When the blood having become more melancholic than natural, ferments and fixes in a part, the diseases called carbuncles are formed, which are sloughy ulcers, for the most part beginning with bullæ, like burnt parts, but sometimes without them; and the patients at first rub the part for its itchiness, whether one bulla is formed or several small ones, like millets, which, having burst, a sloughy ulcer takes place, resembling those occasioned by cauteries, the eschar being sometimes of a cineritious colour and sometimes black, along with its being fixed to the base, and in a certain manner nailed to it, and it spreads at the same time, the surrounding flesh is in a fiery state, black in the colour, and shining like bitumen and pitch. Such is the true black bile. But carbuncles that form in the flesh are speedily circumscribed; whereas those which take place in membranes or nerves remain long, and affect sympathetically the parts below, so as to give origin to erysipelatous inflammations. Not a few terminate in suppuration, and most cases are attended with fever.
Carbuncles also sometimes arise from epidemic causes. We must treat them, unless they are very small, by venesection, carrying evacuation as far as to occasion deliquium animi; and after venesection it will not be improper to make deep scarifications in the part, on account of the thickness of the humour. To the affected part we may apply such things as are moderately repellent and discutient, as the cataplasm of plantain and boiled lentil, receiving the tender part of bread baked in an earthen pan, neither very fine nor foul; and above the ulcer we must put some of the strong applications, such as those of Andron, of Polyides, and of Pasion, mixing them with must, until they are of the consistence of the sordes of oil in baths. And so also the dry Massaleotic powder, which may be diluted in like manner. And the root of dracunculus, or of birthwort, or the juice of laserwort, or the Cyrenaic juice may be properly rubbed in, each of these with vinegar. Cases of an erysipelatous nature may be anointed with the applications for erysipelas; but those parts which are suspected of being sympathetically affected are to be wrapped in unwashed wool, out of wine and oil. When the inflammation abates, we must apply to the carbuncles the cephalic cerates spread upon pledgets. That from herbs is an excellent one, and that from natron, and the dry application for spreading ulcers, separately and with rose-oil. When the hardness remains, we must use the one from apples ascribed to Serapion. But we must hasten the suppuration of the carbuncles as much as possible, by changing the cataplasms and medicines twice during the day, and once during the night. In order to root out the carbuncles, and free them from their attachments to the surrounding parts, having divided sour pomegranates, boil in vinegar, and when softened, triturate, put into a linen rag, and apply. When dried, let them be moistened with vinegar. The carbuncle is made to suppurate and burst, by the inner part of old walnuts, or even of that which is not old, and by the leaves and shoots of cypress, or by its young and tender balls (pilulæ), with barley-flour; by raisins deprived of their stones; by dried figs boiled in wine; by the flowers of horned poppy; by the juice of laserwort, with rue and some honey; by liquid pitch with raisins and axunge.
An excellent application for carbuncles. Of litharge, lb. j; of old oil, lb. j; of arsenic, oz. j; boil the oil and litharge until they do not stain, and taking them off the fire, add the arsenic, and then boil it until it become black, and having levigated it in a mortar, use upon pledgets.
For gangrene, old ulcers, those called chironia, strumous ulcers, and the gout: it is a most admirable application for carbuncle, particularly in the eyelids. Of opium, of acacia, of toasted misy, of flakes of copper, of each, dr. ij; of copperas, dr. j; of the seed of henbane, dr. j; triturate in water, and use. They say also that the ointment called tetrapharmacon, having a fifth part of frankincense, is an excellent application. But for carbuncles in the pudenda, take of chalcitis, of copperas, of each, dr. viij; of aphronitrum, dr. ij; triturate with water, and use. Sheep’s dung roasted with honey is also a good remedy. In Alexandria they use the green serapias, which is also called orchis and triorchis, with crumbs of bread, as a cataplasm for carbuncles and all sloughy ulcers; and when the eschar falls off, they cure them as a common ulcer.
Commentary. The carbuncle is briefly treated of by Hippocrates (Epidem. ii, 1), and is frequently mentioned by him as a symptom of the pestilential fever. (Epidem. iii.)
Celsus gives a very minute description of carbuncle. With regard to the treatment, nothing, he says, answers so well as immediate burning, which produces no pain, as the flesh is dead. The sore is to be treated like other burnt parts. Under the use of eroding applications a crust is formed, which, being removed from the living flesh, carries all the corrupted parts along with it, and leaves a clean cavity, which is to be filled up by incarnants. When the disease is superficial, corrosive or caustic substances may be substituted, of such a degree of strength as to produce a separation between the dead and sound flesh. But if these applications fail, recourse must be had to burning. He recommends abstinence from food and wine at the commencement, and directs water to be given freely, especially if fever be present.
Pliny gives an indistinct account of an epidemical anthrax, which, he says, prevailed in the province of Narbonne. (Nat. Hist. xxvi, 4.)
Galen ascribes the carbuncle to a defluxion of hot, black, and thick blood, which gives rise to blisters, ulcers, and eschars. He directs us to apply to the eschars those medicines the properties of which resemble fire, such as misy, chalcitis, arsenic, quicklime, and sandarach. His particular remedies are quite similar to our author’s. (Meth. Med. xiv), and (ad Glauc. ii.) He mentions the carbuncle as a very unfavorable symptom of the plague. (Epidem. iii, and de Diff. Febr. i, 6.)
The account of the carbuncle given by Aëtius is full and accurate, but is entirely derived from Galen. Oribasius, Actuarius, and Nonnus also repeat his doctrines. Actuarius says that the disease is occasioned by melancholic blood overheated. This is much the same as Galen’s theory.
Octavius Horatianus recommends bleeding at the commencement, and external applications of an acrid and caustic nature, or the actual cautery itself. When danger is apprehended from a hot cautery, he directs us to use a cold one.