts, so as to cause profuse bleeding, will avail anything; 
and the medical man has the miserable task of seeing his patient 
asphyxiated, without being able to relieve him, except by opening 
the trachea. 
Dr. Miiller says that it is usually a favourable symptom when 
the centre of the tumour becomes gangrenous ; for then the sur- 
rounding tumefaction — which, when the face is the seat of the 
disease, often extends up along the scalp, and down even to the 
chest — generally subsides more or less, and the pain is considerably 
relieved. If a line of demarcation is formed around the sphace- 
lated portion of the integuments, the case will, in all probability, do 
well. In general, the formation of sinuses ( fusees de pus) beneath 
the dead cellular tissue has, in my practice, been prevented by the 
use of timely incisions, and by the removal of the gangrenous parts 
as early as possible. In one case, where the adoption of these 
means was delayed, it was necessary to make a counter-opening 
over the top of the sternum for a carbuncle on the cheek ; and, in 
another case, at the elbow for one on the hand. In the latter case, 
the arm became almost as large as the thigh of the patient, and 
the swelling extended even to the integuments of the chest, so 
that he experienced much difficulty and distress in breathing. 
In both cases, however, the swelling quickly subsided after the 
gangrene had made its appearance ; and ultimately a complete cure 
was effected. In the second one, the entire surface of the arm up 
to the shoulder was covered with livid spots, like large petechise, 
which yielded to the application of warm bread poultices prepared 
with a concentrated decoction of cinchona. Although the local 
disease was so formidable, the attendant fever was not very severe, 
and not of a typhoid type ; while in other cases, in which the local 
VOL. XVII. ‘ Q 
