Since this is the result of the introduction of the Staphylococcus aureus into the orifice of the cutaneous ducts, as in boils, the general indications are identical for the treatment of both affections, though the gravity of carbuncle owing to the danger of sepsis, pymmia, and exhaustion is very much greater.
Constitutional treatment will include the administration of large amounts of liquid nourishment in a concentrated form, and often alcoholic stimu lants are clearly indicated. Since the disease frequently supervenes upon the diabetic condition, the dietetic measures suitable in glycosuria are indicated. Fresh air, Quinine and Iron in full doses, and in the presence of cardiac debility Strychnine hypodermically and Morphia for the relief of pain will be required.
Local treatment in the early stage will consist in the relief of tension by warm fomentations. Poultices, owing to the danger of sepsis, are contra-indicated. but hot compresses of lint saturated with strong Boric Acid solution and covered over with impervious tissue meet all require ments. Some surgeons recommend at this stage the injection through the skin of a I in I o Carbolic solution in glycerin and water deeply into the underlying brawny tissue, about i dr. being introduced in all at several spots, with the view of aborting the necrotic process. At a further stage a free crucial incision through the skin down to the sloughing mass may be made, or, better still, a series of incisions which will connect the several openings together, and the warm antiseptic solution reapplied under oiled silk.
In the majority of cases healing will be expedited and the dangers of sepsis minimised by a free curetting of the slough after the incisions have been made, the scraping being extended till the removal of all indurated tissue down to the exposed fascia is accomplished. Strong Carbolic Acid is then to be applied to the walls of the resulting cavity, which should he thoroughly flushed with weak warm antiseptic solution, swabbed with Peroxide of Hydrogen and the wound covered over by boric compresses. This is becoming the routine treatment in the hands of most surgeons, though not without some protests regarding the danger of septic emboli being forced into the divided vessels during the scraping process.
Small carbuncles have been often completely excised by an oval or circular incision made wide of the diseased tissues, the cavity then swilled with hot boric solution, and packed with iodoform gauze.
The older plan of inserting caustics such as Chloride of Zinc, Caustic Potash, or Silver Nitrate through the natural openings is being abandoned; strapping the part encourages the retention of septic products.
The above local measures may he advantageously supplemented by Wright's Vaccine treatment as described under Boils, p. 87.