A Carbuncle, (from carbo, a burning coal). It is called carbo, rubinus verus; code-sel/a, erythema gangraenosum, granatristum, anthrax, pruna, and Avicenna names it Persicus ignis, particularly that species which is attended with pustules and vesications. Paulus .AEgineta says it is a crusty ulcer, beginning, for the most part, with a pustule like a burn, and sometimes without it; at first, the patient scratches the part, whence arise one or more pustules, small as a grain of millet, which, breaking, become a crusty ulcer, as if it was produced by an actual cautery; the crust is rather of an ash colour or blackish; it adheres, and is fixed on its base to the part, and spreads by its phagedenic property; the flesh all around is inflamed and black, and shines like bitumen. Heister says, a carbuncle is an inflammation, which, in pestilential times, rises with such vesicles as are the usual effects of a burn; this inflammation, for the most part, suddenly degenerates into a sphacelus, and corrupts the subjacent parts to the bones, rendering them as black as a coals and this seems to be the reason why the Latins call them carbuncu/i, and the Greeks an-thracea.
In the Edinb. Med. Commentaries, vol. vi. p. 165, it is observed that carbuncles are a gangrenous spot upon the skin, having the appearance of a burn with red, livid, or black vesicles, bounded by an inflammatory ring, which soon terminates in a hard black eschar. The anthrax, an affection of the same nature with the carbuncle, only the former is more prominent, penetrates deeper into the adipose membrane, and occasions a higher degree of inflammation.
Dr. Cullen places it as a variety of phlogosis ervthe-ma, on account of its violence, making it synonymous with anthrax, and the erythema gangrenosum of Sau-vages. Carbuncles generally break out suddenly and unexpectedly, in an hour or two at the most, and are attended with pain and heat. The inflammation proceeds so quickly to mortification, that there is seldom any evident tumour raised, the parts turning black, and ending in real gangrene, often in the course of twenty-four hours from the first attack. But when a tumour does arise, as soon as it is opened, it discharges a livid sanies, or sometimes limpid water. It is black within, which shows that a sphacelus has seized the subjacent flesh, and is making rapid progress. In those that recover, a separation is made betwixt the sound and the disordered flesh, by means of a suppuration. There is no part of the body but what may be their seat; and they are generally attended with buboes. The proximate cause is the inflammation from pestilential contagion, with a putrescent state of the system. Danger is great when the colour is livid; the milder sort are first red and then yellow. When they are seated on the face, neck, breast, and arm pits, they are generally fatal. When they occur, as they sometimes do, internally upon any of the viscera, they must, in every instance, probably prove fatal, as we are not acquainted with any remedies which can ever prevent their progress to mortification. Externally, indeed, when they are not very extensive, nor seated on any of the large blood vessels and nerves, they are frequently conquered, that is, by the destruction of the part affected.
Van Swieten describes another sort of carbuncle in his Comments on Boerhaave's Aphorisms; and says, it is an ulcer, which, when after a violent and commonly very painful inflammation, there happens a rupture of the skin in several places, and fragments of the corrupted paniculus adiposus are discharged at its orifices.
In the view we have thus given, carbuncle appears as a putrid, irritable sore, whose origin is in the cellular substance, and which is intimately connected with putrid or pestilential diseases, the production of a hot climate, or the attendant of weak debilitated constitutions. Anthrax, however, as observed in this country, assumes a different form. A hard substance forms in a fleshy part, often in the back or thigh, with a violent throbbing pain and a burning heat. It frequently happens to old persons, and sometimes seems to be a critical deposition, an effort of nature to discharge some morbid fluids. This hard body suppurates with difficulty, and imperfectly; but if the constitution is sufficiently strong to carry on the process, the whole is separated, and the cavity fills with healthy granulations; the constitution regaining its strength, often with reno-y y vated vigour. It happens, however, frequently in the weak and aged; in persons loaded with fat, and often breathing with difficulty. The latter can seldom bear the tonic powers of bark without suffocation, and to the former any dose of bark or any cordial is generally insufficient. They yield to the discharge, or sink more rapidly from sphacelus.
The substance of this hard tumour seems to be a congeries of the sebaceous glands under the skin, for if on the first appearance of the tumour, the point, which is obvious, be opened, and the tumour gently pressed, a quantity of sebaceous matter is forced out. The throbbing and heat, however, soon return, and the operation must be often repeated. We have frequently, in this way, checked anthrax in its germ.
It more often happens that the tumour is suddenly formed of a considerable size. If this be the case, or the pressing out be neglected, suppuration goes on; not indeed in the tumour, for the sebaceous matter does not admit of this change, but in the parts around, and the tumour is then thrown out like a cancer by the effect of arsenic. The cavity is generally large, and the discharge considerable: few constitutions are equal to it, especially when debilitated by age, the previous fever, and the violent pain.
Every stimulant application externally, and the warmest tonics, with wine and opiates internally, are requisite. Yet these, as we have said, are often useless, or unequal to support the patient under circumstances so violent and distressing. It has been proposed to make incisions into the tumour, and to fill it with stimulating substances; but we have never found this plan of service, for the tumour itself never suppurates. Might the application of corrosive sublimate or arsenic succeed?
See Heister's Surgery, Bell on Ulcers, edit. 3. p. 97 - 99. Kirkland's Med. Surgery, vol. i. 320, vol. ii. 280, 389. Pearson's Principles of Surgery, vol. i. 136. White's Surgery, 15.