A text-book on surgery : general, operative, and mechanical / by John A. Wyeth.

  • John Allan Wyeth
Date:
1891
Catalogue details

Licence: Public Domain Mark

Credit: A text-book on surgery : general, operative, and mechanical / by John A. Wyeth. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

    116/912 page 98
    Carbuncle.—T\n.B disease—which, as Prof. A. R. Robinson * remarks, has been misnamed '■' anthrax—is, characterized by an inHammatory process of a low order, involving chiefly the skin and the connective tis- sues immediately beneath it, and in some instances extending into the deeper organs. Carbuncle is a disease of malnutrition. The process is akin to that of furuncle, though indicative of a more depraved condition of the tissues. The cause is capillary thrombosis or embolism and subse- quent inflammation spreading from the necrotic focus. Gangrene always occurs, and the inflamed area breaks down in several places, giving dis- charge to pus usually in small quantity, as well as to dead tissue. It is apt to occur as a complication of the same diseases with which furuncles are seen—diabetes mellitus, tuberculosis, scrofula, etc. It is apt to occur in parts of the economy subjected to more than ordinary irritation, as the back of the neck, where the collar presses, and in the gluteal region. The symptoms of this affection are a sense of malaise, loss of appetite, headache, fever, varying in intensity, which is followed by or accom- panied with a deep-seated and severe pain in and about the local expres- sion of the disease. The skin at this ]3oint becomes tense, injected, doughy to the touch, throbbing and j)ainful; the epidermis becomes lifted at various spots in the inflamed area, vesicles form, localized gan- grene occurs, and the dead matter sloughs away. Not infrequently the necrotic process rapidly extends through the areolar tissue beneath the skin some time before the integument breaks down. The extent of necrosis varies under different conditions, and may be general or limited. The constitutional symx)toms are determined by the amount of septic absorption and the degree of pain experienced. The process of repair is by granulation, the development of an em- bryonic tissue which advances from the sides and bottom of the cavity as the slough is carried away. As to the length of time carbuncle may last, nothing positive can be stated. Usually from three to seven weeks ; at times, when the process is subacute, several months. The prognosis depends upon the condition of the patient, the age, the location and extent of the lesion, and the ability of the capillaries and lymphatics to resist septic absorption. Occurring in diabetes or any dangerous malady, it hastens a fatal issue. Situated upon the face, the gravity of the prognosis is increased. This is in great part due to the intense pain which follows an invasion of that part of the body in which the trifacial nerve is distributed. When located on the thorax, the pleura may become involved, thereby causing a grave complication. The treatment should look to the immediate improvement of the patient's vitality by all available means. The local treatment should be directed to the relief of tension, the arrest of the invasion, and the dis- charge of septic matter. The only possible objection to early and free incision is haemorrhage, and the operator has only to decide between the danger of sepsis from delayed drainage on the one hand, and that of loss of blood on the other. To my mind, the fear of haemorrhage is unfounded, and should not cause a delay in making the incisions. The patient should be anaesthetized, * Manual of Dermatology, 1884.
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