A carbuncle is similar to a boil in its causation and structure, but is usually a much more serious matter having a tendency to spread laterally and involve the deeper layers of the skin. It is commonly a disease of old persons, those prematurely old or debilitated, and occurs most frequently on the neck, back, or buttocks. It is particularly dangerous when attacking the back of the neck, upper lip, or abdomen.
Carbuncle often begins, with a chill and fever, as a pimple, and rapidly increases in size forming a hot, dusky red, rounded lump which may grow until it is from three to six inches in diameter. Occasionally it runs a mild course, remains small, and begins to discharge pus and dead tissue at the end of a week and heals rapidly. More commonly the pain soon becomes intense, of a burning, throbbing character, and the carbuncle continues to enlarge for a week or ten days, when it softens and breaks open at various points discharging shreds of dead tissue and pus. The skin over the whole top of the carbuncle dies and sloughs away, leaving an angry looking excavation or crater like ulcer. This slowly heals from the edges and bottom, so that the whole period of healing occupies from a week to two, or even six months. The danger depends largely upon blood poisoning, and also upon pain, continuous fever, and exhaustion which follow it. Sweating and fever, higher at night, are the more prominent signs of blood poisoning.
Carbuncles differ from boils in being much larger, in having rounded or flat tops instead of the conical shape of boils, in having numerous, sievelike openings, in the occurrence of death of the skin over the top of the carbuncle, and in being accompanied by intense pain and high fever.
Treatment. Carbuncle demands the earliest incision by a skilled surgeon, as it is only by cutting it freely open, or even removing the whole carbuncle as if it were a tumor, that the best results are accomplished. However, when a surgeon cannot be obtained, the patient’s strength should be sustained by feeding every two hours with beef tea, milk and raw eggs, and with wine or alcoholic liquors. Three two grain quinine pills and ten drops of the tincture of the chloride of iron in water should be given three times daily.
The local treatment consists in applying large, hot, fresh flaxseed poultices frequently, with the removal of all dead tissue with scissors, which have been boiled in water for ten minutes. When the pain is not unbearable, dressings made by soaking thick sheets of absorbent cotton in hot solution of corrosive sublimate (1 to 1,000 as directed under Boils) should be applied and covered by oil silk or rubber cloth and bandage. They are preferable to poultices as being better germ destroyers, but are not so comfortable. When the dead tissue comes away and the carbuncle presents a red, raw surface, it should be washed twice a day in the 1 to 1,000 corrosive sublimate solution, dusted with pure boric acid, and covered with clean, dry absorbent cotton and bandage.
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