Carbuncle.
—This differs from a furuncle in the extent of the local infection, involvement of subcutaneous tissue, and the amount of necrosis which it produces. It is in most instances a more serious affair, life often being destroyed by the extent of the resulting necrosis and the amount of toxins produced. It begins as a local process, but always with constitutional disturbance, and sometimes even with a chill. The affected surface rapidly assumes a brawny hardness, and the infiltration is often extensive; pain is severe and throbbing; the surface becomes more dusky in appearance, numerous pustules appear, development of all the features of a serious carbuncle usually taking place in a few days. Later it begins to soften and the skin gives way at several points, at each of which a small drop of pus is discharged, while after removing this there may be seen white necrotic tissue beneath. The sloughing process extends deeply, generally to the deep fascia, and this itself occasionally succumbs. A person may have a distinct carbuncular lesion where the area primarily involved is not much larger than that of a five-cent piece; on the other hand, in debilitated or dissipated subjects, a lesion of this kind may become as large as a dinner plate, while the sloughing process may expose the underlying bone. This is often the case on the back of the neck and trunk. A carbuncle may occur in any part of the body, but is usually seen on the back; when upon a limb it generally involves the extensor surface. It is especially serious and dangerous when occurring upon the face, as septic thrombosis may readily extend to a cranial sinus and rapidly kill. It was formerly believed that carbuncles of the lip always terminated fatally; while this is not necessarily true it will indicate the seriousness of the condition ([Figs. 100] and [101]).
Fig. 100
Carbuncle of the neck. (Lexer.)
Treatment.
—There are few lesions where both constitutional and local treatment need to be more judiciously combined. Many of these patients are diabetic, and then it assumes malignant tendencies. Others are syphilitics or alcoholics, whom dissipation has reduced to a condition of serious malnutrition. The urine should always be examined for sugar and albumin, and whatever indications it may afford carefully followed. Septic intoxication and infection may so rapidly depress the already weakened patient as to call for stimulants and tonics, and pain may be so severe as to justify the use of anodynes.
The local treatment should consist of soothing applications until the extent of the plastic exudate has declared itself, after which it should be more radical. It is better, therefore, to excise under an anesthetic, the area which ordinarily would require days or weeks to slough. The most satisfactory treatment is the radical. The knife, the scissors, and the sharp spoon constitute the best means of combating this disease. In other respects the treatment was discussed when dealing with septic infection. Nothing will so hasten the sloughing and cleaning up process as brewers’ yeast. The writer’s custom is to make a thorough excision of the affected area and treat the part with yeast for some days. About the lip and face the sharp spoon should take the place of the knife, but even there, if the case be attacked early, tissue can be saved and disfigurement reduced to a minimum. The method used by some of injecting 5 per cent. carbolic solution is less satisfactory, although the measure above recommended is a rather severe operation and usually requires complete anesthesia.
Fig. 101
