GANGRENOUS ULCERATIONS. 
AFFECTING THE FACE, INCLUDING THE LIDS OF BOTH 
EYES AND DESTROYING THE EYEBALLS—THE 
RESULT OF BITES BY A MAN. 
BY SWAN M. BURNETT, M.D., Ph.D. 
Professor of Ophthalmology and Otology, Georgetown University; Direc- 
tor of the Eye and Ear Clinic of the Central Dispensary and 
Emergency Hospital, Etc. 
WASHINGTON, D. C. 
Carrie L., colored, 24 years of age, living in Fair- 
fax County, Virginia, was admitted to the Emergency 
Hospital on April 22, 1898, with the following his- 
tory: Eight days before, at 2 A.M., she had been 
attacked by her husband in a fit of madness. He 
stripped off her clothing and proceeded to bite her 
and claw her with his fingernails about the face and 
upper portion of her body, especially the chest, abdo- 
men and back. She was found in an exhausted state 
by her neighbors in the morning and placed under 
the care of a local physician. Her condition, espe- 
cially as to the injuries on the face, not improving, 
she was sent to the Emergency Hospital, where I saw 
her on the evening of April 22. I found both eyes 
entirely covered with a thick scab composed, as it 
seemed, partly of iodoform and partly of gangrenous 
tissue. There was a large phagedenic ulcer, with 
undermined edges, on the right cheek, three and one- 
half by two inches, involving the entire thickness of 
the skin, a smaller one near the angle of the mouth, 
and two or three still smaller ones on the nose and 
upper lip. On removing the scabs covering the eyes, 
after softening them in hot boric acid solution, it was 
found that the edges of both lids of the right eye had 
been eaten away for their entire length, that the 
conjunctiva of both the eyeball and the lids had been 
destroyed, and the cornea had an ulceration occupy- 
ing two-thirds of its surface and extending through 
its entire thickness, through which the iris had pro- 
lapsed. On the left side the destruction was even 
more extensive. The whole of the outer halves of 2 
both lower and upper lids were involved in an ulcera- 
tion which’extended down on the cheek and temporal 
region, covering a space of three by four inches. The 
destruction was more profound than on the right side, 
going deep'into the tissues of the orbit and reaching 
to the bone at the lower outer portion. The whole of 
the anterior half of the globe, including a portion of 
the sclera, was gone. The surface of the ulcers was 
covered with a most foul-smelling, greenish decom- 
posing matter. 
Figure 1. 3 
The bites on the body were nearly all far advanced 
toward perfect healing, and these wounds seemed not 
to have taken on the phagedenic character of those of 
the face. 
All the dead matter was carefully dissected from 
the surface of the ulcers, until healthy tissue was 
reached. In the left orbit this necessitated the evis- 
ceration of the contents of the eyeball and the cutting 
away of some portions of the tendons of the external 
muscles of the eye, and a removal of a large part of 
Figure 2. 4 
the orbital tissue. Fig. 1 gives a very good idea of 
the appearance after the wounds had been cleansed. 
After this thorough cleansing, the surfaces were cov- 
ered with iodoform gauze and a protectve bandage 
applied. An examination was made of the gangrenous 
material and the discharge, but no unusual micro- 
organisms were found, those present being the staphy- 
lococcus pyogenes aureus and albus. 
At the end of the first twenty-four hours she had a 
sudden rise of temperature to lOfi F. This subsided 
in a few hours to practically the normal, at which it 
remained during the rest of her stay in the hospital. 
Under a nourishing diet and simple dressings of iodo- 
form gauze, the healing went forward rapidly, and at 
the end of two weeks she was able to leave the hospi- 
tal for her home. The condition was then as is rep- 
resented in Fig. 2. There was total symblepharon on 
both sides, and the inside of the lids was every- 
where adherent to the walls of the obits. The resulting 
cicatrices on the face are much smaller than was to be 
expected from such extensive ulceration. 
Having heard legends of the poisonous character of 
the bite of the “blue-gum” negro, I made inquiries as 
to that quality in her husband, but it was most indig- 
nantly denied by the wife. 
In this case it is hardly possible to determine 
whether the extensive ulcerations on the face were 
due to some poisonous quality in the bites or 
scratches, or to the condition of the patient at the 
time, or to the want of treatment at the beginning. 
It is worthy of note that the bites on the abdomen 
and back, made at the same time, healed with prompt- 
ness, and, supposedly, under the same treatment as 
that given to the wounds of the face, and that when 
the wounds of the face were put in an aseptio state 
they also healed well and rapidly. It was expected 
that some virulent micro-organism would be found in 
the discharge, possibly a form of streptococcus, but a 
careful search brought none to light. The general 
health of the patient at the time of her discharge was 
excellent. 
Journal of the American Medical Association June 24,1899.