Page:The American Cyclopædia (1879) Volume XIV.djvu/105

 PUSTULE 97 Godunoff" and "The Stone Guest" (1836); and the novels "The Captive's Daughter" and "The Captain's Daughter." The latter and other novels are comprised in " Russian Ro- mance, from the Tales of Belkin," an English translation by Mrs. J. Buchan Telfer, nee Mura- vieff (London, 1875). Prosper M6rimee and Viardot have translated some of his works into French, and Bodenstedt and others into Ger- man. The best complete editions of Push- kin's works are by Anenkoff (7 vols., St. Pe- tersburg, 1854-'7) and Gennadi (6 vols., 1869 et seq.). PUSTULE, Malignant, a specific disease, essen- tially septic and gangrenous, confined to the cutaneous tissue, and generally to those parts of the surface that are habitually uncovered. It appears most commonly on the face, and next on the hands, neck, and arms. It first appears in the form of a painful swelling, which, after a lapse of time varying from one to three days, rarely more, develops upon its central part a small reddish or purple spot, accompanied with itching. In the course of 12 or 15 hours more this spot changes into a bleb or vesicle, not usually larger than the head of a pin, containing a reddish brown or yellowish fluid. Owing to continued itching, the vesicle is ordinarily ruptured soon after its appearance ; if otherwise, it dries up in about 36 hours, leaving the exposed derma dry, and generally of a livid color. Itching now ceases ; and, after a time varying from a few hours to a day, the centre of this discolored and de- nuded surface begins to grow hard and becomes surrounded by an inflamed areola covered with numerous small vesicles similar to the vesicle which first appeared. The middle of this areola is depressed, and the color varies from yellow to black. It is now hard in the centre and more painful than at any other stage. But it is a remarkable feature of ma- lignant pustule that severe pain is generally absent; and this character, so different from all other acute inflammations of the skin, is a valuable negative diagnostic of the disease. During the next 24 or 48 hours the subcuta- neous tissue becomes involved; the tumor strikes deeper and rapidly extends in all direc- tions, yet it is so indurated as to be easily cir- cumscribed, and its confines determined with- out difficulty. Meanwhile the central point, now of brown or livid hue, exceedingly hard and insensible, becomes gangrenous. If the disease makes no further progress, an inflamed circle of vivid redness now surrounds the gan- grenous portion; the tumefaction, which had before rapidly extended, diminishes; and the patient experiences something like an agree- able warmth accompanied by a pulsatory mo- tion of the affected part. The pulse, which had before grown irritable and feeble, revives; strength increases ; if there has been some de- gree of fever, as occasionally happens, it is now resolved into a gentle perspiration ; sup- puration sets in between the living and the dead parts, and the detachment of the gangre- nous portion leaves a suppurating surface of variable extent in different cases. When the disease tends to an unfavorable issue, gener- ally no suppuration takes place ; the gangrene spreads rapidly from the centre to the circum- ference of the tumor ; the pulse becomes small- er and more contracted ; the patient complains of extreme lassitude with inability to sleep, is attacked with fainting fits, and becomes passive as to the result; there is disinclination to take food or medicine, or have anything done, and a total loss of appetite; the tongue is dry and brown ; the features shrink ; the skin is pkrched ; the eyes are glassy ; and increasing debility and a low delirium indicate a fatal termination. Such are in general the ordinary phenomena of malignant pustule, usually ter- minating in from five to eight days. Excep- tional fatal cases have been recorded, varying from 24 hours to 16 days. In the suddenly fatal cases, the forces of the constitution are so quickly and entirely subverted by the malig- nancy of the disease, that few symptoms are manifested; the powers sink under it, as it were, without resistance. It is most fatal when attacking the face or neck. Another variety, which commonly attacks the hands or arms, is of a less regular character, in some cases pre- senting an appearance and running a course V ery similar to a circumscribed phlegmon, while in others it is exceedingly violent and fatal in a few hours, and in others still runs on for several weeks, and finally proves fatal rather from the effects of the disorder than from the disease itself. In the majority of these cases there is intense local pain in the affected part from the commencement, with enormous swell- ing and more or less redness. A small vesicle or pustule forms in the centre, and takes on a gangrenous character. Sometimes it becomes circumscribed and limits its action to the skin ; but at other times numerous phlyctinaB cover the surface, and the destructive inflammation burrows into the cellular tissue which envel- ops the muscles, completely surrounding and disintegrating these organs, which become soft, black, and gangrenous. The blood vessels and nerves also become involved, and as a necessary consequence the death of the part ensues. The pathology of malignant pustule is distinguished by a fluid state of the blood, which is usually very dark-colored ; the texture of the heart is softened, and its surface covered with ecchy- mosed spots ; the veins are sometimes softened and ecchymosed, and usually contain black or yellowish white clots of blood, of gelatinous consistence. The lungs are covered with su- perficial ecchymoses, presenting over their surface a number of deeply penetrating black spots, produced by local sanguineous infiltra- tion. The inner coat of the stomach and in- testines presents in different places, correspond- ing to the course of the vessels, prominent, dark-colored spots, formed by blood effused between the inner coats and the peritoneal cov-