The Abbeville press and banner. [volume] (Abbeville, S.C.) 1869-1924, 1886-04-14
Carbuncles and BOils.

Whoever has reflected as to the real
nature of carbuncular Inflammation will,
I think, see reason to believe that its
causes are to a large extent local ones.
Respecting both boils and carbuncles, it
is the fact that the most efficient measures
are those which appeal to the local con-
dition. This is true of all the different
measures in rcpute, however dissimilar
at first sight they may appear. Some
have for their object the protection OF
the inf1amed area from further irritation,
as when we cover up boil or commence
ing carbunclc with leather plaster, Others
the subdual of the Inflammation by means
of cold and the like, rs when we use an
ice bladder or a strong spirit lotion. Nor
do those who adopt q time-honored
practice of an early free incision depart
from this principle, for their object IS
still the mitigation of local inflammation
by the relief of tension, and by permitting
the escape of contaminating matters.
From acne, impetigo, and ecthyma to
boils is in many cases matter of degree,
and that there is little or no real dis
tinction between large boil and small
carbuncle, all will, I think, admit.
The age of the patient, and his special
diathetic condition at the time, their site.
the influence of different modes of local
treatment, are conditions which deter
mine the final result.
If. a boil occur in an elderly person, on
the nape of the neck, where it is likely
to be irritated by the shirt collar, and
especially if, instead of being systematic
cally protected from the first, it be
further bullied by premature squeezing
and the like, it is very likely to pass into
O carbuncle. I claim. the strong testi-
mony which has been borne by Sir James
Paget and others to the efficiency of sim
ply protective measures in preventing
the development of small carbuncles, and
obviating the supposed necessity for in
cision, as proof that local spreading is,
in the main, due to local causes, and no
necessary connection with the general
health. In other words, it is not thing
which is inevitable. On the other hand,
we know of no internal remedy which
possesses any marked power in arresting.
carbuncular inflammation.
If we now ask in what does the pecu-
liarity of carbuncular infam nation con- /,
sist2 In what does carbuncular differ
from a boil2 I should be inclined to
reply that it is solely in this tendency to
spread. The spreading is occasioned by
contagion of continuity, and it has GER
tain marked resemblances to what we
observe in erysipelas. A carbuncle might
almost be defined to be an erysipelatous
boil, with the proviso that the expression
is not intended to imply identity of inn
flammatory type, but only close similar
ity.
Throughout its whole course, and how
ever extensive it may be, a carbrncle, IN
combination with its crysipelatous
method of spreading, contains the char
acteristics Of the furuncular process. Its
secretions and its core, or slough, are
exactly like those of a boil, excepting
that they are much more abundant. In
a general way there appears to be a.
natural tendency, independently OF treat
ment, to arrest the process, and this Is
not generally observed in erysipclas. In
other words, erysipelatous intiam nation
is more intensely infective than carbun-
cular. I must, however, qualify even
this admission of difference by stating
that carbun ,ular Inflammation has such
an injurious influence on health that in
all cases in which its spread. continues in
spite of treatment the patient quickly
dies. Thus many cases occur in which
no proof is given of tendency to arrest.
It may easily be the fact that in some
states of system, and some types of car
buncle, there is as little tendency to ar
rest as there is in phlegmonous ezysipe-
las.-Jonathan Hutchinson. H. D. ,