From The British Medical Journal.
THAT carbuncles are due to a want of cleanliness may be the general rule, but there are very many exceptions to it, as would be expected when it is remembered how often the necrosis of tissues begins subcutaneously. Carbuncles are said to account for 20 per cent. of deaths from diabetes, but those physicians who will countenance neither manipulation, such as squeezing or syringing with hydrogen peroxide, nor surgical incision, rarely see a case end fatally.
Manipulation in any form and incision assist septic material to pass into the blood stream. The neck which is being rubbed with the collar for many hours a day, is the site of 80 per cent. of carbuncles. As a preventive measure, therefore, it should be kept clean and dusted with boric powder. Treatment with vaccines is reported to have proved satisfactory when large doses, up to 500 millions of the Staphylococcus aureus, have been injected into the carbuncle itself.
Small carbuncles arising where there is plenty of loose skin may be excised completely, but this should be attempted only when the surgeon is quite satisfied that he can remove all the infected tissue. If this is done satisfactorily the wound heals by first intention and much anxiety is saved.
The view of the majority at the present day is that if the carbuncle cannot be removed completely it should be left alone; statistics show that the mortality is increased by incision, however skillful. No one advocates simple incision, but a minority favour a wide crucial incision. This may establish satisfactory drainage, but how far it increases the possibility of septic embolism remains a problem which statistics may solve.